Returning to Play After an Achilles Injury
Dr. Rahman Kandil
As professional basketball fans know all too well, an injury to the Achilles tendon can be a season-ending injury. Kevin Durant, star forward for the Golden State Warriors, ruptured his Achilles tendon in Game 5 of the NBA finals in 2019. Following surgery, he is expected to be out for the entire next season. Likewise, Washington Wizards’ point guard, John Wall, recently injured his Achilles tendon and also may be out for all of 2019-20. While Achilles injuries are among the most serious that an athlete can suffer, there are successful treatments to help get competitors on the road to recovery.
Types of Achilles Injuries
Tendons are tough fibers that connect muscle to bone. The Achilles tendon connects the calf muscle to the heel bone, and is the largest tendon in the body. The most common injuries to the Achilles are:
- Achilles Tendinopathy: Often referred to as tendonitis, it is an injury to the Achilles tendon that causes pain, swelling, and makes it difficult to move.
- Achilles Tendon Rupture (or Tear): A tearing or separation of the tendon fibers that connect the calf muscle to the heel bone.
Causes of Achilles Injuries
Tendonitis typically is caused by overuse of the Achilles tendon. Over time, the strain on the tendon causes changes that lead to pain. Overuse of the Achilles tendon happens in many ways, including:
- Increasing your speed or running long distances too quickly
- Suddenly adding strenuous hills or stair climbing to your exercise routine
- Stressing the calf muscles too soon after taking time away from exercising
- A sudden or violent contraction of the calf muscles, such as during an all-out sprint
Rupturing the Achilles tendon is caused by:
- Overuse
- Overstretching
- Overworking an inflamed tendon
- Injury from an accident or fall
Risk Factors
A risk factor is something that increases your chances of developing a certain condition. Older adults have a higher risk of Achilles injuries, but other factors that increase your risk include:
- Improper or worn-out footwear
- Weakness or lack of flexibility in the calf muscles
- An improper training program—such as increasing intensity too quickly
- Previous Achilles tendon rupture
- Involvement in sports that involve running, jumping, twisting, or lunging
- Obesity
- Certain medications, such as quinolone antibiotics or corticosteroids, which weaken the tendon
- Collagen vascular diseases like rheumatoid arthritis, lupus, and scleroderma
Symptoms of Achilles Injuries
Symptoms of Achilles tendonitis include:
- Tenderness—usually just above the heel bone and often more noticeable in the morning
- Stiffness that gradually eases as the tendon is warmed-up
- Pain after activity that gradually worsens
- Pain along the tendon during and/or after running
- Swelling in the area of the Achilles tendon
- Pain at the back of the ankle
Symptoms of an Achilles tendon rupture include:
- Popping or snapping noise when the injury occurs
- Sudden, extreme pain at the back of the heel
- Swelling near your heel
- Inability to push off from the ball of the foot
- Inability to walk on the affected leg
Diagnosing Achilles Injuries
Your physician will ask about your symptoms and exercise habits. A physical examination will be done and the motion of your ankle will be checked. If the diagnosis is unclear, the doctor may order imaging tests, such as:
- X-rays
- Ultrasound
- MRI scan
Treatment and Returning to Play
The Achilles tendon may take weeks or months to fully heal. Treatments for tendonitis and tendon rupture may include 1 or more of the following:
Achilles Tendonitis
Rest and Support
The tendon needs a break from movements that cause pain, but full rest is not necessary. Other supportive steps may include:
- Icing the area
- Shoe inserts
- Ankle taping
- Medicine to help manage pain (prescription or over-the-counter)
Physical Therapy
A physical therapist will assess the tendon. Ultrasound and/or massage may be done to help relieve tension and an exercise program will be created to strengthen and stretch the calf muscles. This will aid recovery and help prevent future injuries.
Achilles Tendon Rupture
Your doctor will determine the best course of treatment for you, but surgery is the most common for a tendon rupture. Watch a video of treatment options for an Achilles tendon rupture.
Surgery
An incision is made in the lower leg and the tendon is sewn back together. A cast, splint, walking boot, or brace is worn for 6 to 8 weeks. One of the benefits of surgery is that it lowers the risk of re-rupturing the tendon. Surgery also may be the best option if you are physically active.
The other option is to allow your tendon to heal without surgery. In this case, you also need to wear a cast, splint, walking boot, or brace for 6 to 8 weeks. You also will have specific exercises to do. If you are less active or have a chronic illness that prevents surgery, this option may be best.
Supportive Care
You will need time to heal after surgery. RICE and immediate medical care often are the first part of treatment:
- Rest: Activities will be restricted.
- Ice: Ice therapy may help relieve swelling.
- Compression: Used for a limited time, compression bandages can provide gentle pressure to help move fluids out of the area.
- Elevation: Elevating the area helps fluids drain out and prevent fluids from building up.
In addition, crutches or a walker may be advised to protect the healing tendon. Prescription or over-the-counter medication is given to reduce pain.
Physical Therapy
A physical therapist will assess the tendon and create an exercise program to aid in your recovery and to strengthen the muscles around the Achilles tendon.
Preventing Achilles Injuries
While advances in physical therapy and surgical practices offer better treatment than ever before, the primary goal should be to prevent an Achilles injury from happening in the first place. To decrease your chance of injuring the Achilles tendon:
- Wear appropriate footwear for your sport and replace footwear that shows signs of wear.
- Do warm-up exercises before an activity and cool down exercises after an activity.
- Gradually increase speed, distance, or intensity, including increasing hill work or stairs.
- Stretch and strengthen the calf muscles regularly.
- Maintain a healthy weight.
- Rest if you feel pain during an activity.
- Change your routine. Switch between high-impact activities and low-impact activities.
As Wizards team doctor Wiemi Douoguih said, "Unfortunately, we don't have a lot of data on elite NBA [players] and Achilles tendon ruptures.” Fans can only hope that their favorite players have a complete recovery.
If you would like to make an appointment with Dr. Rahman Kandil to discuss Achilles tendon injuries that may need to be addressed, go to Dr. Kandil's physician page or call (703) 665-2720 and we will be happy to assist you.
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