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Why It’s So Hard to Recover from a Torn Achilles Tendon

Golden State Warriors player Kevin Durant had surgery this week to repair his Achilles tendon.

The Golden State Warriors will face off with the Toronto Raptors in a pivotal game of the NBA finals tonight, but they’ll be missing one key player: Kevin Durant.

After a calf injury sidelined him for multiple games, Durant was able to play in Game Five of the series earlier this week — but was sidelined after he ruptured his Achilles tendon in the second quarter.

This week Durant underwent surgery to repair the tendon.

While his sports future may be uncertain, anyone who has had or treated the injury knows how challenging recovery can be.

The Achilles tendon is one of the strongest tendons in the body. When it tears, the injury can be quite disabling.

“When it happens you feel a sharp pain, and often the person thinks someone hit them or stepped on them in the back of the Achilles tendon, you can also hear a loud pop that all the surrounding individuals will hear,” said Karin Grävare Silbernagel, PhD, a physical therapist and associate professor at the University of Delaware. “After the initial pain you actually have very minor symptoms and that is why this sometimes goes undiagnosed.”

Achilles injuries

This tendon, which runs along the back of the leg down into the heel area, is instrumental for bringing the heel up while allowing us to put our front foot down. It can aid in stopping the front of the foot from coming up and the heel collapsing. Because it controls so many critical movements, any injury to it can interrupt activities of daily life.

Typically, a tear or rupture of the tendon happens most often in middle-aged men when they are sprinting or jumping. They happen more often in men than in women, and occur most often between 30 and 50 years old.

Symptoms of a rupture or tear can include a painful pop behind the ankle, difficulty putting weight on the leg, inability to be active, a feeling of being hit in the tendon itself, delayed swelling, bruising behind the ankle, and deformity where the tendon has broken.

How it is diagnosed

A clinical test known as the Thompson test is performed to diagnose a complete rupture. If the tendon is intact, the ankle will move when the calf muscle is squeezed. If it’s torn, the ankle doesn’t move. Most people can feel the defect. A doctor can do an exam and some perform an MRI to view the extent of the damage, noted Dr. Alan M. Reznik, the chief medical officer at Connecticut Orthopaedic Specialists.

It’s important to differentiate between a complete Achilles tendon rupture, a partial tear, and Achilles tendinosis, explained Dr. Mark Bullock, a podiatric foot and ankle surgeon in Michigan. An Achilles tendon rupture most often occurs during strenuous exercise and will produce a popping noise. The tendon can experience a strain, which can refer to a partial tear of the tendon or Achilles tendinosis. Achilles tendinosis is a degeneration of the tendon from repetitive strain.

While Achilles tendon ruptures most often occur with strenuous exercise and high-impact injury, they can also occur with minor tensile stress to the tendon if there is underlying Achilles tendinosis. Rupture after a minor stress is more common in elderly individuals, Bullock said.

Treating Achilles tendon tears

Not all Achilles tendon injuries require surgery. The ideal treatment varies among individuals and is based on several factors including the extent of the injury.

If the ruptured ends of the tendon can reseal themselves quickly after the injury and the ankle is properly immobilized, it may heal on its own.

Usually, the best position for healing is with the toes pointing down for one to two months. But holding that position can be hard to sustain for that amount of time, though.

In other cases, leaving the tendon to heal on its own without surgery is problematic. Blood clots and scar tissue can form between the two ends of the torn tendon depending on how bad the injury is.

While the tendon may heal without surgery, it may be thinner than before and prone to recurring injuries. A tendon tear that does not properly heal can cause a wider tear gap.

In some cases, if surgery is done long after the initial injury it might mean worse outcomes for the patient.

Achilles tendon repair surgery is typically an outpatient procedure. During the surgery, an incision is made and the tendon rejoined. The tendon is secured strongly, so the ankle does not need to be in an awkward immobilization position to encourage healing.

The goal of treatment is to enable the tendon to heal while handling some load while still limiting the degree of its elongation. At the same time, you have to keep the calf muscle active, Grävare Silbernagel explained.

Predicting outcomes

Outcomes differ largely among people regardless of whether the injury is treated surgically or not.

“Surgery has a slight advantage in reference to rerupture, but minor,” Grävare Silbernagel noted. Early mobilization and rehab are important factors that can influence a person’s recovery. In people who do not have surgery, there’s a larger gap in the tendon that can be seen on imaging.

In Grävare Silbernagel’s research, the type of treatment — whether surgical or not — was a weak predictor of function. Being older at the time of injury or having a higher body mass index (BMI) were better indicators of whether or not a patient was going to have a good outcome.

Most people are off their feet completely for about six weeks, and then do three to four months of physical therapy or rehabilitation. They have to slowly return to activities and often resume full competitive sports anywhere from nine months after injury to about a year, Reznik said.

Avoiding an Achilles ailment

To prevent an Achilles tendon injury, the Mayo Clinic recommends properly stretching, varying physical movements, strengthening calf muscles, not bouncing while stretching, limiting running on hard or slippery surfaces, and slowly boosting training intensity.

Avoiding fluoroquinolone antibiotics may help prevent the injury as well, Grävare Silbernagel noted.

“I would also avoid giving an athlete pain relief for calf and tendon pain since this might allow for the heavy forceful overload, and in these instances the pain relief might remove the body’s protection against overload,” she added.FEEDBACK:Written by Kristen Fischer on June 13, 2019 New

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