Everything You Need to Know About Ankle Tendon Tears

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The ankle is a vital joint that supports the body’s weight and enables activities like walking, running, and jumping. Its complex structure of bones, tendons, and ligaments provides stability and mobility. Injuries, such as tendon tears from acute trauma or wear and tear, can cause pain, instability, and limited movement, significantly affecting daily life if left untreated.

These types of injuries, if left untreated, can worsen and limit the ability to perform even basic tasks. The following guide will explore ankle tendon tears, their causes, symptoms, and treatment options, providing a clearer understanding of this common yet disruptive condition.

How Ankle Tendons Support Stability And Movement

The ankle is supported by several major tendons, each vital in maintaining stability and facilitating movement. These tendons connect muscles to bones, allowing the ankle to flex, extend, and rotate with ease. The most prominent tendons in the ankle include:

Achilles Tendon: The largest tendon in the ankle, connecting calf muscles to the heel bone. It enables pushing off the ground for walking, running, and jumping.
Posterior Tibial Tendon: This tendon runs inside the ankle. It supports the foot’s arch, and stabilizes the ankle during standing and walking. Damage may cause flatfoot and instability.
Peroneal Tendons: Located on the outer ankle, these tendons stabilize the foot and prevent it from rolling outward. These are crucial for balance during side-to-side movements.
Flexor and Extensor Tendons: Flexors curl the toes downward and provide grip during walking, while extensors lift the toes upward, enabling smooth, coordinated movement and preventing the foot from catching the ground.

Each of these tendons plays a distinct role in keeping the ankle stable and mobile. When functioning correctly, they allow seamless transitions during activities like walking, running, and jumping. However, injuries to any of these tendons can lead to pain, instability, and difficulty with movement.

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What Is An Ankle Tendon Tear?

An ankle tendon tear occurs when the fibers within the tendon become partially or completely damaged, often resulting from excessive strain or injury. Tendons are fibrous tissues connecting the body’s muscles to its bones, helping to facilitate movement and maintain stability.

When these tendons are subjected to too much stress or repetitive use, they can tear, leading to pain, swelling, and restricted motion. Tears can range from minor, involving only a few fibers, to severe, where the tendon may rupture entirely.

Type Of Tears

There aren’t necessarily distinct “types” of tears, but rather classifications based on the extent of the damage and how the injury occurred. Tears are often described as partial or complete depending on the severity of the damage to the tendon fibers.

Additionally, tendon tears are categorized as acute or chronic, terms that refer to the timing and mechanism of the injury—whether it has happened recently or developeds gradually over time.

Acute tears: Acute tears are caused by sudden trauma or intense activity, such as falls or twists, leading to immediate pain, swelling, and difficulty moving the ankle.

Chronic tears: Chronic tears develop gradually over time from overuse, repetitive motions, or untreated injuries, causing ongoing pain, weakness, and reduced ankle function.

Classifying Tendon Injuries In The Ankle By Severity

Ankle tendon tears can vary in severity and are classified into three grades based on the extent of the damage. This classification helps physicians determine the appropriate treatment plan and recovery timeline.

Grade 1 – mild: Minor fiber damage with mild pain, swelling, and discomfort. Tendon remains functional, with strength and stability intact. Often heals with rest and basic care.

Grade 2 – moderate: Larger fiber tears causing pain, swelling, weakness, and restricted movement. Ankle may feel unstable. Treatment includes immobilization, physical therapy, and supportive care.

Grade 3 – severe: Complete tendon rupture causing intense pain, swelling, and inability to bear weight. Surgery and rehabilitation are typically required to restore ankle function.

Recognizing The Signs And Symptoms

Ankle tendon injuries can present with symptoms that indicate damage to the tendons. Being aware of these signs is crucial for early diagnosis and proper treatment. The following are common symptoms associated with ankle tendon tears:

Swelling and bruising: Swelling from inflammation is a common sign of tendon injury, causing discomfort and difficulty moving. Bruising may occur from blood vessel damage.

Limited range of motion: Tendon tears reduce ankle movement, causing stiffness and pain that make walking, running, or standing difficult, potentially affecting daily activities if untreated.

Joint weakness or instability: Tendon tears weaken the ankle, causing instability and difficulty maintaining balance. This can result in the ankle “giving way,” increasing injury risk.

Why Ankle Tendon Injuries Occur

Ankle tendon tears can result from a variety of causes, each contributing to the weakening or damage of the tendons that support ankle movement and stability. Understanding the common causes can help in preventing these injuries and recognizing risk factors. The following are key causes of ankle tendon tears:

Traumatic injuries: Sudden impacts or twists from falls or sports can overstretch tendons, leading to tears from excessive force on the ankle.

Overuse or repetitive strain: Repeated movements like running cause minor tendon injuries that accumulate over time, leading to chronic tears without proper rest.

Degenerative changes: Age-related wear and tear weaken tendons, making them more prone to injury from everyday activities, especially in older adults.

Sudden movements: Quick, forceful actions like jumping or pivoting can overstretch tendons, increasing the risk of tears, particularly if unprepared.

Improper footwear: Shoes lacking proper support or cushioning can increase strain on the ankle tendons during physical activity, potentially contributing to overuse injuries or exacerbating existing damage.

Weak muscles: Insufficient muscle strength around the ankle forces tendons to overcompensate, increasing the likelihood of overuse and tearing.

Diagnosing Ankle Tendon Injuries

Early and accurate diagnosis is critical for successful treatment and recovery. Diagnosing ankle tendon injuries involves a combination of the following:

Physical examination: A physician will begin by assessing the ankle for signs of swelling, tenderness, and instability. They may ask about the patient’s symptoms, recent activities, and any history of injury. The physician may also test the ankle’s range of motion and strength to identify areas of pain or weakness.

Imaging:
- X-rays: Although X-rays do not show soft tissues like tendons, they can help rule out fractures or other bone-related issues that could be contributing to the injury.
- Ultrasound: This imaging test provides real-time images of the tendons, allowing physicians to detect tears, inflammation, or other abnormalities in the ankle tendons.
- Magnetic resonance imaging (MRI): An MRI is often used to get a detailed view of the tendons and surrounding soft tissues, helping to confirm the presence and extent of a tendon tear.
Patient history: Reviewing medical history, including past ankle injuries or chronic conditions, helps identify factors contributing to the tendon tear.

By combining these methods, physicians can determine the severity and nature of the tendon injury, allowing for the development of an appropriate treatment plan.

Conventional Treatment Options

Treatment for ankle tendon injuries varies based on the severity of the tear. From conservative approaches to surgical interventions, these methods aim to reduce pain and restore function.

Physical therapy: Strengthening exercises and stretching techniques help restore range of motion, improve stability, and support long-term recovery.
Bracing and orthotics: Ankle braces and custom orthotics support and reduce stress on the tendons and ligaments, helping prevent further injury.
Tendon repair surgery: In severe cases, surgery is required to repair torn tendons, allowing the tissue to heal properly and restore function.

Tendon transfer surgery: This surgical procedure replaces a severely damaged tendon with a healthy nearby tendon, aiming to restore ankle movement and strength when repair isn’t possible.

Can You Recover From A Torn Ankle Tendon Without Surgery?

Recovery from a torn ankle tendon is possible without surgery in many cases. One study suggests that ankle tendon surgery may be no more effective than immobilizing and bracing the ankle for a few weeks. Additionally, surgery carries inherent risks that must be considered.

The ankle contains multiple tendons, and the risks associated with surgery can vary depending on the specific tendon involved and the type of surgical repair required. Achilles tendon injuries are the most common and often result from acute trauma or overuse, such as athletic activities.

While surgery is frequently recommended for Achilles tendon tears, it carries significant risks, including a complication rate of 1 for every 10 individuals per year. Issues such as infections, nerve disturbances, scar-related problems, and post-operative pain are not uncommon, and recovery can be lengthy due to the invasive nature of the procedure.

The success of surgery also depends on the tendon affected. For instance, surgical repair of lateral ankle tendons, often performed for chronic ankle instability, has a reported failure rate of approximately 8.4% and a complication rate of 17.6%. These outcomes further underscore the potential risks and highlight the importance of evaluating all treatment options carefully.

How The Regenexx Approach Supports Ankle Recovery Without Surgery

The Regenexx approach offers innovative, non-surgical treatments for ankle tendon injuries, using the body’s natural healing agents. This less invasive method promotes recovery and improved function, reducing the need for surgery or prescription medications like opioids.

During this outpatient procedure, a physician in the licensed Regenexx network will use precise image guidance to inject custom concentrations of the body’s natural healing agents into damaged areas. This proprietary approach supports the body’s healing processes for Achilles tendon strains and tears.

Unlike surgery, which typically involves lengthy recovery and significant pain medication use, a procedure using Regenexx injectates offers a less invasive alternative with reduced downtime. Many patients return to daily activities sooner, often with minimal reliance on pain medications.

Consult a physician in the licensed Regenexx network to discuss if this customized, non-surgical option is right for your ankle tendon tear.