What is a Partial achilles tendon rupture?
A partial achilles tendon rupture can occur in athletes from all sports but particularly running, jumping, throwing and racket sports. The tendon tears but not completely. Scar tissue will form which is likely to lead to inflammation of the tendon. Often the athlete will not feel the achilles tendon rupture at the time but will become aware of it later when the tendon has cooled down.
Symptoms of a partial achilles tendon rupture:
A sudden sharp pain in the Achilles tendon. (Sometimes the athlete may not feel a sharp pain at the time of the tear but pain is likely to come on when cooled down or the following day).
When returning to exercise after a short period of rest, there may be a sharp pain which disappears when warmed up only to return when stopped.
Stiffness in achilles tendon first thing in the morning.
A small swelling in the tendon.
Treatment of partial achilles rupture:
What can the athlete do?
Apply cold therapy or R.I.C.E. (Rest, Ice, Compress, Elevate) for the first two to three days.
See a sports injury specialist or doctor who can advise on treatment and rehabilitation.
A proper diagnosis is essential. If the rupture is a complete achilles tendon rupture then immediate surgery is usually indicated. Thompson's test (see below) is one way of determining if a total rupture may be present.
What can a Sports Injury Specialist or Doctor do?
Correctly diagnose the injury - Thompson's test (see below) is one way of assessing the achilles tendon.
Tape the Achilles to support it.
Use ultrasound.
Prescribe anti-inflammatory medication such as ibuprofen.
Prescribe a rehabilitation programme.
They might put you in a plaster cast for 4 to 6 weeks.
Operate
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Treatment and rehabilitation of Achilles tendon partial rupture
The following guidelines are for information purposes only. We recommend seeking professional advice before starting any rehabilitation.
Aims of rehabilitation:
Control initial pain and swelling.
Improve mobility and flexibility.
Improve the strength of the tendon.
Return to full fitness.
It may be a month before swelling is reduced and the injury has healed enough to progress into stretching and strengthening exercises.
Controlling pain and swelling.
Apply cold therapy. This can be in the form of ice. Do not apply directly to the skin - place a wet tea towel around the ice or use a specialist product. Apply compression after or during the cold therapy to help reduce swelling.
NSAID (Non Steroidal Anti Inflammatory Drugs (e.g. Ibuprofen) may help reduce the inflammation in the early stages. It is important to always check with your Doctor before taking any medication. You should not take Ibuprofen if you have asthma. Avoid taking medication for more than a week. The effectiveness may be reduced later in rehabilitation and may even hinder healing.
Rest the injury from aggravating activities. If the athlete cannot walk without pain then they may need to use crutches. When the athlete can tolerate walking, place a 2cm heal raise into shoes which will raise the heal, shorten the achilles tendon and reduce the load on the tendon. Continue to rest the tendon until able to tolerate a strengthening programme. With an injury of this kind it may be a month or more before the athlete can attempt strengthening of the tendon.
Taping the achilles tendon may help to reduce the load on it as the athlete returns to walking, especially if they have no choice and have to get about for example at work.
Increasing mobility and flexibility
When swelling has gone down and pain is reduced the athlete may be able to begin to stretch the tendon. It may be as soon as a week after injury but it may be up to a month depending on severity.
Begin with mobility exercises as soon as pain will allow. This may be within a few days but could be over a week depending on how bad the injury is.
Balance exercises should be performed as early as possible in the rehabilitation of this injury. When a tendon or ligament is torn balance is usually impaired, leaving the ankle more at risk of future injuries. Balance boards are great for this.
Strengthening
When pain and swelling has gone then strengthening exercises can begin.
Start very slowly and progress slowly (double leg heel drop taking most of the weight on the uninjured leg).
It is important that the tendon is strengthened in the stretched position by allowing the heels to drop below the toes.
If you feel pain during, after or the next day then you may need to rest and take a step back.
Continue stretching throughout the rehabilitation process. Stretch well before and after strengthening sessions.
Stretching exercises can be done on a daily basis, especially if the loads are light in the early stages.
Strengthening should be continued for many weeks after you have returned to full fitness.
Apply ice to the tendon at the end of a strengthening session to help prevent inflammation.
Return to fitness
When the ankle has regained full flexibility, there is no pain or swelling and strengthening exercises can be tolerated without adverse reaction then a gentle running programme can begin. This may be up to three months after the initial injury depending on severity.
Start gentle jogging on a firm surface. Gradually build up until you can comfortably jog for 45 minutes.
It is unlikely that you will be able to return to competition within four to six months.
Below is an example of a gradual return to running programme.
Day 1: walk 4 minutes jog 2 minutes repeat four times
Day 2: rest
Day 3: walk 4 minutes jog 3 minutes repeat three times
Day 4: rest
Day 5: walk 3 minutes jog 4 minutes repeat 4 times
Day 6: rest
Day 7: walk 2 minutes jog 6 minutes repeat 4 times
Continue this gradual progression until you can confidently run and resume normal training.
Gradually increase the duration of your runs. No more than 10 % per week is usually recommended. If your sport demands sprinting then gradually increase the speed.
Continue with the stretching and strengthening programme. It is important to do these even if you do not gain pain at this stage. Continue for at least three months. Continue to ice the tendon after training. You should now be ready to start back in full training but never neglect stretching and strengthening of the achilles tendon or the injury might return.
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