Talking Achilles Tendon Ruptures with Dr. Geoff Watson – Facebook Live

Dr. Watson, Tell Us A Little Bit About Yourself And What Specialties You See Here At Bone And Joint Institute:

Dr. Geoff Watson: My name is Geoff Watson. I’m a Tennessee native, grew up in East Tennessee. I went through training in orthopaedics and did a five-year residency in orthopaedic surgery and then did a one-year fellowship in foot and ankle at the Hospital for Special Surgery in Manhattan. Achilles ruptures are sort of a topic near and dear to my heart – my dad actually had an Achilles rupture as I first began residency and was in Knoxville and actually had a missed Achilles. The first physician he said did not recognized that and thought it was just an ankle sprain so it took him about six weeks to kind of get that figured out. That [basically] gave him about a 50 percent longer recovery and a bigger surgery to correct that later on. So I can certainly see first-hand how an Achilles [injury] can keep you down and it’s important to diagnose them on the front end to help to get you back to doing the things you want to do on a quicker recovery schedule.

What exactly is an Achilles rupture? Can you tell us where it is and how does it happen?

Dr. Watson: The anatomy of the back of the leg from your knee down, you have two muscles that connect to the Achilles – both the gastrocnemius, which has two parts, and then the soleus, which has one part attached to the Achilles tendon. The calf muscle that you think about, that’s the gastroc, and then those both attach to your heal bone, or your calcaneus, and they help to function for push-off like running, jumping, any high-level activity, generally the Achilles is required to do that motion.

Is there any particular population that Achilles ruptures occur in the most, or is it across the board?

Dr. Watson: So there’s a few factors that contribute to that. The classic is a weekend warrior, somebody like myself – mid-30s or 40s who likes to workout only on the weekend, doesn’t have time to through the work week. So with that, you kind of get these quick bursts in short intervals over the weekend and that’s the biggest risk factor for having an Achilles rupture. The other things that can go along with that, antibiotic use like fluoroquinolones have a risk for that, and also steroid injections into the Achilles, we strongly recommend against because they have a high risk of rupture.

When someone comes into your clinic, how do you diagnose an Achilles rupture?

Dr. Watson: There’s a few simple ways. One is called the Thompson Test, which involves you laying on your belly with your feet usually hanging off the bed. You would squeeze the calf and you would usually see the foot plantar flexor go down. If that doesn’t happen, we’re worried about an Achilles rupture and may consider getting an MRI eventually. The other way is simply again laying on your belly and then bending your knees up so that your feet are kind of hanging there. Generally the foot will have what’s called resting tension, so your foot will be pointed toward the sky. If you have an Achilles rupture, it will generally droop down. That means the Achilles does not have tension to it, it’s not connected anymore and it’s allowing that to happen. So those are the two most common ways we visualize that.

If a patient thinks they have a rupture, is there any common feeling they describe it as?

Dr. Watson: Historically, it’s usually very similar from patient to patient. It’s usually “I thought someone kicked me in the back of the leg and you turn around and nobody is there.” It’s basketball, tennis, all those when you’re planting seems to be when it happens more often than a quick-burst activity but that can generally still happen. In fact, there’s a pretty good video if you remember when Kevin Durant tore his Achilles, you can actually see the muscle kind of go in one of the slow motion videos, which is actually maybe a little bit much for some but kind of fun for people like us [doctors].

Treatment of an Achilles rupture, is it always surgical or are there options there?

Dr. Watson: Traditionally we would always fix these and traditionally there was a pretty decent rate of infection up to five percent. There’s certainly been a lot of research, particular in Europe and Canada, that have sort of suggested that non-surgical treatment is very effective if you’re trying to get to an activity level of walking around. So it’s usually a pretty effective way to get somebody healed but it requires that patient to be seen within 48 to 72 hours, but certainly within two days is probably best. We have a lot of our urgent care clinics that are open, there’s a lot of accessibility to our clinic in general so I do think it’s important if there is a suspicion to get it looked at quickly because if that doesn’t get caught early on, then your risk of re-rupture is much higher and we don’t want to do this again.

When we do treat them surgically, it’s generally to get them back to some higher level activity. That’s a big factor in the way we consider this. So if you’re someone who’s very active, whether you run, jump, anything like that, then that’s when we’re talking about surgery.

Can you go into a little bit about the surgery and what exactly you would do during the procedure?

Dr. Watson: So the basics of it are you’re trying to reset the tension. So basically, the tendon is torn and the calf muscle still works so it pulls the tendon apart. So what we want to do it put those tendons back together. Generally speaking, it’s putting a suture in both ends of the tendon to basically tie them back together at the same tension. So restoring the tension is the main goal of surgery.

We used to do that through a big, open incision and there are some occasional time you have to do that still, but now we’ve had a newer innovation with percutaneous, or a small incision that ends up being about an inch long. But we have a device we can track underneath the skin and put a suture through the tendon and then pull that suture back out and do that above and below. That allows us to reset the tension through a smaller incision and decrease our chance of wound-healing problems.

After Achilles surgical or non-surgical options, is physical therapy key in this?

Dr. Watson: It’s probably just as important as the surgery, and that’s coming from a surgeon. Therapy is huge because it’s quite surprising how quickly you can lose that muscle mass. Even just a few weeks in a boot, you can really lose some of your muscle mass and gaining that back can sometimes take six to nine months. That’s usually a big portion of recovery is gaining that muscle mass back. Therapy, whether you’re doing it on your own or self-directed or with care of a physical therapist, which is usually what we do on the beginning side for sure, it is very important and very helpful in getting you back to doing the things you want to do.

Are there any ways to prevent an Achilles rupture?

Dr. Watson We always think of that as sort of like a little daily hygiene just like you brush your teeth twice a day, maybe, hopefully. You can also stretch your Achilles at the same time. Some people will have a stool in their bathroom, while they’re brushing their teeth they can hang their foot off the edge and stretch the Achilles and that’s pretty effective. Just sort of maintaining whatever quality of exercise you do throughout the week can also be helpful.

Describe the comprehensiveness Bone and Joint Institute of Tennessee offers patients going through an Achilles injury.

Dr. Watson It just keeps it all consolidated, so the open lines of communication for all of our different parts are very easy. It’s simply, we all have each others’ phone numbers, we just pick the phone up and call the therapist or whoever is running the urgent care or one of the physician assistants. That’s what gives us an advantage over some of the other groups.

To watch the full segment with Dr. Watson from Facebook Live, click here.

If you have any questions about osteoporosis or want to schedule an appointment, give us a call at (615) 791-2630 or schedule an appointment by clicking here.