tendonitisI.      Definition:  Tendons are fibrous bands that connect muscles to bones.  Two common tendon injuries of the ankle include strains and tendonitis.  A strain is a condition in which a tendon and connected muscle become stretched, partially torn, or completely ruptured, resulting in pain, swelling, and usually some loss in the ability to walk.  When a tendon is completely ruptured, it is often (but not always) signaled by a “popping” sound and sensation.   Tendonitis is characterized by swelling, heat, and pain of a tendon.

II.      Cause:   A tendon strain can occur when a muscle is pulled too far in one direction while it is contracting in the other direction.  It is usually caused by a single episode, such as a sudden twist of the ankle.  Strains often occur when participating in sports, for example when landing on the side of a foot after a jump, abruptly changing directions, reaching to make a tennis shot, or running on an uneven surface.  Alternatively, tendonitis results from repeated stress on a tendon.  An aggressive exercise program, running on hard surfaces, or wearing shoes that do not provide cushion and support can lead to tendonitis.

III.      Treatment and Prevention:  Steps can be taken to lower the risk of a tendon injury.
•    Keep a regular fitness program to maintain and build muscle strength.
•    Do daily stretching exercises.
•    Maintain a healthy diet.
•    Always warm up before sports activities.
•    Use appropriate athletic equipment for each activity.
•    Limit heavy activity or intense exercise to every other day.

Most tendon injuries can be treated conservatively and are based in decreasing the pain and swelling of the injury.  Ibuprofen, acetaminophen, and other over the counter medications are usually effective in providing relief.  The RICE treatment method should also be followed.

•    Rest – Allow the tendons and muscles to heal by avoiding activities that put pressure on the affected area.
•    Ice – Ice should be applied immediately when a sprain occurs.  Apply ice for 15-20 minutes every 2-3 hours to keep pain and swelling down.
•    Compression – Compress the area with a bandage to keep swelling down.
•    Elevation – Elevate the injured area above the level of the heart to avoid swelling.

In severe cases, surgical treatment may be required to repair a ruptured tendon.  Surgery is usually followed by casting until healing is complete.  The length of the healing process varies between cases, but can take six months or more for full recovery.

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