AT Rupture Advice

[anigee]

If you need any advice on your achilles tendon rupture injury, or it's rehab, feel free to ask.
I'm back playing high level soccer 4months post-op and i'd be happy to help anyone who needs it.

[slaphoundapbt]

Hi anigee, congratulations on your speedy rcovery.
It has been 7 weeks since my surgery. My surgeon told me I will be in a cast for 12 weeks. After the 6th week I was put in an air cast with my foot now in the neutral position and told I can now start to put weight on the leg. I was told this by the casting technician, not the surgeon. When I asked her how much weight I could put on the leg and whether I could sleep without the cast, I go the feeling she wasn't really sure and gave me her opinion.

What I want to know is at what point can I switch to just one crutch, then no crutches?
I think the answer here is when I can do so comfortably.
Is it better for the healing process to have the cast on or off while sleeping?
Not sure about this one. The one thing I think may be an advantage to sleeping with the cast on is that it keeps the tendon stretched taught. I have tried sleeping with the cast off and have no problem getting the foot back to neutral and into the cast in the morning.
Although I was told that physio won't start until after the 12 weeks of casting is up, are there things I can do such as ankle flexing, hot tub, massage... that will improve my rate and quality of recovery?

I see so many differences in what people with the same injury are being told to do and wonder why. My case is standard without any complications and I am very athletic. I therefore expect that my recovery should be as good and fast as anyone.
Your comments would be greatly appreciated.

[anigee]

you can most definetly begin to flex your foot and do gentle self massages. Getting off crutches is a matter of slowly but surely based on comfort, but be sure that you don't try to rush it or your long term results could be affected. Going in the hot tub and s tretching your achilles will also help it gain flexiblity. Doing physio, exercises and stretches will most definitely speed up your recovery, but being athletic alone will help you a lot. If you're in an aircast, once you're weight berring, you can also do the stair master. at 3 months, or about 12 weeks i guess, the tendon is supposed to be healed and from there i t is a matter of breaking down scar tissue, it is at that point that you may want to seek massage, accupressure, or active release. Right now, accupuncture would be a great way to bring down the swelling. As far as sleeping, i stopped sleeping with my cast at 5 weeks. Just don't over do anything, or let your tendon get stiff, good luck! post again if you need more info

[slaphoundapbt]

Hi Anigee, thanks for the response. I just now read your achilles story post. Wow, I didn't realize you were so young. It sucks you had to go through this at such a young age. I am that middle aged man they told you about that this type of injury usually happens to. I too was misdiagnosed an told that I had a calf muscle tear by the weekend shift doctor. She was performing the so called Thompson test and muttering "hmmm, that's strange" while squeezing both of my calves. What she was referring to was that I was able to apply some force with my injured foot to her hand by flexing my ankle, but the T test showed no response. She concluded that it was only a calf muscle strain and sent me on my way with crutches and ice prescribed. Fortunately through internet research and her lack of conviction, I felt I was misdiagnosed. I immediately followed up with my own doctor and a complete AT rupture was the verdict. My surgery was only 4 days post injury. The amount of time that ellapsed for you is rediculous. Thankfully you got your surgery in time to make a full recovery. While doctors do great work and we'd be lost without them, our cases are proof that one should not take what they say as gospel. Especially when they themselves seem uncertain.

Cheers!

[injuryupdate]

Good article just published in the Amer J Sports Med suggests that for Achilles rupture a 5mm gap on ultrasound can decide whether surgery or immobilisation is needed:

Dynamic ultrasound as a selection tool for reducing achilles tendon reruptures.Kotnis R, David S, Handley R, Willett K, Ostlere S.
MBChB, Bsc, MRCS, Kadoorie Centre for Critical Care and Research, Level 3, John Radcliffe Hospital, Headington, Oxford, OX3 7LD UK. rkotnis@hotmail.com.

BACKGROUND: The optimal method of treatment for acute tendo-Achilles ruptures continues to be debated. HYPOTHESIS: The reported lower rerupture rate for operatively treated patients is an effect of tendon end apposition during the healing process, and patients in whom apposition can be demonstrated using ultrasound will have a similar rate of rerupture if treated nonoperatively. STUDY DESIGN: Cohort study; Level of evidence, 2. METHOD: The authors reviewed all patients with an Achilles tendon rupture who were treated to a standard protocol during a 5-year period (2000-2005). Patients with a gap of 5 mm or more in equinus on ultrasound underwent surgery; those with a gap of less than 5 mm received nonoperative treatment. All patients were followed up to a minimum of 12 months. RESULTS: After exclusions, 125 patients were included: 67 treated operatively and 58 nonoperatively. There were 2 reruptures in the nonoperative group and 1 with surgery. There was no significant difference between the groups for any complication. CONCLUSION: Reduction of rerupture and surgery risks may be possible using dynamic ultrasound case selection. Further studies are needed to show whether functional results are the same with surgical and nonsurgical treatment when dynamic ultrasound criteria are used for case selection.

[hellyp]

HI
I'm currently 2 weeks post injury (acute / full achilles rupture). Opted for conservative treatment (no surgery - no MRSA). What a pain this is - can't even carry my own cup of coffee or look after my two boys. At least crutches will give me the shoulders / upper arms of superman in another 8 weeks time (yes, that's what they're telling me I'll have on crutches). No Bingo wings for me! (please ask for translation if you don't get that...)

I'm currently in a light weight cast that will be changed in a week's time and am told that the next cast will be non-full / partial equinus (i.e. not so pointy toed) followed by an air boot or air cast. I'm not sure what an air boot is or what it means mobility wise - will I be able to weight bear, let alone drive (right foot, manual car)??.

ALso, if anyone out there is in England - can you get suitable physio on the NHS???

[slaphoundapbt]

Hi Hellyp, sorry to hear about your misfortune. I am 10 weeks 2 days post surgery for the same thing. My surgeon told me the cast length is the same for both surgery or non operative treatment. 3 weeks pointed toes, 3 weeks not so pointed, then 6 weeks air cast. your foot is in neutral position once in air cast and weight bearing can begin. The air cast is a plastic boot with a foam liner that straps on with velcro straps. There are 2 air bladders that run down the back of the boot that you can inflate with an pump that it comes with. The air bladders give a form fitting cushion and support around the ankle. The boot has a slightly rounded bottom like a rocker. I was walking on mine for a week with crutches before I was able to do away with the crutches and have free hands again. I took mine off for sleeping. I was very active throughout my crutch phase and got sore underarms and wrists from the crutches. I spent about $200 canadian modifying my crutches for comfort and safety. Gel filled articulating crutch tips act as shock absorbers a well as grip the floor flush even at fairly sharp angles. Watch for wet floors. Deadly on crutches. Gel grips ease the stress on the hands and wrists. Lamb skin covers for the under arm portion greatly reduce the friction under the arms at the lats. I had allergy problems to mine and would opt for synthetic fleece if I had it to do over again. All this stuff I got off the net. Now back to the air cast. I would flex my ankle and wiggle my toes whenever I would be sitting with my leg up and cast off. I do lots of stationary bike and upper body weights to speed up my healing, even with my fiberglass cast starting 2 weeks after surgery. Let me know if you need anything else answered.

[Restless but hopefull]

Hi,

I've got a question about rehab. I'll give you a little history first.

I'm 39 and have never broken or torn anything or otherwise hurt myself in the past. I am not the most athletic person, although I am fairly fit.

I completely ruptured my achillies tendon 10 weeks ago. Next day I had operation and was put in cast with toes pointed. 2 weeks later (or 8 weeks ago), the first cast was taken off to remove staples and a new cast was put on, again with toes pointed at same angle. After 8 weeks in cast with toes pointed (or 2 weeks ago), the cast was removed. It was 2 days before I could get to phisio (12 days ago). My first day at phisio, I couldn't stand straight with my heel on the floor. Best I could do, was drop it to within 3/4" (2cm) of the floor. The therapist gave me very light stretching exercises to do. After about 7 days (or 5 days ago) I was able to drop my heel completely to the floor (although I could feel the stretch).

I've been walking with a heel insert and crutches ever since I got the cast taken off. I can walk with one crutch and even no crutch (although I seem to be draging myself more than walking if I drop the crutches entirely). The Doctor had told me I could get rid of the crutches by now and the heel insert after 4 weeks (in another 2 weeks from now).

My concern: The initial progress I made, from not being able to stand on my heel to being able to stand and walk on it (albight with crutches) was great. However, my progress seems to have slowed (although it's hard to measure) since I've been able to hold my foot at the neutral (90deg angle) position. By reading all the threads here, it seems to me that 8 weeks in a cast with toes pointed was way too long. The Doctor told me I had a very acute rupture at the heel and have been going by the assumption that Doctor knows best.

My question: Since the Doctor knew I was not the most athlethic person in the world and I don't rely on my Achillies Tendon for a living as a pro sport athlete does, is it unheard of to go 8 weeks with a cast with toes pointed. Also, should I be able to regain most if not all of my range with phisio and stretching exercises even though my foot was in this position for so long?

Thanks for any and all responses.

[hellyp]

Thanks for that slaphoundapbt!. I'm now in the aircast only 3.5 weeks in and have been told I have to keep in on at all times!! It has been so uncomfortable (little advice given on correct adjustments to the air pockets etc) I'm gogin back to have hte wedges reassessed adjuected next week so I'll make more time to challenge about takaing it off. 2 days in with it though and I am already able to do so much more - walking very gently with one or wo crtuches. I look forward to doing with ou - owever, currently with a whopping FIVE wedges inside it is as if I have one leg about 5 inches longer thanthe other. ...only 8 weeks to go...

[anigee]

Restless but hopeful, i've replied to you on "My Achilles Tendon Rupture Story" thread!

helly p, i'm glad that slaphoudapbt was able to give you some useful advice while i hadn't been on for a while. But after reading your recent post i can say have NO worries aboutthe five wedges! i had 5 for the first few days then 4 for a couple weeks, have no doubts in your recovery unless things get worse. you will hit plateaus where you think you're getting nowhere, but then you will hit days and weeks of breakthrough where everything clicks! so hang in there, and Good Luck