How to treat a ruptured achilles tendon: Achilles tendon rupture – Diagnosis and treatment
Achilles tendon rupture – Diagnosis and treatment
During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. Your doctor might be able to feel a gap in your tendon if it has ruptured completely.
The doctor might ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He or she might then squeeze your calf muscle to see if your foot will automatically flex. If it doesn’t, you probably have ruptured your Achilles tendon.
If there’s a question about the extent of your Achilles tendon injury — whether it’s completely or only partially ruptured — your doctor might order an ultrasound or MRI scan. These painless procedures create images of the tissues of your body.
Treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, younger and more active people, particularly athletes, tend to choose surgery to repair a completely ruptured Achilles tendon, while older people are more likely to opt for nonsurgical treatment.
Recent studies, however, have shown fairly equal effectiveness of both surgical and nonsurgical management.
This approach typically involves:
- Resting the tendon by using crutches
- Applying ice to the area
- Taking over-the-counter pain relievers
- Keeping the ankle from moving for the first few weeks, usually with a walking boot with heel wedges or a cast, with the foot flexed down
Nonoperative treatment avoids the risks associated with surgery, such as infection.
However, a nonsurgical approach might increase your chances of re-rupture and recovery can take longer, although recent studies indicate favorable outcomes in people treated nonsurgically if they start rehabilitation with weight bearing early.
The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair might be reinforced with other tendons.
Complications can include infection and nerve damage. Minimally invasive procedures reduce infection rates over those of open procedures.
After either treatment, you’ll have physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months. It’s important to continue strength and stability training after that because some problems can persist for up to a year.
A type of rehabilitation known as functional rehabilitation also focuses on coordination of body parts and how you move. The purpose is to return you to your highest level of performance, as an athlete or in your everyday life.
One review study concluded that if you have access to functional rehabilitation, you might do just as well with nonsurgical treatment as with surgery. More study is needed.
Rehabilitation after either surgical or nonsurgical management is also trending toward moving earlier and progressing faster. Studies are ongoing in this area also.
Preparing for your appointment
People with an Achilles tendon rupture commonly seek immediate treatment at a hospital’s emergency department. You might also need to consult with doctors specializing in sports medicine or orthopedic surgery.
What you can do
Write a list that includes:
- Detailed descriptions of the symptoms and how and when the injury occurred
- Information about past medical problems
- All the medications and dietary supplements you take, including doses
- Questions to ask the doctor
What to expect from your doctor
The doctor may ask you some of the following questions:
- How did this injury occur?
- Did you feel or hear a popping or snapping sound when it happened?
- Can you stand on tiptoe on that foot?
Achilles Tendon Injuries | Cedars-Sinai
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What are Achilles tendon injuries?
The Achilles tendon is a fibrous
band of tissue that links the muscles in your calf to your heel. The strength and
flexibility of this tendon are important for jumping, running, and walking. Your
Achilles tendon bears a lot of stress and pressure during everyday activities, as
as during athletic and recreational play. If it becomes inflamed, swollen, and
irritated, it’s called tendonitis.
What causes Achilles tendon injuries?
Achilles tendon injuries can be caused by the following:
Tendonitis might be due to
overuse or damage to the area. It can cause pain down the back of your leg and around
your heel. You might notice that parts of your tendon are getting thicker and
hardening because of tendonitis. This will get worse if you don’t treat it. There
two main types of tendonitis:
Noninsertional Achilles tendonitis. Small tears in the
middle fibers of your tendon start to break it down. This causes pain and
swelling. This type of tendonitis usually affects active, younger adults.
Insertional Achilles tendonitis. This damage occurs in
the spot where your tendon meets your heel bone. Bone spurs (extra bone growth)
often form with this type. This type of tendonitis can happen at any age, even in
people who aren’t active.
The tears in your tendon fibers
can cause a complete or partial break (or tear) in your tendon. You might hear a pop
that seems to come from the back of your heel or calf. This may be a tendon rupture,
which needs immediate medical attention.
Who is at risk for Achilles tendon injuries?
Anyone can develop an Achilles tendon injury. They’re often linked to repetitive stress.
The most common risk factors are:
- Increased amount or intensity of an activity or sport
- Starting a new sport
- Tight calf muscles when starting an
exercise or sport, which can place more stress on your tendon
- Bone spurs on your heel, which can rub against the tendon
- Wearing the wrong shoes when you exercise
- Exercising on an uneven surface
- Treatment with the antibiotic
What are the symptoms of an Achilles tendon injury?
Common symptoms of tendon injuries include:
- Pain down the back of your leg or near your heel
- Pain that gets worse when you’re active
- A stiff, sore Achilles tendon when you first get up
- Pain in the tendon the day after exercising
- Swelling with pain that gets worse as you’re active during the day
- Thickening of your tendon
- Bone spurs on the heel bone
- Difficulty flexing the affected foot
- A pop sound and sudden sharp pain,
which can mean a ruptured tendon
How is an Achilles tendon injury diagnosed?
Injury to the Achilles tendon
causes pain along the back of your leg near the heel. Sometimes healthcare providers
misdiagnose Achilles tendon injuries as sprained ankles. It’s important to get the
diagnosis so you can get the right treatment. Several common injuries can make your
Achilles tendon painful or prevent it from working well.
Your healthcare provider will
consider the following when making a diagnosis:
- Your overall health and medical history
- A description of your symptoms
- A physical exam of your Achilles tendon to check for bone spurs, pain, and swelling
- A test to see if you can move your
ankle properly (range of motion)
- Imaging tests, such as ultrasound,
X-ray, or MRI. An X-ray shows bones and can show bone spurs and if the tendon has
become calcified or hardened. Your provider will usually use MRI to see how severe
the tendon damage is and what treatment is best for you.
How are Achilles tendon injuries treated?
Treatment depends on how badly
injured your tendon is. It may include:
- Nonsteroidal anti-inflammatory drugs
(NSAIDs) for pain relief, such as ibuprofen or naproxen
- Specific exercises to strengthen your
- Physical therapy
- Eccentric strength training. This type
of exercise helps strengthen your calf muscles to take pressure off your tendon
- Low-impact activities, such as
- Heel lifts in shoes, orthotic shoes,
cast, splint, or a walking boot
- Extracorporeal shockwave therapy. This
treatment uses high-energy shockwave impulses to help stimulate the healing process
in damaged tendon tissue. This treatment isn’t often used. However, your healthcare
provider may recommend it to see whether you can improve without surgery
If these treatments don’t work or
if the injury is severe or complete, surgery may be considered. The type of surgery
depends on the location and amount of damage to the tendon. It can also depend on
things, such as the severity of the tendonitis. Some of the surgical procedures used
- Surgery to lengthen your calf muscles
- Surgery to remove damaged tendon
tissue or bone spurs and repair the tendon (debridement)
- Surgery to remove your damaged tendon
tissue, fix the remaining tendon, and give it extra strength by moving another tendon
to the heel bone
What are possible complications of Achilles tendon injuries?
Complications of an Achilles tendon injury may include:
- Pain, which can be severe
- Difficulty walking or being active
- Warping of your tendon area or heel
- Tendon rupture from reinjury
Other complications can happen
because of the treatments used to care for an Achilles tendon injury. For instance:
- Sometimes cortisone injections can
cause the tendon to tear
- Surgery can lead to pain and infection
How can I prevent Achilles tendon injuries?
These steps can help prevent injury to your Achilles tendon:
- Warm up before exercising, playing
sports, or other repetitive movements.
- Increase activity slowly, rather than all at once.
- Wear the correct shoes for your activities.
- Don’t exercise on uneven
- Stop activities that cause pain.
- Be aware of the risks of
fluoroquinolone and exercise with caution if you’re taking this medicine.
How to manage an Achilles tendon injury
- Follow your healthcare provider’s
advice to get rest and manage pain and swelling.
- Choose other ways to be active.
- Try low-impact activities that don’t
place a lot of stress on your tendon, such as swimming or bicycling, rather than a
high-impact exercise like running.
- Always let your healthcare provider
know if these strategies don’t help reduce pain, swelling, and loss of function.
When should I call my healthcare provider?
Call your healthcare provider right
away if you hear a pop sound and have sudden pain in the back of your leg or heel.
Otherwise, schedule an appointment if pain or trouble moving affects your regular
Key points about Achilles tendon injuries
- Your Achilles tendon can develop tendonitis. This is when it becomes inflamed, swollen,
- The Achilles tendon can also tear or
rupture, which might sound like a pop that seems to come from the back of your heel
or calf. This needs immediate medical attention.
- Anyone can develop an Achilles tendon injury and it’s often linked to repetitive stress
on the tendon.
- Achilles tendon injuries often cause pain, stiffness, and swelling in the back of
your leg near your heel.
- Achilles tendon injuries can be treated with rest and medicines to help with the inflammation.
Exercises often help too. If needed, surgery can be done to repair the tendon.
- You can help prevent these injuries by doing things like increasing activity slowly,
wearing the correct shoes for your activities, and not exercising on uneven surfaces.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells
- At the visit, write down the name of a
new diagnosis and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take
the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that
- Know how you can contact your provider
if you have questions.
Medical Reviewer: Thomas N Joseph MD
Medical Reviewer: Raymond Turley Jr PA-C
Medical Reviewer: Stacey Wojcik MBA BSN RN
© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.
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Achilles tendon repair – Physiopedia
Original Editor – Matt Anderson.
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The Achilles Tendon connects the calf muscles to the calcaneus (heel bone) and is one of the important tendons in the human body. The main action of the achilles tendon is foot plantar flexion. Common pathologies include: tendinopathy, tear or rupture. Examples of mechanisms of injury for rupture includes: falling from a height, forceful plantar flexion of the ankle (as in jumping with an extended knee), or using the foot to break a fall if you stumble. Clinically they present with a palpable gap on palpation, increased passive dorsiflexion, lack of heel raise and a positive Thompson Test. Achilles tendon rupture is either managed conservatively with a cast or surgically with an achilles tendon repair.
For more details on Achilles Tendon Rupture visit this page.
Conservative vs Surgical Intervention[edit | edit source]
There is much debate in the literature about treatment for achilles tendon rupture with the two options comprising of a conservative or surgical approach. Many studies have shown that the re-rupture rates are higher in cases of non-operative management. More recently studies have demonstrated equivalent or improved rates of re-rupture compare with surgical intervention. However, many people continue to be treated with surgical repair and physiotherapists will continue to see them for post-operative rehabilitation in their clinics.
Visit the achilles tendon rupture page for information on conservative management.
Prior to surgery general oedema reduction interventions should be utilised (Rest, Ice, Compression, Elevation). The surgery will ideally occur within one week of the rupture.
Many techniques exist for this surgery, including transverse, medial and longitudinal incisions. The ankle is placed in neutral position and the severed ends of the tendon are sutured together. The surgeon will then take the ankle through complete range of motion to look at the integrity of the repair. A cast is often applied, with the surgical technique determining how long the cast stays on. Many surgeons are now focusing on early weight bearing and passive motion to improve tendon healing. A new minimally-invasive technique involves utilisation of the peroneus brevis via two para-midline incisions. The technique reportedly preserves skin integrity over the site most prone to breakdown in a vertical incision, open reconstruction. Another study recommended percutaneous repair in the recreational athlete and in patients concerned with cosmesis, and open repair for all high-caliber athletes who cannot afford any chance of rerupture.”
Early mobilisation following achilles tendon repair has been reported to be beneficial in terms of postoperative recovery and improved tendon vascularity. Despite the increasing supported for accelerated rehabilitation regimes, there is still no consensus regarding the most preferable protocol. Protocols have been developed by Brumann et al and Braunstein et al
See the following clinic protocols:
Dutton describes three phases of post-surgical rehabilitation following achilles tendon repair.
Phase I[edit | edit source]
Phase I typically lasts three weeks.
Goals of this phase are as follows:
- Control oedema and protect the repair site
- Minimise scar adhesion and detrimental effects of immobilisation
- Progress to full weight bearing as tolerated/indicated
- Pain 5/10 or less, strength 4/5 all lower extremity muscles except plantar flexors
Phase I interventions include:
- Modalities for pain and oedema
- Stretching of large lower extremity muscle groups, gastrocnemius/soleus added at week 3
- AROM: plantar and dorsiflexion 3×5; 3 times daily; add inversion and eversion at week 2
- Foot/ankle isometrics at week 2; band exercises week 3
- Proprioceptive training for lower extremities; Gait training
- Upper extremity cardiovascular exercise
- Joint mobilisation and soft tissue work, as indicated
Phase II[edit | edit source]
Phase II typically lasts from post op week 4-6.
Goals for this phase are as follows:
- Normalized gait pattern
- Full ankle ROM
- 5/5 lower extremity strength
- Return to full ADL ability
- Pain reported to be <2/10
- Proprioceptive reactions equal to non-surgical side
Phase II interventions include:
- Ankle flexibility at various knee angles
- Progressive closed kinetic chain lower extremity strengthening
- Cardiovascular progression
- Proprioceptive training on variety of surfaces
- Manual resisted exercises and joint mobilization, as indicated
Phase III[edit | edit source]
Phase III typically lasts from post op week 6-15.
Goals for this phase are as follows:
- Initiate running program
- Improve balance and coordination
- Increase velocity of activity
- Return to sport
Phase III interventions include:
- Progressive ankle and lower extremity strengthening
- Agility exercises
- Double heel raise/lower progressing to single leg heel raise at various speeds
A recent systematic review by Brumann and colleagues (2014) identified the most up-to-date rehabilitation protocol for an achilles tendon repair. They summarised their findings with the following guidelines;
Week 0 – 2[edit | edit source]
- Nil ankle RoM
- Orthosis fixed at 30° of PF
- Progress to full weight bearing (FWB)
Week 3 – 6[edit | edit source]
- Active ankle RoM 0-30°
- Orthosis limited to plantargrade (0° DF) to 30° PF
Week 7+[edit | edit source]
- ↑ 1.01.1 Chiodo CP, Glazebrook M, Bluman EM, Cohen BE, Femino JE, Giza E, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg Am 2010;92(14):2466–8.
- ↑ Gulati V, Jaggard M, Al-Nammari SS, Uzoigwe C, Gulati P, Ismail N, Gibbons C, Gupte C. Management of achilles tendon injury: a current concepts systematic review. World journal of orthopedics. 2015 May 18;6(4):380.
- ↑ Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. JBJS. 2010 Dec 1;92(17):2767-75.
- ↑ 4.04.1 Dutton M. Orthopaedic Examination, Evaluation, and Intervention. New York, NY:McGraw-Hill:2004.
- ↑ Carmont MR, Maffulli N. Less invasive Achilles tendon reconstruction. BMC Musc Dis. 2007:8(100).
- ↑ Bradley JP, Tibone JE. Percutaneous and open surgical repairs of Achilles tendon ruptures: A comparative study. AJSM. 1990;18:188-195.
- ↑ Brumann, M., Baumbach, S. F., Mutschler, W., & Polzer, H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-Development of an evidence-based treatment protocol. Injury. 2014
- ↑ Braunstein M, Baumbach SF, Boecker W, Carmont MR, Polzer H. Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2015:1-8.
- ↑ Brumann, M., Baumbach, S. F., Mutschler, W., & Polzer, H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-Development of an evidence-based treatment protocol. Injury. 2014
10. Khan, Riaz JK, et al. “Treatment of acute Achilles tendon ruptures: a meta-analysis of randomized, controlled trials.” JBJS 87.10 (2005): 2202-2210. (Level 1A)
11. Olsson, Nicklas, et al. “Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study.” The American journal of sports medicine 41.12 (2013): 2867-2876 (Level 1B)
12. Huang, Jiazhang, et al. “Rehabilitation regimen after surgical treatment of acute Achilles tendon ruptures: a systematic review with meta-analysis.” The American journal of sports medicine43.4 (2015): 1008-1016. (Level 1A)
13. Kearney, Rebecca S., et al. “A systematic review of early rehabilitation methods following a rupture of the Achilles tendon.” Physiotherapy 98.1 (2012): 24-32. (Level 1A)
14. Kangas, Jarmo, et al. “Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. ” Journal of Trauma and Acute Care Surgery 54.6 (2003): 1171-1180. (Level 2B)
ACHILLES TENDON RUPTURES | Sports Medicine Today
What is it?
An Achilles tendon rupture involves a complete tear of the tendon on the back of the ankle. It occurs most commonly in patients who are in their 30s to 40s but can happen at any age. It typically affects males more often than females.
Achilles tendon ruptures are seen in activities that involve sprinting or pushing off, such as basketball and tennis. Most ruptures happen without a specific injury, and most athletes do not have Achilles tendon pain prior to their rupture.
- Older age
- Poor flexibility
- Inactive lifestyle, or “weekend warrior” athletes who only exercise occasionally
- Steroid medications, either injected or taken by mouth
- Flouroquinolone antibiotics, such as ciprofloxacin
- Certain medical conditions, including diabetes, gout, rheumatoid arthritis, and kidney disease
- Abrupt onset of pain
- A sense of being “kicked” over the back of the leg
- Hearing or feeling a “pop”
- Weakness, bruising, and/or swelling
Sports Medicine Evaluation
A sports medicine physician will examine the injury by looking and feeling for a tendon tear. The physician will test for a tear by squeezing the calf muscle and looking for movement of the foot. The injured foot will show no movement while the non-injured foot will move. A physician may obtain an x-ray to rule out any bone fracture. An MRI or ultrasound may be performed to evaluate the extent of the injury.
Treatment initially involves pain relievers, rest, ice, compression, elevation, splinting the ankle, and crutches. Achilles tendon ruptures can be treated without surgery; this involves time, casting, and physical therapy. Surgical tendon repair may also be considered. The decision about surgical versus non-surgical treatment is made based on an athlete’s age, activity level, risk factors for re-tear, and underlying medical issues.
Athletes should properly warm up prior to activity. They should gradually increase their exercise program, especially those who are overweight or have taken a long break from regular exercise. Maintaining good ankle flexibility and strength are also important.
Return to Play
With both surgical and non-surgical approaches to treatment, athletes may expect at least 6 months prior to returning to activity.
Authors: AMSSM Members Raul Raudales, MD, and David Berkoff, MD
-Netter’s Sports Medicine; C. Madden, M. Putukian, C. Young, E. McCarty; 2010 Saunders Elsevier.
-ACSM’s Sports Medicine: A comprehensive review; F. O’Connor, D. Casa, B. Davis, P. St. Pierre, R. Sallis, R. Wilder; 2013 American College of Sports Medicine.
-5-Minute Sports Medicine Consult; Mark Bracker; March 28, 2012; Lippincott Williams & Wilkins-Publisher.
Achilles Tendon Tear Rupture Injury
In the setting of tendonitis or partial rupture, a treatment of platelet-rich-plasma (PRP) combined with use of a heel lift, soft tissue massage, and a careful physical therapy program can sometimes lead to complete healing without surgical intervention.
Platelet-rich-plasma (PRP) is processed by drawing the patient’s own blood, spinning the blood to concentrate the platelets and growth factors, and then injecting the PRP into the site of injury. The growth factors stimulate the cells of Achilles tendon to produce new collagen and effect repair. One-to-three injections may be required. We never inject cortisone into the Achilles tendon for any inflammation or injury as cortisone may lead to rupture of the Achilles tendon itself.
If the Achilles is completely ruptured, we prefer to not open the ruptured site. This is because when an Achilles tendon ruptures, the body attempts to create a healing environment and, as bleeding occurs within the sheath around the Achilles tendon, it brings new cells to the injury site and starts the repair process. If you open the site, the natural healing factors are then lost into the surgical incision. Open surgery also leads to increased scarring and increased risk of infection.
The alternative to open surgical repair of the ruptured Achilles tendon is a percutaneous repair of the ruptured tissue. This is accomplished by making a small skin nick and passing sutures in a crisscross fashion, capturing the proximal and distal aspects of the tendon and cinching them together. This closed technique permits preservation of the natural growth factors and blood clot that forms around the ruptured ends and facilitates healing with less scarring.
Our results of percutaneous Achilles tendon repair have been superb with only 6 traumatic re-ruptures in twenty years of repairs.
- No full incision
- Reduced risk of infection
- Less scarring
- Less pain
- No general anesthetic required
- Shorter surgery
- The tendon sheath, holding the blood clot that forms at the time of the tendon rupture is kept intact, permitting rapid healing of the tendon.
- The rehabilitation program is accelerated
- Full return to sports is expected
Achilles Tendon Rupture | OrthoVirginia
What is an Achilles tendon rupture?
An Achilles tendon rupture is a tear in the strong fibrous cord that connects the muscles in the back of your calf to your heel bone. The tendon can rupture partially or completely.
Your Achilles tendon is the largest tendon in the body and plays a critical role. In fact, you rely on it every time you move your foot. The tendon helps you point your foot down, rise on your toes and push off as you walk.
An Achilles tendon rupture is a serious injury. If you suspect you have torn your Achilles—especially if you hear a pop or snap in your heel and cannot walk properly—seek medical attention immediately!
How does an Achilles tendon rupture occur?
These injuries usually result from a sudden increase in the amount of stress on the Achilles tendon.
Common causes include:
- Increasing the level of physical activity too quickly
- Falling from a height
- Stepping into a hole
- Over-stretching or over-using the tendon
- Wearing very high heels
Ruptures typically occur within a few inches of the point where the tendon attaches to the heel bone.
What are the symptoms of an Achilles tendon rupture?
Although it’s possible to have no symptoms with an Achilles tendon rupture, common signs include:
- A pop or snap in the back of your ankle
- Severe pain in the back of your ankle or lower leg
- Tenderness, swelling or stiffness in the affected ankle
- An inability to walk properly
- An inability to point your injured foot down, stand on your toes or push off as you walk
Because an Achilles tendon rupture can impair your ability to walk, it’s important to seek medical treatment as soon as possible. The earlier you receive treatment, the better the outcome.
How is an Achilles tendon rupture diagnosed?
In addition to a complete physical exam and patient history, your doctor might order an MRI to determine the extent of the injury.
What is the treatment?
Treatment depends on your age, activity level and the severity of your injury. Most minor to moderate Achilles tendon injuries heal on their own. But it’s important to give them plenty of time. Non-surgical treatment includes rest, ice, compression, elevation, and stretching and strengthening exercises. In some cases, patients wear a cast or walking boot with a heel lift, which allows the ends of the torn tendon to heal.
If the Achilles has ruptured completely, surgery is recommended. The surgeon makes an incision in the back of the lower leg, removes any damaged tissue and stitches the torn tendon together. Surgery is often the treatment of choice for competitive athletes or those whose tendons have ruptured again.
Following surgery, patients wear a cast or walking boot to keep the foot pointed down as the tendon heals. The cast is adjusted gradually to a neutral position. Physical therapy is necessary to strengthen leg muscles and the Achilles tendon itself. Most patients return to normal activities within four to six months.
Treating Your Achilles Tendon Tear Part I: Non-surgical Treatments: Eugene Stautberg, MD: General Orthopedic Surgeon
Achilles tendon tears are one of the more common injuries to the hindfoot. Orthopedic surgeons often treat Achilles tendon injuries. These injuries are typically seen in male ‘weekend warriors’ ages 30-40, but they can happen to anyone in any age group.
If you suffer from an Achilles tendon injury, your orthopedic surgeon will recommend one of the following treatments:
- Non-operative, discussed below
- Minimally invasive surgery
Read more about the basics of the Achilles tendon.
Can the Achilles tendon repair itself?
Yes, with appropriate treatment. At Southwest Orthopedic Group, we individualize treatment of Achilles tendon tears to each patient. We discuss patients’ long-term goals, set appropriate expectations, and evaluate the risks of complications as we develop a treatment plan for each individual.
Non-surgical Achilles tendon treatment
Recently, operative and non-operative treatments have been compared. Non-operative treatment produces good results if the Achilles injury is diagnosed early and treatment is initiated. Early treatment involves being placed into a cast, splint, or a boot with the toes pointed down. Having the toes pointed down allows the tendon edges to get closer together to help healing.
Non-operative treatment requires that you use crutches, a walker, or a wheelchair to remove your bodyweight from the injured leg. You will also need guided physical therapy. Slowly, you will progress from the non-weightbearing treatment to walking in a boot with heel wedges.
What’s the advantage of non-surgical treatment?
Non-operative treatment avoids risks of surgery, primarily any risks of wound complications, infection, and nerve injury. Risk of surgical complications can increase if patients have medical problems, such as diabetes or peripheral vascular disease.
What’s the disadvantage of non-surgical treatments?
Research shows that non-operative treatment of Achilles tendon tears can heal the injury just as well as surgery when treated early; however, research also shows a slightly higher re-rupture rate and increased weakness with non-operative treatment.
But, if there is a delay in diagnosis of your Achilles tendon tear, non-operative treatment may not be a viable option. In this case, the tendon starts to heal with a gap between the edges.
Your orthopedic surgeon may recommend surgery for your Achilles tendon tear.
The American Orthopaedic Foot & Ankle Society (AOFAS) has more information about Achilles tendon tears at FootCareMD.
For more questions or to set up an evaluation, contact Dr. Stautberg’s office at 281-977-4870.
Eugene Stautberg, MD
90,000 Treatment Damage to the Achilles tendon – Orthopedics Ruslan Sergienko
Achilles tendon rupture.
The Achilles tendon is the largest tendon in humans. It is formed as a result of the fusion of the tendons of the gastrocnemius and soleus muscles, and is attached to the tubercle of the calcaneus.
When the muscles contract, they pull on the Achilles tendon, resulting in plantar flexion at the ankle – i. e. we can stand on the toe of the foot or jump, pushing off with our feet.
Between the surface of the calcaneus and the tendon there is a mucous bursa that reduces friction between the bone and the tendon. In addition, the tendon itself is located in a special channel, inside which there is also a little fluid that reduces friction.
The Achilles tendon can rupture in three cases:
- with a direct impact on the stretched Achilles tendon. More often, such a mechanism of injury occurs during sports, for example, when playing football;
- for indirect injury: as a result of a sharp contraction of the leg muscles with an extended leg, examples:
- when trying to jump in basketball or volleyball;
- in case of unexpected sharp dorsiflexion of the foot – for example, when jumping from a step of a ladder;
- when falling from a height on a leg with an extended toe.
There are several theories of tendon damage:
1. Degenerative theory
For the most part, the tendon consists of a special protein – collagen, which practically does not stretch. This protein forms tendon fibers. In some cases, including due to hereditary reasons, collagen becomes weaker (degenerative changes occur) and rupture may occur.
Sometimes collagen becomes so weak that rupture can occur without any trauma at all – in this case, they speak of spontaneous rupture.
Drugs such as corticosteroids (diprospan, hydrocortisone) and fluoroquinolone antibiotics (ciprofloxacin) can contribute to degeneration. It is important to note that corticosteroids increase the risk of tendon rupture not only with local administration (for example, with injections for the treatment of tenopathies, inflammation of the mucous membranes, etc.)), but also with oral (in the form of tablets) or systemic (intravenous, intramuscular) administration in the treatment of various diseases.
Another cause of degeneration is chronic inflammation of the tendon, the so-called tenopathies, tendinitis, etc.
2. Mechanical theory.
Rupture can occur without degenerative changes. This theory is based on the belief that any healthy tendon can rupture if a force is applied to it that exceeds its strength.
In particular, rupture can occur with uncoordinated work of the triceps muscle of the lower leg (for example, when the outer head of the gastrocnemius muscle begins to pull the tendon, and the inner head is delayed by a fraction of a second). This is possible if a person starts to play sports after a long break or if he puts too much stress without a warm-up.
Therefore, the gap often occurs among the so-called “weekend athletes” of 30-50 years of age, who play sports irregularly, from time to time, neglect warm-up and overestimate their physical capabilities.
In addition, microtrauma can also lead to degeneration, when, as a result of repeated sprains, micro tears of the tendon occur, and it becomes weaker.
3. Hyperthermal theory.
The tendon is not an absolutely inextensible structure, it is characterized by elasticity (due to a special protein called elastane). At least about 10% of the energy generated by elastic lengthening of the tendon is converted into heat energy.
For example, after jogging for 7 minutes, the tendon can heat up to 45 degrees Celsius, and tendon cells called tenocytes can be destroyed.Thus, hyperthermia during movement may also contribute to degenerative processes. A good blood supply allows the tendon to cool, and if the blood supply is reduced, the tendon overheats.
Scientists believe that 30-50 years of age is at risk of rupture of the Achilles tendon also because degenerative changes accumulate in the tendon with age, and age still predisposes a person to consider himself absolutely healthy in sports terms, which can lead to overestimation of one’s capabilities and injury.
Usually, when a rupture occurs, a person feels sudden pain, as if someone hit the leg from behind with a stick. Sometimes, at the moment of rupture, a person can hear the sound of the rupture itself, similar to a dry crackle or crunch.
After this, the strength of the triceps muscle of the lower leg decreases sharply – after all, the gastrocnemius and soleus muscles are no longer connected to the heel by the Achilles tendon and cannot extend the foot. After this, swelling occurs and a bruise may appear, which gradually increases in size over several days and can go down to the fingertips.
If a person is not full, then along the Achilles tendon in the place of its rupture, you can see or feel a depression, a fossa.
As a rule, after a rupture of the Achilles tendon, a person cannot straighten the foot. The gait is disturbed, severe lameness appears, and sometimes, due to pain, a person cannot step on his foot at all.
What are the disadvantages of conservative treatment?
Along with the rupture of the tendon, blood vessels rupture, and blood (hematoma) accumulates at the rupture site, which prevents the ends of the torn tendon from drawing closer together.
As a result, the tendon grows together with lengthening, and its strength is significantly reduced. In addition, due to this hematoma, the tendon grows together with a scar, and not with tendon tissue. As a result, it becomes less strong and there is a high risk that a subsequent rupture will occur in the future.
Large scientific studies show that the risk of re-rupture after conservative treatment is three times greater than after surgical treatment (surgical suturing of a torn tendon).
If a tendon rupture occurs against the background of degenerative changes in the tendon itself, the ends of the tendon are frayed, like a tousled washcloth. With conservative treatment, such claws cannot grow together tightly.
Conservative treatment is possible if it is started within a few hours after the rupture (while the ends of the tendon can still be matched), if the patient does not have functional demands, is not only going to play sports, but also to lead an active lifestyle (for example, the elderly who only move around the apartment), as well as if this is the first injury to the Achilles tendon.
In other cases, we consider more justified the operation, which allows you to accurately and firmly suture the torn tendon (or perform plastic surgery, if the suture is not possible), to obtain a more reliable and faster result.
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Achilles tendon rupture – prices for treatment, symptoms and diagnosis of the disease in the clinic “Mother and Child” in Moscow
Symptoms of ruptured Achilles tendon
The main signs of tendon damage include:
Sharp pain.It occurs directly in the area of injury and is compared by patients with the sensation of a cut or sharp blow. In some cases, the pain is poorly tolerated and requires immediate hospitalization of the patient.
Puffiness. It occurs directly in the area of the tendon, but then can spread throughout the lower leg.
Limitations in mobility.The patient cannot stand on toes or bend the foot towards the sole.
When probing the back of the lower leg, the specialist can detect a “failure”. It is usually located just above the attachment point to the Achilles heel bone.
If the damage is chronic, then a decrease in the volume of the diseased lower leg is added to the main symptoms, which is associated with muscle atrophy.
Causes of rupture of the Achilles tendon
The most common cause of tendon rupture is direct injury.Damage is the result of a blow with a stick, foot, etc. Also, the tendon can rupture due to the sharp contraction of the muscle. Typically, injuries occur when starting to run or from excessive flexion of the foot during a fall. The likelihood of damage increases significantly if physical activity is performed without preliminary warming up of the muscle. That is why, before any sports activities or significant physical activity, it is recommended to perform at least the simplest exercises to prepare the musculoskeletal system.
Diagnosis of rupture of the Achilles tendon in the clinic
The diagnosis can be made already on the basis of clinical symptoms by a traumatologist. An experienced specialist immediately sees the clinical picture of the injury and can determine the location of the damage to the musculoskeletal system. The patient should be ready to answer the questions posed by the doctor about the trauma, symptoms, time that has passed since the moment of injury, etc.
Nevertheless, in some situations, a comprehensive examination of the patient may be required.In our clinic, it is carried out using standard and modern techniques. Examinations do not take much time and allow an accurate diagnosis. For an accurate assessment, modern expert-class equipment is used, which is distinguished by a high degree of visualization.
All these examinations are prescribed to clarify the extent of damage, as well as to identify the severity of pathological changes in the tendon. Diagnostics does not take much time.
Achilles tendon rupture treatment in clinic
When a rupture occurs, diastasis (a certain distance) appears between the damaged ends of the tendon. This leads to the fact that natural recovery becomes impossible, as well as conservative therapy.Only surgical treatment is performed.
With fresh fractures, it is possible to use techniques that do not imply an incision. The tendon is sutured through the skin. The intervention takes 30-60 minutes and is easily tolerated by the patient. The use of general anesthesia is optional. After the operation, a plaster cast is applied to the patient for 1 month. Then the sutures are removed and the plaster is applied again. If the rupture is old, the lesion is sutured openly.In addition, tendon plastic is performed.
In some cases, Achilles is additionally strengthened. It is relevant for athletes and all other people who are often exposed to increased physical activity. For such an intervention, the fascia of the thigh (connective tissue) of the patient is used. After suturing, the plaster is applied for 1.5 months. In this case, the patient is allowed to move immediately (always with additional support). Physical therapy is also prescribed.Full load on the leg is provided after 2 months.
Important! The choice in favor of the method of performing the operation is made exclusively by the doctor. At the same time, he focuses on the available indications and contraindications. The period of injury and all its features are taken into account, as well as the individual parameters of the patient and other factors.
Prevention of Achilles tendon rupture and medical advice
To prevent the likelihood of injury, it is recommended:
Refuse any physical activity if even insignificant pain in the Achilles tendon appears.
Wear only comfortable and correct footwear. By using models with flexible soles, the likelihood of injury can be reduced.
Seek medical attention for any discomfort in the heel area and in the area slightly above it.
Perform simple exercises to stretch the muscles and the Achilles tendon in general.
Conduct intensive training using elastic bandages or special orthoses. This reduces the stress on the tendon and prevents the risk of injury.
Important! Any exercise is recommended to be performed under the supervision of an experienced specialist. It will reduce the likelihood of injury and allow you to provide metered loads.
If you are planning to see a doctor for the prevention of ruptures and other injuries of the Achilles tendon, you are planning an operation in our clinic after an injury, call the number indicated on the website or send a request via the feedback form.Our specialist will answer all your questions and make an appointment for a consultation at a convenient time.
Achilles tendon rupture – A.K. Eramishantseva
Achilles tendon rupture is called one of the most common soft tissue injuries of the lower leg. Most often, the pathological condition is recorded in persons aged 30-50 years, leading a sports, active lifestyle. Among the patients with this problem who turned to our traumatologists in Moscow, there are many athletes or people who were actively involved in sports in the past.
Due to the anatomical nature of this tendon, as a rule, it tears completely, in contrast to tears of other tendons, which are often partially torn.
Causes of rupture of the Achilles tendon:
- Direct injury, most often resulting from a blow to the tendon area.
- Sharp contraction of the soleus or gastrocnemius muscles. Most often it can occur while running, when falling from a height, with pathological flexion of the dorsum of the foot.
- Microtrauma of Achilles, “accumulated” as a result of a sports career.
- Cold start in training.
Symptoms of Achilles tendon rupture:
- Sharp soreness in the tendon area, which in its characteristics is similar to pain from a cut or blow.
- Swelling in the tendon area.
- Characteristic “failure”, which is revealed when palpating the Achilles and is located 4-5 centimeters above the place of attachment of the tendon to the heel bone.
- Inability of the patient to stand on toes and bend the foot towards the sole.
- In a chronic case of rupture, atrophy of the leg muscles is observed.
Center for Traumatology and Orthopedics, GKB named after A.K. Eramishantseva provides high-quality diagnostic, treatment and rehabilitation services for ruptures of the Achilles tendon. Using modern diagnostic equipment, their clinical experience and high qualifications, traumatologists of our department restore hundreds of grateful patients to a full, unlimited life with trauma.
When an Achilles tendon rupture is diagnosed, X-rays are usually unsuccessful.Most often, the traumatologists of our department put it on the basis of complaints, anamnesis of trauma and an assessment of clinical manifestations. Modern diagnostic techniques such as ultrasound or MRI can be used.
We provide emergency and planned care for patients with acute or chronic rupture of the Achilles tendon.
Important! Due to certain circumstances, this injury cannot be compensated for on its own. At the first suspicion of it, you should seek the help of traumatologists, who will apply surgical treatment, whose goal will be to restore the torn tendon.
The method of suturing will be determined depending on the timing of the injury. It is possible to strengthen the tendon with the fascia of the patient’s thigh in cases where the injury is professional and the patient’s work is associated with a constant load on the Achilles.
Damage to the Achilles tendon – ProMedicine Ufa
Achilles tendon injury is one of the most common closed soft tissue injuries of the lower leg. It is a complete or partial rupture of the junction of the heads of the triceps muscle of the lower leg and its transition to the calcaneus.More often observed in persons aged 30 to 50 years, often leading an active lifestyle or in the past involved in sports.
Unlike most other tendon injuries, damage to the Achilles tendon is almost always complete.
Symptoms of rupture of the Achilles tendon include: sharp pain, swelling, limitation of movement in the foot, palpation of the “failure” in the Achilles tendon. Diagnostics is carried out mainly according to the results of examination by a traumatologist. Additionally, MRI or ultrasound can be performed.Treatment – surgical or percutaneous suturing of the tendon with immobilization of the foot for 1 month.
There are two types of injury that can lead to rupture: direct and indirect injury.
Direct trauma. It implies a directed blow to a stretched muscle, for example, when playing sports, in particular football. Potential injury with a sharp object or deliberate injury. In this case, the rupture belongs to the category of open injuries, all the rest are closed cases (subcutaneous).
Indirect injury. In case of an unsuccessful fall from a height on the toe of the foot or a jump.
In addition, the causes of the destruction or weakening of the tendon may lie in a hereditary predisposition.
The external manifestations of tendon rupture, and it is usually sharp and complete, are practically similar in all patients. They are characterized by sharp pain, as if someone behind had struck a muscle with a blunt object or slashed with a razor. In this case, the mobility of the leg completely disappears, the triceps muscle can no longer pull up the foot due to the torn tendon.Cyanotic edema appears, starting from the site of injury, and ending with the tips of the fingers. It is almost impossible to step on the foot, lameness appears, the mobility of the foot itself is paralyzed.
In some cases, you can feel a depression on the gastrocnemius muscle, indicating a complete rupture of the tendon. In a successful case, the resulting injury can be only a sprain, the treatment of which is much faster and easier.
Radiography for rupture of the Achilles tendon gives practically no results.The fact is that the tendon tissue does not trap X-rays. However, in some cases, x-rays can indirectly indicate injury to this tendon, for example, when a fracture of the shin bone is detected.
Ultrasound and / or magnetic resonance imaging is used to diagnose Achilles tendon rupture. An MRI will also help diagnose Achilles tendon sprains.
Conservative method. The essence of this method is to immobilize (immobilize) the lower leg using a plaster splint with an extended toe of the foot for 6-8 weeks.The elongated toe allows the torn ends of the tendon to be brought closer to each other, ensuring their gradual fusion.
Conservative treatment is possible only in the first hours after the onset of the injury. In the future, it will be simply impossible to match the ends of the tendon.
Surgical treatment for rupture of the Achilles tendon is much more effective than conservative.
In case of an open injury, the tendon is sutured end-to-end (if there is no defect and no fiber separation).The ends of the tendon are connected and stitched with interrupted and U-shaped lavsan sutures or chrome-plated catgut. Sometimes a wire is used and removed after 6 weeks.
In the presence of a tendon defect, the first step is plastic correction.
In case of closed injuries, the skin is first dissected, then both ends of the tendon are brought to each other, after which suturing is performed. Plastic restoration is possible. For this, flaps of the proximal and distal end of the tendon are used.
After the surgical treatment, the leg is immobilized with a plaster or polymer bandage, which after 3 weeks is changed to a “boot”. The foot is placed in a slightly bent position (5-10 degrees). The heel is attached to the plaster cast, which allows you to fully load the leg. After another 3 weeks, the bandage is removed altogether.
After the termination of immobilization, the lower leg is fixed with an elastic bandage, therapeutic exercises, massage, swimming, etc. are prescribed. Within a month after removing the cast, you must wear shoes with at least 2 heels.5 cm.
Which treatment for ruptured Achilles tendon should I choose?
Achilles tendon rupture is a common injury and occurs with an incidence of 31 per 100,000 people per year, more often in young people and middle-aged people (on average, between the ages of 37 to 44 years). Recent studies have shown an increased incidence of tendon rupture in active elderly people.
Both operative and non-operative methods can be used to treat tendon ruptures.Moreover, the effectiveness of a particular method is a matter of considerable debate.
Researchers from the Netherlands compared the incidence of re-rupture of the tendon, the incidence of complications and functional outcomes after surgical and non-surgical treatment of Achilles tendon rupture.
The systematic review and meta-analysis included randomized clinical (RCT) and observational studies found in PubMed / Medline, Embase, CENTRAL, and CINAHL databases (up to April 2018).
The final analysis included 29 studies – 10 RCTs (944 patients) and 19 observational (14,918 patients).
- The analysis showed a significant decrease in the frequency of re-ruptures of the tendon after surgery, compared with the non-surgical method of treatment (2.3% vs. 3.9%, relative risk, 0.43, 95% CI 0.31-0.60 ; P <0.001; I2 = 22%).
- At the same time, the complication rate was higher in the surgical treatment group (4.9% versus 1.6%; relative risk, 2.76, 95% CI 1.84-4.13; P <0.001; I2 = 45% ).In most cases, it was about infections in the surgical intervention group (2.8%).
- Interestingly, there were no significant differences between groups in the frequency of re-rupture of the tendon in studies using accelerated functional rehabilitation (relative risk, 0.60, 0.26-1.37; P = 0.23; I2 = 0%) …
The results of a meta-analysis indicate that surgical treatment of Achilles tendon rupture reduces the risk of re-rupture compared to conservative treatment.Moreover, surgical treatment is associated with a higher risk of complications.
Source: Yassine Ochen, Reinier B Beks, Mark van Heijl, et al. BMJ 2019; 364: k5120.
Tendon sprain: causes, symptoms and treatment
What are tendons?
Tendons are bundles of fibrous tissue that attach muscles to bones. They play an important role in ensuring movement – it is due to the work of the tendons that muscle contraction is transmitted to a particular bone, thereby ensuring the coordinated work of the joints and the entire musculoskeletal system.
Some of the tendons are very strong and strong, they can withstand heavy loads, several times the weight of a person’s body. These include, for example, the tendons of the muscles of the biceps or lower leg – the so-called Achilles tendon.
What Causes Tendon Strains
In certain situations and under extreme stress, tendons are often injured – they stretch and may even break.This happens in the event of awkward movement, due to wearing uncomfortable shoes, during physical activity or playing sports. In older people, these injuries are more common due to the decrease in tissue elasticity with age.
When the tendon is stretched, micro-ruptures of its individual fibers occur. In this case, a few hours after the injury, swelling occurs in the damaged area, a bruise may appear, pain syndrome develops, and the pain increases with load on the muscle.If, during an injury, a click or clap is heard, which is accompanied by a sharp pain, this indicates that most of the tendon fibers are damaged and it is torn.
Despite its strength, the Achilles tendon is often subjected to sprains and tears. Symptoms of his stretch: pain and increased sensitivity of the skin in the heel area, the appearance of redness and swelling. For such an injury, it is characteristic that the pain increases sharply with stress on the fingers or heel. Achilles tendon rupture is accompanied by a sharp clicking sound, acute pain above the heel, and severe swelling.As a rule, a person cannot stand on the toe of an injured leg 1 .
Tendon Sprain Treatment
If you suspect a tendon rupture, you should see your doctor immediately, as this type of injury can be treated surgically.
If the tendons are sprained, the injured area should be kept at rest. If an arm or leg is injured, it is best to apply a bandage. Ice or cold compress should be applied to the affected area several times a day to reduce swelling.
Non-steroidal anti-inflammatory topical agents, such as Aceclofenac-based Aertal® cream, can be used to treat post-traumatic pain and relieve the symptoms of sprained tendons. This agent has established clinical efficacy with good tolerability. It reduces inflammation, relieves pain and prevents the development of edema and erythema 2 .
The cream is applied with light massaging movements to the damaged area 3 times a day.The duration of treatment depends on the severity of the injury.
1 Kotelnikov G.P. Traumatology and Orthopedics. M .: “Geotar-Media”, 2006.S. 81.
2 AIRTAL® instructions for use.
Aertal ® cream has anti-inflammatory, analgesic and decongestant effects.
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90,000 Useful information about tendon rupture.
Tendon rupture: causes and consequences
One of the most serious injuries to which tendons are exposed is their rupture, which is dangerous for its complications.
The tendon tissue, through which muscles are attached to bones, are dense and strong. But with excessive loads exceeding their physiological capabilities, tendon damage occurs, consisting in its partial or complete rupture.
Causes of tendon rupture
The tendon is at risk of injury during long-term overload, leading to the development of a degenerative-dystrophic process.The provoking factors can be deterioration of blood circulation, metabolic disorders (for example, in diabetes mellitus), chronic inflammatory processes, hypothermia, old age, etc.
Rupture of healthy tendons often occurs during sports. For example, a partial rupture of ankle tendons is often found in basketball and football players with a sharp rotational movement. In bodybuilding and powerlifting, partial tears occur when lifting heavy weights and abrupt movements against the background of an unprepared tendon apparatus.
On the upper limbs, the most common tears are the tendon of the quadriceps brachii muscle and the supraspinatus muscle. As a rule, they are incomplete.
Much more often athletes have injuries to the tendons of large muscles of the lower extremities (biceps, quadriceps) and rupture of the Achilles tendon.
At the moment of injury, a characteristic click is heard, accompanied by a sharp pain. In the future, the pain sensations dislocated in the area of the tendon rupture persist, increasing under load.
In the area of damage on palpation, there is edema caused by internal hemorrhage.
The injured muscle partially or completely loses its functions (flexion or extension).
A fossa is felt at the place of the rupture, and the muscle itself is shortened and rises in the form of a tubercle.
When the Achilles tendon ruptures, there is no severe pain, but the person cannot stand on tiptoe.
An open tendon rupture is accompanied in most cases by numerous injuries of adjacent muscles, blood vessels, and nerves with profuse external bleeding.
Incomplete mild tendon rupture can be treated at home. In the near future after the injury, crushed ice wrapped in a damp towel should be applied to the damaged area for 15-20 minutes. In the future, it is more expedient to use heat. Special orthopedic bandages and rest are also needed. You should definitely consult a specialist doctor.
In case of a more serious injury, complete immobilization of the limb is required, for which a splint or plaster cast is applied to it.In the recovery period, physiotherapy exercises, massage and physiotherapy are prescribed.
In case of complete rupture, especially in athletes, conservative treatment is not enough and surgery may be required to restore the integrity of the tendon.
Consequences of tendon rupture
There have been cases when the injury of the second and third degree caused complications that did not disappear even after the treatment and a long recovery period.
One of the consequences of rupture can be constant pain due to the fact that nodules have formed in the damaged tendon after healing, increasing friction and leading to chronic inflammation.