A Classic Case Study
Just this week in clinic I saw a fit young chap in his early 40s who I, unfortunately, had to diagnose with a ruptured Achilles tendon.
His history was classic and without realising it he had shown symptoms of Achilles Tendonopathy for over a year, alongside the potential consequences. How did this man who is the ideal weight, looked after himself, ate well, and cycled 5 hours a week have an unhealthy tendon that ruptured when he was just playing with his kids in the garden?
A classic history of Achilles Tendinopathy / Tendonitis
He went on to describe a classic history of Achilles Tendinopathy / Tendonitis. See my blog on Achilles Tendonopathy for greater details of the issue as well as treatment to resolve the issue. A Tendinopathy is a tendon that shows degeneration and often a release of chemicals similar to the body’s normal inflammatory response. This creates an imbalance between wear and repair leading to pain, stiffness, loss of function, and a higher risk of this unhealthy tendon rupturing as in the case of this chap.
He reported having stiffness at the base of his calf/tendon for over a year. Two weeks before his rupture he reported pulling his calf whilst playing a casual game of football with friends, this is something he hasn’t done for a while but was keen to get back to. This calf strain settled itself down over the following week with rest and ice. The actual incident that caused the rupture happened at home in his garden whilst having a gentle kick around with his 2 young children. Having kicked the ball he felt a strong sensation at the back of his calf – which he described as feeling as if he had been kicked hard. He did not hear anything but his daughter said she heard a loud snapping sound. This was the point at which his tendon ruptured. He had pain and swelling around the area and was unable to walk properly as he was unable to push off with that leg, this also impeded his ability to drive. He did however manage a short cycle to the clinic mainly using his good leg.
On assessment, he could not push up on his injured leg or push his toes down unless done by gravity. With a normal tendon when you squeeze the calf the foot should move. In this chap, there was no foot movement on the squeeze test. He also had a visible and palpable gap of about 1cm about 5cm up from the insertion. It is rare for me to be the first to diagnose these types of injuries as most go straight to the hospital where they can be diagnosed and get the treatment needed. As a clinician, it is always nice for me to see these especially one with such a classical presentation.
Prompt medical intervention is needed in these situations to prevent further damage and enable successful treatment and repair. I referred him to see one of my surgical colleagues who repaired his tendon. He is now immobilised in a walker boot with a long journey ahead of him to return to full fitness.
Signs & Symptoms of Achilles Tendon Rupture
- Sudden pain (which feels like a kick or stab) at the back of the calf or ankle – initial pain often subsides quickly to a dull ache.
- Popping or snapping sensation and or noise (sometimes described as a gunshot)
- Swelling at the back of the ankle, base of calf.
- Difficulty walking especially upstairs or uphill.
- Difficulty raising onto toes.
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Could this of been avoided?
In this case, there were a few key moments within his history that had he sought advice and treatment is highly likely that this could have been avoided. Let’s look at those.
This chap had been having stiffness at the base of his tendon for over a year. He was physically in good health, however, his tendon was not as healthy hence the stiffness. Although he cycled to a very high level he did little other activity and spent long days at his desk, this meant that his tendon had not been loaded which is vital for it to stay healthy.
Ideally, this chap would have attended clinic a year ago when he began noticing his morning ankle stiffness, he could have even come for advice when he pulled his calf playing football 2 weeks previously. This would have allowed the opportunity to intervene and begin a program of loading to increase the health of the tendon preventing rupture.
Summary
Early identification and then treatment of degenerate and unhealthy Achilles Tendons could significantly reduce the risk of tendon rupture. You should now know if you have any of these symptoms and the importance of addressing them. My Achilles Tendinopathy Program would be beneficial. Here I take you through a complete program to return your tendon to full strength and health, resolving pain and symptoms and reducing the risk of rupture and serious injury. The website has lots more related blogs to help you get tendons in tip-top condition – from eccentric loading to the effects of running on the tendon. But why not just start by learning more about the problem and how to treat it? Knowledge is power after all – I’ve got it covered for you.
Take care, Helen
Helen Manders BSc (Hons), MCSP, HCPC.
Chartered Physiotherapist Since 2001
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