(upbeat rock music) Welcome back to The Art of Medicine. Now that we’ve seen the parts list, let’s identify the symptoms of Achilles tendonitis. In general the symptoms of Achilles tendonitis are basically swelling, pain, difficulty walking, difficulty going up and down stairs, not feeling good unlessyou have shoes on,
sometimes the shoe willrub the back of the foot and they’ll start to bother your ankle and foot. They’re feeling the painmostly behind the heel, in the back of the heel and up the back of the leg. They’ll feel cramping and difficulty walking and pain with putting their foot to the ground. What happens to the tendon when you have Achilles tendonitis
is initially it becomes just swollen. You have a condition of peritendinitis where you just really theoutside fibres become irritated. As time goes on, there becomes more and more swelling, more fluid goes into the area. Ultimately you get a lotof scarring in the area because the tendon itself is not very well vascularized. Achilles tendonitis pain is usually worst when you begin
your exercise program. It’ll be worst in the morning when you first get out of bed. It can also be worst as you go up a set of stairs. The weekend warrior athlete or the older person who has been relativelysedentary who starts up a new program can be really prone to Achilles tendonitis. They can get overuse injuries that make it very difficult to return to what they want to do,
even activities of daily living. Achilles tendonitis, in general,is the sedentary person, their Achilles tendon hasn’t been stretched, it’s working in a shortened position and they get into their old sneakers and they can develop aterrible overuse injury of that Achilles tendon. When we suspect Achilles tendonitis,
we’re looking for pain and tenderness of the Achilles tendon either at the insertion into the heel bone or the calcaneus or a little further up the tendon itself. We’re looking for a history of pain. Either in the morningor when they go up steps or when they start their activities. We’re looking to see if some shoes are more comfortable. Are they happier in an athletic shoe than they are
Blood Clots in the Legs Symptoms and Diagnosis
The most common blockages outside the hearttend to be in the legs. And they’re very common in smokers and diabetics. The symptoms arecalled claudication, which is basically discomfort when people walk. And because of that, a lotof times patients don’t even seek medical attention for that because they think thisis just a symptom of arthritis, getting old, muscle pain and so forth. So unfortunately,a lot of times it goes unrecognized because the patient don’t mention it during theirroutine physical, or visit with their primary care physician or occasionally even with thecardiologist. There’s this expectation that as we get older things should hurt when wewalk. It’s a pain with walking, as I mentioned,
and it’s usually consistent, happens at thesame distance all the time. And and it gets to the point it’s it’s bad, feels like a crampwhere people have to stop. And typical to the claudication, when they stop the paingoes away and usually the amount of time it takes for the pain to go away is is consistentas well. So people will say I usually walk two blocks I get the pain I have to stop andthen to five minutes after I stop the pain goes away and I’ll be able to walk again.Typically it does not happen when people are sitting or laying down unless it’s reallyadvanced phase where the blockage is so severe to start to cause pain even without walkingor doing activities. It’s the same concept.
It starts by defining the blockage, the exactlocation, the severity of it, how many blockages. And the way we do that is to what we callan angiogram, which is similar to heart catheterization in the sense you put a catheter in injectcontrast except now we’re not looking at the heart, we’re looking at the the legs or whateverlocation we suspect that there’s blockage there. Once we establish there’s blockagethen it becomes an issue what’s the best way to treat it. And it’s the same as in the heart,some blockages better served with medication and exercise, some blockages will need surgeryto fix and some blockages can be fixed with a balloon and stent. Which one is the appropriateapproach? It’s a technical issue really. We
have to see the blockage to to make that determination.Big percentage of patients who have blockages in their legs and and outside the heart havea higher risk of having blockage in the heart and vice versa. The disease process it’s theit’s the same it’s what we talked about cholesterol buildup, an interruption in that smooth layerthat line our arteries whether it’s in the heart or outside the heart. The risk factorsare the same to cause heart problems or blockages outside the heart so smoking, diabetes, highblood pressure, family history, really there’s a lot of overlap between the two conditions.