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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Equinus

Equinus

Equinus

What is Equinus?

Equinus is a condition in which the upward bending motion of the ankle is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet. When it involves both feet, the limitation of motion is sometimes worse in one foot than in the other. People with equinus develop ways to “compensate” for their limited ankle motion-and this often leads to other foot, leg, or back problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot. Other patients compensate by “toe walking,” while a smaller number take steps by bending abnormally at the hip or knee.

Causes

There are several possible causes for the limited range of ankle motion. Often it is due to tightness in the Achilles tendon or calf muscles (the soleus muscle and/or gastrocnemius muscle). In some patients, this tightness is congenital (present at birth) and is sometimes an inherited trait. Other patients acquire the tightness through situations that keep the foot pointing downward for extended periods-such as being in a cast, being on crutches, or frequently wearing high-heeled shoes. In addition, diabetes can affect the fibers of the Achilles tendon and cause tightness.Sometimes equinus is related to a bone blocking the ankle motion. For example, a fragment of a broken bone following an ankle injury, or bone block, can get in the way and restrict motion. Less often, equinus is caused by spasms in the calf muscle. These spasms may be signs of an underlying neurologic disorder, such as cerebral palsy.

Foot Problems Related to Equinus

Depending on how a patient compensates for the inability to bend properly at the ankle, a variety of foot conditions can develop, including:

  • Plantar fasciitis (arch/heel pain)
  • Calf cramping
  • Tendonitis-inflammation in the Achilles tendon
  • Metatarsalgia-pain and/or callusing on the ball of the foot
  • Flatfoot
  • Arthritis of the midfoot (middle area of the foot)
  • Pressure sores on the ball of the foot or the arch
  • Bunions and hammertoes
  • Ankle pain
  • Shin splints

Diagnosis

Most patients with equinus are unaware they have this condition when they first visit the doctor. Instead, they come to the doctor seeking relief for foot problems associated with equinus. To diagnose equinus, the foot and ankle surgeon will evaluate the ankle’s range of motion when the knee is flexed (bent) as well as extended (straightened). This enables the surgeon to identify whether the tendon or muscle is tight and to assess whether bone is interfering with ankle motion. X-rays may also be ordered. In some cases, the foot and ankle surgeon may refer the patient for neurologic evaluation.

Treatment Non-surgical Options

Treatment includes strategies aimed at relieving the symptoms and conditions associated with equinus.

When is Surgery Needed?

The patient plays a vital role in minimizing the risk of developing diabetic peripheral neuropathy and in preventing its possible consequences.

 

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Flexible Flatfoot

Flexible Flatfoot

Flexible Flatfoot

What is Flatfoot?

Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common-partial or total collapse (loss) of the arch. Other characteristics shared by most flatfoottypes of flatfoot include:

  • “Toe drift,” where the toes and front part of the foot point outward.
  • The heel tilts toward the outside and the ankle appears to turn in.
  • A short Achilles tendon, which causes the heel to lift off the ground earlier when walking and may act as a deforming force.
  • Bunions and hammertoes may occur in some people with flatfeet.

Health problems such as rheumatoid arthritis or diabetes sometimes increase the risk of developing flatfoot. In addition, adults who are overweight frequently have flatfoot.

Flexible Flatfoot

Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and generally progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed. The term “flexible” means that while the foot is flat when standing (weight-bearing), the arch returns when not standing. In the early stages of flexible flatfoot arthritis is not restricting motion of the arch and foot, but in the later stages arthritis may develop to such a point that the arch and foot become stiff. Symptoms, which may occur in some persons with flexible flatfoot, include:

  • Pain in the heel, arch, ankle, or along the outside of the foot.
  • “Turned-in” ankle.
  • Pain associated with a shin splint.
  • General weakness/fatigue in the foot or leg

Diagnosis of Flexible Flatfoot

In diagnosing flatfoot, the foot and ankle surgeon examines the foot and observes how it looks when you stand and sit. X-rays are usually taken to determine the severity of the disorder. If you are diagnosed with flexible flatfoot but you don’t have any symptoms, your foot and ankle surgeon will explain what you might expect in the future.

Treatment Options

If you experience symptoms with flexible flatfoot, the foot and ankle surgeon may recommend various treatment options.

Flatfoot Surgery

A variety of surgical techniques is available to correct flexible flatfoot. Your case may require one procedure or a combination of procedures. All of these surgical techniques are aimed at relieving the symptoms and improving foot function. Among these procedures are tendon transfers or tendon lengthening procedures, realignment of one or more bones, joint fusions, or insertion of implant devices. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

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Haglund’s Deformity (Pump Bump)

Haglund’s Deformity (Pump Bump)

Haglund’s Deformity (Pump Bump)

What is Haglund’s Deformity?

Haglund’s deformity is a bony enlargement on the back of the heel that most often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone). In Haglund’s deformity, the soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, the deformity is most common in young women who wear pumps.

Symptoms

Haglund’s deformity can occur in one or both feet. The signs and symptoms include:

  • A noticeable bump on the back of heel.
  • Pain in the area where the Achilles tendon attaches to the heel.
  • Swelling in the back of the heel.
  • Redness near the inflamed tissue.

What Causes Haglund’s Deformity?

To some extent, heredity plays a role in Haglund’s deformity. People can inherit a type of foot structure that makes them prone to developing this condition. For example, high arches can contribute to Haglund’s deformity. The Achilles tendon attaches to the back of the heel bone, and in a person with high arches, the heel bone is tilted backward into the Achilles tendon. This causes the uppermost portion of the back of the heel bone to rub against the tendon. Eventually, due to this constant irritation, a bony protrusion develops and the bursa becomes inflamed. It is the inflamed bursa that produces the redness and swelling associated with Haglund’s deformity. A tight Achilles tendon can also play a role in Haglund’s deformity, causing pain by compressing the tender and inflamed bursa. In contrast, a tendon that is more flexible results in less pressure against the painful bursa. Another possible contributor to Haglund’s deformity is a tendency to walk on the outside of the heel. This tendency, which produces wear on the outer edge of the sole of the shoe, causes the heel to rotate inward, resulting in a grinding of the heel bone against the tendon. The tendon protects itself by forming a bursa, which eventually becomes inflamed and tender.

Diagnosis

After evaluating the patient’s symptoms, the foot and ankle surgeon will examine the foot. In addition, x-rays will be ordered to help the surgeon evaluate the structure of the heel bone.

Treatment: Non-surgical Approaches

Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the bursitis, they will not shrink the boney protrusion.

When is Surgery Needed?

If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. The foot and ankle surgeon will determine the procedure that is best suited to your case. It is important to follow the surgeon’s instructions for post-surgical care.

Prevention

A recurrence of Haglund’s deformity may be prevented by:

  • Wearing appropriate shoes; avoid pumps and high-heeled shoes.
  • Using arch supports or orthotic devices.
  • Performing stretching exercises to prevent the Achilles tendon from tightening.
  • Avoiding running on hard surfaces and running uphill.

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