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A Patient's Guide to Achilles Tendon Problems

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A Patient’s Guide to Achilles Tendon Problems The Central Orthopedic Group 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 [email protected] Compliments of: The Central Orthopedic Group DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions,A ailmentsPatient's or treatments. Guide The informationto Achilles should NOTTendon be used in Problems place of a visit with your health care provider, nor should you disregard the advice of your health care provider because of any information you read in this booklet. The Central Orthopedic Group The Central Orthopedic Group 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 [email protected] http://thecentralorthopedicgroup.com All materials within these pages are the sole property of Medical Multimedia Group, LLC and are used herein by permission. eOrthopod is a registered trademark of Medical Multimedia Group, LLC. 2 Compliments of: The Central Orthopedic Group A Patient's Guide to Achilles Tendon Problems Gastroc-soleus muscle group nemius. Together, they form the gastroc-soleus muscle group. When they contract, they pull on the Achilles tendon, causing your foot to point down and helping you rise on your toes. Introduction This powerful muscle group helps when you sprint, jump, or climb. Several different Problems that affect the Achilles tendon problems can occur that affect the Achilles include tendonitis, tendinopathy, tendo- tendon, some rather minor and some quite calcaneal bursitis, and tendonosis. Each severe. of these conditions will be described and explained. These problems affect athletes most often, especially runners, basketball players, and anyone engaged in jumping sports. They are also common among both active and sedentary (inactive) middle-aged adults. These problems cause pain at the back of the calf. Severe cases may result in a rupture of the Achilles tendon. This guide will help you understand • where the Achilles tendon is located Powerful muscle group • what kind of Achilles tendon Tendocalcaneal Bursitis problems there are A bursa is a fluid-filled sac designed to limit • how an injured Achilles tendon causes friction between rubbing parts. These sacs, or problems • what treatment options are available Anatomy Where is the Achilles tendon, and what does it do? The Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. The calf is actually formed by two muscles, the underlying soleus and the thick outer gastroc- 3 Compliments of: The Central Orthopedic Group A Patient's Guide to Achilles Tendon Problems bursae, are found in many places in the body. on the tendon When a bursa becomes inflamed, the condition and experiences is called bursitis. Tendocalcaneal bursitis is a tearing of the an inflammation in the bursa behind the heel tendon. In some bone. This bursa normally limits friction where instances, the the thick fibrous Achilles tendon that runs rupture may down the back of the calf glides up and down be preceded behind the heel. by a period of tendonitis, which Achilles Tendonitis renders the A violent strain can cause trauma to the calf tendon weaker muscles or the than normal. Achilles tendon. Causes Sometimes this is referred to as How do these problems develop? tendonitis. This It’s not entirely clear why these problems injury can happen during a strong develop in some people but not in others. contraction of the Changes in the normal alignment of the foot muscle, as when and leg may be part of the problem. Anyone running or sprinting. with one leg shorter than the other is at Landing on the increased risk of Achilles tendon problems. ground after a jump For the athlete, sudden increases in training can force the foot may be a key factor. Runners may add on upward, also causing miles or engage in excessive hill training injury. The strain while other athletes increase training intensity. can affect different portions of the muscles Other risk factors include obesity, diabetes (or or tendon. For instance, the strain may occur other endocrine disorders), aging, exposure to in the center of the muscle. Or it may happen steroids, and taking fluoroquinolones (antibi- where the muscles join the Achilles tendon (called the musculotendinous junction). otics). Achilles Tendinopathy/Tendonosis Problems with the Achilles tendon seem to occur in different ways. Initially, irrita- Chronic overuse may contribute to changes in the Achilles tendon as well, leading to degeneration and thickening of the tendon. Studies show there is no sign of inflammation with overuse injuries of tendons. Most experts now refer to this condition as tendinopathy, or tendonosis instead of tendonitis. Achilles Tendon Rupture In severe cases, the force of a violent strain may even rupture the tendon. The classic example is a middle-aged tennis player or weekend warrior who places too much stress 4 Compliments of: The Central Orthopedic Group A Patient's Guide to Achilles Tendon Problems tion of the outer covering of the tendon, called the paratenon, causes paratendonitis. Paratendonitis is simply inflammation around the tendon. Inflammation of the tendocalcaneal bursa (described above) may also be present with paratendonitis. Either of these conditions may be due to repeated overuse or ill-fitting shoes that rub on the tendon or bursa. degenerative tendon sets the stage for the possibility of actual rupture of the Achilles tendon. Symptoms What does the condition feel like? Tendocalcaneal bursitis usually begins with pain and irritation at the back of the heel. There may be visible redness and swelling Collagen in the area. The back of the shoe may further As we age, our tendons can degenerate. irritate the condition, making it difficult to Degeneration means that wear and tear occurs tolerate shoe wear. in the tendon over time and leads to a situa- Achilles tendonitis usually occurs further up tion where the tendon is weaker than normal. the leg, just above the heel bone itself. The Degeneration in a tendon usually shows up Achilles tendon in this area may be notice- as a loss of the normal arrangement of the ably thickened and tender to the touch. Pain is fibers of the tendon. Tendons are made up of present with walking, especially when pushing strands of a material called collagen. (Think off on the toes. of a tendon as similar to a nylon rope and the strands of collagen as the nylon strands.) Some An Achilles tendon rupture is usually an of the individual strands of the tendon become unmistakable event. Some bystanders may jumbled due to the degeneration, other fibers report actually hearing the snap, and the victim break, and the tendon loses strength. of a rupture usually describes a sensation similar to being violently kicked in the calf. The healing process in the tendon causes the Following rupture the calf may swell, and the tendon to become thickened as scar tissue tries injured person usually can't rise on his toes. to repair the tendon. This process can continue to the extent that a nodule forms within the Diagnosis tendon. This degenerative condition without How do doctors identify the problem? inflammation is called tendonosis. The area Diagnosis is almost always by clinical history of tendonosis in the tendon is weaker than and physical examination. The physical exami- normal tendon. Tiny tears in the tissue around nation is used to determine where your leg the tendon occur with overuse. The weakened, hurts. The doctor will probably move your 5 Compliments of: The Central Orthopedic Group A Patient's Guide to Achilles Tendon Problems ankle in different positions and ask you to hold Nonsurgical Treatment your foot against the doctor's pressure. By Tendonitis/Tendinopathy stretching the calf muscles and feeling where these muscles attach on the Achilles tendon, In the past, nonsurgical treatment for tendocal- the doctor can begin to locate the problem caneal bursitis and Achilles tendonitis started area. with a combination of rest, ice, and anti- inflammatory medications such as aspirin or The doctor may run some simple tests if a ibuprofen. rupture is suspected. One test involves simply feeling for a gap in the tendon where the Since it is now recognized that many tendon rupture has occurred. However, swelling in the problems occur without inflammation, the use area can make it hard to feel a gap. of antiinflammatories and ice have come under question. In the case of true inflammation, Another test is done with your leg positioned the overuse of these modalities may prevent off the edge of the treatment table. The doctor a normal, healing inflammatory process. squeezes your calf muscle to see if your foot Preventing inflammation needed to clean up bends downward. If your foot doesn't bend cellular debris in the injured area may lead to downward, it's highly likely that you have a delayed or incomplete healing. The result may ruptured Achilles tendon. be future chronic problems of tendonosis and/ When the doctor is unsure whether the or tendinopathy. Achilles tendon has been ruptured, a magnetic Many experts suggest when there is any doubt resonance imaging (MRI) scan may be neces- about inflammation, treatment should proceed sary to confirm the diagnosis. This is seldom as if there are no inflammatory cells present. the case. The MRI machine uses magnetic This approach focuses on pain relief and waves rather than X-rays to show the soft restoring proper motion and weight-bearing so tissues of the body. The MRI creates images you can return to your usual activities. that look like slices and shows the tendons and ligaments very clearly. This test does If there is an inflammatory process, then the not require any needles or special dye and is condition should respond fairly quickly to drug painless.
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