Philadelphia Phillies’ first baseman Ryan Howard may be
returning to play soon, following his surgery at the end of last season for a
torn Achilles tendon. Howard sustained
the injury while making the final out in the 2011 NLDS game. He had been showing signs of improvement
during spring training, but developed an infection at the site of the repair,
requiring revisional surgery. He
reportedly took his first batting practice last week.
What is an Achilles tendon rupture?
The Achilles tendon runs along the back of the leg and
connects the calf muscles to the heel bone.
It is one of the strongest tendons in the body, and functions to help
lift the heel while walking. The Achilles
tendon may sometimes be referred to as the “heel cord”.
The Achilles tendon can rupture when excessive forces run
through the tendon as the muscle is contracting. This may come from landing on the heel during
sports such as basketball, or from accelerating too quickly. It may also be caused by direct trauma to the
back of the leg or foot.
Achilles tendon ruptures are most commonly seen in the
“weekend warriors”. These are typically
middle-aged individuals who participate in high-intensity sport for recreation,
but do not have proper conditioning.
Less commonly, ruptures can be seen secondary to systemic inflammatory
conditions such as rheumatoid arthritis, or with certain types of drugs such as
steroids.
Signs and symptoms of an Achilles tendon rupture include a
sudden onset of pain, which is often described as a snapping sensation in the
back of the leg, as if one has been kicked.
There is often an audible “snap” or “pop”, and the area between the calf
muscles and the heel will swell up almost instantly. A person with an Achilles tendon rupture will
usually have difficulty walking, particularly uphill or upstairs.
Prompt treatment is required in the event of Achilles tendon
rupture. Until the person can be seen by
a doctor, RICE therapy should be applied.
This includes rest, ice, compression, and elevation. Rest should include staying off the foot,
with a wheelchair or crutches if they are available. Ice should be applied to the area, often with
a towel protecting the skin from direct exposure. Compression may be achieved with the use of
an elastic bandage. Elevation of the leg
above the level of the heart will help decrease swelling and pain in the
area.
Diagnosis of an Achilles tendon rupture can be made through
a thorough clinical exam. This includes
inspection of the back of the leg for a delve where the tendon is normally
taught. Motor testing will reveal a
decrease in strength of plantarflexion (pointing the toes towards the ground)
with associated pain. Squeezing the back
of the calf where the muscles are will also recreate the pain, and may show
that the foot has limited or no motion compared to the unaffected side. Imaging studies such as x-rays or MRI may be
used to further evaluate the leg for any associated injury such as fracture or
dislocation, as well as measure the extent of the tear.
Treatment for Achilles tendon ruptures is broken down into
non-surgical and surgical treatment.
Non-surgical treatment involves placing the foot and leg into a cast,
and limiting the motion of the ankle joint.
This allows the ends of the tendon to repair and heal themselves. This process can take anywhere from 8-12
weeks, and avoids surgery. However,
research has shown that there is a higher rate of re-rupture following
conservative treatment versus surgical intervention.
Surgical intervention for Achilles tendon ruptures is often
used, and there are a number of different procedures and techniques
available. Essentially, all of these
techniques revolve around rejoining the broken ends of the tendon. This may be done with sutures, tendon grafts,
or techniques of lengthening the muscle and tendon, or even transferring a
nearby tendon to help in the repair.
There are inherent risks involved in surgical treatment, including
delayed healing and infection. However,
surgical intervention has been shown to have a lower rate of re-rupture, and is
often used in younger patients and high performance athletes.
Whether the treatment for an Achilles tendon rupture is
surgical or conservative, physical therapy is required for rehabilitation. This involves a number of exercises designed
to help strengthen the muscles and tendons, and help retrain the body to adapt
to the repair. It can often take up to
six months for a patient with an Achilles tendon rupture to return to their
pre-injury level of athleticism and performance.
Central Florida Foot and Ankle Center, LLC.
101 6TH St. NW.
Winter Haven, Fl. 33881
863-299-4551
www.FLFootandAnkle.com
