Acquired Flat Foot
Overview
Posterior tibial tendon dysfunction is one of several terms to describe a painful, progressive flatfoot deformity in adults. Other terms include posterior tibial tendon insufficiency and adult acquired flatfoot. The term adult acquired flatfoot is more appropriate because it allows a broader recognition of causative factors, not only limited to the posterior tibial tendon, an event where the posterior tibial tendon looses strength and function. The adult acquired flatfoot is a progressive, symptomatic (painful) deformity resulting from gradual stretch (attenuation) of the tibialis posterior tendon as well as the ligaments that support the arch of the foot. 
Causes
The most common cause of acquired adult flatfoot is posterior tibial tendon dysfunction. What causes adult acquired flat foot? Fracture or dislocation. Tendon laceration. Tarsal Coalition. Arthritis. Neuroarthropathy. Neurological weakness.
Symptoms
Initially, flatfoot deformity may not present with any symptoms. However, overtime as the tendon continues to function in an abnormal position, people with fallen arches will begin to have throbbing or sharp pain along the inside of the arch. Once the tendon and soft tissue around it elongates, there is no strengthening exercises or mechanism to shorten the tendon back to a normal position. Flatfoot can also occur in one or both feet. If the arch starts to slowly collapse in one foot and not the other, posterior tibial dysfunction (PTTD) is the most likely cause. People with flatfoot may only have pain with certain activities such as running or exercise in the early phase of PTTD. Pain may start from the arch and continue towards the inside part of the foot and ankle where the tendon courses from the leg. Redness, swelling and increased warmth may also occur. Later signs of PTTD include pain on the outside of the foot from the arch collapsing and impinging other joints. Arthritic symptoms such as painful, swollen joints in the foot and ankle may occur later as well due to the increased stress on the joints from working in an abnormal position for a long period of time.
Diagnosis
The diagnosis of posterior tibial tendon dysfunction and AAFD is usually made from a combination of symptoms, physical exam and x-ray imaging. The location of pain, shape of the foot, flexibility of the hindfoot joints and gait all may help your physician make the diagnosis and also assess how advanced the problem is.
Non surgical Treatment
This condition may be treated with conservative methods. These can include orthotic devices, special shoes, and bracing. Physical therapy, rest, ice, and anti-inflammatory medication may be prescribed to help relieve symptoms. If the condition is very severe, surgical treatment may be needed. 
Surgical Treatment
Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Bone procedures are necessary at this stage in order to recreate the arch and stabilize the foot. These procedures include isolated fusion procedures, bone grafts, and/or the repositioning of bones through cuts called osteotomies. The realigned bones are generally held in place with screws, pins, plates, or staples while the bone heals. A tendon transfer may or may not be utilized depending on the condition of the posterior tibial tendon. Stage three deformities are better treated with surgical correction, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage. Stage four deformities are treated similarly but with the addition of fusing the ankle joint.
Pain In The Foot's Arch Causes Symptoms And Treatments
Overview
Plantar fasciitis refers to an inflammation of the plantar fascia, a thick, fibrous band running along the sole of the foot. Such inflammation results from direct injury to the plantar fascia, usually, repeated trauma to the tissue where the fascia attaches to the calcaneus or heel bone. The plantar fascia is critical in maintaining the foot?s complex arch system, also playing a role in balance and fine control of certain phases of the athlete?s gait. Injury to the plantar fascia is particularly painful and disabling for runners and can often prove stubbornly resistant to treatment. Rehabilitation is frequently a lengthy and frustrating process. For these reasons, care should be taken where possible to avoid such injury by means of preventative exercises and sensitivity to early warning signs.
Causes
Over-stretching or tearing the arch pad causes the dull ache that is associated with arch pain. Pain is most keenly felt when weight is put onto the foot, or when pushing off the foot into the next stride. The pain of foot arch strain can be particularly acute after sitting for a long time, or when getting up in the morning. Those most susceptible to the condition are people with very high, rigid arches. The injury is also common in middle-aged people who have been inactive for a long period of time before suddenly increasing their physical activity. The injury is particularly common in runners and joggers.
Symptoms
The majority of children and adults with flexible flatfeet never have symptoms. However, their toes may tend to point outward as they walk, a condition called out-toeing. A person who develops symptoms usually complains of tired, aching feet, especially after prolonged standing or walking. Symptoms of rigid flatfoot vary depending on the cause of the foot problem.
Diagnosis
Magnetic Resonance Imaging (MRI) can show tendon injury and inflammation but cannot be relied on with 100% accuracy and confidence. The technique and skill of the radiologist in properly positioning the foot with the MRI beam are critical in demonstrating the sometimes obscure findings of tendon injury around the ankle. Magnetic Resonance Imaging (MRI) is expensive and is not necessary in most cases to diagnose posterior tibial tendon injury. Ultrasound has also been used in some cases to diagnose tendon injury, but this test again is usually not required to make the initial diagnosis.
Non Surgical Treatment
For mild pain or aching, acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen (Advil, Motrin and others) may be effective. When there are no symptoms, treatment is not needed. If a child older than age 3 develops symptoms, the doctor may prescribe a therapeutic shoe insert made from a mold of the child's foot or a corrective shoe. As an alternative, some doctors recommend store-bought arch supports. These appear to work as well as more expensive treatments in many children. With any conservative, nonsurgical treatment, the goal is to relieve pain by supporting the arch and correcting any imbalance in the mechanics of the foot. Surgery is typically offered as a last resort in people with significant pain that is resistant to other therapies.
Surgical Treatment
Patients with adult acquired flatfoot are advised to discuss thoroughly the benefits vs. risks of all surgical options. Most procedures have long-term recovery mandating that the correct procedure be utilized to give the best long-term benefit. Most flatfoot surgical procedures require six to twelve weeks of cast immobilization. Joint fusion procedures require eight weeks of non-weightbearing on the operated foot, meaning you will be on crutches for two months. The bottom line is: Make sure all of your non-surgical options have been covered before considering surgery. Your primary goals with any treatment are to eliminate pain and improve mobility. In many cases, with the properly designed foot orthosis or ankle brace, these goals can be achieved without surgical intervention.
Prevention
Stretch and strengthen important muscles in your feet, ankles and legs in order to guard against future strain. Make sure to acquire suitable arch supports and inserts if necessary, and that your shoes are shock absorbent and in good condition. Wearing tattered shoes provides no protection, and runners should replace their footwear before exceeding 500 miles of usage. Athletes new to arch supports should gradually build their training routine, allowing their feet to become accustomed to a new stance.
Stretching Exercises
Plantar Fasciitis stretches can be incorporated into a comprehensive treatment regime which may involve: ice, heel wedge support, taping, massage, muscle strengthening, orthotic inserts for shoes, topical anti inflammatory gel or oral medication and/or corticosteroid injections. If you suspect you may have Plantar Fasciitis seek accurate diagnosis and treatment from a health professional to ensure a correct diagnosis and reduce the likelihood of developing chronic foot pain. Treatment interventions may be provided by your Physical Therapist, Podiatrist and/or doctor.
Plantar fasciitis refers to an inflammation of the plantar fascia, a thick, fibrous band running along the sole of the foot. Such inflammation results from direct injury to the plantar fascia, usually, repeated trauma to the tissue where the fascia attaches to the calcaneus or heel bone. The plantar fascia is critical in maintaining the foot?s complex arch system, also playing a role in balance and fine control of certain phases of the athlete?s gait. Injury to the plantar fascia is particularly painful and disabling for runners and can often prove stubbornly resistant to treatment. Rehabilitation is frequently a lengthy and frustrating process. For these reasons, care should be taken where possible to avoid such injury by means of preventative exercises and sensitivity to early warning signs.
Causes
Over-stretching or tearing the arch pad causes the dull ache that is associated with arch pain. Pain is most keenly felt when weight is put onto the foot, or when pushing off the foot into the next stride. The pain of foot arch strain can be particularly acute after sitting for a long time, or when getting up in the morning. Those most susceptible to the condition are people with very high, rigid arches. The injury is also common in middle-aged people who have been inactive for a long period of time before suddenly increasing their physical activity. The injury is particularly common in runners and joggers.
Symptoms
The majority of children and adults with flexible flatfeet never have symptoms. However, their toes may tend to point outward as they walk, a condition called out-toeing. A person who develops symptoms usually complains of tired, aching feet, especially after prolonged standing or walking. Symptoms of rigid flatfoot vary depending on the cause of the foot problem.
Diagnosis
Magnetic Resonance Imaging (MRI) can show tendon injury and inflammation but cannot be relied on with 100% accuracy and confidence. The technique and skill of the radiologist in properly positioning the foot with the MRI beam are critical in demonstrating the sometimes obscure findings of tendon injury around the ankle. Magnetic Resonance Imaging (MRI) is expensive and is not necessary in most cases to diagnose posterior tibial tendon injury. Ultrasound has also been used in some cases to diagnose tendon injury, but this test again is usually not required to make the initial diagnosis.
Non Surgical Treatment
For mild pain or aching, acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen (Advil, Motrin and others) may be effective. When there are no symptoms, treatment is not needed. If a child older than age 3 develops symptoms, the doctor may prescribe a therapeutic shoe insert made from a mold of the child's foot or a corrective shoe. As an alternative, some doctors recommend store-bought arch supports. These appear to work as well as more expensive treatments in many children. With any conservative, nonsurgical treatment, the goal is to relieve pain by supporting the arch and correcting any imbalance in the mechanics of the foot. Surgery is typically offered as a last resort in people with significant pain that is resistant to other therapies.
Surgical Treatment
Patients with adult acquired flatfoot are advised to discuss thoroughly the benefits vs. risks of all surgical options. Most procedures have long-term recovery mandating that the correct procedure be utilized to give the best long-term benefit. Most flatfoot surgical procedures require six to twelve weeks of cast immobilization. Joint fusion procedures require eight weeks of non-weightbearing on the operated foot, meaning you will be on crutches for two months. The bottom line is: Make sure all of your non-surgical options have been covered before considering surgery. Your primary goals with any treatment are to eliminate pain and improve mobility. In many cases, with the properly designed foot orthosis or ankle brace, these goals can be achieved without surgical intervention.
Prevention
Stretch and strengthen important muscles in your feet, ankles and legs in order to guard against future strain. Make sure to acquire suitable arch supports and inserts if necessary, and that your shoes are shock absorbent and in good condition. Wearing tattered shoes provides no protection, and runners should replace their footwear before exceeding 500 miles of usage. Athletes new to arch supports should gradually build their training routine, allowing their feet to become accustomed to a new stance.
Stretching Exercises
Plantar Fasciitis stretches can be incorporated into a comprehensive treatment regime which may involve: ice, heel wedge support, taping, massage, muscle strengthening, orthotic inserts for shoes, topical anti inflammatory gel or oral medication and/or corticosteroid injections. If you suspect you may have Plantar Fasciitis seek accurate diagnosis and treatment from a health professional to ensure a correct diagnosis and reduce the likelihood of developing chronic foot pain. Treatment interventions may be provided by your Physical Therapist, Podiatrist and/or doctor.
Does Posterior Tibial Tendon Dysfunction Involve Surgery Teatment ?
Overview
When we have foot pain, it isn?t always easy to pinpoint the source because we can?t visualize the structure of all the bones, muscles, and tendons on the inside. The posterior tibial tendon plays an important supportive role within the structure of the foot. It attaches to your calf muscle and then comes down along the inside of your ankle, connecting to the bones inside your foot at the other side. This tendon?s main function is to hold up your arch and support your foot during each and every movement. Every step, run, walk, or jump is made possible with the support from this crucial tendon. While it is designed to perform such an important role, it is vulnerable to stress and injury. A tear during a traumatic injury or stress from overuse can injure the tissues within the tendon. This kind of injury is referred to as posterior tibial tendon dysfunction (PTTD). A really hard fall during a sports game or exposure to a repetitive motion, such as the impact on feet during soccer, tennis, football or basketball, can cause an injury. Flat foot and flat feet in adults can exacerbate this condition. The tendon can experience small tears and become inflamed. If the inflammation is allowed to continue and worsen over time, it will weaken further and could rupture completely. 
Causes
There are multiple factors contributing to the development of this problem. Damage to the nerves, ligaments, and/or tendons of the foot can cause subluxation (partial dislocation) of the subtalar or talonavicular joints. Bone fracture is a possible cause. The resulting joint deformity from any of these problems can lead to adult-acquired flatfoot deformity. Dysfunction of the posterior tibial tendon has always been linked with adult-acquired flatfoot deformity (AAFD). The loss of active and passive pull of the tendon alters the normal biomechanics of the foot and ankle. The reasons for this can be many and varied as well. Diabetes, high blood pressure, and prolonged use of steroids are some of the more common causes of adult-acquired flatfoot deformity (AAFD) brought on by impairment of the posterior tibialis tendon. Overstretching or rupture of the tendon results in tendon and muscle imbalance in the foot leading to adult-acquired flatfoot deformity (AAFD). Rheumatoid arthritis is one of the more common causes. About half of all adults with this type of arthritis will develop adult flatfoot deformity over time. In such cases, the condition is gradual and progressive. Obesity has been linked with this condition. Loss of blood supply for any reason in the area of the posterior tibialis tendon is another factor. Other possible causes include bone fracture or dislocation, a torn or stretched tendon, or a neurologic condition causing weakness.
Symptoms
The symptom most often associated with AAF is PTTD, but it is important to see this only as a single step along a broader continuum. The most important function of the PT tendon is to work in synergy with the peroneus longus to stabilize the midtarsal joint (MTJ). When the PT muscle contracts and acts concentrically, it inverts the foot, thereby raising the medial arch. When stretched under tension, acting eccentrically, its function can be seen as a pronation retarder. The integrity of the PT tendon and muscle is crucial to the proper function of the foot, but it is far from the lone actor in maintaining the arch. There is a vital codependence on a host of other muscles and ligaments that when disrupted leads to an almost predictable loss in foot architecture and subsequent pathology.
Diagnosis
Diagnostic testing is often used to diagnose the condition and help determine the stage of the disease. The most common test done in the office setting are weightbearing X-rays of the foot and ankle. These assess joint alignment and osteoarthritis. If tendon tearing or rupture is suspected, the gold standard test would be MRI. The MRI is used to check the tendon, surrounding ligament structures and the midfoot and hindfoot joints. An MRI is essential if surgery is being considered.
Non surgical Treatment
Nonoperative treatment of stage 1 and 2 acquired adult flatfoot deformity can be successful. General components of the treatment include the use of comfort shoes. Activity modification to avoid exacerbating activities. Weight loss if indicated. Specific components of treatment that over time can lead to marked improvement in symptoms include a high repetition, low resistance strengthening program. Appropriate bracing or a medial longitudinal arch support. If the posterior tibial tendon is intact, a series of exercises aimed at strengthening the elongated and dysfunctional tendon complex can be successful. In stage 2 deformities, this is combined with an ankle brace for a period of 2-3 months until the symptoms resolve. At this point, the patient is transitioned to an orthotic insert which may help to support the arch. In patients with stage 1 deformity it may be possible to use an arch support immediately. 
Surgical Treatment
Although non-surgical treatments can successfully manage the symptoms, they do not correct the underlying problem. It can require a life-long commitment to wearing the brace during periods of increased pain or activity demands. This will lead a majority of patients to choose surgical correction of the deformity, through Reconstructive Surgery. All of the considerations that were extremely important during the evaluation stage become even more important when creating a surgical plan. Generally, a combination of procedures are utilized in the same setting, to allow full correction of the deformity. Many times, this can be performed as a same-day surgery, without need for an overnight hospital stay. However, one or two day hospital admissions can be utilized to help manage the post-operative pain. Although the recovery process can require a significant investment of time, the subsequent decades of improved function and activity level, as well as decreased pain, leads to a substantial return on your investment.
Living With Achilles Tendinitis Discomfort
Overview
The Achilles tendon attaches your calf muscles to your heel. You use this tendon to jump, walk, run, and stand on the balls of your feet. Continuous, intense physical activity, like running and jumping, can cause inflammation of the Achilles. This is known as Achilles tendonitis (also spelled tendinitis). Achilles tendonitis can often be treated at home using simple strategies. However, if home treatment doesn?t work, it is important to see a doctor. If your tendonitis gets worse, it can lead to a tendon tear. You may need medication to ease the pain or a surgical repair.
Causes
There are a number of ways a person can develop Achilles tendinitis. Some causes are easier to avoid than others, but being aware of them can aid earlier diagnosis and help prevent serious injury. Causes of Achilles tendinitis include, using incorrect or worn out shoes when running or exercising. Not warming up properly before exercise. Increasing intensity of exercise too quickly (e.g. running speed or distance covered). Prematurely introducing hill running or stair climbing to exercise routine. Running on hard or uneven surfaces. Calf muscle is injured or has little flexibility (this puts a lot of strain on the Achilles tendon). Sudden intense physical activity such as sprinting for the finish line. Achilles tendinitis can also be caused by differences in foot, leg or ankle anatomy. For example, some people can have flatness in their foot where there would normally be an arch; this puts more strain on the tendon. The FDA has asked that a boxed warning be added to the prescribing information for fluoroquinolone antibiotics. Patients taking these drugs may experience an increased risk of tendinitis and tendon rupture. Fluoroquinolones include Cipro (ciprofloxacin), Factive (gemifloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), Floxin (ofloxacin) and Proquin (ciprofloxacin hydrochloride). It is important to remember that the risk for injury is not necessarily gone when the drug is stopped. Cases have been reported in which tendon problems occurred up to several months after the drug was discontinued.
Symptoms
Pain anywhere along the tendon, but most often on or close to the heel. Swelling of the skin over the tendon, associated with warmth, redness and tenderness. Pain on rising up on the toes and pain with pushing off on the toes. If you are unable to stand on your toes you may have ruptured the tendon. This requires urgent medical attention. A painful heel for the first few minutes of walking after waking up in the morning. Stiffness of the ankle, which often improves with mild activity.
Diagnosis
A doctor examines the patient, checking for pain and swelling along the posterior of the leg. The doctor interviews the patient regarding the onset, history, and description of pain and weakness. The muscles, tissues, bones, and blood vessels may be evaluated with imaging studies, such as X-ray, ultrasound, or MRI.
Nonsurgical Treatment
More often than not, Achilles tendonitis can be treated without surgery. However, recovery may take a few months. The following will can help you recover and get back in the game. Rest is always the most important thing when recovering from an injury. Your body needs a break to heal. While taking time off from exercise is recommended, if you just can?t ditch all physical activities, switch to more low-impact ones while you?re recovering. When resting your Achilles, try biking, swimming or using an elliptical machine until you?re fully healed. Icing the injured area of your Achilles tendon throughout the day can help to reduce the swelling and pain. However, try not to ice it for more than 20 minutes at a time. Non-steroidal anti-inflammatory medication is recommended to help reduce the swelling and pain associated with Achilles tendonitis. These include such drugs as ibuprofen and naproxen. While they will reduce swelling, the do not reduce the thickening for the tendon. If you find yourself taking these medications for more than a month, speak with your doctor.
Surgical Treatment
Percutaneous Achilles Tendon Surgery. During this procedure the surgeon will make 3 to 4 incisions (approx. 2.5 cm long) on both sides of the Achilles tendon. Small forceps are used to free the tendon sheath (the soft tissue casing around your Achilles tendon) to make room for the surgeon to stitch/suture any tears. Skilled surgeons may perform a percutaneous achilles tendon surgery with ultrasound imaging techniques to allow for blink suturing with stab incisions made by a surgical suture needle. This procedure can be done in 3 different ways depending on the preference and experience of your surgeon. Instead of making several 2.5 cm incisions for this procedure, some surgeons will use guided imaging with an ultrasound to see the Achilles tendon tissue without having to open up your ankle. For this technique, they will use a surgical needle to repeatedly stab your Achilles tendon. These "stab incisions" will allow the surgeon to "blindly" suture your tendon without seeing the actual tissue. As another option - some surgeons will only make 1 to 3 incisions for smaller surgical implements to repair your tendon while relying on imaging ultrasound to see your damaged tissue. During either procedure the use of ultrasound imaging or endoscopic techniques requires a very skilled surgeon.
Prevention
Warm up slowly by running at least one minute per mile slower than your usual pace for the first mile. Running backwards during your first mile is also a very effective way to warm up the Achilles, because doing so produces a gentle eccentric load that acts to strengthen the tendon. Runners should also avoid making sudden changes in mileage, and they should be particularly careful when wearing racing flats, as these shoes produce very rapid rates of pronation that increase the risk of Achilles tendon injury. If you have a tendency to be stiff, spend extra time stretching. If you?re overly flexible, perform eccentric load exercises preventively. Lastly, it is always important to control biomechanical alignment issues, either with proper running shoes and if necessary, stock or custom orthotics.
The Achilles tendon attaches your calf muscles to your heel. You use this tendon to jump, walk, run, and stand on the balls of your feet. Continuous, intense physical activity, like running and jumping, can cause inflammation of the Achilles. This is known as Achilles tendonitis (also spelled tendinitis). Achilles tendonitis can often be treated at home using simple strategies. However, if home treatment doesn?t work, it is important to see a doctor. If your tendonitis gets worse, it can lead to a tendon tear. You may need medication to ease the pain or a surgical repair.
Causes
There are a number of ways a person can develop Achilles tendinitis. Some causes are easier to avoid than others, but being aware of them can aid earlier diagnosis and help prevent serious injury. Causes of Achilles tendinitis include, using incorrect or worn out shoes when running or exercising. Not warming up properly before exercise. Increasing intensity of exercise too quickly (e.g. running speed or distance covered). Prematurely introducing hill running or stair climbing to exercise routine. Running on hard or uneven surfaces. Calf muscle is injured or has little flexibility (this puts a lot of strain on the Achilles tendon). Sudden intense physical activity such as sprinting for the finish line. Achilles tendinitis can also be caused by differences in foot, leg or ankle anatomy. For example, some people can have flatness in their foot where there would normally be an arch; this puts more strain on the tendon. The FDA has asked that a boxed warning be added to the prescribing information for fluoroquinolone antibiotics. Patients taking these drugs may experience an increased risk of tendinitis and tendon rupture. Fluoroquinolones include Cipro (ciprofloxacin), Factive (gemifloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), Floxin (ofloxacin) and Proquin (ciprofloxacin hydrochloride). It is important to remember that the risk for injury is not necessarily gone when the drug is stopped. Cases have been reported in which tendon problems occurred up to several months after the drug was discontinued.
Symptoms
Pain anywhere along the tendon, but most often on or close to the heel. Swelling of the skin over the tendon, associated with warmth, redness and tenderness. Pain on rising up on the toes and pain with pushing off on the toes. If you are unable to stand on your toes you may have ruptured the tendon. This requires urgent medical attention. A painful heel for the first few minutes of walking after waking up in the morning. Stiffness of the ankle, which often improves with mild activity.
Diagnosis
A doctor examines the patient, checking for pain and swelling along the posterior of the leg. The doctor interviews the patient regarding the onset, history, and description of pain and weakness. The muscles, tissues, bones, and blood vessels may be evaluated with imaging studies, such as X-ray, ultrasound, or MRI.
Nonsurgical Treatment
More often than not, Achilles tendonitis can be treated without surgery. However, recovery may take a few months. The following will can help you recover and get back in the game. Rest is always the most important thing when recovering from an injury. Your body needs a break to heal. While taking time off from exercise is recommended, if you just can?t ditch all physical activities, switch to more low-impact ones while you?re recovering. When resting your Achilles, try biking, swimming or using an elliptical machine until you?re fully healed. Icing the injured area of your Achilles tendon throughout the day can help to reduce the swelling and pain. However, try not to ice it for more than 20 minutes at a time. Non-steroidal anti-inflammatory medication is recommended to help reduce the swelling and pain associated with Achilles tendonitis. These include such drugs as ibuprofen and naproxen. While they will reduce swelling, the do not reduce the thickening for the tendon. If you find yourself taking these medications for more than a month, speak with your doctor.
Surgical Treatment
Percutaneous Achilles Tendon Surgery. During this procedure the surgeon will make 3 to 4 incisions (approx. 2.5 cm long) on both sides of the Achilles tendon. Small forceps are used to free the tendon sheath (the soft tissue casing around your Achilles tendon) to make room for the surgeon to stitch/suture any tears. Skilled surgeons may perform a percutaneous achilles tendon surgery with ultrasound imaging techniques to allow for blink suturing with stab incisions made by a surgical suture needle. This procedure can be done in 3 different ways depending on the preference and experience of your surgeon. Instead of making several 2.5 cm incisions for this procedure, some surgeons will use guided imaging with an ultrasound to see the Achilles tendon tissue without having to open up your ankle. For this technique, they will use a surgical needle to repeatedly stab your Achilles tendon. These "stab incisions" will allow the surgeon to "blindly" suture your tendon without seeing the actual tissue. As another option - some surgeons will only make 1 to 3 incisions for smaller surgical implements to repair your tendon while relying on imaging ultrasound to see your damaged tissue. During either procedure the use of ultrasound imaging or endoscopic techniques requires a very skilled surgeon.
Prevention
Warm up slowly by running at least one minute per mile slower than your usual pace for the first mile. Running backwards during your first mile is also a very effective way to warm up the Achilles, because doing so produces a gentle eccentric load that acts to strengthen the tendon. Runners should also avoid making sudden changes in mileage, and they should be particularly careful when wearing racing flats, as these shoes produce very rapid rates of pronation that increase the risk of Achilles tendon injury. If you have a tendency to be stiff, spend extra time stretching. If you?re overly flexible, perform eccentric load exercises preventively. Lastly, it is always important to control biomechanical alignment issues, either with proper running shoes and if necessary, stock or custom orthotics.
