Achilles Tendon Disorders

Achilles Tendon Disorders

Achilles Tendon Disorders

What is the Achilles Tendon?

A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon-the longest tendon in the body-runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the “heel cord,” the Achilles tendon facilitates walking by helping to raise the heel off the ground.

Achilles Tendonitis and Achilles Tendonosis

Two common disorders that occur in the heel cord are Achilles tendonitis and Achilles tendonosis. Achilles tendonitis is an inflammation of the Achilles tendon. This inflammation is typically short-lived. Over time the condition usually progresses to a degeneration of the tendon (Achilles tendonosis), in which the tendon loses its organized structure and is likely to achilles tendondevelop microscopic tears. Sometimes the degeneration involves the site where the Achilles tendon attaches to the heel bone. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.

Symptoms

The symptoms associated with Achilles tendonitis and tendonosis include:

  • Pain-aching, stiffness, soreness, or tenderness-within the tendon. This may occur anywhere along the tendon’s path, beginning with the narrow area directly above the heel upward to the region just below the calf muscle. Often pain appears upon arising in the morning or after periods of rest, then improves somewhat with motion but later worsens with increased activity.
  • Tenderness , or sometimes intense pain, when the sides of the tendon are squeezed. There is less tenderness, however, when pressing directly on the back of the tendon.
  • When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.

Causes

As “overuse” disorders, Achilles tendonitis and tendonosis are usually caused by a sudden increase of a repetitive activity involving the Achilles tendon. Such activity puts too much stress on the tendon too quickly, leading to micro-injury of the tendon fibers. Due to this ongoing stress on the tendon, the body is unable to repair the injured tissue. The structure of the tendon is then altered, resulting in continued pain. Athletes are at high risk for developing disorders of the Achilles tendon. Achilles tendonitis and tendonosis are also common in individuals whose work puts stress on their ankles and feet, such as laborers, as well as in “weekend warriors”- those who are less conditioned and participate in athletics only on weekends or infrequently. In addition, people with excessive pronation (flattening of the arch) have a tendency to develop Achilles tendonitis and tendonosis due to the greater demands placed on the tendon when walking. If these individuals wear shoes without adequate stability, their over-pronation could further aggravate the Achilles tendon.

Diagnosis

In diagnosing Achilles tendonitis or tendonosis, the surgeon will examine the patient’s foot and ankle and evaluate the range of motion and condition of the tendon. The extent of the condition can be further assessed with x-rays, ultrasound or MRI.

Treatment

Treatment approaches for Achilles tendonitis or tendonosis are selected on the basis of how long the injury has been present and the degree of damage to the tendon.

Prevention

To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through daily exercises. Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the condition.

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Acute Inflammation

Acute Inflammation

Acute Inflammation

What is Acute Inflammation?

Inflammation is the body’s normal protective response to an injury, irritation, or surgery. This natural “defense” process brings increased blood flow to the area, resulting in an accumulation of fluid. As the body mounts this protective response, the symptoms of inflammation develop. These include:

  • Swelling
  • Pain
  • Increased warmth and redness of the skin

Inflammation can be acute or chronic. When it is acute, it occurs as an immediate response to trauma (an injury or surgery)-usually within two hours. When it is chronic, the inflammation reflects an ongoing response to a longer-term medical condition, such as arthritis.

Inflammation is not the same as infection. Infections are caused by bacteria, fungus, and viruses, and infections sometimes produce inflammation. However, infection and inflammation are treated very differently. Your foot and ankle surgeon can best determine the cause of your inflamed tissue.

Treatment

To reduce acute inflammation and the resulting swelling and pain, injured tissue needs to be properly treated. The earlier you start treatment, the better.

Elevate the Leg Properly

In addition to the above measures, your foot and ankle surgeon may prescribe a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen,or another type of medication.

If Pain Persists or Becomes Worse

The symptoms of inflammation typically improve within two or three days. If your pain and discomfort do not improve after three days, call your doctor or go to an emergency room to determine whether a more serious problem exists.

As with any medical problem, it’s important that you follow your doctor’s instructions carefully regarding your injury or postoperative care.

 

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Ankle Fracture

Ankle Fracture

Ankle Fracture

An ankle fracture is a break of one or more of the bones that make up the ankle.

The ankle is a hinge type joint that connects the leg to the foot. It consists of one large bone (tibia), one small bone (fibula), and one square shaped bone (talus). These bones fit together snugly and are supported by strong ligaments.

Ankle fractures result when the ankle is forced inward or outward past its normal range of motion. Fractures result from the same causes as sprains. This can occur when a jumping or running athlete lands on an uneven surface. It may also occur when the foot is firmly planted and the body gets twisted. Equipment and surface conditions may also play a role. Sports most commonly associated with ankle fractures include: Basketball, Football, Baseball and Soccer.

The diagnosis of an ankle fracture is considered when a patient gives a history of “turning” or “rolling” his or her ankle accompanied by sudden pain and swelling. The physical exam will reveal tenderness over the involved bones. Deformity and at times severe swelling of the ankle may be present. X-rays are needed to confirm the fracture and plan for treatment. Occasionally, a CT or MRI is ordered to evaluate the cartilage or tendons around the ankle.

Nonoperative: Less severe ankle fractures can be treated by nonoperative means. Typically, a cast or splint is used to stabilize the ankle for several weeks. After the period of immobilization a course of physical therapy to strengthen the muscles around the ankle is needed to complete the recovery process.

Operative: Surgery is often needed to stabilize ankle fractures. Usually, the surgery involves the placement of screws and plates. The patient then is placed in a cast or splint after surgery for a variable period of time depending on the severity of the fracture. Weight bearing may be delayed until there is evidence of early fracture healing. This may take 4-8 weeks depending on the severity of the fracture.

For more information see one of the Doctors of the New Mexico Foot & Ankle Institute. Please call 505-880-1000 to schedule an appointment

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Ankle Replacement

Ankle Replacement

Ankle Replacement

Total ankle replacement (also called ankle arthroplasty) is a surgical option for patients with arthritis of the ankle. This operation can relieve pain and maintain motion in the arthritic ankle joint and is an alternative to arthrodesis (ankle fusion) which can relieve pain but eliminates motion in the joint. Ankle replacement is surgery to replace the damaged bone and cartilage in the ankle joint. Artificial joint parts (prosthetics) are used to replace your own bones. There are different types of ankle replacement surgeries. This surgery may be done if the ankle joint is badly damaged. Your symptoms may be pain and loss of movement of the ankle. Some causes of damage are:

  • Arthritis
  • Bone fracture
  • Infection
  • Osteoarthritis
  • Rheumatoid arthritis

A successful ankle replacement will likely:

  • Decrease or get rid of your pain
  • Allow you to move your ankle up and down

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Ankle Sprain

Ankle Sprain

Ankle Sprain

Definition

Injuries to the outside of the ankle associated with rolling of the foot are known as ankle sprains. The ankle ligaments provide stability to the ankle by helping to hold the ankle bone within the ankle joint. The ankle ligaments usually involved in an ankle sprain are also known as the lateral collateral ligaments of the ankle. The lateral collateral ligaments of the ankle are comprised of the anterior talofibular ligament, the calcaneofibular ligament and the posterior talofibular ligament.

Function of the Ankle Ligaments

By their orientation, the lateral collateral ligaments provide stability to the ankle throughout the gait cycle as the foot bends up and down. Therefore total lateral stability of the ankle is provided by these three ligaments. The most anterior (front) and most frequently injured of these ligaments is the anterior talofibular ligament. This ligament is intracapsular, or blended and contiguous with the lining of the anterior lateral aspect of the ankle capsule (joint). It can be seen as a fibrous thickening of the lining of the joint and courses from the front of the fibula to the front of the lateral surface of the talus. The main function of the anterior talofibular ligament is the prevention of axial or rotational instability of the ankle. During gait as the heel is coming down, the foot is held in a dorsiflexed (up) position. Essentially the foot is pivoting on the edge of the heel only. Any irregularity in the ground, or laterally directed force, will cause the foot to twist in or out depending on the orientation of the force. Similarly, when we push off, the foot is in a plantar flexed (down) position. As the foot is plantar flexed, the postion of the foot increases the long axis of the leg and increases the torque on the ankle region. Any ground irregularity or laterally directed force will cause the foot to twist in or out depending of the orientation of the force.

Classification of Injury

Rolling in of the foot (inversion), with the sole of the foot towards the opposite leg, is defined as a lateral ankle sprain. There are several classifications of this injury. A simple definition of injury breaks the injury down in terms of physiologic injury: sprain, strain or rupture which define the extent of stretching and pulling on the fibers of the ligaments. A second classification of injury of the lateral collateral ligaments of the ankle is known as Grades 1, 2, or 3. This classification describes the functional loss of the ankle and the resultant grade or level of injury. The end result of injury of one or more of the lateral collateral ligaments of the ankle is ankle instability. This instability can show up initially as a result of the severity of the injury or later as a result of chronic ankle instability. During the moment of injury, due to the instability caused by the injury, movement and twisting of the Talus (ankle bone) in the ankle joint resulting in bone to bone compaction and twisting of other ligaments, tendons and nerves may occur. Injuries beyond the level of the ligaments themselves can occur and will occur depending of the level of injury. MRI, CT scans, bone scans and electro diagnostic testing may be recommended to evaluate for these secondary injuries. Chronic Ankle instability occurs much later than then original injury. Once the lateral collateral ankle ligaments are injured, they no longer provide the ability to stop ankle twisting and to hold the Talus within the ankle joint. As you walk or run with an unstable ankle, the talus can twist within the joint and partially come out of the joint. This movement is unnatural and abnormal and redirects force to the outside of the joint. With an increase in joint load to the outside, the foot will roll to the inside producing further tearing of the ligament and further injury.

Treatment

Conservative treatment for ankle sprain depends on the necessity to stabilize the foot to restore the anatomical position of the ankle ligaments. The often noted RICE formula (rest, ice, compression elevation) is the standard initial treatment. Any treatment provided is to allow the ligaments to heal in the correct position and at the correct length. Depending on which ligaments are injured and to what degree the ligaments are injured, your Weil Podiatric physician can provide you with the best ankle brace to stabilize your ankle. Supplemental treatment for secondary injuries incurred at the time of injury will be diagnoses and treated at the same time as the treatment for the ankle ligaments.

Surgical Treatment

Surgical treatment of the ankle ligaments or associated injury conditions are performed when instability develops later or the injury is severe enough initially that stabilization must be done to allow for proper healing. For more information see one of the Doctors of the New Mexico Foot & Ankle Institute.

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