Tendons are rope like structures that connect muscle to bone. The most important and commonly injured ankle tendons are discussed.
Tendinitis is inflammation of the tendon without tearing. Tendinosis is degeneration/scarring of the tendon and also described as interstitial tearing. Tendinosis usually occurs with aging. The examination demonstrates that the involved tendon is grossly intact on strength testing. There can be thickening of the tendon with tendinosis. X-rays do not show injuries to the tendon, but are often obtained to rule out a fracture or other pathology such as arthritis. Calcium buildup or calcification of the tendon may be seen on x-rays and is usually indicative of tendinosis.
The treatment for both conditions is using nonsurgical. This initially involves immobilization in a walking boot or brace, activity modification, over-the-counter anti-inflammatories and icing. Physical therapy is then instituted when the swelling and pain has decreased. For patients that do not respond to this initial treatment, shockwave or PRP may be indicated as an option to avoid surgery.
If the patient does not improve with the above mentioned treatment, a MRI or ultrasound can be obtained. A MRI is usually preferred. The MRI will rule out associated pathology and evaluate the tendon for partial tearing or rupture. Please note, that the radiologist may refer to tendinosis as interstitial tearing. Partial tearing may also be seen. This is not a complete tendon rupture. These conditions usually improve with non-surgical treatment, but may benefit from a tenolysis(release of scar tissue) or repair of a partial tear if still symptomatic despite the non-surgical treatment.
Surgical treatment for tendinitis and tendinosis is performed as an outpatient procedure under general or regional anesthesia. The patient will be discharged with a bandage and crutches, but may place weight on the extremity when they feel comfortable. Sutures are removed at two weeks and a brace may be worn. Physical therapy is performed for approximately one to two months.
A repair of a partial tendon tear is an outpatient procedure under general or regional anesthesia. Since the tendon is being repaired, the patient will be placed in a nonremovable splint and will be nonweightbearing with crutches. At two weeks, the stitches are removed and the patient is placed in a removable boot. The patient is still on crutches for week three and four. Partial weight-bearing in the boot will begin at four weeks and physical therapy at six weeks. The patient transitions from the boot to a lighter brace as they become stronger over the next one month.