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Training & advice

What are shin splints and how do you treat them? Simon Moyes explains

Leading orthopaedic surgeon Simon Moyes explains shin splints and how best to treat them.

Following on from my last piece about sprained ankles, here is my guide to help you identify an Achilles tendon problem and how best to treat it.

Simon Moyes

Simon Moyes

Simon Moyes' guide on how to treat an Achilles tendon problem

What is the Achilles tendon?

The Achilles tendon is a strong cord that connects the calf muscle to the heel. It is this which allows us to point our feet down, raise our heel, and propels us forwards when we walk or run.

What do I need to be worried about?

If you are a regular runner, there is a danger that small tears can develop in the tendon fibres. These can be very difficult to repair easily because the supply of blood to the tendon is rather limited. As a result, the tendon and the lining surrounding it can become inflamed, causing a lot of pain for runners. The degeneration of the tendon is called tendonosis and the inflammation of the lining is tenosynovitis.

If the Achilles tendon becomes weak or overstressed, the tendon will tear completely. If this occurs, it is likely you will feel a snap in the back of the ankle, followed by a sharp burst of intense pain, which will make it very difficult for you to walk. Whilst this only happens in severe cases, patients will still find it very difficult to walk even if they only have a partial tear.

If this happens to me, what do I do next?

If your pain is persistent or if you are worried about a tear, you need to be referred to a specialist with an interest in your problem who will assess and image you.

What are my options?

Tendinosis and tenosynovitis will normally respond to physiotherapy and other non-operative measures. Only if these fail after an extended time frame will surgery be considered.

Depending upon the scale of the injury, surgeons will carry out either debridement or tendon reconstruction.

If you have a minor injury, the surgeon will make small cuts to the tendon during arthroscopic surgery to stimulate in-growth blood vessels, resulting in a healing response. However, if the tendon has been ruptured completely, a cut will be made in the back of the heel and the two ends of the tendon are sewn together.

In the case of extremely severe tendinosis, the surgeon will remove the deteriorated areas and replace them with other tissues from another part of the Achilles tendon, or a tendon from the big toe. The new tissue is attached to the cut section of the Achilles tendon and stitches are used to hold it in place.

When will I be able to return to running?

After surgery, patients will be required to wear a cast for up to six weeks before transferring onto a lightweight air cast walking boot.

Although it will depend on the extent of the injury, the patient and the success of the surgery, it will typically be up to six-12 weeks before patients are able to put their full weight on their foot.

However, you will not be able to return to running for three-to six months. It may even take up to 12 months before maximum strength is restored.

How do I find out more?

If you have a question about arthroscopy/keyhole surgery please leave a comment in the box below or email simonmoyes@simonmoyes.com, call 0207 323 0040 visit www.simonmoyes.com and www.ankle-arthroscopy.co.uk.