Page 137 - ASOP ROT Study Guide

commonest cause of neuropathy is diabetes, and all diabetics need to be aware of the potential risk.
They should regularly inspect their feet and be sure the nails are tidy. Footwear must be chosen
with care and if necessary extra-depth shoes which are very soft on the uppers may be prescribed.
This is essential as, once established, ulcers are difficult to heal and secondary infection may lead
to amputation.

14 . 10 Achilles Tendinitis and Rupture
Pain around the Achilles tendon where it inserts into the os calcis is seen in two groups of people:
♦ Young athletes: signifying over-use. The area may be tender or even swollen. Rest is usually
adequate to recover, but if it is recurrent, a surgical decompression of the tissue surrounding the
tendon will often eradicate the symptoms. An injection of steroids is to be avoided as
penetration of the tendon may lead to rupture.
♦ Middle aged men: a phase of discomfort may precede rupture of the Achilles tendon and this
indicates degeneration within the tendon tissue. The cause is little understood, although we
know that the lower part of the Achilles tendon has a poor blood supply and is often a point of
weakness in some people who keep particularly active into middle age.
If the tendon ruptures it will heal if the ankle is kept in an equinus position for a minimum of eight
weeks. The tendon can be sutured either by a closed technique or by open suture. The latter
technique has a high risk of complication. Whatever method is chosen mere is a significant risk of re-
rupture, although this decreases with time. Wearing a felt raise inside the heel of the shoe, for as
long as possible, will help.

15. SHOULDER DISCOMFORT

15 . 1 Introduction
The shoulder joint (see Skeletal Anatomy - Unit 2) consists of the articulation between the scapula
and the chest wall and between the scapula and the humerus. There are of course other joints to
consider, particularly the acromioclavicular joint (the joint between the acromion process of the
scapula and the clavicle). Good shoulder function relies on the bones and joints of the shoulder and
the associated ligaments, muscles and tendons. All of these structures are frequently injured,
particularly in people who are involved in heavy, repetitive work and/or contact sports.

15 . 2 Clinical Presentation
One symptom of shoulder discomfort is pain, particularly on movement. The pain may be limited
to a particular range of movement. Symptoms quite frequently are associated with a recent incident
such as a pull, or a period of unusual activity such as DIY.

http://stmarysortho.com/conditions/shoulder/shoulder-impingement-
syndrome/