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While the tendons are not involved in the structure and function of the 3 joints in the ankle per se, they are critical for converting the movement of muscle contraction to movement of the foot and/or ankle. The most common tendonous injury is to the Achilles tendon, which connects the muscle of the posterior calf to the bottom of the calcaneus bone, and mediates plantar flexion (toes down) function across the ankle.  Injuries to other tendons that cross the ankle are usually the result of lacerations or direct trauma. As with the ligaments, the severity of all tendonous injuries can vary from mild (stretching) to moderate (tearing) to severe (rupture). With the Achilles tendon, tendonitis (inflammation of the tendon) can also occur and is said to be the most common over-use syndrome seen in sports medicine clinic. In runners who complain of lower leg pain, Achilles tendonitis is present in 6-11% of cases. Achilles tendonitis is thought to result from a combination of repetitive minor trauma to the tendon plus accumulation of repeated stress injuries. Long distance running (10-70 miles per week) is a common charateristic of patients with this condition, and although intrinisic factors such as age, previous injury and anatomic variations may contribute to its development, extrinic factors including a sudden increase in training intensity, a change in running surface, interval physical training or worn out/inappropriate footware are also linked to its development. Anatomically, the Achilles tendon is its thinnest about 2 inches above its attachment to the rear of the calcaneus bone, and this same area is avascular (has no direct blood supply). It is this region of thin and avascular tendon that is the most common site of Achilles tendonitis and injury. Peculiar to the Achilles tendon and several other large tendons in the body, development of tendonitis can progress to "tendonosis" (degenerative changes within the tendon) if ignored, and "tendinosis" can predispose to tendon tearing (partial rupture) or complete rupture if not treated appropriately. While total rest is not usually required for treatment of Achilles tendonitis or "tendonosis", changes in training schedule to decrease the distances run, use of heel lifts or other orthotic devices, oral anti-inflammatory medications and avoidance of hill work or interval training is usually part of the rtreatment and rehabilitation process. The optimal methods for repair of complete Achilles tendon rupture remain controversial. |