What Does an Achilles Tendon Tear Look Like?

You have probably read several articles and heard on the news multiple times about someone famous tearing their Achilles tendon.  This is no simple fete.  The Achilles tendon is the largest tendon in the leg and the force it takes to tear it has to be significant.  Often it is a force that causes the foot to come up towards the leg sharply, causing tremendous stretch of the tendon.  When this occurs, you feel a pop in the back of your leg and often describe it as being hit by a baseball bat or getting shot with a gun.

I have many curious patients who have these types of injuries and they always want to know what it looks like.  So in a recent surgery to fix this rupture, I took a couple of pictures.

In this picture, the stringy thing in the center of the incision is the ruptured Achilles tendon. You can see how large the tendon actually is and there is an obvious tear straight across the tendon.  Also note that there are multiple tears running longitudinally along the length of the tendon.  This gives it the "horse tail" appearance that we often use to describe the tendon after rupture.  

This picture shows how traumatic a rupture can be with significant bleeding and trauma to the tissues.  In this particular case there was also a large bone spur present prior to the injury which caused the tendon to be thicker than normal.  For this patient, the majority of his tendon was degenerative and there was minimal healthy tendon available for use.  So in this case, the tendon was replaced with a graft.  But in cases with healthier tendon, often repair can be done by just sewing the two ends back together if it is repaired quickly.

Recovery for this traumatic event is lengthy, but once healed this patient will return to digging holes, climbing trees, running or anything else they feel comfortable doing.

Albert Pujols Twists His Ankle

“Ouch!” Did you see the replay of Albert Pujols twisting his ankle sliding into base? It actually looked much worse than it was in the instant replay. Looked terrible, but he toughed it out and stayed in the game. Boy, did it look like he was going to be in pain this morning! Over and over they played the tape on Sports Center!

What should you do if this happens to you or your child athlete? The trainer from the Cardinals was immediately evaluating Pujols, but most of us don’t have a trainer on standby!

If you have an ankle sprain, you should be evaluated by a sports medicine podiatric foot and ankle surgeon if you have localized pain, swelling and bruising, as well as inability to walk more than 5-7 steps comfortably. Many a foot fracture has been missed in the emergency room when x-rays were taken only of the ankle and not the foot. The fifth metatarsal is often broken with the same mechanism of injury of an ankle sprain, so the foot should be evaluated as well. If severe ligament injury is suspected, an MRI can evaluate the grade of injury. This is really what decides whether surgery is needed for full recovery.

Treatment for ankle sprains really depends on the degree of severity, which can only be determined by your doctor. Initial treatment always includes “R-I-C-E” therapy – Rest, Ice, Compression, and Elevation. Pain and edema is usually controlled with NSAID’s (non-steroidal anti-inflammatories) like ibuprofen. Bracing or casting coupled with non-weightbearing on crutches may be needed in more severe injuries to rest and stabilize the ankle while it heals. Return to pain-free ROM(What is ROM?) and stability is the goal. Surgery is only recommended in Grade 3 severe injuries in athletes or in those patients who have had multiple ankle sprains and suffer from chronic ankle instability. Long-term ankle instability can often be avoided with an aggressive physical therapy program. Bracing should only be used in the short-term during rehabilitation because long-term bracing actually causes atrophy and decreased ROM.

Physical therapy is needed for all ankle sprains. The goals of physical therapy should be to regain full ROM, strength and proprioception (where your brain thinks your ankle is in space). Regaining strength in the peroneal tendons as well as overall balance training are the keys to successful rehabilitation of an ankle sprain. A maintenance program of ankle strengthening, stretching, and proprioception exercises helps to decrease the risk of future ankle sprains, particularly in individuals with a history of multiple ankle sprains or of chronic instability.

Bottom line: if you happen to fall down and go “Boom”, have your ankle sprain evaluated by a podiatric foot and ankle surgeon. Delaying treatment and rehabilitation can lead to life-long instability.

For more information on ankle sprains and chronic instability, click here.