Many athletes know the feeling, the “snap” followed by pain in the back of your ankle…you have torn or ruptured your Achilles tendon. It happens under all sorts of circumstances…like when Kobe Bryant landed on a misplaced foot, Erik Karlsson came into contact with an errant skate blade or Ryan Howard sprinted to 1st base, it even happened to Brad Pitt while ironically enough playing the part of Achilles in the movie Troy. Regardless, the result is a long and difficult road to recovery.
The Achilles tendon connects to calf muscles (gastrocnemius, soleus, and plantaris) to the calcaneus or heel bone and is the longest tendon in the body. Its function is to initiate plantar flexion, which points the toes toward the ground. This is vital for walking, running and jumping.
Achilles injuries can be caused by a number of reasons, such as overuse, not properly stretching, over exertion or from long-standing foot structure conditions like flat feet. Injuries can also occur with a history of chronic Achilles tendonitis or recent steroid injections into or around the tendon which causes degeneration of the tendon. Medical conditions such as diabetes, gout and hyperparathyroidism can also lead to tendon weakening. The injury typically occurs while the knee is fully extended and the foot is dorsiflexed or pulled up. This position places the tendon at its maximum length where further stress can be too much to handle resulting in a tear or rupture.
When an injury occurs there is often the sensation of a “snap” or “pop” in the posterior ankle followed by intense pain and inability to plantar –flex the foot. Diagnosis can be made via clinical examination but some imaging is required to confirm the diagnosis. Xrays are of little use but are helpful in excluding bony injuries such as an avulsion fracture. Magnetic Resonance Imaging (MRI) and ultrasound (US) are best at both locating the tear or rupture and estimating its extent.
Treatment options are simple…operate or don’t operate. Non-operative treatment options included 6-8 weeks of immobilization with a rigid boot or cast with the foot in a plantar flexed (toes down) position. This places in the tendon in its least stressed position and allows the tendon ends (if ruptured) to be as close together as possible. This treatment option is not recommended for athletes or individuals who plan on returning to “at-risk” activities. Surgical repair allows for more predictable course of healing but most importantly provides a reduced risk of re-injury. Surgical correction can be performed via an open or percutaneous procedure by which the tendon is sutured back together. Various grafting techniques are also often used to enhance strength and decrease adhesions of the tendon.
Return to activities varies depending on the treatment. Non-surgical correction can take up to 1 year for return to full activities whereas return after surgical correction without complication can be 6 to 9 months. Prompt recognition of injury along with proper treatment and perhaps most importantly thorough rehabilitation can prevent recurrent Achilles injuries.
So if you or someone you know have suffered possible Achilles tendon injury, contact North Texas Foot & Ankle for a consultation @ 214-574-9255.
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