The ankle comprises two robust joints crucial for supporting the body’s weight. Renowned for its versatility, the ankle complex is adept at bearing weight, facilitating movement, and providing stability. Serving as our interface with the ground, the foot and ankle enable essential activities like walking, running, standing, and jumping. It must endure the strain of our body weight and swiftly adapt to changes in terrain. Tendons, which link muscles to bones, play a vital role in this process by transferring muscular forces to the bones, facilitating joint movement. When tendons become irritated or inflamed, they can cause pain, known as tendonitis. The tendons around the ankle are particularly susceptible to stress and may even rupture under extreme pressure.

What is an Ankle Tendon Rupture?

An ankle tendon rupture, also known as a peroneal tendon tear, can result in severe pain and disability, potentially leading to damage to the ankle joints. The ankle tendons encompass the peroneals, anterior tibialis, posterior tibialis, and Achilles tendon. Any of these tendons are susceptible to rupture, a serious condition often necessitating surgical intervention for repair. Situated behind the prominent bone on the outer side of the ankle, these tendons play a crucial role in maintaining the foot and ankle position during walking.

Peroneal tendon disorders are a frequent source of ankle discomfort among active individuals. While they’re often linked with lateral ankle sprains, other contributing factors may include functional ankle instability, peroneal tendon subluxation, inadequate support behind the outer ankle bone, low positioning of the fibularis brevis muscle, high-arched foot posture (cavus foot), and tendon tears. Given the multifaceted nature of peroneal tendon issues, when conservative treatments fail to alleviate symptoms, surgery may be considered. Ideally, surgery should be followed by a tailored rehabilitation regimen to optimize recovery and facilitate an early return to physical activities.

Signs & Symptoms

Symptoms of a torn tendon can manifest differently depending on the individual and the location of the tear. Individuals with a torn Achilles tendon typically exhibit one or more of the following physical indications: experiencing sudden and intense pain during activity or injury; hearing and/or feeling a popping or snapping sound at the moment of injury; sensation akin to being struck in the back of the calf; observing swelling and bruising on the inside of the heel or the back of the leg below the calf; and being unable to stand on toes, walk, or put weight on the affected foot. These signs collectively signify the potential occurrence of an Achilles tendon tear, warranting prompt medical attention and evaluation.

Causes of Ankle Tendon Rupture

A torn tendon commonly occurs when the tendon undergoes sudden stretching beyond its limits. In the foot, this often results from forceful pivoting or jumping, placing strain on the calf muscle. It can also stem from abrupt acceleration while running or from traumatic falls or injuries.

The majority of Achilles tendon tears are associated with sports activities, particularly during vigorous physical exertion, running, or jumping. While the tear itself is sudden, it frequently arises from a culmination of smaller tears that have accumulated over time, eventually reaching a critical point.

Although anyone can experience a torn tendon, Achilles tendon tears predominantly affect individuals aged between 30 and 50 who engage in recreational sports. Many times, these individuals may push themselves too hard without adequate training. Studies suggest that one contributing factor to the higher incidence of Achilles tendon tears in this age bracket is the physiological and mechanical changes that occur in the tendon due to aging.

Prevention Methods

Preventing peroneal tendon tears and other soft tissue injuries in the feet and body requires proactive measures such as the ones listed below.

Wear appropriate footwear: Ensure your shoes offer comfort and support tailored to your foot structure, such as high arches. Replace shoes when they no longer fit properly or lack adequate tread, and choose footwear suitable for specific activities that involve lateral movements.

Maintain a balanced fitness regimen: Just as a balanced diet is essential for health, so is a varied exercise routine for injury prevention. Incorporate aerobic exercises like walking, flexibility exercises such as yoga, and strength training using resistance bands.

Prioritize warm-up sessions: Before engaging in vigorous activities like running or yoga, take time to warm up properly. Spend a few minutes gently jogging in place or taking a brisk walk around your surroundings. Warm-ups prepare the various components of your feet and body for the ensuing intensity.

Implement post-workout cooldowns: Avoid abrupt cessation of exercise by transitioning to a slower pace after a workout. For instance, if you’ve been running, gradually reduce your speed to a slow jog and then a walk. Allocate at least 10 minutes to a cooldown phase, incorporating less intense and slower movements.

Embrace flexibility training: Incorporate stretching into your daily routine as it plays a crucial role in injury prevention. Familiarize yourself with correct stretching techniques and make it a habit to stretch regularly.

Treatment Options

Physical therapy involves a variety of therapeutic techniques such as ice, heat, or ultrasound therapy to alleviate swelling and discomfort. As symptoms improve, targeted exercises are integrated to enhance muscle strength, increase range of motion, and promote better balance. Immobilization using a cast or splint effectively restricts movement of the foot and ankle, facilitating the healing process. Medications, including oral or injected anti-inflammatory drugs, are prescribed to provide relief from pain and inflammation as part of the treatment regimen. Surgeons may also recommend the use of braces to offer temporary stabilization for the ankle, especially during activities involving repetitive motion. Bracing can also be considered as an alternative option for patients who are not suitable candidates for surgical intervention.

You can also go the surgical route to treat your ankle tendon rupture. Surgical treatment and repair of peroneal tendons depend on the specific pathology, particularly the condition of the superior peroneal retinaculum (SPR). Surgical approaches may involve tendoscopic or open procedures, with or without repairing the SPR. When the SPR is left unrepaired, rehabilitation initially focuses on early mobilization and range of motion exercises in all directions, as there’s no opening of the peroneal tendons proximal to the fibula’s tip. Non-weight bearing immobilization typically lasts around 2 weeks, with a recommended maximum immobilization period of 4 weeks when the SPR remains intact. However, if the SPR is repaired, immobilization involves non-weight bearing in a lower leg cast for 2 weeks, followed by 4-6 weeks of gradually increasing weight bearing using a walker boot. This protocol aims to prevent tendon dislocation and allow proper healing of the SPR repair.

For more information about ankle tendon rupture treatment options on Long Island, contact Hicksville Physical Therapy today.

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