What Will Be The Signals Of Achilles Tendon Rupture

What Will Be The Signals Of Achilles Tendon Rupture

Overview
Achilles Tendonitis
The largest tendon in the body, the Achilles tendon is a cord connecting the calf muscles to the heel bone. Also called the ?cord of Achilles,? the tendon gets its name from the hero of Greek myth. According to legend, Achilles was invulnerable everywhere but his heel, where a poisoned arrow eventually felled him. Because the blood supply to the Achilles tendon lessens with age, the tendon becomes vulnerable to inflammation and rupture, a fact which makes it a true ?Achilles heel? for many older patients. Achilles tendon injuries are also common among athletes and those who engage in more physically demanding activity.

Causes
The Achilles tendon is most commonly injured by sudden plantarflexion or dorsiflexion of the ankle, or by forced dorsiflexion of the ankle outside its normal range of motion. Other mechanisms by which the Achilles can be torn involve sudden direct trauma to the tendon, or sudden activation of the Achilles after atrophy from prolonged periods of inactivity. Some other common tears can occur from overuse while participating in intense sports. Twisting or jerking motions can also contribute to injury. Fluoroquinolone antibiotics, famously ciprofloxacin, are known to increase the risk of tendon rupture, particularly achilles.

Symptoms
Patients who suffer an acute rupture of the Achilles tendon often report hearing a “pop” or “snap.” Patients usually have severe pain the back of the lower leg near the heel. This may or may not be accompanied by swelling. Additionally, because the function of the Achilles tendon is to enable plantarflexion (bending the foot downward), patients often have difficulty walking or standing up on their toes.

Diagnosis
The diagnosis is usually made on the basis of symptoms, the history of the injury and a doctor’s examination. The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompson’s test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture. If the diagnosis is uncertain, an ultrasound or MRI scan may help. An Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.

Non Surgical Treatment
The treatments of Achilles tendonitis include resting the painful Achilles tendon will allow the inflammation to subside and allow for healing. A period of rest after the onset of symptoms is important in controlling Achilles tendonitis. In patients who have more significant symptoms, a period of immobilization can help. Either a removable walking boot or a cast can allow the inflamed tendon to cool down quickly. A heel wedge can be inserted into the shoe to minimize the stress on the Achilles tendon. These can be placed in both athletic and work shoes. Applying ice to the area of inflammation can help stimulate blood flow to the area and relieve the pain associated with inflammation. Apply ice several times a day, including after exercise. The pain and swelling most commonly associated with Achilles tendonitis can be improved with non-steroidal, anti-inflammatory medications (NSAIDs) which include Celebrex?, Advil?, Motrin?, Naprosyn?. Be sure to consult your physician before starting any medications. Physical therapists can help formulate a stretching and rehabilitation program to improve flexibility of the Achilles tendon. Cortisone injections should not be used for Achilles tendonitis. Studies have shown an increased incidence of Achilles tendon rupture after cortisone injections.
Achilles Tendinitis

Surgical Treatment
Unlike other diseases of the Achilles tendon such as tendonitis or bursitis, Achilles tendon rupture is usually treated with surgical repair. The surgery consists of making a small incision in the back part of the leg, and using sutures to re-attach the two ends of the ruptured tendon. Depending on the condition of the ends of the ruptured tendon and the amount of separation, the surgeon may use other tendons to reinforce the repair. After the surgery, the leg will be immobilized for 6-8 weeks in a walking boot, cast, brace, or splint. Following this time period, patients work with a physical therapist to gradually regain their range of motion and strength. Return to full activity can take quite a long time, usually between 6 months and 1 year.

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.

What Are Fallen Arches

What Are Fallen Arches

Overview

Flat Foot

If you look at an adult foot from the inside, you’ll usually notice an upward curve in the middle. This is called an arch. Tendons, tight bands that attach at the heel and foot bones form the arch. Several tendons in your foot and lower leg work together to form the arches in your foot. When the tendons all pull the proper amount, then your foot forms a moderate, normal arch. When tendons do not pull together properly, there is little or no arch. This is called flat foot or fallen arch.


Causes

Having low or no arches is normal for some people. In these cases, flat feet are usually inherited and the feet are fairly flexible. Occasionally, flat feet can be caused by an abnormality that develops in the womb, such as a problem with a joint or where two or more bones are fused together. This is known as tarsal coalition and results in the feet being flat and stiff. Flat feet that develop in later life can be caused by a condition that affects the joints, such as arthritis, or an injury to a muscle, tendon or joint in the foot. Conditions that affect the nervous system (brain and spinal cord) can also cause the arches to fall. Over time, the muscles gradually become stiffer and weaker and lose their flexibility. Conditions where this can occur include cerebral palsy, spina bifida and muscular dystrophy. Adult-acquired flat feet often affect women over 40 years of age. It often goes undiagnosed and develops when the tendon that supports the foot arch gradually stretches over time. It’s not fully understood what causes the tendon to become stretched, but some experts believe that wearing high heels and standing or walking for long periods may play a part. Obesity, high blood pressure (hypertension) and diabetes are all risk factors. Recent research has found a link with changes to the tendon in the foot and an increase in a type of protein called proteolytic enzyme. These enzymes can break down some areas of the tendon, weakening it and causing the foot arch to fall. Similar changes are also seen in other conditions, such as Achilles tendonitis. This could have important implications for treating flat feet because medication that specifically targets these enzymes could provide an alternative to surgery. However, further research is needed and this type of treatment is thought to be about 10 to 15 years away.


Symptoms

Not everyone who has flat feet experiences symptoms. Others, however, feel persistent pain in their feet and wearing shoes can prove additionally painful. Others only feel symptoms when they walk more than normal, go jogging or participate in a sport that involves running or kicking.


Diagnosis

Podiatrists are trained in expertly assessing flat feet and identifying different risk factors and the causes for it. Initial assessment will begin with a detailed history attempting to find out if any underlying illness has resulted in this. A detailed clinical examination normally follows. The patient may be asked to perform certain movements such as walking or standing on their toes to assess the function of the foot. Footwear will also be analysed to see if there has been excessive wear or if they are contributing to the pronation of the foot. To assess the structure of the foot further, the podiatrist may perform certain x-rays to get a detailed idea of the way the bones are arranged and how the muscle tissues may be affecting them. It also helps assess any potential birth defects in a bit more detail.


Non Surgical Treatment

Have you found yourself in the store looking at all the different foot care products? There is everything from massaging gel insoles to foam arch supports and heel cushions. If your arches fall the same amount on each side, you might be able to use an insert off the shelf. If they fall differently, then a generic insert will not fix the imbalance. If you have a high arch, a generic insert will likely not be high enough for full correction. Good custom orthotics provide a number of advantages over the generic inserts that you find in the store. Custom orthotics can take into account your body weight and degree of flexibility in your foot, not someone else?s. They also account for the anatomical differences in your feet. The corrected height of one arch is often higher in one foot than the other. A G-Laser foot analysis can provide you with this information.


Surgical Treatment

Acquired Flat Feet

Surgery for flat feet is separated into three kinds: soft tissue procedures, bone cuts, and bone fusions. Depending on the severity of the flat foot, a person?s age, and whether or not the foot is stiff determines just how the foot can be fixed. In most cases a combination of procedures are performed. With flexible flat feet, surgery is geared at maintaining the motion of the foot and recreating the arch. Commonly this may involve tendon repairs along the inside of the foot to reinforce the main tendon that lifts the arch. When the bone collapse is significant, bone procedures are included to physically rebuild the arch, and realign the heel. The presence of bunions with flat feet is often contributing to the collapse and in most situations requires correction. With rigid flat feet, surgery is focused on restoring the shape of the foot through procedures that eliminate motion. In this case, motion does not exist pre-operatively, so realigning the foot is of utmost importance. The exception, are rigid flat feet due to tarsal coalition (fused segment of bone) in the back of the foot where freeing the blockage can restore function.

Fallen Arches Explained

Fallen Arches Explained

Overview

Acquired Flat Feet

Fallen arches, or flatfoot, is a condition in which the arch on the inside of the foot is flat and the entire sole of the foot rests on the ground. It affects about 40% of the general population. Although flat feet in themselves are not usually problematic, they can create problems in the feet, hips, ankles and knees. Pain may be experienced in the lower back if there are alignment problems and if the individual is engaged in a lot of heavy, high impact activities that put stress on the bones and muscles in the lower legs. The arches of most individuals are fully developed by the age of 12 to 13. While some people are born with flat arches, for others the arches fall over time. The tibial tendon, which runs along the inside of the ankle from above the ankle to the arch, can weaken with age and with heavy activity. The posterior tendon, main support structure for the arch, can become inflamed (tendonitis) or even tear if overloaded. For women, wearing high heels can affect the Achilles tendon and alter the structure and function of the ankle. The posterior tibial tendon may compensate for this stress and break down, causing the arches to fall. Obesity is another contributing factor, as well as a serious injury to the ankle or foot, arthritis and bad circulation such as occurs with diabetes.


Causes

There is a lack of normal arch development, probably due to inherent ligamentous laxity. Around 20% of adults have Pes planus. The majority have a flexible flat foot and no symptoms. However, if there is also heel cord contracture, there may be symptoms (see ‘Contributing factors’, below). Loss of support for the arch. Dysfunction of the tibialis posterior tendon, a common and important cause. Tear of the spring ligament (rare). Tibialis anterior rupture (rare). A neuropathic foot, e.g from diabetes, polio, or other neuropathies. Degenerative changes in foot and ankle joints. Inflammatory arthropathy, eg rheumatoid arthritis. Osteoarthritis. Fractures. Bony abnormalities, eg tarsal coalition.


Symptoms

A symptom is something the patient feels and reports, while a sign is something other people, including the doctor may detect. An example of a symptom may be pain in the ankle, while a sign may be a swelling. Symptoms may vary and generally depend on the severity of the condition. Some have an uneven distribution of bodyweight and find that the heel of their shoes wears out more rapidly and more on one side than the other. The most common signs or symptoms of flat feet are pain in the ankle (inner side), there may also be swelling of the foot in general, swelling in the arch of the foot, the calf, knee, the hip, the back, the general lower leg area. People with flat feet may also experience stiffness in one or both feet. One or both feet may be flat on the ground (either no arch, or very slight arch). Shoes may wear unevenly.


Diagnosis

Diagnosis of flat feet or fallen arches can be made by your health practitioner and is based on the following. Clinical assessment involving visual gait assessment, as well as biomechanical assessment. A detailed family and medical history. A pain history assessment determining the location of painful symptoms. Physical palpation of the feet and painful areas. Imaging such as MRI or x-ray can be used by your practitioner to assist in the diagnosis.


Non Surgical Treatment

Fallen arches lead to flat feet, where the arch of your foot collapses and may even touch the ground. This condition is common in infants and young children because your arches are still developing during childhood, says the Instep Foot Clinic. If your flat feet persist into adulthood, or the condition causes pain, a doctor or podiatrist may prescribe strengthening exercises as part of your treatment.


Surgical Treatment

Flat Foot

Feet that do not respond to the treatments above may need surgery. The surgery will help to create a supportive arch.


Prevention

Sit up straight in a chair with your feet flat on the ground. Scrunch up the toes of one foot as if you are trying to grab hold of the floor then use your toes to drag your foot a small distance forwards. Do this a couple of times on each foot, but don?t use your leg muscles to push your foot forward — the movement should come solely from the muscles in your feet. Sit in a chair and place a cleaning cloth, towel or small ball on the floor at your feet. Use the toes of one foot to grasp the object and lift it off the floor. This action will require you to clench your toes and contract your arch. Once you have lifted the object a little way off the floor, try to throw it in the air and catch it by stretching your toes and arch out and upwards. Repeat the exercise several times on both feet. Sit on the floor with your legs straight out in front of you then bend your knees out to either side and place the soles of your feet together so your legs form a diamond. Hold on to your ankles and, keeping your heels together at all times, separate your feet so your toes point out to either side. Open and close your feet in this way several times, making sure your little toes stay in contact with the floor throughout the exercise. Starting in the same position, try separating your heels, keeping your toes together at all times.


After Care

Time off work depends on the type of work as well as the surgical procedures performed. . A patient will be required to be non-weight bearing in a cast or splint and use crutches for four to twelve weeks. Usually a patient can return to work in one to two weeks if they are able to work while seated. If a person’s job requires standing and walking, return to work may take several weeks. Complete recovery may take six months to a full year. Complications can occur as with all surgeries, but are minimized by strictly following your surgeon’s post-operative instructions. The main complications include infection, bone that is slow to heal or does not heal, progression or reoccurrence of deformity, a stiff foot, and the need for further surgery. Many of the above complications can be avoided by only putting weight on the operative foot when allowed by your surgeon.

Achilles Tendon Pain In Children

Achilles Tendon Pain In Children

Overview

Achilles TendinitisAchilles tendonitis is commonly seen in athletes who sustain an increase in training load, and is most often due to overuse. Tendons respond poorly to overuse, therefore healing is slow. This can leave a tendon pathologically defective, which decreases tendon strength and leaves it less able to tolerate load, thus vulnerable to further injury or tendinosis. Extrinsic factors contributing to this condition include training errors and inappropriate footwear. Intrinsic factors include inflexibility, weakness and malalignment. In other situations, there will be clinical inflammation, but objective pathologic evidence for cellular inflammation is lacking, and in these conditions the term tendinosis is more appropriate. Tendinosis is a degeneration of the tendon?s collagen in response to chronic overuse; when overuse is continued without giving the tendon time to heal and rest, such as with repetitive strain injury, tendinosis results. Even tiny movements, such as clicking a mouse, can cause tendinosis, when done repeatedly.

Causes

The cause of paratenonitis is not well understood although there is a correlation with a recent increase in the intensity of running or jumping workouts. It can be associated with repetitive activities which overload the tendon structure, postural problems such as flatfoot or high-arched foot, or footwear and training issues such as running on uneven or excessively hard ground or running on slanted surfaces. Tendinosis is also associated with the aging process.

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

Physicians usually pinch your Achilles tendon with their fingers to test for swelling and pain. If the tendon itself is inflamed, your physician may be able to feel warmth and swelling around the tissue, or, in chronic cases, lumps of scar tissue. You will probably be asked to walk around the exam room so your physician can examine your stride. To check for complete rupture of the tendon, your physician may perform the Thompson test. Your physician squeezes your calf; if your Achilles is not torn, the foot will point downward. If your Achilles is torn, the foot will remain in the same position. Should your physician require a closer look, these imaging tests may be performed. X-rays taken from different angles may be used to rule out other problems, such as ankle fractures. MRI (magnetic resonance imaging) uses magnetic waves to create pictures of your ankle that let physicians more clearly look at the tendons surrounding your ankle joint.

Nonsurgical Treatment

Achilles tendonitis will often respond to rest or changes in activity, stretching, or ice after activity. Non-steroidal anti- inflammatory drugs (NSAIDs), such as ibuprofen or naproxen may also help. Physical therapy focusing on stretching and strengthening, massage, alternating hot and cold baths, and ultrasound or sound waves can also help with healing and comfort. The temporary use of a heel lift or the insertion of an arch support, called an orthotic, into the shoe or sneaker can also help. Although seldom necessary, the ankle may be kept in a short leg cast or splint. Surgery is rarely needed but can remove bone spurs or the bony prominence of the heel bone. The injection of corticosteroids such as cortisone into the area of the Achilles tendon is usually avoided because it may cause the tendon to rupture.

Achilles Tendonitis

Surgical Treatment

Open Achilles Tendon Surgery is the traditional Achilles tendon surgery and remains the ‘gold standard’ of surgery treatments. During this procedure one long incision (10 to 17 cm in length) is made slightly on an angle on the back on your lower leg/heel. An angled incision like this one allows for the patient’s comfort during future recovery during physical therapy and when transitioning back into normal footwear. Open surgery is performed to provide the surgeon with better visibility of the Achilles tendon. This visibility allows the surgeon to remove scar tissue on the tendon, damaged/frayed tissue and any calcium deposits or bone spurs that have formed in the ankle joint. Once this is done, the surgeon will have a full unobstructed view of the tendon tear and can precisely re-align/suture the edges of the tear back together. An open incision this large also provides enough room for the surgeon to prepare a tendon transfer if it’s required. When repairing the tendon, non-absorbale sutures may be placed above and below the tear to make sure that the repair is as strong as possible. A small screw/anchor is used to reattach the tendon back to the heel bone if the Achilles tendon has been ruptured completely. An open procedure with precise suturing improves overall strength of your Achilles tendon during the recovery process, making it less likely to re-rupture in the future.

Prevention

Warm up slowly by running at least one minute per mile slower than your usual pace for the first mile. Running backwards during your first mile is also a very effective way to warm up the Achilles, because doing so produces a gentle eccentric load that acts to strengthen the tendon. Runners should also avoid making sudden changes in mileage, and they should be particularly careful when wearing racing flats, as these shoes produce very rapid rates of pronation that increase the risk of Achilles tendon injury. If you have a tendency to be stiff, spend extra time stretching. If you?re overly flexible, perform eccentric load exercises preventively. Lastly, it is always important to control biomechanical alignment issues, either with proper running shoes and if necessary, stock or custom orthotics.

Pain In The Arch Reasons Warning Signs And Treatment

Pain In The Arch Reasons Warning Signs And Treatment

Overview

We all experience sore arches now and again after a long hike, standing in a long line or walking from one end to the other of a big shopping mall. It’s normal for feet to get tired out sometimes, and there’s usually no need to worry unless the pain persists. If you’re turning to the web because it’s dawning on you that your arches are sore several days a week, or maybe even every day, you’re doing a smart thing. Chronic pain in the arches can actually be a symptom of a significant underlying condition called Plantar Fasciitis that requires attention and treatment to prevent it from worsening. This article will quickly point out what you need to know about arch pain and Plantar Fasciitis and provide you with resources for learning how to recover.

Pain In Arch

Causes

The most common cause of arch pain is plantar fasciitis. Plantar fasciitis is inflammation of the fibrous band of tissue that connects the heel to the toes. Sufferers of plantar fasciitis typically feel pain early in the morning when they first get out of bed. Another common cause of arch pain is fallen arches or flat feet. Fallen arches result in the sole of the foot becoming flat so that the entire sole of the foot touches the ground. Fallen arches can lead to pain in the ankles, knees, feet, and even in the legs. While fallen arches are often inherited, for some it develops as a result of wear and tear on your feet. Wearing shoes without proper metatarsal support, or arch support, can overstretch the tendon that supports the arch causing the arch to flatten out.

Symptoms

Arch pain symptoms could include any of the following, a dull, constant ache if the ligaments have been stretched, swelling or tenderness in the foot, redness or bruising in the event of a more serious injury, difficulty putting weight on the foot, sharp pain when the foot is turned or manipulated, tenderness when pressure is applied. Because the arch of the foot is such a complex structure, arch pain could be an indicator of several different types of injuries. Chronic illnesses such as arthritis could also cause arch pain, and depending on the cause or source of your pain, you may experience discomfort in a variety of different areas. Ask a doctor if you believe you may have injured your foot arch.

Diagnosis

The adult acquired flatfoot, secondary to posterior tibial tendon dysfunction, is diagnosed in a number of ways with no single test proven to be totally reliable. The most accurate diagnosis is made by a skilled clinician utilizing observation and hands on evaluation of the foot and ankle. Observation of the foot in a walking examination is most reliable. The affected foot appears more pronated and deformed compared to the unaffected foot. Muscle testing will show a strength deficit. An easy test to perform in the office is the single foot raise.

Non Surgical Treatment

Tight arches, overpronation and flat feet as well as tight calves all lead to inflammation of the connective tissue that forms this arch of your foot. This condition, plantar fasciitis, can be very painful, from your first step in the morning. Fortunately, treatment is easier than most. No operations, no fancy pulsed waves, no night splints necessary. Good arch supports? full length flexible (not hard) orthotics are key. Stretches of the calf relieve arch tightness as the heel bone acts like a fulcrum pulling back the arch tissues if too tight. Regularly perform the gastroc and soleus stretches that you learned at the gym. If lazy, buy “Pro-Stretch” on line which helps you stretch your calves easily. Use it often. You can’t stretch too often, only too little. Finally, the magic cure is to roll a golf ball under the arch for half-hour once a day. (I know; a half-hour is a long time to perform one exercise, but that’s what it takes. Once you master this exercise, it is easy to do while you work at your desk or are watching a half hour TV program.) This may hurt the first week. Keep going because by week two, after you go over the pain hump, the pain will be gone.

Arch Pain

Surgical Treatment

Although most patients with plantar fasciitis respond to non- surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial. No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstays of long-term treatment for plantar fasciitis.

Prevention

To prevent arch pain, it is important to build up slowly to your exercise routine while wearing arch supports inside training shoes. By undertaking these simple measures you can prevent the discomfort of arch pain which can otherwise linger for many months. While you allow the foot to recover, it will help to undertake low impact exercises (such as swimming or water aerobics).

Stretching Exercises

Strength training and stretching can help avoid injury and keep your feet free from pain. Stretching should focus on the bottom of your foot to loosen tissues and tight ligaments surrounding your arch. The easiest way to do this is by grabbing a towel and sitting on the floor. You can do this while you catch up on the news in the morning, or when you get home from work. Put one leg out in front with your foot flexed up. Loop the towel around the ball of your foot and gently pull your toes towards you. Hold for thirty seconds and then repeat 3-4 times before switching feet.