KaryLupkin - Blog

Hammertoes Treatment At Home

6/24/2015

Overview

A hammer toe can be defined as a condition that causes your toe to bend downward instead of pointing forward. While it can occur on any toe on your foot, it usually affects the second or third toe. If your baby toe curls instead of buckling, it is also considered a hammer toe. There are two types of hammer toes. If your toes still can move around at the joint, then it is considered a flexible hammer toe. It is a milder form of the condition and there are more treatment options. The other type is called a rigid hammertoes, which occurs when the tendons in your toe become so rigid that they push your toe joint out of alignment, and it cannot move at all. Typically, you will need surgery to fix it.

Causes

Hammertoe commonly develops because of structural changes that take place over time in the muscles and tendons that bend the toes. People with certain medical conditions, such as diabetes, are at risk for developing hammertoe. It can be an inherited condition for some people. Other causes include trauma and wearing shoes that are too tight, narrow, or have high heels. The toe next to the big toe (second toe) is most frequently affected by hammertoe.

Hammer Toe

Symptoms

The symptoms of hammertoe are progressive, meaning that they get worse over time. Hammertoe causes the middle joint on the second, third, fourth, or fifth toes to bend. The affected toe may be painful or irritated, especially when you wear shoes. Areas of thickened skin (corns) may develop between, on top of, or at the end of your toes. Thickened skin (calluses) may also appear on the bottom of your toe or the ball of your foot. It may be difficult to find a pair of shoes that is comfortable to wear.

Diagnosis

Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.

Non Surgical Treatment

Symptomatic treatment of hammertoes consists of such things as open toed shoes or hammertoe pads. There are over the counter corn removers for temporally reducing the painful callous often seen with the hammertoe. These medications must be used with caution. They are a mild acid that burns the callous off. These medications should never Hammer toes be used for corns or callouses between the toes. Persons with diabetes or bad circulation should never use these products.

Surgical Treatment

Surgery to correct for a hammertoe may be performed as an outpatient procedure at a hospital, surgery center, or in the office of your podiatrist. There are multiple procedures that can be used depending on your individual foot structure and whether the deformity is flexible or rigid. There may be a surgical cut in the bone to get rid of an exostosis, or a joint may be completely removed to allow the toe to lay straight.

Over-Pronation

6/4/2015

Overview

Pronation, in anatomical terms, means to rotate, and it applies to any rotational movement of a bone. Pronation in the feet involves an inward rolling of the foot throughout the gait which helps with the transfer of force. Normally the foot will move from the heel to the toes with only a small degree of pronation, with a slight inward roll from the outside of the heel to the inside of the foot which helps to support the body weight. Normal pronation involves the rolling of the foot to approximately 15 degrees. If you have normal foot arches, you are likely to be a neutral runner and will most likely pronate normally. Foot Pronation

Causes

Excess stress on the inner surface of the foot can cause injury and pain in the foot and ankle. Repeated rotational forces through the shin, knee, thigh and pelvis also place additional strain on the muscles, tendons and ligaments of the lower leg.

Symptoms

Common conditions seen with overpronation include heel pain or plantar fasciitis, achilles tendonopathy, hallus valgus and or bunions, patellofemoral pain syndrome, Iliotibial band pain syndrome, low back pain, shin splints, stress fractures in the foot or lower leg.

Diagnosis

At some point you may find the pain to much or become frustrated. So what are you options? Chances are your overpronation has led to some type of injury if there's pain. Your best bet is to consult with someone who knows feet. Start with your pediatrist, chiropodist or chiropractor. They'll be able to diagnose and treat the injury and give you more specific direction to better support your feet. One common intervention is a custom foot orthotic. Giving greater structural support than a typical shoe these shoe inserts can dramatically reduce overpronation.

Non Surgical Treatment

Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improperly fitting footwear can lead to additional foot problems.

Surgical Treatment

Depending on the severity of your condition, your surgeon may recommend one or more treatment options. Ultimately, however, it's YOUR decision as to which makes the most sense to you. There are many resources available online and elsewhere for you to research the various options and make an informed decision.

What Are The Causes Of Severs Disease?

5/16/2015

Overview

If your teen or preteen is complaining of heel pain, it might be Sever?s disease. No need to stress - this isn?t actually a ?disease,? but rather a common type of growing pain that only lasts a few weeks or months and doesn?t leave any long-term damage. Sever?s disease occurs in kids as they hit their adolescent growth spurt, usually between the ages of 8-13 for girls and 10-15 for boys. It?s most common among active kids that run, play basketball or soccer, or do gymnastics. Kids with flat feet, high arches, short leg syndrome, over-pronation (feet that roll inward when they walk) or who are overweight or obese also have an increased risk.

Causes

Apart from age, other factors that may contribute to developing Sever?s disease include physical activity, any form of exercise that is weight bearing through the legs or stresses the soft tissue can exacerbate the pain of the disease. External factors, for example, running on hard surfaces or wearing inappropriate shoes during sport. Overuse injury, very active children may repeatedly but subtly injure the bones, muscles and tendons of their feet and ankles. In time, the accumulated injuries cause symptoms.

Symptoms

This is a condition that affects the cartilage growth plate and the separate island of growing bone on the back of the heel bone. This growth plate is called the physeal plate. The island of growing bone is called the apophysis. It has the insertion attachment of the Achilles tendon, and the attachment of the plantar fascia. This island of bone is under traction from both of these soft tissue tendon and tendon-like attachments.

Diagnosis

A doctor can usually tell that a child has Sever's disease based on the symptoms reported. To confirm the diagnosis, the doctor will probably examine the heels and ask about the child's activity level and participation in sports. The doctor might also use the squeeze test, squeezing the back part of the heel from both sides at the same time to see if doing so causes pain. The doctor might also ask the child to stand on tiptoes to see if that position causes pain. Although imaging tests such as X-rays generally are not that helpful in diagnosing Sever's disease, some doctors order them to rule out other problems, such as fractures. Sever's disease cannot be seen on an X-ray.

Non Surgical Treatment

Reduce inflammation:

Ice: For at least 20 minutes after activity or when pain increases.

Nonsteroidal anti-inflammatory drugs:(NSAIDs) may also help. Stretch the calf. Increase calf flexibility by doing calf stretches for 30 to 45 seconds several times per day.

Protect the heel: The shoe may need to be modified to provide the proper heel lift or arch support.

Select a shoe with good arch support and heel lift if possible. Try heel lifts or heel cups in sports shoes, especially cleats. Try arch support in cleats if flat feet contribute to the problem.

Take it one step at a time:. Gradually resume running and impact activities as symptoms allow. Sever?s disease usually goes away when the growth plate (apophysis) matures, which should be by age 12 to 13 years in females and 13 to 14 years in males.

All The Things You Should Know About Heel Pain

3/29/2015

Overview

Heel Pain

When walking, your heels repeatedly hit the ground with considerable force. They have to be able to absorb the impact and provide a firm support for the weight of the body. When pain develops in the heel, it can be very disabling, making every step a problem, affecting your posture. There are various types of heel Heel Pain. Some of the most common are heel spurs (plantar fasciitis); heel bursitis and heel bumps.

Causes

In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we've suffered. When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury. Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.

Symptoms

The primary symptom is pain in the heel area that varies in severity and location. The pain is commonly intense when getting out of bed or a chair. The pain often lessens when walking.

Diagnosis

The diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions. Pain can be referred to the heel and foot from other areas of the body such as the low back, hip, knee, and/or ankle. Special tests to challenge these areas are performed to help confirm the problem is truly coming from the plantar fascia. An X-ray may be ordered to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation. Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter's syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but may show up at first as pain in the heel.

Non Surgical Treatment

Depending on the underlying cause, treatment can include. Rest from activities that stress the heel (such as running and jumping). Ice packs. Regular foot massage, concentrating on the arch of the foot. Professional strapping. A splint worn at night. Flexibility exercises. Ultrasound therapy. Anti-inflammatory medicine (topical or oral). Checking your posture and walking style, to correct imbalances and gait abnormalities that may contribute to the pain. Shoe inserts (orthoses) to help support the foot. In some cases, surgery may be recommended to treat conditions including neuroma, bursitis and heel spurs.

Surgical Treatment

When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.

Prevention

You can reduce the risk of heel pain in many ways, including. Wear shoes that fit you properly with a firm fastening, such as laces. Choose shoes with shock-absorbent soles and supportive heels. Repair or throw out any shoes that have worn heels. Always warm up and cool down when exercising or playing sport, include plenty of slow, sustained stretches. If necessary, your podiatrist will show you how to tape or strap your feet to help support the muscles and ligaments. Shoe inserts (orthoses) professionally fitted by your podiatrist can help support your feet in the long term.

Treatments And Causes Of Achilles Tendinitis Pain And discomfort

3/5/2015

Overview

The Achilles tendon is the largest tendon in the body. Tendons are long, tough cords of tissue that connect muscle to bone. The Achilles tendon is located in the back of the foot and connects your heel bone to your calf muscle. It helps you to walk, run and jump. The Achilles tendon is able to endure stress, but sometimes injury can occur to the tendon when overly stressed. Overuse of the Achilles tendon may cause the tendon to swell, become irritated, inflamed and cause pain. This is Achilles tendinitis. It is a common sports injury related to running, but can happen to anyone who puts a lot of stress on their feet (e.g.: basketball players and dancers). If you do not get treatment for Achilles tendinitis, the problem can become chronic and make it difficult for you to walk.

Causes

Tight or tired calf muscles, which transfer too much of the force associated with running onto the Achilles tendon. Not stretching the calves properly or a rapid increase in intensity and frequency of sport training can make calf muscles fatigued. Activities which place a lot of stress on the achilles tendon, such as hill running and sprint training, can also cause Achilles Tendinitis. Runners who overpronate (roll too far inward on their feet during impact) are most susceptible to Achilles Tendinitis. Runners with flat feet are susceptible to Achilles Tendinitis because flat feet cause a 'wringing out' effect on the achilles tendon during running. High arched feet usually absorb less shock from the impact of running so that shock is transferred to the Achilles tendon. Use of inappropriate footwear when playing sport or running e.g., sandals, can also put an extra load on the Achilles tendon. Shoes are now available that have been designed for individual sports and provide cushioning to absorb the shock of impact and support for the foot during forceful movements. Training on hard surfaces e.g., concrete, also increases the risk of Achilles Tendinitis. Landing heavily or continuously on a hard surface can send a shock through the body which is partly absorbed by the Achilles tendon. A soft surface like grass turf helps to lessen the shock of the impact by absorbing some of the force of the feet landing heavily on the ground after a jump or during a running motion.

Symptoms

People with Achilles tendinitis may experience pain during and after exercising. Running and jumping activities become painful and difficult. Symptoms include stiffness and pain in the back of the ankle when pushing off the ball of the foot. For patients with chronic tendinitis (longer than six weeks), x-rays may reveal calcification (hardening of the tissue) in the tendon. Chronic tendinitis can result in a breakdown of the tendon, or tendinosis, which weakens the tendon and may cause a rupture.

Diagnosis

A doctor examines the patient, checking for pain and swelling along the posterior of the leg. The doctor interviews the patient regarding the onset, history, and description of pain and weakness. The muscles, tissues, bones, and blood vessels may be evaluated with imaging studies, such as X-ray, ultrasound, or MRI.

Nonsurgical Treatment

Treatment will focus on relieving the pain and preventing further injury. Your podiatrist may create shoe inserts or a soft cast to effectively immobilize the affected area for a period of time. (Often, a couple of weeks are needed for the tendon to heal.) Medication can help too. Your podiatrist may recommend or prescribe oral medication.

Achilles Tendinitis

Surgical Treatment

Not every Achilles tendon injury or condition requires surgery. It is generally understood by doctors and surgeons, that surgery will introduce more scar tissue into the Achilles tendon. This added scar tissue will be problematic, requiring physical therapy and conservative treatment options post-surgery. If not dealt with properly, your ankle and Achilles tendon could end up in worse condition than before the surgery! This is why surgery is only performed as a last resort.

Prevention

Wear shoes that fit correctly and support your feet: Replace your running or exercise shoes before the padding or shock absorption wears out. Shock absorption greatly decreases as the treads on the bottoms or sides of your shoes begin to wear down. You may need running shoes that give your foot more heel or arch support. You may need shoe inserts to keep your foot from rolling inward. Stretch before you exercise: Always warm up your muscles and stretch gently before you exercise. Do cool down exercises when you are finished. This will loosen your muscles and decrease stress on your Achilles tendon. Exercise the right way: If your tendinitis is caused by the way that you exercise, ask a trainer, coach, or your caregiver for help. They can teach you ways to train or exercise to help prevent Achilles tendinitis. Do not run or exercise on uneven or hard surfaces. Instead, run on softer surfaces such as treadmills, rubber tracks, grass, or evenly packed dirt tracks.

Achilles Tendon Rupture The Facts

2/27/2015

Overview

The Achilles tendon attaches the calf muscles in the leg to the heel bone. It is the largest yet most exposed tendon in the body. An Achilles tendon rupture injury is when the tendon fibres tear, causing symptoms of pain and loss of function. A rupture can be either partial or complete and treatment may involve surgery. Achilles tendon rupture is most common in weekend athletes trying to train too hard and is least common in well-trained professional athletes. The injury is more common in men than in women and the frequency of rupture increases over the age of 30 years.

Causes

Often the individual will feel or hear a pop or a snap when the injury occurs. There is immediate swelling and severe pain in the back of the heel, below the calf where it ruptures. Pain is usually severe enough that it is difficult or impossible to walk or take a step. The individual will not be able to push off or go on their toes.

Symptoms

Ankle pain and swelling or feeling like the ankle has ?given out? after falling or stumbling. A loud audible pop when the ankle is injured. Patients may have a history of prior ankle pain or Achilles tendonitis, and may be active in sports. Swelling, tenderness and possible discoloration or ecchymosis in the Achilles tendon region. Indentation above the injured tendon where the torn tendon may be present. Difficulty moving around or walking. Individual has difficulty or is unable to move their ankle with full range of motion. MRI can confirm disruption or tear in the tendon. Inability to lift the toes.

Diagnosis

In order to diagnose Achilles tendon rupture a doctor or physiotherapist will give a full examination of the area and sometimes an X ray is performed in order to confirm the diagnosis. A doctor may also recommend an MRI or CT scan is used to rule out any further injury or complications.

Non Surgical Treatment

Treatment of the initial injury is with use of ice, elevation, and immobilization. If suspected you should contact your podiatrist or physician. Further treatment with continued immobilization, pain medication, or anti-inflammatory medications may be advised. If casted the foot is usually placed in a plantarflexed position to decrease the stretch on the tendon. As healing progresses the cast is changed to a more dorsiflexed position at the ankle. The casting processes can be up to 8 weeks or more.

Achilles Tendonitis

Surgical Treatment

This condition should be diagnosed and treated as soon as possible, because prompt treatment probably improves recovery. You may need to be referred urgently to see a doctor in an orthopaedic department or accident and emergency department. Meanwhile, if a ruptured Achilles tendon is suspected, you should not put any weight on that foot, so do not walk on it at all. A new piece of research found that surgery and conservative treatment actually gave equally good results, when patients were also given early mobilisation treatment using a brace. If an operation is needed, there is a type of surgery called percutaneous, which uses smaller cuts than the traditional operation. This seems to reduce the risk of getting a wound infection. After surgery, a brace seems to be better than a plaster cast in terms of faster recovery and return to normal activities, a lower complication rate and patient preferences.

Living With Achilles Tendonitis

2/25/2015

Overview

Achilles Tendinitis

A tendon is a band of connective tissue that anchors muscle to bone. The Achilles tendon is the largest tendon in the body. It attaches the calf muscles to the heel bone (calcaneus) and is very important because it lets you lift your heel when you start to walk. It also helps you to walk, run or stand on tiptoe. Achilles tendonitis is inflammation of the Achilles tendon. In most cases, it is a type of overuse injury and is more common in younger people. Professional and weekend athletes can suffer from Achilles tendonitis, but it is also a common overuse injury in people not involved in sport. Treatment includes rest, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy and avoiding activities that aggravate the condition.

Causes

Like any muscle or tendon in the body, the older we get, the more likely we are to sustain an injury. So middle-aged men and women are most at risk, with a slightly higher risk factor attributed to males. Those who participate in more intense athletic activities like high impact sports (tennis, running, basketball) are most susceptible to the injury. Certain underlying medical conditions can also be a contributing factor. Diabetics are more at risk of suffering from Achilles Tendinitis, as are those who are not in great physical shape. Some antibiotics, particularly fluoroquinolones can make one more likely to suffer a strained Achilles Tendon.

Symptoms

Symptoms of Achilles tendonitis include, pain in the back of the heel, difficulty walking, sometimes the pain makes walking impossible, swelling, tenderness and warmth of the Achilles tendon. Achilles tendonitis is graded according to how severe it is, mild - pain in the Achilles tendon during a particular activity (such as running) or shortly after. Moderate - the Achilles tendon may swell. In some cases, a hard lump (nodule) may form in the tendon. Severe - any type of activity that involves weight bearing causes pain of the Achilles tendon. Very occasionally, the Achilles tendon may rupture (tear). When an Achilles tendon ruptures, it is said to feel like a hard whack on the heel.

Diagnosis

X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning.

Nonsurgical Treatment

Treatment will depend on the severity of the injury. In general terms, the longer the symptoms are present before treatment begins, the longer the timeframe until complete recovery is achieved. Complete recovery can take between three and nine months. Initial treatment of Achilles tendonitis includes, Rest, to avoid further injury to the area. Ice, to reduce inflammation, Elevation, to reduce swelling. Bandaging or strapping, to support the area and restrict movement of the tendon. Anti-inflammatory medications to reduce pain and inflammation. (Cortisone (steroid) injections to reduce inflammation are not usually recommended as they may weaken the tendon and increase the risk of rupture). Other treatments include, Physiotherapy, Physiotherapy plays an important role in the treatment of Achilles tendonitis. This generally focuses on two main areas - treatment and rehabilitation. Treatment may involve such techniques as massage, ultrasound, acupuncture and gentle stretching. Rehabilitation involves the development of an individualised recovery programme, the most important aspect of which is strengthening. Strengthening of the muscles surrounding the Achilles tendon helps to promote healing in the tendon itself. Strengthening is achieved through the use of specific exercises, which will be taught by the physiotherapist. One such exercise is eccentric loading, which involves contracting the calf muscle while it is being stretched. It is common for the rehabilitation programme to take up to three months. Podiatry, including gait analysis and the fitting of orthotic devices to support the foot and reduce stress on the tendon, may be recommended. For cases of Achilles tendonitis that do not respond to initial treatment, casting or splinting of the affected foot may be recommended to allow it to rest completely.

Surgical Treatment

Chronic Achilles tendon tears can be more complicated to repair. A tendon that has torn and retracted (pulled back) into the leg will scar in the shortened position over time. Restoring normal tendon length is usually not an issue when surgery is performed within a few weeks of the injury. However, when there has been a delay of months or longer, the treatment can be more complicated. Several procedures can be used to add length to a chronic Achilles tear. A turndown procedure uses tissue folded down from the top of the calf to add length to the Achilles tendon. Tendon transfers from other tendons of the ankle can also be performed to help restore function of the Achilles. The results of surgery in a chronic situation are seldom as good as an acute repair. However, in some patients, these procedures can help restore function of a chronically damaged Achilles.

Prevention

Although Achilles tendinitis cannot be completely prevented, the risk of developing it can be lowered. Being aware of the possible causes does help, but the risk can be greatly reduced by taking the following precautions. Getting a variety of exercise - alternating between high-impact exercises (e.g. running) and low-impact exercise (e.g. swimming) can help, as it means there are days when the Achilles tendon is under less tension. Limit certain exercises - doing too much hill running, for example, can put excessive strain on the Achilles tendon. Wearing the correct shoes and replacing them when worn - making sure they support the arch and protect the heel will create less tension in the tendon. Using arch supports inside the shoe, if the shoe is in good condition but doesn't provide the required arch support this is a cheaper (and possibly more effective) alternative to replacing the shoe completely. Stretching, doing this before and after exercising helps to keep the Achilles tendon flexible, which means less chance of tendinitis developing. There is no harm in stretching every day (even on days of rest), as this will only further improve flexibility. Gradually increasing the intensity of a workout - Achilles tendinitis can occur when the tendon is suddenly put under too much strain, warming up and increasing the level of activity gradually gives your muscles time to loosen up and puts less pressure on the tendon.

Causes Signals And Treating Of Achilles Tendon Ruptures

2/19/2015

Overview

Achilles Tendinitis

An Achilles tendon injury can affect both professional and amateur athletes. The Achilles tendon is one of the longer tendons in your body, stretching from the bones of your heel to your calf muscles. You can feel it, a springy band of tissue at the back of your ankle and above your heel. It allows you to extend your foot and point your toes to the floor. Unfortunately, it's a commonly injured tendon. Many Achilles tendon injuries are caused by tendinitis, in which the tendon becomes swollen and painful. In a severe Achilles tendon injury, too much force on the tendon can cause it to tear partially or rupture completely.

Causes

Causes of and contributors to Achilles tendon rupture include trauma (caused by injury, usually an acceleration injury such as pushing off or jumping up). Preceding tendon problems. Chronic Achilles tendonitis (can lead to small tears within the tendon, increasingly weakening it). Certain drug therapies/treatments. Drugs that have been linked to Achilles tendon rupture include. Fluoroquinolone antibiotics - after nearly 900 reports of tendon ruptures, tendonitis and other tendon disorders (most associated with the Achilles tendon) linked to Ciprofloxacin (Cipro) alone were collected in the U.S. Food and Drug Administration (FDA)?s database, at least one public-interest group petitioned the FDA to recommend that a "Black Box Warning" be added to Cipro's packaging. Some researchers speculate this class of antibiotics is toxic to tendon fibers, and that in some cases may reduce their blood supply. Patients should at least be more aware of the potential for ruptures so that they can be switched to other antibiotics at the onset of early warning signals such as tendon pain.

Symptoms

Patients present with acute posterior ankle/heel pain and may give a history of ?felt like someone kicked me from behind?. Patients may report a direct injury, or report the pain started with jumping or landing on a dorsiflexed foot. It is important to elicit in the history any recent steroid or flouroqunolone usage including local steroid injections, and also any history of endocrine disorders or systemic inflammatory conditions.

Diagnosis

The diagnosis of an Achilles tendon rupture can be made easily by an orthopedic surgeon. The defect in the tendon is easy to see and to palpate. No x-ray, MRI or other tests are necessary.

Non Surgical Treatment

Not every torn Achilles tendon needs an operation. Recent studies have shown that even a conservative treatment, i.e. immobilizingt the leg can lead to satisfactory healing successes. This requires, however, that the patient is fitted with a cast (immobilization splint) and/or a special boot for a period of approximately 6 - 8 weeks. After that, the boot must be worn during the day for about two more weeks. An intensive physiotherapy will start after about six weeks to train the calf muscles so that the initial coordination can be restored. Running training on flat ground can be started again after another 10 - 12 weeks. Studies show that the danger of a recurring torn tendon is higher after a conservative treatment opposed to an operative treatment. Depending on the type of treatment, about 10 - 15 percent of those affected can expect at some point to again suffer from a tear of the Achilles tendon. Moreover, in the non-operated cases, we see more often a significant permanent weakness of the footprint, particularly restricting the ability to participate in sports.

Surgical Treatment

Debate remains regarding the best form of treatment for a ruptured Achilles tendon. The 2 options are:immobilisation or operation. A recent meta-analysis of scientific studies showed that compared to immobilisation, an operation reduces the risk of re-rupture and allows a quicker return to work. An operation is not without risk and these must be balanced against the benefit of a lower re-rupture rate. Both treatments involve immobilisation for 8 weeks.

Prevention

Here are some suggestions to help to prevent this injury. Corticosteroid medication such as prednisolone, should be used carefully and the dose should be reduced if possible. But note that there are many conditions where corticosteroid medication is important or lifesaving. Quinolone antibiotics should be used carefully in people aged over 60 or who are taking steroids.

The Facts Not Common Myths Regarding Achilles Tendon RuptureS

2/19/2015

Overview

Achilles Tendinitis

The Achilles tendon is the extension from the two large muscles in the calf region, the gastrocnemius and the soleus. These two muscles combine to form the Achilles tendon. The tendon forms in the lower one third of the leg and extends to the back of the heel bone (calcaneus). When the muscles of the calf contract this produces tension on the Achilles tendon pulling on the back of heel causing the heel to rise and the foot to point downward. It is during this motion that high-tension force is transmitted through the Achilles tendon during pushing and jumping activity. This high tension force can cause the Achilles tendon to tear or rupture. This happens in 3 common locations. The most common location for a tendon tear is within the tendon substance just above the heel. The second and third most common locations are where the Achilles tendon attaches into the heel bone and higher in the leg, where the tendon begins.

Causes

The Achilles tendon can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Achilles tendon rupture is more common in those with preexisting tendinitis of the Achilles tendon. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics, including quinolones such as levofloxacin [Levaquin] and ciprofloxacin [Cipro]) can also increase the risk of rupture. Rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a pickup game of basketball, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are tennis, racquetball, basketball, and badminton. The injury can happen in the following situations. You make a forceful push-off with your foot while your knee is straightened by the powerful thigh muscles. One example might be starting a foot race or jumping. You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully overstretching the tendon. You fall from a significant height or abruptly step into a hole or off of a curb.

Symptoms

When the Achilles tendon ruptures a loud bang or popping sound may be heard. The person may feel that they have been hit or kicked in the back of the lower leg and often they will look over their shoulder to see who or what has hit them. This is quickly followed by the sudden onset of sharp pain in the tendon and a loss of strength and function. If a complete rupture has occurred it may not be possible to lift the heel off the ground or point the toes. Often the degree of pain experienced, or lack of it, can be inversely proportional to the extent of the injury, ie a partial rupture may in fact be more painful than a complete rupture.

Diagnosis

During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. In many cases, doctors can feel a gap in your tendon if it has ruptured completely. The doctor may also ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He or she may then squeeze your calf muscle to see if your foot will automatically flex. If it doesn't, you probably have ruptured your Achilles tendon. If there's a question about the extent of your Achilles tendon injury, whether it's completely or only partially ruptured, your doctor may order an ultrasound or MRI scan. These painless procedures create images of the tissues of your body.

Non Surgical Treatment

There is no definitive protocol for conservative management. Traditionally, conservative treatment involved immobilisation in a cast or boot, with initial non-weight bearing. Recently, good results have been achieved with functional bracing and early mobilisation, and it is common to be immediately weight-bearing in an orthotic. Conservative management reduces the chance of complications, such as infection. There is a risk the tendon can heal too long and more slowly.

Achilles Tendonitis

Surgical Treatment

Debate remains regarding the best form of treatment for a ruptured Achilles tendon. The 2 options are:immobilisation or operation. A recent meta-analysis of scientific studies showed that compared to immobilisation, an operation reduces the risk of re-rupture and allows a quicker return to work. An operation is not without risk and these must be balanced against the benefit of a lower re-rupture rate. Both treatments involve immobilisation for 8 weeks.

Prevention

To help reduce your chance of getting Achilles tendon rupture, take the following steps. Do warm-up exercises before an activity and cool down exercises after an activity. Wear proper footwear. Maintain a healthy weight. Rest if you feel pain during an activity. Change your routine. Switch between high-impact activities and low-impact activities. Strengthen your calf muscle with exercises.

Hammertoes Treatment At Home

Over-Pronation

What Are The Causes Of Severs Disease?

All The Things You Should Know About Heel Pain

Treatments And Causes Of Achilles Tendinitis Pain And discomfort

Achilles Tendon Rupture The Facts

Living With Achilles Tendonitis

Causes Signals And Treating Of Achilles Tendon Ruptures

The Facts Not Common Myths Regarding Achilles Tendon RuptureS

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