ACHILLES'-TENDON STRAIN |
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General Information
DEFINITION--Injury to the Achilles' tendon or its adjoining muscle or bone. These 3 parts comprise a unit. The strain occurs at the weakest part of the unit. Strains are of 3 types:
Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Achilles' tendon.
Muscle attached to the Achilles' tendon.
Heel bone.
Soft tissue surrounding the strain, including nerves, periosteum (bone covering), blood vessels and lymph vessels.
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SIGNS & SYMPTOMS
Pain when flexing or extending the foot.
Muscle spasm at the rear of the calf.
Swelling around the Achilles' tendon.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the muscle or its tendon (visible with X-ray).
Inflammation of the sheath covering the Achilles' tendon.
CAUSES
Prolonged overuse of muscle-tendon units in the ankle.
Single episode of stressful overactivity, as in hurdling, long-jumping, high-jumping or starting a sprint.
RISK INCREASES WITH
Contact sports.
Running.
Sports that require quick starts, such as long-jumping, hurdling or running races.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Obesity.
Poor nutrition.
Previous Achilles'-tendon injury.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
Tape the Achilles' area before practice or competition.
Wear proper protective shoes.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis.
Application of tape, plaster splints or casts (sometimes).
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Surgery (severe strain).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas to rule out fractures.
POSSIBLE COMPLICATIONS
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic ankle following repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as bone fractures. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDFollow instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CAREIf a cast or splints are used, leave toes free and exercise them occasionally. If a cast or splints are not used:
Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Wrap the injured ankle with an elasticized bandage between treatments. Insert a heel lift in your shoe.
Massage gently and often to provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Aspirin, acetaminophen, or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain (rare).
Injection of a corticosteroid, such as triamcinolone, to reduce inflammation (rare).
ACTIVITY
For a moderate or severe strain, walk with crutches for at least 72 hours--longer with a cast or splints. See Appendix 3 (Safe Use of Crutches).
Resume normal activities gradually after pain has subsided.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe Achilles'-tendon strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.
The following occurs with a cast or splints:
Pain, numbness or coldness below the injury.
Dusky, blue or gray toenails.
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