Ludie Mischo

Hammer Toe Pain

6/21/2015

Overview

What Is A hammertoe? A hammer toe, or claw toe, describes a condition where the toe(s) become buckled, contracted or crooked. The toe could even cross over an adjacent toe, which is called a cross over toe. Any of the toes may be affected, but the 2nd and 5th toe are most commonly involved.

Causes

A hammertoe is formed due an abnormal balance of the muscles in the toes. This abnormal balance causes increased pressures on the tendons and joints of the toe, leading to its contracture. Heredity and trauma can also lead to the formation of a hammertoe. Arthritis is another factor, because the balance around the toe in people with arthritis is so disrupted that a hammertoe may develop. Wearing shoes that are too tight and cause the toes to squeeze can also be a cause for a hammertoe to form.

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

Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough hammertoe history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.

Non Surgical Treatment

You can usually use over-the-counter cushions, pads, or medications to treat bunions and corns. However, if they are painful or if they have caused your toes to become deformed, your doctor may opt to surgically remove them. If you have blisters on your toes, do not pop them. Popping blisters can cause pain and infection. Use over-the-counter creams and cushions to relieve pain and keep blisters from rubbing against the inside of your shoes. Gently stretching your toes can also help relieve pain and reposition the affected toe.

Surgical Treatment

If this fails or if treatment is not sought until the toes are permanently misaligned, then surgery may be required. Surgery may involve either cutting the tendon or fusing the joint. Congenital conditions should be treated in early childhood with manipulations and splinting.

Bunions And Corns

6/15/2015

Overview
Bunion Pain

A bunion (a.k.a Hallux Valgus) is a common foot condition associated with a prominent bump on the inside of the forefoot (see Figure 1). The word bunion? comes from the Greek root for the word turnip. Bunions can lead to discomfort over the prominence, especially if patients wear tight fitting shoes. It is common for bunions to run in family? and gradually increase over time. The vast majority of bunions can be managed successfully with basic non-operative treatment. Surgery is reserved for patients who have persistent symptoms in spite of appropriate non-operative treatment.

Causes
Although bunions tend to run in families, it is the foot type that is passed down-not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.

Symptoms
Alteration in alignment of the first toe. Pain in the 1st toe joint with movement. Restriction in range of demi pointe. Inflammation of the 1st toe joint. Rotation of the big toe so that the nail no longer faces upwards. Occasionally bruising of the toe nail occurs.

Diagnosis
Clinical findings are usually specific. Acute circumferential intense pain, warmth, swelling, and redness suggest gouty arthritis (see Gout) or infectious arthritis (see Acute Infectious Arthritis), sometimes mandating examination of synovial fluid. If multiple joints are affected, gout or another systemic rheumatic disease should be considered. If clinical diagnosis of osteoarthritic synovitis is equivocal, x-rays are taken. Suggestive findings include joint space narrowing and bony spurs extending from the metatarsal head or sometimes from the base of the proximal phalanx. Periarticular erosions (Martel sign) seen on imaging studies suggest gout.

Non Surgical Treatment
You can try over-the-counter remedies like pads to stop them rubbing, or take painkillers such as paracetamol or ibuprofen if they play up. Devices that fit into your shoe, called orthotics, or splints that you wear at night, can slow the progression of bunions. If these don't help and the bunion is causing a painful and substantial deformity that?s seriously limiting your footwear, your GP will probably refer you to see a podiatrist, medical professionals who specialise in feet. They can give further advice about non-invasive treatments and also refer you for an operation, either with a podiatric or orthopaedic (bone) surgeon, ultimately the only thing that can correct the gnarly blighters. You can visit a podiatrist privately, which will cost anything from ?140-?200. But Mike O?Neill, spokesperson for the Society of Podiatrists and Chiropodists, suggest always going via your GP, who will know the best qualified. Such is the complexity of the bone structure of the foot, there are more than 130 different surgical procedures for bunions. One person?s op may be very different from another?s, so be wary of sounding out a friend about theirs. Bunion Pain

Surgical Treatment
The choice of surgical procedures (bunionectomy) is based on a biomechanical and radiographic examination of the foot. Because there is actual bone displacement and joint adaptation, most successful bunionectomies require cutting and realigning the 1st metatarsal (an osteotomy). Simply "shaving the bump" is often inadequate in providing long-term relief of symptoms and in some cases can actually cause the bunion to progress faster. The most common procedure performed for the correction of bunions is the 1st metatarsal neck osteotomy, near the level of the joint. This refers to the anatomical site on the 1st metatarsal where the actual bone cut is made. Other procedures are preformed in the shaft of the metatarsal bone (see procedures preformed in the shaft of the metatarsal) and still other procedures are selected by the surgeon that are preformed in the base of the metatarsal bone (see surgeries preformed in the base of the metatarsal).

Prevention
To minimize the chance of developing bunions, never force your feet into shoes that don?t fit. Choose a shoe that conforms to the shape of your foot. Opt for shoes with wider insteps, broad toes, and soft soles. Shoes that are short, tight, or sharply pointed should be avoided.

The Causes And Treatments Of Overpronation Of The Foot

5/31/2015

Overview

Pronation describes the natural process of the inward rolling of your foot when the outer edge of your heel strikes the ground and your foot flattens out. Excess pronation, known as flat foot, can result in flattened arches and overstretched foot muscles. Advanced conditions may affect your hips, knees, ankle, back and foot functioning. Use natural techniques to stretch and strengthen your muscles in order to help pronation.

Causes

There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. Often people with flat feet do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.

Symptoms

It is important to note that pronation is not wrong or bad for you. In fact, our feet need to pronate and supinate to achieve proper gait. Pronation (rolling inwards) absorbs shock and supination (rolling outwards) propels our feet forward. It is our body?s natural shock-absorbing mechanism. The problem is over-pronation i.e. the pronation movement goes too deep and lasts for too long, which hinders the foot from recovering and supinating. With every step, excess pronation impedes your natural walking pattern, causing an imbalance in the body and consequent excessive wear and tear in joints, muscles and ligaments. Some common complaints associated with over-pronation include Heel Pain (Plantar Fasciitis) ,Ball of foot pain, Achilles Tendonitis, Shin splints, Knee Pain, Lower Back Pain.

Diagnosis

If you cannot afford to get a proper gait analysis completed, having someone observe you on a treadmill from behind will give you an idea if you are an overpronator. It is possible to tell without observing directly whether you are likely to be an overpronator by looking at your foot arches. Check your foot arch height by standing in water and then on a wet floor or piece of paper which will show your footprint. If your footprints show little to no narrowing in the middle, then you have flat feet or fallen arches. This makes it highly likely that you will overpronate to some degree when running. If you have low or fallen arches, you should get your gait checked to see how much you overpronate, and whether you need to take steps to reduce the level to which you overpronate. Another good test is to have a look at the wear pattern on an old pair of trainers. Overpronators will wear out the outside of the heel and the inside of the toe more quickly than other parts of the shoe. If the wear is quite even, you are likely to have a neutral running gait. Wear primarily down the outside edge means that you are a supinator. When you replace your running shoes you may benefit from shoes for overpronation. Motion control or stability running shoes are usually the best bet to deal with overpronation. Foot Pronation

Non Surgical Treatment

Heel counters that make the heel of the shoe stronger to help resist/reduce excessive rearfoot motions. The heel counter is the hard piece in the back of the shoe that controls the foot?s motion from side-to-side. You can quickly test the effectiveness of a shoe?s heel counter by placing the shoe in the palm of your hand and putting your thumb in the mid-portion of the heel, trying to bend the back of the shoe. A heel counter that does not bend very much will provide superior motion control. Appropriate midsole density, the firmer the density, the more it will resist motion (important for a foot that overpronates or is pes planus), and the softer the density, the more it will shock absorb (important for a cavus foot with poor shock absorption) Wide base of support through the midfoot, to provide more support under a foot that is overpronated or the middle of the foot is collapsed inward.

Prevention

With every step we take, we place at least half of our body weight on each foot (as we walk faster, or run, we can exert more than twice our body weight on each foot). As this amount of weight is applied to each foot there is a significant shock passed on to our body. Custom-made orthotics will absorb some of this shock, helping to protect our feet, ankles, knees, hips, and lower back.

Physical Therapy For Severs Disease

5/15/2015

Overview

Sever?s disease, also referred to as calcaneal apophysitis, is an injury in the growth plate of the lower part of the heel bone where the Achilles tendon attaches to the bone. Sever?s disease is a common condition affecting children between the ages of 8 and 15 that participate in sports or are particularly active. This condition is believed to be caused by repeated trauma to the heel, weakening its internal structure. Typically occurring in adolescence, Sever?s disease causes painful inflammation of the growth plate. This condition can affect any child, however there is a higher probability of its occurrence if the child experiences pronation, has flat or high arches, short leg syndrome and/or is overweight.

Causes

Sever?s disease is an osteochondrosis caused by overloading the insertion of the Achilles tendon onto the calcaneus and the apophyseal growth plate in this area. This C-shaped growth zone can become inflamed secondary to repetitive traction stress of the Achilles tendon. Calcaneal apophysitis is a common injury in young athletes and is believed to be caused by running and jumping. Active Children and adolescents (usual age of occurrence 7 to 15 years), particularly during the pubertal growth spurt or at the beginning of a sport season (e.g. gymnasts, basketball and football players), often suffer from this condition. This disease occurs most commonly during the early part of the growth spurt. A boy-to-girl ratio is 2-3:1. None of these causative factors has been tested prospectively and, where tested, none of the measurements has been carried out systematically, and reliability or validity of the measurements has not been considered.

Symptoms

In Sever?s disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she stands on tiptoe. Your child?s heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your provider may also find that your child?s heel tendons have become tight.

Diagnosis

Sever condition is diagnosed by detecting the characteristic symptoms and signs above in the older children, particularly boys between 8 and 15 years of age. Sometimes X-ray testing can be helpful as it can occasionally demonstrate irregularity of the calcaneus bone at the point where the Achilles tendon attaches.

Non Surgical Treatment

The practitioner should inform the patient and the patient?s parents that this is not a dangerous disorder and that it will resolve spontaneously as the patient matures (16-18 years old). Treatment depends on the severity of the child?s symptoms. The condition is self-limiting, thus the patient?s activity level should be limited only by pain. Treatment is quite varied. Relative Rest/ Modified rest or cessation of sports. Cryotherapy. Stretching Triceps Surae and strengthen extensors. Nighttime dorsiflexion splints (often used for plantar fasciitis, relieve the symptoms and help to maintain flexibility). Plantar fascial stretching. Gentle mobilizations to the subtalar joint and forefoot area. Heel lifts, Orthoses (all types, heel cups, heel foam), padding for shock absorption or strapping of heel to decrease impact shock. Electrical stimulation in the form of Russian stimulation sine wave modulated at 2500 Hz with a 12 second on time and an 8 second off time with a 3 second ramp. Advise to wear supportive shoes. Ultrasound, nonsteroidal anti-inflammatory drugs. Casting (2-4 weeks) or Crutches (sever cases). Corticosteroid injections are not recommended. Ketoprofen Gel as an addition to treatment. Symptoms usually resolve in a few weeks to 2 months after therapy is initiated. In order to prevent calcaneal apophysitis when returning to sports (after successful treatment and full recovery), icing and stretching after activity are most indicated. Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition. The level of evidence for most of what we purport to know about Sever?s disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment.

Recovery

In some cases, children will simply outgrow Sever's Disease when they reach a certain age, but this does not mean that symptoms should be ignored. If children express that they are in pain, this should always be taken seriously by their parents or guardians. Heel pain may be a sign of Sever's Disease and this condition should not be left untreated, due to the damage it can cause to the growing heel bones. Scheduling a doctor's appointment is always the first step to take in gaining a diagnosis of symptoms and speedy help for the child.

How To Deal With An Achilles Tendon Rupture

4/13/2015

Overview Achilles Tendinitis

The Achilles tendon is a conjoined tendon composed of the gastrocnemius and soleus muscles with occasional contribution from the plantaris muscle, and it inserts on the calcaneal tuberosity. The plantaris muscle is absent in 6% to 8% of individuals. The Achilles tendon is approximately 15-cm long and is the largest and strongest tendon in the human body. The tendon spirals approximately 90? from its origin to its insertion and this twisting produces an area of stress approximately 2- to 5-cm proximal to its insertion. The tendon has no true synovial sheath; instead it is wrapped in a paratenon. The Achilles tendon experiences the highest loads of any tendon in the body, and bears tensile loads up to 10 times body weight during athletic activities. The tendon most commonly ruptures in a region 2- to 6-cm proximal to its insertion. Causes The Achilles tendon is a strong bands of fibrous connective tissue that attaches the calf muscle to the heel bone. When the muscle contracts, the tendon transmits the power of this contraction to the heel bone, producing movement. The Achilles tendon ruptures because the load applied to it is greater than the tendon's ability to withstand that load. This usually occurs as a result of a sudden, quick movement where there is a forceful stretch of the tendon or a contraction of the muscles eg: jumping, sprinting, or pushing off to serve in tennis. This occurs most often in sports that require a lot of stopping and starting (acceleration-deceleration sports) such as tennis, basketball, netball and squash. The Achilles tendon is on average 15cm in length. Most ruptures occur 2-6cm above where the tendon inserts into the heel bone. This is the narrowest portion of the Achilles tendon and is also the area with the poorest blood supply. achilles tendon rupture is most common when the muscles and tendon have not been adequately stretched and warmed up prior to exercise, or when the muscles are fatigued. the Achilles tendon has a poor blood supply, which makes it susceptible to injury and slow to heal after injury. During exercise the amount of blood able to travel to the tendon is decreased, further increasing the risk of rupture. Most experts agree that there are no warning signs of an impending rupture. However, frequent episodes of Achilles tendonitis (tendon inflammation) can weaken the tendon and make it more susceptible to rupture. Symptoms Symptoms usually come on gradually. Depending on the severity of the injury, they can include Achilles pain, which increases with specific activity, with local tenderness to touch. A sensation that the tendon is grating or cracking when moved. Swelling, heat or redness around the area. The affected tendon area may appear thicker in comparison to the unaffected side. There may be weakness when trying to push up on to the toes. The tendon can feel very stiff first thing in the morning (care should be taken when getting out of bed and when making the first few steps around the house). A distinct gap in the line of the tendon (partial tear). Diagnosis A consultation and physical exam with a qualified musculoskeletal expert is the first step. X-ray or MRI scanning may be required for a diagnosis. Once a rupture is diagnosed it should be treated to prevent loss of strength and inadequate healing. Non Surgical Treatment Achilles tendon ruptures can be treated non-operatively or operatively. Both of these treatment approaches have advantages and disadvantages. In general, younger patients with no medical problems may tend to do better with operative treatment, whereas patients with significant medical problems or older age may be best 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 (i.e. one where the tendon ends are not kept opposed) will lead to marked problems of the leg in walking, which may eventually lead to other limb and joint problems. Furthermore, late reconstruction of non-treated Achilles tendon rupture is significantly more complex than timely treatment. Achilles Tendonitis

Surgical Treatment Thanks to a new surgical technique, operative procedures are often more beneficial.The operative treatment of Achilles tendon ruptures has significantly changed in recent years. The objective today is to connect the torn tendons using modern suture and possibly adhesive materials. Through small surgical incisions the ends of the torn tendon are surgically exposed, and sutures are used to tie the ends permanently together. Thus, the operated repaired tendon is again resilient within a reasonable time. The cast treatment and walking on crutches required in the past, is with this procedure usually not necessary. Instead, functional treatment following the surgery involves wearing a special boot, meaning that the patient can put weight onto the operated leg again within a few days after surgery. Physical therapy training will start immediately following the operation. The philosophy behind such an early functional treatment is that tissue adequately adapts to stress and thus accelerates the healing process. For the patient, the modern surgical treatment of an Achilles tendon rupture has the distinct advantage that no prolonged hospital stay is necessary. Hospital stay usually lasts only a few days. Using crutches, patients can return to work soon after the surgery. Prevention Achilles tendon rupture can be prevented by avoiding chronic injury to the Achilles tendon (i.e. tendonitis), as well as being careful to warm up and stretch properly before physical activity. Additionally, be sure to use properly fitting equipment (e.g. running shoes) and correct training techniques to avoid this problem!

Does Pain In The Arch Need Surgery Treatment ?

4/13/2015

Overview

The arch of the foot is formed by the tarsal and metatarsal bones and is strengthened by ligaments and tendons that enable the foot to correctly support the weight of the body. The underside of the foot is made up of four layers of muscle tissue as well as a length of thick connective tissue called the plantar fascia, which supports the arch. If the surrounding muscles weaken, the plantar fascia will drop and the arch will collapse. If the arch collapses, the whole foot touches the ground, which is known as pes planus or flat feet. Flat feet affect about 15 per cent of Britons. Although usually genetic, the condition may be exacerbated or triggered by poorly fitted shoes or conditions such as arthritis and pregnancy, when sudden changes in shape and weight can alter the body's centre of gravity leading to a weakening of the arches.

Foot Arch Pain

Causes

Over-stretching or tearing the arch pad causes the dull ache that is associated with arch pain. Pain is most keenly felt when weight is put onto the foot, or when pushing off the foot into the next stride. The pain of foot arch strain can be particularly acute after sitting for a long time, or when getting up in the morning. Those most susceptible to the condition are people with very high, rigid arches. The injury is also common in middle-aged people who have been inactive for a long period of time before suddenly increasing their physical activity. The injury is particularly common in runners and joggers.

Symptoms

Pain in arch of foot is really the only symptom of this condition. It is unlikely to see any swelling or bruising and instead there will be a deep tender spot near the heel. Occasionally the pain may radiate further down the foot. With this condition, pain will usually be felt first thing in the morning or after periods of sitting. This is because the plantar fascia tightens and shortens slightly when there is no weight on it and by standing on it it suddenly stretches and becomes painful. After a few steps it starts to loosen off and the pain may subside. If this is the same pattern of pain you experience it is quite likely you have plantar fasciits. Pain may also be felt when walking up stairs or standing on tip-toes (anything that stretches the fascia).

Diagnosis

In a person of any age, the doctor will ask about occupational and recreational activities, previous foot trauma or foot surgery and the type of shoes worn. The doctor will examine your shoes to check for signs of excessive wear. Worn shoes often provide valuable clues to gait problems and poor bone alignment. The doctor will ask you to walk barefoot to evaluate the arches of the feet, to check for out-toeing and to look for other signs of poor foot mechanics.

Non Surgical Treatment

Depending on your overall health, symptoms and severity of the the flat foot, the condition may be treated conservatively and/or with surgery. Non-surgical treatments for flat feet are centered at decreasing and/or resolving the symptoms (pain). Simple Treatments Patients Can do themselves include wear proper supportive shoes. Use an arch support. Wear shoes with a wide toe box. Modify your activities. Lose weight. Wear shoes with cushion. Non-surgical treatments a doctor might do include Prescribe an oral anti-inflammatory medication. Anti-inflammatory medication is useful to significantly reduce pain and inflammation. Prescribe physical therapy. A physical therapist may perform ultrasound and other techniques to reduce inflammation. You will also be instructed how to stretch your foot and leg properly. Keeping the joint mobile may preserve function. Strengthening weak foot and leg musculature can help prevent further collapse. Prescribe protective pads. Padding and/or cushioning of when areas of bone become prominent on the bottom of the foot, as an effective method of preventing mechanical irritation with shoes. Pads with cutouts may off-weight specific areas of concern. Prescribe custom foot orthotics. A custom foot orthotic is a doctor prescribed arch support that is made directly from a casting (mold) of your feet, and theoretically should provide superior support compared to shoe insert that you would purchase from a pharmacy. In the case of flat feet, specific modifications can be made to the orthotic device to strategically balance the foot. Prescribe custom ankle-foot orthoses. A custom ankle-foot orthotic (AFO) is a doctor prescribed molded arch and lower leg support that stabilizes both the foot and ankle. This is used when the flat foot is significant and provides more support than the simple foot only insert. Give cortisone injection. A articular cortisone injection is a powerful anti-inflammatory medication that is used to rapidly reduce the pain associated with inflammation. Cortisone shots can be extremely effective in alleviating symptoms of flat feet, but will not correct the structure.

Arch Pain

Surgical Treatment

The procedure involves cutting and shifting the bone, and then performing a tendon transfer. First, the surgeon performs a calcaneal osteotomy, cutting the heel bone and shifting it into the correct position. Second, the surgeon transfers the tendon. Reroute the flexor digitorum to replace the troublesome posterior tibial tendon. Finally, the surgeon typically performs one or more fine-tuning procedures that address the patient?s specific foot deformity. Often, the surgeon will lengthen the Achilles tendon because it is common for the mispositioned foot to cause the Achilles to tighten. Occasionally, to increase the arch, the surgeon performs another osteotomy of one of the bones of the midfoot. Occasionally, to point the foot in a straightforward direction, the surgeon performs another osteotomy of the outside portion of the calcaneus.

Prevention

Warm up properly. This means not only stretching prior to a given athletic event, but a gradual rather than sudden increase in volume and intensity over the course of the training season. A frequent cause of plantar fasciitis is a sudden increase of activity without suitable preparation. Avoid activities that cause pain. Running on steep terrain, excessively hard or soft ground, etc can cause unnatural biomechanical strain to the foot, resulting in pain. This is generally a sign of stress leading to injury and should be curtailed or discontinued. Shoes, arch support. Athletic demands placed on the feet, particularly during running events, are extreme. Injury results when supportive structures in the foot have been taxed beyond their recovery capacity. Full support of the feet in well-fitting footwear reduces the likelihood of injury. Rest and rehabilitation. Probably the most important curative therapy for cases of plantar fasciitis is thorough rest. The injured athlete must be prepared to wait out the necessary healing phase, avoiding temptation to return prematurely to athletic activity.

Rupture Of The Achilles Tendon

4/2/2015

Overview

An Achilles tendon rupture is when part or all of your tendon is torn. The Achilles tendon connects the calf muscle in your lower leg to your heel bone. It allows you to point your foot down and to rise on your toes. A tear is caused by an injury or increased pressure, such as during sports or a fall. The following may make your Achilles tendon weak or stiff, and more likely to tear. A past tendon tear. Lack of physical activity. Abnormal bone structure in your foot. Obesity. Older age. Medicines, such as steroids and antibiotics.

Causes
An Achilles tendon rupture is often caused by overstretching the tendon. This typically occurs during intense physical activity, such as running or playing basketball. Pushing off from the foot while the knee is straight, pivoting, jumping, and running are all movements that can overstretch the Achilles tendon and cause it to rupture. A rupture can also occur as the result of trauma that causes an over-stretching of the tendon, such as suddenly tripping or falling from a significant height. The Achilles tendon is particularly susceptible to injury if it is already weak. Therefore, individuals who have a history of tendinitis or tendinosis are more prone to a tendon rupture. Similarly, individuals who have arthritis and overcompensate for their joint pain by putting more stress on the Achilles tendon may also be more susceptible to an Achilles tendon rupture.

Symptoms
It happens suddenly, often without warning. There is often a popping sound when the tendon ruptures. The patient usually feel as if someone has kicked their heel from the rear, only to turn around to find nobody there. There is acute pain and swelling in the back of the heel due to bleeding from the tendon rupture. The patient will have difficulty walking as they cannot toe off without pain. This causes them to walk with a limp.

Diagnosis
A physician usually can make this diagnosis with a good physical examination and history. X-rays usually are not taken. A simple test of squeezing the calf muscles while lying on your stomach should indicate if the tendon is still connected (the foot should point). This test isolates the connection between the calf muscle and tendon and eliminates other tendons that may still allow weak movement. A word of caution, Achilles tendon rupture is often misdiagnosed as a strain or minor tendon injury. Swelling and the continuing ability to weakly point your toes can confuse the diagnosis. Ultrasound and MRI are tests that can assist in difficult diagnosis. Depending on the degree of injury, these tests can also assist in determining which treatment may be best.

Non Surgical Treatment
A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain. Use support devices as directed. You may need crutches or a cane for support when you walk. These devices help decrease stress and pressure on your tendon. Your caregiver will tell you how much weight you can put on your leg. Ask for more information about how to use crutches or a cane correctly. Start activity as directed. Your caregiver will tell you when it is okay to walk and play sports. You may not be able to play sports for 6 months or longer. Ask when you can go back to work or school. Do not drive until your caregiver says it is okay. Achilles Tendinitis

Surgical Treatment
Your doctor may recommend surgery if youre young and active, or an athlete. However, this will depend on where your tendon is ruptured. If the rupture is at, or above, the point at which your tendon merges with your calf muscle, for example, surgery may not be possible. There are three main types of surgery to repair a ruptured Achilles tendon. Open surgery. Your surgeon will make one long cut in your leg to reach the tendon and repair it. Limited open surgery. Your surgeon will still make a single cut but it will be shorter. Percutaneous surgery. Your surgeon will make a number of small cuts to reach the tendon and repair it. In all types of surgery, your surgeon will stitch the tendon together so it can heal. Each type of surgery has different risks. Open surgery is less likely to injure one of the nerves in your leg for example, but has a higher risk of infection. Ask your surgeon to explain the risks in more detail. After your operation, you will need to wear a series of casts or an adjustable brace on your leg to help your Achilles tendon heal. This will usually be for between four and eight weeks. There is a chance that your tendon will rupture again after the operation.