Long-Term Tendon Rupture: Treatment Options and Care for Ankle Pain

Chronic tendon rupture?

Dear Vice Dean Li,
Hello.
My father, who is 71 years old, has recently been experiencing discomfort in his right ankle.
Externally, there appears to be swelling on the right side, and there is tenderness upon pressure.
He experiences soreness while walking.
He visited the rehabilitation department, and an ultrasound revealed a long-standing rupture on the right side of the ankle, which has likely been present for about thirty years.
This injury was probably caused by a soccer-related incident in his youth when he kicked and missed the ball.
At that time, he was young and strong, so he only experienced pain and did not seek treatment.
Now, there are signs of deformity in his right ankle, which is gradually tilting outward.
My questions are: Is it possible to reattach the ruptured tendon? If reattachment is successful, will it improve the swelling and pain in the joint? If reattachment is not feasible, what daily care should he undertake? Thank you for taking the time to respond.

Lin Xiansheng, 40~49 year old female. Ask Date: 2018/10/04

Dr. Li Yongheng reply Orthopedics

Hello, your father's right ankle tendon has been ruptured for a long time, and it is unlikely that it can be reattached.
Daily care should involve avoiding prolonged standing and weight-bearing activities.
It is advisable to purchase some supportive braces to provide stability to the ankle.
I recommend accompanying your father to an orthopedic outpatient clinic for an examination to rule out other possibilities, such as degenerative arthritis, gout, or tendinitis.
Additionally, while ultrasound can be a helpful tool for diagnosing ankle tendon ruptures, the definitive diagnosis should be made using magnetic resonance imaging (MRI).
Wishing your father a speedy recovery.

Reply Date: 2018/10/04

More Info

Long-term tendon rupture, particularly in the ankle, can pose significant challenges, especially for older adults. Given your father's situation, it is essential to understand the implications of a long-standing tendon rupture and the available treatment options.

Firstly, it is crucial to identify which tendon is ruptured. Commonly, the Achilles tendon is involved in ankle injuries, but other tendons, such as the peroneal or tibialis tendons, can also be affected. The fact that your father has had this injury for approximately thirty years suggests that it may have become chronic, leading to potential complications such as tendon retraction, muscle atrophy, and joint deformity.

In terms of treatment options, if the tendon is still viable and there is a possibility of surgical intervention, a tendon repair or reconstruction might be considered. However, the success of such procedures diminishes with time, especially after three decades. Surgical repair aims to restore function and alleviate pain, but the outcome can vary significantly based on the extent of the injury, the age of the patient, and the overall health condition.

If surgical repair is not feasible or if the tendon has retracted too much, conservative management becomes the primary approach. This may include:
1. Physical Therapy: Engaging in a structured rehabilitation program can help strengthen the surrounding muscles, improve flexibility, and enhance overall function. A physical therapist can design a program tailored to your father's specific needs, focusing on exercises that promote stability and reduce pain.

2. Orthotic Devices: Custom orthotics or ankle braces can provide support and help realign the foot and ankle, reducing strain on the affected area. These devices can also help in managing pain during daily activities.

3. Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to alleviate pain and reduce inflammation. However, long-term use should be monitored due to potential side effects, especially in older adults.

4. Activity Modification: It may be necessary to adjust daily activities to avoid exacerbating the condition. Low-impact exercises, such as swimming or cycling, can be beneficial while minimizing stress on the ankle.

5. Regular Monitoring: Given the chronic nature of the injury, regular follow-ups with a healthcare provider are essential. This allows for ongoing assessment of the condition and adjustments to the treatment plan as needed.

Regarding the question of whether the ruptured tendon can be reattached and if this would improve joint swelling and pain, it largely depends on the specific circumstances. If the tendon is still in a condition that allows for repair, surgical intervention may lead to improved function and reduced pain. However, if the tendon has significantly degenerated or retracted, the benefits of surgery may be limited.

In summary, while there are treatment options available for managing long-term tendon ruptures, the success of these interventions can vary. It is essential to have a thorough evaluation by an orthopedic specialist who can provide personalized recommendations based on your father's specific condition. Engaging in a comprehensive rehabilitation program and considering supportive devices can significantly enhance quality of life and functional outcomes.

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