Achilles Heel
Road to Recovery: Achilles Tendon Ruptures and Rehabilitation
We’ve seen and heard all too much about Achilles ruptures or tears over the last few weeks, thanks to the likes of big name athletes like Aaron Rodgers going down mere minutes into a game. Kevin Durant several years before that, in a pivotal playoff match-up against my beloved Toronto Raptors.
They occur far more often than we would like. But many individuals still don’t understand what or where the achilles is and how one can tear it. After Rodgers went down 70 seconds into his game, many laid blame to the astro-turf field that he was playing on.
Although astro-turf fields are known to lead to more injuries when compared to natural grass turf, you cannot blame all injuries on the playing surface.
Some will occur as a result of contact (like Rodgers), while others will be attributed to an underlying weakness or structural issue in the tendon or injured tissue to begin with, likely stemming from previous injuries or perhaps training routines.
In any case, I wanted to shed some light on Achilles tendons and the injuries that are sustained to them as it is very important that they are managed properly and in a timely manner. It is considered a medical emergency and a prompt visit to the Emergency Department is warranted so that a proper care and recovery can begin.
An Achilles tendon rupture is a common injury that can be painful and debilitating, but with the right approach to rehabilitation, individuals can make a full recovery. Whether you're an athlete or not, understanding the causes, symptoms, and rehabilitation process for Achilles tendon ruptures is crucial. In this blog post, we'll explore what the Achilles tendon is, what causes it to rupture, the signs and symptoms, and a comprehensive guide to rehabilitation.
**What is the Achilles Tendon?**
The Achilles tendon is the largest and strongest tendon in the human body. It connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). This tendon plays a vital role in various activities, including walking, running, jumping, and even standing on your toes.
**Causes of Achilles Tendon Rupture**
Achilles tendon ruptures often occur during activities that involve sudden and forceful movements of the foot and ankle. Some common causes include but are not limited to:
1. **Sports Injuries:** Activities like basketball, soccer, and tennis can put stress on the Achilles tendon, leading to a rupture. I had a patient several months ago who was playing tennis overseas and he fell to the ground thinking someone hit him with the ball. WIth lots of people playing on courts near by, it was possible. But not one of his playing partners saw anything, so they assumed it must have been true. Upon returning from his trip, i saw a classic divot sign in his achilles tendon and quickly sent him to Emergency to seek the care of an orthopaedic surgeon.
2. **Aging:** As we age, the Achilles tendon can weaken and become more susceptible to injury. A gentleman i know recently took up pickle ball. After not participating in any activity other than walking, challenging oneself with a quick change of direction sport can put some added strain on the tendon if its already de-conditioned or not able to adapt to the load imparted on it. In his 2nd week playing, he ruptured his achilles tendon trying to change directions for a passing ball.
3. **Tight and/or weak Calf Muscles:** Tight calf muscles can increase the risk of an Achilles rupture. As can weak calf muscles when trying to forcefully push off or move suddenly when playing sports for example. For example- Kevin Durant’s injury against the Raptors in 2019, when he was trying to make a move forwards and collapsed as his achilles ruptured.
4. **Certain Medications:** Some medications, like fluoroquinolone antibiotics and corticosteroids, have been associated with an increased risk of tendon ruptures.
**Signs and Symptoms**
A ruptured Achilles tendon can be painful and lead to various signs and symptoms, including:
1. **Sudden, severe pain in the back of the ankle or calf that is often described as being kicked by someone OR being hit in the leg by a ball (if playing tennis).**
2. **A snapping or popping sensation at the time of injury.**
3. **Swelling and bruising around the affected area.**
4. **Difficulty walking or standing on tiptoes.**
5. **A gap or depression in the back of the heel where the tendon has torn.**
**Rehabilitation Process**
Recovery from an Achilles tendon rupture typically involves a multifaceted approach, often guided by a an Orthopaedic Surgeon/ Sport Medicine Physician/ Physiotherapist. There are generally 2 approaches to rehab and recovery. The first of which being surgical repair, is used less frequently as the years go by. The second and more common method is a more conservative and non-invasive approach of immobilization/ casting and rehab. Much of the reasoning for this is due to the fact that the immobilization approach has been shown to be just as effective (if not more), and safer as its non-invasive and no risks associated when compared to the surgical approach.
Here's a general outline of the rehabilitation process:
1. **Immobilization:** Initially, the affected leg may be placed in a cast or walking boot to protect the tendon and allow it to heal. This can typically be anywhere from 6-12 weeks depending on the severity and the individual.
2. **Physical Therapy:** A physiotherapist will design a customized exercise program to strengthen the calf muscles and improve the range of motion of the foot/ankle. This may include calf stretches, heel raises, and ankle exercises.
3. **Gradual Weight-Bearing:** As healing progresses, you'll gradually transition from non-weight-bearing to partial weight-bearing exercises.
4. **Gait Training:** Learning to walk normally again is a crucial part of rehabilitation. Your physiotherapist will work with you to regain a natural gait pattern.
5. **Return to Activity:** This phase involves a gradual return to activities and sports, ensuring that the tendon is strong enough to handle the demands.
6. **Preventive Measures:** To prevent future injuries, maintaining flexibility, strength, and proper footwear are essential.
Fair warning, recovery from an Achilles injury, like any other injury is no linear path. (Thanks to Adam Meakins for his beautiful depiction.) There can be lots of up’s and down’s, forward progress but also backward progress. It can certainly be a challenging journey, but with patience, dedication, the right guidance and rehabilitation, most individuals can regain their strength and mobility. It's crucial to seek prompt medical attention and work closely with a physiotherapist to ensure a successful recovery.
Remember, everyone's healing process is unique, so it's important to follow your healthcare provider's recommendations closely. With dedication to your rehabilitation program, you can look forward to returning to your normal activities with confidence.
