Achilles Tendon Injury and Rupture Treatment in Singapore: A Comprehensive Clinical Guide

Tendinitis involves inflammation of the tendon sheath or the tendon itself. It is usually an overuse injury seen in individuals who have recently increased their training intensity. It is characterised by pain and swelling that often improve with rest but recur with activity.

Unlike tendinitis, tendinosis is a chronic condition where the tendon’s collagen begins to break down at a microscopic level. The tendon may become thickened and develop small nodules. This condition is often painless in its early stages but can weaken the tendon over time, increasing the risk of a rupture.

A partial rupture occurs when some of the tendon fibres are torn, but the overall continuity of the tendon remains intact. These can be particularly deceptive because the patient can often still walk, leading to a delay in seeking medical attention. If ignored, a partial tear can easily progress to a complete rupture.

This is a total separation of the tendon. It most frequently occurs during “stop-and-start” sports. When a rupture occurs, the mechanical link between the calf and the foot is severed, making it impossible to perform movements such as standing on tiptoe or pushing off for a stride.

An acute rupture is identified shortly after the injury occurs. A chronic rupture is one that has gone undiagnosed for several weeks. In chronic cases, the torn ends of the tendon may have retracted (pulled apart), and scar tissue may have filled the gap, often requiring more complex surgical reconstruction.

• Stiffness in the morning that gradually loosens with movement.
• Pain along the back of the leg or heel that worsens after exercise.
• A visible “bump” or thickening on the tendon.

• The “Pop”: Many patients report hearing a loud snap or pop at the moment of injury.
• The “Kick” Sensation: A common description is feeling as though someone has kicked them in the back of the leg, even when no one is there.
• Gap in the Tendon: A palpable indentation or “soft spot” may be felt a few centimetres above the heel bone.
• Functional Loss: An immediate inability to push off the foot or stand on the toes of the affected leg.
• Swelling and Bruising: Rapid onset of swelling around the ankle, followed by bruising that may travel down toward the toes.

This approach focuses on allowing the tendon to heal naturally.

• Immobilisation: The foot is placed in a cast or a specialised walking boot, usually with the toes pointed downward (plantar flexion) to bring the torn ends together.
• Functional Rehabilitation: Modern protocols involve early, protected weight-bearing to encourage the tendon fibres to align correctly as they heal.
• Suitability: This may be considered for patients who are less active or those with medical conditions that make surgery higher risk.

Surgery is often recommended for active individuals and athletes to restore the tendon’s length and tension.

• Open Repair: A traditional incision is made to allow the surgeon to directly suture the torn ends of the tendon together.
• Minimally Invasive Repair: Using smaller incisions and specialised instruments, the surgeon can repair the tendon with less disruption to the overlying skin. This may help reduce the risk of wound complications.
• Tendon Transfers: In chronic or severe cases, the surgeon may move a nearby tendon (such as the tendon that moves the big toe) to reinforce the repaired Achilles.

• Platelet-Rich Plasma (PRP): This involves injecting concentrated platelets from the patient’s own blood into the injury site. The growth factors in the platelets may support the healing of the tendon tissue.
• Shockwave Therapy (ESWT): For chronic tendinosis, shockwave therapy can be used to stimulate blood flow and trigger a healing response in the degenerated tissue.

The primary goal is to protect the repair (whether surgical or natural). Patients are typically in a boot with “wedges” that keep the heel elevated. Weight-bearing is gradually introduced according to the surgeon’s instructions.

The heel wedges are removed one by one, bringing the foot back to a neutral position. Physiotherapy focuses on restoring the range of motion of the ankle and beginning very light strengthening exercises.

Once the tendon has healed sufficiently, the focus shifts to building calf strength. This often involves “eccentric” exercises, where the muscle is strengthened as it lengthens.

Patients begin straight-line jogging before progressing to agility drills, jumping, and eventually full sports participation. Final clearance for contact sports usually requires the patient to demonstrate near-equal strength between the injured and healthy leg.