Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Achilles Bursitis or Tendinitis


Related Terms

  • Achilles Bursitis
  • Achilles Peritendinitis
  • Achilles Tendinosis
  • Achilles Tendonitis
  • Achillobursitis
  • Tendinitis of the Heel
  • Tendocalcaneal Bursitis

Differential Diagnosis

Specialists

  • Orthopedic (Orthopaedic) Surgeon
  • Physical Therapist
  • Rheumatologist

Comorbid Conditions

Factors Influencing Duration

Factors that may lengthen disability include the cause and severity of the injury, length of time before treatment begins, type of treatment provided, the individual's response to treatment, development of complications, and the individual's compliance with treatment recommendations.

Medical Codes

ICD-9-CM:
726.7 - Enthesopathy of Ankle and Tarsus
726.71 - Achilles Bursitis or Tendinitis
726.72 - Tibialis (Anterior) (Posterior) Tendonitis

Overview

Achilles bursitis and Achilles tendinitis involve painful inflammation and swelling of respectively, the small sacs (bursae) that surround that tendon or the tendon (Achilles tendon) that joins the heel bone (calcaneus) to the calf muscle. Tendons are bands of fibrous tissue that connect muscles to bones or other structures. Bursae are small fluid-filled sacs located over bony prominences between tendons and the skin. Bursae produce synovial fluid that lubricates and protects tendons and ligaments from wear by reducing the effects of friction and impact. In repetitive movement such as walking, running, and jumping, the calf muscles provide the power for pushing off with the foot, and the Achilles tendon raises and lowers the heel during the movement. The force of these repetitive activities can cause irritation and inflammation of the Achilles tendon and bursae, resulting in either tendinitis or bursitis. Individuals with familial high cholesterol (familial hyperlipidemia type II) are at greater risk of developing Achilles tendinitis because they may develop fat-like deposits (xanthomas) in tendons.

Incidence and Prevalence: The exact incidence and prevalence of Achilles bursitis or tendinitis is not known because many cases go unreported. However, this condition is most common in active middle-aged individuals and individuals over age 65.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals at higher risk for developing this condition include those who perform repetitive task-related movement such as walking or going up and down steps (e.g., day laborers, roofers, or postal carriers), fitness walkers and runners, and athletes who participate in sports involving running or jumping. Wearing ill-fitting shoes may also contribute to the development of tendinitis. Age-related changes, such as bony growths characteristic of osteoarthritis, also may increase risk for inflammation in the Achilles tendon and bursae.

Source: Medical Disability Advisor



Diagnosis

History: With either Achilles tendinitis or bursitis, individuals generally report heel or calf pain that is made worse by activity, although pain may persist while the individual is at rest. The area overlying the inflammation may be tender and swollen. Other reported signs include swelling around the joint and a grating sound (crepitus) when flexing and extending the foot. The individual may also report pain associated with occupational tasks and sports activities, a history of trauma to this area, arthritis in multiple joints, and/or a family history of high cholesterol.

Physical exam: With tendinitis, physical examination usually reveals swelling and tenderness. Mobility (ankle extension, especially bending the foot up) may be limited because of pain. An examination of the individual's shoes may provide information about the individual's gait or running pattern. Cases of Achilles bursitis usually involve swelling on both sides of the tendon, with the individual experiencing pain upon extension of the ankle. Arthritic nodes are sometimes found in the heel and ankle.

Tests: No diagnostic laboratory tests are usually required to confirm Achilles tendinitis, although plain film x-rays of the joint and surrounding area may be taken. Diagnostic ultrasound may also be useful in examining the area, particularly if the tendon is viewed during contraction. When the physician is not sure if the tendon is intact, MRI may be performed to identify tears, partial tears, inflammation, or tumors. In cases of suspected Achilles bursitis, synovial fluid may be withdrawn from the bursae with a needle (aspirated), cultured, and examined microscopically to help the physician determine whether the inflammatory bursitis is caused by infective organisms or irritation from overuse.

Source: Medical Disability Advisor



Treatment

The goal of treatment is to relieve pain, reduce inflammation, and rest the joint. Specific recommendations depend on the cause of the injury. Treatment may consist of a heel lift, application of ice, and protective pressure wraps to the area. The individual also should decrease or modify the repetitive activity to allow the tendon to heal properly and prevent symptom recurrence. Nonsteroidal anti-inflammatory drugs (NSAIDs) are useful in relieving pain and inflammation. Immobilizing the muscle and tendon using a brace, cane, or crutch may treat severe cases of Achilles tendinitis. Casting of the foot and ankle is another treatment option in the most severe cases. Following a recovery period, the individual may receive physical therapy and instruction in stretching exercises.

Treatment of Achilles bursitis includes elevating the joint and applying gentle compression such as an elastic bandage. Some cases may require administration of one or more injections of corticosteroids into the bursae to relieve inflammation. Most experts, however, believe that cortisone injection anywhere near the Achilles tendon is disallowed (contraindicated) since it may predispose for Achilles tendon rupture.

In rare cases of persistent tendinitis that does not respond to nonsurgical treatment, removal of unhealthy tissue (débridement) of the Achilles tendon may be suggested. The ankle is then placed in a cast until healing takes place (about 6 to 8 weeks). Once the cast is removed, the individual begins physical therapy to restore strength and mobility of the ankle and lower leg.

When bursitis is cause by infection, it is treated with antibiotics and the infected bursa may be drained surgically.

Source: Medical Disability Advisor



Prognosis

Achilles tendinitis usually resolves completely following a period of rest, use of anti-inflammatory medications, and splinting or casting if necessary. Acute bursitis may progress to chronic or long-term bursitis and result in limitations of ankle or foot range of motion.

Surgical débridement of the tendon usually has a good outcome but carries common surgical risks.

Source: Medical Disability Advisor



Rehabilitation

An important step in the rehabilitation of Achilles bursitis or tendinitis is to modify any risk factors that are associated with the occurrence of this condition, including poor ankle flexibility, biomechanical abnormalities of the lower limb, and training errors in sports activities such as practicing on a hard running surface or wearing worn-out shoes.

Achilles bursitis is an inflammation of the retrocalcaneal bursa. Achilles tendinitis can affect the tendon itself, the overlying sheath, or both. In either case, the initial goal of the rehabilitation is to decrease pain and inflammation. Later, the aim is to restore function and prevent reoccurrence of the condition.

Initially, it is recommended to follow the PRICE principle (protection, rest, ice, compression, elevation) (Canale). Modification of activities should always be part of the initial treatment. A soft heel pad in the individual's shoe can reduce pressure on the Achilles tendon and the bursa. In some cases an ankle-foot orthosis night splint or a short leg cast may be tried for up to 6 weeks. Topical glyceryl trinitrate patches placed on the Achilles tendon have also been used (Canale). As soon as pain and inflammation are reduced, the individual should be instructed in a home program of stretching and eccentric strengthening exercises of the gastrocnemius and soleus muscles (Canale). Heat and cold may be used for pain management. Injection of steroids into the surrounding tendon tissue remains controversial. Although steroid injection may provide pain relief, it weakens the Achilles tendon, increasing the risk of a tendon rupture (Biundo; Huang). In select cases of Achilles bursitis, careful injection into the retrocalcaneal bursa may be effective (Canale).

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistAchilles Bursitis or Tendinitis
Physical TherapistUp to 10 visits within 6 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Possible complications include rupture of the tendon and symptom recurrence.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If casting is required, temporary transfer to sedentary duties may be necessary for individuals with jobs that require prolonged standing, walking, climbing, or lifting. Accommodations may need to be made during this usually short recovery period.

Individuals with a chronic condition should permanently be reassigned to jobs that do not require prolonged standing, walking, climbing, or lifting.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was this a recurring injury?
  • Was diagnosis confirmed with x-ray, diagnostic ultrasound, or MRI?
  • Was synovial fluid aspirated and examined microscopically?
  • Was the fluid cultured to differentiate between infection and inflammation?

Regarding treatment:

  • If underlying infection was identified, how was it treated?
  • Has infection resolved?
  • Was immobilization required (pressure wraps, elastic bandages, brace, cast)?
  • Was surgery indicated? Was surgery performed?
  • Were anti-inflammatory drugs used to reduce inflammation?
  • Did individual receive physical therapy and instruction on stretching exercises?
  • Is a home exercise program being followed?
  • Did individual use a cane or crutch?
  • Was casting of the joint employed?

Regarding prognosis:

  • Did individual return to work or activities too soon?
  • Was individual adequately instructed in how to modify activities?
  • Did individual wear protective strapping or adhesive bandage for several weeks after healing?
  • Was individual instructed in prevention techniques (warm up before activity, proper moves and techniques for that activity, physical conditioning)?

Source: Medical Disability Advisor



References

Cited

Biundo, J. J., R. W. Irwin, and E. Umpierre. "Sports and Other Soft Tissue Injuries, Tendinitis, Bursitis, and Occupation-Related Syndromes." Current Opinion in Rheumatology 13 2 (2001): 146-149. National Center for Biotechnology Information. National Library of Medicine. 15 Nov. 2004 <PMID: 11224739>.

Braddom, Randolph L. Physical Medicine and Rehabilitation. 3rd ed. Philadelphia: W.B. Saunders, 2006.

Canale, S. Terry, and James H. Beaty, eds. "Chapter 46 - Traumatic Disorders." Campbell's Operative Orthopaedics. 11th ed. Philadelphia: Mosby Elsevier, 2008.

Schepsis, A. A., H. Jones, and A. L. Haas. "Achilles Tendon Disorders in Athletes." American Journal of Sports Medicine 30 2 (2002): 287-305. National Center for Biotechnology Information. National Library of Medicine. 15 Nov. 2004 <PMID: 11912103>.

General

Frontera, Walter R., ed. Essentials of Physical Medicine and Rehabilitation. 1st ed. Philadelphia: Hanley & Belfus, Inc., 2002.

Source: Medical Disability Advisor






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