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Q: I think I have a slight tear in my Achilles tendon. I've followed doctor's orders of no running, hiking or cycling for four months, but I'm still sore and stiff. I don't want surgery. What are my options?
A: The Achilles tendon is the large tendon at the back of the ankle that connects your calf muscles to the bone in the heel of your foot. Large forces go through the tendon when running and jumping.
Often, when a partial Achilles tendon tear occurs, the tendon's central fibres are broken while the surrounding ones remain connected. This is particularly common in running, jumping, throwing and racket sports.
It can be caused by:


		wearing unsuitable shoes;



		a change in your training;



		failure to warm up your calf muscles properly before exercising.

Initial treatments include:


		rest, ice, compression and elevation (RICE);



		use of oral anti-inflammatory medication and painkillers;



		a brace to keep the Achilles tendon straight so it can heal;



		a heel raise to shorten the Achilles tendon to help in healing;



		massage to soften the scar tissue;



		strengthening exercises.

If your pain symptoms persist, the most important step now is to obtain an accurate diagnosis.
An MRI scan of your Achilles will tell us whether you have a partially torn tendon or if you are suffering from other conditions, such as Achilles tendinopathy.
The scan can also quantify the degree of the tear.
Persistent pain in the Achilles is often caused by partial ruptures leading to a hypoxic state in the tissues, insufficient healing and an immature, painful scar. It is notoriously slow to heal because of its poor blood supply.
If the partial tear involves less than 25 per cent of the tendon's cross section and the diagnosis is made acutely, casting the ankle for a short period followed by physiotherapy to strengthen the muscle-tendon unit may be helpful. Minor partial tears can heal without surgery, but may take months.
As your condition has persisted for more than three months, you should be referred for a course of physiotherapy without the need for casting.
There are preliminary reports of a non-operative biological treatment approach for partial Achilles tendon lesion using autologous platelet growth factors through multiple platelet-rich plasma (PRP) injections. It is believed these injections with processed blood taken from one's body can promote tendon healing.
But significant partial ruptures involving more than 25 per cent of the tendon's cross section seem to respond poorly to conservative measures and do not improve with time.
Surgical treatment to excise the degenerated tissue is usually the preferred option for such cases. This is because it fully restores function and gives complete relief from pain in most cases.
Dr Chang Haw Chong is an orthopaedic surgeon with an interest in orthopaedic sports medicine. He works with Synergy Orthopaedic Group at the Mount Elizabeth Novena Specialist Centre in Singapore
 
 


Ask the Doctors: looking after your Achilles tendon

Illustration: Corbis

Lifestyle

Health

I think I have a slight tear in my Achilles tendon. I've followed doctor's orders of no running, hiking or cycling for four months, but I'm still sore and stiff. I don't want surgery. What are my options?
