ACHILLES TENDON PROBLEMS
ACHILLES TENDON RUPTURE
Achilles tendon ruptures commonly occur while performing activities that require sudden changes in direction and stretch the tendon too much. Patients usually describe a sharp pain or pop in the back of their ankle or heel. They can feel as if they were hit in the back of the leg when there actually was no contact. While some patients cannot walk, others can continue to bear weight. The diagnosis of an acute Achilles tendon rupture is made on clinical examination. The Achilles is the largest tendon in the body and provides strength critical for walking and pushing off with the foot.
Acute Achilles tendon ruptures can be successfully treated non-operatively, or operatively. Surgical treatment can lead to a faster recovery and a lower rate of re-rupture. However, surgery can be associated with very serious complications such as an infection or wound healing problems. Therefore, non-operative treatment might be preferable in certain individuals, such as patients with diabetes, vascular disease, and those who are heavy smokers.
The diagnosis of an Achilles tendon rupture is made on physical examination. Often, there is a palpable defect in the Achilles a few centimeters above the heel. The main test used to determine whether the Achilles has been ruptured is the Thompson test. This involves placing the patient on their stomach and squeezing the calf muscle. If the Achilles is intact, the foot will flex. If it is ruptured, the foot will not move.
Patients will usually be able to move the foot up and down because there is no injury to the other surrounding muscles and tendons. Sensation and circulation to the foot and ankle will be normal.
X-rays will be normal unless the Achilles injury involves a pulling off (avulsion) of the bone on the calcaneus (heel bone). An MRI is generally not needed to diagnose an acute rupture unless there is some uncertainty. Ultrasounds can also be used to confirm an Achilles tendon rupture.
Achilles tendon ruptures can be treated non-operatively or operatively. Both treatment approaches have advantages and disadvantages. In general, younger patients with no medical problems may tend to do better with operative treatment (Achilles repair), whereas patients with significant medical problems or older age might best be served with non-operative treatment. However, the decision of how the Achilles tendon rupture is treated should be based on each individual patient after the advantages and disadvantages of both treatment options are reviewed. It is important to realize that while Achilles tendon ruptures can be treated either non-operatively or operatively, they must be treated.
A neglected Achilles tendon rupture can lead to chronic problems. Pain and weakness can cause dysfunction in gait. Surgery for old injuries is significantly more complex than initial treatment.
During surgery, an incision is made along the back of the ankle to access the tendon. If the torn ends can be repaired, they will be reattached with strong sutures. Sometimes a tendon that helps to move the toes needs to be transferred (re-routed) to reconstruct the Achilles tendon.
After surgery, patients will need to use a walking boot or cast for 6-8 weeks and will require physical therapy to maximize recovery.
For an example of surgery, please watch this video: https://www.orthoillustrated.com/animation/4-achilles-tendon-rupture-repair-with-arthrex-pars-system
Achilles tendinosis is a condition in which very small tears form and inflammation occurs in the Achilles tendon. This disorder happens when too much stress is placed on the tendon and can be related to tightness in calf. Symptoms include pain when walking, tenderness, stiffness, swelling. Achilles tendinosis can increase your risk of rupturing your Achilles tendon, a condition that requires immediate attention.
If you are suffering from Achilles tendinosis, you may be able to treat the condition at home through rest, ice, and over-the-counter pain medication. If these methods are ineffective, your doctor might recommend a walking boot, physical therapy, or surgery. Surgery removes the damaged tissue in the area.
INSERTIONAL ACHILLES TENDINITIS
Insertional Achilles tendinitis occurs when the tendon degenerates where it connects to the heel. It can cause inflammation and pain, and imaging studies can reveal bone spurs.
Insertional Achilles tendinitis might be treatable with rest, ice and over-the-counter pain medication. In more severe cases, your doctor might recommend a walking boot, physical therapy, or surgery to remove the inflamed tissue.
A sprain is a stretching or tearing of one or more ligaments, the tough bands that hold the ankle bones in place. Sprains can be caused by a sports injury, accident, or stepping on an uneven surface that leads to twisting or turning the ankle. Symptoms include pain, swelling, stiffness and bruising. The ankle might be unstable or unable to hold weight.
Most acute ankle sprains can be treated non-operatively with a period of RICE (rest, ice/immobilization, compression, elevation). A walking boot, brace, and crutches can be used for comfort. Physical therapy can be helpful in strengthening the ankle and developing good balance to prevent future injury.
CHRONIC ANKLE INSTABILITY
Chronic ankle instability is a condition in which the outer portion of the ankle constantly gives out. Patients do not trust their ankle. It typically when walking or running, although it can also occur while standing still. Chronic ankle instability results from an ankle sprain that has not healed properly.
Most cases of chronic ankle instability can be treated through non-surgical measures including physical therapy, ankle bracing, and over-the-counter pain medication. Severe cases might require surgical correction, which involves repairing or reconstructing the damaged ligaments.
For additional information, please visit: https://anklesprain.com/
OSTEOCHONDRAL LESION OF THE TALUS (OLT), OR OSTEOCHONDRITIS DISSECANS (OCD)
The talus is a bone that is completely covered with cartilage to allow for smooth movement of the ankle joint. When the ankle is injured, the cartilage can be torn, leading to an osteochondral lesion. Symptoms include pain, clicking, catching or locking, swelling, feeling as if the ankle will give out.
Treatment for osteochondral lesions usually begins with conservative methods including nonsteroidal anti-inflammatory drugs, immobilization, physical therapy, bracing, and injections. If these methods fail to relieve the symptoms, surgery might be needed. Surgery involves removing the loose cartilage or bone within the joint.
POSTERIOR TIBIAL TENDON DYSFUNCTION (PAINFUL FLATFOOT)
Posterior tibial tendon dysfunction (or insufficiency) is also known as a painful flatfoot. This is a condition where the tendon is weak and unable to provide appropriate arch support. Symptoms include pain, swelling, weakness, and difficulty walking.
This can be treated successfully with physical therapy, anti-inflammatories, orthotics, or bracing. In more severe cases, surgery may be required to reconstruct the damaged tendons and realign the foot.
PERONEAL TENDON INJURY
Peroneal tendon injuries take place when the tendons running on the outside of the ankle are damaged. This can happen with ankle sprains or repetitive strain through normal activity. Symptoms include pain, swelling, weakness, and even instability.
Many peroneal tendon problems can be treated nonoperatively with physical therapy, anti-inflammatory medication, and bracing. In severe cases, the tendon can be repaired through surgery.
TARSAL TUNNEL SYNDROME
Tarsal tunnel syndrome causes chronic pain in the ankle, foot and toes due to abnormal pressure on the tibial nerve. Like carpal tunnel syndrome in the wrist, this can cause burning or tingling pain and even numbness. This can sometimes be treated with rest, over-the-counter pain medication, or orthotics. Some cases require surgery to relieve the pressure on the nerve.
Arthritis involves damage to the joints in our feet and ankles. Cartilage lines the bones in our joints and can be damaged by aging (“wear and tear”), injury (trauma), and conditions such as rheumatoid arthritis or gout. As the cartilage wears, the bones can rub on each other and cause symptoms.
Symptoms include pain, stiffness, swelling, instability, bone spurs, joint deformity and difficulty walking. If the nerves surrounding the joint become irritated, patients may experience numbness and tingling.
Many cases of arthritis can be treated with supportive shoes, orthotics, braces, modifying activities (such as limiting impact activities), anti-inflammatory medications, and cortisone injections. Surgery might be necessary for patients who do not respond to conservative treatment methods.
Surgery includes joint fusion, and for some patients, ankle joint replacement.
For more information on ankle fusion and ankle replacement surgery, please visit: https://www.myankle.com/treatment-of-arthritis/
BUNION (HALLUX VALGUS)
A bunion (hallux valgus) is a common condition that involves a bony bump at the base of the big toe. The big toe might also turn inward toward the second toe, which can lead to corns and calluses and other toe deformities like hammer toes.
Bunions can form when there is an improper balance of forces exerted on the joints of the foot, causing instability in the joint of the big toe. This can occur as a result of shoes that do not fit properly or because of genetics. Bunions can also be caused by injury, arthritis, or certain neuromuscular disorders.
Although bunions are not usually a serious condition, they can be painful and embarrassing and can limit shoe wear. Treatment depends on the severity of the condition. Mild bunions may be relieved of pain simply by changing shoes to ones with a wider toe box or using splints or straps. Surgical treatment, usually reserved for more severe cases, can improve pain, inflammation, deformities and stiffness. Some bunions can be treated with minimally invasive surgery.
Foot and Ankle Anatomy
For more information about foot and ankle anatomy, click on the link below.
Ankle arthroscopy is a surgical procedure during which the internal structure of the ankle is examined for diagnosis and treatment of problems inside the joint.
For more information about ankle arthroscopy, click on the links below.
Ankle injuries are the most common sports-related injury. An ankle fracture is a break in one or more bones that make up the ankle joint. Sometimes ligaments may also be damaged.
For more information about ankle fractures, click on the links below.
A bunion is a foot deformity that changes the shape of the foot, causing the big toe to turn inward, leading to pain and inflammation. A bunion can be caused by poorly fitting shoes, joint damage, arthritis, or inherited traits.
For more information about bunion surgery, click on the links below.
Achilles Tendon Rupture
The Achilles tendon is a strong fibrous cord behind the ankle that connects the calf muscles to the heel bone. It is used when you walk, run, and jump. If the Achilles tendon is overstretched, for example while you are playing recreational sports, it can tear (rupture) partially or completely.
For more information about Achilles tendon rupture, click on the link below.
A sprain is characterized either by stretching or tearing of ligaments, which connect adjacent bones in a joint and provide stability to the joint. An ankle sprain is a common injury that may occur when you suddenly twist the ankle joint, or when you land your foot in an awkward position after a jump.
For more information about ankle sprains, click on the links below.
Common Toe Deformities
A variety of toe deformities can occur in children’s feet. These deformities can affect a child’s walking, balance, weight-bearing, and other activities.
For more information about common toe deformities, click on the links below.
Plantar fasciitis is a common problem that causes pain under the heel bone, often after a long walk or prolonged standing. It is most often seen in middle-aged men and women. The plantar fascia is a thick band of tissue that lies at the bottom of the foot, running from the heel bone to the toe. It functions as a shock absorber, and also supports the arch of the foot.
For more information about plantar fasciitis, click on the links below.
Click on the topics below to find out more from the Orthopaedic connection website of American Academy of Orthopaedic Surgeons.
- Achilles Tendon Rupture (Tear) (video)
- Ankle Fractures (Broken Ankle)
- Ankle Fractures in Children
- Calcaneus (Heel Bone) Fractures
- Lisfranc (Midfoot) Injury
- Pilon Fractures of the Ankle
- Sprained Ankle
- Stress Fractures of the Foot and Ankle
- Talus Fractures
- Toe and Forefoot Fractures
- Turf Toe
- Achilles Tendinitis
- Adult Acquired Flatfoot
- Arthritis of the Foot and Ankle
- Charcot-Marie-Tooth Disease
- Claw Toe
- Diabetic (Charcot) Foot
- Flexible Flatfoot in Children
- Hammer Toe
- Heel Pain
- Ingrown Toenail
- Morton’s Neuroma
- Plantar Fasciitis and Bone Spurs
- Posterior Tibial Tendon Dysfunction
- Rheumatoid Arthritis of the Foot and Ankle
- Stiff Big Toe (Hallux Rigidus)
- Tarsal Coalition
- Vertical Talus
- Bunion Surgery
- Care of the Diabetic Foot
- Foot and Ankle Conditioning Program
- Athletic Shoes
- Shoes: Finding the Right Fit
- Tight Shoes and Foot Problems
- Patient Story: Ankle Fracture
- Patient Story: Ankle Fracture and Chronic Ankle Laxity
- Patient Story: Ankle, Elbow, and Vertebral Fractures
- Patient Story: Multiple Fractures in the Spine, Knees, and Ankles
- Additional Resources on the Foot & Ankle
- Getting the Most Out of Your Doctor’s Visit
- Orthopaedic Evidence-Based Medicine
- Questions to Ask Your Doctor Before Surgery
- The Physician-Patient Relationship: The Importance of Good Communication