Question

You have an athlete who during a history tells you that this is their first year of running cross country in the college setting. They mentioned that they noticed an increase in the number of miles and a change in training surface as they transitioned from HS to college running. Upon further note taking you learn that the athlete just switched to a new pair of shoes and also decided to change shoe brands after 6 years of running in asics.

Upon observation you note the following s/s:
Swelling in the Achilles Tendon region
TTP on the poster aspect of the Achilles Tendon
- crepitus during DF and PF
- tendon thickness
+ superficial pinch test
- deep pinch test
What do you suspect?

Answer 1

The athlete likely has Achilles tendinopathy, possibly due to the combination of increased mileage, change in training surface, and a sudden switch to a new pair of shoes.

Step-by-step explanation:

Achilles tendinopathy is a common overuse injury among runners, particularly when there are abrupt changes in training variables, such as mileage, surface, and footwear. The athlete's recent transition to college running, with an increased number of miles and a change in training surface, may have contributed to the development of Achilles tendinopathy.

Moreover, the sudden switch to a new pair of shoes and a different brand after six years of consistent use could have placed additional stress on the Achilles tendon, leading to the observed symptoms.

The swelling in the Achilles tendon region, tenderness to palpation (TTP) on the posterior aspect of the Achilles tendon, crepitus during dorsiflexion (DF) and plantarflexion (PF), increased tendon thickness, and a positive superficial pinch test all align with the clinical presentation of Achilles tendinopathy.

The superficial pinch test indicates localized swelling, while crepitus during DF and PF suggests degenerative changes within the tendon. The differential findings between the superficial and deep pinch tests may indicate involvement of the paratenon, a common feature in Achilles tendinopathy.

Addressing this issue involves a comprehensive approach, including rest, gradual return to activity, appropriate footwear, and possibly physical therapy. It's crucial to educate the athlete on the importance of a gradual transition in training variables and the potential consequences of abrupt changes. Additionally, a thorough assessment of the new shoes' suitability, considering factors like cushioning and support, is essential for preventing further strain on the Achilles tendon.