Advanced Foot and Ankle Center
Eric M. Silvers, DPM, PA
4501 Medical Center Drive, Suite 300
McKinney, Texas 75069
170 N. Preston Road, Suite 30
Prosper, Texas 75078
972-542-2155
www.advancedfoottexas.com
About Custom Orthotics
What is a custom orthotic?
A custom molded foot orthotic is a custom-made three-dimensional foot brace that is inserted in your shoe to help the pain and discomfort caused by the weakness and instability and/or deformity of your foot.
Orthotics work by decreasing high-pressure areas, stabilizing foot alignment and/or cushioning the foot. They also help to stabilize your foot during the walking cycle. Orthotics will not permanently change your anatomy and will function only when you are standing or walking on them.
Orthotics commonly used to relieve symptoms of common injuries, such as plantar fasciitis, metatarsalgia, neuromas, and various foot and ankle tendon injuries, as well as helping individuals with diabetes or arthritis. Orthotics complement other treatments such as physiotherapy, stretching, icing, and massage and at time foot and ankle surgery
.
How will the orthotics feel at first?
When you first wear your orthotics, it is normal for the orthotics to feel strange; however, properly fitting orthotics should not cause any new pain, blistering or redness. If this does occur, remove the orthotics and make an appointment with your Dr. Silvers or Dr. Williams for an adjustment.
Although symptomatic relief will not occur over night, consistently wearing your orthotics for a period of time will realign your foot and allow healing to occur.
How do I take care of my orthotics?
To clean your orthotics, wash with warm water and mild soap and air dry. Do not expose them to high heat.
Are Orthotics Adjustable?
Yes, depending on the adjustment needed, it can be performed either in the office or by sending the orthotic back to the lab that fabricated the device.
Are Custom Orthotics Covered By Insurance?
Orthotic coverage does vary from insurance plan to insurance plan. Our staff will do our best to find out if orthotics are covered under your plan. Please be aware that we can only forward the coverage information to you that the insurance company gives to us. This is not a guarantee of coverage since the insurance company cannot guarantee benefits until the claim is processed. If you are concerned if your insurance company covers custom molded foot orthotics, we urge you to call your insurance company to confirm coverage or non coverage. The billing code for custom molded foot orthotics is L3000. Please feel free to always ask our staff if you have any questions or concerns. We are here to help you and our primary concern is your complete satisfaction.
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155
Showing posts with label heel. Show all posts
Showing posts with label heel. Show all posts
Tuesday, March 24, 2009
Wednesday, March 18, 2009
Heel pain in Children
Heel pain is one of the most common conditions that we see here at Advanced Foot and Ankle in McKinney and Prosper, Texas. Many of our heel pain patients are children. Now, pain in the heel is not normal. It is your body's way of saying to you, "hey, I am not feeling very well down here!" With that being said, pediatric heel pain should not be ignored.
Your child often will complain of pain along the back and/or bottom of the heel or heels and you may see him or her limping or walking on their toes. Often times the heel pain is present during and/or after activity.
The most common cause of pediatric heel pain is a condition called "Calcaneal Apophysitis" or "Sever's Disease." This typically effects kids between the ages of 8-14 years old. This is not the only cause of pediatric heel pain. Other causes can be a fracture, contusion, infection, warts, callouses and in rare cases a tumor.
Pediatric heel pain does differ from heel pain seen in adults. Heel pain seen in adults is often "Plantar Fasciitis" which is a condition that causes inflammation of a long ligament called the Plantar Fascia that runs from the heel bone to the soft tissues behind the toes. Plantar fascia pain is worse after rest (in the morning after rising from bed or after sitting for a while). In the case of Pediatric Heel pain, the pain often increases with activity such as walking and playing sports. Heel pain in kids is common due to the fact that the heel is still growing. The heel bone is not fully developed until the child is 14. There is a growth plate (called the apophysis) along the back of the heel. If the the apophysis is stressed, heel pain will begin due to inflammation. The Achilles tendon inserts along the back of the heel behind this growth plate, and because of this, its aggressive pull on the heel often irritate the growth plate.
It is important to seek treatment at Advanced Foot and Ankle in McKinney and Prosper, Texas for pediatric heel pain since there are more than once cause of pediatric heel pain. Causes include Calcaneal Apophystitis as discussed, Tendo-Achilles bursitis which is a condition in which a sac of fluid between the achilles tendon and the heel bone becomes inflamed. Causes of bursitis can be inflammatory conditions such as arthritis, poor footwear or trauma.
Overuse syndromes can also cause pediatric heel pain. Overuse syndromes typically are seen in kids older than 14 years old. They may suffer from tendinitis of the Achilles Tendon, or less common, plantar fasciitis.
Fractures of the heel can also be seen in kids. Stress fractures are small hairline fractures that are seen more often in teenagers that are active in athletics. Stress fractures are often associated with increased activity. Acute fractures are seen as a result of trauma such as jumping off a piece of furniture, stairway, fence or roof. Heel fractures can be very serious and medical attention should be sought out immediately.
Treatment of pediatric heel pain is often initiated by seeing one of the Podiatrists at Advanced Foot and Ankle. A thorough extremity exam will be carried out follow by X-rays. Sometimes a MRI or CT scan may be necessary. Blood work may also need to be order to rule out arthritic inflammatory conditions or if an infection is suspected.
Treatment depends on the diagnosis and the intensity of the pain. Rest or reduced activity is often suggested. Our doctors may suggest that the child refrain from high impact activity including running and/or jumping. Heel lifts, night splints and/or walking cast immobilization may also be entertained as treatment options. Anti inflammatory medications, physical therapy and custom molded foot braces (orthotics) are other ways of treating pediatric heel pain. On rare occasions surgery may be needed, especially if the child has a short heel cord.
Can anything be done to prevent pediatric heel pain? Yes, shoe gear such as avoiding cleated shoes, avoiding obesity, choosing well constructed shoes that coincide with the patients activity and avoiding activity that may be too aggressive for the child's physical ability.
Dr. Eric Silvers and Dr. Kory Williams see pediatric heel pain daily and are well trained to treat all foot and ankle conditions seen in children. They can be reached at 972-542-2155 or you may visit our website at http://www.advancedfoottexas.com/ .
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155
Your child often will complain of pain along the back and/or bottom of the heel or heels and you may see him or her limping or walking on their toes. Often times the heel pain is present during and/or after activity.
The most common cause of pediatric heel pain is a condition called "Calcaneal Apophysitis" or "Sever's Disease." This typically effects kids between the ages of 8-14 years old. This is not the only cause of pediatric heel pain. Other causes can be a fracture, contusion, infection, warts, callouses and in rare cases a tumor.
Pediatric heel pain does differ from heel pain seen in adults. Heel pain seen in adults is often "Plantar Fasciitis" which is a condition that causes inflammation of a long ligament called the Plantar Fascia that runs from the heel bone to the soft tissues behind the toes. Plantar fascia pain is worse after rest (in the morning after rising from bed or after sitting for a while). In the case of Pediatric Heel pain, the pain often increases with activity such as walking and playing sports. Heel pain in kids is common due to the fact that the heel is still growing. The heel bone is not fully developed until the child is 14. There is a growth plate (called the apophysis) along the back of the heel. If the the apophysis is stressed, heel pain will begin due to inflammation. The Achilles tendon inserts along the back of the heel behind this growth plate, and because of this, its aggressive pull on the heel often irritate the growth plate.
It is important to seek treatment at Advanced Foot and Ankle in McKinney and Prosper, Texas for pediatric heel pain since there are more than once cause of pediatric heel pain. Causes include Calcaneal Apophystitis as discussed, Tendo-Achilles bursitis which is a condition in which a sac of fluid between the achilles tendon and the heel bone becomes inflamed. Causes of bursitis can be inflammatory conditions such as arthritis, poor footwear or trauma.
Overuse syndromes can also cause pediatric heel pain. Overuse syndromes typically are seen in kids older than 14 years old. They may suffer from tendinitis of the Achilles Tendon, or less common, plantar fasciitis.
Fractures of the heel can also be seen in kids. Stress fractures are small hairline fractures that are seen more often in teenagers that are active in athletics. Stress fractures are often associated with increased activity. Acute fractures are seen as a result of trauma such as jumping off a piece of furniture, stairway, fence or roof. Heel fractures can be very serious and medical attention should be sought out immediately.
Treatment of pediatric heel pain is often initiated by seeing one of the Podiatrists at Advanced Foot and Ankle. A thorough extremity exam will be carried out follow by X-rays. Sometimes a MRI or CT scan may be necessary. Blood work may also need to be order to rule out arthritic inflammatory conditions or if an infection is suspected.
Treatment depends on the diagnosis and the intensity of the pain. Rest or reduced activity is often suggested. Our doctors may suggest that the child refrain from high impact activity including running and/or jumping. Heel lifts, night splints and/or walking cast immobilization may also be entertained as treatment options. Anti inflammatory medications, physical therapy and custom molded foot braces (orthotics) are other ways of treating pediatric heel pain. On rare occasions surgery may be needed, especially if the child has a short heel cord.
Can anything be done to prevent pediatric heel pain? Yes, shoe gear such as avoiding cleated shoes, avoiding obesity, choosing well constructed shoes that coincide with the patients activity and avoiding activity that may be too aggressive for the child's physical ability.
Dr. Eric Silvers and Dr. Kory Williams see pediatric heel pain daily and are well trained to treat all foot and ankle conditions seen in children. They can be reached at 972-542-2155 or you may visit our website at http://www.advancedfoottexas.com/ .
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155
Tuesday, March 17, 2009
Achilles Tendon Pain?
Thanks for visiting our blog on this week's topic...."Achilles Tendon Problems." We hope you find it informative.
Achilles Tendon Injuries & Problems
Problems that affect the Achilles tendon include tendonitis, tendinopathy, retrocalcaneal bursitis, and tendonosis. Each of these conditions will be described and explained. These problems affect athletes most often, especially runners, basketball players, and anyone engaged in jumping sports. They are also common among both active and sedentary (inactive) middle-aged adults. These problems cause pain at the back of the calf. Severe cases may result in a rupture of the Achilles tendon.
Anatomy of the Achilles Tendon
The Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. The calf is actually formed by two muscles, the underlying soleus and the thick outer gastrocnemius. Together, they form the gastroc-soleal muscle group. When they contract, they pull on the Achilles tendon, causing your foot to point down and helping you rise on your toes. This powerful muscle group helps when you sprint, jump, or climb. Several different problems can occur that affect the Achilles tendon, some rather minor and some quite severe.
Retrocalcaneal Bursitis
A bursa is a fluid-filled sac designed to limit friction between rubbing parts. It acts like a pillow between the heel bone or calcaneus and the achilles tendon. These sacs are found in many places in the body. When a bursa becomes inflamed, the condition is called bursitis. Retrocalcaneal bursitis is an inflammation in the bursa behind the heel bone. This bursa normally limits friction where the thick fibrous Achilles tendon that runs down the back of the calf glides up and down behind the heel.
Achilles Tendinitis
A violent strain can cause trauma to the calf muscles or the Achilles tendon. Sometimes this is referred to as tendonitis. This injury can happen during a strong contraction of the muscle, as when running or sprinting. Landing on the ground after a jump can force the foot upward, also causing injury. The strain can affect different portions of the muscles or tendon. For instance, the strain may occur in the center of the muscle. Or it may happen where the muscles join the Achilles tendon.
Achilles Tendinopathy/Tendinosis
Chronic overuse may contribute to changes in the Achilles tendon as well, leading to degeneration and thickening of the tendon. Studies show there is no sign of inflammation with overuse injuries of tendons. Most experts now refer to this condition as tendinopathy or tendonosis instead of tendonitis.
Achilles Tendon Rupture
In severe cases, the force of a violent strain may even rupture the tendon. The classic example is a middle-aged weekend warrior who places too much stress on the tendon and experiences a tearing or pop of the tendon. In some instances, the rupture may be preceded by a period of tendonitis, which renders the tendon weaker than normal.
Problems with the Achilles tendon seem to occur in different ways. Initially, irritation of the outer covering of the tendon, called the paratenon, causes paratendonitis. Paratendonitis is simply inflammation around the tendon. Inflammation of the retrocalcaneal bursa may also be present with paratendonitis. Either of these conditions may be due to repeated overuse or ill-fitting shoes that rub on the tendon or bursa.
As we age, our tendons can degenerate. Degeneration means that wear and tear occurs in the tendon over time and leads to a situation where the tendon is weaker than normal. Degeneration in a tendon usually shows up as a loss of the normal arrangement of the fibers of the tendon. Tendons are made up of strands of a material called collagen. (Think of a tendon as similar to a nylon rope and the strands of collagen as the nylon strands.) Some of the individual strands of the tendon become jumbled due to the degeneration, other fibers break, and the tendon loses strength.
The healing process in the tendon causes the tendon to become thickened as scar tissue tries to repair the tendon. This process can continue to the extent that a nodule forms within the tendon. This degenerative condition without inflammation is called tendonosis. The area of tendonosis in the tendon is weaker than normal tendon. Tiny tears in the tissue around the tendon occur with overuse. The weakened, degenerative tendon sets the stage for the possibility of actual rupture of the Achilles tendon.
Retrocalcaneal bursitis usually begins with pain and irritation at the back of the heel. There may be visible redness and swelling in the area. The back of the shoe may further irritate the condition, making it difficult to tolerate shoe wear.
Achilles tendonitis usually occurs further up the leg, just above the heel bone itself. The Achilles tendon in this area may be noticeably thickened and tender to the touch. Pain is present with walking, especially when pushing off on the toes.
An Achilles tendon rupture is usually an unmistakable event. Some bystanders may report actually hearing the snap, and the victim of a rupture usually describes a sensation similar to being violently kicked in the calf. Following rupture the calf may swell, and the injured person usually can't rise on his toes.
Diagnosis
Diagnosis is almost always by clinical history and physical examination. The physical examination is used to determine where your leg hurts. We will probably move your ankle in different positions and ask you to hold your foot against the our hand pressure. By stretching the calf muscles and feeling where these muscles attach on the Achilles tendon, we can begin to locate the problem area.
We may run some simple tests if a rupture is suspected. One test involves simply feeling for a gap in the tendon where the rupture has occurred. However, swelling in the area can make it hard to feel a gap.
Another test is done with your leg positioned off the edge of the treatment table. We will squeeze your calf muscle to see if your foot bends downward. If your foot doesn't bend downward, it's highly likely that you have a ruptured Achilles tendon.
When we are unsure whether the Achilles tendon has been ruptured, an MRI scan may be necessary to confirm the diagnosis. This is seldom the case. The MRI creates images that look like slices and shows the tendons and ligaments very clearly. This test does not require any needles or special dye and is painless.
We may order an ultrasound test. An ultrasound uses high-frequency sound waves to create an image of the body's organs and structures. The image can show if an Achilles tendon has partially or completely torn. This test can also be repeated over time to see if a tear has gotten worse.
By using the MRI and ultrasound tests, we can determine if surgery is needed. For example, a small tear may mean that a patient might only need physical therapy and not surgery.
Treatment
Nonsurgical Treatment
Tendonitis/Tendinopathy
In the past, nonsurgical treatment for retrocalcaneal bursitis and Achilles tendonitis started with a combination of rest, ice, and anti-inflammatory medications such as aspirin or ibuprofen.
If there is an inflammatory process, then the condition should respond fairly quickly to drug and antiinflammatory interventions. Limiting, but not eliminating, inflammation is the new goal.
Physical therapy may be recommended for any of these tendon problems. Treatment will depend on what type of problem (tendonitis or tendinopathy/tendonosis) is present.
Your therapist will know when and how to apply cold modalities to reduce swelling and pain but still allow the healing inflammatory process. Physical therapy for chronic tendon problems may also include a special program of stretching and eccentric strengthening exercises. Your therapist will instruct you in a home care program.
Low-energy shock wave therapy has been used successfully for chronic tendinopathy. The procedure does not require anesthesia but it may take several treatment sessions. The vibration produced by the energy waves is applied to areas of tenderness while the affected foot and ankle are gently moved in all directions. Shock wave therapy works by turning off nerves responsible for pain without affecting motor function. It also stimulates soft-tissue healing by increasing blood supply to the area treated.
Tendinosis
If the problem is one of tendon tissue degeneration, healing and recovery may take longer. The injury will not respond to treatment designed to reduce inflammation. Correct treatment of tendinosis involves allowing new tendon tissue growth and improving the strength of the tendon. Rehabilitation following rupture of the tendon is quite different and is described later.
An acute injury needs rest. This can be done by limiting activities like walking on the sore leg. A small ¼ or ½ inch heel lift placed in your shoe can minimize stress by putting slack in the calf muscle and Achilles tendon. Be sure to place a similar sized lift in the other shoe to keep everything aligned. A cortisone injection is not advised for this condition, due to the increased risk of rupture of the tendon following injection.
Tendon Rupture
Nonsurgical treatment for an Achilles tendon rupture is somewhat controversial. It is clear that treatment with a cast will allow the vast majority of tendon ruptures to heal, but the incidence of rerupture is increased in those patients treated with casting for eight weeks when compared with those undergoing surgery. In addition, the strength of the healed tendon is significantly less in patients who choose cast treatment. For these reasons, we feel that Achilles tendon ruptures in nearly all patients should be surgically repaired.
Surgery
Surgical treatment for Achilles tendonitis is not usually necessary for most patients. Surgery options range from a release of the tendon to a more involved, open approach of repair.
In some cases of persistent tendonitis and tendinosis a procedure called debridement of the Achilles tendon may be suggested to help treat the problem.
This procedure is usually done through an incision on the back of the ankle near the Achilles tendon. The tendon is identified, and any inflamed tissue is removed. The tendon is then split, and the degenerative portion of the tendon is removed. The split tendon is then repaired and allowed to heal. It is unclear why, but removing the degenerative portion of the tendon seems to stimulate repair of the tendon to a more normal state.
Surgery may also be suggested if you have a ruptured Achilles tendon. Reattaching the two ends of the tendon repairs the torn Achilles tendon. This procedure is usually done through an incision on the back of the ankle near the Achilles tendon. Numerous procedures have been developed to repair the tendon, but most involve sewing the two ends of the tendon together in some fashion.
After Surgery
Traditionally, patients would be placed in a cast or brace for six to eight weeks after surgery to protect the repair and the skin incision. Crutches would be needed at first to keep from putting weight onto the foot. Complications can occur such as delayed healing, infection, and scarring. More serious problems such as tendon rupture and nerve damage can also occur.
Passive range of motion exercises during this period help patients maintain good general muscle strength and aerobic fitness. Upon removing the cast, a shoe with a fairly high heel is recommended for up to eight more weeks, at which time physical therapy begins.
Immobilizing the leg in a cast can cause joint stiffness, muscle wasting, and blood clots. To avoid these problems, surgeons may have their patients start doing motion exercises very soon after surgery. Patients wear a splint that can easily be removed to do the exercises throughout the day. A crutch or cane may be used at first to help you avoid limping.
Dr. Silvers and Dr. Williams of Advanced Foot and Ankle Center in McKinney and Prosper, Texas have 5 years combined postgraduate training in foot and ankle conditions including managing achilles tendon problems. They also have over 12 years combined private practice experience in treating all conditions of the foot and ankle.The physicians at Advanced Foot and Ankle Center in McKinney and Prosper, Texas are the providers to seek out for treatment not only for achilles tendon problems, but for all of your foot and ankle needs.Advanced Foot and Ankle Services the residents of McKinney, Allen, Plano, Frisco, Prosper, Pilot Point, Little Elm, Melissa, Anna, Celina and surrounding communities. We strive for compassionate and uncompromised foot and ankle care. Our doctors and staff will treat you like family and we respect your busy schedule. Your foot and ankle care is our top priority and we strive to deliver excellent care for all of your podiatric needs. To schedule an appointment to see Dr. Eric Silvers or Dr. Kory Williams of Advanced Foot and Ankle Center , please call us at 972-542-2155 or visit our website at http://www.advancedfoottexas.com/ . We often have same day appointments along with lunchtime, evening and early morning hours.Eric M. Silvers, DPM , PABoard Certified Foot and Ankle SpecialistAdvanced Foot and Ankle CenterMcKinney , TexasProsper, Texashttp://www.advancedfoottexas.com
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155
Achilles Tendon Injuries & Problems
Problems that affect the Achilles tendon include tendonitis, tendinopathy, retrocalcaneal bursitis, and tendonosis. Each of these conditions will be described and explained. These problems affect athletes most often, especially runners, basketball players, and anyone engaged in jumping sports. They are also common among both active and sedentary (inactive) middle-aged adults. These problems cause pain at the back of the calf. Severe cases may result in a rupture of the Achilles tendon.
Anatomy of the Achilles Tendon
The Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. The calf is actually formed by two muscles, the underlying soleus and the thick outer gastrocnemius. Together, they form the gastroc-soleal muscle group. When they contract, they pull on the Achilles tendon, causing your foot to point down and helping you rise on your toes. This powerful muscle group helps when you sprint, jump, or climb. Several different problems can occur that affect the Achilles tendon, some rather minor and some quite severe.
Retrocalcaneal Bursitis
A bursa is a fluid-filled sac designed to limit friction between rubbing parts. It acts like a pillow between the heel bone or calcaneus and the achilles tendon. These sacs are found in many places in the body. When a bursa becomes inflamed, the condition is called bursitis. Retrocalcaneal bursitis is an inflammation in the bursa behind the heel bone. This bursa normally limits friction where the thick fibrous Achilles tendon that runs down the back of the calf glides up and down behind the heel.
Achilles Tendinitis
A violent strain can cause trauma to the calf muscles or the Achilles tendon. Sometimes this is referred to as tendonitis. This injury can happen during a strong contraction of the muscle, as when running or sprinting. Landing on the ground after a jump can force the foot upward, also causing injury. The strain can affect different portions of the muscles or tendon. For instance, the strain may occur in the center of the muscle. Or it may happen where the muscles join the Achilles tendon.
Achilles Tendinopathy/Tendinosis
Chronic overuse may contribute to changes in the Achilles tendon as well, leading to degeneration and thickening of the tendon. Studies show there is no sign of inflammation with overuse injuries of tendons. Most experts now refer to this condition as tendinopathy or tendonosis instead of tendonitis.
Achilles Tendon Rupture
In severe cases, the force of a violent strain may even rupture the tendon. The classic example is a middle-aged weekend warrior who places too much stress on the tendon and experiences a tearing or pop of the tendon. In some instances, the rupture may be preceded by a period of tendonitis, which renders the tendon weaker than normal.
Problems with the Achilles tendon seem to occur in different ways. Initially, irritation of the outer covering of the tendon, called the paratenon, causes paratendonitis. Paratendonitis is simply inflammation around the tendon. Inflammation of the retrocalcaneal bursa may also be present with paratendonitis. Either of these conditions may be due to repeated overuse or ill-fitting shoes that rub on the tendon or bursa.
As we age, our tendons can degenerate. Degeneration means that wear and tear occurs in the tendon over time and leads to a situation where the tendon is weaker than normal. Degeneration in a tendon usually shows up as a loss of the normal arrangement of the fibers of the tendon. Tendons are made up of strands of a material called collagen. (Think of a tendon as similar to a nylon rope and the strands of collagen as the nylon strands.) Some of the individual strands of the tendon become jumbled due to the degeneration, other fibers break, and the tendon loses strength.
The healing process in the tendon causes the tendon to become thickened as scar tissue tries to repair the tendon. This process can continue to the extent that a nodule forms within the tendon. This degenerative condition without inflammation is called tendonosis. The area of tendonosis in the tendon is weaker than normal tendon. Tiny tears in the tissue around the tendon occur with overuse. The weakened, degenerative tendon sets the stage for the possibility of actual rupture of the Achilles tendon.
Retrocalcaneal bursitis usually begins with pain and irritation at the back of the heel. There may be visible redness and swelling in the area. The back of the shoe may further irritate the condition, making it difficult to tolerate shoe wear.
Achilles tendonitis usually occurs further up the leg, just above the heel bone itself. The Achilles tendon in this area may be noticeably thickened and tender to the touch. Pain is present with walking, especially when pushing off on the toes.
An Achilles tendon rupture is usually an unmistakable event. Some bystanders may report actually hearing the snap, and the victim of a rupture usually describes a sensation similar to being violently kicked in the calf. Following rupture the calf may swell, and the injured person usually can't rise on his toes.
Diagnosis
Diagnosis is almost always by clinical history and physical examination. The physical examination is used to determine where your leg hurts. We will probably move your ankle in different positions and ask you to hold your foot against the our hand pressure. By stretching the calf muscles and feeling where these muscles attach on the Achilles tendon, we can begin to locate the problem area.
We may run some simple tests if a rupture is suspected. One test involves simply feeling for a gap in the tendon where the rupture has occurred. However, swelling in the area can make it hard to feel a gap.
Another test is done with your leg positioned off the edge of the treatment table. We will squeeze your calf muscle to see if your foot bends downward. If your foot doesn't bend downward, it's highly likely that you have a ruptured Achilles tendon.
When we are unsure whether the Achilles tendon has been ruptured, an MRI scan may be necessary to confirm the diagnosis. This is seldom the case. The MRI creates images that look like slices and shows the tendons and ligaments very clearly. This test does not require any needles or special dye and is painless.
We may order an ultrasound test. An ultrasound uses high-frequency sound waves to create an image of the body's organs and structures. The image can show if an Achilles tendon has partially or completely torn. This test can also be repeated over time to see if a tear has gotten worse.
By using the MRI and ultrasound tests, we can determine if surgery is needed. For example, a small tear may mean that a patient might only need physical therapy and not surgery.
Treatment
Nonsurgical Treatment
Tendonitis/Tendinopathy
In the past, nonsurgical treatment for retrocalcaneal bursitis and Achilles tendonitis started with a combination of rest, ice, and anti-inflammatory medications such as aspirin or ibuprofen.
If there is an inflammatory process, then the condition should respond fairly quickly to drug and antiinflammatory interventions. Limiting, but not eliminating, inflammation is the new goal.
Physical therapy may be recommended for any of these tendon problems. Treatment will depend on what type of problem (tendonitis or tendinopathy/tendonosis) is present.
Your therapist will know when and how to apply cold modalities to reduce swelling and pain but still allow the healing inflammatory process. Physical therapy for chronic tendon problems may also include a special program of stretching and eccentric strengthening exercises. Your therapist will instruct you in a home care program.
Low-energy shock wave therapy has been used successfully for chronic tendinopathy. The procedure does not require anesthesia but it may take several treatment sessions. The vibration produced by the energy waves is applied to areas of tenderness while the affected foot and ankle are gently moved in all directions. Shock wave therapy works by turning off nerves responsible for pain without affecting motor function. It also stimulates soft-tissue healing by increasing blood supply to the area treated.
Tendinosis
If the problem is one of tendon tissue degeneration, healing and recovery may take longer. The injury will not respond to treatment designed to reduce inflammation. Correct treatment of tendinosis involves allowing new tendon tissue growth and improving the strength of the tendon. Rehabilitation following rupture of the tendon is quite different and is described later.
An acute injury needs rest. This can be done by limiting activities like walking on the sore leg. A small ¼ or ½ inch heel lift placed in your shoe can minimize stress by putting slack in the calf muscle and Achilles tendon. Be sure to place a similar sized lift in the other shoe to keep everything aligned. A cortisone injection is not advised for this condition, due to the increased risk of rupture of the tendon following injection.
Tendon Rupture
Nonsurgical treatment for an Achilles tendon rupture is somewhat controversial. It is clear that treatment with a cast will allow the vast majority of tendon ruptures to heal, but the incidence of rerupture is increased in those patients treated with casting for eight weeks when compared with those undergoing surgery. In addition, the strength of the healed tendon is significantly less in patients who choose cast treatment. For these reasons, we feel that Achilles tendon ruptures in nearly all patients should be surgically repaired.
Surgery
Surgical treatment for Achilles tendonitis is not usually necessary for most patients. Surgery options range from a release of the tendon to a more involved, open approach of repair.
In some cases of persistent tendonitis and tendinosis a procedure called debridement of the Achilles tendon may be suggested to help treat the problem.
This procedure is usually done through an incision on the back of the ankle near the Achilles tendon. The tendon is identified, and any inflamed tissue is removed. The tendon is then split, and the degenerative portion of the tendon is removed. The split tendon is then repaired and allowed to heal. It is unclear why, but removing the degenerative portion of the tendon seems to stimulate repair of the tendon to a more normal state.
Surgery may also be suggested if you have a ruptured Achilles tendon. Reattaching the two ends of the tendon repairs the torn Achilles tendon. This procedure is usually done through an incision on the back of the ankle near the Achilles tendon. Numerous procedures have been developed to repair the tendon, but most involve sewing the two ends of the tendon together in some fashion.
After Surgery
Traditionally, patients would be placed in a cast or brace for six to eight weeks after surgery to protect the repair and the skin incision. Crutches would be needed at first to keep from putting weight onto the foot. Complications can occur such as delayed healing, infection, and scarring. More serious problems such as tendon rupture and nerve damage can also occur.
Passive range of motion exercises during this period help patients maintain good general muscle strength and aerobic fitness. Upon removing the cast, a shoe with a fairly high heel is recommended for up to eight more weeks, at which time physical therapy begins.
Immobilizing the leg in a cast can cause joint stiffness, muscle wasting, and blood clots. To avoid these problems, surgeons may have their patients start doing motion exercises very soon after surgery. Patients wear a splint that can easily be removed to do the exercises throughout the day. A crutch or cane may be used at first to help you avoid limping.
Dr. Silvers and Dr. Williams of Advanced Foot and Ankle Center in McKinney and Prosper, Texas have 5 years combined postgraduate training in foot and ankle conditions including managing achilles tendon problems. They also have over 12 years combined private practice experience in treating all conditions of the foot and ankle.The physicians at Advanced Foot and Ankle Center in McKinney and Prosper, Texas are the providers to seek out for treatment not only for achilles tendon problems, but for all of your foot and ankle needs.Advanced Foot and Ankle Services the residents of McKinney, Allen, Plano, Frisco, Prosper, Pilot Point, Little Elm, Melissa, Anna, Celina and surrounding communities. We strive for compassionate and uncompromised foot and ankle care. Our doctors and staff will treat you like family and we respect your busy schedule. Your foot and ankle care is our top priority and we strive to deliver excellent care for all of your podiatric needs. To schedule an appointment to see Dr. Eric Silvers or Dr. Kory Williams of Advanced Foot and Ankle Center , please call us at 972-542-2155 or visit our website at http://www.advancedfoottexas.com/ . We often have same day appointments along with lunchtime, evening and early morning hours.Eric M. Silvers, DPM , PABoard Certified Foot and Ankle SpecialistAdvanced Foot and Ankle CenterMcKinney , TexasProsper, Texashttp://www.advancedfoottexas.com
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155
Thursday, November 13, 2008
Dr. Silvers to open a Prosper, Texas Location
Dr. Eric Silvers of McKinney Foot and Ankle Center will be opening a second office in Prosper, Texas the early part of 2009. Dr. Silvers is a board certified foot and ankle specialist and has been in practice for over 11 years. He serves communities in Collin County including Prosper, McKinney, Plano, Allen, Anna, Melissa, Frisco and Princeton Texas. Dr. Silvers treats all ages from infants to geriatrics with foot and ankle conditions. Some conditions include heel and arch pain as a result of plantar fasciitis, injuries to the foot and ankle including running injuries, fractures and wound care to the foot and ankle, bunions, plantar warts, shin splints, Achilles tendinitis and tendon ruptures, ingrown and fungal toenails, just to name a few. Dr. Silvers will still maintain his main location in McKinney, Texas.To schedule an appointment with Dr. Silvers please call McKinney Foot and Ankle Center at 972-542-2155 or visit our website at www.mckinneyfootcenter.com.
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