Christian McCaffrey’s Achilles Tendinitis
Football fans and all fantasy football players are probably aware of the San Francisco 49er running back Christian McCaffrey’s injury status. He was a possible starter for the team’s opener against the New York Jets but a late decision for him not to play was made. After his inability to play this weekend, the star running back was placed on the team’s injured reserve list. Reports are that this star running back is down with the cursed Achilles tendonitis.
What is Achilles Tendonitis?
What exactly is Achilles tendonitis? The term Achilles tendonitis can encompass the entire area of the Achilles tendon from its origin near your calf muscle belly through its course, and distally to its insertion or attachment point on the back of your heel or calcaneus.
Since this term covers such a broad area, there is more than one possible injury and the devil is in the details. To understand what McCaffrey is suffering from, we will need to start with some fundamentals.
We will start with what does tendonitis actually mean. Ironically, the term tendonitis is a misnomer. The suffix -itis means inflamed. For a structure to become truly inflamed, it requires a blood supply to bring the inflammatory response to the area. All tendons are what we call avascular, meaning they have no direct blood supply. Rather tendons have a tendon sheath to help maintain their integrity and health. The tendon sheath also secretes synovial fluid and helps the tendon glide when it is pulled. The tendon sheath does not have blood vessels on its interface with the tendon. All tendons can therefore not become inflamed, thus lending “tendonitis” impossible to develop.
So, what does happen? There are several types of Achilles tendon injuries outside of ruptures that we will review here.
The Issues with Achilles Tendon
One very common issue is at the Achilles tendon’s boney attachment or insertion on the back of the heel. Irritation at the heel bone can lead to painful insertional bone spurs. The insertional bone spur, otherwise known as an enthesopathy, is your body’s response to stress or overload of the tendon at its boney attachment. Enthesopathies typically arise from weakness of your calf muscle or from severe restriction in ankle range of motion. Often both weakness and lack of range of motion are present. At times, the spur that develops fractures and becomes severely painful requiring prolonged immobilization in a walking boot or cast.
A second type of Achilles tendonitis could be something known as tenosynovitis. The Achilles tendon itself has a sleeve around it that looks like a Ziploc bag. This tendon sheath saturates the tendon, nourishing it with synovial fluid. When the synovial fluid and lining become inflamed, this is called tenosynovitis.
A third site of pain with Achilles tendonitis is within the tendon itself. Damaged, irritated, or degenerative tendon can occur in an area of the Achilles tendon just above the heel called the watershed zone. The watershed region is often where acute Achilles tendon ruptures occur, a different injury altogether. Tendinosis or tendon degeneration in the watershed region can become painful. Damaged tendon fibers can lead to an acute rupture. This is likely how the famous basketball player Kevin Durant ruptured his Achilles during the NBA playoffs in a non-contact type injury.
How does the tendon become degenerative? Well, the tendon becomes overused or injured usually from overuse or repetitive high stress impact. The Achilles tendon can act like a shock absorber. And like shocks, if you don’t use the right grade with too much weight or stress on it, the shock can break. The tendon takes a lot of stress with activities like walking or descending stairs stopping your body’s forward momentum. The tendon takes even more stress with things like jumping, sprinting, or cutting. These high loads can lead to damage and degeneration of the tendon fibers and at times fatty tissue infiltrates the tendon due to the damage.
As we discussed earlier, the tendon lacks a direct blood supply making it very difficult to heal any injury. Usually tendinosis starts very small, so you don’t feel the damage. You will continue your activity or sport, and the Achilles continues to degenerate over time. This can lead to a lump in the tendon. It can often be felt like a knot in the tendon itself, and can be painful to the touch. Early tendon damage or loss of integrity can be diagnosed with ultrasound or MR imaging. This often is not caught due to a lack of pain in the area with early-stage injury.
With McCaffrey’s delayed return, and potentially missing 4-6 games, my suspicion is he has tendinosis present. The team is likely avoiding his return to play due to concerns over possible tendon degeneration getting to a point of total rupture which would then very likely require surgical repair. This, of course, is all speculation but my hopes are that you find it as interesting as we do.
Contact Us
Do you think you have Achilles “tendonitis”? As your trusted foot and ankle experts, we can help. There are a variety of treatments available to control your pain and get you back to your game-ready state. We offer the same great treatments here in our Tampa office that athletes like McCaffrey have access to in the NFL. We have the latest technology with the most evidence driven results, including extracorporeal shockwave therapy, platelet rich plasma injections, and stem cell injections, to name a few. Give us a call to schedule your consultation today! We love keeping our patients in the game.