Achilles tendon contracture
Achilles tendon contracture: Excerpt from Professional Guide to Diseases (Eighth Edition)
Achilles tendon contracture is a shortening of the Achilles tendon (tendo calcaneus or heel cord) that causes foot pain and strain and limits ankle dorsiflexion.
Causes
Achilles tendon contracture may reflect a congenital structural anomaly or a muscular reaction to chronic poor posture, especially in women who wear high-heeled shoes or joggers who land on the balls of their feet instead of their heels. Other causes include paralytic conditions of the legs, such as poliomyelitis or cerebral palsy.
Signs and symptoms
Sharp, spasmodic pain during dorsiflexion of the foot characterizes the reflex type of Achilles tendon contracture. In footdrop (fixed equinus), contracture of the flexor foot muscle prevents placing the heel on the ground.
Diagnosis
Physical examination and patient history suggest Achilles tendon contracture.
CONFIRMING DIAGNOSIS A simple test confirms Achilles tendon contracture: While the patient keeps his knee flexed, the examiner places the foot in dorsiflexion; gradual knee extension forces the foot into plantar flexion.
Treatment
Conservative treatment aims to correct Achilles tendon contracture by raising the inside heel of the shoe in the reflex type; by gradually lowering the heels of shoes (sudden lowering can aggravate the problem) and stretching exercises if the cause is high heels; or by using support braces or casting to prevent footdrop in a paralyzed patient. Alternative therapy includes using wedged plaster casts or stretching the tendon by manipulation. Analgesics may be given to relieve pain.
With fixed footdrop, treatment may include surgery. Although this procedure may weaken the tendon, it allows further stretching by cutting the tendon. After surgery, a short leg cast maintains the foot in 90-degree dorsiflexion for 6 weeks. Some surgeons allow partial weight bearing on a walking cast after 2 weeks.
Special considerations
After surgery to lengthen the Achilles tendon:
❑ Elevate the casted foot to decrease venous pressure and edema by raising the foot of the bed or supporting the foot with pillows.
❑ Record the neurovascular status of the toes (temperature, color, sensation, capillary refill time, and toe mobility) every hour for the first 24 hours and then every 4 hours. If any changes are detected, increase the elevation of the patient’s legs and notify the surgeon immediately.
❑ Prepare the patient for ambulation by having him dangle his foot over the side of the bed for short periods (5 to 15 minutes) before he gets out of bed, allowing for gradual increase of venous pressure. Assist the patient in walking, as ordered (usually within 24 hours of surgery), using crutches and a non-weight-bearing or touch-down gait.
❑ Protect the patient’s skin with moleskin or by petaling the edges of the cast. Before discharge, teach the patient how to care for the cast, and advise him to elevate his foot regularly when sitting or whenever the foot throbs or becomes edematous. Also, make sure the patient understands how much exercise and walking are recommended after discharge.
❑ To prevent Achilles tendon contracture in paralyzed patients, apply support braces, universal splints, casts, or high-topped sneakers. Make sure the weight of the sheets doesn’t keep paralyzed feet in plantar flexion. For other patients, teach good foot care and urge them to seek immediate medical care for foot problems. Warn women against wearing high heels constantly, and suggest regular foot (dorsiflexion) exercises.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Deep tendon reflexes, hyperactive (Professional Guide to Signs & Symptoms (Fifth Edition))
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