Submitted By David A. Porter M.D. PhD.
09.03.2009

The Achilles tendon is named after the ancient warrior Achilles who fought in the Trojan War. According to legend, he was dipped in the protective waters of the river Styx by his mother, who held him by the heels. Therefore, it was rumored he could only be killed by a blow to his heel, which makes it appropriate that he would share his name with this tough, essential tendon.

The tendon connects the bone of the heel to the muscle of the calf, which makes it important when pushing off of the foot. Injury to the Achilles tendon is most commonly seen in athletes between the ages of 30 and 55, but younger competitive athletes can injure this tendon as well.

A common and potentially devastating injury to the Achilles occurs when the tendon ruptures (tears completely) after it has become progressively tighter overtime and with activity. Many patients feel a “pop” when this occurs and sometimes feel as though they’ve been “kicked in the leg” or “shot in the heel”, and observe mild to moderate swelling over the tendon with an inability to continue with their sport or activity.

An Achilles injury can be treated either with surgery or with prolonged immobilization in a boot or cast. With immobilization there is a 12-14 percent chance of re-rupture, and patients usually regain about 60-80 percent of their original strength. However, the preferred method of treatment for the active athlete is surgical repair. Surgery offers patients an 80-100 percent chance of regaining their original strength and only has a two percent chance of re-injury. Surgery also decreases a patient’s recovery time, allowing them to return to their daily activities and chosen sport quicker.

Through our research we have discovered several interesting facts about surgical treatment of the Achilles tendon. Although patients regained 85-95 percent of their former strength one year after surgery, the calf muscle of the operative leg was up to two centimeters smaller in circumference than before the injury.  This could be because the patient favors the operative leg after injury. Also, there is a higher rate of tendon rupture in the other leg (5-10 percent) than there is of re-rupture in the repaired leg (two percent), which could also be caused by slight overworking of the uninjured leg in favor of the operative leg. These discoveries emphasize the need for equal strength recovery in both limbs during postoperative therapy.

Happily, the treatment of Achilles ruptures has progressed through the years, so that the injury is not quite as menacing as the warrior who gave the tendon its name.