Now that soccer legend David Beckham has had surgery to repair the Achilles tendon he ruptured Sunday, all he has to do now is heal, and heal well. While his may be the most recent and notable case of a torn Achilles, the injury is not uncommon, especially among active types, including elite athletes and weekend warriors.
The Achilles tendon connects the back of the heel bone to the calf muscle and drives the foot off the ground. It can be vulnerable because a lot is required of it--in many sports, for example, the tendon is subjected to an enormous amount of stress from repetitive pounding, turning, running and jumping. That can lead to inflammation, pain, and even micro-tears. When those tears form scar tissue, the tendon becomes inflexible and can be extremely painful. Treatment usually includes rest, plus ultrasound or massage therapy to break up scar tissue. Low-level laser therapy is sometimes used to reduce inflammation.
In extreme cases, like Beckham's, the Achilles tendon can completely rupture. People often feel the tendon snap, followed by searing pain and an inability to walk on that leg.
What comes next is up to you and your doctor. Some cases are treated surgically, some non-surgically, with both typically involving a cast and/or functional brace that allows some ankle movement, followed by physical therapy. Neither treatment guarantees that the tendon won’t re-rupture, although surgery has a slight edge on that. So which is better?
A study presented at the American Academy of Orthopaedic Surgeons annual meeting in New Orleans last week showed little difference in outcomes from surgery versus non-surgery for a ruptured Achilles. In the study, done in Sweden, 100 people with ruptured Achilles tendons were randomly assigned to surgical or non-surgical treatments. All participants had a below-the-knee cast for two weeks, followed by an adjustable brace for six weeks, and had standard physical therapy. Symptoms and physical activity levels were measured using two scales.
The non-surgical group had six re-ruptures, while the surgical group had two, an insignificant difference, according to researchers. There were also no substantial differences in the participants' level of physical activity or in their symptoms and function during follow-ups at six and 12 months.
The group that had surgery did show more improvement in function at six months, but at 12 months the groups were neck and neck--save for one heel-rise test on which the surgery group did better. During the year-long follow-up both groups showed progress, but injured legs still had a reduction in function compared with uninjured legs.
Professional athletes are generally treated with surgery for an Achilles rupture, says Dr. David McAllister, professor of orthopedic surgery and chief of sports medicine at the David Geffen School of Medicine at UCLA. "The recovery is faster and the repair is likely to be more durable, and that's everything for a pro athlete."
Beckham will likely be able to play again after several months and a lot of rehab, McAllister added. Achilles ruptures are not always a career-ender--even for a weekend warrior. McAllister said many of his patients are middle-age men who play in recreational basketball leagues. "Even though they're not pros it's a big part of their existence," he says. "The vast majority get back to playing basketball."
David Beckham lies on the ground, with player Andrea Mantovani next to him at a match at San Siro Stadium in Milan, Italy, on Sunday. Photo credit: Damien Meyer/AFP/Getty Images