Achilles Tendon Rupture

For active patients out there, one injury that can’t really be outrun is an Achilles tendon rupture. The problem is that they occur most often in the active population, so being young and healthy does not necessarily protect you. Countless professional athletes have been hobbled by this injury, including Kobe Bryant, Shaquille O’Neal, Dominique Wilkins, and Elton Brand. Those are all top NBA players who had ruptured their Achilles tendons during peak physical health and, even with full-time physical therapy, then struggled to return to their elite level.

The more common presentation is in the “weekend warriors.” Those individuals who do box jumps in Crossfit or participate in Spartan runs, while sitting at a desk job throughout the week, put themselves at risk of rupture. The problem is that the muscles that comprise it tend to be just too strong. The gastrocnemius and soleus muscles combine and twist anatomically as they insert into the heel bone, or calcaneus. This creates a wringing effect before it gets to the calcaneus, which then creates an area where there just isn’t enough blood flow.

Most evidence suggests that chronic microtrauma does not put a tendon more at risk of rupture, but the true cause of rupture is sudden contraction of these muscles. When the Achilles tendon contracts, it pulls the foot down, and it pulls it down hard. If the foot is bent up, or dorsiflexed, at the time, the sudden contraction of the stretched and stressed tendon can be enough to rupture. Much like a rubber band or rope snapping, there isn’t usually a partial rupture. Once it goes, it goes.

Then comes the treatment. Depending on many factors, including age and activity, there are two basic treatment options. Surgical intervention is generally the first line of treatment in otherwise healthy individuals. This allows the surgeon to sew the ends together while removing any of the diseased, degraded tendon. Generally, the recovery takes several months to get over the surgery. For a little bit, the entire repair is held together by just the stitches within the tendon, but within a few weeks, the body is already beginning to heal.

There is some controversy, though. Newer research is coming out and supporting the idea of a more “conservative” approach. It isn’t necessarily easier for the patient, but it does avoid surgery. Some promising results are being seen in patients who participate in early specialized physical therapy protocols, where the tendon is able to heal biologically while the PT aides in orienting the fibers and making the tendon stronger. With this new protocol still being developed, most patients would likely still benefit from surgical repair.

Should you find yourself in the unenviable position of having an Achilles tendon rupture, rest assured that we at Eagle-Summit Foot & Ankle are well-trained in helping you with this injury. From establishing the diagnosis to determining and performing the best treatment, Dr. Maurer and Dr. Bernhard are here to help.

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