Achilles Heel

Football session is here and so are the injuries. The Tennessee Vols have been plagued with the no so typical football injury. We commonly think about football injuries such as knee sprains, stingers to the shoulder, and turf toe, but Ben Martin and Marlon Walls of the University of Tennessee football team are both out for a prolonged period of time due to Achilles injuries. Coach Derek Dooley was quoted on utsports.com saying, "Our Achilles heel so far has been our Achilles heel."

The Achilles, also know as the "calf", is made up of two muscles, the gastrocnemius and the soleus. They are responsible for pushing your toes down, kind of like the action of pushing down on a gas pedal. These two muscles attach around the knee and on the back of the calf in two different areas but merge together close to the ankle becoming a tendon that attaches on the back of the heel.

These injuries were non-contact and often the mechanism of injury can be as simple as a missed step, stepping into a hole during non-athletic sports, or explosive push off when running. These injuries are generally caused when there is significant "eccentric" force on the muscle attempting to control the upward pressure on the foot that the Achilles tears. The main action of this muscle points your toes, but when you are on your toes, it is the muscle that controls your heel slowly coming to the floor, and this is the "eccentric" phase of the muscle.

Interestingly enough, pain with this type of injury is a good sign. "What? This guy must be mean," you may be thinking to yourself right now. However, a painful Achilles injury means that the tendon is still partially intact. A complete rupture will tear and visibly ball/roll up in the upper part of the calf, and because there are no pain fibers to pull on any longer, complete tears are relatively reasonable with pain. Obviously, partial tears have quicker recovery, but because the pain receptors are still relatively intact, it is not pleasant to walk.

Jason McVeigh, MS, PT, ATC, LAT, the Director of Sports Medicine for the University of Tennessee Volunteers, reports that Achilles tendon ruptures are a relatively uncommon sports injury in collegiate athletics resulting from an overload of the tendon to the point of rupture. As with most major injuries, the severity, location, and prior history of injury can influence the long term outcome. At times they may require a surgical repair and extensive rehabilitation, and athletes commonly are able to return to participation in sport.

Dr. Jeffrey Peterson, of Advanced Orthopaedics and Sports Medicine, explains that there are generally two treatment options for complete Achilles ruptures: Non-surgical cast immobilization for a minimum of 6-10 weeks or open surgical repair of the rupture. The main difference between the two is that the non-surgical group has a higher chance of re-rupture and patients may complain of less strength after treatment whereas the surgical group generally has a lower re-rupture risk but assumes the risks of surgery. In athletes, the surgical route is most common due to their activity level, while lower demand and older patients may be do well with the non-surgical path. Whichever route is taken the recovery time averages around 6 months and physical rehabilitation will usually be required.

The season for the Vols will go on, injuries are part of the game. Two weeks until the season opener!

Zach Sutton, DPT, MS, OCS