Member Case Study: Torn Tendon

author : AMSSM

comments : 0

Tendonitis can often be treated effectively through a variety of means including therapeutic exercise, medications, modalities, taping, and, most importantly, activity modification.

Question from YogaNerd
Early this year I increased my running and biking mileage to move from sprint distance to Olympic distance. Within a few months, I noticed a new pain at the back end of the fifth metatarsal of my left foot. After several trips to the podiatrist, several rounds of X-rays, and finally an (expensive) MRI series, I have been diagnosed as having a TORN PERONEUS BREVIS TENDON, tendonitis, and thinning of the tendon. I have stopped running and switched to the elliptical, but even after a few months of non-running and limited walking, I still have pain. The only alternative that I have been informed of is surgery which is not very appealing because it means a considerable amount of time off of my feet, no biking, no swimming, no elliptical. 

What can I do to expedite the healing of this tendon, and prevent further injury? Will a lot of yoga help - lengthening the muscle to put less stress on the tendon? I am formally an Athena-class triathlete…is reducing my BMI the panacea? Help - I am one very frustrated triathlete!

Answer:
Overuse injuries, such as tendonitis, often come shortly after a change has been made in a training regimen as you describe in your letter. There are other overuse injuries that are common in running athletes too. The information you share makes me wonder what's actually wrong with your foot. Is it tendonitis? A tendon tear? Could it be a stress fracture at the base of the bone?

Tendonitis can often be treated effectively through a variety of means including therapeutic exercise, medications, modalities (e.g. ice, ultrasound, phonophoresis), taping, and, most importantly, activity modification. If continued sport participation during rehabilitation does not allow for healing, then reduction in activities is needed. If the tendon has been torn from its origin, it may need to be surgically re-attached. If tears are noted "along the grain" of the tendon, but it is still attached, a period of immobilization followed by a tailored rehabilitation program may lead to healing.

If pain persists, surgical intervention may prove helpful. If you actually have a stress fracture and continue to train, you can break the bone right through. In this particular bone, poor healing is common. For this reason, some fractures of the 5th metatarsal, so-called Jones' fractures, may require surgical fixation for adequate healing.

You can see that any of the above mentioned treatment options may require that you refrain from impact-loading training for a prolonged period of time. There is no "quick fix," and a single intervention won't likely lead to a cure on its own.

James Moeller, MD
FACSM, AMSSM
 

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date: October 1, 2006