Vols Lose 2 With Achilles Tendon Injuries
The Tennessee Volunteers lost two players this week to Achilles tendon injuries: Senior defensive end Ben Martin, and Sophomore defensive tackle Marlon Walls. What is this injury and how does it effect the performance of football players?
The Achilles tendon is the longest tendon in the human body. It is made up of two muscles: the gastrocnemius muscle and the soleus muscle. The muscular unit of the tendon attaches from the back of the knee to the heel bone. About 2/3 of the way down the leg, the muscle bellys transition to the Achilles tendon. The Achilles tendon is prone to injury in the area known as the watershed area. This area goes from 2-6 centimeters up from the attachment site of the Achilles tendon to the heel bone. In the watershed are, the blood supply to the tendon is poor. This is an area where the tendon has a poor ability to heal itself. Most Achilles tendon tear will occur in this area.
The Achilles tendon functions to bring the ankle downward, similar to the motion of press on the gas pedal. With jumping activities, the Achilles tendon sees forces 8 times that of one’s body weight. With sprinting activities, that force increases to 12 times that of one’s body weight.
Achilles tendon tears or ruptures are commonly seen in weekend warriors and those who participate in sports with a lot of push-off actions. Some patients who have been on an antibiotic from the fluoroquinolone family may be at risk of tearing the Achilles tendon.
Patients will report a sudden pop in the back of the ankle and a rush of blood. Some will say they feel like someone has kicked them in the back of the ankle. They will notice a loss of strength in the foot when trying to stand on the ball of the feet. Pain, swelling, and bruising are common. When carefully touching the Achilles tendon in the watershed area, a gap may be felt in the tendon. Achilles tendon tears can not be seen on xray. Very rarely is an MRI or ultrasound needed to make the diagnosis. The diagnosis is usually made with physical exam findings alone.
WHEN TO SEEK MEDICAL CARE
If you are concerned about an Achilles tendon tear, you should see a medical professional within hours or days of the injury.
Treatment options range from non-surgical options to surgical options using a variety of techniques.
Non-surgical options are reserved for those patients who are against surgery, are elderly, are medically too sick to withstand surgery, or are not active. The treatment involves a short leg, non-weightbearing cast for 8 to 10 weeks, followed by extensive physical therapy.
Surgical options are recommended in the athletes and active population. There are three techniques that are used:
1. The traditional open technique where an 8 to 10 centimeter incision is made on the back of the ankle. The tear is cleaned out and the tendon ends are sutured together. The number one complication of this approach is wound healing issues. You can see a video of this technique at: http://www.youtube.com/watch?v=uzzV5BRWlIc
2. A percutaneous technique where needles are placed through the skin and Achilles tendon. The tendon ends are never seen, so it is difficult to be sure that they are toughing when the tendon ends are sutured together.
3. A mini-open technique using a 2 to 3 centimeter incision on the back of the Achilles. In this technique, the tendon ends are seen and cleaned. A small device is used to place the sutures in the tendon. The tendon ends are then brought together. You can see a video of this technique at: http://www.youtube.com/watch?v=QgSeD8lyQaM
Nonsurgical patients have an 18-20% chance of re-tearing the Achilles and lose some push-off power. This is a concern for elite athletes. Surgically treated patients have approximately a 2% chance of re-tearing the tendon and have a more normal push off in the injured ankle.
RETURN TO ACTIVITIES
We conducted a study on NFL players who had an Achilles tendon tear. In general, only about 66% of players were able to return to the NFL and took about 11 months to do so. Furthermore, when they returned to the NFL, their performance was severely affected. To read this paper, see: http://www.lowerextremityreview.com/index.php/article/return-to-football-after-achilles-tendon-rupture
It is unlikely that Martin or Walls will play this season.
For a video animation of “Surgery for Achilles Tendon Rupture”, please see the “Education” tab of my website. Click orthopaedics, then foot and ankle, then procedures , then Surgery for Achilles Tendon Rupture.
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