The recent Achilles tendon injury of Richard Sherman, a Seattle Seahawks Pro Bowl cornerback, highlights a relatively common injury seen in professional and recreational athletes alike. Unfortunately, Achilles tendon ruptures are significant injuries that disconnect the powerful calf muscles from the heel bone in the foot. Achilles ruptures require timely diagnosis and appropriate treatment by a foot and ankle orthopedic surgeon to provide the best chance for return to normal functional and recreational activities.
Achilles tendon ruptures are most commonly seen in recreational athletes in their thirties and forties, although can occur at any age. They tend to be more common in men than women, generally occur during sporting activities, particularly ball and racquet sports. The classic presentation involves the feeling of a sudden snap or pop in the lower calf associated with severe pain and inability to walk normally. Often patients report feeling like they were kicked, shot or cut in the back of the leg although there generally is no direct contact. There generally is swelling and tenderness over the Achilles region. Patients often are still able to move the foot up and down using accessory muscles. However, with an Achilles rupture there is a notable inability to push off the ball of the foot when walking. Any of these signs or symptoms requires prompt evaluation to ensure that the appropriate diagnosis is made and a potentially serious Achilles injury is not missed.
Achilles tendon ruptures can be treated both with surgical repair and non-surgical casting and bracing. Those best suited for surgical repair include healthy, active individuals who want to return to activities such as hiking, jogging, biking and other sports. Surgical repair generally results in a lower rate of re-rupture and improved calf muscle strength by better restoring the Achilles tendon length. Non-surgical treatment is often for more sedentary individuals or for individuals not healthy enough to undergo surgery. The decision for surgery should be discussed with your foot and ankle orthopedic surgeon.
Surgical repair of the Achilles tendon typically occurs in an outpatient setting, meaning the patient has surgery and goes home the same day. The goal of surgery is to repair the two separated ends of the Achilles back together in the appropriate tension with strong suture. This is done through an incision over the Achilles on the lower part of the leg. This suture repair keeps the tendon ends from separating as the patient begins to rehabilitate from their injury.
Rehabilitation from an Achilles tendon rupture is a long process. Generally patients are not allowed to put weight on the leg anywhere from 4-6 weeks depending on the injury. This is followed by a gradual progression of motion, strengthening and weight bearing activities often under the guidance of a physical therapist. Ultimate return to maximum strength and function takes a long time with most studies showing improvements continuing well past a year after the injury. Unfortunately, Achilles tendon ruptures are season-ending injuries; however, prompt diagnosis and treatment by an orthopedic surgeon can allow a full return to recreational and sports activities.
The world-class orthopedic doctors on our foot and ankle team specialize in the prompt diagnosis and treatment of sports injuries of the lower leg, ankle and foot including ankle sprains and fractures, Achilles strains and ruptures, stress fractures and midfoot/forefoot injuries. If you have suffered a sports injury, contact us to get back to your active lifestyle as soon as possible!
Blog written by Erik J. Novak, M.D., Ph.D.