Achilles injuries

Achilles Tendon Ruptures and Repair

achilles tendonThe Achilles tendon connects the muscles in the back of your calf to your heel bone. There are two basic variations of Achilles injuries: Achilles tendonitis, and a complete tear. It’s important to know whether the Achilles is torn or not, because the treatment is very different: a torn Achilles may require surgery; Achilles tendonitis probably means rehab and rest. While tendonitis is a gradual onset of pain that tends to get worse with more activity, an Achilles tear is a sudden injury, and it feels as if you were hit or kicked in the back of the ankle. A tear usually affects your ability to walk properly.

Because an Achilles tendon rupture can impair your ability to walk, it’s common to seek immediate treatment. You may also need to consult with doctors specializing in sports medicine or orthopaedic surgery.

Tests and Diagnosis

During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. In many cases, doctors can feel a gap in your tendon if a complete rupture has occurred. Achilles tendon rupture can be diagnosed reliably with clinical examination, but if there’s a question about the extent of your Achilles tendon injury then your doctor may order a magnetic resonance imaging (MRI) scan.

Repair

The best treatment for a ruptured Achilles tendon in an active individual is typically surgery. While an Achilles rupture can sometimes be treated with a cast, splint, brace, or other device that will keep your lower leg from moving, surgery provides less chance that the tendon will rupture again and offers more strength and a shorter recovery period. Surgery may be delayed for a period of a week after the rupture, to let the swelling go down.

There are two types of surgery to repair a ruptured Achilles tendon and both involve the surgeon sewing the tendon back together through the incision(s):

  • Open surgery – the surgeon makes a single large incision in the back of the leg.
  • Percutaneous surgery – the surgeon makes a number of small incisions rather than one large incision.

Depending on the condition of the torn tissue, the repair may be reinforced with other tendons.

Rehabilitation

After treatment, whether surgical or nonsurgical, you’ll go through a rehabilitation program involving physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to daily activity within four to six months, though high-impact athletes may take up to a year to return to sport.

About Dr. Labib

Sam Labib, MDSam Labib, MD, is a sports medicine fellowship-trained surgeon and director of the foot and ankle service at Emory. Dr. Labib started practicing at Emory in 1999. He is an Associate Professor of Orthopedic Surgery.

He has lectured both nationally and internationally at many orthopedic meetings. His research has been published in several journals, including the JBJS, Arthroscopy, Foot and Ankle International and the American Journal of Orthopedics as well as numerous video presentations and book chapters. Dr. Labib is Board Certified in orthopedic surgery with additional subspecialty certification in Sports Medicine Surgery.

For the past 5 years, Dr. Labib has been nominated by his peers as one of “America’s Top Doctors” as tracked by CastleConnelly.com. Dr. Labib has a particular interest in problems and procedures of the knee, ankle, and foot. He is the head team physician for the athletic programs at Oglethorpe University and Spelman College, and an orthopaedic consultant to the Atlanta Falcons, Georgia Tech and Emory University.

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Understanding Talar Fractures

talus fractureThe talus is a small bone that sits between the heel bone (calcaneus) and the two bones of the lower leg (tibia and fibula). Where the talus meets the bones of the foot, it forms the subtalar joint, which plays an important role in walking and stabilization. The talus is an important connector between the foot and the leg and body, helping to transfer weight and pressure forces across the ankle joint. The talus has no muscular attachments and is mostly covered with cartilage, which makes injuries difficult to heal.

What causes a talus fracture?

Talus fractures are often the result of high-energy injuries. Most injuries to the talus result from motor vehicle accidents, although falls from heights also can injure the talus. These fractures also may occur from twisting the ankle, particularly when significant weight bearing forces are involved, which can result in small chips or fragments that are broken off the edges of the talus. Talus fractures may occur in running and jumping sports involving change of direction such as soccer, football, basketball, etc.

Signs and symptoms of a talus fracture

Many patients with a talus fracture will experience a sudden onset of intense pain and swelling about the ankle following the injury. The pain will usually be felt at the front of the ankle—although it may be felt on the sides or back of the ankle—and may lead to an inability to walk due to bruising and swelling, often to protect the talus. In severe cases, particularly involving a displaced fracture of the talus, the patient will be unable to bear any weight on the area. One common sign of a talus fracture is pain that increases during certain movements of the foot or ankle or when standing or walking up hills or uneven surfaces.

How are talus fractures diagnosed?

In many cases the diagnosis can be made by your physician on physical examination alone. He or she will examine your foot, and an X-ray is usually required to confirm diagnosis and assess the severity of the injury.

Treatment for a talus fracture

Depending on the severity of the injury, a talus fracture may be treated with either a cast or possibly surgery. Your orthopedic specialist will advise the patient which management is most appropriate based on a number of factors, including the location, severity and type of the fracture. It’s important to note that a talar fracture that is left untreated or that doesn’t heal properly will most likely create problems for you later. Your foot function will be impaired, you may develop arthritis and chronic pain, and the bone may collapse.

Non-surgical treatment

In rare cases, a talus fracture can be treated without surgery if X-rays show that the bones have not moved out of alignment. You will have to wear a cast for at least six to eight weeks and will not be able to put any weight on the foot during that time.

Surgical treatment

Most fractures of the talus require surgery to minimize later complications. Your orthopaedic surgeon will realign the bones and use metal screws to hold the pieces in place. If there are small fragments of bone, they may be removed and bone grafts may be used to restore the integrity of the joint.

Recovery

Recovery can be prolonged, with no weight or walking on the leg being allowed for eight to 12 weeks.
Patients with a fractured talus should perform flexibility, strengthening and balance exercises as part of their rehabilitation to ensure proper healing. This aspect of rehab is important, as balance, soft tissue flexibility and strength can be quickly lost with inactivity. Most people, depending on the type and severity of the fracture, are able to return to most work and recreational activities.

About Dr. William Reisman

William Reisman, MDWilliam Reisman, MD, specializes in Orthopedic Trauma and has been practicing at Emory since 2010. He is the Chief of Orthopedics at Grady Memorial hospital and is the Director of Orthopedic Trauma. His interests include general fracture care, pelvic and acetabular fractures, periarticular fractures and multi-extremity injuries. He has active research focusing on areas of fracture care, acute compartment syndrome and cost savings analysis at Level I trauma centers.

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When it Comes to Your Health, are High Heels Worth the Price of Looking Good?

High Heels Back PainEmory Orthopaedics, Sports and Spine physicians Kyle Hammond, MD  and Oluseun A. Olufade, MD recently participated in “Ladies Night Out”  at Emory Johns Creek Hospital.

The Ladies Night Out event is an annual health fair held by Emory Johns Creek Hospital for women to talk with physicians and other providers in the Johns Creek and North Atlanta communities and learn about services near them.

At the Emory Orthopaedics, Sports & Spine table, Drs. Hammond and Olufade spoke with women about potential injuries that could occur from wearing high heeled shoes and what women might be able to do to help prevent injuries to their backs, ankles, feet, hips and knees.

As a fun activity at the Ladies Night Out event, we also had a free drawing for high heeled shoes that were displayed at the table.  Five lucky women went home with a new pair of shoes and lots of tips to prevent orthopedic injuries.

Emory Orthopaedics and Spine Team at the Ladies Night Out Event
Below are 5 orthopedic conditions or injuries related to wearing high heels and tips on how you can prevent them:

ACHILLES TENDINITIS

Symptom: Pain & swelling in lower calf and heel cord resulting in decreased calf flexibility

Achilles Tendinitis Prevention:

  •  Calf stretches with towel or band
  • Calf raises / strengthening exercises
  • Heel pads
  • Wear short heels or flats

ANKLE SPRAIN / FRACTURE

Symptom: Pain, bruising, swelling and inability to walk

Ankle Sprain & Fracture Prevention:

  • Wear short, wide heels (no stilettos)
  • Single leg balancing
  • Ankle ‘A, B, Cs’

BUNIONS

Bunion Symptom: Tenderness and prominence inside of the big toe joint

Bunion Prevention:

  • Ensure proper shoe size & fit
  • Wear short heels with wide toe box
  • Use pads to cushion bunions
  • Wear heels for brief periods of time if possible

KNEE AND HIP INJURIES

Symptom: Muscles in your hip and knee have to work harder when you wear heels as muscles become fatigued and more prone to injury

Possible Injuries:

  • Muscle strain
  • Tendinitis
  • Meniscus tear
  • Hip impingement

Hip & Knee Injury Prevention:

  • Stretch hamstrings, quads, & hip
  • Strength training for lower body
  • Alternate heels with flats during the work week
  • Balance exercises

LOW BACK PAIN

Low Back Pain Causes: Normal center of gravity changes, increasing the curvature of your low back and tilting your pelvis forward.

Low Back Pain Prevention:

  • Change into flats for long walking distances
  • Strengthen your core (crunches & low back extension exercises)

Although high heels look nice and are fun to wear at special events, try to limit the high heels to special occasions and stick with flats for your day to day activities.  Your body will thank you!

About Dr. Kyle Hammond

Dr. Hammond is an orthopaedic surgeon new to the Emory Orthopaedics faculty.  He recently completed his fellowship at the University of Pittsburgh Medical Center.  While at the University of Pittsburgh he was the Associate Head Team Orthopaedic Surgeon for both the Duquesne University Football team and the University of Pittsburgh Men’s Basketball team.  He also worked as a Team Physician for the Pittsburgh Steelers, the Pittsburgh Penguins, the University of Pittsburgh athletics, Robert Morris College athletics, as well as the Pittsburgh Ballet.

Dr. Hammond sees patients at Emory Johns Creek Hospital, as well as Emory Orthopaedics & Spine Center in Atlanta.  Dr. Hammond has a special interest in the overhead/throwing athlete, ligament injuries to the knee, Tommy John surgery, joint preservation surgery, and is one of the few fellowship trained hip arthroscopists and concussion specialists in Georgia.

About Dr. Oluseun A. Olufade

Dr. Olufade is board certified in Physical Medicine & Rehabilitation and Interventional Pain Medicine. He completed fellowship training in both Sports Medicine and Interventional Pain Medicine. During his fellowship training, he was a team physician for Philadelphia Union, a major league soccer (MLS) team, Widener University Football team and Interboro High School Football team.

Dr. Olufade employs a comprehensive approach in the treatment of  sports related injuries and spinal disorders by integrating physical therapy, orthotic prescription and minimally invasive procedures. He specializes also in concussion, tendinopathies and platelet rich plasma (PRP) injections. He performs procedures such as fluoroscopic-guided spine injections and ultrasound guided peripheral joint injections. Dr. Olufade individualizes his plan with a focus on functional restoration. Dr. Olufade sees patients at Emory Johns Creek Hospital.

About Emory Ortho, Sports and Spine in Johns Creek and Duluth

Emory Orthopaedics, Sports & Spine has recently opened two new clinics, one in Johns Creek and one in Duluth.  Emory physicians, Kyle Hammond, MD, and Oluseun A. Olufade, MD see patients in Johns Creek.  Mathew Pombo, MD and T. Scott Maughon see patients in Duluth.  Our new clinic locations care for a full range of orthopedic conditions including: sports medicine, hand/wrist/elbow, foot/ankle, joint replacement, shoulder, knee/hip, concussions, and spine.

To schedule an appointment call 404-778-3350

Related Resources:

Preventing and Treating Achilles Tears

Brandon Mines, MDYou may know that Chamique Holdsclaw, one of my former Atlanta Dream players (not to mention one of basketball’s most gifted female athletes), suffered an Achilles tendon injury this year. While this injury is common with basketball players, it is most prevalent in men ages 35-45. They’re often the “weekend warrior” types—so the injury is more likely to happen when they overdo it, and when they don’t have a good stretching regimen.

There are two basic variations of Achilles injuries: a bad sprain, and a complete tear. It’s important to know whether the Achilles is torn or not, because the treatment is very different: a torn Achilles means surgery; a strained Achilles means rehab and rest. Some people with Achilles tears are misdiagnosed with sprains, only to find out later that they have Achilles tears and they’ve missed the window to have it fixed. (An Achilles tear should be repaired within four weeks of tearing it.)

Here’s the difference between an Achilles strain and a tear: a strain is a gradual onset of pain that tends to get worse with more activity. An Achilles tear is a sudden injury, and it feels as if you were hit in the back of the ankle—the tendon actually pops and tears in a sudden fashion. Most people who have this tear will actually say, “Somebody must have kicked me me because I felt it in the back of my heel/ankle.”

If you’ve suffered an injury like this, it’s important for you to see a sports medicine doctor immediately. You can also take our Ankle Quiz.

If you’re healthy and uninjured, be sure to do everything you can to keep it that way. Here’s are some tips to prevent Achilles injuries:

  • Exercise regularly; in other words, don’t jump into a game of full-court basketball after not working out for a year.
  • Wear shoes with a lot of support.
  • Warm up and stretch for 15 minutes before playing.
  • Stretch and stay warm during breaks in the action.

Do you have any questions about the prevention or treatment of Achilles tendon injuries? If so, be sure to let me know in the comments section.

About Brandon Mines, MD:

Dr. Mines has been practicing with Emory since 2005 and specializes in family practice and sports medicine. His areas of clinical interest include ankle, shoulder, hand, knee, sports injuries, upper extremities, and wrist. Dr. Mines holds organizational leadership memberships at the American College of Sports Medicine and the American Medical Society of Sports Medicine.

Dancing Again After a Broken Foot & Torn Achilles Tendon

A few years ago, I treated a delightful young woman, Erin Weller, who broke her foot while rehearsing for a performance in a contemporary dance show. The show was being produced by Crossover Movement Arts, a dance company managed by her significant other, Blake Dalton. Erin’s injury was a simple fracture requiring no surgery—just a cast. Unfortunately, due to the injury she had to drop out of the show, but a few months later she was back to dancing and to studying martial arts with Blake.

Earlier this year, I saw Erin in my office again. She and Blake had recently married, and Erin was still dancing and studying martial arts. She was also working as a communications coordinator with Moving in the Spirit, an organization that teaches dance and life skills to at-risk youth. She was doing good work in the world.

While it was nice to see them both again, the reason for their visit wasn’t so nice. Blake had torn his Achilles tendon after landing badly from a high leap. A 12-year veteran professional dancer with Core Performance Company, a contemporary dance company in Atlanta, Blake makes his living through dance, and he had the kind of injury that could have once ended his career.

Fortunately, we’ve made great advances in the surgical repair of torn Achilles tendons. I was able to repair the tendon, and after a few months of working hard at his physical rehabilitation with our superb physical therapists, Blake recently started performing once again, just in time for the launch of Core’s 30th anniversary season.

Have a look at this video to meet this charming couple and learn more about how Emory Sports Medicine was able to help them get back on the dance floor: