When Alex Trebek, host of the TV game show "Jeopardy," raced down a hall pursuing a thief who had stolen his mother's bracelet and other items from his hotel room, his Achilles tendon snapped. He fell to the floor in extreme pain and hobbled onto the set of the show the next night, telling the audience that his foot and ankle would have to remain in a cast for six weeks. Then the day after that there was announcement that he would have surgery to repair the break.
What the Achilles Tendon Does, What Causes Ruptures
The Achilles is the biggest tendon in the body, and is crucial for all movements of the foot during walking, running and jumping. It connects your calf muscles to your heel bone and is used when you walk, run, and jump. When it's not working, these activities are just about impossible. A rupture can involve some of the fibers that make up the tendon, or it can be complete. A snapping sound can be a sign that the rupture is serious. Weekend athletes trying very hard, or people who have just begun a rigorous exercise regimen without adequate time for the body to adjust are prone to this injury.
Snapping an Achilles tendon, the way Mr. Trebek did, is not a rare event, and it occurs more often when people are over 60 years of age, as he is, than in groups of younger people. His risk for a rupture may have been greater than usual because of the sudden, unusual increase in his activity. In addition to that, it could have been an overuse injury or the tendon could already have been in a state of degeneration because of his age. Whatever the reason, it may be a couple of months before he's back to normal, and then he will need to be careful not to injure the tendon again.
Treatment of Achilles Rupture
There is disagreement about how to treat Achilles tendon rupture -- whether to operate or whether to use conservative methods such cast immobilization, as Mr. Trebek had at first, or functional bracing that allows more movement. But a review study of 14 clinical trials involving 891 patients concluded that open operative treatment of acute Achilles tendon ruptures significantly reduces the risk of re-rupture compared to non-operative treatment. However, the surgical treatment does have the risk of complications, including infection. Infections may be reduced, however, if minimally invasive surgery (percutaneously -- through the skin) is done. Post-operative splinting in a functional brace appears to reduce hospital stay, time off work and sports, and may lower the overall complication rate.
Achilles Tendonitis
Sometimes the tendon doesn't snap as it did in Mr. Trebek's case. It just hurts, and the swelling, pain and inflammation can go on a long time and become chronic. For instance, a bone spur -- extra bone -- where the Achilles tendon attaches to the heel can rub against the tendon and cause chronic pain but not rupture. Sometimes torn tendon fibers harden due to calcification. There are also other causes, such as overuse and degeneration, for chronic Achilles tendonitis. Yet another cause is repetitive stress.
The tendonitis can occur in the middle of the tendon or toward the lower heel, where the tendon attaches to the bone. When the inflammation is in the heel, you can suffer from tendonitis even if you are not physically active. High impact weight bearing activities such as jogging, fast walking and running are usually limited due to tendonitis. Cutting move such as those typical of martial arts, field supports and dance are virtually impossible. Non-impact and fitness activities such as cycling and using an elliptical trainer may also result in symptoms. Whereas individual differences exist, most complain of pain with daily activities such as walking or climbing stairs. An athlete with Achilles tendonitis has a 200-fold risk of sustaining an Achilles rupture on the opposite foot.
Treatment of Achilles Tendonitis
My initial treatment goal is to decrease my patient's pain and to reduce inflammation. Therefore stopping aggravating activities is crucial. Icing for 20 minutes up to three times daily coupled with anti-inflammatory/analgesic medication can be used to reduce pain. A counterforce brace is also often helpful. A simple heel lift (1/8 to 1/2 inch) can decrease some of the stress along the tendon. Injections of platelet-rich plasma have become a popular trend, but some clinical trials show that they are no more effective than placebo in treating chronic Achilles tendon pain after a one-year trial.
In one survey of people who had chronic pain, patients preferred treatments that cost less, took less time and had a greater chance of success, and they preferred exercises to injections. A clinical trial showed that patients with Achilles tendon tendonitis fully recovered. In my experience, rehabilitation for this injury is best initiated in a structured physical therapy program, followed by home therapeutic exercises.
Prevention of Achilles Rupture and Tendonitis
You can help keep your Achilles tendon in good health by warming up before any weight-bearing activity and cooling it with ice afterwards. Exercise in advance to improve your fitness if you're going to take part in a seasonal sport, maintain a healthy weight so as not to increase pressure on muscles and tendons, wear shoes that are appropriate for your activity, increase your exercise regimen gradually over time and "warm down" after strenuous exercise.