Page 19 - Leisure Living Spring 2016

Tendonitis Is No Small Matter - When It Comes To The Achilles Tendon
By Dr. Molly S. Judge, www.MollyJudge.com
This article is part of a series on the prevention of painful conditions of the foot and ankle. And for those who already have pain, some helpful tips on reducing discomfort that will help improve quality of life.
A patient came to my office shortly after an in- jury from a Saturday football scrimmage. A week- end warrior, this 40-year-old man’s athletic activ- ity consists of playing football with friends only on rare weekends and he never warms up for such events. Other than that, he is an armchair quar- terback who admits that he has had Achilles ten- donitis on and off over the years. He came into the office using crutches a neighbor had lent him.
When asked how this injury occurred, he said he really didn’t understand it himself. He was run- ning and looking back over his shoulder trying to complete a reception. Out of no where, he said he heard a shot and felt a sharp, stabbing pain in his leg and ankle. He said, “It was like someone hit me in the leg with a bat, or shot me or something.” He really expected to turn around and see someone behind him but no one was even close.
This description of a sharp, sudden pain behind the ankle and lower leg is classic for an Achilles tendon rupture. He couldn’t stand on his foot without searing pain in the ankle and he had lost his ability to stand up on his toes. Doing a simple toe rise is a quick and easy test of the strength and function of the muscles and joints of the ankle and foot. He failed miserably and it was due to the rupture of the Achilles tendon
When he was lying on his belly, I could see a small cup-shaped defect, a dell behind his ankle where the tendon ends had split apart. This con- dition is one of the most devastating injuries that can occur in the leg and foot. Without proper treatment, disability is certain. When this injury happens it is vital to first stabilize the ankle and eliminate swelling of the calf to prevent other complications such as blood clots. In many cases, special pictures of the tendon, an MRI (Magnetic Resonance Imaging), will show the extent of ten- don injury and the size of the gap between tendon
ends. This helps the physician to decide whether to simply put the leg in a cast or perform surgery. For conservative treatment a short leg, hard cast
is applied for approximately eight weeks. This is followed by a very long course of rehabilitation for regaining strength and function of the Achilles tendon. In some cases, surgery is the most bene- ficial way to repair the tendon and allow for it to heal, returning to a normal length. If you have suf- fered from this injury, it is important to be evalu- ated by a foot and ankle specialist to get an expert opinion on what treatment is best.
An Achilles tendon tear or rupture is often the result of Achilles tendonitis that has gone without treatment. Over time, the inflammation of this condition gets worse causing changes within the tendon that weaken it and later result in partial tears.
Achilles tendonitis, inflammation of the stron- gest tendon of the leg, ankle and foot, can sneak up on you very slowly over time. Often patients fail to identify any injury or accident that may have caused it to develop. This condition results in pain and a loss of motion at the ankle. If you have pain behind your ankle and cannot bend the ankle beyond 90 degrees to the leg it is likely that you have a tight Achilles tendon. To check for this, a patient lies flat on his back with the knee bent. The foot is positioned with the second toe align- ing with the center of the knee. Pushing up on the foot the ankle will flex causing tension along the
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