SPORTS TIP Achilles Tendon Injuries EXPERT CONSULTANT: Michael S. George, MD

The Achilles tendon is one of the largest, can mask symptoms and lead to greater While partial tears are typically treated thickest, strongest tendons in the human injury as the athlete tries to play through non-operatively, complete Achilles body. It connects the calf muscles to the the pain. tears may be treated both with surgical heel bone, and allows the heel to push off repair and without surgery. While most the ground during movement. Problems Achilles Tendon Ruptures competitive athletes typically undergo affecting the Achilles tendon vary from The Achilles tendon is one of the most surgical repair of the torn Achilles, some mild inflammation and tendinopathy, commonly ruptured tendons in the human recent research studies have shown to partial tears, to complete ruptures. body. The tendon can rupture as the that outcomes may be similar in the athlete is coming down from a jump, general population between tears treated Achilles Tendinopathy and also during a start-and-stop motion operatively and non-operatively. Therefore, Tendinopathy (otherwise known as of many sports. the decision as to whether surgical or non-surgical treatment is chosen should tendinitis or tendinosis) typically results In cases of a complete rupture, a sudden be made by the patient and the treating from repetitive microtrauma and tendon pop or snap is typically felt in the back physician, and should include careful overuse, such as may occur with sports of the ankle, sometimes “as if someone consideration of such factors as the and exercise, and manifests as tendon kicked the leg,” while running, jumping, patient’s age, activity level, and other degeneration and inflammation of the or quickly changing directions. Almost medical issues. surrounding tissues. The most common always the injured athlete is unable to activities that lead to Achilles tendon continue playing or exercising. On-the- Rehabilitation after Achilles repair or overuse include running (especially hills) field medical attention should include during non-surgical treatment involves and jumping. Certain athlete-specific pulling the injured player out of the game, protecting the healing tendon with either factors may predispose to Achilles and eliminating weight-bearing activity a cast or a brace for a period of 6 to 8 tendinopathy, including congenital foot on the injured leg (i.e., putting the weeks, followed by a rehabilitation deformity (for example, an abnormally athlete on crutches). program to gradually regain motion, high arch), excessive weight, muscle strength, and function. Return to athletic Suspected Achilles ruptures should weakness, and lack of flexibility. activities typically occurs after 6 months. be evaluated by a doctor as soon as Typical symptoms of Achilles tendinopathy possible, since delays in diagnosis and Reference include pain, weakness, and limited treatment have been shown to lead to Saltzman CL, Tearse DS. Achilles Tendon Injuries. motion. Treatment must begin with worse outcomes and function. Initial J Am Acad Orthop Surg. 1998;6:316-325. eliminating or decreasing the offending medical evaluation will include a careful activity, and altering the pre-disposing physical examination, and typically X-rays factors, if possible. A guided physical to make sure that there are no fractures therapy program is often instituted or other bone injuries. However, Achilles and is aimed at reducing inflammation, tears cannot be seen on X-rays, and if the improving flexibility and strength, and diagnosis is not obvious from the physical gradually returning the athlete to their examination, an ultrasound or an activity. Anti-inflammatory medications MRI may be ordered. These imaging can be used to help control the pain procedures may also help distinguish associated with inflammation, but between a partial and a complete tear, should be used with caution, as these and determine how significant a tear is.

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