Nicholas Campitelli, DPM | Akron Podiatrist | Foot and Ankle Surgeon

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Achilles tendinitis is a painful inflammation of the Achilles’ tendon with pain occurring to the back of the Achilles’ Achilles tendinitis is a painful inflammation of the Achilles’ tendon with pain occurring to the back of the Achilles’ tendon behind the ankle joint. With Achilles tendonitis, the pain will usually occur within the tendon itself as opposed to bursitis which is a similar condition that effects the back of the heel bone. The pain can present with sharp stabbing pain to the tendon that will be worse in the morning and then improve as you walk around and the tendon “warms up”. Pain will then occur later in the day as the tendon begins to become tired from being on your feet all day. You may feel a “creaking” in the tendon when moving your foot up and down if the sheath overlying the tendon becomes swollen. As the condition becomes chronic one will begin to see thickening or enlargement of the tendon itself. This can take months to resolve and will be painful for a long time if left untreated.

Treatment for Achilles tendonitis begins with rest from aggravating activity, taking anti inflammatories, and beginning stretching exercises. If this fails, immobilizing the ankle in a cam walker to reduce the motion to the tendon and take the stress off of it is the next step. Patients will sometimes need to be immobilized for 6 weeks in a cam walker to all the tendon to heal. After resting the tendon and allowing the inflammatory phase to resolve, strengthening with physical therapy is the next step. One can try eccentric strengthening exercises at home, but going to a physical therapist and receiving hands on treatment will provide more predictable results.

When conservative treatment options fail, the next step is surgical intervention. Surgery can involve an minimally invasive technique where a needle like probe is inserted into the Achilles’ tendon and the chronic inflammatory tissue is broken up and removed. This is a great option for patients who present with thickening of the central portion of the Achilles’ tendon that is not responding to conservative therapy. Severe cases of tendonitis that develop tears within the tendon itself that are seen on MRI may eventually require open repair and augmentation with adjacent tendons.

It is important to treat Achilles tendonitis before the condition becomes so severe that the tendon ruptures. Ruptured Achilles’ tendons can take months or even years to recover from, and will often leave patients with life long symptoms. Ruptured Achilles’ tendons are now being repaired with a minimally invasive technique that Dr. Campitelli performs and allows for a faster recovery.

behind the ankle joint. With Achilles tendonitis, the pain will usually occur within the tendon itself as opposed to bursitis which is a similar condition that effects the back of the heel bone. The pain can present with sharp stabbing pain to the tendon that will be worse in the morning and then improve as you walk around and the tendon “warms up”. Pain will then occur later in the day as the tendon begins to become tired from being on your feet all day. You may feel a “creaking” in the tendon when moving your foot up and down if the sheath overlying the tendon becomes swollen. As the condition becomes chronic one will begin to see thickening or enlargement of the tendon itself. This can take months to resolve and will be painful for a long time if left untreated.

Treatment for Achilles tendonitis begins with rest from aggravating activity, taking anti inflammatories, and beginning stretching exercises. If this fails, immobilizing the ankle in a cam walker to reduce the motion to the tendon and take the stress off of it is the next step. Patients will sometimes need to be immobilized for 6 weeks in a cam walker to all the tendon to heal. After resting the tendon and allowing the inflammatory phase to resolve, strengthening with physical therapy is the next step. One can try eccentric strengthening exercises at home, but going to a physical therapist and receiving hands on treatment will provide more predictable results.

When conservative treatment options fail, the next step is surgical intervention. Surgery can involve an minimally invasive technique where a needle like probe is inserted into the Achilles’ tendon and the chronic inflammatory tissue is broken up and removed. This is a great option for patients who present with thickening of the central portion of the Achilles’ tendon that is not responding to conservative therapy. Severe cases of tendonitis that develop tears within the tendon itself that are seen on MRI may eventually require open repair and augmentation with adjacent tendons.

It is important to treat Achilles tendonitis before the condition becomes so severe that the tendon ruptures. Ruptured Achilles’ tendons can take months or even years to recover from, and will often leave patients with life long symptoms. Ruptured Achilles’ tendons are now being repaired with a minimally invasive technique that Dr. Campitelli performs and allows for a faster recovery.

 

 


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Ankle pain can be very difficult for a patient to describe to their physician.   It is also very difficult for general practitioners to adequately diagnose  ankle arthritis if they are not proficient in performing an ankle and foot examination.  Ankle arthritis will cause pain with dorsiflexion (moving foot upwards) and plantar flexion (moving foot downwards)  due to the bone spurs that form around the ankle joint.  The more severe the arthritis becomes, the more cartilage will erode and you will end up with “bone on bone”.  When cartilage is destroyed, it cannot be “repaired” and bone articulating on bone will create more pain and inflammation.  The longer this occurs the more irreversible the damage to the joint becomes.

Normal ankle joint

Arthritic ankle joint

Early treatment can consist of cortisone injections into the joint to reduce the soft tissue inflammation that occurs in the initial stages of arthritis.  If injections fail and the condition continues to worsen, ankle arthroscopy to clean out the soft tissue inflammation and synovitis as well as any bony fragments that may be within the joint.

When conservative treatment fails, fusing the ankle joint is the next step.  This is performed to stop motion to the ankle joint and reduce pain.  While one would think the motion is needed to walk normal, pain from the grinding and limited mobility will be worse in regards to trying to walk normal.  Many patients resume normal walking after the joint is fused compared to how they were walking prior to the surgery with pain and limping from the arthritis.

Fusion of arthritic ankle joint

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One of the most common complaints for foot pain is the result of tendonitis which occurs when a patient compensates from another foot problem. There are two tendons known as the peroneous longus and peroneous brevis which prevent the foot from inverting or turning in when walking. Essentially they are stabilizers and prevent you from spraining your ankle. If anything occurs to your foot that causes you to "limp", these tendons work harder as you compensate.


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Here’s a 65 year old male who presented with a chronic painful left ankle that he described as occasionally “giving out”.

Radiographs revealed an abnormally large fragment of bone (os trigonum) to the back of his ankle joint.
An MRI was performed as I was suspicious of a ruptured peroneal tendon. The MRI revealed no damage.


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