Achilles Tendonitis and Tears

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1 Achilles Tendonitis and Tears The Achilles tendon is an important structure for normal ankle motion and normal function, even for daily activities such as walking. Achilles tendonitis can occur in patients of all ages. Achilles tendon tears typically occur in adults during sporting activity, particularly sports involving jumping or sudden change of direction. The Achilles tendon is primarily made up of 2 major calf muscles, the gastrocnemius and the soleus. These two muscles combine to form the Achilles tendon, which attaches the calcaneus (heel bone). The calf muscles and Achilles tendon function to plantarflex the ankle ( point your foot down ) and are important for pushing the leg and body forward during normal walking motion. Achilles tendonitis often occurs in patients involved in sports and activities that involve repetitive running or jumping. Oftentimes, these patients have less flexibility of the calf muscles and tendon, putting more stress on the tendon during sports. Continued tendon irritation and inflammation can result in small tears within the tendon. This causes the tendon to weaken and be at higher risk for possible complete tear. Achilles tendon tears typically occur during sports and activities that involve sudden jumping or change of direction motions. Patients with Achilles tendonitis typically have persistent pain in the back of the heel that worsens after participating in activities that involve running or jumping. Pain and swelling are located at the site of the injured tendon close to the calcaneus. Walking with Achilles tendonitis can also be uncomfortable. Patients may also develop stiffness in the tendon and ankle, especially in the morning after sleep. The pain can also be worse at night before sleep. Patients with an Achilles tendon tear often have an acute sharp pain in the back of the ankle. Many patients feel and/or hear a pop and have significant difficulty with weight-bearing or walking after a tear. Significant swelling and bruising can occur at the back of the heel. The ankle can feel very weak.

2 For most patients with Achilles tendonitis, non-surgical treatment can allow for successful return to sports and activities. is focused on reducing pain and swelling, restoring motion, reducing stiffness, and regaining strength with a specific physical therapy program. Initially, treatment is dedicated to reducing pain and progressing to comfortable weight bearing. Immobilization with a boot may be needed temporarily at first to help with this transition. Splints worn at night can help keep the tendon and muscle stretched to improve flexibility. More prolonged or recurrent injuries may require a cast for prolonged immobilization. Once the tendon is allowed to heal, a rehabilitation program focused on restoring normal ankle motion and strengthening the leg and ankle is implemented. Sport-specific training is performed to prepare the patient for return to sports and activities. For many patients, non-surgical treatment can provide the relief necessary to return to sports and activities. However, some patients may not improve as expected, especially those with recurrent Achilles tendonitis. In these cases, surgery may be recommended. Dr. Kumar will discuss these options with you prior to surgery. After surgery, a rehabilitation program specific for each patient is created with a physical therapy team in order to reduce post-surgical pain, restore motion, and regain strength. Sport-specific training is a critical aspect of recovery in order to return patients to sports and activities as quickly and safely as possible. For patients with Achilles tendon tears, surgery is often recommended soon after the injury to repair the tendon. Non-surgical treatment may result in higher rates of retear, especially if patients are attempting to return to sports and activities. The goals of surgery are to repair the tendon, lower retear rate, and allow for effective rehabilitation. The tendon is repaired using a minimally invasive technique. For some patients, the tendon edges are too far apart and a small incision is made to allow for a better repair. Dr. Kumar will discuss surgical options with you prior to surgery and describe the expected recovery course. After surgery, a rehabilitation

3 Ankle Sprain The ankle is a complex joint with multiple stabilizing ligaments that are critical for good joint function, particularly during sports and high impact activities. Ankle sprains are a very common injury and can occur in patients of all ages. Ankle sprains can vary significantly in severity based upon degree and location of injury. Unlike the shoulder, the ankle is a constrained joint with limited flexibility. Multiple stabilizing ligaments allow it to tolerate significant forces. The most common ankle sprain occurs when the foot inverts, or twists and rolls inward. This strains the ligaments on the outside (lateral) aspect of the ankle. Another common ankle sprain is when the foot rolls outward, or everts. This movement stresses the ligaments of the inner (medial) ankle. Another less common type is the high ankle sprain, which occurs after a rotational twisting injury of the ankle. In this case, the fibrous connection between the tibia (shin bone) and fibula is stressed and injured. These injuries are typically seen during cutting, twisting, and pivoting sports and activities. Patients with ankle sprains typically have sharp pain that occurs after the ankle twists or rolls. Pain and swelling are located at the site of the injured ligament. Walking after a sprained ankle can be difficult, especially with a high ankle sprain. Bruising can also occur in cases of a severe injury with multiple torn ligaments. Patients with multiple ankle sprains can develop ankle instability, which occurs when the torn ligaments are too damaged to heal appropriately. In these cases, the ankle can twist and roll much more easily and abnormally. The ankle can ache and fatigue easily with sports and activities and the ankle can feel loose or unstable. For most patients with ankle sprains, non-surgical treatment can allow for successful return to sports and activities. is focused on reducing pain and swelling, restoring motion, and regaining strength with a specific physical therapy program. Initially, treatment is dedicated to reducing pain and progressing to normal weight bearing. Immobilization with a boot may be needed temporarily and crutches can be used at first to help with this transition. More severe injuries or recurrent injuries may require a cast for prolonged immobilization. Once the ligaments are allowed to heal, a rehabilitation program focused on restoring normal ankle motion and strengthening the leg and ankle is implemented. Sport-specific training is performed to prepare the patient for return to sports and activities. For patients involved in sports and activities that require twisting, cutting, and pivoting, a brace may be used initially when returning to sports. For many patients, non-surgical treatment can provide the relief necessary to return to sports and activities. However, some patients may not improve as expected, especially those with severe injuries or patients with recurrent ankle instability. In these cases, surgery may be recommended. Because there are several types of ankle instability, surgery may be different for each patient. Dr. Kumar will discuss these options with you prior to surgery. After surgery, a rehabilitation

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5 Osteochondritis Dissecans of the Ankle Osteochondritis dissecans (OCD) is a condition that weakens the bone which supports cartilage inside a joint. Eventually, this leads to cartilage softening and damage and can sometimes cause a piece to break off. OCD usually affects younger patients ages years old and can be found in multiple joints. What does it do? The cartilage inside each joint is supported by bone. The bone provides structural support and nutrition to the cartilage to keep it healthy and strong. OCD causes the bone in certain locations of the knee to become weak, soft, and diseased. Over time, this can lead to the cartilage becoming damaged and non-functional. In severe cases, the cartilage eventually dies and cannot heal. The exact cause of OCD is unknown. It has been associated with a disruption in the blood supply to the bone and with repeated impact stresses to the ankle. Genetics may also play a role as there may be an association with family history. Patients with OCD of the ankle will oftentimes have gradual ankle pain and soreness with sports and activities. Some patients will have swelling that comes and goes, particularly after times of intense training. The pain and swelling usually get more frequent and more bothersome over time. Sometimes, patients will describe an acute, sharp, sudden pain in the ankle and develop much more swelling than normal. Walking after this episode can be difficult and uncomfortable. The ankle may start to click. These symptoms might indicate that the OCD has broken off inside the ankle joint. This can also cause the ankle to lock and lose motion. is based upon various factors including patient age, open or closed growth plates, and severity of disease. In early stages of OCD ( stable OCD ), non-surgical treatment can allow the body to heal the bone and cartilage. Usually this involves a period of limited weight-bearing to allow the ankle to rest and recover. This is followed by physical therapy designed to rehabilitate the hip, thigh, leg, and ankle to restore strength and conditioning for return to sports and activities. In some patients, the OCD has difficulty healing and surgery may be recommended. Surgery is performed arthroscopically using a minimally invasive technique to help increase the blood flow to the area of sick bone. In patients with severe or advanced disease, the OCD can become loose and even come out of place ( unstable OCD ). In such cases, surgery is may be recommended to either fix the unstable lesion to allow it to heal or to replace the bone and cartilage if the OCD is too advanced. There are multiple options which can be used to accomplish these goals, and Dr. Kumar will discuss these options with you prior to surgery. Many factors are considered, including prior surgeries, patient age, status of the growth plates, and severity of disease. Surgery can be performed arthroscopically or open depending on the exact procedure. After surgery, a rehabilitation