Levaquin Blog

Tendon injuries happen – just ask Andre Brown of the New York Giants or Misty May-Treanor of Dancing with the Stars.  That doesn’t mean that they are inevitable. 

Two-time Olympic beach volleyball gold medalist Misty May-Treanor had surgery to repair a torn Achilles' tendon a day after she dropped out of the "Dancing with the Stars" competition. Source: AP Photo

Although Achilles Tendons may just “snap” for no apparent reason, studies have shown that the risk of people taking Levaquin suffering this “sudden” injury is increased many times over than those not taking Levaquin.  Levaquin is an important drug, but it is VERY strong and the benefits do not always outweigh the risks. Speak to your doctor about alternative drugs before committing to the Levaquin course of action.

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Here is an informative interview with Jim Barnett, former team physician for the NBA’s Orlando Magic, that discusses the basic causes of Achilles tendon injuries and recommends preventative measures:

What does the Achilles tendon do?

Dr. Barnett: The Achilles tendon is a thick band of tissue that attaches the muscles of the calf to the heel bone and is the key to the foot’s ability to flex. The Achilles tendon enables the athlete to push off of the foot when walking or running.

What causes the Achilles tendon to rupture?

Dr. Barnett: There can be a number of factors that cause the tendon to tear. There is no question that patients with certain systemic disease processes can have a predisposition to tendon ruptures in all areas of the body. These include people who have taken steroids for a long time, as immuno-suppression tends to weaken connective tissue. We define these as pathologic ruptures where there is a pre-existing problem with the stability of the tendon itself.

The most common cause of Achilles tendon tears is related to a problem called tendinosis — a painless degenerative condition with the tendon due to old age or overuse. With this condition, the tendon is not as strong in any one part of its length as it should be, and some type of trauma causes it to rupture.

We see this commonly in the weekend athlete who doesn’t exercise on a regular basis or does not properly stretch before an activity. In the professional arena, most Achilles injuries seem to occur in the quick acceleration/jumping-type sports like basketball or racquetball. 

What accounts for the number of non-contact Achilles tendon tears?

 Dr. Barnett: There is a situation we refer to called an eccentric load, when a load or stress is applied to a tendon that’s already being stretched. An example of this would be an athlete running backwards. This is the opposite of a concentric load, in which you are applying a load to a muscle that’s being shortened, such as when you are doing toe raises and walking up a flight of stairs.

What we think happens in a number of ruptures of the stop-and-start variety or the backward-to-forward transition, is that the tendon has a concentric load applied to it followed quickly by an eccentric load or vice versa. Think of a quarterback dropping back to pass and then stepping up into the pocket, or a tennis player that rushes the net and then retreats for a lob over his head.

 Are aging athletes more susceptible to Achilles tendon injuries?

Dr. Barnett: We see a lot of tendinitis in the Achilles region in younger athletes as a result of overuse but probably the most common group affected by Achilles tendon ruptures are the older, weekend warrior-type athletes. Characteristically, the tendon tears a certain distance from its insertion in the heel bone, where it has the least amount of blood supply. There seems to be direct correlation to aging where the older athlete, in general, has less blood flow to this region.

How is a rupture diagnosed?

Dr. Barnett: The patient will usually relate that it feels that someone or something has hit him in the calf. He normally doesn’t have the sensation that something actually has torn. There is a good amount of swelling and pain and a little bit of weakness when he walks. We’ll perform something called the Thompson’s test if we suspect Achilles damage. The patient lies face down on a table and the physician squeezes the calf muscle. If the tendon is intact, the foot will point down, which shows tendon integrity and means that there is not a complete tear. However, if you squeeze the calf and the foot remains motionless, this signals that the tendon is ruptured.

How is an Achilles tendon rupture treated?

Dr. Barnett: Most young, healthy athletes on the high school, college or professional level recover more quickly and require less rehabilitation when their Achilles is repaired surgically. The two ends of the tendon are sewn together and the foot and lower leg are placed in a cast with the foot pointed down to lessen the tension on the repaired tendon. In older, less active individuals, we favor a more conservative approach, which involves casting and a lengthy period of immobilization. Regardless of the treatment, you’re looking at a six- to 12-week recovery period. It is almost always a season-ending injury for the athlete because of the tenuous situation with the blood supply to the area. Complete healing needs to take place or there is a possibility of recurrence.

How can ruptures be prevented?

 Dr. Barnett: The best advice we give to people to lessen their chances of injuring the Achilles area is to practice proper stretching before beginning an activity. Loosen up by breaking a light sweat and then do gentle calf stretches. This is especially true if you are older or not well-conditioned. Be aware of any pain in the Achilles tendon and make sure to treat any sign of tendinitis with RICE — rest, ice, compression and elevation.

Source: ESPN.com

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Tendons are the tough fibers that connect muscle to bone. For example, the Achilles tendon connects the calf muscle to the heel bone. Tendon injuries typically occur near joints, such as the knee, ankle, shoulder and elbow. Tendon injuries could occur suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.

What causes a tendon injury?

Tendon injuries are usually the result of gradual wear and tear to the tendon from overuse or aging. Anyone can suffer a tendon injury, but people who make the same motions over and over in their daily activities are more at risk to damage a tendon.

A tendon injury can happen suddenly or gradually over time. A sudden injury is more likely to occur when the tendon has been weakened over time.

What are some symptoms of tendonitis?

Tendonitis usually causes pain, stiffness and loss of strength in the injured area.

• The pain may get worse when you use the tendon.
• There may be more pain and stiffness during the night or when you get up in the morning.
• If there is inflammation, the area may be tender, red, warm, or swollen.
• There may be a “crunchy” sound or feeling when the tendon is used.

How is a tendon injury diagnosed?

How is tendonitis treated?

There are many home remedies available for minor pains.  These include:

• Resting the affected area, and avoiding activities that worsen the pain.
• Applying ice for 10 to 15 minutes at a time, up to two times an hour, for the first three days.
• Continuing using ice as long as it provides relief.
• Taking over-the-counter pain relievers such as ibuprofen if needed.
• Stretching and exercising to prevent stiffness.

Doctors might also suggest physical therapy. With severe and long lasting injuries, doctors may see fit the use of a splint, brace, or cast to hold the tendon still.

It could take weeks or months for a tendon injury to heal. If the injured tendon is used prematurely, more damage could occur.

Source: Yahoo Health

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What is an Achilles tendon rupture?

By Jonathan Cluett, M.D.

An Achilles tendon rupture occurs when the tendon attaching the calf muscle to the heel is ruptured. This is a common injury, most often seen in middle-age, male, “weekend warriors.”

What are the symptoms of an Achilles tendon rupture?

An Achilles tendon rupture is a traumatic injury that causes sudden pain behind the ankle. Patients may hear a ‘pop’ or a ’snap,’ and will almost always say they feel as though they have been kicked in the heel (even though no one has kicked them). Patients have difficulty pointing their toes downward, and may have swelling and bruising around the tendon.

Which patients sustain Achilles tendon ruptures?

Achilles tendon ruptures are most commonly seen in men who are around the age of 30-40 years old. About 15-20% of patients have symptoms of Achilles tendonitis prior to sustaining an Achilles tendon rupture, but the vast majority of patients have no history of prior Achilles tendon problems. Over 75% of Achilles tendon ruptures are associated with playing ball sports (commonly basketball or tennis).

Other risk factors that are associated with Achilles tendon rupture include:

Cortisone injections into the tendon
Gout
Fluoroquinolone antibiotic use
Fluoroquinolone antibiotics are used very commonly in medicine for treatment of respiratory infections, urinary tract infections, and other bacterial infections.

These antibiotics, such as Cipro, Levaquin, and others, are associated with Achilles tendon rupture. Exactly why this is the case is unclear, but patients on these medications should consider an alternative medication if Achilles tendon pain develops.

What is the treatment for Achilles tendon rupture?

Achilles tendon rupture is most often treated surgically to reattach the tendon to its normal position.

Nonoperative management can be undertaken, generally people who live sedentary lifestyles or who may have problems with wound healing. Nonsurgical treatment of an Achilles tendon rupture is accomplished by casting the Achilles tendon for several months. In these patients, the number of reruptures is higher compared to those patients who have surgical repair. In patients who have surgery for an Achilles tendon rupture, less than 3% experience a rerupture of the tendon.

How is surgery done for treatment of an Achilles tendon rupture?

The surgery to treat an Achilles tendon rupture involves an incision along the back of the ankle. Usually the incision is made just to the side of midline so shoes will not rub on the site of the scar. The torn ends of the Achilles tendon are identified and strong sutures are placed in both ends of the tendon. These strong sutures are then tied together to repair the tendon.

What are the complications of Achilles tendon repair?

The most common and worrisome complications following an Achilles tendon repair are problems with wound healing. The skin over the Achilles tendon sometimes does not heal well. Therefore, careful wound management is of utmost important following surgical repair of an Achilles tendon rupture. Other potential problems include infection, ankle stiffness, and rerupture of the tendon.

What is the rehab following Achilles tendon repair?

Rehabilitation following Achilles tendon repair is a controversial topic. Traditionally, patients were casted after surgery for a period of 4 to 8 weeks and after that time, patients were allowed to gently move the ankle.

More recently, studies have shown that patients do well and heal faster with more rapid mobilization. If a solid repair is attainable, patients may not be casted at all, and allowed to begin motion immediately after surgery. These patients will use a removable boot when walking for several weeks.

Sources:
www.about.com
Saltzman CL, Tearse DS. “Achilles tendon injuries” J. Am. Acad. Ortho. Surg., Sep 1998; 6: 316 – 325.
Schepsis, AA, et al. “Achilles Tendon Disorders in Athletes” Am. J. Sports Med., March 1, 2002; 30(2): 287 – 305.
Peck, P. “Study Confirms Increased Risk of Achilles Tendon Rupture With Fluoroquinolone Use” IDSA 41st Annual Meeting: Poster 195. Presented Oct. 10, 2003.

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The New Jersey Law Journal has reported that “The New Jersey Supreme Court has designated mounting litigation over the Johnson & Johnson antibiotic Levaquin as a mass tort and has assigned it to an Atlantic County, N.J., judge. The suits charge that the drug, which is prescribed for bacterial infections of the lungs, urinary tract and skin, has caused Achilles’ tendon ruptures and other damage.”

Plaintiff attorneys argued “that the litigation will likely involve thousands of cases with the same defendants, similar complex issues of law and fact, and plaintiffs with a high degree of commonality in their injuries and damages.”

The drug “was approved by the Food and Drug Administration in 1996, but in July 2008, the FDA warned that Levaquin, and other drugs in the fluoroquinolone class of antibiotics, put users at heightened risk of developing tendonitis and tendon ruptures. (See, New Jersey Law Journal, July, 2009, Toutant).
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This is the first of many actions to be filed against the manufacturer of Levaquin. It is important to understand that if you or someone you know has an unexplained injury it may be due to this commonly prescribed drug and you should seek a lawyer for consultation. Do not dismiss what you are feeling. Your case should be evaluated by a professional.

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