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Achilles Tendon Rupture

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A total rupture of the achilles tendon is a complete tear of the tendon and typically affects men over the age of 40 involved in recreational sport.

A complete rupture of the achilles tendon is not always recognized at the time of injury, however it is very important it is treated properly as soon as possible to increase the chances of a good recovery.

Symptoms

Symptoms include a sudden sharp pain in the achilles tendon which is often described as if being physically struck by an object or implement. A load snapping noise or bang may also be heard at the time. A gap of 4 to 5 cm in the tendon can be felt which may be less obvious later as swelling increases.

After a short while the athlete may be able to walk again but without the power to push off with the foot. There will be a significant loss of strength in the injured leg and the patient will be unable to stand on tip toes. There may be considerable swelling around the achilles tendon and a positive result for Thompson’s test can help confirm the diagnosis.

Treatment

If you suspect a total rupture of the achilles tendon then apply cold therapy and compression and seek medical attention as soon as possible. In most cases surgery is required and the sooner this takes place the higher the chances of success. If the injury is left longer than two days then the chances of a successful outcome decrease. Cold and compression can also be applied throughout the rehabilitation phase as swelling is likely to be an issue with such a serious injury.

A medical professional will take MRI scans to confirm the diagnosis and indicate the extent of the injury. Sometimes the leg is put in a cast and allowed to heal without surgery. This is generally not the preferred method, particularly for young active people. Surgery is the most common treatment for an achilles tendon rupture. 

You can expect to be out of competition for 6 to 9 months after achilles tendon surgery. This is increased to 12 months if the ankle is immobilized in plaster instead of operated on. There is also a greater risk of re-injury if you do not have the surgery.

A complete rupture of the achilles tendon is a serious injury and rehabilitation should be a very gradual process taking 6 to 9 months.

The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any self treatment.

Aim of rehabilitation

  • To allow the tendon to heal, reducing pain swelling and inflammation.
  • To restore the tendon and muscles to their original flexibility and strength.
  • To gradually return to normal activity and training levels.

There are two methods of treatment; surgical and non surgical or conservative. The speed at which a patient can progress with the rehabilitation will vary and should at all times be done under the supervision of a qualified professional. The timescales indicated below are only a rough guide and you should always take the advice of your consultant.

Surgical approach

The surgical approach is usually the preferred one, especially for young and active people. Immediately following injury the principles of PRICE should be followed which are protection rest, ice, compression, elevation. Go as soon as you can to a sports medicine professional or accident and emergency unit. Surgery will usually be performed within 48 hours or as soon as possible.

Non surgical approach

This will follow a similar pattern to that of the surgical approach although will take a lot longer. A plaster cast will be applied in a plantar flexed position (toes and foot pointing down). Sometimes after four weeks this may be altered to allow less plantar flexion. After 8 weeks the tendon is usually healed.

Rehabilitation program

Week 1 to 8

  • A plaster cast is applied after surgery.
  • No stretching or exercise, just let it heal.
  • You may be able to work the upper body.
  • Try to do something positive, it will certainly help your state of mind.

Week 8 onwards

Stage 1 – range of motion and flexibility.

  • Place heel raises (1-2cm) in the shoes to take some of the pressure off the achilles tendon.
  • Sports massage techniques and ultrasound can aid in this process by helping to realign the new fibres in line with the tendon.
  • Active stretching. Pull your toes upwards to stretch the achilles tendon. Very gently at first and gradually build up.
  • If active stretches produce no pain then passive stretches can commence. This involves someone or something assisting in the stretching process.
  • When a full range of motion has returned (the ruptured leg is as flexible as the other leg) then a gradual strengthening programme can start.
  • Balance exercises should also be introduced as the sense of balance and positioning is often decreased after tendon or ligament ruptures and if not re-gained, can lead to future injuries. Wobble boards (balance boards) are great for this.

Sports massage can play a part in the rehabilitation of this injury by improving blood flow to the area, helping the muscles relax and become more supple.

Stage 2: Strengthen the achilles tendon and calf muscles.

  • Great care must be taken when commencing a strengthening programme. There is a fine line between strengthening the tendon and re-injuring it.
  • You can start strengthening exercises as soon as they can be tolerated. It may be a full month after the cast comes off before exercises can begin.
  • The athlete may feel a little pain when you first start these exercises. If the pain is intolerable then do not continue.
  • Gradually each day the pain should be less. The athlete should not attempt to increase the level of exercise until there is no pain during or after the exercises.
  • The strengthening exercises must be done after a gentle warm up and stretch. The muscles can be warmed up by raising the heels up and down on the toes while seated. Heat applied directly to the tendon for example by a hot water bottle can also help.
  • Flexibility training must be continued throughout.
  • Remember to apply cold therapy or ice after exercise, this will help keep inflammation down.
  • Avoid explosive or ballistic movements or this may lead to a re-rupture.

Return to fitness 

  • When the patient has gone at least a week without pain then they may begin to return to training.
  • If they feel pain when returning to training then stop. Begin each training session with a walk to warm up followed by stretching.

Day 1: walk 4 minutes jog 2 minutes repeat four times

Day 2: rest

Day 3: walk 4 minutes jog 3 minutes repeat three times

Day 4: rest

Day 5: walk 3 minutes jog 4 minutes repeat 4 times

Day 6: rest

Day 7: walk 2 minutes jog 6 minutes repeat 4 times

Continue this gradual progression until you can confidently run and resume normal training.

How long until I am back to full fitness?

  • Most athletes can expect to be out of competition for 6 to 9 months after surgery.
  • This is increased to 12 months if the achilles was immobilized in plaster instead of operated on. There is also a greater risk of re injury if the athlete does not have the surgery.

CURE YOUR ACHILLES TENDON RUPTURE TODAY! CALL US AT +65 64712744 OR EMAIL TO: INFO@BONECLINIC.COM.SG FOR APPOINTMENT

Achilles Tendonitis

Achilles tendinitis

Achilles tendinitis is when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It is used for walking, running, and jumping.

Causes

There are two large muscles in the calf. These muscles are important for walking. They create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel.

Heel pain is most often due to overuse of the foot. Rarely it is caused by an injury.

Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes.

Achilles tendinitis may be more likely to occur if:

  • Suddenly increase the amount or intensity of an activity
  • Your calf muscles are very tight (not stretched out)
  • You run on hard surfaces such as concrete
  • You run too often
  • You jump a lot (such as when playing basketball)
  • You do not have shoes with proper support
  • Your foot suddenly turns in or out

Tendinitis from arthritis is more common in middle-aged and elderly people. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling.

Symptoms

Symptoms include pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning.

The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe.

Exams and Tests

The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes.

X-rays can help diagnose bone problems.

An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.

Treatment

The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.

Try putting ice over the Achilles tendon for 15 to 20 minutes, two to three times per day. Remove the ice if the area gets numb.

Changes in activity may help manage the symptoms:

  • Decrease or stop any activity that causes you pain.
  • Run or walk on smoother and softer surfaces.
  • Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.

Your health care provider or physical therapist can show you stretching exercises for the Achilles tendon.

They may also suggest the following changes in your footwear:

  • A brace or boot or cast to keep the heel and tendon still and allow the swelling to go down
  • Heel lifts placed in the shoe under the heel
  • Shoes that are softer in the areas over and under the heel cushion

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can help with pain or swelling. Talk with your health care provider.

If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. Surgery also can be used to remove the bone spur that is irritating the tendon.

Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.

Outlook (Prognosis)

Lifestyle changes usually help improve symptoms. However, symptoms may return if you do not limit activities that cause pain, or if you do not maintain the strength and flexibility of the tendon.

Possible Complications

Achilles tendinitis may make you more likely to have an Achilles rupture. This condition usually causes a sharp pain, like someone hit you in the back of the heel with a stick. Surgical repair is necessary, but difficult because the tendon is not normal.

When to Contact a Medical Professional

If you have pain in the heel around the Achilles tendon that is worse with activity, contact your health care provider for evaluation and possible treatment for tendinitis.

Prevention

Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.

CURE YOUR ACHILLES TENDINITIS TODAY! CALL +65 6471 2744 OR EMAIL TO: info@boneclinic.com.sg FOR APPOINTMENT

Achilles Tendon Rupture

Having Achilles Tendon Injury? Achilles Rupture? You are at the right place. Treat your Achilles Injury today. Call us +65 64712744 or SMS to +65 92357641 to schedule for an appointment today.

The Achilles tendon is very strong and flexible. It’s found at the back of your ankle and connects your calf muscle to the bone in the heel of your foot (calcaneum). When an Achilles tendon rupture happens you may partially or completely tear the tendon.

This type of injury occurs most often in athletes or people between the age of 30 and 50, but it can affect anyone. Complete rupture is more common in men.

Achilles Tendon Rupture

Achilles Tendon Rupture

Symptoms of Achilles tendon rupture

If you rupture your Achilles tendon you will feel a sharp pain in the back of your leg and you will be unable to flex your ankle or point your toes. You may:

  • have swelling in your lower leg
  • be unable to put your full weight on your ankle
  • hear a snapping or tearing sound when it happens
  • have a limp, and be unable to stand on tiptoe or climb stairs
  • develop bruising

When the injury occurs, you may feel like you have been kicked or hit in the back of the leg.

Causes of Achilles tendon rupture

Achilles tendon rupture is most likely to happen when your leg is straight and your calf muscle is contracted during activities such as running, jumping or playing sport such as football or tennis.

There is a very small risk of Achilles tendon rupture if you have Achilles tendinopathy. Achilles tendinopathy is pain, thickening and stiffness in your Achilles tendon both during exercise and often following exercise.

Certain medicines taken together may increase the risk of Achilles tendon injuries. These are quinolone antibiotics (eg ciprofloxacin) and corticosteroids. The exact risk of Achilles tendon rupture caused by these medicines isn’t clear.

Diagnosis of Achilles tendon rupture

Our specialist may ask you to do a series of movements or exercises to see how well you can move and how affected your lower leg is. These may include squeezing your calf muscle or asking you to try to stand on tiptoe.

At the hospital, you may have further tests to look at your Achilles tendon. These may include:

  • an ultrasound scan, which uses sound waves to produce an image of the inside of a part of the body
  • an MRI (magnetic resonance imaging) scan, uses magnets and radiowaves to produce images of the inside of the body

Treatment of Achilles tendon rupture

Achilles tendon ruptures are treated using surgery, or by keeping it immobile while it heals. The treatment you have may depend on how much time has passed since the injury, your age and how active you are.

Whether you have an operation or not, you will have a plaster cast on your lower leg and won’t be able to put weight on it for at least four weeks.

You can take painkillers that you would usually take for a headache, for example a non-steroidal anti-inflammatory painkiller such as ibuprofen. Always read the patient information leaflet that comes with your medicine.

Surgery

Surgery is usually recommended for active young people.

There are two types of surgery used to repair a ruptured Achilles tendon:

  • open surgery, which is when one long cut is made to reach the tendon to repair it
  • percutaneous surgery, which is when a number of small cuts are made to reach the tendon to repair it

Both types of surgery involve stitching the tendon together so it can heal. Open surgery is less likely to cause injury to one of the nerves in your leg.

After surgery you will have a series of casts or an adjustable brace on your leg to help the Achilles tendon heal. This will usually be for between four and eight weeks.

About five in 100 people who have surgery for this injury get an infection. This can be treated with antibiotics. There may be a lower risk of infection if you have percutaneous surgery. For between one and three in 100 people the tendon will re-rupture after the operation.

Non-surgical treatment

A cast or brace is put onto your lower leg to help the tendon heal. You will have to wear a cast or brace for at least six to eight weeks. During this time the cast will be changed a number of times to make sure the tendon heals in the right way. It usually takes longer to recover from Achilles tendon rupture using this treatment, compared with surgery.

There is no risk of infection from this type of treatment and it’s suitable for people who may have complications during surgery.

The tendon may re-rupture in about 13 in every 100 people who have this treatment.

If your tendon is partially ruptured you’re more likely to be given a cast or brace, instead of surgery.

After your treatment

Once your cast or brace is removed you will need to gradually increase your activity to strengthen the tendon. Your doctor, or a physiotherapist, will give you a number of exercises to do, which will increase the range of movement and strength in your lower leg. Your physiotherapist may try various techniques to reduce the pain. These may include exercises and soft tissue techniques (deep tissue massage). He or she will also advise you on returning to exercise. You should be able to return to your usual level of activity six months after your injury. However, this may take longer and will also depend on the activity.

Prevention of Achilles tendon rupture

There are ways to reduce the risk of injury to your Achilles tendon. To prevent injury when starting a new exercise regime, gradually increase the intensity and the length of time you spend being active.

Warming up your muscles before you exercise and cooling them down after you have finished may help. Five to 10 minutes of low intensity activity, such as brisk walking, is enough for a warm up and this is also needed for a cool down. You can do a series of muscle stretches to help prevent injuries after your warm up and cool down. This can include a calf muscle stretch, which will lengthen the Achilles tendon before you exercise.

Treat your Achilles Tendon Rupture today. Call +65 6471 2744 (24 Hours) / Email to: info@boneclinic.com.sg to schedule for an appointment.