The Achilles is the largest tendon in the body, thick connective tissue extending from the bones of your heel to your calf muscles. It supports an athlete's entire body weight. It also aids balance and supports the ankle joint for running, jumping and other activities. Any injury is usually non-contact, with a foot planted.
Achilles Injuries
The tendon can become inflamed, strained, partially torn or ruptured completely.
Tendinitis: Inflammation typically caused by overuse. You will feel the pain whether standing or walking. A professional athlete usually misses 2 to 4 weeks. Anti-inflammatory medications are the go-to treatment.
Strain: An overstretched Achilles that's often a warning of something worse -- a tear.
- Grade 1: Mild, with few torn tendon fibers. It produces some tenderness and sometimes minor swelling.
- Grade 2: Less than half of tendon fibers torn, causing pain, tenderness and some swelling. Most activities (walking, running or jumping) are accompanied by pain.
- Grade 3: A full rupture, often with a "pop" or other sensation in the calf area. You no longer have the power to walk, much less run or jump.
How Is A Ruptured Achilles Repaired?
When surgery is required, doctors make an incision over the torn tendon, realign the tissue and sew it together. The tendon remains in no shape to support the body's weight -- most patients use crutches for about six weeks, followed by a walking boot. Physical therapy is a vital component of rehabilitation, with light running or jogging about six months after surgery. More intense physical activity begins anywhere from one to three months later.
"Muscles and tendons are in a constant balance of damage and regeneration," says Dr. Clifford Rios, Bone & Joint Institute orthopedic surgeon and board-certified in sports medicine. "When the scale tips too far toward damage, without adequate time for regeneration/repair, injury happens.
"This can be due to repetitive overuse (microtrauma) or a single traumatic event. A chronically inflamed tendon is more prone to acute rupture. There are other modalities -- ultrasound, iontophoresis, eccentric strengthening, etc. that help -- but inadequate recovery time before significant stress is going to cause injury eventually."
Recovery Time
Seattle Seahawks cornerback Richard Sherman, in a December 2016 article headlined "Why I Hate Thursday Night Football" he wrote for the The Players' Tribune, called Thursday Night Football "terrible" because of the injury risk. "Maybe the league should take away one preseason game and add a second bye week for each time, which would occur before its Thursday game," Sherman wrote. "That way, at least teams would have a full week to recover and prepare."
Sherman eventually ruptured his right Achilles in a Nov. 2017 game against the Arizona Cardinals.
"Football is one of the hardest sports on the body," says Dr. Rios. "Adequate rest between contests in critical. This is why pro and most college teams do not do contact practices once their season begins. These guys are always on the brink of injury and a short week increases that risk. In my opinion, teams with a Thursday game should get a bye week so no one is playing Sunday, then Thursday. The NFL will always deny the role of the game/schedule on risk of injury. It is bad for business."
Which Recovery Is More Difficult, Torn Achilles Or Torn ACL?
"Tendon repair rehab is different than ligament (ACL) reconstruction," says Dr. Rios. "A tendon repair requires limited mobility for a period of time. Trying to 'stretch' immediately after a tendon repair will only put the repair at risk for failure. Early on, the repair site is the weak link in the system.
"Generally speaking, an athlete can progress to obtaining full motion immediately after ACL reconstruction. There are a lot of strengthening/muscle stimulation exercises that can occur immediately/soon after ACL reconstruction. An athlete needs to wait months before strengthening after Achilles repair so the repair site doesn't come undone.
"If the tendon lengthens even a short amount (through the repair site), there will be more slack in the muscle and the muscle will be less effective. In addition, nearly all other strengthening of the lower extremity (bike, squats, etc.) need to come to a halt because these would stress the Achilles repair."