AT tear or rupture?

[achilles5579]

I am obviously not an expert nor is it possible to see a doctor until my medical insurance becomes effective. Taking this into account I could really use some advice.:confused: I'll tell you what I do know. There is no "ball" of tendon on the backside of my knee. I can point my toe/foot forward from neutral about 2 inches and only partially flex my calf muscle. There is quite a bit of swelling between the sides of my ankle and around the backside and also on my heel. I imagine the swelling might account for some of the inflexibility. I can engage very slight downward pressure with my foot. I am not in any pain and have been icing and elevating for 3 days since the incident.

When I hear the term rupture I assume that's a full tear with no mobility in the foot? Is this correct? I am very willing to get surgery to fix this problem but have read that its best to wait until the swelling goes down (usually about a week). This is a convenient piece of info if true as that it will be at least 3 days until I am insured. It may be closer to 2 weeks from date of injury before my insurance is fully squared away and I can hence afford surgery.

Right now I am committed to icing, elevating and staying completely off this leg until I am ready to be treated. I am resting the foot in the natural position which is in a slightly pointed position (maybe 120 degrees measured from the front of the ankle) Does anyone have any ideas- I am in a tough position and any information would be much appreciated. Thanks

[dougdigital]

I'm sorry to hear about your injury. I tore my achilles 19 months ago and I have fully recovered since then. Are you able to point your toes upward at all? If you can point your foot up above neutral then its possible that you didn't tear anything. When I tore my achilles I could point my foot down but I could not point it up above neutral. I had the same amount of swelling and I could put pressure on my foot but I couldn't push off. However, it is good that you calf muscle can flex when you move your foot. The 'ball' of tendon that you speak about is when someone tears their achilles completely and their calf muscle will roll up. That did not happen with me but I did completely tear my achilles.

The best thing for you to do is make sure that the swelling goes down as much as possible and get an MRI to make sure. A doctor will probably give you a positive thompson test in which he will move your foot up and down to see if you calf muscle flexes. Hope this helps feel free to reply

[achilles5579]

Thanks DeD- to clarify I can hardly flex the calf. I can feel that the achilles is attached though and it wants to flex fully it just can't. I can trace the tendon when taught (flexed) from the bottom of my calf all the way to 2 inches above my heal where there is a small area about an inch and a half tall that feels mushy. In that area, however, I can still feel what I would guess to be about 30% of the tendon connected but feeling very weak. I suspect that the rest of the tendon in that area became splayed out around the side of my ankle...does this sound feasable? When I squeeze the tendon up behind my knee I can feel a sort of shooting sensation that is felt down around the right side of my ankle making me think there are some frayed pieces of the tendon down in that area. I will continue to rest it and apply ice and pressure so the swelling will go down. It would be great if I could slow the scar tissue from forming as I know that will probably weaken me in the long term. I'm wondering based on what I'm describing if this sounds like a typical partial rupture or if there is even such a thing as typical. Hopefully I'll be to the doctor by friday- thank you so much everyone for this valuable source of information!!:) Congrats on the smooth recovery DougEDigital and I appreciate your reply.

[achilles5579]

Oh..I can raise it above neutral too.

[dougdigital]

Your welcome. Sounds like its a tear and not a rupture. I forgot to mention that my foot would shake whenever I tried to move or flex it. I figured it was because of the rupture. Does your foot shake at all? There's not much you can do about the scar tissue right now. There's nothing wrong with having surgery 2-3 weeks post injury date. I had mine 17 days after the injury. The doctor will most likely have you wait this long if you're not able to have surgery the day after the injury.

[achilles5579]

Great- this is really encouraging for me. I don't have any shaking to speak of, it feels pretty solid and contained-as the swelling is going down my range of motion is increasing.:) The only thing is that I don't feel like I would want to stand on my toes. I started massaging the swollen area and am still keeping it on ice most of the time.

Thanks again- really appreciate it.

[slaphoundapbt]

Thompson test is where you kneel on a chair so that your feet hang over the edge freely.
When the calf muscle is squeezed, the ankle will flex moving the foot. A comparison is done on the good leg as a standard. If the foot doesn't flex, there is no connection left of the Achilles which is a complete rupture. The tendon does not always ball up in the calf muscle and you may still be able to point your toes with a little force. In the case of a complete rupture, there is usually a gap that can be seen and felt about 1.5 inches above the heel along the tendon. Get professional help ASAP. This tendon is made up of strands, so a partial rupture is quite possible. If your foot flexes during the Thompson test, you may still have a partial rupture.

Good luck!