After his
Achilles tendon rupture last October,
Ryan Howard was on track to rejoin the
Philadelphia Phillies this May but a serious infection near the healing tendon required surgery, putting off the first baseman's return for a while longer.
The Phillies told Howard to rest and he has not been seen at the team's complex. There is no estimate as to when he will return to practice.
"We immobilized him," Amaro said, "just because our main priority is to get the infection out of there." Amaro added that Howard is taking a strong dose of antibiotics to remove the infection, which can take anywhere from 7 to 10 days to leave his body.
An Achilles tendon rupture like Howard had is serious business.
A tendon is a band of tissue that connects a muscle to a bone. The
Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the "heel cord," the Achilles tendon facilitates walking by helping to raise the heel off the ground.
An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause the tear. An injury to the tendon can also result from falling or tripping.
Achilles tendon ruptures are most often seen in "weekend warriors"- typically middle-aged people participating in sports in their spare time. Less commonly, illness or medication, such as steroids (hmm...) or certain antibiotics, may weaken the tendon and contribute to ruptures.
A person with a ruptured Achilles tendon may experience one or more of the following:
- Sudden pain (which feels like a kick or a stab) in the back of the calf or ankle- often subsiding into a dull ache.
- A popping or snapping sensation.
- Swelling on the back of the leg between the heel and the calf.
- Difficulty walking (especially uphill or upstairs) and difficulty rising up on the toes.
These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the R.I.C.E. method should be used (Rest, ice, compression, and elevation).
In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes.
The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases however, the surgeon may order a
MRI or other advanced imaging tests.
Treatment options for an Achilles tendon rupture include surgical and nonsurgical approaches. The decision of whether to proceed with surgery or nonsurgical treatment is based on the severity of the rupture and the patient's health status and activity level.
Nonsurgical treatment, which is generally associated with a higher rate of re-rupture, is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. Nonsurgical treatment requires the use of a cast, walking boot, or brace to restrict motion and allow the
torn tendon to heal.
Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient's push-off strength and improves muscle function and movement of the ankle.
Various surgical techniques are available to repair the rupture. The surgeon will select the best procedure suited to the patient.
Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weight-bearing.
Complications such as incision-healing difficulties, re-rupture of the tendon or nerve pain can arise after surgery.
Whether an Achilles tendon rupture has been treated surgically or nonsurgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve the range of motion of the foot and ankle.
Craig M. Kaufman, DPM
Sports Podiatrist in CT
Podiatrist in Newington, Kensington, and Middletown CT
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