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The Achilles Tendon

Coming from an athletic background, and still loving to watch and participate in sports, I commonly find myself contemplating different foot and ankle injuries that could happen while I am playing. While shooting around last weekend, I found myself thinking about Achilles tendon ruptures. They happen very commonly while playing basketball from either jumping or “pushing off” with the leg strait, or from a hard landing where the foot is violently dorsiflexed. Achilles tendon ruptures are most common in men in the age group of 30-50, and in the “weekend warrior” population. A “weekend warrior” is someone who is busy during the week and may not have time to work out, but come the weekend they go nuts. With many people having busy life and work schedules, this is becoming more and more common. In fact it is hard for me to believe that I now fit both the age and “weekend warrior” category for this injury.

In 2013, during the end of the regular season, Kobe Bryant suffered an Achilles tendon rupture. He felt a pop and thought that somebody had kicked him (which is a common complaint of patients undergoing this injury). He had his tendon surgically repaired and it took him nearly 8 months to fully rehab and get back on the court for a regular season game.

In the recent past, Achilles tendon rupture surgery required large incisions and a long functional recovery. Most surgeons still perform this large incision surgery. Recently, a new technique has come out which allows for a very minimal incision, with equal repair strength. In my experience, it also allows for a quicker return to activity. During my residency training I was lucky enough to perform quite a few of these operations with outstanding results. One of my patients was a college soccer player who was able to return to jogging with no pain at 3 months. He even ran a marathon at 8 months. Achilles tendon ruptures are a tough injury nonetheless, but with these recent advances, I am less worried about sustaining this injury while participating in sports.

FAQ

1. Does someone that has an Achilles tendon rupture always need surgery?

Achilles tendon ruptures can be treated non-surgically by casting or bracing. This actually has good results but when compared to surgically treated patients, conservatively treated patients have a higher risk of re-rupture and slower return to normal activities. Some studies also show a decreased amount of strength in conservatively treated patients. Personally, I feel more comfortable starting physical therapy earlier in surgically repaired patients, which is an important aspect in the healing process. If I myself had an Achilles Tendon Rupture, I would elect to have surgery.

2. What does the typical recovery after Achilles tendon rupture surgery consist of?

Previously Achilles tendon rupture surgery had a very long recovery with many physicians keeping their patients non-weight bearing for long periods of time. In the past decade, a push has been made toward a quicker, more functional rehabilitation protocol. My usual post-op protocol is two weeks non-weight bearing in a splint to control swelling. After two weeks the patient is allowed to weight bear in a removable cast (CAM walker), with removable heel lifts being removed each week. Formal physical therapy is started at 2-3 weeks. Usually at the 6 week mark, patients are able to come out of the CAM walker and return to tennis shoes with a brace.

3. Why is Achilles tendon rupture common in “weekend warriors” above age 30?

Achilles tendon rupture is common in “weekend warriors” above age 30, because after age 30, our blood supply to the tendon starts to slowly decrease. This tendon in general does not have the best blood supply partially due to the nature of the way the tendon twists as it inserts onto the heel bone. As we are inactive during the week, the tendon tends to tighten up and when we are extremely active on the weekend this puts a lot of tension and strain on the tendon that it is not used to incurring. This is one of the most powerful tendons in the body and we are asking it to do a lot when participating in sports, even more so if it has been inactive most of the time.

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