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PUNCTURE ALONG ACHILLES TENDON

by CLAY
(JACKSONVILLE FL)

I GOT A LACERATION/PUNCTURE ALONG MY ACHILLES HEEL, THAT REQIURED 3 STITCHES, FROM THE BEGINNING I TOLD THE ER DR THAT I HAD NUMBNESS AND TINGLING IN MY FOOT, HE TOLD ME THAT IS COMMON WITH A LACERATION. NOW 5 DAYS LATER I STILL HAVE SWELLING AND NOW BRUISING AROUND MY HEEL OF MY FOOT. AS WELL AS PAIN WHEN FLEXING MY CALF. I ASKED THE DR IF I COULD OF NICKED MY TENDON IN ANY WAY, BUT HE SAID NO, THEY NEVER TOOK XRAYS TO MAKE SURE AND I AM FEARFUL THAT I MAY OF MESSED UP MY TENDON. WHAT IS YOUR TAKE ON THIS


RESPONSE

Hi Clay,

My take on this is that I wish I could see your laceration just to see how bad it is.
Obviously it was bad enough to require stitches and yes, the Achilles tendon is directly under the skin in the back of the heel, so theoretically, the tendon may have been nicked.

Having said that, you only had three sutures put in so that tells me the incision is not very wide.

The bottom line here is yes, the tendon may have been nicked, but I am "guessing" probably not too deep.

You could very well have tingling in your foot without the tendon being cut. There are many superficial nerves running down the ankle and the laceration may have nicked a nerve, thus giving your sensation of numbness and tingling.

An x-ray is of no value in this situation as an x-ray generally only shows bone damage, not soft tissue damage. Depending on the quality of the film, if the Achilles tendon showed up really well, you might be able to make out a deviation in the tendon which might represent a nick in the tendon, but that is a big stretch and for that reason, x-rays would not normally be taken in this kind of injury.

I am not sure what you mean by "flexing your calf". I will take that to mean flexing your foot, pointing your foot downward. If that is the case and that type of motion does cause pain in the affected area, then it might be indicative of a nick in the tendon.

However, it might also be due to inflammation that is occurring around the laceration itself. Inflammation will cause swelling and thus, when you flex your foot (point your foot downward) that may very well cause pain in the lacerated area.

If your swelling and irritation has been getting worse over the last couple of days, I would be concerned about the possibility of an infection in the sutured area. Under normal healing, the pain and swelling should diminish each day as healing takes place. The pain and swelling should not be getting worse.

My suggestion would be for you to see another doctor to make sure the wound is not infected and the other thing I would ask of the doctor is to check your muscle strength when you flex your foot,compared with your other foot.

Since you are able to flex your foot, we know the Achilles tendon is not severed. But if there is a nick of any kind in the tendon, the muscle strength in the affected foot, in theory would be less then your good foot.

That is the best I can do without having the luxury of actually examining you. If you have any concerns about your injury, seek medical attention.

Marc Mitnick DPM
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