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Buffalo Bills G Ike Boettger’s Achilles Injury

What is the outlook for Boettger’s recovery?

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NFL: Buffalo Bills at New England Patriots David Butler II-USA TODAY Sports

Bam! Like a gunshot going off, Buffalo Bills guard Ike Boettger knew something was immediately wrong after several steps early in the second quarter Sunday. Quarterback Josh Allen immediately ran to Boettger’s side followed by the Bills training staff that tended to him. The cart rapidly came out to whisk the young guard to the locker room for further tests.

On Monday, the news of Boettger tearing his left Achilles tendon was made official after an MRI confirmed the injury. While the Bills have been relatively healthy this season, allowing them to regain hold of the AFC East with a win over the New England Patriots, they have not been without several serious injuries, Boettger being the latest one.

Below is the breakdown of Ike Boettger’s Achilles injury and outlook heading into next season.

The Play

In the video, you can see that Boettger is driven backward while attempting to hold his block against Patriots defensive tackle Daniel Ekuale before Ekuale abandoned Boettger to go tackle Devin Singletary. Boettger took the first step forward and appeared to lose his balance before hopping on his right foot and falling down. He either tore when he took his last step backward or when he lost his balance stepping forward with his left foot in full dorsiflexion and attempting to push through his foot to run forward.

Achilles Anatomy

The Achilles tendon is a band of connective tissue that connects the gastrocnemius to the calcaneus, allowing the foot to plantarflex or point down. This is essential during walking, jumping, running, and sprinting.

Achilles tendon

A rupture of the Achilles tendon occurs when an eccentric load is placed through the area, overloading the muscle, resulting in the tendon tearing. This commonly occurs when a player is trying to push forward but gets driven back such as blocking on the offensive line, cutting hard and pushing through the foot as one would see in a running back, or landing from jumping in the case of a defensive back.

These movements could lead to forceful dorsiflexion or the foot moving upward. This could also occur if the knee is extended and placing excess force through the front of the foot, overstressing the Achilles area.

Achilles tendon rupture

Risk Factors for Achilles Injury

These injuries are sudden and typically come without warning, which makes this injury all the more devastating. There is usually a loud pop and immediate pain as if the person was stabbed or shot. Weakness and the inability to flex the foot down are common symptoms and swelling and a possible gap in the tendon when palpating the area.

Achilles tendon tears are easy to diagnose with several special tests including the Thompson test. This is when the person is placed into a prone position and the lower leg hanging off the table. The calf muscle is squeezed and a positive test is when the foot does not plantarflex when the muscle is contracted due to the squeeze.

A more accurate test that was likely performed back in the locker room is the Matles test. The person lies on their stomach and bends their knee to 90 degrees. If the foot does not move or moves into dorsiflexion, then that is a positive sign that it is torn. The foot would normally slightly point downward in a negative test, indicating a tightening of the calf muscle that connects at the knee.

Surgery and Rehab

Surgery and rehabilitation take roughly six to nine months to return to normal activities and athletics. Details of the various types of surgical repair can be viewed here.

An example of Achilles tendon repair

Unfortunately, Boettger has been down this road before. During his redshirt senior year at Iowa, Boettger suffered a right Achilles tear in college in Week 2 of the 2017 season.

While he does have prior knowledge of going through this rehab, it was several years ago and a significant reason that he ultimately went undrafted that year. The rehab at the end of the day still is not easy and requires maximum effort for optimum results.

This is the second Achilles injury for the Bills this year. Boettger’s teammate, Bryan Cox Jr. suffered a left Achilles tear back in June during minicamp, ending his 2021 season.

Return to Play and Performance

His prior Achilles tear almost certainly had no bearing on this latest injury. Once he does return, he has a one-to-two percent chance to re-tear the same side in the general population.

The concern to re-tear in the NFL is higher, closer to 15 percent, but this number may be more accurate as there are far more eyes on a smaller group of individuals than the general population that relies on outside data for studies.

Return-to-play rates do vary but levels as high as 78 percent have been reported within the NFL according to studies. The average amount of time takes 8.9 months with some returns as quickly as 5.5 months. We are seeing that in real-time with Los Angeles Rams running back Cam Akers, recently activated to the active roster.

Due to more aggressive rehab, there have been advances that have shaved the return to play in the NFL down to six to eight months. Improvement in performance following the injury has been observed, suggesting that this isn’t as much of a career-ender as it was a decade or two before. Return-to-play rates are north of 80 percent, according to The Athletic on a profile of the Indianapolis Colts’ management of the injuries.

Philadelphia Eagles G Brandon Brooks suffered a torn Achilles in 2018, returned in eight months for the 2019 season to play all 16 games before tearing the other side in 2020.

Indianapolis Colts offensive tackle Eric Fisher tore his Achilles in the AFC Championship game against the Buffalo Bills in late January 2021 when he was a member of the Kansas City Chiefs. He returned to play as the starting offensive tackle in Week 2 after he signed with the Indianapolis Colts in the offseason. How he’s performed is up for debate but he was able to play, starting every game since then.

Another offensive lineman who tore their Achilles and returned to play is former Buffalo Bills offensive tackle Jason Peters. He suffered his tear in 2012 and continued to play at a high level towards his likely Hall of Fame career.

Career Outlook

Boettger will return from this injury as he has before, but the Bills don’t have a lot invested into him financially. He has been with the team since 2018 as a top reserve player, but with how inconsistent the offensive line as a whole has been this season, this puts Boettger into an awkward position. He is coming off a season-ending injury on a one-year contract. Hopefully, the Bills like him enough and re-sign him to bring him back to camp in 2022.

Depending on how his rehab is going at the time, he may be able to participate in training camp OTA’s in June or may start the season on the PUP list in July. I would not be surprised or concerned if he starts on PUP due to roster management and they activate him shortly into training camp. My biggest concern would be the strength needed to play on the offensive line and display the power needed to block and move grown men around.

Unless there are complications or setbacks, it’s very reasonable to expect he will be ready in Week 1 of the 2022 NFL season. If he can get through the 2022 season at a lesser version of himself, the research suggests that he can return to his pre-injury level after one season.

This was a highly unfortunate injury for a player who was showing flashes of what he could be in this league. He has a long and arduous road to recovery with an uncertain NFL future. I wish him the best of luck in his recovery and future.