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What Causes Tendon Rupture After Loosening Cast?

Posted on Wed, 24 Jun 2015

Question: Hi have been in a cast now for 6 weeks to treat peroneal tendonitis. I have had several cast changes and found that when the cast was loose my tendon was still snapping inside the cast. The last cast I requested that it be applied more snug which did keep the tendon in place and I finally felt relief. My concern though is that now that the cast is loose again my tendon is snapping again. My MRI at the beginning of my treatment did not show any tears just tendonitis and my doc also said I am the 20% with the shallow groove. I don't recall my tendon snapping when I first started treatment. Is it possible that during treatment my retinaculum has torn causing my tendons to dislocate? Bottom line after 6 weeks and there is still snapping is there any hope my ankle will get better or should I consider surgery? My ortho has been very supportive with me extending the conservative treatment. We even have tried non weight bearing but I am terrible at being compliant which also makes it difficult for my ankle to heal. Any advise would be appreciated.

Thank you nicky

Answered by Dr. Dr. Naveen Kumar Sharma (8 minutes later)

Brief Answer:
Tendon snapping is not indication for surgery

Detailed Answer:
Hello,
I have studied your case and I can assure you that if there is only tendon snapping and you are not feeling any pain then it is not an indication of surgery. You should remove cast and start walking. If there is no pain then you can ignore sound.
If it is painful then following options are availble.
1.Hot water fomentation.
2.Shoe modification so that it does not rub on that side of ankle.
3.Steroid injection in tendon sheath take care of inflammation and it will improve your pain significantly.
4.Tablet Tendocare one daily for six months.
If all these measures are successful then you can avoid surgery. Other wise go ahead with surgery in which tendon sheath is excise and you will feel pain relief immediately. You need to wear special shoes even after that surgery.
thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Naveen Kumar Sharma (8 minutes later)

The snapping is extremely uncomfortable. I have really bad tendonitis pain even after this period of immobility on. The subluxation makes it very painful to walk even in the cast.

Answered by Dr. Dr. Naveen Kumar Sharma (8 hours later)

Brief Answer:
Then you should go ahead with surgery

Detailed Answer:
Hello,
If snapping is giving you problem then you need to get surgery done as soon as possible. No plaster cast or any other conservative treatment is going to be helpful for this.
As you know snapping occurs because either groove is shallow or tendon is lax.So during surgery tendon is anchored with underline structure. You wil be immediately relieved and relaxed.
I hope this answer will be useful for you. Let me know if there is any other followup questions.
thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Naveen Kumar Sharma (22 minutes later)

Thank you for your response. Your opinion seems to be inline with what my ortho doctors opinion. He said I can live with it or consider surgical options.

What are the odd that by not repairing it that the tendon will tear? That seems to be a concern.

Answered by Dr. Dr. Naveen Kumar Sharma (14 hours later)

Brief Answer:
Tendon can get torn

Detailed Answer:
Hello,
There is always a chance of torn tendon if it is not get fixed in the groove. So it is better to fix it. There is no point in delaying this surgery. You should get it done as soon as possible.
Thanks

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar