October 22, 2024
Football fans watched as Cleveland Browns’ quarterback Deshaun Watson went down yesterday with what has been reported as an Achilles rupture. The Achilles tendon attaches the calf muscle to the heel and is the largest and strongest tendon in the body. Its function is to give the legs the power to walk, run and jump. Sometimes very painful, this injury is not uncommon in athletes.
Among the general public, the incidence of Achilles tendon ruptures (tears) is 1.8 people per 100,000 each year, but it is meaningfully higher among athletes. The sports most associated with Achilles tendon injuries are basketball, soccer, football, tennis, and running.
We talked with Dr. Daniel Bohl, one of our experienced foot and ankle surgeons at Midwest Orthopaedics at Rush about this injury and Watson’s prognosis.
“Whether you are an athlete or not, an Achilles injury should be seen by an appropriate medical provider right away,” Dr. Bohl explains. “It’s really important for restoring normal function of the foot and ankle.”
3 grades of Achilles tears explained
Grade 1
This is a mild injury with a small number of torn fibers in the Achilles, also known as a partial tear. Symptoms include tenderness and minor swelling.
Grade 2
In this case, less than half of the Achilles tendon fibers are torn. Symptoms include pain, tenderness, and some swelling, and pain with most activities.
Grade 3
In a full rupture, most or all the Achilles fibers are torn. Symptoms include being unable to walk, run, or jump, and often the patient has heard a "pop" in the calf area.
A simple way to tell if you might have a Grade 3 Achilles tendon rupture is if you can't point your ankle or toes. If you can't, and you see a large bump in your upper calf, where the tendon has retracted, this indicates a full rupture.
“The longer you wait, the more your options narrow. Delaying treatment can result in a much more complicated situation.” Dr. Bohl cautions.
Achilles rupture treatment
Depending on the grade of an Achilles injury, these are the most common treatment options:
Partial tears
In the case of a partial tear, such as in a Grade 1 or 2 rupture, nonsurgical treatment can involve immobilization of the foot and ankle with a walking boot. Physical therapy is important and full recovery is typically achieved in just a few months.
Complete ruptures — nonoperative management
When treatment begins within the first few days after a rupture, nonsurgical management can be very effective. This involves initial immobilization in a splint with the ankle pointed downwards, followed by mobilization in a boot, increased weight bearing, and therapy.
Complete ruptures — operative management
Surgical treatment is another good option for management of Achilles ruptures. Sutures are used to bring the two ends of the tendon together to enable healing. The biggest advantage of surgery over nonoperative management involves a decrease in the risk of re-rupture. There may also be an advantage in terms of strength.
What about a ‘speed bridge’ procedure?
Fellow NFL player Aaron Rodgers reportedly recently underwent a newer type of Achilles surgery referred to as a “speed bridge.” In this procedure, the surgeon drills two small holes in the heel bone and creates a connection between the tendon and the bone using sutures. The "speed bridge" serves as an internal brace that protects the Achilles and can potentially help the patient return to sports more quickly than traditional techniques. Other potential advantages include the fact that it is a knotless repair with a very minimally invasive technique.
Watson’s prognosis
“The grade and extent of Watson’s Achilles rupture is not known to us, but with proper treatment, he can expect a full recovery within six to nine months,” Dr. Bohl says. “Most likely, given his age and high level of sport, his physicians will offer surgery followed by physical therapy. He should continue to have a great career.”
