Achilles Tendon Rupture
Achilles Tendon Rupture
What is an Achilles Tendon Rupture?
What Causes an Achilles Tendon Rupture?
When your Achilles tendon snaps or pops, it is known as Achilles tendon rupture. Often an Achilles tendon rupture can occur spontaneously without any prodromal symptoms. Unfortunately, the first “pop” or “snap” that you experience is your Achilles tendon rupture.
Achilles tendon rupture most commonly occurs in the middle-aged male athlete (the weekend warrior engaging in a basketball pickup game, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often, these are tennis, racquetball, squash, basketball, soccer, softball and badminton.
Achilles rupture can happen in these situations:
- You make a forceful push-off with your foot while the powerful thigh muscles straighten your knee. One example might be starting a foot race or jumping.
- You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully overstretching the tendon.
- You fall from a significant height.
The most significant risk factor for Achilles tendon rupture is tendon cell death resulting from poorly managed tendinopathy.
Higher Risk of Achilles Tendonitis History
It does appear that any previous history of Achilles tendinopathy results in a degenerative tendon, which can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase Achilles tendon rupture risk.
Achilles Tendon Diagnosis
Achilles tendon ruptures misdiagnosis is a staggering 20%-30%. Yet, they shouldn’t be if your healthcare practitioner is methodical and thorough in their assessment. Thompson (calf squeeze) test is 96% sensitive and 93% sensitive. Unfortunately, some health practitioners fail to perform this simple clinical test. An ultrasound examination or an MRI can confirm an Achilles tendon rupture. A palpable “gap” in the Achilles tendon is another positive sign of at least partial rupture.
Please consult your trusted physiotherapist or a sports doctor for a thorough Achilles assessment.
Ruptured Achilles Tendon Treatment
Treating a ruptured Achilles tendon is usually conservative (non-operative) in a Controlled Motion Ankle (CAM) Boot, or it may require surgery. Your decision should involve a conversation with your ankle surgeon. The current consensus based on research is to treat them conservatively since the functional outcome and chance of re-rupture are similar (7% to 15%) using both approaches. Surgical intervention has a higher risk of infection.
Achilles tendon surgery is more likely if your Achilles has re-ruptured or if a delay of two weeks between the rupture and the diagnosis and commencement of conservative bracing and treatment.
Post-Achilles Repair Physiotherapy
Most surgeons will recommend that you commence physiotherapy about one-week post-op. It is vital not to over-stress your Achilles tendon repair. We recommend the professional guidance of a physiotherapist experienced in Achilles tendon rupture rehabilitation for your best outcome.
Ruptured Achilles Tendon Prognosis
You will typically be in your CAM brace for between 6 to 12 weeks. If everything goes perfectly during your rehabilitation, it takes at least 12 weeks before considering your gradual return to sport program. This timing is, of course, at the discretion of your Achilles surgeon. However, some Achilles tendon repairs can take six to 12 months to rehabilitate successfully and return to sport if there are complications.
Seek Professional Advice
The best advice is to seek early advice from your physiotherapist, doctor or orthopaedic surgeon. Delay does result in a poorer prognosis.
If you are lucky, you may avoid surgery but require a walking boot, or similar, with a graduated rehabilitation program to strengthen your injured tendon and prevent further injury.
How Do You Treat Achilles Tendinopathy?
The Achilles tendon is one of the biggest and strongest tendons in the human body. It is a continuation of the calf muscles and inserts at the bottom of the calcaneus (heel bone). “Achilles tendinopathy” refers to a combination of changes affecting the Achilles tendon, usually due to overuse or chronic excessive stress on the tendon. It can occur in athletes and non-athletes.
The specific approach used to treat Achilles tendinopathy can differ slightly depending on the location and stage of your tendinopathy. However, there are common strategies that research has shown to be effective.
- Activity modifications include a temporary reduction in the activities that cause more than mild discomfort.
- Heel lifts, supportive shoes and offload taping can effectively allow acute symptoms to settle.
- Manual therapy, including massage or dry needling to improve mobility and ease muscle spasms around the lower leg and ankle.
- Appropriate tendon loading exercises to restore flexibility and strength in the Achilles tendon and surrounding muscles.
- Anti-inflammatory medications may be considered in particularly stubborn cases to assist in settling acute symptoms.
- Management of other contributing factors such as obesity, diabetes and lifestyle habits is also beneficial.
Your physiotherapists at PhysioWorks will diagnose your Achilles tendinopathy and identify any contributing factors. They use various strategies and manual therapy techniques to settle your pain and guide you through a specific tendon loading program to restore tendon strength and allow you to return to usual activities and sports.
For more advice regarding Achilles Tendinopathy, please contact your nearest PhysioWorkc clinic.
More Info: Achilles Tendinopathy
When Should You Worry About Foot Or Ankle Pain?
Some cases of foot and ankle pain require urgent attention.
Sudden Onset Foot Or Ankle Pain
Traumatic injuries that occur at speed or involve a multi-direction component such as twisting may result in foot or ankle fractures or significant soft tissue injuries, e.g. syndesmosis or high ankle sprains.
The Ottawa Ankle Rules determine the need for X-rays in acute ankle or foot injuries.
Ankle X-ray is only required if:
- There is any pain in the malleolar zone; and,
- Any one of the following:
- Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, or
- Bone tenderness along the distal 6 cm of the posterior border of the fibula or end of the lateral malleolus, or
- An inability to bear weight immediately and in the emergency department for four steps.
Foot X-ray is indicated if:
- There is any pain in the midfoot zone; and,
- Any one of the following:
- Bone tenderness at the base of the fifth metatarsal (for foot injuries), or
- Bone tenderness at the navicular bone (for foot injuries), or
- An inability to bear weight immediately and in the emergency department for four steps.
Chronic Ligament Instability
Chronic ligament instability in your foot and ankle can cause premature osteoarthritis and joint deformity. Some conditions can be safely rehabilitated without surgery, whereas other conditions, such as a Lisfacnc injury, may require surgical repair.
Please consult your doctor or physiotherapist for specific foot or ankle injury advice.
Gradual Onset Pain That Fails to Improve
Stress fractures can be serious. While you may not have had a sudden traumatic injury, the ankle and foot are highly susceptible to stress fractures. Several bones in your foot can have their blood supply compromised by a stress fracture, leading to bone necrosis (death). These potentially life-changing conditions should seek an early assessment from your doctor or physiotherapist.
The good news is that most ankle and foot pain is not sinister and improves with physiotherapy and other non-surgical options.
Please ask your physiotherapist or doctor for advice.
Common Heel Pain & Injury Conditions
Traumatic Ankle Ligament Injuries
- Achilles Tendon Rupture
- Achilles Tendinopathy
- FHL Tendinopathy
- Peroneal Tendinopathy
- Tibialis Posterior Tendinopathy
- Ankle Fracture (Broken Ankle)
- Stress Fracture
- Stress Fracture Feet
- Severs Disease
- Heel Spur
- Shin Splints
Soft Tissue Inflammation
Common Youth Leg Injuries
Why are Children's Injuries Different to Adults?
Adolescent Leg Injuries
Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.
In the adolescent leg, common injuries include:
Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.
More info: Osgood Schlatter's Disease
Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.
More info: Sinding Larsen Johansson Syndrome
Anterior Knee Pain
Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.
More info: Patellofemoral Pain Syndrome
The cartilage between the leg bones has a better blood supply and is more elastic in adolescents than adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.
More info: Knee Ligament Injuries
ACL (Anterior Cruciate Ligament) Injuries
This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.
More info: ACL Injury
Your meniscus is crescent-shaped cartilage between the thigh (femur) and lower leg (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.
Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.
More info: Sever's Disease
An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. With the correct treatment, a low ankle sprain usually improves in two to six weeks. Your ankle physiotherapist should check even simple ankle sprains to eliminate high-ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.
More info: Sprained Ankle
Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.
More info: Patella Dislocation
The separation of a bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.
Growth Plate Fractures
A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.
Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children
An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow, and ankle are the most common locations for lower limb avulsion fractures in young sportspeople.
Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.
An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.
For more information regarding your youth sports injury, please consult your physiotherapist or doctor.
Youth Leg Injuries
Pelvis & Hip
- Osgood Schlatter's Disease
- Sinding Larsen Johannson Disease
- Patellofemoral Pain Syndrome
- Patella Dislocation
- Meniscus Tear
- Discoid Meniscus
- Juvenile Osteochondritis Dissecans
Heel & Ankle
Common Youth & Teenager Sports Injuries
Acute Injury Signs
Acute Injury Management.
Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.
For detailed information on specific injuries, check out the injury by body part section.
Don't Ignore these Injury Warning Signs
Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.
Immediate Injury Treatment: Step-by-Step Guidelines
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
- Elevate the injured part to reduce swelling.
- Consult your health practitioner for a proper diagnosis of any serious injury.
- Rehabilitate your injury under professional guidance.
- Seek a second opinion if you are not improving.
Elite Sports Injury Management
You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving, or other problems will develop.
Ice or Heat?
We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Would you please ask us if you are uncertain about what to do next?
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries. Think where your damage is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:
- An inappropriately treated previous injury (e.g. old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury. Would you please use our advice to guide you out of pain quicker? And for a lot longer.
If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.