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Achilles Tendon Tear/Rupture
Achilles tendon tear or rupture is very common in all running or jumping sports, especially ball and racquet sports. Symptoms include a sudden onset of pain in the Achilles region (back of the calf), in cases of tendon rupture, a snap may be heard and the calf muscle will be almost useless. Swelling and bruising will be apparent after some time and may track into the foot or up the leg. Immediate medical attention is usually required in the case of rupture.
Achilles tendonitis is common in running sports especially endurance sports such as long distance running. Achilles tendonitis is inflammation of the Achilles tendon and is characterised by slow onset pain in the Achilles region that will worsen with physical activity. Swelling will always accompany the pain. Pain will tend to be worse in the morning, worse with increased activity and worse after activity. Over time, a tight calf and thickening of the Achilles tendon may be apparent. Pain may decrease with rest and icing.
Tibialis Posterior Syndrome
This problem will commonly occur in those with ‘flat feet’. The excessive rolling inwards associated with flat feet puts extra tension on the tibialis posterior tendon which runs behind the ankle joint on the inside of the Achilles tendon. Symptoms include a burning pain, swelling and sometimes ‘creaking’ on the inside of the ankle joint behind the bony protrusion. This pain will increase with walking and especially running. Rest and ice may decrease the pain.
Posterior Impingement Syndrome
This problem is caused by the opposing bones in the ankle joint repetitively coming into contact with each other at the back of the ankle when the foot is bent downwards, or ‘plantarflexed’. This constant contact causes an inflammatory reaction in the outer layer of the bone and sometimes, cartilage damage.
Impingement occurs when the ligamentous ‘capsule’ surrounding the joint is tight following previous injury such as an ankle sprain. Posterior impingement is common in sports such as ballet and gymnastics. It is also common in footballers following repetitive kicking of the football. Pain is felt at the back of the ankle joint deep to the Achilles tendon. Pain will intensify when the ankle is bent forward or plantarflexed.
The Achilles bursa is a fluid filled sack that stops the Achilles tendon rubbing on the bone underneath during movement. It can become inflamed with repetitive running and is therefore common in athletes. Achilles bursitis also commonly occurs with Achilles tendonitis. To find which problem is actually causing pain is difficult but may be done by feeling with the fingers. If tendonitis is present tenderness will be felt on the tendon. If bursitis is the problem the pain may be felt deep to the tendon.
Early Injury Management
For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.
R - Rest
I - Ice
C - Compression
E - Elevation
Rest from aggravating activity.
Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.
Compression can be achieved with an elastic bandage.
Elevation is used to help swelling to return to the heart through the blood stream.
The injured area should be elevated above the level of the heart.
Strengthening programs should only be commenced when:
Exercises should be three sets of 8-12 repetitions.