From an interview with
Dr. Adam Mandel
McLeod Orthopaedics Seacoast, Foot and Ankle

Achilles tendonitis comes in two forms. One is called Insertional Achilles Tendonitis. That’s where the Achilles goes into the heel bone, so you get pain at the back there. The other variant is called the Non-Insertional Tendinopathy, which occurs a couple centimeters above where the Achilles. McLeod Orthopedic Specialist Dr. Adam Mandel describes the problems and treatments for ankle problems.

Here is a summary of Dr. Mandel’s comments:

CAUSES

More common causes in men than women and reasons include:

• Tightness of the calf muscle
• A high arch or a very low arch
• Steroid use
• Inflammatory arthritis
• Sports, usually a weekend warrior variant
• And sometimes here is no reason whatsoever

TREATMENTS
Depending on how acute the injury is, sometimes we immobilize patients in a walking boot. Sometimes I’ll prescribe physical therapy. There is an in-office injection that we can do called platelet rich plasma (PRP). Surgery is always an option.

When someone injures their ankle, either a twisting injury, a fall or a motorcycle accident or motor vehicle accident, the most common thing to look for is inability to bear weight. If a person can’t bear weight, it is more likely to be a fracture than a sprain.

There’s certain conditions where you may not feel pain, such as diabetics with nerve problems. The most important thing is to get checked out either in the orthopedic surgeon’s office or elsewhere. Get an X-ray, which confirms whether you broke your ankle versus a sprain.

The treatments for a sprain versus a fracture vary. Both injury sites will be swollen, but with a fracture you can’t bear weight. With a fracture, you will have tenderness on the inner and outer ankle bones.

Sometimes, in addition to spraining the ankle, experiences a peroneal tendon strain. The two peroneal tendons sit on the outside of the ankle. They start on the outer portion of the leg. They come down and wrap around the outer ankle bone. Twisting the ankle reflects the most common ankle injury. It can happen in conjunction with a sprain. Other causes include a traumatic injury, such as car crash or fall from a height.

Another condition to look out for is a peroneal subluxation or a peroneal dislocation. That’s where the tissue that holds these tendons at the back of the ankle bone gets disrupted, and these tendons can come dislodged or dislocated.

ACTION YOU CAN TAKE
If you have pain in our ankle and have problems putting weight on it, see an Orthopedic Specialist or your person physician.

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