What did Alex Trebek, host of Jeopardy, rupture while chasing a burglar in a California hotel? What is ‘his Achilles Tendon’. We recently came across this achilles tendon story on the news and thought it would be a great time to elaborate a bit on what causes this painful injury and how it is typically treated. If you’re ever experienced a similar injury, we would love to hear about your experience in the comments.
What is the Achilles Tendon?
A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the “heel cord,” the Achilles tendon facilitates walking by helping to raise the heel off the ground.
What is an Achilles Tendon Rupture?
An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping. Achilles tendon ruptures are most often seen in “weekend warriors”— typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.
Signs and Symptoms
A person with a ruptured Achilles tendon may experience one or more of the following:
• Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf—often subsiding into a dull ache
• A popping or snapping sensation
• Swelling on the back of the leg between the heel and the calf
• Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes
These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the “R.I.C.E.” method should be used. This involves:
• Rest. Stay off the injured foot and ankle, since walking can cause pain or further damage.
• Ice. Apply a bag of ice covered with a thin towel to reduce swelling and pain. Do not put ice directly against the skin.
• Compression.Wrap the foot and ankle in an elastic bandage to prevent further swelling.
• Elevation. Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level.
In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests.
Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches. The decision of whether to proceed with surgery or non-surgical treatment is based on
the severity of the rupture and the patient’s health status and activity level.
Non-surgical treatment, which is generally associated with a higher rate of re-rupture, is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. Non-surgical treatment involves use of a cast, walking boot, or brace to restrict motion and allow the torn tendon to heal.
Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient’s push-off strength and improves muscle function and movement of the ankle. Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient. Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weightbearing. Complications such as incision healing difficulties, re-rupture of the tendon, or nerve pain can arise after surgery.
Whether an Achilles tendon rupture is treated surgically or non-surgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve the range of motion of the foot and ankle.
WHAT’S THAT PAIN IN MY BIG TOE JOINT?!
From a dull aches to sharp throbs, foot pain in the joint just below the big toe, known in medicine as the first metatarsal-phalangeal joint (1st MTPJ), is no fun. It is not surprising that your 1st MTPJ feels sore or injured since the balls of your feet take a pounding with each step. Researchers estimate that the front of your foot absorbs three to four times your body weight with each stride as you run. With an average of 1500 strides per mile, runners and athletes can put considerable stress on their feet. Moreover, feet have complex structures, each containing 26 bones, 33 joints, 112 ligaments, not to mention the additional tendons, nerves and blood vessels. With such a complex machine as the foot, it is often difficult for foot doctors to diagnose and treat 1st MTPJ injuries, and almost impossible to provide one uniform treatment plan for injuries to this area. This blog post addresses one type of 1st MTPJ injury, injuries to small bones in the 1st MTPJ called sesamoids, which effect a large number of runners and athletes of all ages and ability levels.
Embedded inside the tendons that connect your big toe to the rest of your foot are two pea-sized bones called sesamoids. These two bones, the tibular and fibular sesamoids, act as pulleys and assist the propulsion of the big toe. As your toe moves up, they allow for dorsi flexion, and as your toe moves down they allow for plantar flexion. The sesamoids are parts of a fascinating system that assist in absorbing the weight put on the ball of the foot and propelling the foot forward. Without them, we wouldn’t be able to run.
But with more elements that make up the foot’s anatomy, there is more opportunity for injury. All athletes are susceptible to sesamoid injuries, especially athletes who put more pressure on the balls of their feet such as runners, tennis players, soccer players, football players and dancers. Children can have injuries to their sesamoids especially because of torsion or trauma in impact sports. Those of us with high arches put a lot of pressure on the MTP joints, and can therefore damage the sesamoids. Other factors that contribute to sesamoid injuries include wearing high heels or other tight shoes (like pointe shoes for ballet or climbing shoes), and traumatic injuries to the front of the foot.
Sesamoid bones, like other bones, can be dislocated, sprained and fractured. There are a few common types of sesamoid injuries. Turf toe is an injury of the soft tissue surrounding the big toe joint and the sesamoid bones, and could even be a fracture of the sesamoid. It usually occurs when the big toe is extended beyond its normal range. Turf toe is a traumatic injury – with this injury you’ll feel a sharp pain immediately, your MTP joint will swell, you might even hear a popping noise during impact and your range of motion will probably be limited after the injury. Breaking a sesamoid bone (known as an acute fracture) is a traumatic injury, with similar immediate symptoms to turf toe (immediate pain and swelling), but may not disrupt the range of motion in your big toe. A stress fracture (otherwise known as a chronic fracture) is usually an overuse or repetitive motion injury. The pain will probably come and go with a stress fracture. Another common overuse injury to the sesamoid bones is known as sesamoiditis. Due to inflammation of the sesamoid bones and their surrounding tendons, the sesamoid bones can be put under an increasing amount of pressure resulting in a dull pain under the 1st MTPJ. With sesamoiditis you may find that the pain worsens when you wear certain shoes or do certain activities.
Self-diagnosis and treatment is neither reliable nor advisable for sesamoid injuries. As previously mentioned, sesamoid injuries are often tricky to diagnose even with xrays and MRIs. Their size and position within the tendons of your feet makes it difficult to see injuries to the bones. On top of their small size, varied foot morphology and injury pathology will significantly alter treatment programs. Be sure to make an appointment Dr. Chang and Dr. Murray to have your injury diagnosed and to receive a recommended treatment plan sooner rather than later.
Dr. Chang and Dr. Murray can help tailor the right treatment program for your sesamoid injury. Treatment will most likely be varied, and may include padding, strapping or taping the big toe and 1st MTPJ. It may be important to immobilize the joint, especially in the case of fractures, in order to allow proper and expedited healing. Rest, elevation, ice, ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) will help reduce the swelling (whenever taking NSAIDs for a prolonged period be sure to drink lots of water to flush them through your system). In order to increase the blood flow to the area for healing, physical therapy, including range of motion exercises and stretches, may be prescribed.
It is critical to consider the environment in which you keep your feet during and following a treatment plan. Both over-the-counter and custom orthotics can help with healing and injury prevention. New shoes with rocker soles or a stiff forefoot will help you both during exercise and throughout the rest of the day. Remember that your feet are always absorbing impact, even when you are not exercising. Especially with sesamoid injuries, it is highly advisable to avoid cheap and unsupportive shoes or flip flops even outside of exercise. Finally, when you are injured or in pain, being tough means having the patience to give your injury time to heal. When you take time off and allow your body to recover, you’ll be able to get back to your favorite activity sooner and at a higher level.
When non-invasive treatments do not work, your podiatrist may suggest a range of options for foot surgery. Be sure to discuss these various options with your podiatrist.
Don’t let your injury get to this point if you can prevent it! Preventing injuries to the sesamoid bones requires employing a range of good judgment. Be sure you have a proper training program. For all athletes, this includes warming up, stretching, and not overdoing it. For runners, stick to a 10% maximum increase in mileage per week – any more will likely result in injury. For runners or other athletes who tend to pound, stomp, or make a lot of noise when their feet hit the ground, it’s advisable to slow down. Find a pace that is pound free and stick to it for a while, trying to speed up gradually while maintaining a softer stride.
If you are anxious before beginning a training program because of previous injuries or other concerns, consulting your podiatrist before starting could be helpful. Podiatrists may provide helpful input, and suggest ways to factor your foot structure, foot function, and body type into your training program.
Most importantly, proper shoes and orthotics can be lifesavers for preventing injuries. Visit Dr. Murray and Dr. Chang for advice on over the counter and custom orthotics. Various shoe and running stores around Charlottesville and Waynesboro, including Ragged Mountain Running, the Charlottesville Running Company and Richey and Co. Shoes will provide expert shoe advice by evaluating the way your foot is structured and how it moves moves, and matching your individual needs and concerns to an appropriate shoe.
Be good to your feet when they’re hurting. Visit your podiatrist in Charlottesville or Waynesboro for a diagnosis and integrated treatment plan for sesamoid injuries. Be sure you are wearing shoes with stiff toe boxes that do not cramp your foot. And finally, allow your injury the time and conditions it needs to heal.
Comment on this post to share your sesamoid injury story or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!
Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
Summer heat shouldn’t stop you from regular outside activity, but being aware of how to deal with the heat is key for comfort, safety and enjoyment of staying active in the heat. Here are some tips for summertime running, most of which you can apply to other outdoor activities, regardless of age or ability level.
Preparing for the heat begins before your run starts. Be sure to check the weather and heat index and to modify activity on especially hot days. Running in the morning or evening enables you to avoid the hottest hours of the day (10am-5pm). By running in the shade or woods you can avoid direct sunlight and keep yourself cooler.
Consistent hydrating will help your body deal with heat. Experts recommend drinking 2-3 cups of water during meals, 2 ½ cups of water 2 hours before a run, and 2 cups of water just before running. Alternatively, aiming for 6-8 fluid oz. of water at least every two hours throughout the day can help your body adjust to hot temperatures.
Athletic clothing is designed to help regulate body temperature and stay comfortable. Cotton can impede your body’s thermoregulation because it absorbs your body’s moisture but does not dry easily. When it’s hot outside, the human body cools down by the process of evaporating and cooling through sweating, so it is increasingly difficult to stay cool as the humidity rises because evaporation becomes less efficient. Athletic companies design sweat-wicking and breathable clothing to help your body regulate the temperatures (and to keep you smelling fresh!). Lightweight, loose fitting and light-colored clothes are best to regulate your body’s heat and to reduce chafing.
Consider the material when you reach for a pair of socks. In order to reduce blisters, wear lightweight socks. Acrylic microfiber socks absorb moisture while allowing evaporation. If you’re heading out for a long day of activity, and especially if you’re blister prone, consider packing an extra pair of socks for your upcoming adventure. If you predict moisture problems with your feet or in your shoes, try sprinkling powder like Gold Bond Foot Powder in your shoes before activity. These powders regulate moisture and prevent nuisances like athlete’s foot and fungus. The breathability of your shoes is another important consideration. We cannot emphasize enough the importance of good shoes, replaced every 350-400 miles or as needed for the management of blisters and the support of your feet and ankles.
In addition to clothing protect your skin by applying sweat-resistant sunscreen at least 20 minutes prior to your run. Sunglasses and hats protect your face and keep bugs out of your eyes. Light colored hats or bandanas can be lifesavers for people with dark or thick hair, but remember that your body loses most of its heat through the top of your head, so you don’t want to sport heavy headwear. Some helpful tricks include cooling a cap in the freezer before your run and soaking it in water mid-run.
Warming up sounds ridiculous when it’s blazing hot outside, but starting slowly (even at a walk) and building up to your normal running pace will help your body adjust to the heat. Warming up is especially important when your body is adjusting from inside air-conditioned climates to the outside heat, and to that effect, some running experts even suggest that runners limit their use of the A/C.
DRINK WATER DURING YOUR RUN! Be sure to find the right system of carrying water with you or mapping your run around public water fountains. If you are running for one hour or less, water alone should be sufficient for hydration. For a longer run, be sure to bring sports drinks or carbohydrates for adequate electrolyte and carbohydrate replacement. Studies indicate that your body absorbs chilled fluids faster, and cold water has the added bonus help lower your body temperature.
Pouring water on your face feels great in humidity, and it also helps wash away the sweat if your skin breaks out from sweating. (Note that moisture-wicking material and sunscreen that doesn’t clog your pores is great for preventing breakouts on other parts of your body too). Also try pouring water on the top of your head, the back of your neck, and on the inside of your wrists while running – sure ways to cool you down.
Be conscious of how hard you’re pushing yourself, and listen to your body. Heat stroke and heat disease are serious problems. Primary symptoms can be cramps in your legs, dizziness, excessive breathlessness, intense heat built-up in the head, headaches, nausea, disorientation, loss of muscle control, cessation of sweating, and unusual heart beat or rhythms. After initial symptoms, drinking water with salt in it, or sports drinks, can help. If you pulse is low and your breathing is growing rapid, you might have heat exhaustion. This can be due to dehydration and from overheating. STOP EXERCISING when this happens! Your body has probably sent too much blood to your skin to keep your skin cool and is not pumping enough blood and oxygen to your brain. These symptoms are serious – so slow down, drink lots of room temperature fluids, with a pinch of salt in each glass, or take a cool bath.
Remember that heat illness can be exacerbated if you already have a viral or bacterial infection, are taking medications, are dehydrated or hung over, have a sunburn, are not well acclimatized to the heat, are over exercising, have experienced heat disease in the past, are sleep deprived, and have medical conditions like high cholesterol, high blood pressure, are under stress, have asthma, diabetes, epilepsy, cardiovascular disease or smoke. Using common sense, good judgment and attention to symptoms and preexisting conditions are paramount in keeping yourself healthy and safe.
Staying healthy, blister-free and hydrated continues after exercise too. Try not to leave your feet in sweaty, muddy or wet shoes after exercise. Be sure your feet are sufficiently aired out after your run – this will prevent getting blisters or hot spots in the future and keep your shoes (at least a bit more) odor free. Replenishing the fluids you lost through exercise is essential for both recovery and preparation for your next run. Additionally, a healthy and balanced diet, with attention to healthy levels of sodium (which enables water retention), potassium (promoting proper nerve and muscle firing), and fats (that enable thermoregulation), is as important to staying hydrated as drinking water.
Clubs, such as the Charlottesville Track Club, The Charlottesville Trail Running Club, or the Charlottesville Running Company, are active in the summer and bring the running community together. Joining these clubs can help with motivation, and running in a group can also keep you safe from the heat.
So keep being active, folks, but take care of your body by exercising right! If you have any other tips, tricks and suggestions, we’d love to hear from you. Feel free to post a comment on this blog.