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Antibiotics and Achilles Tendon Tears

In our recent YouTube video, we discussed how the antibiotic class of Fluoroquinolones can cause tendon tears in several areas of the body, especially the Achilles tendon. There are several types of Fluoroquinolones, including: ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), ofloxacin (Floxin), and gemifloxacin (Factive). This class of antibiotics have often been used in the treatment of bronchitis, sinus infections, and urinary tract infections in the past. At this time, it has been recommended that the Fluoroquinolones class of antibiotics be used as a second or third line option for resistant bacterial infections due to the serious side effects.
In my physical therapy practice, I’ve seen several cases of acute Achilles tendinopathy and complete Achilles tendon tears, from one week to six months, after taking a course of this type of antibiotic. This can occur in the highly active athletic population that is more prone to Achilles tendon problems and whose association with taking antibiotic is not often appreciated. The other high-risk group is more sedentary, less active individuals with poor tendon health and other co-morbidities such as diabetes. We’ve also seen these antibiotic side effects in tennis elbow and rotator cuff tendon problems.
When initiating physical therapy with this population, you must take a very conservative approach in progressing the strengthening and stretching of the individual. In the cases of Achilles tendon tears and tendinopathies, occasionally we will provide heel lifts, ankle boots or orthotics. One of the difficulties in providing a proper diagnosis is noticing the causal relationship between taking the antibiotics and the resulting tendon pain or dysfunction. Often the patient doesn’t link the two events and associates the pain with normal muscular skeletal pathology.
In some cases, pain in the Achilles can also be related to a lumbar pathology or referred from a retro calcaneal bursitis, plantar fasciitis and / or ankle dysfunction. At my clinic, we guide patients through a McKenzie mechanical evaluation of the foot and ankle complex to rule out whether some of the Achilles pain is related to another structure in the foot and ankle complex. Upon completion of the evaluation, we hope to establish a movement or position that will increase a patient’s mobility and reduce their pain with certain movements and ultimately restore their ability to function.
If you are unsure if you’ve taken this type of antibiotic, consulting with your pharmacy is a good first step. In cases where you suspect you may be having a side effect from this type of antibiotic, it is imperative that you discontinue any activity that produces pain and consult with a physician.
For more information, view Tom’s YouTube video on the topic. Don’t forget to subscribe to Apex’s YouTube Channel while you’re there!

Contact Apex today and schedule your FREE physical therapy assessment session in Paramus today!
Tom Willemann

Tom Willemann

Tom Willemann is a premier physical therapist based out of Bergen County, New Jersey. He holds an MS in physical therapy from the University of Miami, is credentialed in the world-renowned McKenzie Method of Mechanical Diagnosis and Therapy (MDT), and holds an OCS (Orthopedic Clinical Specialist) certification. As of 2018, there are approximately 14,000 ABPTS certified specialists in the nation and less than 400 of them are located in the state of New Jersey. Tom is the owner and director of Apex Orthopedic Rehabilitation in Paramus. He opened the clinic, which specializes in spine and sports injury prevention, in 2004 after many years of experience in the field. Tom’s caring interest in others and his strong belief in continuity of care, combined with his clinic’s ability to find solutions for the most difficult orthopedic problems, have earned Apex Orthopedic Rehabilitation its excellent reputation with patients and medical professionals in northeastern New Jersey and beyond. A true “family man,” Tom takes pride in his clinic’s warm and welcoming environment.
Tom Willemann

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