Have you been told you have an ankle tendon tear and need surgery? Do you really need this procedure or will less invasive injections do the trick? Let’s review ankle tendon surgery and who needs it and who doesn’t.
What Is an Ankle Tendon Tear?
The ankle has many tendons that come from leg muscles. They help stabilize the ankle and move the foot up, down, left, and right. The ankle tendons include:
FHL (Flexor Hallicus Longus)
FDL (Flexor Digitorum Longus)
Causes & Types of Tears in Ankle Tendons
These can be torn in trauma or due to wear and tear. The types of ankle tendon tears are (2):
Partial – only part of the tendon is damaged
Split – the tear is lengthwise through the tendon
Complete non-retracted – The tear is through and through the tendon, but enough fibers remain to hold the tendon together
Complete retracted – The tear is through and through, but there are no undamaged fibers and the tendon is snapped back like a rubber band.
Symptoms of Ankle Tendon Tears
If you have torn an ankle tendon, symptoms include:
A “popping” sound at the time of injury.
Immediate pain and swelling.
Ankle giving out
Indentation above the torn tendon.
Difficulty walking or moving around
Do X-rays Show Tendon Damage? Can an Ultrasound Show Tendon Damage?
No, x-rays can’t show tendon damage as they only show bones well. An ultrasound can show the tendon in high detail as can an MRI (3). Between the two technologies, for ankle tendon tears, ultrasound imaging is higher resolution. However, while many physicians have added ultrasound to their practice, most orthopedic surgeons and podiatrists have yet to learn how to effectively use the technology for diagnosis.
Do Tendon Tears Heal on Their Own?
Many smaller tears will heal on their own on the fly. However, larger tears may need rest or a boot to allow the tendon to heal (4). This can take 4-6 weeks. If that fails, then options include injections or surgery.
How Do You Treat a Torn Tendon in the Ankle?
If rest fails, then the two major options are:
Interventional Orthopedic injections
Interventional Orthopedic injections include platelet-rich plasma or bone marrow concentrate containing stem cells. For example, research has shown that PRP injections can heal tendon tears based on pre and post-biopsy samples taken of the tendon (5). These procedures are performed using ultrasound guidance and are called Percutaneous Orthobiologic Tenotomy (Perc-OT).
The Perc-OT procedure starts with the doctor mapping out the location of the tendon tear with ultrasound imaging. A needle is then guided using ultrasound to the exact site of the tear where platelet-rich plasma (or bone marrow concentrate) is injected. These healing cells then enhance the body’s natural repair mechanisms.
As far as surgery is concerned, ankle tendon reconstruction uses either suturing or tendon grafts (6). Both of these techniques are associated with extensive downtime. Let’s review the recovery process below.
Ankle Tendon Repair or Reconstruction Recovery
You will be immobilized in a boot for 6-12 weeks (7). Range of motion exercises (gentle movement) will begin around 4 weeks. Also, expect to be off your foot for about a month. Putting partial weight on that foot can begin at about 4-8 weeks after surgery. Strengthening exercises can start with a physical therapist at around 6 weeks and running isn’t recommended until 3-6 months after surgery. Return to full sports won’t be until well after 6 months.
Perc-OT Candidacy and Recovery
First, only patients with partial, split, or complete non-retracted tears are candidates for the Perc-OT procedure. That’s about 7-8 in 10 patients who have an ankle tendon tear on MRI and have been told they need surgery. Hence, there’s a good chance you’re a candidate.
Second, recovery times can be everything from minimal for partial tears to about half or less of that for surgery. For example, if you have a partial ankle tendon tear, then you’ll likely be in pain and limping from post-injection soreness for the first 3-7 days. After that, expect to slowly return to normal activities over several weeks, but you are encouraged to walk and be as active as you feel able during this time.
For larger tendon tears, most patients aren’t immobilized, but a few with the largest tears may need to be. In the worst-case scenario, recovery would be about twice to three times as fast as what’s listed for surgery. Why? Less tissue damage from the procedure means a quicker recovery.
The upshot? Most ankle tendon tear patients don’t need surgery. If you do, this is a good guide for recovery and what to expect.
Our Doctors Who Treat Ankle Tendon Tear
Christopher J. Centeno, MD
Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…
My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.
Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.
Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.
Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…
Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…
It happened several weeks ago as you stepped off the curb. Your doctor told you that you sprained your ankle. What is an ankle sprain? What are the different types of ankle sprains? How can I tell if I have an ankle sprain? How long does a sprained ankle stay swollen? Let’s dig in. What … Continued
Is your ankle sore after walking? Is it inflamed or painful? Dr. Centeno talks about what could be causing the issue. Transcript Ankle Sore after Walking? What’s Wrong Hi, this is Dr. Centeno. There are many people who, after they go for a walk, have ankle soreness, or, after they go for a run. So, … Continued
Dr. John Pitts talks about a common ankle ligament tear, what treatment options are available, and what to do if you would like to seek help for you ankle pain Transcript Hi, everybody. This is Dr. John Pitts from Centeno-Schultz Clinic. Today, I like to talk about a torn ankle ligament. So what is a … Continued
Dr. Schultz gives a tutorial on the ligaments of the ankle – what they are, what they support, and why you should care. Transcript Hi everybody, this Dr. Schultz, thanks for checking in. Today, we’re going to be reviewing the ligaments of the ankle. This is really important, and I just want to take a … Continued
Ligaments are the thick connective bands of connective tissue that connect one bone to bone. There are three important ankle ligaments on the outside of the ankle that provide stabilize the joint. Brostrom ankle surgery is a reconstruction of one or more lateral ankle ligaments. Dr. Schultz discusses the risks and rehabilitation of Brostrom ankle surgery and a new treatment that is an effective alternative to lateral ankle sugery.
Ankle ligaments are thick bands of connective tissue that provide support to the ankle joint and are susceptible to injury. Dr. Schultz discusses the different types of ankle ligament injuries, ankle ligament surgery, and nonsurgical alternative to treat ankle ligament injuries.
(1) Golanó P, Vega J, de Leeuw PA, et al. Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc. 2010;18(5):557–569. doi: 10.1007/s00167-010-1100-x
(2) Davda K, Malhotra K, O’Donnell P, Singh D, Cullen N. Peroneal tendon disorders. EFORT Open Rev. 2017;2(6):281–292. Published 2017 Jun 22. doi:10.1302/2058-5241.2.160047
(3) Park JW, Lee SJ, Choo HJ, Kim SK, Gwak HC, Lee SM. Ultrasonography of the ankle joint. Ultrasonography. 2017;36(4):321–335. doi:10.14366/usg.17008
(4) Ochen Y, Beks RB, van Heijl M, et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019;364:k5120. Published 2019 Jan 7. doi: 10.1136/bmj.k5120
(5) Alsousou J, Thompson M, Harrison P, Willett K, Franklin S. Effect of platelet-rich plasma on healing tissues in acute ruptured Achilles tendon: a human immunohistochemistry study. Lancet. 2015 Feb 26;385 Suppl 1:S19. doi: 10.1016/S0140-6736(15)60334-8.
(6) Dombek, Michael F et al. Peroneal tendon tears: a retrospective review. The Journal of Foot and Ankle Surgery, Volume 42, Issue 5, 250 – 258
(7) van Dijk PA, Lubberts B, Verheul C, DiGiovanni CW, Kerkhoffs GM. Rehabilitation after surgical treatment of peroneal tendon tears and ruptures. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1165–1174. doi: 10.1007/s00167-015-3944-6