News Category: Foot

People with severe arthritis in the first metatarsophalangeal joint, or big toe, can find it difficult and painful to walk. To treat this, surgeons have been fusing the bones together, a procedure called arthrodesis. Arthrodesis does have a fairly good rate of keeping the bones together, called a union rate, at between 77 percent to 100 percent, but there are drawbacks to the surgery. The fixed bone can make it hard to walk because the toe does not bend, causing problems with other bones and joints in the foot.

A replacement to the joint has been tried in a few different forms. In this study, the authors wanted to see if a metallic replacement (hemiarthroplasty of the toe joint had a better outcome than the fusion.

The authors looked at 46 patients who had had either surgery; 21 feet in 20 patients (6 men) had had a replacement and 27 feet in 26 patients (10 men) had fusions. The ages ranged from 32 to 73; the average age of the patients with the replacement was 60 years and for the fusion was 54 years.

The average time for follow up for the replacement patients was 79 months, ranging from 68 to 86 months. Among the replacement group, 5 patients had to have follow up surgery because the replacement did not work properly. Four of the patients ended up with a fusion. Among the patients who had fusions, the follow up was between 13 and 67 months after surgery. All fusions were healed and no revisions were needed. Two patients complained of problems with one of the screws, which was corrected with a local anesthetic while in the doctor’s office. When asked to rate their pain at the follow up visits, using the visual analog scale (VAS), which is a scale of 1 to 10, with 10 being the worst pain, the replacement group reported an average of 2.4.

When the researchers looked at the comparisons between the groups regarding surgery outcome, they found the patients with the replacement saw significant improvements in pain and in motion. Sixty percent of the patients said that they would do the same procedure again if needed given the same situation. Twenty-four percent rated the results as excellent, 33 percent as good, 10 percent as fair, and three remaining as poor. Among the fusion group, there was also improvement noted in pain and movement. As well, 85 percent of the patients said that if they had to do the procedure again for the same problem, they would. Seventy-eight percent of the patients rated their results as excellent, 4 percent as good, 15 percent as fair, and 1 patient rated it as poor. Pain, measured by VAS, after surgery was lower (0.7) than that of the replacement group.

The authors conclude that although the particular type of replacement they were investigating did appear to offer some advantages over the previously used ones, at this point, fusion appears to be the most effective technique for osteoarthritis of this toe joint.

Severe bunions often require surgery to correct this painful deformity. The medical term for bunion is hallux valgus deformity. In this study, the results of reconstruction surgery for hallux valgus are reported.

The surgical procedure used was a proximal osteotomy of the first metatarsal. An osteotomy is the removal of a wedge- or pie-shaped piece of bone from one side of the bone. The rest of the bone is then shifted in the direction of the missing bone. This helps realign the toe in a more neutral position.

A metatarsal is the main bone in the forefoot at the base of each toe. The first metatarsal is at the base of the big toe. The first metatarsal and toe is also called the first ray.

The authors showed X-rays of severe hallux valgus deformities before and after surgery. Surgery was done for patients who had severe pain and difficulty wearing shoes. Details of the X-ray exam and surgical procedure were provided.

Results were measured by pain levels, ankle motion, and movement of the first ray. Foot imprints made on a mat and angles measured on X-ray were also used to track progress. Mat imprints were used to assess how flat the feet were.

The authors report there was no evidence that limited ankle motion was linked to the formation of bunions. About 15 per cent of the patients had a very low arch. This did not cause increased rotation of the first ray or angular changes contributing to bunions.

Recurrence of the hallux valgus deformity can occur after surgery. Hypermobility (increased motion) at the first ray has been blamed for this problem. The results of this study did not support the hypermobility theory of bunion recurrence.

Overall, this study showed that osteotomy with soft tissue realignment was a reliable way to correct a hallux valgus deformity. Patients were satisfied with the functional results. Recurrence was rare. A few patients expressed some concern about the final cosmetic appearance.

Foot skin and toenail problems in patients with diabetes can lead to amputation. Early detection and treatment are always the best prevention techniques. In this review article, doctors from the Long Beach Memorial Medical Center discuss myths and advice related to diabetic foot care.

The first and best advice is to check the skin and toenails of the feet every day. Many people with diabetes also have a loss of normal sensation in the feet. They don’t feel small sores, breaks, or changes in the skin. Wearing white socks can also help show any oozing or bleeding from sores or wounds.

Any change should be reported to your doctor or health care provider.
This is important because people with chronic diabetes are more likely to have poor circulation. This is especially true in the feet because they are the farthest away from the heart. Loss of blood supply to a wound can lead to infection.

Poor circulation combined with loss of sensation is a recipe for poor or delayed wound healing. This is all the more reason why early treatment is advised. Even before early intervention, preventing toenail disease and skin wounds are the primary goals.

Amputation is not a sign that the patient or the treatment has failed. Sometimes long-standing problems just can’t be treated effectively any other way. If the patient isn’t going to heal and will continue to lose function, amputation may be the best approach.

Patients may not have the resources or help they need to avoid serious problems. Mobility problems from aging and/or arthritis and reduced incomes contribute to this problem. Patient education by physicians and other health care providers can go a long way in helping patients with diabetes who have limited resources.

The causes and effects of plantar fasciitis (PF) remain the topic of study and research. The plantar fascia is the fibrous connective tissue under the foot. It goes from the heel along the arch of the foot to the base of the toes.

PF is a painful inflammation of this fascia. It causes heel pain when standing or walking. In this study, three factors are measured and compared to see if they contribute to PF. Ultrasound was used to measure the thickness of the fascia. X-rays were used to measure the shape of the arch. And forces within the foot were measured using a special pressure platform while walking.

Two groups of adults were included. One group had PF just on one side. They reported heel pain when standing or walking that went away with rest. The pain was rated on a scale from zero (no pain) to 10 (most pain). The control group didn’t have any symptoms of PF.

After analyzing the data, the authors report that pain was linked with thickness of the fascia, arch angle, and loading on the midfoot in the group with PF. The thickness of the fascia was related to arch angle in both groups.

This is the first study to use ultrasound readings to show that the thickness of the plantar fascia is related to the severity of heel pain in PF. Thicker fascia increases the stiffness of the arch. This puts more pressure on the foot when standing and walking.

Despite these new findings, the researchers still don’t know which came first: the changes in the fascial thickness, arch shape, and loading on the foot or the PF. It’s possible that pain from PF changes the way the person walks and that’s what brings about the change in arch angle and load.

Or it may be that the fascia is thicker but can’t handle a normal load so pain develops. The exact relationship between the fascia and the arch still isn’t clear. Future studies are needed to sort out which came first and which of the three factors is most important.

This is the first study to compare two methods of surgical treatment for Achilles’ tendon rupture. Twelve patients had a percutaneous Achilles’ tendon repair. Twelve others had a minimally invasive (MI) one. All patients had injured the tendon within the last seven days.

In surgery, percutaneous refers to any procedure where the skin is punctured with a needle rather than making an open cut. In this study, three pairs of 5-mm skin incisions were made along each side of the tendon. One was at the level of the rupture. The other two were above and below the injured tissue.

For the MI method, a single small incision was made at the site of the injury. A special device called am Achillon® was inserted. The Achillon® gave the surgeons a complete view of the tendon. Sutures were passed through the Achillon® and the repair was made.

Results were measured for both methods using rates of rerupture and complications. The authors also compared how much time it took to return to work or sports. They found no differences between the two groups in terms of function, satisfaction, or return to activity.

The percutaneous group had a greater loss of calf size in the injured leg. Muscle strength was not decreased in this group. The authors concluded that percutaneous and minimally invasive methods of Achilles’ tendon repair give the same results.

In this article, surgeons from the Miller Foot and Ankle Institute in North Carolina review a condition called Bunionette Deformity. Most people are familiar with the term bunion. It refers to a bump alongside the joint at the base of the big toe.

A bunionette is a similar deformity alongside the base of the little toe. The cause of bunions in either toe is usually narrow shoes or some other kind of chronic pressure. Bunionette deformity is also called tailor’s bunion. It was named after clothing tailors who developed the problem from sitting on the floor with their legs crossed. These bunions formed from constant pressure along the outside edge of the foot.

Treatment is often nonsurgical. Wider shoes and padding are used first. Sometimes the shoes can be stretched or a larger shoe size is needed. Patients are advised to avoid shoes with a pointy toe. They should look for a shoe with a large, square-shaped box. The box is where your toes are placed inside the shoe.

About 10 to 20 per cent of the patients with bunionettes aren’t helped by these measures. Surgery may be needed to remove part of the bone and/or realign the joint. The authors describe in detail each individual operation that can be done. These include:

The authors of this report have been working on a way to quickly and easily measure foot posture. The first tool called the Foot Posture Index (FPI-8) had eight test items. It was tested and found valid and reliable. The FPI-8 was even used in several studies of athletes and orthotics.

But further research showed that two of the eight items in the test appeared to be measuring something else. These two tests didn’t measure overall foot posture and were more likely a measure of foot shape or size.

In this study, the authors dropped the two misfit items and retested two groups using the FPI-6. The first group had a known foot problem associated with a condition called Charcot-Marie-Tooth disease. The second group had normal, healthy adults ages 18 to 65 years.

Analysis of the results confirmed that the FPI-6 is a good measure of foot posture. It can be used to assess a wide range of foot postures. The finalized FPI-6 should be tested again with a larger group. Normal values must be established.

There are two tiny sesame-shaped bones under the base of the big toe. These are called the hallucal sesamoids. They are prone to injury. Anatomy, types of injuries and other conditions affecting the hallucal sesamoids, and treatment are discussed in this review article on the topic.

Inflammation, uneven wear and tear, fracture and loss of blood supply called osteonecrosis are the most common problems encountered. The sesamoids bear 50 per cent of a person’s body weight. During push-off of the big toe in the walking cycle, this load can increase to 300 per cent or more of the body weight.

The ligaments and tendons attached to these bones make them susceptible to inflammation from stress and overuse. Fracture is most often the result of trauma when the toe gets bent back too far. Running injuries also contribute to sesamoid fractures. Ballet dancers who put repeated stress on the big toe are at increased risk of sesamoid fractures.

Other problems include osteoarthritis, infection, and dislocation of the sesamoid bones in patients with bunions. In the case of dislocation, the deformity causing the bunion also pushes the sesamoid bones out of place. Less often, the sesamoid bones pinch a nerve in the toe causing pain.

Treatment for most sesamoid problems is with rest, ice, and antiinflammatory drugs. Special shoe inserts called orthotics are very helpful. A gel insert may be put directly under the bones. Custom-made inserts may be used for some problems. Casting is needed for most fractures.

If the fracture doesn’t heal or a fractured sesamoid bone is displaced, then surgery is done to remove the bone fragments. Because of problems that occur without these tiny bones, surgeons try to repair and save them if at all possible. The authors review and discuss specific surgical techniques involving the sesamoids.

Doctors can expect to see more cases of sesamoid problems in the future. Increased sports activities, high-impact aerobics, and more common use of artificial playing surfaces will likely contribute to these problems.

Stress fractures of the talus bone in the foot and ankle are rare. Studies reporting the long-term results of treatment for this problem are equally rare. Most published articles are case reports of one or two patients.

In this study, patients were identified at a military hospital who had a stress fracture in the talus. Stress fracture was defined as bone marrow edema and low-signal fracture line seen on MRI.

Over a period of eight years, only nine cases were found. Only eight of the cases were reviewed. All were treated with reduced exercise and non-weightbearing status.

Patients were interviewed and examined by an orthopedic surgeon 14 to 74 months later. Joint motion and ligament stability were measured. X-rays and MRIs were taken of each ankle/foot. Imaging studies were compared to tests done at the time of the initial injury.

MRIs for half the patients showed at least minor bone changes. There was bone marrow edema in the joint close to where the fracture had been. Half the patients had completely normal findings. No one had an unstable ankle from ligament damage. No one had any tenderness when the foot/ankle was examined.

About one-third of the group reported minor ankle pain or swelling after exercise. None of these patients noticed any ankle problems during everyday activities. The results of this study show that stress fractures of the talus in military recruits do not result in permanent disability. Minor symptoms are still observed a few years after injury.

The results of this study confirm earlier reports that stress fractures of the talus are low-risk injuries. Over a short to mid-term period of three to four years, degenerative findings are present. Long-term follow-up may show more severe symptoms later.

Something has to be done to help people with pain from osteoarthritis (OA). According to this study from Canada, the cost of caring for musculoskeletal problems in adults is second only to cardiovascular disease. Knee OA causes pain, stiffness, and decreased function. In this study, a special walking shoe was used for 12 weeks to see if there were any changes in pain and balance.

Two groups of patients with knee OA and pain on walking were included. The first (control) group wore New Balance high-end walking shoes. The test group received a pair of Masai Barefoot Technology®(MBT®) shoes.

The MBT® shoe has a multilayered sole. It is designed to challenge the walker’s balance. It turns flat, hard surfaces into uneven ground. Increased muscle activity is required in the legs to meet this challenge.

Balance was tested for each person before wearing the shoes. Pain levels and knee range of motion were also measured. Everyone in both groups wore the shoes as much as possible. All test measures were repeated at three weeks, six weeks, nine weeks, and 12 weeks. A home journal was used to track patient cooperation and compliance with the program.

The results showed no difference in pain with walking or knee and ankle motion between the two groups. Strength increased in both groups. Balance was improved only in the MBT® group.

The authors conclude a good walking shoe can reduce knee pain from OA. Special shoes such as the MBT® may be needed to improve balance. The dynamic shoe-to-surface may help train proprioceptive systems in the small muscles of the feet and legs used for balance control.

Physical therapists (PTs) often help patients find ways to stretch as a treatment for chronic soft tissue problems. In this study, a group of PTs from the Center for Foot and Ankle Research at the University of Rochester (New York) report on a fascia-stretching program for chronic plantar fasciitis.

An earlier study by this same group presented the results of 82 patients with chronic plantar fasciitis. Two different treatment methods were used. The first group did a stretch for the Achilles-tendon (calf muscle). The second group did a specific stretch for the plantar fascia.

Results after eight weeks showed greater improvement with the plantar fascia stretch. In phase two of this study, the Achilles stretching group was given the same plantar fascia stretch the other group had in the first study. They did the stretch three times a day, starting first thing in the morning before taking their first steps. The plantar fascia stretching program was done for at least eight weeks.

Now two years later, in this report, the researchers tell about the long-term results for this same group of patients. Pain, function, and satisfaction were measured using a survey mailed to each patient.

At the end of two years, everyone had improved. The Achilles tendon group from the original study improved the most after they were given the plantar fascia stretch. About one-fourth of the patients still reported some limitations in recreational activities. A small number of patients from both groups went on to seek additional treatment.

The authors conclude a specific plantar fascia stretch can be done for plantar fasciitis with good results. This stretch only costs time and can be done any time during the day, especially after long periods of sitting or before long periods of standing.

In this study, researchers compare different ankle-foot orthoses (AFO) used by patients with subtalar osteoarthritis (OA). The subtalar joint is part of the ankle. It is located just above the calcaneus (heel bone) where the talus bone meets the calcaneus.

AFOs are a type of brace made from a rigid polypropylene (plastic). The goal is to limit hindfoot motion thereby reducing pain and improving stability. They are especially helpful for walking over uneven surfaces.

Ten patients with subtalar OA were included. Three types of AFOs were used: rigid AFO, rigid hindfoot orthosis (HFO-R) and articulated hindfoot orthosis (HFO-A). The rigid AFO supports the back of the calf down to the base of the toes. The HFO-R starts midcalf and includes the ankle but not the foot or toes. The HFO-A starts midcalf, has a hinge joint at the ankle, and goes to the base of the toes.

Patients were filmed walking over level ground, up and down a ramp, and on two types of slopes. Tests were also done in standard shoes without the orthoses. A special computer program analyzed the three-dimensional movement. Angles of motion of the hindfoot were calculated.

The results showed that none of the orthoses kept the hindfoot from moving all the time. Motion was certainly less with an orthotic compared to without it. The HFO-R did the best job holding the hindfoot stable while still allowing motion in the forefoot.

The authors conclude patients with pain and stiffness from subtalar OA should try the HFO-R orthotic. Besides reducing pain, it may also improve step and stride length. The patient may be able to walk longer distances with less fatigue.

Some sports injuries are uncommon or even rare. Doctors need some ways to recognize these problems sooner. Tarsal tunnel syndrome (TTS) is one of these conditions. TTS is the compression of the tibial nerve as it travels through the bones of the ankle. It is often misdiagnosed or overlooked. Delay in diagnosis and treatment can cost an athlete the season.

In this study, surgeons at the Osaka Medical College in Japan looked back at the charts of patients who were treated for TTS. The idea was to look for any typical factors that would help doctors identify TTS sooner.

For example, they checked the medical charts to see how many patients diagnosed with TTS had a previous history of trauma to the foot and/or ankle. How severe was the injury? They looked for physical movements or sports activities that were linked with the patient’s pain before the diagnosis was made. They recorded tests done and results for each one.

What they found was that all the patients had tenderness behind the medial malleolus (inner ankle bone). All had a positive Tinel’s sign. This means when the skin is tapped over a nerve, the patient gets a slight shocking sensation.

Nerve testing showed decreased motor and sensory function. Most patients had symptoms during repetitive motions. Jumping, sprinting, and quick flexion of the ankle brought the symptoms on in all cases. The results of X-rays, CT scans, and MRIs were all reviewed to see what structures were abnormal around the ankle and foot.

In almost every case, the imaging studies showed the cause of the problem. Sometimes it was an extra muscle or extra bone putting pressure on the tibial nerve. Old or new bone fractures were found. Cysts, bulges in the normal bones, flatfeet, or partial bone fusions were other causes of TTS.

All patients’ symptoms went away after surgery to release pressure on the tibial nerve. This was the final diagnostic test for TTS. The authors conclude that sports athletes with symptoms described who have a positive Tinel’s sign should be further examined with X-rays or other more advanced imaging. Surgery may be needed to restore the tibial nerve and return the athlete to full participation in sports.

In this review article, surgeons from the Foot and Ankle Institute in North Carolina offer primary care physicians advice about acute Achilles rupture. Anatomy, cause of injury, and patient presentation are discussed. The authors also offer treatment suggestions including details of possible surgeries.

Achilles ruptures are becoming more common as aging adults remain physically active. Middle-aged men involved in recreational sports are affected most often.

Early treatment is important to avoid future problems, especially re-rupture. Most ruptures occur when the tendon is lengthening from a shortened position. Falls off a ladder or from a height and stepping into a hole are also common causes of Achilles ruptures.

The injury isn’t always painful. Most people can still walk with a slight limp. Many cases are misdiagnosed as ankle sprain with a delay in the correct treatment. The Thompson test is the best way to confirm the diagnosis. The patient lies prone (face down) on an exam table. The doctor squeezes just below the widest part of the calf muscle. With a normal Achilles, the foot should point as a result of the test. When the tendon is ruptured, the foot doesn’t move.

The authors advise primary care or emergency room doctors to put the leg in a cast or splint. The foot should be pointed slightly to bring the torn ends of the tendon together during healing. Surgery is needed if the gap is too large to close. The authors review the merits and problems of open versus percutaneous (closed) surgical repair.

Surgery is advised for patients who want to return to activity after treatment. Achilles tendon injuries and reinjuries may be prevented through routine calf stretching exercises.

Like carpal tunnel syndrome in the wrist, tarsal tunnel syndrome (TTS) of the foot is caused by pressure on a nerve. In both cases, the nerve is pinched, pressed, or entrapped as it passes through a tunnel formed by a ligament stretched across the ankle bones. TTS occurs in the foot as a result of pressure from the laciniate ligament pressing on the tibial nerve.

In this study surgeons report on a 10-year case of heel and ankle pain from TTS. The patient was a 44-year-old woman. She had tried all kinds of conservative treatment with only temporary relief of her symptoms.

She had many tests done over the years to find out what was wrong. X-rays and MRI showed a large bone spur on her calcaneus (heel bone). The surgeon removed the bone spur and she was in a cast for four weeks. Then she wore a fracture boot for another four weeks.

She still had pain so another nerve test was done. Previous nerve conduction velocity (NCV) tests were negative. This time the NCV test showed changes in the tibial nerve function. She was diagnosed with TTS. Part of the nerve was removed and found to have a neuroma (nerve tumor).

Three months later the patient’s symptoms were almost all gone. Two years later, she was wearing normal shoes and walking pain free for long distances.

The authors report that this complex case was difficult to diagnose and treat correctly. The patient’s symptoms weren’t typical for a diagnosis of calcaneal nerve neuroma. The pathology report described the neuroma caused by trauma, most likely from body weight (the patient was obese).

Plantar fasciitis, a painful condition along the arch and heel of the foot is a common orthopedic disorder. The cause and cure remain unknown. In this study, shockwave treatment was used to treat the problem. Long-term results are reported.

Two groups of patients were included. Group 1 (shockwave group) had a single session of shockwaves to the heel where the plantar fascia attaches to the calcaneus (heel bone). Group 2 (control group) had conservative care with antiinflammatory drugs, orthotics, physical therapy, and/or a cortisone injection to the area.

The shockwave group had much better results based on reduced levels of pain and improved function. Almost 70 percent of the patients rated their results as “excellent” compared to zero in the control group. An excellent result was defined as no heel pain during daily activities.

There was no change in the size or shape of heel spurs in any of the patients. Shockwave patients improved within the first two weeks after treatment. Maximum results were seen by the end of two months. Two-thirds of the athletes were able to return to their full sports activities.

The authors conclude that although shockwave treatment didn’t work for everyone, it did have a positive effect on many patients. When compared with other more conservative treatment shockwave therapy is safe and effective with good long-term results.

In this report Dr. Hurwitz, director of the Foot and Ankle Surgery at the University of Virginia updates an article he wrote in 1997 on the topic of bunions. He carefully reviews the causes, anatomy, and diagnosis of bunions. Treatment including nonoperative care and surgery are also discussed.

Changes in the normal foot and ankle alignment can lead to bunions. This is especially true in someone with a family history of bunions. Improper shoe wear and dancing on toe (pointe) make this a condition most common with women. Flatfeet, loose ligaments, and tight heel cords (Achilles tendon) can change the way a person walks also contributing to bunions.

In severe cases tendons and bone can get displaced. The result may be a subluxed (partial) or complete dislocation. Pain along the inside border of the big toe is common when wearing shoes or walking. The pain may go away when the patient rests or takes his or her shoes off.

Most bunions are easy to see by looking at the foot. The two bones of the first toe form an obvious angle. There may be a large bump from bony overgrowth along the inside of the big toe. X-rays are usually used to confirm the diagnosis.

Once the diagnosis is made, treatment begins. Nonoperative care includes instructions in proper shoes, exercises, and antiinflammatory drugs for pain relief. Sometimes a splint or shoe insert is used. The need for surgery becomes more obvious when treatment measures don’t help. There are many different types of surgery for this problem. The goal is to make it possible for the patient to stand and walk without pain.

The author concludes by reminding patients that the deformity that causes bunions can come back. The bunions or bony bump doesn’t grow back. Patients are advised to follow the doctor’s instructions to maintain the correction and avoid recurrence of the problem.

Years ago studies showed the best treatment for a tarsal navicular stress fracture (NSF) of the foot in athletes was at least six weeks in a cast. The person wasn’t allowed to put any weight on the foot. Today doctors avoid immobilizing athletes whenever possible. This study looks at the long-term results of that decision for NSF.

Nineteen (19) patients with navicular stress fractures were followed for at least one year. The navicular bone is in the mid-foot area. It is on the same side as the big toe and just in front of the tarsal bone at the true ankle joint.

With a stress fracture no fracture line appears on X-rays or CT scans. A positive bone scan for increased bone activity helps make the diagnosis. The patient usually reports midfoot pain with weight-bearing activities.

All patients were seen at a university sports medicine center. Less than half were treated with nonweight-bearing rest. Only two patients got the recommended care of cast immobilization for six weeks. Six patients were able to get back to their previous level of sports activity.

The authors report poor results for athletes with NSF who weren’t casted. They suggest that even though casting and nonweightbearing aren’t very popular, this treatment is still the best choice for patients with NSF. More studies are needed in the area of NSF and tissue engineering for bone healing. More advanced treatment might help speed up the recovery time.

Researchers at the Norfolk and Norwich University Hospital in the United Kingdom have some questions about shock wave treatments. These high-energy sound waves have been used for kidney stones. Now they are being used for some soft tissue conditions.

Can shock wave therapy relieve chronic Achilles’ tendon pain? Does it improve the patient’s general health? Does shock wave therapy change ankle motion? Can this kind of treatment result in tendon rupture?

In this study 49 patients with chronic Achilles’ tendon pain were divided into two groups. Everyone had pain that got worse with activity and exercise. The treatment group had 1500 shocks three times (once each month for three months).

The control group had a placebo treatment. The same machine was used but bubble wrap was placed between the machine and the patient’s skin. This dispersed the sound waves so none got through.

Everyone was followed for one year after the start of the study. The authors report no difference in results between the two groups. They say their results give no support to the use of shock wave therapy for chronic Achilles tendon pain. Two older patients (60-65 years old) in the treatment group had an Achilles’ tendon rupture within two weeks of the first treatment. Shock wave therapy should be used with caution in this age group.

How well do patients fare after surgery and rehab for a ruptured Achilles tendon? That’s the focus of this study from the Methodist Sports Medicine Center in Indianapolis, Indiana.

Results were evaluated by reviewing the records of 89 patients with Achilles tendon rupture. All were treated with the same surgery to repair the tear. An early rehab program was also used.

The patients formed two major groups: those patients 30 years old and younger and anyone 31 years old and older. The researchers report the younger group had a higher rate of reinjury (Achilles tendon re-rupture) than the older group. In fact, the older group had no re-injuries. Almost 20 percent of the younger group reported re-rupture of the injured
Achilles tendon.

Those who re-ruptured were males younger than 31 and with a similar athletic body type. The authors report they were unable to find rate in younger patients. Perhaps they are more aggressive during activities and put more stress on the repaired tendon. Older patients may be more sedentary and less likely to stress
the healing tendon.

More study is needed to understand the biology of tendon rupture and repair. Results may bring changes in the way ruptured tendons are treated. It may be that treatment for younger patients should be different than treatment for older adults.