The Achilles tendon is the strongest tendon in the human body, capable of supporting loads up to 10 times our body weight! This reliable tendon, however, is susceptible to acute and overuse injury.Approximately one million athletes suffer some type of Achilles tendon injury annually and the number of Achilles tendon injuries is on the rise.Thanks to advances in conservative care options, more patients are utilizing non-surgical therapies to treat a host of Achilles tendon injuries. Whether you are dealing with tendonitis or an Achilles tendon tear, there are many rehabilitation strategies to choose from. Minimally invasive Achilles tendon surgery is only one of the treatments we offer at Sports Medicine Oregon.
When it comes to sports injuries and overuse injuries, prevention is the best medicine. With this in mind, there are many preventive steps you can take to minimize your Achilles tendon injury risks. It’s imperative to stretch the calf muscles and Achilles tendons prior to exercise, especially activities involving running, jumping, or quick directional changes, like tennis and basketball. Additionally, when training, many athletes will drastically increase regimen intensity or duration rather than slowly and progressively. Ramping up a workout routine suddenly can cause structural fatigue and may even result in severe injuries, including Achilles tendon ruptures.
Many athletes and active individuals maintain a well-balanced workout routine that incorporates stretching, rest days, and gradual intensification yet fail to heed one of the most basic injury prevention guidelines: wearing the appropriate clothing or gear! Properly fitting shoes and assistive devices will support the joint and connective tissues during activity. Individuals with Achilles tendon issues often complain of irritation while exercising, due to rubbing or friction from shoes.
In some cases, it may be necessary to utilize braces, inserts, or immobilizers to assist the natural movement of the foot and ankle.Something as simple as adding heel cups to a pair of running shoes can go a long way in minimizing impact along the heel. Shoe inserts for supination and pronation can be used to ensure the foot is landing ergonomically during exercise. This will promote proper range of motion with the ankle joint and limit excess stress on the Achilles tendon during strenuous activity. Nonetheless, even with a proper warm-up and the right gear, Achilles tendon injuries can still occur.
Even with the most cautious and proactive approach, sports injuries are part of the game. Today, “Achilles tendinopathy” is often used as a coverall term to include broad spectrum of overuse injuries and conditions associated with the Achilles tendon. Intense physical activity and sports involving running, jumping, or quick directional changes may irritate and inflame the Achilles tendon, resulting in a painful condition known as tendonitis. Typical Achilles tendonitis symptoms include Achilles tendon inflammation, pain, and calf muscle tightness. This pain and swelling is often more pronounced during and immediately after athletic activity. Many active individuals today suffer from chronic Achilles tendonitis, a condition known as Achilles tendonosis. Achilles tendonosis is caused by overuse, repetitive injuries and strain over time, all of which results in microtears along the tendon. The overuse slowly degenerates and weakens the tendon, making the Achilles more susceptible to injury and even a full Achilles tendon rupture.
From competitive athletes and “weekend warriors,” people who enjoy a high level of activity are likely to experience Achilles tendon tears, but it’s also common for such injuries to occur as a result of accidents around the house. After an Achilles tear, many patients have difficulty with basic foot and ankle mobility, let alone weight-bearing activities. This reality brings us to one of the most common questions regarding severe Achilles tendon injuries: “Can you walk with a torn Achilles?”
A torn Achilles is a painful injury but, after sustaining an Achilles tendon rupture, some individuals are still capable of bearing weight on the affected foot, despite reduced overall mobility.Typical torn Achilles symptoms are bruising and swelling along the foot and ankle, near the tendon. Achilles tendon popping sounds and sensations are common with Achilles tendon tears.In fact, many individuals report hearing a “pop,” as well as feeling sudden sharp pain along the back of the heel, during the initial trauma.
Remember that it is possible to sustain an Achilles tendon partial tear rather than a full rupture. With a partial tear, a portion of the Achilles tendon is still intact. However, the exact Achilles tendon injury and the extent of this injury will not be known until your doctor performs a physical examination of the affected area. During this diagnosis, the doctor will inquire about the onset of the Achilles tendon pain and any activities that routinely trigger this pain and inflammation to rule out other possibilities. While many common Achilles tendon injuries can be diagnosed without imaging, such diagnostics may be used prior to surgery to understand the extent of damage beforehand. However, not all Achilles tendon injuries will require surgery and today there are many nonsurgical options used to treat tendonitis, tendonosis, and even some Achilles tendon tears.
Once an Achilles injury has been diagnosed, your doctor will then explain the spectrum of treatment options. Less severe injuries such as ankle sprains, Achilles tendonitis, and even Achilles tendonosis respond well to nonsurgical conservative care treatment options. First, your doctor may recommend home remedies and strategies before progressing to more intensive therapies. A diligent observation of rest, ice, compression, and elevation (also known as the R.I.C.E. method) can help minimize pain, discomfort, and swelling following rigorous activity. Similarly, anti-inflammatory medications can also help with mild Achilles tendon pain symptoms. Next, individuals may need to consider making modifications to their lifestyle to help manage Achilles tendon pain. Incorporating a weight loss regimen may reduce the impact on the Achilles tendon during activity. It may also be beneficial to limit the intensity or regularity of any trigger activities.
Achilles tendon physical therapy will play an integral part in both nonsurgical and postsurgical Achilles tendon treatment. Today, physical therapy is a common pathway for those seeking achilles tendon rupture treatment without surgery. Fortunately, Sports Medicine Oregon can perform many of these services at our onsite state-of-the-art rehabilitation facility.
After an assessment, one of our trained physical therapist will tailor a rehabilitation program to your specific injury. Achilles tendon physical therapy exercises will strengthen the surrounding muscles to minimize stress on the tendon before increasing range of motion. Many of these Achilles tendon exercises can be performed at home between physical therapy sessions. Other treatments, such as ultrasound heat therapy and massage therapy, help increase blood circulation in the affected area to support the overall healing process.
After an Achilles rupture, many patients might, in an attempt to avoid surgery, forgo treatment altogether. An Achilles tendon rupture will not properly heal on its own and ineffective treatment may leave the tendon weakened (and thus susceptible to greater damage) moving forward. Furthermore, research has also shown that those who wait to repair an Achilles tendon injury for more than a month risk minimized overall functionality after surgery. For this reason, an achilles tendon rupture (or partial Achilles tendon tear) demands the attention of a qualified doctor. A physical examination and diagnostic imaging by a medical professional will determine the extent of the damage, empowering your doctor to determine a proper plan of action and treatment timetable.
There are many Achilles treatment options available and, depending on the injury, surgery may be recommended for optimal results. Not all Achilles tendon injuries will require surgery, but nonsurgical approaches to Achilles tendon ruptures tend to have a higher rerupture rates when compared to Achilles tendon tears treated surgically. During a typical Achilles tendon tear surgery, the surgeon makes a small incision on the back of the heel, ankle, and lower leg along the tendon. Small retractors are used to hold the incision open and then damaged portions of the tendon are removed. Next, sutures are used to sew the partially torn or fully ruptured Achilles tendon together. Depending on the severity of the damage, a graft may be necessary during Achilles tendon reconstruction. In total, the entire procedure takes approximately 30 minutes to one hour. Once the tendon has been repaired, the incision along the back of the heel is closed with stitches and medication may be prescribed to help minimize any pain following surgery.
Minimally invasive Achilles tendon surgery using the Percutaneous Achilles Repair System (PARS) is quickly becoming the gold standard in sports medicine for Achilles tendon repairs. When compared to traditional open surgeries, minimally invasive PARS involves a smaller incision which decreases risks of infection or adhesion, and decreases pain after surgery. PARS also encourages stronger repair and faster rehabilitation than traditional open surgeries. In fact, some athletes are able to return to the playing field as soon as six months after their injury. Dr. Schroeder, our foot and ankle surgeon, has used this minimally invasive Achilles tendon surgery for over five years.
Standard Achilles tendon recovery protocols and processes have changed in recent years. Previously, it was common for the surgically repaired foot and ankle to be immobilized for up to eight weeks following surgery. However, recent studies have shown that allowing weight-bearing activities (as recommended by a medical professional) early in recovery may aid in the healing process. Patients should still expect to use crutches for the first few weeks following Achilles tendon surgery. During this time period, Achilles tendon physical therapy will initially focus on knee and hip abduction exercises while wearing a brace or immobilizer on the surgically repaired foot. After about a month, individuals may begin full weight-bearing activities while wearing an immobilizing boot to protect the tendon.
At this point, basic Achilles tendon exercises may be introduced at the recommendation of your doctor or physical therapist. Depending on the patient’s overall progress, by about two or three months after surgery, many patients will begin light range-of-motion exercises focused on the ankle joint. This portion of the Achilles tendon rehab process may also include some resistance training. At your doctor’s recommendation, you may be able to return to your preinjury activity levels around the ninth month of the Achilles tendon recovery. Remember, a full achilles tendon rupture recovery can take up to a year.
As is the case with any surgery, patients should have realistic expectations about the recovery process to avoid setting themselves up for disappointment or pushing themselves too far. Each Achilles tendon injury will require an individualized treatment strategy and timetable, however, with the proper conservative care treatment or surgery, many individuals return to their preinjury activity levels in a matter of months.
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