Not All Achilles Tendons are Treated the Same

It's Saturday morning -- time for your 'weekend warrior' basketball game with the guys. Your team is still undefeated and it feels great to be in the game -- until it doesn't. After you go up for a slam dunk to end the period, you land on your foot and a loud 'pop' reverberates through your entire body. You try to make your way off the court, but lifting your foot to walk is next to impossible. Something is definitely wrong; it feels like a broken foot... but it isn't. You've ruptured your Achilles tendon.

The Achilles tendon is a band of tissue that runs down the back of the lower leg and connects the calf muscle to the heel bone to help facilitate walking by helping to raise the heel off the ground. When an Achilles tendon is ruptured, a complete or partial tear of the tendon occurs leaving the heel bone separated (or partially separated) from the knee.

According to Amol Saxena, DPM, FACFAS, a California foot and ankle surgeon and Fellow member of the American College of Foot and Ankle Surgeons, "This separation can cause moderate to severe pain in the heel, muscle weakness and difficulty pushing off the foot," adds Dr. Saxena.

Foot and ankle surgeons gathered last month at the 75th Annual Scientific Conference of the American College of Foot and Ankle Surgeons (ACFAS) in Las Vegas to examine advances in surgically treating Achilles tendon ruptures.

Achilles tendon ruptures tend to occur more often during "high-impact" sports, such as basketball, where the participant needs to "explode" off their foot very quickly. And according to foot and ankle surgeons, these type of tendon ruptures are more commonly seen in men than women.

"Science has attributed this gender differential to increased flexibility or elasticity of the tendons in females in comparison to males," said Dr. Saxena. "At baseline, however, the most reliable predictor of a rupture is prior history of tendonitis, or inflammation of the Achilles tendon, caused by prior injury or injuries."

Chronic inflammation of the Achilles tendon can also result in tendonosis, which is the actual degeneration of the tendon in which microscopic tears weaken the tendon causing more concern for rupture.

Unfortunately, relief for Achilles tendon ruptures does not happen overnight. Recovery times vary depending on if a surgical or nonsurgical treatment approach is prescribed.

"Treatment processes are dependent upon a patient's overall health, activity level and ability to follow a functional rehabilitation protocol," said Jeffrey E. McAlister, DPM, FACFAS, a fellowship-trained Arizona foot and ankle surgeon and Fellow member of ACFAS.

According to Dr. McAlister, typically unhealthy and less-active patients may choose a non-operative approach, since they are not trying to return to active sports. But, we should keep in mind that the re-rupture rate is roughly 10 percent higher with non-operative treatment.

"A non-operative approach works well in a patient who does not have the expectation of aggressive sports and activities. This usually involves a lengthy functional rehabilitation process," said Dr. McAlister.

The downside of nonsurgical treatment is that there is a longer recovery time, usually between nine and 12 months. With less activity during this time, there is also a higher incidence of dangerous blood clots, also known as deep vein thrombosis.

"For more athletic and younger patients, the surgical option may be best," said Michael VanPelt, DPM, FACFAS, a Texas foot and ankle surgeon and Fellow member of ACFAS. "We anticipate these patients have shorter healing times."

Foot and ankle surgeons suggest recovery times for Achilles rupture can vary, but the number one complication to consider when weighing options, is that the Achilles tendon is not an area of the body with great vascularity, or blood flow, so healing a large surgical wound can be tricky.

Jason Kayce, DPM, FACFAS, an Arizona foot and ankle surgeon and Fellow member of ACFAS also suggests, "Advances in surgical techniques to repair Achilles tendon ruptures include limited incision, or smaller incision, surgical approaches to help patients have smaller scars, and less of a chance of wound complications."

The best way to learn which option is right for you to properly recover from an Achilles tendon rupture is to be seen by a foot and ankle surgeon. To find a foot and ankle surgeon in your area or for more information on Achilles tendon ruptures or other foot and ankle health information, visit the patient education website of the American College of Foot and Ankle Surgeons, FootHealthFacts.org