Achilles Tendon Injuries
by, Dr. Michael Younes, DPM, ATC, FACFAS
Martin Foot and Ankle

With the doldrums of winter far behind us, the tendency for people to initiate a more active lifestyle becomes a mainstay.  With this comes the propensity for injuries to occur.  A very common injury seen by the Foot and Ankle surgeon is an acute rupture of the Achilles tendon.  This is classically seen in the “Weekend Warrior” on the basketball court with males being most commonly affected in their mid 30’s and 40’s.   The Achilles tendon is the strongest tendon in the body. It is comprised of three muscles that combine together forming the tendon and insert in the back of the heel bone.  The most common area of rupture occurs a few centimeters above its insertion called the watershed area.  This area is prone to injury due to poor blood flow and lack of healing potential.

The mainstay of treatment in the active patient is a surgical repair to reconnect the ends of the rupture.  The repair itself is not technically difficult, but the recovery is fairly prolonged, in excess of 10 weeks in a cast post-operatively.  Although an active post-operative lifestyle is expected, the re-rupture rate has been documented to be around 15%.

Another commonly seen Achilles tendon condition is the chronic Achilles tendonitis with concomitant Heel Spur condition. This malady combines the enlargement of the insertional area of the Achilles tendon, the heel spur, causing a chronic inflammation of the Achilles tendon.  Conservative treatment measures include the use of anti-inflammatories, orthotic management, physical therapy, and alteration of activity.  If this is left untreated, it can lead to a partial rupture of the Achilles tendon. This necessitates surgical intervention.  The repair itself is similar to the above mentioned repair of the acute rupture, but the resection of the heel spur is necessary as well.  The post operative care is mildly shortened in this procedure requiring a minimum of six to eight weeks in a cast.

The cause of the chronic Achilles tendonitis has long been thought to have been caused by an excessively tight heel cord.  With long standing high tension of the Achilles tendon pulling on its insertion to the heel bone, a spur forms due to the tension imposed upon it.  With this being said, it is common to employ an additional procedure to lengthen the heel cord as well as to diminish the chronic tension post-operatively.

Overall the Achilles tendon is an amazing structure of human anatomy that is essential for normal human gait.  Its strength has been likened to that of steel, although it is vulnerable to injury as is any other part of the foot and ankle.  Early recognition and treatment of the above named conditions are the foundation for proper care as conservative measures may thwart off the need for surgical intervention.