Ankle Ligament Tear & Achilles Tendon Injuries
Achilles Tendon Injuries
The Achilles tendon
is the tendon of the gastronemius and soleus muscles of the posterior leg and connects these muscles to the
heel bone (calcaneus). It is located along the lower back portion of the calf and runs to the heel. This muscle
tendon group is responsible for plantar flexion of the ankle and is the primary motor for standing and walking on
the toes as powers push off when a person runs or jumps.
Injury usually results when the tendon is stressed by short quick movements, or sudden starts and stops such as
in Racquetball, tennis, football, or dance. It can also affect women who frequently wear high-heeled shoes and
switch to sneakers to exercise. This stress could be cumulative or develop from a single spontaneous movement
following an insufficient "warm-up" or stretch.
Inflammation of this tendon is known as Achilles Tendonitis. It occurs when the overstressed tendon becomes inflamed
and causes pain, swelling and restricted flexibility. If untreated, it could grow progressively worse and a small
tear may lead to tendon rupture, separating the calf muscle from the heel bone. When this occurs, normal movement
of the ankle is impossible.
If Achilles Tendonitis is treated before tendon rupture, there are a number of non-operative ways to recover
strength to the area. They include stretching, ice, shoe modifications, nutritional supplements, and alterations
in an individual's training schedule. Still, the best treatment is prevention. Tendonitis can be avoided with the
proper strengthening of all muscle groups in the leg, along with adequate stretching and warm-ups before demanding
activities or sports.
A complete rupture
often occurs spontaneously during sports, without a pre-existing tendonitis. The complete rupture requires surgery to
reconstruct the torn edges of the tendon, or more uncommonly repair the tendon back to the bone. After surgery, a
Cryo/Cuff® is applied followed by a very short period of casting. Patients
are back in sports by three months.
Ankle Sprain
Ankle sprains are one of the most common injuries for athletes. Anyone who has played a sport is likely to have
experienced this type of injury. Also known as ankle instability, or a lateral ankle ligament tear,
it occurs when someone awkwardly plants the foot. When this happens, the foot is turned inward and is occasionally
followed by a "popping" sound. Walking is difficult and the foot shows immediate swelling. During this time, there
is extreme pain.
Upon examination of such an injury, the ankle appears loose and may be "turned in" far more than the opposite side.
An X-ray may reveal no broken bones or a chip fracture of the distal fibula. And though an MRI, which is often used,
would show a tear in the lateral ankle ligaments, it is expensive and generally not necessary for the diagnosis of
such injuries. A thorough examination of the site would identify the problem. It includes a stress for lateral and
anterior instability, and direct palpation of the affected area for tenderness. And tightness of the Achilles
tendon must be evaluated.
In treating this injury, a system referred to as "RICE" is used and includes Rest, Ice, Compression, and Elevation.
The best instrument for achieving both ice and compression is the Cryo/Cuff®. Therefore, patients are encouraged
to immediately begin using a Cryo/Cuff®, while keeping the ankle elevated. Following several days of elevation,
patients are told to begin walking, with or without crutches - though crutches are discouraged. Patients are then
put in a special brace called an Air-Stirrup Ankle Brace, which can be placed over
a sock and worn with a high top tennis shoe. This brace provides support and compression for the injured ankle
within the shoe, allowing athletes to begin exercising, and regaining strength more quickly.
Working out the ankle and stretching the heel cord are very important for the rapid recovery of an ankle sprain.
By working the ankle in dorsi and plantar flexion, an athlete can begin practicing his sport once again. If the
Air-Stirrup Ankle Brace is worn for the full four weeks, rarely is additional treatment required for a sprain.
An ordinary ankle sprain does not require an urgent MRI. Nor does it require a cast, crutches, or regular
treatments by a doctor. It does not require immediate surgery. Ninety five percent of acute ankle sprains are
successfully treated with conservative rehabilitation and proper care.
Surgical Treatment
There is, though, a small, repeat small, group of people with sprained ankles, which have recovered with
"residual laxity." This occurs when the sprain is not properly treated. These patients are always subject to
re-spraining the ankle with even the most minimal trauma. Patients, who were not properly treated for the first
sprain and continue to experience ongoing problems with the ankle, may need to consider other surgical treatments.
While this condition is uncommon, the surgical treatment Dr. Sanders uses for recurring sprains or instability
is called Ankle Ligament Reconstruction.
It is performed in the Day Surgery section of a hospital. In this procedure, Dr. Sanders makes an incision at the
outside of the ankle. He then takes a piece of tendon (peroneal brevis) from the foot and weaves it through the old
ligament - passing it through a drill hole in the fibula (outside bone of the ankle) and then sewing it into the heel
bone. Following the ligament reconstruction, the ankle is no longer subject to recurrent sprains.
Post surgical treatment for patients includes a Cryo/Cuff® and crutches until the wounds heel - both of which
are sent home with the patient. This treatment continues for approximately two weeks. They are then put in an
Air-Stirrup Ankle Brace. After an eight-week period, the brace is removed and worn only when playing sports. It is
worn during sports for several months post-surgery.
Staying Strong
A sound nutritional program and Reconditioning exercise plan are encouraged for all patients at the Sanders Clinic.
Lateral collateral ankle ligaments are similar to tendons and work optimally with regular training and proper nutrition.
Dr. Sanders recommends a course of nutritional supplements containing Glycosaminoglycans, and Chondroitin sulfate.
These, as well as other vitamins, are found in Nutriex Sport.
