ArcaMax

DEAR DR. ROACH: I am a 69-year-old, very active male. My left Achilles tendon severed two years ago and was surgically repaired. I had an 8-inch incision that has totally healed, with the exception of one small area about the size of the lead of a pencil. It's 3 inches above my heel. This small area would close up for a few days, then reopen with small amounts of off-white fluid oozing from the little hole.

Sometimes I apply Iodosorb, which does keep the area dry for a while. For whatever reason, showers seem to make the incision release fluid. I apply a bandage over the wound for most sporting or exercise events, just so that it doesn't get rubbed by the top of my shoe. Is there any solution to this, or do I just have to live with it? -- R.M.

ANSWER: The Achilles tendon is a thick, tough piece of connective tissue between the calf muscles and the heel bone. It can rupture under extreme trauma (often sports injuries), in people with weakness of the tendon, or due to treatment with antibiotics in the quinolone class, such as ciprofloxacin. When repairing the tendon, the surgeon uses sutures or wires to put it back together.

A residual wound defect is quite concerning to me. The foreign material in the tendon is at a high risk for infection. It's possible that there is an infection, which led to a fistula (an abnormal connection) between the tendon. I definitely recommend going back to see the surgeon. They may want to do further testing (possibly imaging) to see if there is any evidence of an infection in the repaired tendon.

DEAR DR. ROACH: I'm a 63-year-old man in generally good health. Recently, we moved into a new home with a pool. When I floated on my back, I noticed a 6-by-2-inch bulge from my breastbone to my navel. I contacted my doctor, who said it was rectus diastasis.

I researched online, and there doesn't appear to be anything that can be done to correct it. Apparently, it doesn't pose a serious problem. Am I correct that I should just live with it? -- G.B.

ANSWER: Correct. The left and right halves of your abdominus rectus muscle (your "abs") are normally connected in the middle by tough fibrous tissue. Instead of them being held tightly together, in some people they are separated by a centimeter or two (called congenital rectus diastasis). Sometimes, the muscles can separate during adulthood when people's abdomens start to get larger, whether it's through pregnancy, weight gain or other reasons. The area can bulge out with increased abdominal pressure.

There is nothing that needs to be done, and although there are elective cosmetic surgeries to correct it, I've never had a patient want one. Most of the time, I make the diagnosis when I'm doing an abdominal exam, and the patient isn't even aware that they have it. (Or they think everyone has it.)

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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