Achilles tendon and Aircast boot

[stepco]

I am a 51 - yr old English male and I ruptured my Achilles tendon playing tennis a few weeks ago. A scan showed it to be torn / stretched badly at the muscle end. I was told to wear an Aircast boot which I have been doing for 3 weeks now and I expect to continue having to wear it for another 4 months. I was not offered surgery or a plaster cast which is what I expected. Is this adequate treatment for such an injury? Will the tendon return to full use ? I want to be reasonably active in the future -will I be able to be? If I walk around will this do any harm?: I am off work at the moment as my job demands alot of standing and moving around. I remove it to sleep - is this OK?Can I remove it to drive? Each morning my foot is still painful which does not give much confidence in this treatment especially when reading comments from others who have experienced simliar problems. Please help - I have little confidence in this form of treatment and wonder if it is still at an experimental stage
Stepco.

[slaphoundapbt]

hey there STEPCO, tough luck with the tear. I suspect based on the type of treatment you are receiving that your rupture was not complete, meaning that some strands of the tendon were still connected. If this is the case, you are fortunate. I don't know of surgery being offered as an option for partial tear. Probably no advantage and only risk to do so. The fact that you are in an air cast from the beginning means you don't require plantar flexion to relax the tendon. At this stage in my recovery I didn't wear the cast to bed. I would seek physio from a good sports physiotherapist immediately if you haven't already. Even if they don't start working the injured tendon at this point, there is a lot they can have you do to prevent atrophy in all the leg muscles. I did lots of stationary bike with cast on. As far as regaining full function, I don't know. I am at 12 weeks now and am working at strengthening and stretching as per therapist instruction. I believe if you get the correct information and apply it faithfully, you will get almost full function back if not full.

[Betty]

Hi Stepco,

First of all sorry to hear about your injury - its a blo*ody pain eh?!? From what I have read a rupture can be more straightforward to treat than a partial rupture but in the long term a partial rupture heals more quickly. I think it is a good thing if your consultant did not feel that surgery was necessary but he/she should perhaps have explained the justification for the reccomended course of treatment. This is not a dig at consultants but I think as they see these types of injuries every day they can become a little bit blaze with the patient. For us it is new and scary but for them they have probably seen 100 such injuries that week so it all par for the course. I guess I would say don't be afraid to ask. When I first had my plaster off and my boot on, the palster technician removed the dressing on my surgical wound, this had the effect of the wound getting rubbed by the boot which made it weep. I already had the frightners put into me about infection (see my post!) but I debated for ages whether I should ask someone if I should continue with the dressings until the wound was properly dried up! So silly in hindsight beacuse when I did speak to the plasterer guys they were really helpful and gave me all the dressings I needed. Anyway the moral of the story is ask, even if you feel like you are being a pain!

I for one am still amazed that it happened at all. It is incredible to think that just like that a tendon can snap and it often doesn't have to be something dramatic like a fall to happen. I have heard of people injuring their tendon by walking up the stairs or just by standing up! It still puzzles me that a tendon that can take something like 8 times your body weight can snap, with no warning and from doing some every day activity. The consultant told me that the joints/tendons/ligaments all get old and you just can't do the same activities as you used to.....I am in my thirties for goodness sake!!

Anyway, good luck with your recovery and I second slaphoundapbt that the right info applied faithfully is the key.

[kjwilkin]

I am a 51 - yr old English male and I ruptured my Achilles tendon playing tennis a few weeks ago. A scan showed it to be torn / stretched badly at the muscle end. I was told to wear an Aircast boot which I have been doing for 3 weeks now and I expect to continue having to wear it for another 4 months. I was not offered surgery or a plaster cast which is what I expected. Is this adequate treatment for such an injury? Will the tendon return to full use ? I want to be reasonably active in the future -will I be able to be? If I walk around will this do any harm?: I am off work at the moment as my job demands alot of standing and moving around. I remove it to sleep - is this OK?Can I remove it to drive? Each morning my foot is still painful which does not give much confidence in this treatment especially when reading comments from others who have experienced simliar problems. Please help - I have little confidence in this form of treatment and wonder if it is still at an experimental stage
Stepco.
Hi there Stepco,

I am surprised to hear that you will be in the aircast boot for 4 months. It seems an incredibly long time. Would have thought that it would be better to get your leg moving ASAP. I was in a cam walker for about 6 weeks after having my plaster removed post surgery for an ankle reconstruction and peroneal reconstruction in late January.

About 18 months I returned to Melbourne from living in London for a couple of years. Whilst I lived there I went to a great sports medicine clinic called Pure Sports Medicine in London. Their website is www.puresportsmed.com It may be worth going to see one of their sports physicians who will be able to recommend the appropriate treatment. They have access to some of the top orthopods in the country. The guy that set up Pure Sports Medicine clinic had a bad experience in Oxford after tearing his Achilles Tendon. He was told that he'd be put in plaster, but wasn't happy with that. So, rang his Sports Physician in Australia who ended up recommending surgery as I think his tendon was totally torn. Alternatively, they may be able to recommend a clinic closer to where you live.

Sometimes half the battle is getting the right people to treat you. I now have the best sports physicians, physios and orthopods treating me. It has taken a while to find the right people.

Good luck and let us know how you go !

[Choz]

Hi Stepco,

I'm a bit late in this forum, but I have only recently ruptured my achilles and am now 2.5 weeks post surgery. From my research and also chatting to a doctors, there are a few different reasons why surgery is not an option, one obvious one is if it is not completely ruptured, but the other side of things is if the tendon has been fully ruptured but has detached high up towards the calf rather then mid tendon, then surgery cant be performed as they would be trying to sew the tendon back into the muscle, which is a bit like sewing your tendon onto a juicy steak, the stitches wouldnt hold has the muscle is to tender to hold it together. Normal surgerical ruptures are mid tendon, therefore sewing the tendon together with the other half of the tendon.

Thats my two bobs worth today, I hope it all makes sense.

Best of luck with recovery.

[robyn]

All these responses make very interesting reading. I had my surgery 3 days be4 Xmas and am finding my immobility extremely hard to come to terms with. I have an appt. with my surgeon on Thurs.4th Jan (2 wks from day of surgery)-can anyone tell me what to expect? Could I have a boot put on or is it likely I will get re cast? My husband must go away on the 12th Jan is it likely I could have some mobility and therefore independence (albeit limited)by then? How soon after achilles surgery is it safe to fly?

[nkd]

Hi
Sorry to hear that. I was in the same boat about 6 weeks ago after I re-ruptured my AT at 6 weeks. I had surgery on 26th November 2006. Therafter I was in a plaster for 2 weeks with 2 crutches. My sutures then came out. My wound had healed (one of the downside of operation is delayed wound healing). I was put in an AIRCAST boot from them on- told not to weight bear for a further 2 weeks (5 wedges inside) folllowed by partial weight bearing for another 2 weeks with 3 wedges inside(each wedge is 1 cm each). At 6 weeks I have been told to fully weight bear (2 wedges)on the boot and remove a wedge every 2 weeks. At end of 10th week I would not have a wedge but have to wear the Aircast boot for another week. Therafter the boot comes off and I go back to normal shoes with a heel lift inside.
The boot is excellent. It is safe and you can take it off at night or if you sit down for some time. I would prefer someone to wear the boot while taking a shower ( I re-ruptured it after a shower without the boot as I slipped; boot can covered with 2 dustbin liners)). After repair of the tendon the leg feels fine but if you are an active person then the strain is in your back as your leg is about 2-3 inches longer than the other. You could compensate it by going to the Orthotic department where you could ask for a wedge of 1'' to be inserted to your other shoe in addition to a 1-1 1/2 inch height shoes. You can drive an automatic car if your left achilles is ruptured.

I must also point out that achiiles injury are managed by different consultants in different ways. You have to see what regime your doctor asks you to follow. AIRCAST boot is an excellent boot and is worth mentioning to the doctor.

[Choz]

All these responses make very interesting reading. I had my surgery 3 days be4 Xmas and am finding my immobility extremely hard to come to terms with. I have an appt. with my surgeon on Thurs.4th Jan (2 wks from day of surgery)-can anyone tell me what to expect? Could I have a boot put on or is it likely I will get re cast? My husband must go away on the 12th Jan is it likely I could have some mobility and therefore independence (albeit limited)by then? How soon after achilles surgery is it safe to fly?

Hi Robyn,

I am now 7 weeks post op for my AT rupture, so I can definately understand what you are going through. Like yourself I went and say my surgeon two weeks after the surgery and he put me into a full fibre glass cast, which I remained in for another 4 weeks (so all up I had a cast for 6 weeks). This will depend on the surgeon that you are seeing, as some like to have people in boots, others stick with the immobilising option with the cast. I have now been out of my cast for 6 days in which I have improved dramatically, I can pretty much walk without the aid of the crutches, slowly I must add, but I still keep my crutches handy to aid my recovery, really just using one crutch now for added support and peace of mind.

In terms of being able to fly, it should be fine (provided it is a short flight), however I am no doctor so make sure you consult your surgeon as he is the best judge for this. Ddue to the altitude it increases the chance of DVT's which from my knowledge is not uncommon in an immobilised post AT patient, and also flying is not the best for swelling, but as mentioned a short flight shouldnt be too much harm.

Good luck with all of your recovery, and take it easy

[Elmoblue1964]

Hi All,,,,,,,just read all off your reports on a/t ruptures.........i did mine on the 14/12/06....carried on working, with great difficulty......(being a postman on a walk it really was painfull )......had surgery on the 03/01/07...it was a complete rupture, and i have been put in a upper cast........i go to see a physio on the 13/01/07 which seems to me to be to early listening to all your comments, they said it would be to check the stitches and to give me some sort of physio.....then put it back on till i see the consultant the week later.....i find it hard to get my head around not being able to do things that i do day in day out.......(driveing walking etc )......i have been told ill be in a BOOT like most of you are in, in 2/3 weeks.........i must say 1 thing tho.......since the opp, i can move, my toes, leg,at knee, and feel i can move the (ankle) in the cast.......with out any Pain.......is this normal....many thanks to you all........HOPE YOU ALL RECOVER TO FULL FITNESS.......PS the injurey happened when playing football (soccer)....it felt as if i was shot from behind . ..............take care all :)