Joe A Shaw PA-C - 7/21/2009

Question
QUESTION: Hello and thank you for taking my question. About 3 to 4 weeks ago a friend and I were working in my backyard and in a pretend wrestling bout- I turned to run away and "injured" my Achilles tendon? I think?? Well the first 2 days the back of my heel not the part I walk on but the rear of my heel bone was on FIRE!. Since then it has really simmered down quite a bit.I used ice and massage since then and even occasionally use a TENS machine for that area- to what end- I really do not know???I can say for sure that once I get around and start walking the SLIGHT pain and discomfort I have does go away- and I am a Pharmacist who walks and stands on his feet ALL day.But the discomfort is noticed when I sit for a period of time or when I sleep- when I INITIALLY get up on my feet I feel the tinge of pain at the back of my Calcaneous bone where the tendon INSERTS into the bone!. Only after WARMING it up so to speak does it go away?? I went on you tube and saw some exercises- like flexing of the foot and rotating of the foot to stretch the tendon etc etc?? I even do the WALL stretch for the tendon-- BUT when will the pain COMPLETELY stop?? I mean I cannot really run OR walk up and down stairs without FEELING some DISCOMFORT?? Can you PLEASE advise me what I should or should not be doing to make this heal faster. Like I said- it cannot be a real bad rip because I walk fine etc etc- BUT it is the waking phase and the up and down stairs that I feel it- so I am not sure what I doctor can do at this point?? Is there anything extra I can do at home to speed up the healing process. By the way I am 51 years old and i pretty good shape as well. Thanks so much for your time . I really appreciate it

ANSWER: Monte,
Yeah you tore your AT..I doubt you ruptured it completely though..as you would see a ball of sorts and be in more pain.I had a ortho tell me he would almost rather deal w a complete rupture and reattachment than a partial tear. IT will get better but This will be months time frame not weeks to get better before stairs/running. It would be best to see an ortho for xrays to make sure you didn't avulse a piece of bone and they could but you in a tibial walker(moon boot) and offer a cortisone injection/NSAIDs which would help the pain and inflamation.Prescribed exercises are best by a PT as this will essentially be your rehab.
You are the typical pt that gets this...males over 45-50yrs old,no stretching/warm-up before episode and acute injury..I had a 50 yr old guy coming into work one morning and stepped up on a curb and popped his completely into..needed surgery..
Usually an MRI is not ordered or needed unless you were a big time athlete!
People get could relief w biofreeze 3xday since it is so close to the skin..you could try that for a couple of weeks to see if it helps.You may be able to get some through your sources if not I usually have the cheapest place on the web.

http://www.carpal-tunnel-symptoms.com/pain-relief-creams.html

---------- FOLLOW-UP ----------

QUESTION: Hello again and thanks for the quick response- you are very nice to do so.. I am seeing a PODIATRIST this Thursday-- because I went on an achilles injury site and it said find a doctor in your area and it linked to all podiatrists no orthos-- I have been to him before and he does have his own x-ray machine in his office so hopefully he can diagnose it further---But I do want to ask you a couple more questions if I may--Like I said I have NO problem walking all day long- it actually does NOT hurt at all- yet when I go home and drive my car for the 30 minutes and then get OUT of the car-- it is the few initial steps that I feel DISCOMFORT- because the TENDON is not WARMED up I guess??? Also as I stated I am very good with sticking to exercising- in your opinion- should I continue to do 1) the wall stretches,2) the circular motion with the foot, and 3? the up and down motion of the foot-- all to STRENGTHEN and stretch the tendon??? And should I use the TENS machine???Can you advise me on those few exercises???I mean the pain from the fist 2 days when it happened to now is quite a different world- What do you think ? And thanks so much again for your advice you are very kind

Answer
yes those are good exercises to do..wouldn't do others until firm diagnosis is made. Yes when the muscle/tendon is static for long periods of time..swelling will set in,making it very painful and stiff to move again. So you may want to try ice after use. I have never used a TENS unit for achilles tendon injuries,but perhaps others have.Either way it will take time(mos in many cases) to heal completley..
You should be able to find a ortho,but if you are comfortable w DPM yoou can try him.

http://www.carpal-tunnel-symptoms.com/find-an-orthopedic-doctor.html