During last week’s game against the Chicago Rush, San Antonio Talons quarterback John Dutton ruptured his right Achilles tendon. This injury ended Dutton's first season with the Talons. Dr. Marvin R. Brown discusses what an Achilles tendon tear means.
The Achilles tendon is the largest tendon in the body, located on the back of the lower leg. It is formed by the merging together of the gastrocnemius muscles of the calf and inserts into the back of the heel bone. The tendon functions by allowing the ankle to flew downward, like you would if you were pushing down a gas pedal.
Achilles tendons are one of the most frequently ruptured (or torn) tendons. Most ruptures occur in male recreational athletes, aka “weekend warriors." Achilles injuries occur when mechanical loads exceed the physiologic capability of the tendon. Activities such as cutting, sprinting or jumping place the Achilles tendon in significant jeopardy due to the forceful push off of the forefoot while the knee is in full extension.
Overuse can also increase the likelihood of tendon rupture as repetitive motions can overload the tendon. Overuse injuries are seen frequently with running or jumping workouts.
While most acute ruptures are seen in athletes, there are other factors that make certain people more susceptible to Achilles tendon rupture. These factors apply mostly to men and include:
- Having a close relative with a history of Achilles rupture
- Having a history of contralateral rupture (rupture of the Achilles tendon on the other leg)
- Having a mechanical malalignment such as a high arched foot or flat foot
- Increasing age
- Obesity
Although the tendon is the largest in the body, ruptures typically occur in an area of the tendon called the “watershed zone.” This is located just above the insertion into the heel. This area receives poor blood flow, making tears likely and healing difficult. With an Achilles rupture, most feel a sudden “pop” or feel as though they have been hit in the back of the ankle. This is followed by pain, swelling and bruising. One might also notice weakness when trying to push off of the forefoot.
Non-operative treatment of an Achilles tendon rupture consists of placing the lower leg in a cast for a period of 6-8 weeks. Casting and immobilization has a lower complication rate in respect to wound healing and nerve injury. Drawbacks to conservative treatment include calf atrophy, weaker push-off, adhesion formation and risk of deep vein thrombosis. The re-rupture rate of those treated non-operatively is 18% versus 2% for those treated surgically.
Those opting for surgical repair typically have a shortened recovery and a quicker return to sports. Following repair, the lower leg is casted for the first 2 weeks. Provided all wounds have healed, a fracture boot is given at the 2 week follow-up and early ankle range of motion and aqua therapy are started. The first six weeks will be non-weight bearing with progressive weight bearing the following 6 weeks. Barring complications in the postoperative period, sports play can be resumed 6-8 months following the repair.
Dr. Marvin R. Brown is a board certified orthopaedic surgeon, fellowship trained in conditions of the foot, ankle and lower leg. He treats patients aged 1 year and up and his special interests include Achilles tendon reconstruction and total ankle replacement. To schedule an appointment with Dr. Brown, please call 210.281.9595.