Achilles Tendon Injuries
Achilles Tendon Anatomy and Use
The Achilles tendon is the strongest tendon in the human body! The Achilles tendon is a tough band of tissue that connects the two calf muscles to the heel bone and is located at the lower end of the leg muscle.
The Achilles tendon helps you walk, run, jump and stand on your toes! When the calf muscles are flexed, the Achilles tendon pulls on the heel, pressing the ball of the foot into the ground and pushing you forward.
Advanced Imaging for the Achilles Tendon
- X-Ray: An x-ray shows any changes to underlying bone structure, hardening of the soft tissues and guides Dr. Castelein to order further imaging to diagnose tendonitis or ruptures. Brighton Foot and Ankle has an in-office x-ray machine, which allows Dr. Castelein to quickly diagnose and treat the injury.
- Ultrasound: Ultrasound is an important diagnostic tool that is used to identify lesions on the Achilles tendon, tendinopathy, or full thickness tear of the tendon.
- MRI: MRI is the most advanced imaging modality to diagnose tendonitis, partial or complete rupture of the Achilles tendon. MRI offers the greatest level of information during the pre-surgical planning process. Dr. Castelein works closely with radiologists and takes time to evaluate each MRI himself. This allows for the availability to evaluate studies quickly and schedule follow up appointments as needed.
Injury and Pathology Discussion
Achilles tendonitis occurs when the Achilles tendon becomes inflamed, painful or swollen. Usually, pain begins as a mild ache in the back of the leg or above the heel during activity. Episodes of more severe pain may occur after strenuous exercise. Achilles tendonitis usually results from repetitive or excess stress to the tendon from a sudden increase in activity, tight calf muscles or certain foot deformities. The structure of the tendon itself can weaken with time, which increases the chances of injury. Untreated and/or advanced Achilles tendonitis increases the risk of severe injury such as tendon rupture in the future.
Achilles Tendonitis typically responds well to conservative treatments. Dr. Castelein focuses first on reducing inflammation and pain, then on supporting and reducing stress to the tendon. Inflammation is reduced by prescribing anti-inflammatory medications and mechanical methods such as stretching and massage. Long-term pain relief and support is given to the tendon by a combination of wearing certain shoes, custom orthotics, at-home stretching exercises, and physical therapy.
If the conservative methods of treatment are not aiding the pain of Achilles tendonitis, Dr. Castelein may suggest minimally invasive surgery. One surgical option utilizes a microdebrider, roughly the size of a needle, to remove focal areas of thickened and painful scar tissue within the tendon; which helps to restore the body’s natural healing process. Another potential solution includes lengthening the muscle complex of the Achilles tendon itself which is known as an Endoscopic Gastrocnemius Recession. This procedure utilizes a camera to visualize, inspect and lengthen the muscle-tendon complex. It is a very powerful procedure reducing stress to the Achilles tendon. This is an outpatient procedure allowing patients to walk the same day.
Achilles Rupture or Tear
Injury and Pathology Discussion
An Achilles tendon rupture occurs when the tendon is stretched beyond its normal capacity and results in a partial or complete tear. Sudden accelerations when running, jumping forcefully, or quickly pivoting can cause the tendon to rupture. When a rupture occurs, most people experience a popping or snapping sound at the time of injury, moderate to severe pain or swelling near the heel, an inability to bend the foot downward, or an inability to stand on the toes. Achilles tendon ruptures are most commonly seen in people known as “weekend warriors” who engage in sports in their spare time. Rupture usually occurs in a small section of the tendon, just above where it attaches itself to the heel bone. This area is called the “watershed region” and is at greater risk of injury due to a natural reduction in blood flow.
The course of treatment Dr. Castelein utilizes will depend on your age, activity level, and the severity of your injury. Conservatively, the treatment involves a walking boot to immobilize the ankle and resting the tendon itself by using crutches. However, nonsurgical treatment of a ruptured Achilles tendon is generally associated with a higher likelihood of re-rupture and decreased strength to the area.
In most cases, Dr. Castelein will recommend surgery to repair the ruptured Achilles tendon. Surgical repair of the tendon will lessen the future likelihood of the tendon rupturing, provide greater strength, and improve muscle function. The goal of Achilles tendon repair is a return to pre-injury activity. There are various minimally invasive surgical techniques Dr. Castelein can offer to repair the ruptured tendon. Depending on the severity of the injury and your age, Dr. Castelein will select the appropriate procedure for you. He looks to combine the best repair techniques with added advanced healing material to provide the best outcome. During the recovery process Dr. Castelein will tailor post-operative protocols for the fastest return to daily and physical activity. He communicates with local physical therapists to ensure continuity of care and adherence to the latest advancements in therapy.
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