Achilles Tendon Rupture

What is the Achilles Tendon?

A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the "heel cord," the Achilles tendon facilitates walking by helping to raise the heel off the ground.

What is an Achilles Tendon Rupture?

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping.

Achilles tendon ruptures are most often seen in "weekend warriors" – typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.

Signs and Symptoms

A person with a ruptured Achilles tendon may experience one or more of the following:

·     Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf – often subsiding into a dull ache

·     A popping or snapping sensation

·     Swelling on the back of the leg between the heel and the calf

·     Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes

These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the "R.I.C.E." method should be used. This involves:

·     Rest. Stay off the injured foot and ankle, since walking can cause pain or further damage.

·     Ice. Apply a bag of ice covered with a thin towel to reduce swelling and pain. Do not put ice directly against the skin.

·     Compression. Wrap the foot and ankle in an elastic bandage to prevent further swelling.

·     Elevation. Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level.

Diagnosis

In diagnosing an Achilles tendon rupture, the Doctors at Hosey Foot and Ankle Centers will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes.

The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests.

Treatment

Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches. The decision of whether to proceed with surgery or non-surgical treatment is based on the severity of the rupture and the patient’s health status and activity level.

Non-Surgical Treatment
Non-surgical treatment, which is generally associated with a higher rate of re-rupture, is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. Non-surgical treatment involves use of a cast, walking boot, or brace to restrict motion and allow the torn tendon to heal.

Surgery
Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient’s push-off strength and improves muscle function and movement of the ankle.

Various surgical techniques are available to repair the rupture. A Doctor from Hosey Foot and Ankle Centers will select the procedure best suited to the patient.

Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The Doctor from Hosey Foot and Ankle Centers will determine when the patient can begin weightbearing.

Complications such as incision-healing difficulties, re-rupture of the tendon, or nerve pain can arise after surgery.

Physical Therapy

Whether an Achilles tendon rupture is treated surgically or non-surgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve the range of motion of the foot and ankle.

Nail Fungus

A fungus is an organism that lives in warm moist areas. Fungus of the toenails is a common problem that can affect people of all ages, although it most commonly affects individuals who are older.

Toenail fungus often begins as an infection in the skin called tinea pedis (also known as athlete’s foot). The fungus often starts under the nail fold at the end of the nail. Over time it grows underneath the nail and causes changes to its appearance, such as a yellow or brownish discoloration. It can also cause thickening and deformity of the toenail.

Many people have difficulty with their toenails and need assistance in caring for them. A Doctor at Hosey Foot and Ankle Centers can diagnose the cause of toenail problems and recommend treatments.

Tingly Feet

“Tingly feet" can be a sign of nerve loss. The nerves in the feet come from the lower back. Pressure or chemical change in the nerve can cause a tingling sensation in the feet. Any sensation that is out of the ordinary can be an early sign of neurologic or vascular problems. In addition to tingling, feet may feel numb or feel like they are "falling asleep." There may also be a burning sensation in the feet.

Diabetes is one of the most common medical conditions with which "tingly feet" can be associated. A thorough evaluation by one of the Doctors at Hosey Foot and Ankle Centers is advised to determine the cause of "tingly feet."

Foot Lumps

Foot lumps are soft tissue masses (not bone) that can occur anywhere on the foot.  They can be caused by soft tissue swelling, sacs of fluid, fatty tissue, and nerve, vessel or muscle enlargements. Foot lumps may be without pain (asymptomatic) or they can cause pain and affect the function of the foot.  Painful foot lumps can be treated by the Doctors of Hosey Foot and Ankle Centers use a variety of conservative treatments. In some cases, surgery may be necessary.

Charcot Foot

What Is Charcot Foot?
Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.

Charcot foot is a very serious condition that can lead to severe deformity, disability, and even amputation. Because of its seriousness, it is important that patients with diabetes—a disease often associated with neuropathy—take preventive measures and seek immediate care if signs or symptoms appear.

Causes
Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain, or trauma. Because of diminished sensation, the patient may continue to walk—making the injury worse.

People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot.

Symptoms
The symptoms of Charcot foot may include:

·     Warmth to the touch (the affected foot feels warmer than the other)

·     Redness in the foot

·     Swelling in the area

·     Pain or soreness

Diagnosis
Early diagnosis of Charcot foot is extremely important for successful treatment. To arrive at a diagnosis, the surgeon will examine the foot and ankle and ask about events that may have occurred prior to the symptoms. X-rays and other imaging studies and tests may be ordered.

Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition.

Non-Surgical Treatment
It is extremely important to follow the surgeon’s treatment plan for Charcot foot. Failure to do so can lead to the loss of a toe, foot, leg, or life.

Non-surgical treatment for Charcot foot consists of:

·     Immobilization. Because the foot and ankle are so fragile during the early stage of Charcot, they must be protected so the weakened bones can repair themselves. Complete non-weightbearing is necessary to keep the foot from further collapsing. The patient will not be able to walk on the affected foot until the surgeon determines it is safe to do so. During this period, the patient may be fitted with a cast, removable boot, or brace, and may be required to use crutches or a wheelchair. It may take the bones several months to heal, although it can take considerably longer in some patients.

·     Custom shoes and bracing. Shoes with special inserts may be needed after the bones have healed to enable the patient to return to daily activities—as well as help prevent recurrence of Charcot foot, development of ulcers, and possibly amputation. In cases with significant deformity, bracing is also required.

·     Activity modification. A modification in activity level may be needed to avoid repetitive trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot, so measures must be taken to protect both feet.

When is Surgery Needed?
In some cases, the Charcot deformity may become severe enough that surgery is necessary. The  Doctors of Hosey Foot and Ankle Centers will determine the proper timing as well as the appropriate procedure for the individual case.

Preventive Care
The patient can play a vital role in preventing Charcot foot and its complications by following these measures:

·     Keeping blood sugar levels under control can help reduce the progression of nerve damage in the feet.

·     Get regular check-ups from a foot and ankle surgeon.

·     Check both feet every day—and see a surgeon immediately if you notice signs of Charcot foot.

·     Be careful to avoid injury, such as bumping the foot or overdoing an exercise program.

·     Follow the surgeon’s instructions for long-term treatment to prevent recurrences, ulcers, and amputation.