Expertise provided by Dr. Michael Johnson, Orthopaedic Foot and Ankle Surgeon, UAB Medicine
Disclaimer: This expertise is shared based on a typical injury and not intended to diagnose or provide an outlook on George Kittle’s situation.
What is an Achilles tendon?
The Achilles tendon is a strong band of tissue at the back of the ankle connecting the calf muscles to the back of the heel bone. An Achilles tendon tear may occur either in the middle of the tendon or the tendon may tear and pull off the insertion into the heel bone.
How does this type of injury usually happen?
Tears typically occur when a sudden acceleration or push off of the foot occurs. It may also occur with excessive dorsiflexion of the foot or strong force applied to a plantar flexed ankle.
What are the immediate symptoms?
Many patients suffering an Achilles tear feel like someone may have kicked the back of their ankle or felt a “pop.” They will experience pain at the Achilles and weakness with ankle push off. Swelling and bruising are typically seen in the back of the ankle and into the foot.
How is an Achilles tear diagnosed?
Diagnosis of an Achilles tear begins with a detailed history and exam. X-rays are typically obtained to rule out any boney injury. On physical exam there is often weakness, but not absence, of plantarflexion strength. Further exam demonstrates a palpable gap along the tendon and squeezing of the calf muscle will not lead to plantar flexion of the foot. An MRI may be used to confirm the diagnosis.
Does this injury require surgery?
An Achilles tendon usually requires surgery but may be treated surgically or non-surgically. While athletes are routinely treated surgically, a discussion with your orthopaedic surgeon will determine the best option for you.
What does recovery typically look like?
Recovery will involve a period of non-weight bearing followed by protected weight bearing in a boot with heel lifts. Physical therapy is initiated to regain muscle strength.
When can someone return to play or activity?
Return to activity is graduated based on tendon healing, with most patients returning to regular activities of daily living by 3 months. Return to sports activity takes longer with athletes returning to their sport 6-12 months after injury.
Can this injury be prevented?
Risk of tendon tear can be reduced by maintaining Achilles flexibility, focusing on eccentric stretching and strengthening. Maintaining an active lifestyle while avoiding sudden increases in load (rapid initiation of running, jumping; “weekend warrior”) can decrease the risk of tendon tear. A proper active warm up is always recommended before activity to help stretch the Achilles tendon before play.
When should someone see a sports medicine specialist?
Seek evaluation from your orthopaedic surgeon if you note any of the early warning signs of Achilles tendinitis – stiffness, tightness, painful palpable lump in the Achilles. Avoid the fluoroquinolone family of antibiotics – Ciprofloxacin (Cipro), Levofloxacin (Levaquin), Moxifloxacin (Avelox), Ofloxacin – as they have been shown to increase the risk of tendon rupture. If you feel you may have an acute Achilles tear, immobilize the ankle, limit weight bearing, and seek evaluation from your orthopaedic surgeon.