Wounds often form over tendons (particularly the Achilles and the lateral ankle). It’s important to ask the patient to move whatever the tendon might attach to – to see if the wound “moves” with the tendon. For example, if the wound is over the Achilles, ask the patient to dorsiflex the foot up and down. My experience is that if a tendon is involved, you will need to reduce this movement in order to get the wound to heal. Imagine cells trying to grow while in constant motion! Usually that means putting the patient in some sort of brace.

These are really tough wounds because tendons naturally work overtime to prevent granulation tissue (blood vessels) from growing over them so that their range of motion won’t be limited. You have to bring your best wound management game to get these wounds to close. They may not look that bad, but a small, deep wound can be the hardest to close, particularly if it exposes tendon.