As an active gymnast, 15-year-old Zoe had her fair share of injuries over the years. But nothing prepared her for the sudden, intense pain she felt when she attempted a tumble turn – one she’d successfully performed hundreds of times before – and came crashing down onto the practice mat.

“I couldn’t get up. I couldn’t walk,” Zoe says. “The pain was intense.”

An emergency room visit and imaging at a nearby hospital in Delaware showed the injury was worse than either Zoe or her parents had feared – it wasn’t just a partial tear of her Achilles tendon; it was a compete Achilles rupture of the fibrous tissue on the back of the lower leg that connects the calf muscles to the heel bone.

The Achilles tendon is the largest and strongest tendon the body, allowing humans to run, walk, jump and stand on our toes. For a gymnast like Zoe, the Achilles tendon is crucial for tumbling floor exercises such as rolling, twisting, handsprings and somersaults.

Clinicians at the local hospital put a hard cast on Zoe’s lower leg and ankle – to immobilize it – and recommended surgery as soon as possible.

“I told them we were going to Children’s Hospital of Philadelphia (CHOP) for surgery,” says Charlotte, Zoe’s mom. “We knew she wanted to continue competing at an elite level in college and surgery at CHOP would allow her the best chance to do that.”

If not treated properly, an Achilles rupture could spell the end of Zoe’s gymnastics career. She’d begun competing with First State Gymnastics at age 6, enjoying the camaraderie and rivalry with other students. By age 15, Zoe was competing at level 10, the highest in the USA Gymnastics Junior Olympics Program.

A friend — who’s child is also an elite youth athlete – recommended the family see J. Todd Lawrence, MD, PhD, an attending pediatric orthopedic surgeon at CHOP, who works with the Orthopedic Center, and the Sports Medicine and Performance Center.

Repairing an Achilles rupture

A few days later, Zoe and her mom met with Dr. Lawrence at CHOP’s Philadelphia Campus. Dr. Lawrence reviewed Zoe’s imaging results, discussed potential timing and various surgical approaches and learned about Zoe’s personal goals. Surgery was scheduled for less than a week after Zoe’s injury.

Zoe’s surgery was a success. Dr. Lawrence was able to repair the tendon without the need for additional reinforcement and she was released home with a hard cast on her lower leg.

Over the next few weeks, Zoe returned to CHOP for regular assessments and recasting. At first, her foot was in a toes-down position to help keep excessive tension off her Achilles tendon while it healed. As the repaired tendon recovered, clinicians gradually stretched out her calf muscles – using serial casting every couple of weeks – until her foot was parallel with the ground and in a natural position for walking.

After the cast, Dr. Lawrence prescribed a walking boot to further protect Zoe’s Achilles tendon, and physical therapy near her home in Smyrna, Del., to increase her mobility, strength and flexibility.

Cleared to compete after Achilles injury, and looking ahead

In July of 2021 – nearly nine months after her injury – Zoe has regained all her explosive strength and was officially cleared to begin gymnastics training again. Dr. Lawrence still cautioned her to go slow and listen to her body when it needed to rest.

“Recovery was slow and frustrating, but it was so worth it,” Zoe says. Nearly 18 months after her injury, Zoe is once again competing at the top of her sport. She recently placed third for vault in a national gymnastics competition and earned a full athletic scholarship to attend Ball State University in Indiana, where she’ll compete on its NCAA Division I gymnastics team.

Zoe will start college in the Fall of 2022 and says she wants to pursue a career in sports psychology. “I’d like to work with kids – youth athletes like I was – and help them get back to the sport they love,” says Zoe, now 17. “So many people helped me return to what I love, and I want to help other kids do the same thing.”