Symmetry Blog

Injury of the week - Ruptured Achilles

Symmetry Physio - Thursday, June 20, 2019

If you were watching the NBA Finals you will have seen Kevin Durant rupture his Achilles.

 

Injury of the week - Ruptured Achilles

Those who follow the NBA finals would have heard about the controversy surrounding the injury to star player Kevin Durant who ruptured his right Achilles tendon during the second quarter of game 5.

Kevin’s injury displayed a typical scenario seen with Achilles ruptures. He pushed of his right leg to manoeuvre around his opponent and fell to the floor clutching the back of his leg toward his heel.

Most people who have ruptured their Achilles will feel an immediate ‘pop’ or‘snap’ and describe it as getting shot or kicked in the back of the lower leg and often look behind them thinking someone was there.

What is a rupture


The Achilles is a strong tendon that attaches to the calf muscle to the heel bone. It is the largest tendon in the human body. When the calf muscle contracts it tightens the Achilles tendon and pulls on the heel which allows your toes to point down or plantar flex. This is the specific movement required during walking, running and jumping. When the Achilles tendon is stretched beyond its capacity it can rupture resulting in the inability to push off and point the foot. This can make standing and going onto tip toes difficult and lead to an inability to walk, jog or run. The severity of the rupture will depend upon how much the tendon is torn. The site of the tear is usually located approximately 5 cms above the heel. A partial rupture will present similar to a strain with some but not all fibres torn. A complete tear is more common than a partial tear and causes most of the tendon to tear and contract up. This results in a significant loss of strength, movement and normal function.

Symptoms

Most people will know they have injured their Achilles with a particular incident being described. Symptoms may include;

  • Immediate pain
  • Stiffness
  • Bruising
  • Inability or difficulty to walk or raise up on tip toes

Causes

Interestingly many people who rupture their Achilles do not have any prior Achilles pain or symptoms and males seem to suffer higher incidences (above 80%) of ruptures compared to females.

Degenerative tendons, diabetes, arthritic conditions, the use of medications including steroids and some antibiotics have been shown to increase the incidence of rupture.

Management

First 48-72 hours

  • RICER principles
  • No HARM principles
  • Crutches and boot/cast to provide tendon rest with heel support
  • Imaging such as ultrasound or MRI
  • Referral to an orthopaedic surgeon or sports physician depending on severity.

Recovery

Non athletes or those with low levels of general physical activity with lesser degree tears can successfully return to normal activities following an Achilles rupture with intensive physiotherapy and without surgery. Competitive athletes or those with high levels of physical activity will be likely offered surgery to enable the best chance for returning to their demanding sport and reduce the chance of re occurrence. Kevin Durant has already undergone surgery 2 days following his injury and his road to recovery has begun.  

Kevin will most likely miss next season as he embarks on his rehab and ensuring he is fully healed, fit and strong prior to returning. Recovery following an Achilles rupture can take 8-18 months depending on the demands required.

Most people will remain in a cast or boot for a minimum of 6 weeks then gradually allowed to weight bear and weaned slowly off heel support and out of the boot over a period of time dependant on the surgeons protocol.

Physiotherapy will focus initially on the complications associated with immobilisation such as muscle atrophy and ankle joint stiffness and guide the removal of heel support to assist with lengthening the tendon. Restoring strength and explosive movements of the calf muscle with a graduated loading and strengthening program is essential to progress to normal daily activities and your desired level of sport.

We wish Kevin Durant all the best in his recovery and return to the basketball court.

Kim Garland

Symmetry Physiotherapy


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