Every middle-aged man on the tennis court fears a ruptured Achilles tendon. Now that James (not his real name) was in his 40s, he fell into this category. And unfortunately for him, he recently heard and felt the dreaded “pop” while playing tennis doubles.
At first, he thought the ball from the next court had hit him on the back of the leg. Then he realised what had happened and knew what was to come: surgery, weeks of non- and partial-weight bearing, and the huge inconvenience when it came to work and life in general.
Risk factors for an Achilles injury fall into two categories: non-modifiable and modifiable. Non-modifiable factors include age, race, sex, medical issues, pre-existing musculoskeletal disease or tendon changes, ankle/foot alignment, and genetic factors.
Modifiable risk factors include obesity, sports activity, medication such as steroids, and smoking.
If a video of the injury is slowed down, you will see the player taking a back step to push off while the knee forcibly extends. The combined force of foot plantar flexion and knee extension is likely too much stress for the tendon to handle.
The incidence of Achilles tendon rupture is approximately 18 per 100,000 people. It typically occurs in males between 30 and 50 years old and accounts for about 40% of all operative tendon repairs.
Some 75-80% of cases can be attributed to participation in athletic activity, including ball and racquet sports.
There is ongoing debate as to the best course of treatment – surgical repair or non-operative.
Surgery involves bringing the two ends of the tear together and suturing them in place while the tendon heals. Non-surgical treatment involves casting the foot in plantarflexion (toes pointed down) and recasting weekly with gradual progression into dorsiflexion (toes up).
Non-operative care has demonstrated a re-rupture rate of 10-30%, while surgery provides a higher chance of cure.
For James, there was no question. He elected to have surgery as he wanted the best chance of a full recovery.
Rehabilitation was the most frustrating part. For surgeries such as a tear or sprain of the anterior cruciate (ACL reconstruction), the harder the patient works, the more quickly they recover.
It’s the opposite with an Achilles repair. The tendon needs time to heal, so for the first two to four weeks, patients can’t put any weight on their foot.
Over the next three to four weeks they gradually increase weight bearing, wearing a boot with a heel lift, to take pressure off the tendon.
Strengthening is started late in the rehab process, which means it takes a long time and many people never regain full strength after the injury.
It takes approximately three to four months to go back to running and to initiate sports activities, while complete recovery takes close to half a year. It is indeed a long and slow recovery.
Is there any way to prevent an Achilles injury? For someone older like James, it is important to improve flexibility and fitness by warming up and cooling down before any sporting activity.
James will do his rehab and get back on the tennis court soon. He is sharing his story to encourage others to prepare themselves before engaging in strenuous sporting activity.
Ask a fitness coach or physiotherapist for advice on how to maintain fitness and muscle strength as you get older and more susceptible to injury.
TELEME Healing Life Stories is a collection of inspirational stories of how ordinary people triumph over their health conditions and recover to lead a healthier life after that. Feel free to email [email protected] to share your story.
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