Achilles tendon injuries have skyrocketed in the past year, according to researchers in the Department of Orthopedic Surgery at Michigan Medicine (HealthDay, 2021). And some of these injuries have made headlines: the New York Jets defensive end Carl Lawson ruptured his left Achilles in August during practice, meaning he will miss the entire 2021 football season (Cimini, 2021). The same injury occurred at the Tokyo 2020 Olympics; during the 3000m steeplechase, Australia’s Genevieve Gregson ruptured her Achilles tendon on the last water jump (Campbell, 2021). Experts say the spike in injuries is due to people returning to physical activity after a year of relative inactivity during the pandemic (HealthDay, 2021). This is especially true for professional athletes, who quickly ramped up the frequency and intensity of their workouts in anticipation of the Olympics or regular season play that had been on hold.
The Achilles tendon (AT) is a fibrous band of tissue that connects two calf muscles (the gastrocnemius and the soleus) to the heel of the foot; it is the thickest and strongest tendon in the human body, and makes running, walking, and jumping possible (Petrie, 2021). An AT rupture is often described as a popping sensation in the lower calf; they often occur without warning during any sudden, dramatic movement that strains calf muscles, like sprinting, jumping, or changing direction. Partial tears of the tendon sometimes have no symptoms, but a complete AT rupture can cause significant disability after it occurs, and recovery can be challenging. According to the results of a recent study published in Foot & Ankle International, almost 25% of professional athletes who experienced AT rupture were unable to return to their sport (Johns et al., 2020).
There is no consensus regarding optimal treatment protocol for AT ruptures, and both operative and nonoperative treatments are used. Surgical repair is most common, but might not always be necessary, according to research (Ecker, 2016). Studies have shown that individuals who undergo nonoperative treatment for AT ruptures have similar range of motion in their ankles as people who undergo surgical repair and are able to return to prior functional levels and athletic activities as well as people who had surgery. People who undergo surgical repair have less chance of a re-rupture than those who undergo nonoperative treatment, but the overall likelihood for occurrence in either group is low (Ecker, 2016). The specifics of nonoperative treatment vary among surgeons and physical therapists, but several components of rehabilitation are typically present in all treatment protocols. First, the injured person is casted, with the injured foot pointed downward for the tendon to heal (Petrie, 2021). Several weeks later the individual can transition to a walking boot and begin weight bearing and mobility exercises. After a walking boot, balance and calf-strengthening exercises are instrumental to physical therapy plans, along with calf stretching (Petrie, 2021). From there, with sufficient strength, a person may be cleared to begin higher-level tasks like jumping or running (Ecker, 2016). All in all, the estimated recovery time is 6 months for the general population, and longer for professional athletes (Johns et al., 2020).
Developments in both surgical and nonsurgical treatment protocols have transformed the perception of AT ruptures. For professional athletes, “It used to be the kiss of death,” said surgeon Robert Anderson (Cohen, 2021). “You had an Achilles rupture, your career was done.” Basketball star Kevin Durant suffered this injury during the 2019 NBA Finals, and many worried that he would never play the same way again. Instead, he returned 18 months later to his spot as one of the top players in the NBA (Cohen, 2021). More research is needed to further enhance treatment protocols for AT ruptures. In the meantime, the rise in AT injuries highlights the importance of regular exercise and being careful of muscle and tendon overuse (HealthDay, 2021).
References
Campbell, J. (2021, August 5). Australia’s Stars Leave It All Out On The Track. Women’s Health. https://www.womenshealth.com.au/tokyo-2020-olympics-briefing-australia-s-stars-leave-it-all-out-on-the-track.
Cimini, R. (2021, August 19). Top New York Jets free-agent signing Carl Lawson ruptures Achilles, will miss 2021 season. ESPN. https://www.espn.com/nfl/story/_/id/32050843/top-new-york-jets-free-agent-signing-carl-lawson-carted-practice.
Cohen, B. (2021, February 12). How Kevin Durant Beat the Worst Injury in Basketball. Wall Street Journal. https://www.wsj.com/articles/kevin-durant-achilles-injury-brooklyn-nets-11613093797.
Deng, S., Sun, Z., Zhang, C., Chen, G., Li, J. (2017, November 1). Surgical Treatment Versus Conservative Management for Acute Achilles Tendon Rupture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Journal of Foot & Ankle Surgery, 56(6). https://doi.org/10.1053/j.jfas.2017.05.036
Ecker, T. M., Bremer, A. K., Krause, F. G., Müller, T., & Weber, M. (2016). Prospective Use of a Standardized Nonoperative Early Weightbearing Protocol for Achilles Tendon Rupture: 17 Years of Experience. The American Journal of Sports Medicine, 44(4), 1004–1010. https://doi.org/10.1177/0363546515623501
HealthDay News. (2021, August 14). Achilles Tendon Injuries are Rising – Here’s How to Spot Them. U.S. News & World Report. https://www.usnews.com/news/health-news/articles/2021-08-14/achilles-tendon-injures-are-rising-heres-how-to-spot-them.
Johns, W., Walley, K., Seedat, R., et al. (2020, November 20). Career Outlook and Performance of Professional Athletes After Achilles Tendon Rupture: A Systematic Review. Foot & Ankle International. https://journals.sagepub.com/doi/10.1177/1071100720969633.
Petrie, T. (2021, August 24). How an Achilles Tendon Rupture Is Treated Without Surgery. VeryWell Health. https://www.verywellhealth.com/achilles-tendon-rupture-non-operative-treatment-5197425.