Achilles Tendon Injury

The Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to the heel bone. It is a vital structure for walking, running, and jumping. Accordingly, the Achilles tendon can rupture in elite or recreational athletes participating in sports that involve these movement patterns.

Orthopedic Surgeon and Sports Medicine specialist, Dr. Jonathan Koscso, successfully diagnoses and treats patients in Sarasota, FL and the surrounding Gulf Coast region who have experienced an Achilles tendon injury.

Symptoms of an Achilles Tendon Rupture

When the Achilles tendon ruptures, you will experience severe pain in the back of your leg above your heel, swelling, stiffness, and difficulty standing on tiptoe and moving the leg when walking. A popping or snapping sound is often heard when the injury occurs.

To diagnose an Achilles tendon rupture, Dr. Koscso will perform a comprehensive medical history including details surrounding the injury as well as a physical exam of the involved leg. Often, the injured leg may have a palpable gap or depression in the tendon just above the heel bone. Additionally, squeezing of the calf muscle belly may not cause any resultant movement of the foot (compared to the uninjured leg where calf compression typically causes the foot to flex downwards). Depending on the history or exam, Dr. Koscso may obtain radiographs and/or an MRI of the leg to characterize the extent of the injury.

Non-Surgical Treatment

Achilles tendon ruptures can be treated using non-surgical methods or with surgery to repair the tendon. Non-surgical treatment begins with pain relieving measures such as icing of the involved leg as well as anti-inflammatory medication such as ibuprofen, naproxen, or meloxicam, etc. To properly immobilize the leg to allow for healing, patients must wear a cast or specialized brace which lifts the heel. This immobilization protocol lasts several weeks with a gradual increase in ankle motion during that time. Most importantly, patients progress through a focused physical therapy protocol to optimize strength and minimize the potential for re-tearing of the tendon.

Surgical Treatment

Surgical repair of a ruptured Achilles tendon involves opening the skin and suturing the torn tendon edges together. Postoperatively, patients are placed in a splint to immobilize the leg to allow for early healing. This is then transitioned to a specialized brace with a heel-lift along with the initiation of a specialized physical therapy protocol to optimize motion and strength of the ankle. Surgery can help to decrease the recurrence of the Achilles tendon in comparison to the non-surgical treatment, and therefore it is often our recommended treatment in elite and recreational athletes. Nonetheless, with either treatment, a focused physical therapy regimen is paramount to improve the strength and flexibility of the leg muscles and the Achilles tendon.

Graphic representation of an Achilles tendon repair through a minimally-invasive approach with multiple sutures passed through the tendon edges which are then tied to secure the repair.

Post-Operative Recovery

For a comprehensive reading of the expected post-operative recovery, including restrictions, physical therapy progressions, and return to work/sport guidelines after Achilles tendon repair or injuries that are treated nonoperatively, please see our corresponding protocol on our physical therapy protocols page. Note that there are different protocols depending on whether or not surgery was performed.

About the Author

Dr. Jonathan Koscso is an orthopedic surgeon and sports medicine specialist at Kennedy-White Orthopaedic Center in Sarasota, FL. Dr. Koscso treats a vast spectrum of sports conditions, including shoulder, elbow, knee, and ankle disorders. Dr. Koscso was educated at the University of South Florida and the USF Morsani College of Medicine, followed by orthopedic surgery residency at Washington University in St. Louis/Barnes-Jewish Hospital and sports medicine & shoulder surgery fellowship at the Hospital for Special Surgery in New York City, the consistent #1 orthopaedic hospital as ranked by U.S. News & World Report. He has been a team physician for the New York Mets, Iona College Athletics, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Jonathan Koscso and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Jonathan Koscso for your specific case, we recommend contacting our office to make an appointment.