Friday, November 8, 2013

5 things you must know about Achilles tendon disease

5 things you must know about Achilles tendon disease

Did you know that Achilles tendon ruptures represent a large portion of sports-related injuries and are seen in younger patients and older ones as well.  The average age is 29-40 with a male to female ratio of 20:1. 
In fact, "weekend-warriors" is a term used to classify patients above the age of 35 who participate in occasional exercise activities and especially those that involve high-impact sports such as basketball and soccer.  Those patients are statistically known to be at the highest risk for sustaining Achilles tendon ruptures.
Progression of Achilles Tendon disease

Achilles tendon anatomy.  Image from Gray's Anatomy Text..
Here are Five important facts you must know when dealing with Achilles tendon disease:
  • Achilles tendon disease is progressive - It involves a chronic and repetitive process of micro-tearing and degeneration within the tendon.  This process weakens the tendon and can eventually lead to spontaneous ruptures
  • Pain is not always a clinical symptom of Achilles tendon disease - In fact, the more chronic is the tearing, the less likely pain is involved and thus anti-inflammatory medications would not work
  • Tight calf muscle groups increase the load on the "diseased" tendon
  • Foot-type and mechanics can make you susceptible to Achilles tendon disease
  • Specific family of antibiotics, namely Fluroquinolones, have shown association with Achilles tendon disease and spontaneous ruptures.
Here are important elements to consider for treatment of Achilles tendon disease:
  • Temporary immobilization in a boot/cast is to be expected in the initial "inflammed-state"
  • Shoe-gear modifications, foot-orthoses, physical therapy and stretching exercises are pillars  in the treatment process because they loosen the load off of the tendon
  • Platelet-Rich Plasma injections have shown tremendous promise and results in the treatment especially amongst the athletic/active population
  • Shockwave therapy has also shown great benefits from a non-operative point of view
  • Surgical intervention is warranted if no clinical improvement is seen with non-operative approaches and it involves debridement of the tendon with either a reconstruction of the diseased tendon or a tendon transfer from another tendon in the body. 
    • Recovery involves immobilization in the cast for 3-4 weeks then followed with a period of 4-6 weeks of CAM boot immobilization with Physical therapy
    • Results on average are rated as good to excellent.
If you have any questions about Achilles tendon disease or ruptures, then please consult with your foot and ankle specialist.

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