A total tear in the Achilles tendon can happen in any part of its length. It is a sudden, traumatic injury. When the tendon snaps, it leaves two broken ends which may stay close together or spring apart, leaving a visible dent. There may also be bruising.

Achilles Tendon Rupture

Rupture is very rare in children, uncommon in teenagers, and happens most often to people in early and later middle age.

What you Feel When you Have Achilles Tendon Rupture

You feel as if something has hit you hard in the back of the leg. If you try to walk, you stumble or fall over. Your foot feel floppy: you can draw the foot upwards into dorsiflexion, but while toes can still move downwards into flexion, you cannot point the foot down at the ankle. If you lie on your stomach, the foot falls to a right angle. If the gastrocnemius muscle is squeezed, the foot does not move as it normally would: this is a standard test for Achilles tendon rupture, and does not cause pain.

Causes for Achilles Tendon Rupture

Although the rupture can be caused by a direct blow to the back of the leg when the calf is under tension, more often it is intrinsic, with no obvious cause. It usually happens late in an exercise session or competition, and is associated with fatigue and circulatory problems rather than being cold or not warmed up properly. You may have had previous warning signs, such as tightness, cramping or involuntary twitching in the calf. You may have been stressed, overtired or suffering from an infection. The tendon may have been weakened by previous injury or injection, or overworked by compensating for a previous thigh or foot injury.

Treatment for Achilles Tendon Rupture

The foot must be supported immediately with bandaging or taping in the plantarflexed position, pointing down from the ankle. Avoid putting weight through it: hop using crutches. If you have to put the foot down, keep the leg away from your body turned out sideways, and try to keep your weight on the heel.

Seek specialist advice as quickly as possible. You have the choice of an operation or non-intervention. Surgery can be done through a scar as open surgery.

Non-intervention is a choice between either immobilisation in a plaster cast for several weeks, or support in a removable walking boot which allows weight-bearing, remedial therapies, exercises and alternative training to commence immediately. You should decide with your doctor which approach you want to use, and then follow all instructions to the letter.

Read more about Achilles Tendon Injury: Should I go for Surgery?.

Rehabilitation Phases

In all cases the foot is held pointing downwards in plantarflexion for the first phase, as the tendon has to be prevented from lengthening as it heals. If it is not in plaster, the leg can be taped to hold the position. Crutches are used as directed by the specialist. In the case of the walking boot they may not be needed for long, but should be used when exercises are done without boot on.

Rehabilitation starts with calf strengthening holding the Achilles tendon in a shortened position. Progression through the rehabilitation phases should generally be pain-free. However, sometimes following open surgery there is a moment when some movement causes a tearing sensation around the scar, almost as if the injury has happened again. This is usually due to adhesions round the scar breaking, and does not interfere with your progress to fitness. If in doubt, refer back to your doctor.

Achilles Tendon Specialist

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore


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Sudden spasm in the calf muscles is a common problem in sporting and non-sporting people alike, at any age. It can happen during activity, rest or sleep. Severe leg cramp after sports sometimes called a ‘charley horse’.

Calf Cramps

What You Feel During Calf Cramp

The effects of calf cramp range from a mild tension in the muscles to severe tightness and agonising pain.

Causes of Calf Cramp

Because of their close association with the circulatory system, the lower leg muscles reflect any adverse changes in the blood flow. Calf cramps, especially at night, happen most often because of dehydration, sometimes combined with overexercising. In very hot humid climates, loss of minerals can be a factor. Females can become prone to calf cramps related to the menstrual cycle or pregnancy, and are more vulnerable if they are dehydrated or mineral-deficient. Other contributory factors include stress, raised cholestrol, varicose veins and certain medicines. Soleus muscle strain can cause cramping in the calf, especially when you walk to try to run.

Treatment for Calf Cramp

Calf cramps are usually treated with physiotherapy and oral medicines. No surgery is necessary. If you suffer cramps often, and not sure why, you should consult a doctor.

Calf Cramp Specialist

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore


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The gluteus medius is one of the main buttock muscles that are responsible for holding the pelvis stable and supporting your body on your legs when standing, walking, or running. It also helps control the sideways movement of your legs. If the gluteus medius is strained in some way, it can become tender and tight and less able to function normally.

Gluteal Muscles

Causes for Gluteus Medius Dysfunction

Stress or tension alone, if it continues with some intensity over a long period of time, can make your gluteus medius tighten up. Apart from the pain this causes, the muscles may become shortened and less flexible. In addition, referred pain from the spine or hip can cause dysfunction in the muscle. However, the most common cause of  injury to the gluteus medius is overworking or stretching them beyond their normal range. Athletes, particularly runners, hurdlers, and long jumpers, frequently overuse their gluteus medius and soometimes cause them to tear from failing to adequately stretch or warm up before any activity, particularly in cold weather. A less common cause of gluteus medius trauma is a direct impact, such as a heavy fall onto the buttocks, which usually leads to bruising and irritation of the underlying bursa (a protective fluid-filled sac).

Symptoms and Diagnosis for Gluteus Medius Dysfunction

Apart from buttock and hip pain on one or both sides of your body, and possibly leg pain, you may feel stiff, be slightly unstable when standing, and find moving your hip awkward. Your doctor will carry out a physical examination to establish the cause of your problems.

Risks and Recovery for Gluteus Medius Dysfunction

Minor strains and bruises will usually heal on their own within a few weeks, but if action is not taken fairly promptly to rehabilitate overtight or stretched muscles, recovery may be slower. Muscles held in a state of tension for too long will fail to regain their former range of movement and response.

Gluteus Medius Specialist

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore


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A variety of conditions can cause pressure on one or more nerves as they leave your vertebral column in the middle and lower back. And, depending on the cause, the severity of symptoms, also known as “radiculopathies,” can vary.

Symptoms for Nerve Root Impingement

Pressure on the nerve roots often causes what is known as “radicular pain” – that is, pain that seems to come from some distance away from the site of the original problem. This is because the nerves that emerge from your spine form the link between your brain and you outlying tissues: if they are pinched or damaged, you’ll feel pain in the areas that they supply.

The symptoms of nerve root trouble in the middle and lower back can vary from back pain and numbness to nerve pain. Bending forward or sitting tends to relieve the pain of spinal stenosis because this flexed position enlarges the space available for the spinal cord or cauda equina, a bundle of nerves at the end of the cord. There may no symptoms until the condition has been present for some time. In other cases, there’s an immediate onset of pain.

What Causes Impingement on the Nerve Roots?

There are a number of ways a nerve root can become compressed in this area:

Spinal Stenosis

Spine Anatomy
Spine Anatomy

A narrowing of the canal and bony openings (foramina) through which the spinal cord travels and the nerve roots emerge, spinal stenosis can cause a number of nerve root problems in the lumbar spine. The lower part of the lumbar region is more often affected than the upper part.

Spinal stenosis is usually the result of the aging process, when osteoarthritis sets in and your discs become drier and shrink. The growth of bony projections – spurs, called osteophytes, that protrude into the canal and foramina can also contribute to nerve root problems.

Other causes of the spinal stenosis are a herniated or bulging disc, inflamed facet joints, a vertebra that has slipped forward (spondylolisthesis), trauma (such as road accident or fall from a ladder), scoliosis, bone disease, a tumour of the spine, or a congenital defect of the spine, such as a narrower that usual spinal column that has been present from birth.

Slipped Disc and Disc Bulges

Herniated Disc

Unfortunately poor movement patterns, such as bending with your back rather than your legs o pick up things, can damage the innermost rings of your vertebral discs. The damage gradually spreads to the outer rings, allowing the gel-like fluid in the center to leak out. If the outermost rings are still mainly intact, the fluid causes a bulge, which can press into the central spinal canal or into the space where the nerves leave your spine, and pinch them – causing, for example, problems such as sciatica. If all the rings are damaged, and the fluid seeps out of it, the disc ruptures and “slips” – what doctors call a “prolapse” or “herniation.”

Facet Joint Problems

These tiny joints are located at the back of the vertebrae. They are the joints at which the upper part of each vertebra joins the lower part of one above it, and the lower part joins the upper part of the one below. But if, for example, the lumbar spine loses stability, as a result, say, of poor lifting technique, the fibrous tissue surrounding the facet joints can thicken in an effort to regain stability and protect the area. This can not only pinch nerves as they leave the vertebral column, it can encourage the growth of bony spurs called osteophytes that will also pinch the nerves.

Proper Posture in Lifting Heavy Load

Figuring Out Nerve Root Impingement

Back pain should always be investigated by your doctor. In particular, if you experience bowel and bladder incontinence, severe numbness down the legs, muscle weakness, poor balance, or paralysis, seek immediate medical attention. Following a physical examination, and listening to an account of your symptoms, your doctor will probably be able to make a preliminary diagnosis. An X-ray, CT scan, or MRI of the spine may confirm the precise cause.

Fixing Nerve Root Impingement

Many cases of nerve root inflammation get better without treatment. If this doesn’t happen, the treatment options your doctor may consider include:

  • Physiotherapy
    This usually involves stretching and strengthening exercises. Posture and movement training are also likely to be included.
  • Medication
    NSAIDs, and injections may be helpful.
  • Surgery
    May be an option to relieve pressure on your spinal cord and/or nerve roots.

Nerve Root Impingement Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

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A harmless but painful bony enlargement on the outer posterior heel is called a Haglund’s deformity, named for the doctor who first described it. This condition is commonly referred to as a “pump bump”, because women’s pump-style shoes, with rigid heel counters, contribute to its symptoms. Given this common name, it isn’t surprising that Haglund’s deformity occurs most frequently in women who spend a lot of time wearing dressing shoes

Haglund's Deformity

What Causes Haglund’s Deformity?

Most people with Haglund’s deformity have inherited a foot structure with this bony enlargement present at birth. With pressure and rubbing on the heel over time, a bursa forms and becomes inflamed and painful (bursitis). High-arched feet, in particular, tend to supinate when walking (inward movement of the heel causing a person to walk on the outside of the heel), causing the back of the heel to rub repetitively against the shoe’s heel counter. A tight or shortened Achilles tendon also contributes to the condition by compressing another bursa (the retrocalcaneal bursa, which everybody has) against the heel bone.

Symptoms of Haglund’s Deformity

Symptoms of Haglund’s deformity include pain, redness, and swelling at the back of the heel. Often, a callus also develops over the affected area.

Treatment of Haglund’s Deformity

Treatment of Haglund’s deformity begins with

If the above conservative treatments are not helpful, you may want to consider surgery. The procedure usually involves removing both the prominent bony enlargement on the back of the heel bone and the inflamed bursa.

Haglund’s Deformity Foot Specialist

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore


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