Your ‘Achilles Heel’: More than a Metaphor

Have you ever wondered why the tendon connecting the calf to the heel bone is called the Achilles tendon? In Greek mythology, Achilles was a hero and a warrior who fought in the Trojan War. As a baby, his mother held him by his heel and dipped him into the river Styx, and everywhere the water touched became invulnerable to harm. However, the water did not touch the area on his heel where she held him, and many years later, the Trojan Prince Paris shot a poison arrow into his heel, killing him. That’s why today the term “Achilles heel” is often a metaphor for vulnerability.

Your Achilles tendon can also be vulnerable to injury, but it’s not often a common concern for most people. Shore Physicians Group Orthopedic Surgeon in Somers Point, New Jersey, Dr. Dante Marconi, said the Achilles tendon is a very important structure. “It allows you to plantar flex, or move the foot in a downward motion away from the body. That movement is important for many actions, most importantly, everyday walking,” said Dr. Marconi. “While athletes are at an increased risk of an Achilles tendon tear, a rupture can also happen from trips, falls, and other injuries.”

Symptoms of Achilles Weakness

According to Dr. Marconi, as we age, the Achilles undergoes degenerative changes. “Tight calves and the overall lack of mobility of the ankle can increase the risk of injury,” said Dr. Marconi.

For some, an Achilles tendon tear will happen with the classic “pop” that feels like a shade just rolled up the back of the leg, signaling a rupture. Dr. Marconi explained that there may be early signs a tear could happen, such as tenderness or pain in the area around the Achilles, but a rupture or tear can also occur without warning.

“The rupture happens when there is excessive force in the area of the Achilles tendon. Forced dorsiflexion (upward motion) or plantar flexion (downward motion) of the ankle can lead to an Achilles injury.”

Achilles Treatment Options

An Achilles injury can stop even the strongest in their tracks. But does that mean surgery is the only option to repair a damaged Achilles?

Dr. Marconi says patients do have options, but it depends on whether the injury is a full or partial Achilles tear.

“Initially, we would treat partial tears non-operatively,” said Dr. Marconi. “If symptoms do not improve over time, surgery could be warranted. Also, we can treat a full-thickness tear non-operatively if it is treated immediately after the injury and without significant retraction of the tendon edges.”

He explained, “Many factors determine if a patient is a candidate for surgery. After an acute injury, their ages and activity levels are a big factor. The amount of retraction of the tendon is also a consideration. High-level athletes who are trying to return to elite levels of sport typically benefit more from surgical intervention. Patients trying to return to moderate exercise who need a functional ankle with minimal pain could be a candidate for non-operative management. Delay in treatment usually leads to poor outcomes with non-operative management, so patients should be seen immediately by an orthopedic surgeon.”

Achilles Tear Recovery

Dr. Marconi explained there are two ways to surgically repair an Achilles tear. One way is with open surgery, a traditional surgical method where the surgeon uses a scalpel to open the tissue and repairs both tendon ends with sutures. The second way is with minimally invasive surgery, which involves a small incision and a precise device that allows the surgeon to place the sutures in the appropriate position to allow the tendon edges to heal. Patients are non-weight bearing for three weeks, progressing to full weight bearing by six weeks. Patients can wear a sneaker after eight to 10 weeks in a post-operative boot. Normally, the patient can return to jogging in about five months and return to their athletic activity in six to nine months.

Non-operative treatment rehabilitation is similar to the operative protocol, according to Dr. Marconi, however, the first two weeks require immobilization in plantar flexion to help begin the healing process.

Dr. Marconi said, “Whether we use a surgical or a non-operative option, patients should expect to have excellent mobility. In terms of overall strength, the goal is to obtain 90% of their pre-injury strength.”

Is a Repeat Rupture Likely?

The fear of another Achilles rupture is legitimate, but Dr. Marconi explained, “In the past, non-operative treatment has been known to have an increased risk of re-rupture in the same leg. However, with modern, accelerated rehabilitation protocols, this increased risk of rupture is close to the re-rupture rate after a surgical tendon repair. There is always a risk of re-rupture after surgical treatment due to the prior injury and development of scar tissue. There is also a risk the contralateral, or opposite side, could rupture if the same condition occurs that injured the prior tendon.”

Other Contributing Factors to Achilles Injuries

Aside from activity-related factors in an Achilles rupture, Dr. Marconi indicated steroid injections to the area can increase the risk of a rupture. Likewise, he said, certain antibiotics have been known to increase the risk of an Achilles rupture.

How to Avoid Achilles Injuries

Maintaining an adequate range of motion of the ankle as well as muscle strength can help decrease the risk of an Achilles tendon rupture. Stretching is also key. Dr. Marconi said, “The more stretch the muscle and tendon have, the further distance tolerated before the time of rupture.”

Dr. Marconi is a proponent of education as well. “Seeing an orthopedic surgeon, sports medicine physician, or physical therapist can help a patient become educated on proper technique and appropriate exercises to help decrease their risk of a rupture. Otherwise, frequent stretching and exercise can help decrease the risk of a tear. Patients who increase their activity level can suddenly be at risk for rupture; therefore, patients should gradually increase the intensity of their workouts if they are starting something new or have taken a significant amount of time off.”

Dr. Dante Marconi treats patients ages 10 and up at Shore Physicians Group’s Orthopaedic Division located at 710 Centre Street in Somers Point, New Jersey. For more information or to make an appointment with Dr. Dante Marconi, click here or call 609-365-6280.