partial tear- achilles

Hi, on the 6th Oct i was playing netball, and as i was running back i heard a pop and then i went down, i could no longer put pressure on my foot and had to get a lift home. The next day i went to the Drs who put me on ati inflammatories and he could feel that my tendon was still all together - not a complete rupture.. Was sent of for an u/s immed just to confirm which showed up a partial tear on my tendon, appr 15cm from my heel. I had physio immed. When the physio did the Thompson test she was concerned as my foot did not flex, but she could also feel that all my tendon was in place and i could point my toes .. I was put in a cam boot with a crutch. Last week i went back to the physio and as i again faile the Thompson test she sent me back to another u/s just in case it was a full tupture. So off again i went and it showed exactly the same as the first u/s, just a partial tear, the size of the tear was different , but she said it could depend on the angle of the u/s machine.. Physio just wanted to be sure, she could feel my tendon, there was no gap etc, and i could move my foot certain ways ,a nd claims if it was a full rupture i couldnt do it.. The physio thinks that i may have done my calf as well and this could be the popping i heard.. So i am in a boot with the crutch and physio is thinking at the end of the week, i can take the boot off and see how i go.. i am so nervous. i can walk on it but only very flat footed.. i am scared of a fully ruptire, but physio assures me the chance of this happening is slim.. So if anyone out there has had a partial tear what was your recovery like, when could you walk normal? it is 2weeks tomorrow, my calf is also feeling quite tight.. physio has advised i dont need surgery as well as the sonographer.
Also the tear is 15cm from the calcaneum..

You should not fail a test of the achilles if your tendon is not ruptured. Get them to test and compare to the other leg to see if it is normal laxity for you. If the results do suggest that the injured leg is ruptured then get to a sports Dr. for an MRI. I would treat a partial tear with almost as much care as a conservative rupture. i.e. 6 weeks in the boot before retesting. Let us know how you get on. If it's a partial tear and you begin to work it to early it may go on to a full thickness tear. So be careful at this time.

hi, if you have a partial tear and also did your calf , can you fail the thompson test reflex. does an MRI show up differently then an Ulstrasound. also my tendon is still there and no gap in it. i am doing excercises , and it seems to be improving. but physio still twice a week

Dear Marylou

I empathize with your situation, tendon tears like that can be painful and you seem quite worried. It sounds like you are under good care especially from a physio who would request for another US since you failed the Thompson's test twice. Kudos to her for being thorough.

Before I give any advice, I would try to explain possibly why you may have failed a thompson test inspite of further investigations suggesting only a partial tear.
The anatomy of the calf muscles include two (or three) major muscles, the lateral and medial heads of the gastroc and the soleus. You mentioned that on re-examination, the size of the tear had changed (you didnt mention whether it was larger or smaller). Perhaps the images were not clear at the time of investigating because of swelling?

One possibility is the technique of the THompson test carried out.

This test is often done by squeezing the muscle belly of the calf to elicit passive plantarflexion. It is possible that your TA tear could have involved one of these muscles and not the other, therefore testing with these test high up or too superficially in the muscle bulk alone may falsify results giving false negative. You mentioned that your tear is 15 cm above the calcaneal bone that indicates largely within the gastroc tendon (if my mental picture of measurements is right, i have never been good in maths...infact i flunked it many times...to make matters worse my parents suggested i went for "further" maths classes..go figure). It sounds to me that the major tear is within the gastroc tendon not the soleus. Maybe your therapist needs to explore the entire bulk of the calf area to see if passive plantarflexion can be elicited?
Having no gap between the tendons is not always a reliable method...because this can be filled with fluid giving the impression of an intact tendon

the other possibility could be with the imaging used...some studies have shown that Ultrasound though it is highly accurate can give false positive results in a very very very few cases often for the worse i.e suggesting a full tear when things are infact partial tears...this is not the case with you...

Studies have shown the thompson test to be quite sensitive and specific in clinically evaluating traumatic TA injuries ....

Both aspects seem contradictory...I know...so we will use some clinical reasoning

One basic question, are you in pain? were you in pain after the injury? if after the injury all you felt was pain then and not after...then it could be a rupture...
Being able to move you ankle by pointing your toes does not tell you anything to be honest simply because you have other muscles that help with this action...

As physiobob has suggested trying another imaging technique such as an MRI may clarify things...

If it is a partial tear, I would advise you to be very patient because poor rehab can mean a full rupture in the future especially if you go back into sports early... (your rehab sometimes can run into months for a sporting candidate)...only because the tendon needs to strong and flexible again to be able to withstand the rigors of sports...remember that tendons generally have a low blood supply so they heal rather slowly.

I would worry that being a partial tear much of the reliability of that tendon is already in question, because scar tissue forms generally reducing the strength of the tendon, this scar tissue will in time resemble the structure of the tendon but may not enquire all its properties. Secondly with a partial tear, you already have a gap in the overall tendon structure causing some abnormal lengthening and weakness. In my mind a full rupture is more likely to have a better outcome because with surgery you knit the ends of the tendon together enhancing the tensile strength. So rather than worry about a full rupture, I think there is more to worry with a partial rupture really.

be patient and work with your physio to get very good outcomes

Good luck with your rehabilitation

Wow, thanks so so much for your very detailed response. my physio is confident that the calf has also been damaged and claims that is why the Thompson test failed,she did do my other leg and that did flex immed how it shoud.. The night when i did the injury my husband and i could feel the tendon immed, there seemed to be no sponginess (hmm if that is in fact a word) and it seemed to be together. The sonographer, radiographer have both looked at the 2 u./s and got the same results.. my physio was confident it was only the partial test, but she couldnt understand why the failed thompson test.

When i actually did it, i didnt have to much pain for the first few minutes, but wow i had a lot of pain that night, terrible, it was relieved with pain medication. i am no longer in pain

I am walking very slowly and cant lift the heel, my physio advises it could be 4weeks away. whilst i am at work 2days a week, i have kept the boot on, mainly just for protection. the swelling is almost down now - the injury is 3weeks on wed.. i am doing the excercises what the physio has given me, and will be seeing her again tonight. I will mention to her about getting an MRI done.. do you think with partial tears it is possible after 2 half weeks that you would still be walking flat footed, not able to lift heel to much, i am nervous to even try to walk to much. Going back to sport to early at this stage for me is a definite no no, i am to scared to even think of it. Will stick to walking for a while i think.

My physio advises that swimming will be good, i was also maybe thinking down the tracka bit of accupuncture to get the blood flowing

It sounds like your physio is doing everything right and that you should trust her.
You can have a MRI - but it'll really be for your piece of mind. I don't truely believe you need it... MRI's are most commonly used by surgeons to assess whether surgery is required. In your case you appear to have enough evidence to be confident with continuing down a conservative treatment pathway for now with a good physio guiding you (which I believe you have).
Good luck

Thanks for that, I actually had the Thompson test done on me last night and my foot flexed this time . Took 3weeks for this to happen!!!! Better late then never hey !!!! .. My physio seems to think that as my ankle and calf muscle were so swelled (and still are. WOW they are huge, very unattractive ) that is why I kept failing the calf squeeze..

hey marylou

Congatulations!!!(i dont know if that is the right thing to say at this point) but can you let us know what was different about how this was done this time? has ur swelling gone down significantly?

Hi, yes the swelling has gone down, not completely but a fair bit, the test was done on the same spot etc but physio seems to think that it wasnt flexing due to the calf injury as well, maybe she couldnt get into the muscle correctly.. i am not sure if you do your calf muscle if it actually means the test will fail as well ?? out of the boot today at work, mainly sitting at my desk moving my foot around to help with the swelling. still walking flat footed, no pain, but seems to be getting better daily.. i dont think will be going back to sport-netball anytime soon, too scared it may fully rupture next time !! may stick to walking, and gym