On Wednesday, about 42 hours after Mike Evans hobbled to the locker-room tunnel during a 23-17 win over the Commanders, the San Francisco 49ers wide receiver had new shoes because he had the same old limp.
Evans, 33, entered the locker room wearing what looked like comically oversized high tops. The shoes are designed to provide stability, support and comfort for Evans as he deals with Achilles tendinitis, a condition that forced the six-time Pro Bowl selection to leave Monday's game late in the second quarter after it prevented him from practicing last week.
On Tuesday, a day after head coach Kyle Shanahan said that he didn't think Evans' injury was a "long-term thing," ESPN's Ian Rapoport said Evans would have to "manage" his Achilles discomfort for "the better part of the season." Asked about that Wednesday, Shanahan said he didn't know how long Evans' injury would linger.
"We had to manage it last week and we're managing it this week," Shanahan said. "So we'll see how the rest of the year goes."
For 49ers fans, the situation could inspire unpleasant memories of the 2024 season when running back Christian McCaffrey missed the first eight games with bilateral Achilles tendinitis.
At the time, however, Shanahan struck a more ominous tone than he has this week with Evans.
In 2024, Shanahan said the 49ers had to be "very careful" with McCaffrey after Shanahan had been told by the team's medical staff that McCaffrey risked suffering a torn Achilles if he returned too early.
When discussing Evans after Monday's game, Shanahan noted the 13-year veteran had dealt with Achilles tendinitis previously in his career. He said Evans wouldn't require further testing and even mentioned the possibility of Evans playing on Sunday against Atlanta. To be clear, the chances of Evans playing appear remote considering he was still walking with a pronounced limp Wednesday.
Dr. Kenneth Jung, a foot and ankle surgeon who is a consultant to the Los Angeles Rams, said it's likely Evans was dealing with low-grade tendinitis before he was forced to leave after playing 22 snaps Monday.
"An Achilles rupture, obviously, is the worst-case scenario," said Jung, who works at Cedars-Sinai Orthopaedics and Sports Medicine in Los Angeles. "But, at the (NFL) level, he's had an MRI, multiple evaluations, so they have a good idea of the extent of what he's dealing with. If it was something that was a very high grade, with a high risk of a rupture, you wouldn't see him out there. A lot of the decision-making is based on the diagnostic imaging, especially an MRI."
Achilles tendinitis is an overuse injury that causes inflammation, pain and tightness. Serious cases can involve microscopic degeneration, small tears in the fibers in the middle of the tendon, that can increase the odds of a rupture.
Given Evans' age, and history with Achilles tendinitis, Jung said Evans is likely dealing with "wear and tear," minor tissue degeneration that might have progressed to the point where he's had a flare-up severe enough to sideline him. Evans did not miss a game due to an Achilles issue in his first 12 seasons.
Achilles tendinitis is often treated with rest, icing and supportive footwear. Many cases can resolve within a few weeks. Assuming Evans didn't seriously exacerbate his condition by playing Monday, it's conceivable he could miss just one game.
After Sunday's visit to Atlanta, the 49ers have a bye before hosting the Raiders on Nov. 8, which would be 20 days after Evans last played.
The 49ers will have their fingers crossed. Despite finishing just four games, Evans has been among the biggest reasons for their 6-0 start. He has 27 catches for a team-high 420 yards and three touchdowns.
"If it's just some (Achilles) wear and tear, then you're probably in a situation where you're managing it," Jung said. "You try to get it to a point where it settles down, it doesn't flare up and you just kind of keep managing it."
As Shanahan noted, the 49ers managed it last week by holding Evans out of practice. Their approach wasn't entirely successful considering Evans had three catches for 94 yards against Washington, but he limped off before halftime. They will presumably manage Evans this week by not playing him against the Falcons.
After that? There seems to be reason for optimism, but even Shanahan isn't making any bold predictions: The 49ers will have to wait and see how the rest of the season goes.
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There’s more to San Francisco with the Chronicle. Subscribe today for just 25¢.This article originally published at How long might 49ers' Mike Evans be sidelined? Surgeon provides perspective on Achilles tendinitis.