There you are – out on the tennis court playing in a tough match to clinch your USTA League season and advance to Mid-Atlantic League Regionals. You’re playing tough and your opponent is starting to catch fire too. They hit a burner down the line and you lunge for the ball when – bang – out of nowhere you start experiencing searing pain in the back of the leg.
Greetings USTA Mid- Atlantic members. My name is Dr. Blake Moore with Atlantic Orthopaedic Specialists in Virginia Beach, VA. What I’ve just described is injuries to the Achilles tendon – everything from tendonitis to the dreaded Achilles tendon rupture.
Tendonitis is a term that indicates an overuse phenomenon where the tendon becomes inflamed and irritated in an attempt to heal itself. When this occurs in the Achilles tendon it can cause pain with every step and significantly restrict extracurricular activities. Some people will even go on to develop a form of Achilles tendonitis which appears as small amounts of bone growth in the Achilles tendon that can be seen on x-ray. This typically occurs following a long duration of these symptoms. The most extreme of Achilles injuries is those who report an Achilles tendon rupture. A rupture is where the tendon actually “pops” and fails. Following this type of explosive injury there is commonly a notable gap, often palpable, where there was once a strong connection from the calf muscle to the heel bone where the Achilles inserts.
Tendon disorders comprise 30 to 50 percent of all activity related injuries.1 Yet, Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. Current research suggests that there is a significant correlation between the prevalence of Achilles tendonitis and those who suffer from other diseases such as obesity, hypertension, and steroid use.2
Now, I mentioned Achilles tendon ruptures. The Achilles tendon is the largest, strongest tendon in the body and is critical for climbing, running and explosive movements which you often use on the tennis court. It’s necessary for anything from serving a tennis ball to carrying groceries up the stairs. The Achilles tendon can rupture for multiple reasons including injuries, medications, or biomechanical malalignment, and typically occurs when the Achilles tendon is stretched in a traumatic fashion. Patients frequently report a sudden “pop” and a sensation of someone kicking them in the back of the leg with no one there.
What can be done for Achilles Injury?
Achilles tendon ruptures can be treated either operatively or non-operatively if caught early and treated appropriately following time of injury. Non-operative treatment typically includes casting and physical therapy whereas surgical treatment aims to reattach the tendon and restore function. Many people are shocked to hear that research shows outcomes are essentially the same regardless of treatment plan. Recovery after an Achilles tendon rupture is possible! A recent study revealed that 70% of NFL, MLB and NBA players returned to participation in the following season after surgical treatment.3
Most patients see a dramatic decrease in their symptoms following the completion of a conservative care protocol – treatments that avoid invasive measures. Many who experience Achilles tendonitis related symptoms improve with a home stretching program and 6-8 weeks of physical therapy once their acute symptoms subside.
It is not uncommon when I see patients with debilitating/severe symptoms for me to place patients in a walking boot with a heel lift to immobilize, and minimize the tension on the Achilles tendon. This can often decrease pain and discomfort and get patients back to activity such as tennis quicker.
For those who do not feel significant symptomatic relief there is evidence to suggest benefits from platelet rich plasma injections and extracorporeal shockwave therapy which is a non-surgical and non-invasive treatment that uses shock wave outside the body to stimulate healing.
As a last result, if all conservative efforts fail, there is an operative procedure that can be performed. Naturally, as with any operation this requires significant time away from tennis and downtime during recovery so it is avoided at all costs.
If you or someone on your tennis team or at your tennis club is suffering from nagging ankle pain or suffers a sudden injury, we at Atlantic Orthopaedic Specialists are here for you. Please email my Athletic Trainer, Riley Fontaine, MSAT, ATC, OTC at FontaineR@atlanticortho.com and we will be glad to get you an appointment!
Dr. Blake Moore is an Orthopaedic surgeon who specializes in foot and ankle injuries. He is a physician with Atlantic Orthopaedic Specialists in Virginia Beach, Va. AOS provides Athletic Trainers for several USTA Mid-Atlantic Regional, Sectional and other tennis events.
1. Nicola Maffulli, MS, MS, PhD, FRCS(orth), et al (2003). Types and epidemiology of Tendiopathy. Clin. Sports Med, 22, 675-692.
2. Robert J. de Vos, MD (2010, January 13). Platelet-Rich plasma injection for chronic Achilles Tendinopathy. JAMA, volume 303, 142-149.
3. Trofa, David P., et al. “Professional Athletes’ Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture.” The American Journal of Sports Medicine (2017): 0363546517713001.)