The Center for Podiatric Care and Sports Medicine

NBA News: Achilles Tendon Recovery Slow for Timberwolves’ Pekovic After Surgery

Posted by on Wednesday, November 25th, 2015

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At the end of last month, it was estimated that the Timberwolves’ Nikola Pekovic could be out at least another month after Achilles tendon surgery.1http://www.cbssports.com/fantasy/basketball/news/timberwolves-nikola-pekovic-could-be-out-another-month/ While he was able to “start doing some workouts” — including core work, medicine ball tosses and light activity — he was still unable to participate in practices or basketball-related training. Even though it has been more than six months since his April surgery, Pekovic is still relegated to the sidelines. “They said everything went fine,” Pekovic said, adding, “but I’m always saying I don’t believe anything until I start running.”

achilles tendon recovery
Nikola Pekovic may be off the MN Timberwlves roster permanently if his Achilles keeps acting up. Image Source: Flickr CC user Michael Tipton

What Happened to Nikola Pekovic?

Nikola Pekovic has struggled with foot and ankle problems for the better part of three years. In 2012, he had surgery to remove bone spurs from his ankle. He’s only played 31 games this season and was limited to 54 games last season due to the pain. “Every step was painful,” he recalled.2http://www.startribune.com/excuse-pek-if-he-has-doubts/330028121/ Though the pain was alleviated in that specific area after bone spur removal, Pekovic began to suffer pain in other areas and doctors told him he’d be dealing with “general soreness” for up to a year.

Things have only gotten worse. Pekovic explained, “It’s really tough, when you try to do everything, for like a year, and nothing helps you and you get to the point where you have to sit. But you have to deal with it, that’s all.” Cleaning up the tissue surgically was seen as the last resort.3http://www.startribune.com/pekovic-calls-pending-foot-surgery-the-last-thing-i-can-try/298604691/

What Is Achilles Debridement Like?

His April Achilles debridement and repair was done by Dr. Bob Anderson, a well-known Charlotte foot surgeon. During the procedure, Pekovic was placed under anesthesia and positioned face down on the operating table while an 8 cm vertical incision was made up his heel bone.4http://www.dailymail.co.uk/health/article-101363/A-surgeon-describes-achilles-tendon-operation.html#ixzz3pyRDjQc9 The skin, fat layers, and thickened paratenon sheath were opened to reveal the thickened, abnormal tendon beneath. A healthy tendon appears slightly yellow and almost rope-like, while damaged tendons appear white, thick, and have lost their sheen. The tendon is sliced and peeled open like the pages of a book. Soft, inflamed tissue and fluid-filled cysts are then scooped out using a curette. The tendon is folded back into place and reattached with strong nylon sutures.

Patients may spend a night or two in the hospital to ensure that there are no complications and to make it easier for the patient’s foot to remain elevated. Pekovic spent a month in a cast and another two months in an immobilizing boot, and he’s been nursing his limp with crutches ever since. While he’d like to be running in a couple of weeks and playing basketball in December, it’s not uncommon for this type of procedure to heal over the course of 12 months and the Star Tribune has reported that the injury could very well be “career-threatening.”5http://www.startribune.com/wolves-pekovic-to-undergo-achilles-surgery-next-week/298509901/ Understandably, Pekovic is worried about much more than just basketball. “I’m pretty much worrying about how this is going to affect my life in 10 years,” he said.

Why Is Achilles Tendon Recovery So Difficult?

By its very nature, the Achilles tendon is a particularly troublesome spot to injure. As the largest tendon in the body, the Achilles absorbs a tremendous amount of force during activities like jumping, propulsion, and heel lifting. Katja Heinemeier, PhD, from the Institute of Sports Medicine Copenhagen, explains: “The Achilles tendon carries the highest load. During normal movement, it comes closest to the maximum load that the tendon can tolerate without breaking.”

Not only that, but the Achilles tendon is more prone to injury from repetitive strain because it does not have as good a blood and oxygen supply or ability to heal itself as other tendons in the body. According to recent research, the Achilles tissue doesn’t undergo processes of renewal over time — meaning that the tendon you have at 17 is the same tendon you’ve got at 47.6http://www.prevention.com/fitness/fitness-tips/achilles-injuries-rarely-heal

Once the injury starts to develop, complications like tendon degeneration and scar tissue formation (Achilles tendonosis) are common. Scar tissue formation begins as soon as a week after the initial injury. Many of the cases we see are much older than this and have been ignored by patients until the pain becomes intolerable. Once chronic inflammation, tendon degeneration, and scar tissue formation has occurred, the likelihood of suffering a complete rupture is very high.

On top of all that, our knowledge about the Achilles tendon is still evolving, despite being a heavily studied area of sports medicine research. As Podiatry Today puts it: ” While the treatment of Achilles tendinosis continues to expand and evolve, there are few scientifically proven methods.”7http://www.podiatrytoday.com/article/6184#sthash.2Yvb2AHY.dpuf Unfortunately, most interventions are dependent upon “the surgeon’s personal experience and philosophy,” with few proven standards of care for successful tendon recovery.

Achilles Tendon Recovery and Treatment in NYC

The Center for Podiatric Care and Sports Medicine offices in Manhattan and Westchester, NY are a great resource for local athletes and active individuals suffering from Achilles pain in the back of the heel and ankle. We offer the latest non-invasive therapies for pain relief and tendon repair, including extracorporeal shockwave and injection therapies. We can help you find the right immobilizing brace, take the proper recovery measures at home, and complete physical therapy to enhance range of motion. If your tendon issue does not resolve within six months of conventional therapy or if feel you have suffered far too long, our experienced, board-certified podiatric surgeons are happy to help. Contact us to learn more about expert-level care from our team of sports medicine specialists.

 

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1. http://www.cbssports.com/fantasy/basketball/news/timberwolves-nikola-pekovic-could-be-out-another-month/
2. http://www.startribune.com/excuse-pek-if-he-has-doubts/330028121/
3. http://www.startribune.com/pekovic-calls-pending-foot-surgery-the-last-thing-i-can-try/298604691/
4. http://www.dailymail.co.uk/health/article-101363/A-surgeon-describes-achilles-tendon-operation.html#ixzz3pyRDjQc9
5. http://www.startribune.com/wolves-pekovic-to-undergo-achilles-surgery-next-week/298509901/
6. http://www.prevention.com/fitness/fitness-tips/achilles-injuries-rarely-heal
7. http://www.podiatrytoday.com/article/6184#sthash.2Yvb2AHY.dpuf

If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.