The serious nature of Achilles injuries

by Eric Kohn DPT, OCS, CSCS

We all watched in shock as the quarterback tried to get up after an awkward end of a play after he was taken down by the opponents D lineman.  He got up and quickly sat back down.  He declined help from his teammates and just sat there in dismay as the trainers came out and the crowd was silent as their Super Bowl or bust aspirations disappeared on the fourth play from scrimmage.  

We all know who this  story is about.  Aaron Rodgers.  The previous leader of the much-envied team to the east by Vikings fans.  

Now, after a summer of endless sports talk show predictions, the Jets fall back to the reality of a mediocre team with a great defense and under-performing offense. How could 15 minutes change the course of one team so quickly as Rodgers had just run on to the field carrying the flag and the hopes of all the New York fan base along with the captive national audience to now sitting on the field.  

In a similar fashion, Baltimore Raven’s running back J.K. Dobbins had his promising season end in the same fashion.  A torn Achilles tendon.  His injury was not the top story of the week, but still important to his team.  Selfishly, he was going to be the consistent workhorse point-getter on my fantasy team!  Both players succumbed to the same season ending injury.  Let’s take a deep dive into the Achilles tendon injury from risks to recovery.

The Achilles is a tendon, which connects the calcaneus or heel bone, to the gastroc/soleus complex.  This rope like tendon can easily be on the backside of the ankle and above the heel.  A few risks show up in literature that can increase the likelihood of injury.  Male and over the age of 30 are the two greatest risks.  A history of chronic inflammation is another risk.  Unfortunately for Rogers he is 3 for 3 with risk factors.  He is usually battling some calf injury each year.  

The injury itself is usually caused by a sudden and violent flexion or push off of the ankle as it is being loaded. I will also see this injury occur in softball as the runner decides to “go for two” and really pushes off as they round second base.  The tear is usually described as a quick sharp pain like being kicked or a ball hitting them in the back of the ankle.  The athlete will fall to the ground and will not be able to get up.  The ability to raise up on his toes on the side will be lost.  Discoloration and bruising will be seen within a short time and a defect can also be felt in the tendon.  Crutches should be used to take pressure of the affected leg and seek out professional care.

The importance of early intervention by a physician is important.  The torn tendon can continue to retract and can make surgery more difficult if delayed.  The test that will be performed by the physician is the Thompson test.  The test is completed by squeezing the calf with the patient in a relaxed position usually kneeling on a chair or sitting off of exam table. The tear is most common seen 2 to 6 cm above the heel attachment.   Following surgery and reattachment, the patient will be in a boot for the first 10-12 weeks and limited weight bearing for the first 1-2 weeks.  Crutches are used until the patient is full weight bearing and stable with ambulation in the boot. At about 12 weeks, the patient is able to get out of the boot and return to normal shoe wear with a small heel lift in the shoe to keep some tension off as it continues to heal.  The lack of good blood flow to the area is the reason for the prolonged healing process.  The return back to light jogging occurs at around 6 months and jumping and cutting around 8 months.  Full return back to high level activities is usually around 9-12 months.  

The recovery of Rodgers and Dobbins will be closely monitored and will have the highest level of care available.  They are both elite athletes and their healing will be quicker, but the thought of returning late in the season is very unlikely.  We can only hope they can come back next year and return hope for post season success to their respective fan bases. 

Eric is a Board Certified Orthopedic Clinical Specialist, Doctor of Physical Therapy and Certified Strength and Conditioning Specialist.  He practices at St Cloud Orthopedics in Central Minnesota and is an adjunct professor at The College of St. Benedict/St John’s University.