05/07/2013    Amol Saxena, DPM

RE: Laker Basketball Star's Injury May Have Been Preventable: TX Podiatrist (Ed Davis, DPM)

There is no level 3 or higher study to support
Achilles tendon ruptures are associated with
having ankle equinus. Quoting one level 4 study
is not very assuring. Furthermore, there is also
no evidence that stretching and other
rehabilitation techniques are helpful. In fact,
the mainstay of treatment for Achilles
tendinopathy (but not ruptures) is eccentric
strengthening. All NBA teams have a rigorous
conditioning and rehabilitation team that utilize
these techniques. Unfortunately ruptures are just
part of the sport. If stretching the Achilles is
so helpful, why do virtually all patients who
present with Achilles tendinopathy state they
already have been stretching when they come in
for treatment?

In addition, trying to reduce the equinus in an
athlete can be detrimental. It has been shown
that over-lengthened Achilles decreases
propulsion, a death sentence in sports where
speed and jumping is essential. Most patients
have symmetric ankle ROM just prior to their
ruptures and do not sustain these injuries
bilaterally. Previous research on asymptomatic
professional and adolescent athletes shows most
have “equinus”. Prospective studies should been
performed on these groups and the “normal”
population to see any correlation to Achilles
tendon rupture.

To date, a positive family history, certain
medical conditions such as gout and diabetes, use
of Quinolones, oral and locally injected
steroids, certain blood types, lower heel height
shoes and prior injury have been found to be
associated but not necessarily causative for
Achilles tendinopathy and ruptures. Tightness or
equinus of the Achilles has not been evaluated
thoroughly to make any conclusion that it is
associated with its rupture or tendinopathy. At
this point, to say it is, and state Achilles
tendinopathy and rupture can be prevented, should
only considered personal opinion, which at this
point is not supported by science.

Amol Saxena, DPM, Palo Alto, CA, Heysax@aol.com

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