Podiatric Disorders Case Studies

1513 Words 7 Pages
This case study follows the management of a 47 year old man who attends a Podiatry clinic presenting with pain and a fusiform swelling on the posterior aspect of the right ankle. The patient states that he has experienced discomfort for approximately the last three months, with the pain exacerbating after exercise. He discloses that he recently joined a local running club with the aim of training to run a marathon next year, leading to a significant increase in his activity levels. The patient is concerned as pain levels have increased dramatically as of late, causing him to miss the last few training sessions. At worst, he states that the pain scores an 9/10 on the Numeric Pain Rating Scale.
A full medical and social history was taken prior
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However, in the case of this patient, this treatment modality would be ineffective, as he has been diagnosed with a chronic midportion Achilles tendinopathy, rather than an acute inflammation (OrthopaedicsOne, 2009). Childress and Beutler (2013), recommend that first line treatment for this condition should consist of eccentric exercises, which have been proven in trials (Roos et al, 2004 & Jayaseelan et al, 2016), to be one of the most effective treatments in helping to aid in the reduction of pain and increase the overall function of the tendon, which is the main objective of conservative treatment. Eccentric exercises involve the lengthening of a muscle during contraction, to help increase the overall muscle strength, power and size. Exercises include repetition of single heel drops, eventually progressing onto single heel drops with weights, which should be conducted every day and last for approximately 12 weeks. It is often noted that a patient’s pain levels may worsen before seeing any improvements. According to Childress and Beutler (2013), eccentric exercise programs are believed to provide between 60 and 90 percent improvement in pain and function of the tendon within a time range of around 12 weeks. In …show more content…
It is a non-evasive treatment that allows the passage of shockwaves through the skin to the affected area, encouraging stimulation of soft tissue healing and blocking pain receptors in the process (Rompe, Furia and Maffulli, 2008). A randomized control trial conducted by Rompe, Furia and Maffulli (2008), found at a four month follow up, that the use of shock-wave therapy alongside eccentric exercises was beneficial in improving the recovery rate of Achilles tendinopathy and therefore recommend this treatment for patients with chronic mid-portion tendinopathy. NICE (2017c) however, encourage additional research to be conducted into the impact of extracorporeal shock-wave therapy, with a further one year follow up to determine the effectiveness of the treatment overall.
As well as extracorporeal shock-wave therapy, another treatment that can be used in conjunction with eccentric exercises is low level laser therapy. Low level laser therapy is thought to help increase the production of collagen and reduce blood flow in new vessels (NICE, 2017b). Overall, the adjunct treatment of low level laser therapy and eccentric exercise programs seem to be beneficial in the recovery of Achilles tendinopathy (Nogueira Júnior and Júnior, 2015), however there is a need for further research to be made in this area to best assess the effectiveness of this

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