The Center for Podiatric Care and Sports Medicine

Weekend Warriors: Beware The Dreaded Achilles Rupture

Posted by on Wednesday, May 20th, 2015

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Matthew Mattison was training for his second Ironman in his hometown of Coeur D’Alene. He completed a rigorous workout with his professional triathlete friends — swimming, biking, and running. He recalls, “The day I ruptured my Achilles, I had done a solid 2.5 hour ride and right into a 12 mile run and then decided to go play in a men’s league basketball game.” He wasn’t thinking of how the basketball game would exert his already stretched and strained Achilles; he was thinking of tacking on a speed workout.

“Well, I didn’t make it very far,” Mattison continued. “Less than a minute into the game and a few times up and down the court, POP! A slight push off and my game and hopes of racing in June were over. I had no idea that was just the beginning of a long and emotional journey.”

This story is not at all uncommon at The Center for Podiatric Care and Sports Medicine in New York City, which specializes in the treatment of Achilles injuries, ruptures and tendinitis. We see a third of all Achilles ruptures in the spring, when our so-called “weekend warrior” patients emerge from their winter hibernation and attempt to make up for lost time.

achilles rupture
Sudden weekend training can cause Achilles ruptures, especially at the start of the warm weather season. Image Source: StFrancis-Shakopee.com

 Are You A Weekend Warrior?

“The weekend warrior is a well-recognized subset of orthopedic patient,” says the American Academy of Orthopaedic Surgeons. At one time, our weekend warriors were almost always male, but we’re seeing an increasing number of female patients doing Cross-Fit and race training as well. Definitions may vary, but it is generally agreed that the typical “weekend warrior” patient:

– Is over 30 years of age, but still in reasonably good shape

– May have participated in competitive sports in high school or college

– Has the internal drive to compete or push themselves to achieve health goals

– Exercises in concentrated bursts of vigor as the mood strikes, usually on the weekend

– Spends a longer duration of time exercising, trying to cram the recommended 150 minutes of physical activity into one session

– Participates in strenuous activities like aerobics, running 10Ks, mountain biking, Cross-Fit, racing, lifting, or playing basketball

“Physical expectations may remain high, despite a decrease in training,” explains Bryan D. Hartog MD, a surgeon at the University of South Dakota. “The mind may keep appointments the body can’t keep,” he adds. While many weekend warriors still imagine it’s possible to achieve the same level of training they sustained in high school or college, there is a marked decline in athletic performance that begins around age 35. It’s unclear exactly why the decline occurs — whether it’s due to natural aging processes or lifestyle changes — but it’s believed dietary deficiencies play a part.

Weekend warriors are most susceptible to Achilles injuries, says Dr. Steve Raikin, director of foot and ankle service at the Rothman Institute and professor of orthopedic surgery at Thomas Jefferson Medical College. “In the winter, people are much less active so the tendons tend to tighten,” he explains. “Like warming up your car in the morning, it is harder to get your body going. People tend to head out without stretching enough.”

How Do Achilles Ruptures Happen & How Are They Treated?

The Achilles tendon connects the heel of the foot to the calf muscles and is responsible for the push-off phase of gait. While it’s the largest and strongest tendon in the body, it can become compromised when the tendon is too tight or repeatedly torn bit by bit through intense exertion. Lots of jumping, sprinting, pushing off, squatting and twisting can injure the Achilles. In his most recent study, “Achilles Tendon Injuries in a United State Population,” Dr. Raikin and colleagues found that the most common sports associated with Achilles tendon ruptures included basketball, tennis, football, volleyball and soccer.

Often, athletes hear a tell-tale “popping” sound, indicating rupture. The pain is incapacitating and no weight can be placed on that foot once a complete tear has occurred. Patients have described the feeling as “someone stepping on the back of my ankle” or “being hit by a rock or arrow.” Calf pain and swelling are other common symptoms associated with this injury, say the doctors at The Center for Podiatric Care and Sports Medicine. Once the injury has occurred, you must get off your feet right away. Elevate the foot above the heart and place an ice pack on the injury to decrease swelling. Then call us at 212-996-1900 (Manhattan office) or 914-328-3400 (Westchester office) to be seen right away.

Surgery is necessary to repair the tendon and prevent re-rupture. We perform this surgery over the course of an hour and it is done as an outpatient treatment. We locally numb the area with a nerve block and suture the torn tendon ends back together through an open or minimally invasive method, depending on the precise nature of the injury. Whenever possible, we prefer to use smaller cuts to limit the risk of wound infection. Antibiotics are typically prescribed as well. The use of growth factors may be employed to speed healing.

Immediately after surgery, you’ll go into a cast, which then transitions into a walking boot with a heel wedge, finally graduating to physical therapy rehabilitation, which we are equipped to do here, at our office. It can take six months to a year to regain full strength again, but some elite athletes can often resume some type of training after three months.

How Are Achilles Injuries Prevented?

Stretching is the most important action you can take to prevent Achilles injuries — not just in your heel, but in your calves as well. We’re not talking about a five minute stretch right before a game or a run — but rather, 5 minutes of stretching 3-4 times a day, whether you’re rigorously exercising or not. The two best stretches are:

The Runner’s Stretch: Standing facing a wall, put your right foot forward and lower down into a lunge. Place your hands against a wall and lean forward. Switch sides.

– The Achilles Stretch: Stand with your resting leg on a step, with the stretching leg hanging halfway off the step. Slowly lean back onto your stretching leg, pushing the heel downward for 10-20 seconds. Alternate sides.

Cross-training is also an important prevention strategy. Add low-impact swimming, recumbent biking, elliptical training, and walking into your schedule. Avoid hill running and jumping activities as much as possible. Increase intensity in duration, intensity, and frequency by no more than 10% from week to week. Training with a board-certified podiatrist and sports medicine doctor is another way to ensure you don’t injure yourself again. Contact The Center for Podiatric Care and Sports Medicine to address acute Achilles rupture, as well as chronic pain issues associated with the Achilles tendon.

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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.