Monday 15 October 2018

Dear Dr Nina: My wife says I should give up five-a-side after two injuries, but I love the kickaround with the lads

'The Achilles Tendon is the largest tendon in the body'
'The Achilles Tendon is the largest tendon in the body'

Nina Byrnes

I'm a reasonably active 40-year-old dad but in the past four years, while playing five-a-side at the weekends, I have torn my Achilles tendon not once, but twice. On both occasions it was excruciatingly painful and I spent many weeks on crutches in recovery. I suppose that after the first tear, the tendon must have weakened and I'm not sure if it is now really weak. My wife says I should give up the five-a-side and stick to low-impact exercise like cycling, but I really love the weekend kickaround with the lads and don't want to give it up. Do you have any advice?

Dr Nina replies: The Achilles tendon is the largest tendon in the body. It connects the calf muscles to the heel bone and is used for any movement that involves using your tiptoes such walking, running, stair climbing, and jumping. The Achilles tendon is very strong and can withstand great stresses from running and jumping, but it is also prone to injury and strain.

The Achilles tendon most commonly ruptures if there is a sudden forceful downward movement of the foot against resistance.

These kinds of injuries are most likely when pushing off to jump with great force. Trauma can also happen falling from a height or stumbling into a hole.

Achilles injuries are particularly common in sports such as basketball, tennis and football. Rupture can also happen spontaneously in otherwise healthy active individuals. Injury is most common in those aged 30 to 50, and men are more commonly affected than women.

There are certain risks. Medication such as steroids and fluoroquinolone antibiotics increase the risk of tendon inflammation or rupture. Poor training and conditioning can put undue stress on the tendons. Those who have previously injured their Achilles remain at risk of future injuries on the same or opposite side.

Tendon rupture causes a sudden, sharp pain in the back of the heel. Those affected describe a "snap". The foot then may drop and drag, making walking difficult. Tendon rupture may be complete or partial depending on the strain.

Treatment for Achilles tendon rupture can be conservative or surgical. You don't mention what kind of treatment you had. Conservative treatment involves immobilising the ankle for 10 weeks in a cast or boot.

The advantage of this treatment is that surgery and its recovery is avoided, however repeated rupture is more common, occurring in up to 40pc of cases.

Surgical treatment of a ruptured tendon may be a more definitive treatment. There are risks involved, as with any surgery, but repeated rupture risk is reduced to 5pc. Returning to full activities is also more likely.

There are things you can do to help prevent Achilles tendon injury. Ensure adequate stretching and strengthening of your calf muscles. Don't bounce during stretches. Don't run on hard surfaces, and always wear well-fitting and cushioned shoes for sport.

If you are training, increase intensity by no more than 10pc per week. Abrupt increases can put the tendon at risk of damage. Vary the types of exercise between low- and high-intensity workouts. Swimming, cycling and elliptic training all put less stress on the Achilles tendon.

If you have not had surgery to the tendon, I would advise discussing specialist referral with your GP.

An orthopaedic surgeon who specialises in foot and ankle surgery will be able to help to guide you towards the treatment best suited to the injury you have. This is probably your best chance of getting back to the football you love.

If you have had surgery, it may be that your wife's advice to consider lower-impact activities is a good idea.

If you have any health queries for Dr Nina Byrnes, please email drnina@independent.ie. Please note that Dr Nina cannot enter into individual correspondence

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