AllCare Foot & Ankle Center: Podiatry

Tendons are bands of connective tissue that join muscles with bones. The role of a tendon is to transfer the force created by muscle into a nearby bone to facilitate the movement of your joints. While tendons are structured to withstand significant degrees of force, they can become damaged or tear as a result of extreme intensity. 

The tendons in your feet work together to stabilize your feet and ankles. When one of these tendons becomes injured, it can cause discomfort when you stand or walk. The most serious type of tendon injury is a torn tendon, a condition that makes it difficult or impossible to take a step or apply weight to your foot. 

Multiple tendons run from your lower leg to your foot. The Achilles tendon, which connects your calf muscle to your heel bone, runs down the back of your lower leg. It is the largest tendon in your body and one of the most commonly injured. 

If you believe you’ve experienced a torn tendon in your foot or ankle, it’s important to seek medical treatment as soon as possible. Achilles tendon specialist Michael V. Tran, DPM, and the staff at AllCare Foot & Ankle Center in Arlington and Dallas, Texas, specialize in the diagnosis and treatment of tendon tears and other tendon injuries. Based on a thorough examination and the results of diagnostic tests, Dr. Tran determines the source of your symptoms and an appropriate treatment plan to relieve discomfort and restore normal movement. 

In this blog, Dr. Tran discusses the signs of a torn tendon and what to expect if you experience this type of injury. 

What is a torn tendon?

A torn tendon, also called a ruptured tendon, is a tearing and separation of the fibers that make up the tendon. This type of damage to the tendon makes it unable to function normally. 

Most tears in the Achilles tendon occur in the substance of the tendon so that there is a gap between the upper and lower portions of the tendon. The most common location is about 4-6 cm above the heel. 

The Achilles tendon can also tear away from its insertion on the heel bone, resulting in a complete detachment. This may cause a fragment of bone to be pulled away from the heel by the tendon, causing the tendon to disconnect from the bone.  

What causes a torn tendon?

A torn tendon usually occurs when the tendon is suddenly stretched beyond its capacity. In the foot, this typically involves forceful pivoting or jumping that stresses the calf muscle. It can also result from a sudden acceleration of running or a traumatic fall or injury.

Most tears of the Achilles tendon are sports-related, occurring during intense physical activity, running, or jumping. While the tear happens suddenly, it is often the result of an accumulation of smaller tears that have occurred over time and have reached their breaking point. 

While a torn tendon can affect anyone, tears in the Achilles tendon typically affect people between the ages of 30 and 50 years old who are recreational athletes. In many cases, these individuals may attempt to do too much too soon without proper training. 

Research indicates one reason for the higher incidence of Achilles tendon tears in this age group is the age-related changes that occur in the physiology of the Achilles tendon and its mechanics.  

What are the symptoms of a torn tendon?

While symptoms of a torn tendon can vary by individual and location of the tear, individuals who experience a torn Achilles tendon often experience one or more of the following physical signs:

• A sudden, severe pain during activity or injury
• Hearing and/or feeling a popping or snapping sound at the time of injury
• Feeling that you’ve been struck in the back of the calf
• Swelling and bruising on the inside of your heel or the back of the leg below the calf
• Inability to stand on your toes, walk, or put your foot down

What is the treatment for a torn tendon?

With prompt and appropriate treatment, most tendon tears can be repaired so that you can return to sports and other activities. Treatment for a torn Achilles tendon depends on several factors including the type and location of the tear, the degree of damage, and your overall condition.

Nonoperative treatment typically includes immobilization of the affected leg with casting with the foot and ankle flexed downward. This positions the two ends of the broken tendon closer together so they can naturally fuse together and heal.

Surgery may be recommended if you are a young or middle-aged adult, especially if you’re athletically active. The procedure involves attaching the two ends of the torn tendon together with sutures. This restores length and tension to the torn tendon. 

Postsurgery recovery involves immobilizing the affected leg in a splint, cast, or walking boot. Physical therapy is typically recommended when the affected tendon starts to heal. 

If you’re experiencing signs of a torn tendon, prompt medical attention can give you the best chance of healing and returning to normal activities as soon as possible. To schedule a consultation, book online or call our Dallas or Arlington office today. 

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Foot Tendon Tears | Orthopedics Sports Medicine

Diagnosis & Tests

To properly diagnose a foot injury, you may need to see an orthopedic specialist who is trained to detect and treat foot and ankle injuries. During the exam, the doctor will:

• Ask about the injury, ask how your foot feels now, and when it hurts most
• Examine your foot and ask you to move it in certain ways
• Recommend imaging tests such as an:
  • X-ray to check for broken bones and look for other damage
  • MRI or CT scan if there is any question about which part of the foot is injured or the severity of the injury

Treatments

Treatment tendon tear in the foot will depend on how serious the tear is and your overall health, but may include any of the following:

• Rest. You may need to take a break from any activities that put pressure on the injured tendon.
• Ice. Cold packs may help to reduce pain and swelling. Ice the injury right after it happens, and then 3 or 4 times a day while it is healing. Put ice in a towel or cloth and ice for only 20 minutes at a time. Don’t put ice directly on your skin. When you start back to your usual activities, it may help to ice the area that was injured for 20 minutes after activity to prevent swelling.
• Nonsteroidal anti-inflammatory medicine (NSAID). NSAIDs like ibuprofen can reduce pain and swelling after the injury. Ask your doctor about the appropriate dose for your injury and how long you should take them.
• Brace or cast. Your doctor may recommend you use a brace, cast, or boot to support your foot and keep it still while it is healing.
• Orthotics. An orthotic is an insert that goes in your shoes to support your foot and help you use it the right way. Sometimes a tendon injury changes the shape of your foot, which may require special support.
• Steroid (cortisone) injections. Cortisone shots can reduce inflammation and pain that come with a tendon injury.. Your doctor will help you decide if this is the right treatment for you.
• Exercise and physical therapy. Exercises that stretch and strengthen your muscles and tendons may help. A physical therapist will teach you the correct way to do these exercises and coach you as you do them when you first start your exercise program.
• Surgery. If your tendon is ruptured or your pain and swelling doesn’t go away, surgery may be recommended to repair or replace a tendon. Surgery may also be done to remove any inflamed tissue around the tendon or to change the muscle or bone that the tendon attaches to.

Prevention

It’s not always possible to prevent injuries. But you can lower your risk of a foot tendon tear by taking care of the muscles that tendons attach to. Know your limits and don’t push your muscles to do what they are not ready to do.

If you have a foot tendon injury, you can prevent further damage and future injuries by getting the right treatment.

Ligamentous injuries of the ankle joint (ankle joint instability) — symptoms, diagnosis, treatment
Injuries to the ligaments of the ankle joint occur as a result of an injury – a twist of the foot, often – when playing sports or in winter, with ice. Pain may not occur immediately. In a short time or immediately after the injury, swelling of the ankle joint appears, its contours are smoothed out, subcutaneous hematomas (bruises) appear. Sometimes patients report a “click” at the time of injury. Movement in the ankle joint causes acute pain, it is almost impossible to lean on the leg.

It is necessary to apply cold and fix the damaged joint, then go to a medical institution, where you will have an x-ray of the ankle joint. Often this is not enough and a number of additional examinations may be required, such as ultrasound examination of the joint, magnetic resonance imaging (MRI) to assess the condition of the soft tissue structures (ligaments, tendons) of the ankle joint.

Conservative treatment of ankle ligament injuries

If the ligaments are partially damaged, then we are usually talking about conservative treatment – wearing a plaster or polymer bandage, special bandages, orthoses. Courses of physiotherapy and exercise therapy are prescribed.
Ineffective and incorrect treatment of this pathology can lead to serious complications, such as arthrosis, chronic instability of the ankle joint, lameness and others.

Surgical treatment of ankle ligament injuries

If all these measures are ineffective – pain, swelling, a feeling of instability in the joint, recurring injuries, as well as complete damage to the external or internal complex of the ligamentous apparatus of the ankle joint, surgical treatment is indicated – restoration of the ligaments (ligament plasty) to prevent the above complications.

Depending on the degree of damage, one of the methods of surgical intervention is used:

• stitching ligaments (if they are in place but deformed)
• periosteal valve (if ligaments are torn or not visible)
• grafting of tendons and ligaments, use of plantar material, or tendons to replace from 2-3 ligaments, when performing these interventions, absorbable (absorbable) materials are used for fixation

The operation is performed under arthroscopic control (using a video camera inserted into the joint, its cavity is examined). Thanks to this, it is possible to diagnose and eliminate problems not only with damaged ligaments, but also within the joint during one surgical intervention.

Immediately after the operation, the joint is fixed with a plaster cast so as not to expose it to unnecessary stress. This will lead to a speedy recovery. The sutures are removed on the 12-14th day. After the stitches are removed, restorative treatment can begin. After 4 weeks, the cast can be changed to a semi-rigid U-shaped ankle brace. Walking without crutches with full load on the joint is possible after a few weeks.

Rehabilitation treatment after ankle ligament injuries

It is very important to consider a course of rehabilitation treatment for such injuries in order for the function of the ankle joint to recover to the maximum extent. Upon discharge from the hospital, the patient receives a detailed recovery plan.
Rehabilitation treatment includes a course of physiotherapy, shock wave therapy, a set of active and passive exercises aimed at strengthening and stretching muscles with a partial load on the joint, and exercises to develop movements in the joint.
In addition, at the NCC No. 2 (CCH RAS), a biomechanics laboratory was created on the basis of the rehabilitation treatment department, in which patients undergo rehabilitation after various injuries of the musculoskeletal system, incl. professional athletes. On its basis, various parameters of walking are studied, an optimal rehabilitation plan is developed in accordance with the data obtained.

Ankle injuries

Achilles tendon

The strongest tendon in the human body is the Achilles tendon, which can support a weight of 400 kg. The proximal end of the tendon begins at the junction of the biceps and triceps muscles of the lower leg, the so-called soleus muscle. The distal end of the tendon is attached to the tubercle along the posterior surface of the calcaneus.

The picture shows the Achilles tendon

Tendonitis (inflammation) of the calcaneal tendon and its rupture are the most common pathologies that occur in people involved in sports.

The picture shows diseases of the Achilles tendon

Tendinitis (inflammation) of the calcaneal tendon is a traumatic injury characterized by inflammation of the tissue around the calcaneal tendon, pain and swelling in the calcaneal tendon, and limitation of range of motion. Basically, this condition can develop while running for long distances at high speed. Depending on the duration of the course of symptoms, tendonitis is divided into acute (less than 2 weeks), subacute (2-6 weeks), protracted (6 weeks – 6 months) and chronic (more than 6 months). The main symptoms of inflammation of the calcaneal tendon include: pain and swelling in the area of ​​the calcaneal tendon, increased pain during flexion and extension of the leg muscles, a local increase in sensitivity during palpation of the calcaneal tendon.

Methods of treatment

One of the main methods of treatment is the patient’s avoidance of sports that can lead to symptoms. Performing exercises to contract the triceps calf and calcaneal tendon, as well as wearing an orthosis, can have a positive effect during treatment. The introduction of low molecular weight heparin subcutaneously for three days has an excellent effect in acute tendonitis. The patient should be warned about the possible occurrence of bruises on the body. Patients who have problems with blood clotting, the introduction of heparin is contraindicated. Since heparin therapy requires the patient to visit the doctor several times, in addition, when it is administered, the risk of bleeding increases, this type of therapy can be used only when the athlete needs to recover in a short time due to competition.

Anti-inflammatory drugs should always be recommended when symptoms are identified; however, these drugs cannot be used in conjunction with heparin (paracetamol is used instead). If tendinitis becomes chronic, then injections of glucocorticoids should be made. A few weeks between each injection is recommended. Since injections of glucocorticoids increase the risk of dislocations, they should not be injected into the joint cavity. After the injection of glucocorticoids, a two-week break should be taken before subjecting the patient to serious physical exertion.

Calcaneal tendon rupture – this type of injury most often occurs among men in the age group of 30-50 years, during exercise, especially during sports with the ball. We can say that with a rupture of the calcaneal tendon, degenerative changes always occur. Fluoroquinolone antibiotics, especially when used with steroids, in patients over 60 years of age increase the risk of tendon rupture.

Symptoms

Tendon ruptures cause short-term acute pain. The feeling that the patient may be hit on the back of the foot very often worries the patient. In some cases, tears may be painless. With a tendon rupture, the patient cannot stand on their toes. If the function of the flexors of the toes and the peroneal muscle is preserved, partial flexion of the leg is possible. At the site of injury, edema and hematoma are detected.

Diagnosis

The main diagnostic tests are the Thompson and Copeland tests.

When performing the Thompson test, the patient lies on their stomach, moves their leg to the edge of the couch, and the examiner squeezes the calf muscles. The test result is considered positive (indicative of an Achilles tendon rupture) if the foot does not flex.

During the Copeland test, the patient lies on their stomach and bends the leg at the knee. The cuff of the tonometer is fixed on the widest part of the lower leg. The leg is in a flexed position (plantar flexion) and the pressure rises to 100 mmHg. If the tendon is healthy, leg extension (dorsiflexion = extension) causes the pressure to rise to 140 mmHg. When a tendon rupture occurs, the pressure does not change.

Magnetic Resonance Imaging (MRI) is a very informative method for localizing a tendon rupture.

Methods of treatment

The main method of treatment for tendon ruptures is surgical treatment. During the operation, the ends of the Achilles tendon are sutured end to end. After the operation, the doctor applies a plaster cast on the ankle joint, in the flexion position of the foot (plantar flexion). The plaster bandage is removed after six weeks, then physiotherapy is started. After six months, the patient returns to an active lifestyle.

Image showing Achilles tendon and images taken during surgery sti and refers to complex joints. In this joint, the upper articular surface and the surface of the medial malleolus are connected to the tibia, and the fibula interacts with the surface of the lateral malleolus. The ankle joint is strengthened with the help of the internal ligament, the external tibiofibular and calcaneal-fibular ligament. Flexion and extension movements can be performed in this joint. When a person stands in an upright position, an angle of 9 is formed between the leg and lower leg.0 degrees. With flexion, the angle between the leg and lower leg increases, and with extension it decreases. During flexion, the talus moves backward, the narrowest part passes into the widest part between the processes of the calcaneus, and thus the possibility of turning the foot in and out arises.

The figure shows the ligaments of the outer surface of the foot

The main cause of damage to the ligaments of the ankle joint is the case of tucking of the foot. As a result of a sharp and sudden action, damage to the ligaments of the joint or periarticular soft tissues can occur due to their contraction and sometimes rupture, which is called joint tuck. In the tucked joint, there is a sharp unbearable pain. After twisting the foot for several hours, swelling, redness, fever and limited range of motion are observed in the joint area.

Twisting of the ankle joint occurs when the normal position of the joint is disturbed due to a sudden movement. This sudden movement puts strain on one or more of the ligaments in the joint, and can also cause a partial or complete tear. The most common injury is to the anterior talofibular ligament. Injury to the calcaneofibular ligament occurs in 10-20% of all ligament injuries. The posterior talofibular ligament is damaged only as a result of a dislocation of the ankle joint. In rare cases, damage to the internal ligament may occur. There are three degrees of tucking of the foot, depending on the degree of damage: mild, moderate and severe.

Mild ( Grade I ): this grade of damage results from slight strain on the ligaments and minimal damage is seen.

Medium severity ( Grade II ): this degree of damage is characterized by a partial rupture of the ligaments.

Severe ( Grade III ): this degree of damage is characterized by a complete rupture of the ligaments. During the examination, instability of the ankle joint can be observed. Significant swelling and bruising are noticeable.

Grades of ligament injury shown below

Causes of ankle tuck are listed below:

• Falls causing foot flexion
• Excessive load on the leg after bouncing or turning
• Sports and walking on uneven terrain

Risk factors

Sports

Foot twists are injuries that are very common in sports such as basketball, tennis, football, running. This type of injury accounts for 20-30% of cases of injuries that occur during physical activity. Half of basketball injuries and one third of football injuries involve ankle strain.

Uneven surfaces

Walking and running on uneven terrain can increase the risk of foot tuck.

Previous foot injuries

After a previous foot tuck, the risk of re-twisting of the ankle increases.

Ankle laxity

Weakness in the ankle joint during sports activities and increased elasticity increase the risk of foot tuck.

Unsuitable shoes

Shoes that are not the right size for the activity, or shoes with high heels, can contribute to foot tuck.

Symptoms and diagnosis

Symptoms and clinical signs of foot tuck vary depending on the severity of the injury. Symptoms of tarsal tuck include: pain, tenderness in the feet, swelling, bruising, limited range of motion, weakness in the foot, stiffness, discoloration of the skin.

Diagnosis

During ankle tucking, the diagnosis is made on the basis of complaints and clinical examination. During the examination, a thorough examination of the condition of the lower leg, foot and heel is carried out. The doctor checks sensitive points and range of motion. In order to understand in what position the patient experiences unpleasant and painful sensations, the doctor asks the patient to make leg movements.

If the severity of the injury is severe, certain examinations are recommended to exclude possible bone fractures or to more accurately determine the degree of damage to the ligamentous apparatus.

X-ray: X-ray of the ankle joint allows you to determine the presence / absence of fractures in this area. For this purpose, the patient is exposed to radiation exposure in small doses.

Magnetic Resonance Imaging (MRI): All soft tissues in the area of ​​the ankle joint, including the ligaments, can be assessed with this examination method.

Computed tomography (CT): This examination method can provide additional information about the bones that form the joint. CT allows you to get an image from different angles using x-rays. She combines them in order to get a three-dimensional image.

Ultrasound: This test uses ultrasound waves. This study helps to assess the condition of the ligaments and tendons in various positions.

Methods of treatment

Treatment of ankle tuck is planned depending on the severity of the injury. The goals of treatment are to reduce pain and swelling, speed up the healing of the injured ligament, and restore function to the foot. For the treatment of ankle tuck (especially with mild damage), use protocol RICE .

Rest ( R .. Rest ) – orthoses are used at this point of treatment, it is recommended not to put a load on the leg. Stop performing actions that contribute to the development of pain and discomfort, as well as the occurrence of edema in the foot area.

Applying an ice pack ( I .. Ice ) – at this point of treatment, an ice pack is applied several times a day, kept for 20 minutes. However, you need to be careful when applying bandages to patients with vascular atherosclerosis, diabetes mellitus, or decreased sensitivity in the legs.

Compression ( C .. Compression ) – at this point of treatment, elastic bandages or special bandages for the foot are used. In order to prevent impaired blood flow, bandages should not be applied too tightly. In case of serious complaints, to speed up recovery, the ankle joint should be completely stabilized by applying a splint-like cast to prevent any movement.

Elevation ( E .. Elevation ) – at this point of treatment, to reduce swelling, you need to raise the leg and keep it at the level of the heart.

During treatment, it may be sufficient to use painkillers such as ibuprofen, naproxen and acetaminophen. With a decrease in the size of the edema and the degree of pain to the level where the patient can perform movements, in order to restore the strength of foot movements, its stability and elasticity, sports exercises and physiotherapy are recommended. If there is no healing of ligament injuries and restoration of stability and joint, in some cases surgical treatment is required.

Treating an ankle tuck in the wrong way, re-twisting or returning to sports immediately after an injury can cause many complications.