Achilles Tendon
First off, what is the Achilles tendon? The Achilles tendon is the largest tendon in the body and is located at the back of the lower leg and inserts into the heel. The Achilles tendon helps facilitate walking by helping raise the heel off the ground.
Next, we will talk about some Achilles tendon injuries.
An Achilles tendon tear, or rupture can be partial or complete. A tear or rupture most often occurs 2 to 3 inches above the heel bone but can be directly at the attachment or higher in the leg.
A tear usually occurs during activities such as running and jumping, or trauma such as a slip or fall.
In some cases, illnesses or medications such as steroids and antibiotics can contribute to ruptures
Most patients report their first feeling was a "pop" or a feeling like they were struck in the back of the ankle, followed by pain.
There often is no pain in this area before the actual tear.
After the tear, patients complain of weakness when pushing off of their foot during walking or when trying to stand on their tiptoe. There may be a small bruise on the inside of the heel during the first few days.
The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through proper examination. In some cases, MRIs and ultrasound can be helpful in determining the extent of the tear or rupture.
Treatments
Both non-surgical and surgical treatments have been well studied but remain debated. In general, surgical treatment is thought to give greater strength and result in a lower risk of repeat tear. However, surgery has an increased risk of wound healing problems, nerve damage, and infection plus the usual risks associated with surgery. Blood clots are a concern with both types of treatment. Every individual is unique, and we will work with you to guide you through the pros and cons and help you to select the best option. There are also injuries where the Achilles tendon does not rupture but breaks away a portion of the calcaneus. These are known as calcaneus avulsion (tongue type) fractures. These are medical emergencies as early surgical intervention is required due to the possibility skin tenting resulting in necrosis
Non-surgical Treatment
Non-surgical treatment starts with a period of rest in a brace for the injured leg. You will need to use crutches, a walker, or wheelchair in order to not put weight on the leg. Within the first few weeks you will start doing active motion. The brace will be adjusted over time as the Achilles tendon heals to allow increased movement. Gradually, you will be allowed to put weight on the leg and start specific strengthening exercises. The length of treatment may be different for each patient but usually takes about three months. It is often guided by a physical therapist along with the surgeon.
Surgical Treatment
In this surgery, your foot and ankle surgeon will place stitches into the tendon above and below the area of the tear and then pull the ends together. This is because the actual tear appears similar to two wet mops with multiple uneven strands that need to be brought together. The stitches can be applied through one or more incisions (viewing the tendon directly) or through multiple small incisions (placing the sutures through the tendon using a guide). The recovery after surgery is similar to the non-surgical treatment but can be slightly shorter.
Recovery
Since tendons do not have a great blood supply, healing is a slow process. Patients usually can start light jogging in 3-6 months with return to sports involving cutting and jumping in 6-9 months. Full return of strength and the feeling of being normal may take more than a year and require extensive physical therapy. Make an appointment today with Dr. Jonathan Pajouh to further discuss treatment options and which treatment option best fits you.
Achilles Tendonitis / Tendinosis
What is Achilles tendonitis (Tendonosis)
First off, what is the Achilles tendon? The Achilles tendon is the largest tendon in the body and is located at the back of the lower leg and inserts into the heel. The Achilles tendon helps facilitate walking by helping raise the heel off the ground.
In Achilles tendinitis, there is injury to the tendon which results in inflammation of the surrounding tissue resulting in pain. In Achilles tendinosis, there is degeneration of the tendon itself which results in pain. These conditions can occur simultaneously. Tendinitis is typically seen more often in younger patients and symptoms can start spontaneously or gradually progress. These symptoms typically get worse with physical activities and exercise. Tendinosis is typically seen in middle-aged individuals and pain can occur with minimal physical activities such as walking.
Symptoms
- Pain at the Achilles tendon insertion extending proximally
- Swelling around the Achilles tendon
- Difficulty and weakness while walking and other physical activities
- Pain with ankle range of motion
Treatments
Most cases of Achilles tendinitis and tendinosis are successfully treated nonoperatively with the use of medications such as nonsteroidal anti-inflammatory medications, and conservative treatments such as immobilization, stretching, heel lifts and physical therapy. Other treatments include injections with platelet rich plasma which may provide relief. Surgical treatment is often left for patients who fail conservative treatment options and include removal of any calcifications as well as reconstruction of the Achilles tendon itself by removing degenerative tissue. These may be accompanied by a lengthening of the posterior calf muscle also known as a gastrocnemius recession in cases with tight calf muscles. Dr. Pajouh will discuss the best treatment option for you. Make an appointment today with Dr. Jonathan Pajouh to further discuss treatment options and which treatment option best fits you.