In the Treatment Room: A Discussion About Ruptured Achilles Tendons

On February 24th, Taiwan Easterling underwent surgery to repair his ruptured Achilles Tendon. Per initial reports, his recovery is going as expected. Unfortunately, we won't see Taiwan on the football field for quite some time.

Take a look inside for a detailed discussion about this type of injury and the expected recovery...

MIAMI - OCTOBER 04:  Wide receiver Taiwan Easterling #82 of the Florida State Seminoles tries to avoid being brought down by linebacker Darryl Sharpton #50 and defensive back Brandon Harris #1 of the Miami Hurricanes at Dolphin Stadium on October 4, 2008 in Miami, Florida.

Photo from daylife.com

 

So this might be a little late in the grand scheme of things as Taiwan has already undergone surgery and is on his way to recovery. But, this is the first piece in what, I hope, will become a regular article about sports related injuries. You will have to let me know if you like it and what can be done to make it better. I will try to keep it relevant and talk about the specific injuries that our players have sustained. So why not start with Taiwan?

In early February, we learned that Taiwan had ruptured his Achille's Tendon and was scheduled for surgery. Apparently, the surgery went well and he is progressing through the rehabilitation process.

Your Achilles Tendon is the large tendon that connects your calf muscles, specifically your gastrocnemius and soleus muscle, to your calcaneus, which is your heel.

 

http://healthinformation.centracare.com/library/healthguide/en-us/images/media/medical/hw/nr55552004.jpg

 

The gastrocnemius muscle is used for plantar flexion of your foot. That is the action necessary to push down on a gas peddle and allows you to stand on your tip-toes and perform heel raises. It also helps with the flexion (bending) your knee when your foot is dorsiflexed, which is the opposite of plantar flexion. This dual action of the gastrocnemius is due to its origin and insertion sites: the posterior (back) of the femur and on the calcaneus.

Achilles Tendon ruptures usually occur in individuals over the age of 30 and typically in individuals with weak soleus muscles. Obviously, Taiwan is not over 30 nor is he out of shape. However, the tendon can rupture is there is a significant load placed on the tendon when the gastroc and soleus muscle are at maximal stretch. Imagine yourself standing on the edge of a stair and allowing your heel to drop and you feel that stretch in your calf. That is the position in which a tendon rupture can occur in a healthy individual.There are other "setups" for Achilles Injuries: Overuse (too fast of an increase in athletic activities or doing too much too quickly) Misalignment (leg length discrepancy, short muscles, misshaped bones), Improper footwear or Medication side effects.

Some individuals will report a few days of pain in the tendon before the actual rupture occurs and other conditions like gout and hyperparathyroidism predispose individuals to tendon ruptures. Also, any injection of steroids into or around the tendon can be an inciting event. I don't know if Taiwan had any type of pain or injury prior to this and was receiving such therapy, so we cannot speculate that this was the case. Rupture may occur from

When the injury occurs, the individual or athlete will typically report a "pop" or "snap." This is associated with sever pain and results in significant swelling and brusing. Afterwards, the individual may have a lot of difficulty walking and will not be able to stand on his or her toes. There is a special test that physicians perform, the Thompson test, to see if the tendon is ruptured or not. You can see a video of it here.

If the tendon is not completely ruptured, the individual may be placed in a special walking boot of brace and go through significnat physical therapy. If non-operative management is selected, athletes should not expect to resume full activities for one year. 18% of people will re-rupture and up to 30% of people have residual weakness.

For high level athletes and younger patients, surgery is typically the treatment option. In general, 83% of athletes who have surgery are able to return to their pre-injury level of participation. Having surgery allows for early return to sports and earlier return of function and power. I won't show images or videos of the surgery here, but it essentially entails making a long incision to the side of the tendon and then opening the sheath in which the tendon is located and then suturing the tendon back together. Sounds easy right? Here is a cartoon version of the surgery.

After surgery, the patient is placed in a splint for 10 days with the toes pointed down to minimize tension on the incision. They are then placed in a special boot and are non weight bearing for 3-4 weeks, simple range of motion exercises are allowed. Weight bearing is allowed in 6 weeks after the surgery. Athletes are typically out of competition for 6-9 months after the injury. So the earliest we might see Taiwan back at competition level is August, but October may be more realistic. Speed of recovery is dependent on the severity of the injury and time to surgery and quality of the surgery.

Hopefully this will help you understand a little bit more about this type of injury and what we can expect from Taiwan and his recovery. He has a long road a head of them and this is, unfortunately, a really difficult injury to manage. We might see him back on the field this year, but I expect it would be in a more limited role. It may not be until the 2010 season that he is truly back up to speed. Unfortunately, due to the long recovery period and the timing of his injury, it might be a while.

Please let me know if you would like to see this in a different format or with more pictures, more information....

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