The E3 Rehab Podcast 199. Achilles Tendinopathy: A Guide to Differential Diagnosis w/ Rodrigo Scattone Silva
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May 6, 2025 Rodrigo Scattone Silva, a sports physical therapist and assistant professor from Brazil, joins to unpack the intricacies of Achilles tendon pain. They discuss the critical need for thorough assessments and differentiate between various types of tendinopathy. The conversation dives into how factors like age and activity level impact treatment strategies, particularly for young athletes. They also explore modern rehabilitation techniques compared to traditional immobilization, highlighting the changing landscape of Achilles injury management.
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Testing and Managing Posterior Impingement
- Use passive plantar flexion testing in prone to distinguish posterior impingement from Achilles tendinopathy.
- Avoid end-range plantar flexion exercises if posterior impingement is suspected to prevent worsening symptoms.
Managing Haglund's Exostosis
- Imaging is necessary to confirm Haglund or calcaneal exostosis affecting insertional Achilles tendinopathy.
- Initial management emphasizes removing compression via high heel lifts and activity modification before considering surgery.
Identifying and Treating Subtalar Joint Pain
- Identify subtalar joint pain if pain is medial/lateral and reproduced by calcaneal inversion/eversion with talus stabilized.
- Consider foot orthoses and tibialis posterior strengthening after symptom modification assessment.