Ryan Howard Injury: Torn Achilles Leaves Phillies First Baseman With Long Recovery Road

SB Nation's medical expert, Dr. Ali Mohamadi looks at the road ahead for Ryan Howard after the Phillies' first baseman suffered an Achilles tear.

For Phillies fans, it may take weeks to recover from the emotional pain of a lost season, but for Philadelphia first baseman Ryan Howard, the mere split second it took to leave the batter's box has put his entire offseason, if not longer, in jeopardy.

An MRI of Howard's left leg yesterday revealed a complete rupture of the Achilles tendon, an injury that occurred while running to first on the final out of the Phillies' season-ending loss to the St. Louis Cardinals on Friday night. While not career-threatening, the injury will require an offseason of surgery and intense rehabilitation if he hopes to make it back to the field in time for the start of the 2012 MLB season.

The Achilles tendon is a large, ropelike band of fibrous tissue in the back of the ankle that connects the powerful calf muscles to the heel bone (calcaneus). Sometimes called the heel cord, it is the largest tendon in the human body. When the calf muscles contract, the Achilles tendon is tightened, pulling the heel. This allows the foot to point and an individual to stand on tiptoe. It is vital to such activities as walking, running, and jumping.

Achilles-tendon_medium

The Achilles tendon can grow weak and thin over time, making it prone injury or rupture. In Howard's case, it bears noting that a history of ankle and foot issues, while not directly related to the Achilles itself, could possibly have resulted in his needing to compensate for these injuries by overusing muscles that ultimately caused chronic strain on the Achilles. A complete tear through the tendon like Howard sustained, which usually occurs about 2 inches above the heel bone, is called an Achilles tendon rupture.

Rupture most commonly occurs during recreational sports that require bursts of jumping, pivoting, and running. When an individual makes a forceful push-off with the foot while the knee is straightened, as in the case of a hitter leaving the batter's box, the Achilles tendon is under maximal strain and if already weakened, prone to rupture.

Treatment of a ruptured Achilles tendon can be conservative (casting, rest, and rehabilitation) or surgical. Some studies show the long-term outcome is similar to surgery with regard to strength and function. However, compared with conservative management, surgery has a lower incidence of re-rupture than nonsurgical treatment and allows return to pre-injury activities sooner and at a higher level of functioning with less shrinkage of muscle, making it the option of choice for competitive athletes.

Surgical repair of a ruptured Achilles tendon requires physically suturing the ends of the tendon back together. Typically, as the rupture site heals, a small lump remains from the scarring, but this does not impact healing or resumption of physical activity. Weight bearing commonly begins at about 6 weeks with a heel support. A return to running or athletics typically requires 6 months of rehabilitation after the surgery, which cannot take place, as the Phillies have already said in a statement, until swelling resolves.

Given the nature of the sport and more specifically the demands of the first base position compared to others, with a successful surgery and rehab program Howard stands a chance of being able to take the field at the start of the 2012 season. Once healed, his Achilles should be strong enough not to significantly impact his power numbers, although many athletes report having to work through a slight limp in the weeks after returning to action. Although there is little that could relieve their anguish over this year, Howard's possible return to action early in the 2012 season is one piece of good news for Phillies fans to hold onto during the offseason.

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