The Achilles Tendon Tear

When the Philadelphia Phillies were eliminated from the playoffs last month, they not only had to leave the field as losers, but their star slugger, Ryan Howard, had to limp off with a torn Achilles tendon on the last out of the game.

His quote afterwards was very telling.  “It felt like my bat came around and hit the back of my Achilles, “ he told reporters after the game.  “I tried to run and felt a pop and it felt like the whole thing was on fire.  ... like I was literally on a flat tire.  I tried to get to get up, but I couldn’t go.”

A very typical history given by the weekend warrior as well who feels the “pop” or “shot” to the back of the Achilles tendon when it gives way for no apparent reason.  “I turned around thinking someone had kicked me” is what I hear a lot of.  While it can happen at any age, most patients are over 30.

What happens in this sudden, non-contact injury?  How can someone be running hard one second, then all of a sudden be clutching his leg when he wasn’t touched?

This YouTube video of David Beckham and rupturing his Achilles tendon and accompanying analysis in March, 2010 demonstrates it well-

In layman’s terms, the tendon snaps when the calf muscle contracts while the ankle is dorsiflexed (foot extended toward the front of the leg) suddenly.  The tendon gives way many times with the feeling of a pop.

While non-operative treatment by casting the foot with toes pointed down can work, in general, most patients and surgeons opt for operative repair, to ensure that the tendon will heal in a tight, functional position and decrease the chance of re-rupture. 

Rehabilitation generally involves a brief period of immobilization followed by careful, systematic increase in range of motion and eventually strengthening.  Because the calf muscle and associated Achilles tendon is so vital to proper gait and running, it is important to get as close to full strength as possible.  The process, however, can take from 8 months to a year to get back to “normal”.  

So if your favorite pro (or weekend warrior) tears his/her Achilles tendon, don’t expect them back till next season.  This one’s a season ender!