Achilles Tendon Paratenonitis

Mr Lim is a businessman who does regular brisk walking. He came 2 weeks ago with complaints of painful swelling in his back of his left ankle (Achillles Tendon). He started using a pair of leather shoes with a high heel tab which comes in contact with the Achilles tendon every time he walks.



He was examined and I found that had pain standing on his toes (ankle plantarflexion) but little pain stretching his calf (ankle dorsiflexion). He had severe tenderness, oedema and mild redness over the middle of his Achilles tendon.


I advised him to use a low-cut shoe, apply RICE treatment and Anti-Inflammatory gel (e.g. Reparil, Volteran Emulgel). His gait was otherwise normal and he did not have any calf muscle spasm. He would do well with a course Ultrasound treatment.

Extensor Digitorum Brevis Ganglion Cyst

Mr Chin is an ardent 45 yrs old runner who plays badminton occasionally. Since 2 years ago he noticed a swelling on his right midfoot when he runs marathons or plays badminton more frequently. The swelling goes of after several weeks. I examined the swelling and found it to be non-tender, like a fluid-filled sac (cystic) and seem to arise from the fascia covering the Extensor Digitorum Brevis muscle (Inferior Extensor Retinaculum). This chap also has Hallux Valgus.

I told him that he could do an Ultrasound to confirm the diagnoses and a possible X-ray to rule out any bony anomaly which could cause the swelling. He was quite content as the swelling was usually painfree and decided to leave it alone for the time being.

24 hour Walk Swollen and Bruised Toes

Mr Singh is an ex-athlete and junior walking coach who participated in the 4th Malaysia International 24-hour walk at Dataran Merdeka on the 11th August. He came back with a pair of swollen feet with both big toe badly bruise when I saw him on the next day.

It is common for marathon runners to have such lesion after competition. I advised him to keep his feet elevated, have them iced, use the lysozyme tablets (for swelling) and NSAIDS (for pain and swelling). He would need to have the subungual hematoma (blood accumulation under the nailbed) relieved by the doctor using a sterile needle. Surprisingly he only a few small blisters.

He told me today that his feet were perfectly fine after doing the RICE treatment.