The team announced that Ibrahim was set to undergo surgery on Tuesday for what they are calling a “lower body injury.” Head coach P.J. Fleck didn’t elaborate on the specifics of the injury any further, other than to say the injury is a tear, it’s “clean” and he expects Ibrahim to make a full recovery in 4-6 months.

So while Minnesota stopped short of announcing that it was an Achilles tendon tear, but everything else we’ve seen and read from other orthopedic specialists is that this is a classic Achilles tendon rupture. (Although it is not 100 percent confirmed from the team, for the rest of this blog, we will be referring to Ibrahim’s lower body injury as an Achilles tear.) You can see a slow motion video of the rupture below.

#Minnesota running back Mohamed Ibrahim out with a leg injury. Something definitely popped. Scary stuff. Hope he’s okay. Absolutely phenomenal talent. #CFB pic.twitter.com/yxBskbLWNN

— SportSource Analytics (@SportSourceA) September 3, 2021

Dr. Silverman Comments

This is in Achilles tendon rupture. You can see it pop and the reverberation in his calf muscle.

This is a classic mechanism of eccentric lengthening. Basically, he’s pushing down on the ball of the foot but the ankle is going the opposite way and that generates a massive amount of force. If there is silent degeneration within the Achilles and it reaches a certain point, pop.

He will need Achilles tendon repair in order to get back to sport and return with the best function. It will not be a short healing time period, it will probably take more than 6 to 9 months before he is allowed to start aggressive training again, which is a little longer than the 4-6 month timeline initially mentioned by Fleck.

There are some methods to speed the healing, however, tendons still need time to fully organize, and this particular tendon has to manage the most amount of force in the body, so rushing back can be disastrous. With his eyes on the NFL, he’ll need to be cautious during his recovery to ensure his tendon really strengthens the best it can. But with youth and a great medical staff on his side, I see no reason why Ibrahim can’t come back just as strong if not stronger than before. We wish him the best in his recovery.

The post Gophers Lose Star Running Back Ibrahim To Achilles Tendon Tear appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

Bonnie underwent multiple surgeries, including an appendectomy, a full hysterectomy and 17 bowel repairs before emerging from the hospital nearly 30 pounds lighter.  She was determined to work her body back into her former form, but her persistence led to her tearing the fascia in both of her feet only two weeks after beginning rehabilitation.

Bonnie’s determination was matched only by her love of the outdoors, and after six grueling months of rehabilitation she sat perched on her bike, facing another obstacle: a two-day, 150 mile bike ride to combat Multiple Sclerosis.  She overcame the course, just like the disease she fought six months earlier, only this time she did it with a few more smiles along the way.

In the following months, Bonnie would continue rehabbing in hopes of returning to full strength.  But once again she found herself in front of a surgeon in hopes of repairing her painful arches.  Previously, Dr. Silverman had fixed torn ligaments and tendons in her ankle and set her foot in a cast, but Bonnie couldn’t stand the restrictions the cast put on her mobility.  The cast was supposed to stay on for four weeks.  Bonnie cut it off after seven days.

Bonnie has since recovered from her foot injuries and continues to test her limits to this day.  Her desire to push her body to the extreme has led her to sign up for the Arrowhead 135, a 135-mile course that traverses the coldest parts of Minnesota at the most frigid time of year.

Arrowhead 135 is not for your average adventure nut.  What began in 2005 among a group of 10 thrill seekers has expanded into a yearly challenge for 135 of Minnesota’s best athletes.  Participants can choose to bike, ski, or walk across the death-defying course.  They have 48 hours to complete the course without any outside help, meaning racers must carry all the gear they need to get them through the two-day trek.  From subzero sleeping bags to toilet paper, and everything in between, racers must carry their supplies throughout the 135-mile journey.

Bonnie hopes to beat the course next month on a bike.  While traversing the course on bike may seem like the easiest option, bikers only average 3-5 miles per hour over the snow covered course.  She’s in for a long 60 hours.

The race is a little over a month away, and Bonnie continues to train for what will be one of her biggest challenges yet.  For someone who has overcome so much already, no challenge seems too tough.  No matter whether she finishes the 135-mile trek or not, one thing’s for certain.  She’ll do it with a smile on her face.

The post Pushing Forward: One Woman’s Quest to Overcome Life’s Obstacles appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

Pros of Minimally Invasive Achilles Surgery 

• A smaller incision is associated with better healing, as there tends to be less wound complication.
• Generally, procedures with less wound complication lead to a faster recovery, but that is not always the case.

Cons of Minimally Invasive Achilles Surgery

• Visualization of the tendon edges during surgery is harder.  Because of this, nerve injury rates are higher during a minimally invasive procedure.
• In a small number of cases the surgeon finds that the Achilles is more damaged than originally thought, which means a more invasive procedure is necessary.
• Because of the nature of the procedure, the patient must be asleep and lie on their belly with a tube down their throat to protect the airway.  Anesthesia risks are slightly higher with this type of procedure.
• Minimally invasive surgery is more costly than a more invasive procedure.

Bottom line 

Doctors who can carefully perform Achilles surgery with minimal soft tissue trauma can usually get the same results as a minimally invasive procedure with less expense and less risk.  Even in a more invasive surgery, if the doctor treats the skin and underlying tissues with care and uses the latest generation of stitching techniques, the patient can begin weight bearing the day after surgery.  Training without explosive sprinting can begin as early as 8 weeks, and athletes can get back to their sport after 4-5 months with an accelerated rehabilitation program.

The post The Pros & Cons of Minimally Invasive Achilles Tendon Surgery appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

Most commonly the peroneal tendons tear by fraying. They are placed under repetitive stress and have tears within the tendon that slowly tear apart.

Symptoms are not always clear. Since tendons themselves have no nerves inside them, pain is often transmitted to other areas. Tendons connect muscle to bone. The muscle has good nerve input and sometimes people feel cramping pain in the side of the leg (often at night after a lot of activity). The insertion on the bone has great nerve supply so sometimes people have pain on their 5th metatarsal bone on the outside (lateral side) of the foot.

Why do people tear the tendon?

• Acute Dislocation (unusual)
• Overuse (most common)

How to Treat?

Acute dislocation and tears have an abysmal response to non-surgical treatment. In fact, I usually refuse to do it in almost all circumstances. Treating it non-surgically leads to further tearing and can make the tendon irreparable.  It also causes intense scaring in the back of the ankle and the instability is never fixed.  Because these rare cases can potentially result in permanent damage, I routinely get the patient to surgery quickly.

I also see many patients with incomplete treatment. They have undergone isolated peroneal tendon repairs and they have recurrent pain or MRI documented recurrent tears.

It can be very challenging to determine ankle ligament instability in a patient with peroneal tendon tearing. The pain from the tear can cause spasm and difficulty relaxing to permit a good ligament stress test. Even knowing how to do the right ligament stress test is hard. I am acutely sensitive to this exam as I practice it every day on every patient that walks in the office.

The real question everyone has is why the tendons have problems in the first place.  The ankle has several sources of stability.  The bony structure is a mortise (like a door) and it is intrinsically stable on flat ground going straight, while the ligaments give mechanical stability for side to side and rotational forces.

When you sprain the ankle severely, the ligaments heal at an extended length and the peroneal tendons must take up the slack so to speak. They work overtime as the secondary dynamic stabilizers.

When they tear and begin to become dysfunctional, instability and pain becomes an even bigger problem than before. Sometimes the instability doesn’t become evident until the tendons tear and other times it is evident soon after the sprain. Regardless, if and when it causes a functional problem, it needs to be fixed.

I get frustrated when I hear that patients “stopped playing basketball” or “stopped going for my daily walk” because they couldn’t do it anymore. This is an easily solved problem with a surgery that lasts less than an hour. Patients are walking on the ankle in a cast by day 1, in a boot by day 18, and in an ankle brace starting physical therapy by 4-6 weeks post-op. Then, it’s just a matter of how hard they work at it to get better, but most athletes begin training by 8 weeks and most people are back to heavy labor by 3-4 months.

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