Another week has gone by in the NFL and another franchise quarterback has suffered a ruptured Achilles that will force him out for the season. In week 1, 39-year-old Aaron Rodgers suffered a ruptured Achilles and this week it was 35-year-old Kirk Cousins of the Minnesota Vikings that has suffered a ruptured Achilles.
Following Rodgers ruptured Achilles, I posted a blog discussing the typical recovery timeline following surgery from a ruptured Achilles. Following Cousins ruptured Achilles, I’m going to explore
Achilles tendon ruptures are the most common tendon rupture in the lower limb. The injury is also most common in adults between the ages of 30-50, which fits the age profile for both Rodgers and Cousins. Acute ruptures, for example whilst playing sports, typically present with sudden onset of pain associated with a ‘snap’ or ‘pop’ heard at the ankle. People who have ruptured their Achilles typically describe this moment similar to being kicked in the back of the calf. Along with these sensations, a ruptured Achilles typically causes significant pain and disability.
The cause of a ruptured Achilles typically involves sudden forced plantar flexion of the foot and trauma, both of which is consistent with the mechanism Rodgers and Cousins Achilles ruptures. What is unknown to the general public is if either of these athletes were suffering from long-standing Achilles tendinopathy, which can also increase the likelihood of an Achilles rupture.
Looking at the pathophysiology of Achilles tendon ruptures, it involves a combination of mechanical, structural and biomechanical factors:
Mechanical factors: Due to its configuration, the Achilles tendon is the strongest tendon in the body. As it descends from the calf muscle, it twists counterclockwise on the right and clockwise on the left, rotating 90 degrees by the time it attaches to the calcaneus. However, as we have learnt with Rodgers and Cousins, when the tendon is suddenly exposed to excessive tensile loads, it can rupture or tear.
Structural factors: The Achilles tendon comprises mainly dense and strong muscle fibres with its unique configuration as previously discussed. As people age, these fibres can become less organised and more prone to degeneration. This can compromise the tendon’s structural integrity and increase the risk of rupture.
Biomechanical factors: Stiffness noted in foot mechanics and calf tightness is associated with being potential risk factors for Achilles injuries. When the tendon is exposed to chronic stress or repeated trauma, biomechanical factors combined with a compromised blood supply can lead to the degeneration of tendon fibres and potential rupture.
Achilles ruptures are typically investigated and confirmed with MRI, but there is a highly specific and sensitive test that can indicate the presence of an Achilles rupture. A positive Thompson test is 96% to 100% sensitive and 93% to 100% specific.
If you would like to continue reading about the typical treatment pathway, please continue reading on the previous blog post about Aaron Rodgers Achilles rupture.
Information extracted from:
‘Shamrock AG, Dreyer MA, Varacallo M. Achilles Tendon Rupture. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430844/’