Kategoriarkiv: Rupture of the hollow foot tendon

Rupture of the joint capsule at the front of the ankle joint

11. juli 2011Rupture of the hollow foot tendonurtehave_com

RUPTURE OF THE JOINT-CAPSULE AT THE FRONT OF THE ANKLE JOINT

Diagnosis:

Anatomy: The ankle joint is stabilised by a joint-capsule as well as a wide fan shaped ligament on the inside (ligamentum deltoideum/mediale), and a set of outer ligaments (ligamentum talofibulare anterius fore, ligamentum calcaneofibulare centre, and ligamentum talofibulare posterius at the rear). There is also a strengthening of the ligaments fore and rear (ligamentum tibiofibulare anterius & posterius). The joint-capsule and ligaments stabilise the ankle joint, especially when twisting and running with sudden directional changes.

Cause: A rupture of the joint-capsule at the front of the ankle joint arises if the foot is over-stretched (plantar flexion), resulting in the joint-capsule over-streching and rupturing. This is often seen when a football player kicks the ground, or strikes the ball on the toe when trying to kick with the instep. In slight cases the injury can be termed a strain or sprain, and in more serious instances as full or partial rupture or tear.

Symptoms: Pain in the ankle joint which is worsened when stretching the ankle joint.

Acute treatment: Click here.

Examination: Medical examination is not necessarily required for very minor cases (slight sprain) with only minimal swelling and no discomfort when walking. The extent of the swelling is, however, not always a mark of the degree of the injury. Medical examination is recommended with more extensive swelling or pain, in order to eliminate bone fracture, bone membrane tear (periosteal avulsion), outer ligament injury in the ankle joint, inner ligament injury in the ankle joint and rupture of the ligament between shin and calf bones (syndesmosis rupture) (article). A normal medical examination is usually sufficient in order to make the diagnosis. X-ray examination will confirm or exclude any suspicion of fracture. Small bone membrane tears (periosteal avulsions) will be best seen using ultrasound scanning.

Treatment: Treatment of uncomplicated joint-capsule ruptures will usually be conservative (rehabilitation).

Rehabilitation: INSTRUCTION

GENERAL STEP1 STEP2 STEP3 STEP4

Bandage: It is recommended to use tape in the course of rehabilitation when starting to run on an uneven surface, with sudden directional change, or kicking balls. Taping does, however, not have the same importance as with injuries to the outer or inner ligament in the ankle (tape-instruction).

Prevention: Seesaw exercise is important in the rehabilitation phase, as well as in a preventive capacity. As a preventive measure, seesaw exercises should be performed frequently throughout the rest of the active sporting career if ligament injuries in the ankle joint have previously been experienced. Begin by standing with both feet on the seesaw and use hands for support on the wall. Gradually let go of the support to finally train by standing on only one leg (article). Special bandages have in some studies been shown to reduce the risk of ligament injuries (article).

Complications: If there is not a steady improvement in the condition consideration must be given as to whether the diagnosis is correct, or if complications have arisen:

Degenerative arthritis

9. juli 2011Rupture of the hollow foot tendonurtehave_com

SLIDGIGT

Diagnosis:

(Osteoarthritis)

Anatomy: The surfaces of the joints are lined with a cartilage covering of a few millimetre’s thickness which serves to reduce the load or strain on the joint surfaces.

Phalanx media
Tuberositas ossis metatarsalis V
Os cuboideum
Calcaneus
Talus
Os naviculare
Os cuneiforme laterale
Os cuneiforme intermedium
Os cuneiforme mediale
Os metatarsalei
Os sesamoideum
Phalanx proximalis
Phalanx distalis

THE FOOT FROM ABOVE

Cause: Degenerative arthritis occurs with repeated (over) load when first the cartilage takes damage, and then the bone under the cartilage. Degenerative arthritis can in some instances cause an irritation of the synovial membrane which will result in concentration of fluid, swelling, reduction in mobility and pain in the joints. Degenerative arthritis in the ankle joint is often seen after repeated ligament injuries (outer ankle joint ligaments, inner ankle joint ligaments), where cartilage lesions in the ankle joint have occurred at the same time.

Symptoms: Pain in the joint with movement under load. Occasionally swelling in the joint.

Examination: Normal clinical examination is often sufficient. However, it is also often necessary to perform an x-ray (or ultrasound scan or MRI examination) to make the diagnosis. Ultrasound scanning will often reveal inflammation surrounding new bone development at the joint surfaces.

Treatment: Treatment comprises relief from the painful activities until the swelling has gone down, after which training can commence with the primary aim to strengthen the muscles surrounding the joint and retain joint mobility. There is no treatment which can restore the damaged cartilage (and bone). Cartilage transplants are, as yet, not suitable for general degenerative arthritis. In cases of swelling in the joint, and with inflamed new bone development at the joint surfaces, inflammation of the synovial membrane can be attempted subdued by using rheumatic medicine (NSAID), or by draining the fluid and injecting corticosteroid. The injections can be performed to advantage by utilising an ultrasound guided method. Pain without swelling of the joints is best treated with paracetamol. In severe cases of degenerative arthritis where there is pain when resting (at night), it may be necessary to fix the joint by operation.

Rehabilitation: Rehabilitation is completely dependent upon the degree of the degenerative arthritis and in which joints it is located.
Also read rehabilitation, general.

Bandage: A supportive tape (Hollywood bandage) can be attempted to aid degenerative arthritis in small joints (toes) (tape-instruction). Tape provides no help to attacks in the ankle joint.

Complications: Degenerative arthritis which sits on the weight bearing parts of the joint is one of the most serious sports injuries, and often results in a termination of active sport. It is usually possible to continue sport activities with light strain on the joints (cycling, swimming), whereas it is advisable to participate in activities with great strains on the joint (running, ball games) with restraint. The diagnostic considerations in connection with degenerative arthritis include:

Special: Shoes with shock absorbing inlays will reduce the discomfort of degenerative arthritis.

Stress fracture

9. juli 2011Rupture of the hollow foot tendonurtehave_com

STRESS FRACTURE

Diagnosis:

Anatomy: The foot bones comprise the 7 tarsal bones (ossa tarsi), the 5 metatarsal bones (ossa metatarsi) and the 14 bones in the toes (phalanx).

Phalanx media
Tuberositas ossis metatarsalis V
Os cuboideum
Calcaneus
Talus
Os naviculare
Os cuneiforme laterale
Os cuneiforme intermedium
Os cuneiforme mediale
Os metatarsalei
Os sesamoideum
Phalanx proximalis
Phalanx distalis

THE FOOT FROM ABOVE

Cause: Repeated load or strain (walking or running) can in some cases entail the load exceeding the strength of the bone tissue, thus resulting in a stress (or fatigue) fracture. Stress fractures are most often seen in the metatarsal bones, (article) (article).

Symptoms: Pain when applying pressure (direct or indirect tenderness), and when applying load or strain.

Examination: X-ray examination will usually, but not always, reveal a stress fracture. The x-ray examination can be repeated after a few weeks as a number of stress fracture are not easily discernible in the early stages. Bone scintigraphy, ultrasound scanning and MRI examination can often diagnose a stress fracture much earlier than x-ray examination (Ultrasonic image), (Scintigraphy-image).

Treatment: Treatment is primarily relief and rest, and possible bandaging. Surgical intervention is only required in very special cases. It is imperative that shoes are equipped with impact absorbing soles (article).

Rehabilitation: Rehabilitation is totally dependent upon the type of fracture, and the treatment (conservative or surgical). Until the pain has subsided, the guidelines under rehabilitation, general should be followed.

Complications: If there is not a steady improvement in the condition a medical examination should be performed once more to ensure that the fracture is healing according to plan. In some cases, a false joint can develop which will require surgical treatment.

Bone fracture in the ankle

9. juli 2011Rupture of the hollow foot tendonurtehave_com

BONE FRACTURE IN THE ANKLE

Diagnosis:

Anatomy: The foot bones comprise the 7 tarsal bones (ossa tarsi), the 5 metatarsal bones (ossa metatarsi) and the 14 bones in the toes (phalanx). Furthermore, the lower part of the shin bone (tibia) and calf bone (fibula) form a part of the ankle joint.

Phalanx media
Tuberositas ossis metatarsalis V
Os cuboideum
Calcaneus
Talus
Os naviculare
Os cuneiforme laterale
Os cuneiforme intermedium
Os cuneiforme mediale
Os metatarsalei
Os sesamoideum
Phalanx proximalis
Phalanx distalis

THE FOOT FROM ABOVE

Cause: A blow or violent twist can cause a fracture of the bone (X-ray picture).

Symptoms: Pain when applying pressure (direct or indirect tenderness), and when applying load or strain.

Acute treatment: Click here.

Examination: X-ray examination will usually reveal the fracture. The fracture can in some cases first be seen after 14 days, thus the x-ray examination should be repeated if there is a continued suspicion of a fracture.

Treatment: Treatment is completely dependent upon which bones are broken, and whether there is a dislocation of the fracture. In some cases relief and rest without bandaging can be opted for, whereas other types of fracture require bandaging and possibly surgical intervention (article) (X-ray picture).

Rehabilitation: Rehabilitation is totally dependent upon the type of fracture, and the treatment (conservative or surgical).
Also read rehabilitation, general.

Special: As there is a risk that the injury can cause permanent disability, all cases should be reported to your insurance company.

treatment-article5

6. juli 2011Rupture of the hollow foot tendonurtehave_com

SportNetDoc

High frequency ultrasonographic findings in plantar fasciitis and assessment of local steroid injection.

Kamel M, Kotob H. J Rheumatol 2000 Sep;27(9):2139-41.

OBJECTIVE.
To investigate the value of ultrasonography in the diagnosis of plantar fasciitis and changes in plantar fascia following ultrasound guided local steroid injection.

METHODS.
Twenty patients with a clinical diagnosis of plantar fasciitis and 20 healthy subjects were studied prospectively. Ultrasound examination was performed using an ATL Apogee 800 and linear array 11 MHz transducer. The affected heel was injected with 15 mg triamcinolone hexacetonide and 2 ml of 2% lidocaine. Ultrasound examination was performed at time of clinical evaluation, again immediately after injection, and at 1, 6, and 30 weeks later. The thickness, echogenicity, and marginal appearance of plantar fascia were measured.

RESULTS.
Ultrasonographic measurement of plantar fascia showed a significant increase in symptomatic heels (range 4.8-6.5, mean 5.8 +/- 2.06 mm) compared with healthy subjects (range 1.8-3.4, mean 2.4 +/- 0.64 mm) (p < 0.001). A significant decrease in the thickness of plantar fascia was observed 1 week after local steroid injection (range 2.1-3.5, mean 2.3 +/- 0.91 mm). Complete relief of symptoms and signs was further observed at 6 and 30 weeks.

CONCLUSION.
Ultrasonographic examination of plantar fascia is easy and quick to perform. Ultrasound procedure should be considered early in diagnosis and management of heel pain. Ultrasound guided local steroid injection proved safe and effective in the treatment of plantar fasciitis.

treatment-article4

6. juli 2011Rupture of the hollow foot tendonurtehave_com

SportNetDoc

Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection.

Tsai WC, Wang CL, Tang FT, Hsu TC, Hsu KH, Wong MK. Arch Phys Med Rehabil 2000 Oct;81(10):1416-21.

OBJECTIVE.
To investigate the efficacy of ultrasound-guided steroid injection for the treatment of proximal plantar fasciitis and to evaluate mechanical properties of the heel pad after steroid injection.

DESIGN.
Proximal plantar fascia and heel pad were assessed with a 10-MHz linear array ultrasound transducer. Pain intensity was quantified with a tenderness threshold (TT) and visual analog scale (VAS). The transducer was incorporated into a specially designed device to measure mechanical properties of the heel pad. Evaluations were performed before injection and at 2 weeks and 3 months after injection.

SETTING.
An outpatient clinic of a tertiary care center.

PATIENTS.
Fourteen consecutive patients with unilateral proximal plantar fasciitis.

INTERVENTION.
Ultrasound-guided injection of 7 mg betamethasone and 0.5 mL of 1% lidocaine into the inflamed proximal plantar fascia.

MAIN OUTCOME MEASURES.
VAS, TT, heel pad and plantar fascia thickness, and echogenicity of the proximal plantar fascia on sonogram were assessed. Mechanical properties included unloaded heel pad thickness, compressibility index, and energy dissipation ratio.

RESULTS.
Both VAS score +/- standard deviation (SD; 5.43 +/- 2.03, 1.39 +/- 2.19, 0.57 +/- 1.40 at the 3 measurements, respectively) and TT +/- SD (5.05 +/- 1.42, 9.34 +/- 1.84, 9.93 +/- 1.98 kg/cm2 at the 3 measurements, respectively) improved significantly (p < .001) after steroid injection. The mean thickness of the plantar fascia was greater in the symptomatic side than in the asymptomatic side before treatment (0.58 +/- 0.13 cm vs 0.40 +/- 0.11 cm, p < .001). The thickness had decreased significantly 3 months after injection (0.46 +/- 0.12 cm at 2 weeks, 0.42 +/- 0.10 cm at 3 months, p < .001). The hypoechogenicity at the proximal plantar fascia disappeared after steroid injection (p < .001). Mechanical properties of the heel pad did not change 3 months after steroid injection (p > .05).

CONCLUSION.
Ultrasound offers an objective measurement of the therapeutic effect on proximal plantar fasciitis. Accurate steroid injection under ultrasound guidance can effectively treat proximal plantar fasciitis without significant deterioration of the mechanical properties of the heel pads.

treatment-article3

6. juli 2011Rupture of the hollow foot tendonurtehave_com

SportNetDoc

SETTING.
An outpatient clinic of a tertiary care center.

PATIENTS.
Fourteen consecutive patients with unilateral proximal plantar fasciitis.

INTERVENTION.
Ultrasound-guided injection of 7 mg betamethasone and 0.5 mL of 1% lidocaine into the inflamed proximal plantar fascia.

Corticosteroids

6. juli 2011Rupture of the hollow foot tendonurtehave_com

corticosteroid

CORTICOSTEROIDS

Injection of corticosteroid in sports-medicine is used as a result of the following indications:

Reduction of the acute inflammation of the bursa (bursitis), inflammation of the tendon sheath (tenosynovitis) or concentration of fluid in the joint (traumatic arthritis/synovitis)
Reduction of the damaging effect of chronic inflammation in certain protracted over-load injuries, especially inflammation of the tendon (tendinitis), and inflammation of the tissue surrounding the tendons (peritendinitis).

No other legal treatment of sports injuries has been so controversial as localised injection of corticosteroid. There is, however, no documentation that injection of corticosteroid in the area surrounding the tendons, in the joint or in the bursae should be harmful (article) (article). Although laboratory tests do indicate an immediately weakening in the tendon tissues shortly after the injection (article), human studies show no sign thereof (article). Injections direct into the tendons should be advised against however, as certain animal studies suggest that the tendon is thereby weakened (article).

Indications. Arthritis (swelling of joints due to rheumatism). Injection of corticosteroid in the joint is one of the treatments most commonly used in rheumatic illnesses. Placebo controlled studies have documented the effect of this form of treatment.
Chronic over-load symptoms from tendons. The chronic changes in the tendons are properly a mix of wear (degeneration) and inflammation (article). There are several scientific studies which documents the short term effect of corticosteroid injection around the overloaded tendons almost every where in the body. Almost all patients experienced fewer symptoms and (partial) normalisation of the chronic thickened tendons simultaneous with the disappearance of the inflamed blood vascularisation, however, a significant number experienced a relapse of the symptoms, possibly due to a much too short rehabilitation period. The way to fast rehabilitation after the injection of corticosteroids (after the pain has disappeared but before the tendon has strengthened) could also be a result as to why corticosteroids are more effective than different types of rehabilitations in the first 3 months, while rehabilitation is more effective than corticosteroids after 6 months (article). This is why it is very important that the treatment with corticosteroids are accompanied with prolonged rehabilitation (even if the discomfort fades after 1-2 months) over (more than) a half year.
Inflammation of the tissue surrounding the tendons, myositis ossificans (calcification in muscles after bleeding), bursitis and muscle rupture. Only a modest amount of documentation is available regarding treatment of these injuries with corticosteroid injection, despite the treatment being widespread.

Mechanism of action. The mechanism of action is not fully clarified.

Side effects. The risk of infection is minimal with the observance of simple sterile procedures (disinfection with surgical spirits at least twice, sterile equipment, “non-touch technique”). Bleaching of the skin above the infection with visible blood vessels in the skin, a change in the sensitivity of the area, and partial loss of fatty tissue are frequent occurrences, but only in very rare cases give any discomfort. The majority of discomfort disappears spontaneously after several months (years). The risk of systematic effect following injection of corticosteroid is shown by facial blushing (about 10 %), menstruational disorder and fluctuation of blood sugar which is seen quite frequently while serious side effects like allergic shocks are extremely rare. Erroneous injection direct into the tendons as well as injection surrounding partial (and total) ruptured tendons can occour. It is for this reason that ultrasound scanning is recommended prior to all injections in areas where there are large tendons (Achilles tendon, knee cap tendon, hollow foot tendon), to ensure the correct diagnosis and exclude partial ruptures. If injections are given under the guidance of ultrasound, it will ensure the correct injection and optimal effect whilst minimising the risk. The athlete should be advised of the risk of tenderness in the area for a while after the injection (fading away during the course of a few hours or days). Local treatment with corticosteroids is allowed by the doping law.

Contraindications. Suspicions of infection in the vicinity of the place of injection and active tuberculosis. As there is only modest experience of the effects of corticosteroid injections on children, this treatment is seldom indicated for minors.

Administration. The corticosteroid is mixed with local anaesthetic prior to injection, thereby reducing the risk of side effects. The temporary subduing of pain (due to the local anaesthetic) will furthermore aid the confirmation (or the disconfirmation) of the diagnosis. Systemic treatment (tablets, suppositories, injections in the muscles and veins for systemic effect) with corticosteroid is not permitted in sport.

Discussion. Injections with corticosteroid in the area surrounding tendons can amongst other things be used as a supplement to treatment for chronic over-load conditioned tendon injuries. The basis treatment is “active rest” with increasing load within the pain threshold. If the athlete does not follow the rehabilitation principles and instead forces the rehabilitation, the chronic inflammation, the lengthy rest period and the suddenly increased training load will present a risk of rupturing the tendon.
Ultrasound scanning is recommended in treatments with injection of corticosteroid in the area surrounding larger tendons. If there is no positive effect (or the effect is passing despite correct rehabilitation) following the first ultrasound-guided injection, there are no grounds to repeat the process. If there is positive, but only partial, effect, the injection can be repeated once or twice with a minimum interval of four weeks.

Conclusion. Localised injection of corticosteroid is considered effective as treatment for bursitis, chronic inflammation of the tendon (tendinitis), inflammation of the tendon sheath (tenosynovitis), inflammation of the tissue surrounding the tendons (peritendinitis) and fluid accumulation in the joints (traumatic arthritis/synovitis), although the scientific documentation is incomplete.
On a correct indication following verification of the diagnosis with ultrasound scanning, ultrasound-guided injection of corticosteroid in the area surrounding the tendons could be an useable supplement to the basis treatment (rehabilitation) if correct rehabilitation haven’t made a progress.
The short term effect of the treatment is well documented but not for the long term effect which is only available through long term controlled rehabilitation.
If the treatment is misused to allow the athlete to continue a potentially damaging sports activity, the treatment will indirectly increase the risk of the chronic injury and tendon ruptures.

Resumé. Medicinal treatment is only a supplement to the basis treatments of sport injuries. Used the right way, the medicinal treatment can reduce the relieving period thereby starting the rehabilitation faster. If the treatment is abused to continue a harming sports activity without corrective training measurements, the risk of chronic injuries will increase.

treatment-article(1&2)

6. juli 2011Rupture of the hollow foot tendonurtehave_com

SportNetDoc

Plantar fascia rupture: diagnosis and treatment.

Rolf C, Guntner P, Ericsater J, Turan I. J Foot Ankle Surg 1997 Mar-Apr;36(2):112-4.

Two patients with spontaneous medial plantar fascia rupture due to a definite injury with no prior symptoms, were referred to our institution. Clinically, there was a tender lump in the sole, and magnetic resonance imaging confirmed the diagnosis. Nonoperative treatment was sufficient in curing the acute total rupture. Endoscopic release was used on the partially ruptured plantar fascia, but it is probably more optimal in the acute phase. The literature provides no comparative data on operative or nonoperative treatment efficacy for this rare condition.

Inflammation of the tendon (fasciitis plantaris)

6. juli 2011Rupture of the hollow foot tendonurtehave_com

Diagnosis:

(Fasciitis plantaris)

Anatomy: The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. The calf muscles are attached to the rear of the heel bone (calcaneus) via the Achilles tendon. The hollow foot tendon (aponeurosis plantaris) runs from the heel bone under the sole, and is attached to all five toes. The hollow foot tendon is a functional extension of the Achilles tendon, and is instrumental in maintaining the arch running the length of the foot (Photo).

Aponeurosis plantaris
Tuber calcanei

SOLE OF THE FOOT

Cause: Occurs after repeated overload in the form of running or jumping. Since the hollow foot tendon is a functional extension of the Achilles tendon, the provoking factors which are instrumental in injuries due to overload of the hollow foot tendon and the Achilles tendon are often the same.

Symptoms: Pain when running and jumping, as well as when applying pressure at the attachment point of the hollow foot tendon directly under the heel bone. The pain is often most pronounced slightly on the inner side of the attachment.

Acute treatment: Click here.

Examination: Medical examination is not necessarily required in slight, early cases where the tenderness is slowly increasing without sudden worsening. A normal medical examination is usually sufficient in order to make the diagnosis, and in all cases when there is a sense of a “crack”, or sudden shooting pains in the tendon, medical attention should be sought as soon as possible to exclude a (partial) rupture of the hollow foot tendon and bone fracture. This situation is best determined by use of ultrasound scanning (or MRI examination), as a number of injuries requiring treatment can easily be overlooked during a clinical examination. In cases where satisfactory progress is not in evidence, an ultrasound examination should be performed as early as possible. Ultrasound scanning enables an evaluation of the extent of the change in the tendon; inflammation of the tendon (tendinitis), development of cicatricial tissue (tendinosis), calcification, inflammation of the tissue surrounding the tendon (peritendinitis), inflammation of the bursa (bursitis), as well as (partial) rupture (article) (Ultrasonic image).

Treatment: Rest from the painful activity (running). The injury can in some cases heal within a few weeks if treatment is commenced at an early stage (article). If the pain has been present for several months, and especially if ultrasound scanning reveals thickening and change in the tendon, a rehabilitation period of several months must be anticipated. Special emphasis is laid upon strengthening exercise where the calf muscle is activated simultaneously with being stretched (eccentric training). It is imperative that the footwear is in order, with good running shoes including shock absorbing heels. Pressure on the hollow foot tendon can be relieved by walking in shoes with an arch support. Treatment with ice can be repeated every time the hollow foot tendon becomes tender during the rehabilitation phase. If satisfactory progress is not made in the training, medical treatment can be considered in the form of rheumatic medicine (NSAID) or injection of corticosteroid in the area around the thickened part of the tendon. Ultrasound guided injection increases the effect of the injection, as well as reduces the risks involved. Research has shown that ultrasound guided injections of corticosteroid are extremely effective in reducing the extent of the thickened tendons, to enable more active rehabilitation to commence (article). As the injection of corticosteroid is always an element in the long term rehabilitation of a very serious, chronic injury, it is vital that the rehabilitation period lasts over several months in order to reduce the risk of a relapse or rupture. It is not unusual for a rehabilitation period of six months before maximum strain or load in the form of jumping is permitted. The tendon is naturally unable to accommodate maximum strain or load after a prolonged injury period after only a short rehabilitation period. If the diagnosis is made by use of ultrasound scanning, the injections are performed under guidance of ultrasound, and the rehabilitation is progressed in accordance with the guidelines mentioned, then the treatment involving corticosteroid injections has very few risks connected (article). During recent years, different types of experimental treatment have been seen such as shock-wave (ultrasound treatment). However, there is no sure or clear documentation for the effect of the treatment. If the rehabilitation and conservative treatment does not yield progress, surgical intervention can be attempted. The long term results of operations are often disappointing (article-1), (article-2), (article-3).

Rehabilitation: INSTRUCTION

GENERAL STEP1 STEP2 STEP3 STEP4

Heel spur: Inflammation of the hollow foot tendon is occasionally connected to a heel spur. A heel spur is a new bone development which is seen in connection with a prolonged inflammation at the point of attachment of the hollow foot tendon on the heel bone due to overload. A heel spur is thus a consequence of an injury due to overload, and not the cause. If a heel spur has developed, it will never disappear. Heel spurs have no practical significance, and require no treatment. Many symptom free athletes have heel spurs without having had symptoms from the point of attachment of the hollow foot tendon. Surgical removal of heel spurs as performed in earlier days is now virtually no longer used

Bandage: Taping to relieve problems with the hollow foot tendon is of questionable significance, but can be attempted as the tape will not invoke further injury if applied in the correct manner (tape-instruction).

Complications: If there is not a steady improvement in the condition an ultrasound scan should be performed to exclude:

Few sports injuries carry as large a risk of chronic, permanent sporting disability as inflammation of the hollow foot tendon. In the severe, chronic cases, all treatment and rehabilitation attempts will often result in permanent inability to continue the sports activity.

Special: As prolonged overload or strain on the hollow foot tendon has a large risk of developing in to chronic inflammation, which is extremely difficult to treat, it is important to prevent the injury from arising or recurring. The principles in “Rehabilitation, general” should be followed to ensure that quickly increasing training loads at the season start, or after an injury period, are avoided. It is important that running shoes fit well (tight heel cap, shock absorbing soles ). It is vital that the first signs of tenderness or pain are reacted upon, to enable the training to be adapted before the injury reaches the stage where continuing the sports activity may be at risk.