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Thursday, July 5, 2012

Partial Rupture Achilles Tendon

View of cross section of the achilles tendon showing small tear with fluid accummulation. The tendon itself is 1/3 larger than it should be typical in a injured tendon that is trying to heal with scar tissue and chronic inflammation

Side View of the same achilles belonging to the patient below. The 3/8th inch tear in length is more easily seen. The area around the tear is thicker than normal as the body attempts to heal. 
Dear Dr. Blake:

I received your voice-mail message yesterday.  Thank you.  I have the following questions:

You said there is a tear in the left achilles.  What is the size and extent of the tear?  Can you ascertain from the MRI how long it has been there, and if there are signs of healing?
Dr Blake's comment: 
The tear is one inch long and is 10% of the total tendon. No, cannot determine how long it has been there. In 6 months, we can get a new MRI to assess the healing status. 

The worst of the achilles was after a long hike in November, 2011.  I did use a boot for approximately 3 weeks in December, which did seem to help.  Since then I have been getting some physical therapy.  
You did say that you didn't think that physical therapy would be useful, although it seems to me that the deep tissue work along with the ultrasound which I have been getting has been helpful.
Dr Blake's comment: PT can be helpful, just unpredictable, and will not heal the tear. I do know patients whose tear remained, but their symptoms resolved. Unsure why?

  Although much better, the injury is still problematic, especially in going up and down stairs and up and down an incline.  Hiking is one way I try keep in shape, keep my weight down and work off stress, but I have been unable to hike for many months.  Can you tell me your prognosis for this injury?
Dr Blake's comment: People get better with this injury, but it is approached in many ways. One of the main questions is "Can you coexist with the injury without surgically fixing it?" I had mentioned to the patient that there were many options including 3 month removable boot to rest the tendon, PRP injection(s) (Plasma Rich Proteins), Topaz surgical welding of the good parts of the tendon together, more traditional open incision with exploration and fixing what find, and deep tissue work with the boot. 

Of the treatment options you mentioned, I am most inclined toward the most conservative treatment which seems to be immobilizing the foot in a boot for a period of time.  I am concerned that walking in a boot may cause other problems with my back, hips, ect, as I have had those problems in the past.  What is your opinion regarding this potential side effect? 

Dr Blake's comment: For the other side you will use an EvenUp which helps protect your back.
Regarding the X-rays of my right foot, you indicated that there is no sign of fracture.  That's great, however I do still have a lot of pain in the joint of the second toe.  If it is not fractured, what is causing the pain?  I am using the toe brace you prescribed which does give me some relief.  I have been getting physical therapy for that as well, but it is too painful to do much manipulation of the joint.  Do you think
 a Cortisone injection be helpful in any way?
Dr Blake's comment:  Regarding second toe, stay away from cortisone shot since it would
weaken ligament.  Probably should get  MRI of this. No fracture seen
on xray, but still
could exist.

How does the injury of the left achilles effect the injury of the right, second toe, and visa versa?  (It seems to me that a shoe with a slight heal relieves the left achilles, but aggravates the right, second toe; and a flat shoe relieves the right, second toe but aggravates the left achilles.)
Dr Blake's comment: Yes, why a boot with Even Up is best.

Thank you for your willingness to communicate with me via email.  It is so much easier and more efficient for me.  I look forward to your reply.

Very truly yours,

Dr Blake's Comment: I would be remiss not to mention BRISS, the acronym for the management of all tendinitis conditions like you have. Please see the link to my original post on this. Rich

1 comment:

  1. Thanks for this sharing. Your posts & replies will help many in this who are having any such problems.


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.