The Achilles tendons, which get their name from the mythological Greek hero whose lone weakness was in his heel, are the largest and strongest tendons in the body. On average, they are approximately 6 inches long and 5 millimeters thick. The Achilles is extremely important in walking, running, and jumping. Connecting the heel bones to the calf muscles at the back of the ankle, the Achilles tendons are strong enough to withstand the force of up to 1,100 pounds.
Achilles tendons are made up of strong fibrous tissue, but this tissue does not have the greatest blood supply and that is why they are predisposed to injury and rupture.
But overstretching or straining can result in a torn tendon. Achilles tendon tears are typically classified as follows:
- Partial tear, in which some of the tendon fibers remain connected
- Compete tear, in which the tendon ruptures and all the fibers disconnect from each other
Why does recovery take so long?
Unlike muscle tissue, tendons don’t get a significant supply of blood. Blood delivers fluid and nutrients that are essential for healing.
The less blood delivered, the longer it takes for tissue to heal. Add to that the sheer size of the Achilles tendon, and you’re in for a lengthy recovery. Even for professional athletes these are usually season-ending injuries, and in some cases career-ending injuries.
With a tear or rupture, you'll likely be out of commission for at least one season of your sport of choice. Even walking will be difficult, if it's possible at all, for several weeks during initial recovery.
Your treatment plan will depend on many factors, including the severity of the injury. The non-surgical approach involves keeping the foot and ankle flexed downward with a boot or cast, followed by physical therapy. The goal would be for the tear to heal itself. However, many cases require surgery for proper healing.
What happens in Achilles tendon repair surgery?
Surgical repair is usually an outpatient procedure followed by several weeks of protection in a cast or boot. Physical therapy and exercises may begin as soon as the surgical incision is healed.
You will be placed under anesthesia to sleep through the surgery. The surgeon will open the skin of the calf and back of the ankle. In some cases, minimally invasive or percutaneous repair through small incisions can be used. In other cases, an incision of about three to four inches may be necessary.
During the procedure, the surgeon will open the sheath of tissue around the tendon and remove damaged tissue. Then, they will repair the tear. If the tear is significant, the surgeon might remove a small piece of tendon from elsewhere in your foot and use it to replace a portion of the Achilles tendon. Then, the surgeon will close the incision with sutures. Most patients can return home the same day.
With surgical or nonsurgical treatment, you likely will be walking normally in about three months. Physical therapy will focus on regaining strength in the leg and tendon, as well as increasing flexibility so you can safely perform more explosive athletic maneuvers such as running, jumping, or pivoting.
