CLEVELAND -- If Miami Dolphins quarterback Dan Marino has a complete rupture of his right Achilles' tendon, and it is assumed he does, he faces immediate surgery and a three-stage rehabilitation that will take a minimum of six months to complete.
However quickly he heals, he is finished with football the rest of this season, including the playoffs, if the Dolphins get that far.
The timetable for Marino's surgery and rehab depends on his doctors. But, typically, aggressive treatment of the injury involves a 1- to 1 1/2 -hour surgery, followed by a week to 10 days of rest to let the skin heal.
Dr. Keith Hechtman, associate professor of medicine at the University of Miami and an expert in Achilles' surgery, could not speak directly to the Marino injury.
But, he said, "Our protocol is to start a program of guarded range of motion after that week to 10-day healing period following surgery. We usually put athletes through six to eight weeks of that with no stress on the repair.
"Then, if everything is going well, we'll begin strengthening the gastrocnemius [calf] muscle. That's when we begin more aggressive rehab.
"That becomes progressive, but we hold off any running for approximately three to four months, and, of course, the rehab continues even after that."
It is not unusual for NFL players to come back from Achilles' surgery and perform at top levels. This is the same injury sustained by New York Giants linebacker Lawrence Taylor and former Dolphins punter Reggie Roby, now with Washington, in 1992.
The Achilles' tendon connects from the heel to the back of the calf. When it ruptures, Hechtman said, the frayed ends resemble the strands of a mop.
"The procedure in repairing the Achilles' is to make bundles out of those frayed ends and interlace them, tying them together like the braiding of hair," he said. "What you're trying to do is get a thicker, stronger bundle."
Hechtman said Achilles' tears in athletes typically occur about 2 to 3 inches above where it connects to the heel and can extend upward 3 or 4 inches.
The Achilles' tears not because the calf muscle is weak, Hechtman said, but because of overuse. Ruptures often are preceded by microscopic tears in the Achilles', which leave athletes complaining of pain above the heel.
It is not known if Marino had been getting treatment for Achilles' soreness.
It's an injury that occurs without contact. Hechtman explained why the Achilles' bursts.
"Why does a rope all of a sudden bust when you're pulling in a boat?" he asked rhetorically. "It's the same thing with the Achilles'. You are exceeding the tensile strength of the tendon.
"Dan might have been trying to push off on his foot when someone was on it or he might have been leaning forward."
Hechtman said athletes often say they feel as if they have been shot when the rupture occurs.
That's exactly what Marino told O. J. Simpson, who was reporting from the locker room on NBC's television broadcast.
There is no way to put a strain gauge on the Achilles' to test its strength, Hechtman said.
But athletes can take MRIs (magnetic resonance imaging), which will show an inflammation in the tendon.