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The Achilles tendon at risk from increased vigorous activity

DEAR DR. ROACH: I ruptured my Achilles tendon playing basketball seven years ago at the age of 49. I was able to recover and continue playing. My question has to do with others who have suffered from this: Why do so many young people appear to tear their Achilles? I can think of a handful of guys I know who have recently done this, and all of them are in their 20s or 30s. I don’t remember this happening when I was at their age. Is there an increase in the number of young people tearing/rupturing their Achilles at such a young age? And if so, what is this attributable to? – F.H.

ANSWER: There is indeed an increase in the rate of rupture of the Achilles tendon. Experts have attributed this to increased vigorous physical activity. Competitive sprinters, decathletes, soccer players, jumpers and basketball players all have a greater than 10% lifetime risk of tendon rupture. The most common age for this to happen is 30-40, and it’s about five times more likely in men than women.

A class of antibiotics, which includes ciprofloxacin, is associated with increased risk of tendon rupture within a month of taking it. Surgical consultation should occur immediately after tendon rupture, although not everyone will need surgery.

DEAR DR. ROACH: About seven years ago, I was diagnosed with hemochromatosis, and my ferritin level was in the thousands. A liver biopsy showed no damage from the excess iron, and after having regular blood tests and phlebotomies, my ferritin level is now down to an acceptable level.

After relocating to a new state and finding a new hematologist, my ferritin count is now down to 250. The normal range is 24 – 336 nanograms per liter. The doctor wants me to have another phlebotomy, as she states that the ideal range for someone with hemochromatosis is 100 or below. My 250 reading is the lowest I have ever been since I was diagnosed, and I can’t find any info verifying the 100 or below recommendation. – D.M.

ANSWER: Hereditary hemochromatosis is a disease of iron absorption. Normally, the body absorbs iron very efficiently when the body’s iron levels are low, and doesn’t absorb much or any when the iron level is where it should be. In hereditary hemochromatosis, iron is absorbed at the highest possible level by the body all the time. This leads to iron overload since the body has (almost) no way of ridding itself of extra iron. The “almost” refers to women with menstrual periods, which does get rid of some iron. Women typically develop symptoms of HH later than men, but it is possible for menstruating women to develop iron overload.

Bloodletting (phlebotomy) remains the most effective treatment for hemochromatosis. Every unit of blood contains 200-250 mg of iron, and some people with HH may need 30 units of blood removed to get to a normal iron level, while others may need 100. Once the iron level is in the target range, periodic phlebotomy is necessary to keep the iron in the normal range.

Most experts now aim for the lower range of normal to just a little bit below normal. Below 100 ng/L is certainly a reasonable goal, but some guidelines recommend even lower, below 30 ng/L. In my opinion, 250 ng/L is not an ideal goal, as excess iron may deposit into various tissues even at that level. I agree with your hematologist.

One good place to read more is tinyurl.com/NIH-HH-info.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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