(Warning: Graphic surgical pictures!)
I recently penned a FanPost about some fighters recovering from various injuries. One of those is Marcus Brimage, who in late May suffered a torn Achilles tendon tear while training. He had surgery in early June to repair the damage. His manager expects Brimage to be out for a six-to-nine month time frame. From the comments on that post, it seems that there are a few MMA fans who have some experience with Achilles injuries, so I thought I would give a little more information about surgery for this injury.
Achilles was the Greek hero of the Trojan war. His mother Thetis was a nymph who tried to make him immortal by dipping him in the river Styx. He was left vulnerable at his heel, since this was the part of his body where she held him as she dipped him in the river. Achilles was killed by a poisoned arrow fired into his heel. This is how one's weakest point has come to be described as their "Achilles heel".
The Achilles tendon is at the back of the lower leg and attaches the calf muscles to the back side of the heel bone. In younger people, Achilles tears usually occur during some type of sport activity, such as jumping, or with excessive, forceful stretching of the tendon. (Here is a video of NBA player Chauncey Billups tearing his left Achilles. The tear was the result of a forceful stretch as he went to change directions. The injury occurs at the 0:21 mark.)
With regard to vulnerability to Achilles tears, younger men have something in common with older women. Tears typically occur in males aged 30-40 years, and in females aged 60-80 years. The typical tearing point of the tendon is about 3/4" to about 3" up from the tendon's attachment on the heel. This area of the tendon does not have a rich blood supply (ie, it is poorly vascularized). The picture below is from surgery on a ruptured Achilles. You can see the two ends of the torn tendon outlined in black, and the gap indicated by the arrow.
Here is a video of a surgeon performing an Achilles repair on an athlete. (Warning: Graphic!) In this screen capture from that video (below), note how the surgical team is holding the foot in a downward, or plantarflexed position.
To help orient you, the arrow in this picture points toward the location of the toes. The foot is held in a plantarflexed position to help bring the two torn ends of the tendon closer together during the repair.
Dr. Robert Klapper, an orthopedic surgeon in California, has posted some awesome Tweets over the past few months about Kobe Bryant's Achilles tendon repair. In one of them, he notes the reason for shortening the tendon during surgery.
In Achilles Surgery we intentionally shorten the length on the tendon just slightly. This insures solid contact of overlap scar formation— Dr. Robert Klapper (@DrRobertKlapper) June 22, 2013
Following the repair, the the traditional method of protecting the tendon was for the foot to be immobilized for 6-8 weeks, with no weight bearing on the foot. However, good research now points to favorable outcomes with early weight bearing, possibly within the first two weeks. In this instance, one will wear the immobilizer boot or splint with the foot positioned in a plantarflexed (or downward) orientation to reduce tension on the Achilles. Early weight bearing can help to prevent muscle atrophy not only of the calf muscles, but the muscles of the entire leg in general. This can pay big dividends for the MMA athlete in later rehab phases.
In a future post, I will review some rehab considerations following Achilles repair.
1. Kearney, RS, McGuinness, KR et al. A systematic review of early rehabilitation methods following a rupture of the Achilles tendon. Physiotherapy 2012;98(1):24-32.
2. Hess, GW. Achilles tendon rupture: A review of etiology, population, anatomy, risk factors and injury prevention. Foot Ankle Spec 2010;3(1):29-32.
3. Strom, AC, Casillas, MM. Achilles tendon rehabilitation. Foot Ankle Clin N Am 2009;14:773-782.