Tendons are fibrous connective tissue bands that connect muscles to bones and often surround and support joints. There are thousands of tendons in the human body and the Achilles tendon, that cord-like structure on the back of the heel, is the largest, as well as the strongest.
When the Achilles tendon is overstretched or repetitively injured to the point that there is a chronic partial or degeneration of the Achilles, surgery may be required to repair and debride the tendon. Often with chronic tears, there is calcification or bone spurs that form in the tendon. When there is significant degeneration of the tendon, or if the tendon had ruptured months prior, a reconstructive procedure such as a tendon transfer might be needed.
What Is the Achilles Tendon?
The Achilles tendon connects the muscles in the leg to the heel bone (the calcaneus) and is responsible for the foot being able to flex up and down. This flexibility is what enables us to walk, run, jump, climb stairs and many of our other daily activities. The strength of the Achilles tendon is seen in its ability to withstand not only repeated stress, but the force required for movements like running and jumping, which can be the equivalent of 10 times body weight.
Although the Achilles tendon is strong, it is also susceptible to injury. Strength and vulnerability give the Achilles tendon its name. Many will recognize Achilles as a well-known hero of mythology, whose mother was one of the gods but whose father was a mortal. Fearing that his mortal half would put him in danger, Achilles’ mother dipped him in the supposedly magical waters of the River Styx to make him invulnerable. Unfortunately, she held him by the heel, which meant the water wasn’t able to touch it. This led to his death during the Trojan Wars when his heel was pierced by a poisoned arrow.
We use the term “Achilles heel” to describe the weak point of an otherwise strong or powerful person. And, we name the strongest tendon in the body the “Achilles tendon”, because, while it routinely withstands forces equal to 10 times body weight, it is also a common site for injuries. Not just simple injuries, either, but those that can be extremely painful and immediately have a significant effect on mobility.
Achilles Tendon Chronic Tears or Degeneration
Causes and Risk Factors
Some of the more common causes and risk factors for Achilles tendon chronic tears include:
- Sudden pivot or change in direction
- Sports injury due to repetitive movement and injuries to tendon
- Excessive activity or overuse
- Running or exercising on a hard or uneven surface
- Prior injury
- Aging and just wear and tear
- Improper or poorly fitted shoes
- Underlying condition, such as diabetes or rheumatoid arthritis
Not everyone with Achilles tendon tears will have the same symptoms. The more common signs and symptoms include:
- Pain, often severe, accompanied by swelling in the heel area
- Soreness and stiffness in the heel area first thing in the morning when getting out of bed
- Difficulty in bending or flexing the foot
- Thickening of the tendon or bump at back of heel
- Pain at back of heel in shoes
Achilles Reconstruction with FHL Tendon Transfer
Achilles tendon repair can often be done by making an incision in the back of the lower area of the leg and repairing the tendon back together. In more extreme cases, where the injury was not adequately treated, where more than 50 percent of the tendon is degenerative, or when there are very large bone spurs, reconstruction surgery, which includes tendon transfer, may be needed.
The flexor hallucis longus (FHL) tendon, which is the tendon responsible for flexing the big toe, is commonly used in reconstruction surgery for the Achilles tendon. Originating in the fibula, the FHL runs down the leg and passes through the band of tendons in the back of the ankle on its way through the foot to the big toe. By transferring it to the back of the heel bone, the Achilles tendon attachment is strengthened.
The procedure is performed under regional anesthesia, with the patient positioned chest-down on the operating table. An incision is made in the back of the leg and the FHL tendon is repositioned to run through the damaged Achilles tendon and then attached to the heel bone.
Achilles Reconstruction Recovery
Full recovery from Achilles reconstruction surgery may take as long as six months. Initially, the patient will be in a cast for about a month and instructed to avoid placing weight on the foot. Physical therapy will typically be recommended for rebuilding strength and restoring function as quickly as possible.
Contact Dr. Hubbard Today to Schedule an Appointment For Achilles Reconstruction
If you are experiencing issues with your Achilles tendon, Dr. Christopher Hubbard has the experience and training to provide you with options designed specifically for you, to give you the very best potential for recovery. Contact our office today to get started on your treatment.