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Q. What treatment is available for a swollen and paining Achilles tendon?

Answered by
Dr. Akshay Kumar Saxena
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 16, 2017 and last reviewed on: Mar 20, 2021

Hello doctor,

About a week ago, I got off the lounge chair and felt a sharp pain in the back of my left ankle. The pain has not changed during the week. The whole ankle is still swollen.  The pain has not changed, and it radiates from inside the heels up to my Achilles and into the lower back part of my leg.  I can hardly walk. Three days ago I went to the hospital, wherein a portable ultrasound scan of the Achilles' tendon was performed, which revealed that it was still intact, but the doctors said it could be torn. About eight months back, I had an accident at the workplace and had torn my L5/S1 disc. And this had created a leaking disc and a bulge affecting the nerves in my legs. I had a nerve conduction test done, and the results were positive with nerve issues in my left leg, but I never had this pain before in this part of my foot. I have attached a photo of the back of my ankle, and you can see the Achilles' tendon is badly swollen. When it is strapped, it is a little better, but still painful. When it is unstrapped it is worse, and I can hardly walk on it. What do you think my injury is? Could it be related to my back and nerve injury? What treatment is available and what should I do now?

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Hi,

Welcome to icliniq.com.

Firstly, there is no attachment and hence I could not see the clinical picture.

  • You have mentioned about the pain at the back of your ankle along with swelling over the affected region. The injury as described by you could be Achilles Tendinitis or a partial tear in the tendon especially if there was any injury which you can recollect immediately preceding the onset of your symptoms.
  • Your symptoms right now do not appear to be related to your lower back region as it would not cause any associated swelling, although the variable presentation of pain can be there as a nerve may be getting impinged in your back region as a result of herniated L5/S1 disc.
  • It is actually difficult to tell you any treatment without arriving at a diagnosis, but I can guide you as to what is needed.
  • Ice compression may help you to get relief from swelling and pain. The elevation of your limb, especially at night may also help in reducing the associated swelling around the back of your ankle.
  • You can take a gentle anti-inflammatory medication like Ibuprofen or Diclofenac or Paracetamol along with medications to reduce swelling.
  • You will need to certain tests like complete blood count, erythrocyte sedimentation rate, C-reactive proteins and serum uric acid levels.
  • To rule out an Achilles tendon tear, you need to undergo an MRI of the affected region and not ultrasound. MRI is also indicated if you have an associated weakness of your ankle plantar flexion but that can be assessed only by a trained orthopedic surgeon as it will require a clinical examination.
  • On the contrary, if these symptoms are due to the spine, it will not cause any swelling. In that case, activity modification, anti-inflammatory medications and medications to reduce neuropathic symptoms like Pregabalin or Gabapentin may be initiated for relief.
  • If you can send me the clinical picture, I can assess and let you know my opinion. Also, please send the ultrasound report and if possible MRI of your ankle with emphasis on tendon Achilles integrity. Do get the blood investigations done to rule out any infection or any other inflammatory cause for pain and swelling.

The Probable causes:

Injury around a week ago.

Investigations to be done:

1. MRI scan.

2. Blood investigations as advised.

3. Ultrasound report and images (if possible).

Differential diagnosis:

1. Hyperuricemia.

2. Infection.

Treatment plan:

As advised.

Regarding follow up:

Revert back with clinical pictures and investigations reports to an orthopaedician and traumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

Thank you doctor,

Sorry, I do not know why the photo did not work, but I have attached it again.

#

Hi,

Welcome back to icliniq.com.

Thanks for sending me your images and sorry that you had trouble uploading your initial images.

  • It appears that there is not only swelling but also an erythematous patch all along the tendon. So I would like to see the MRI for this, and then a decision can be taken whether this needs to be managed conservatively or through any procedure.
  • You can actually feel the tendon all along your leg, which becomes better, especially if you stretch your foot upwards. If you feel any depression or any sort of discontinuity in the tendon, please get an MRI done because tendon Achilles injuries cannot be neglected.
  • The healing by itself in the case of a complete rupture is very poor. Meanwhile, you can apply a brace till you can get your tests done.

For further information consult an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist


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