DEAR DR. DONOHUE: During a basketball game I was playing in, I heard a loud popping sound. When I went to take a step, I fell to the ground. An associate told me I had a sprained ankle and that it would get better in six weeks. During that time I was in a lot of pain and had to hop up stairs, since I live on the second floor. After 10 weeks, I saw a specialist and was told to get an MRI scan and a cast walker brace. The MRI revealed that the tendon was almost completely torn. The specialist said it was too late for a brace and that I needed surgery. So far I have had two surgeries. I told my associate that if he hadn’t said I had an ankle sprain, I would have had treatment earlier and might not have needed surgery. He says I would have had to have surgery anyway. Who’s right? – T.T.

The Achilles tendon attaches the calf muscle to the back of the heel. Contraction of the calf muscle moves the foot in a position where the toes point downward. It permits us to take a step or stand on our toes, and it stabilizes the ankle when we have to make quick, off-to-the-side movements. It’s supposed to be a weak spot, but it’s actually a very strong tendon.

Achilles tendon inflammation is common. It comes from too much use, beginning a new running program, running on uneven surfaces or hills or wearing worn-out shoes. Rest is the most important treatment for tendon inflammation.

Tearing a tendon (rupture) is often associated with previous tendon inflammation that hasn’t completely gone away. It also can happen to a normal tendon when a person makes a sudden movement or cuts to the side quickly. The person hears a popping noise, just like you did, and thinks he or she has been kicked in the heel. It’s impossible to rise on the toes with a torn tendon. It’s painful to walk with one too.

If an elderly person tears a tendon, that person can get by with putting the affected leg in a cast. For a younger person like you, surgery is often chosen right away, especially if there is gap between the split ends. Surgery usually provides better results and quicker healing.

DEAR DR. DONOHUE: I am a 68-year-old woman. I have been going to a health club for seven years. I use the treadmill and stair stepper, and then do a Nautilus workout. I also do housecleaning, four to six hours, three times a week. I do not really get a cardio workout. Do you think it’s necessary that I add a cardio workout? – M.

Why do you say you aren’t getting a cardio (heart) workout? You use a treadmill and a stair stepper. Both are cardiac exercises. The basics of a heart workout are using large muscles continuously to raise the heart rate for a protracted period of time3, 10 to 15 minutes. The treadmill and stair stepper are doing that for you.

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