Achilles Tendon Injuries and Ruptures In Basketball

 

Achilles tendon injuries and ruptures are common, can be quite disabling to an athlete, and full recovery of this injury is often lengthy.

The Achilles tendon is a strong, large, strap-like tissue that connects the two calf muscles to the heel bone, allowing the leg to flex the foot downward.  Without this tendon, the foot would uncontrollably flop upward during the walking cycle.  Ruptures and simple injuries can occur for a wide variety of reasons.  The constant rotational force on the ankle from side to side and quick stopping and cutting movement creates strain on the Achilles tendon.  This ongoing action gradually leads to tendon degeneration (tendonitis), and the potential for rupturing.  Tightness of the tendon can lead to strain as the body weight forces the tight fibers to stretch beyond what they are easily capable of. Ruptures can occur when degenerative tendon tissue is keeps getting damaged further, and in athletes more commonly when the foot is flexed upward forcibly while one is pushing downward or sometimes when the back of the heel is forcibly kicked or stepped on.

The symptoms of Achilles tendonitis usually consist of a sharp pain to the back of the heel or just above it, and a dull achy pain can be felt as well when not active.  The pain increases as the foot is stretched upwards, and feels lessened when the foot is stretched downward.  Achilles tendon pain tends to be especially worse after trying to flex the foot upward after a period of inactivity when the tendon stiffens further.  Furthermore, the tendon can be painful when direct pressure is applied to it, even if that pressure is simply from the back of a shoe. The tendon can also feel enlarged and lumpy to the touch where it is inflamed and damaged.  Often athletes typically play through the pain; the damage of untreated tendonitis can worsen and eventually lead to a higher chance for rupturing.

Ruptures typically occur at a place above the heel bone where there is poor blood flow to the tendon tissue.  A rupture will feel sharp and stabbing, and often a pop or snap is heard.  The calf can feel like it has been hit from behind.  Walking is extremely difficult, and after the rupture the ability to rise up on the toes is lost.  The back of the heel can become swollen and bruised, and there may be an indentation in the heel where the Achilles tendon rupture has formed a gap.

Treatment of Achilles tendonitis involves reducing the inflammation, stabilizing the tendon so it can heal, and mobilizing the tendon to prevent future injury.  Inflammation can be reduced by anti-inflammatory medications, icing, and rest.  The tendon is typically stabilized by employing a high quality ankle brace to resist excessive ankle motion.  This is typically worn during all activity, including at home.  At the same time, the Achilles tendon needs gentle mobilization to increase its flexibility and reduce the potential for strain.  This is accomplished through stretching exercises, although physical therapy is sometimes needed.  Severe cases of tendonitis may need surgery to repair the tendon or stimulate it to heal.

Treatment of Achilles ruptures in athletes usually requires surgery to repair the severed ends of the tendon together.  The sooner the repair can take place, the easier the tendon ends will heal together.  Lengthy delays in repair, especially those months in duration, will often lead to scar tissue, tendon degeneration, and a widening of the gap between the severed tendon ends.  This makes repair very difficult.  Once the ends are stitched together, the foot is held in place within a cast for four to six weeks as the tendon heals.  Physical therapy is usually started soon afterwards to restore strength and flexibility. 

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