ACHILLES' TENDON STRAIN
DESCRIPTIONAn Achilles' tendon strain is an injury to the Achilles' tendon or its adjoining muscle or bone. These 3 parts comprise a unit. The strain occurs at the weakest part of the unit. The Achilles' tendon, the muscle attached to the Achilles' tendon, the heel bone, and the soft tissue surrounding the strain are involved.
Appropriate health care includes: doctor's diagnosis; application of tape, plaster splits, or casts (sometimes); self-care during rehabilitation; physical therapy; surgery (sometimes).
SIGNS & SYMPTOMSPain when flexing or extending the foot.
Muscle spasm at the rear of the calf.
Swelling around the Achilles' tendon.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the muscle or its tendon (visible with X-ray).
Inflammation of the sheath covering the Achilles' tendon.
CAUSESProlonged overuse of muscle-tendon units in the child's ankle.
A single episode of stressful overactivity, as in hurdling, long-jumping, high-jumping, or starting a sprint.
Contact sports; running; sports that require quick starts, such as long-jumping, hurdling, or running races; any cardiovascular medical problem that results in decreased circulation; medical history of any bleeding disorder; obesity; poor nutrition; previous Achilles' tendon injury; poor muscle conditioning.
PREVENTING COMPLICATIONS OR RECURRENCEYour child should participate in an appropriate strengthening and conditioning program and should warm up before participating in sports. The child should tape the Achilles' area and wear proper shoes for sports.
MEDICAL TESTSYour own observation of symptoms; medical history and physical exam by a doctor; X-rays of injured areas to rule out fractures.
POSSIBLE COMPLICATIONSProlonged healing time if the child resumes activity too soon; proneness to repeated injury; an unstable or arthritic ankle following repeated injury; inflammation at the attachment to bone (periostitis); prolonged disability (sometimes).
If this is a first-time injury, proper care and sufficient healing time before the child resumes activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as bone fractures. Average healing times are: mild strain--2 to 10 days; moderate strain--10 days to 6 weeks; severe strain -- 6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
FIRST AIDFollow instructions for R.I.C.E., the first letters of rest, ice, compression, and elevation. See R.I.C.E. Appendix 39 for details.
If a cast or splints are used, leave the child's toes free and exercise them occasionally. If a cast or splints are not used:
Use ice massage 3 or 4 times a day for 15 minutes at a time. See Glossary.
After the first 24 hours, apply heat instead of ice, if it feels better to your child. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Provide the child with whirlpool treatments, if available.
Wrap the injured ankle with an elasticized bandage between treatments. Insert a heel lift in the child's shoe.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONFor minor discomfort use aspirin, acetaminophen, or ibuprofen; topical liniments and ointments.
Your doctor may prescribe stronger pain relievers; injection of a long-acting local anesthetic to reduce pain (rare); injection of a corticosteroid, such as triamcinolone, to reduce inflammation (rare).
For a moderate or severe strain, your child should walk with crutches for at least 72 hours -- longer with a cast or splints. See Appendix 37 (Safe Use of Crutches).
The child can resume normal activities gradually after the pain has subsided.
DIET & FLUIDS
OK TO GO TO SCHOOL?Yes, when condition and sense of well-being will allow.
CALL YOUR DOCTOR IF
Your child has symptoms of a moderate or severe Achilles' tendon strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.
The following occurs with a cast or splint: pain, numbness, or coldness below the injury; dusky, blue, or gray toenails.