I meant to post my ATR story from the start on this brilliant site but never got round to it. I’m currently at the 21 week point so here’s everything from the start. I’m a 34 year old male living in Cardiff, U.K, treated conservatively on the NHS. Sorry this is a massive post, I’m rubbish at self-editing. I’ve split it into sections.
The first 4 weeks:
I’m quite an active person and normally participate in British Military Fitness, a form of outdoor circuit training, about four times a week and regularly run. So it was a surprise that it would be a one off game of badminton that injured me.
I ruptured my left tendon the night before April fools day playing badminton. I was going for a shot then felt a bang like sensation in my heel and fell forward. I looked around for the low bench which I thought I had clipped my heel on, of course there was no bench anywhere near me. My foot was very floppy and the ankle a bit numb, but strangely there was no pain. I think I knew had ruptured my ATR but being a bit of an idiot and perhaps in shock (it was my first real injury) , I continued to plod around on the foot even getting up my stairs and having a shower. I think I was hopeful of it just being a sprain. I got into bed and googled ATR injuries, the classic signs were there including an obvious gap in the tendon. I phoned NHS direct who advised me to head to Accident and Emergency. My star of a girlfriend drove me there and got me a wheel chair to the department at 1 in the morning. They performed a Thompsons test and diagnosed an Achilles rupture. Unfortunately, being so late, the plaster room wasn’t open, so they bandaged up my lower leg,gave me some crutches and told me to return in the morning.
The following morning they had another look at the tendon and sent me for an ultrasound. The radiologist had bad and good news. The tendon had completely ruptured but the ends did meet quite nicely with the foot in the equinus position. He also told me that they see about one person a week with an ATR from badminton. I saw the doctor and he gave me the options of surgery or non-op. Given my age, 34, he suggested surgery, so they plastered my foot in the equinus position and booked me in to see the surgeon a week later to hopefully be admitted for surgery. I was also given clexane blood thinning injections to self-administer daily whilst I was in a cast and told to elevate the leg as much as possible. I found placing pillows underneath the mattress a good way of elevating at night.
The injections and elbow crutches weren’t much fun. Luckily I managed to borrow a pair which had soft rubber moulded handgrips (available from disability shops). With the hospital crutches I tried weightlifting gloves to help with palm soreness. A friend told me that wrapping cycle handlebar tape around the crutch handles can help with cushioning. A rucksack or satchel helped to carry items from room to room. Beware of wet tiled surfaces when on crutches, I almost went flying a few times in wet Cardiff pubs and toilets the first few weeks. Strategically placing chairs around the kitchen to kneel on helped with cooking. I bought a LimbO cast cover for showering and a fleece toe cosy. In my experience you still have to be careful when showering with a cover on because they can leak. The first week in the cast there would be occasional calf pain when flexing my knee, but otherwise not too much discomfort. .
The next week I saw the surgeon fully prepared to be operated on. He’d seen the ultrasound which showed a tear at the calf muscle insertion. This area is very tricky to suture and would involve a large surgical incision. He recommended treating it conservatively but if I really wanted it surgery was also an option. By this point I had read a few studies on non-op vs. operative treatment and knew the key to success in both treatments was early mobilisation and weight-bearing. I was quite happy with the non-op option. I was to cast up for 4 weeks and would then be put in a walking boot for 4 weeks. My foot was re-cast in the 30 degree equinus position in a lighter compomer cast and told to return in 3 weeks, having already spent a week in the plaster cast.
The next three weeks were quite uneventful. I kept the limb elevated as much as possible and wiggling my toes. I tried to move around on the crutches every couple of hours to exercise a bit. There would be the occasional sharp aches from the injured area but these generally didn’t last very long.
The Boot week 4 onwards
I went back to trauma clinic where the cast was sectioned and removed. The tendon was quite thick and my ankle quite swollen. The surgeon said the tendon was filling in nicely. I think my type of rupture heals more quickly as it has a good blood supply compared to a tear at the heel bone. I was horrified at how much my calf muscle had atrophied.
Normally they use an aircast boot with wedges but they had run out of wedges. The surgeon didn’t want to recast me and wait for a wedge order to come in so they found a hinging walking boot which hadn’t been used for years. I wasn’t overly confident about this but was keen top get out ofthe cast. The boot was locked out at 30 degrees dorsiflexion and neutral. I put my foot in it and was immediately aware of how uncomfortable it felt to stretch my tendon. The surgeon reassured me that I was to bear as much weight as I could tolerate on it. I was also advised to sleep with the boot on. I stood up and placed my bad foot down. I could hardly place any weight on it at all, it was quit sore.
I crutched my way out of the clinic and thought I’d try and see if I could put my foot down and let the boot hinge. I immediately felt a tearing like sensation and genuinely thought though I had re-ruptured the tendon. I popped back to the trauma clinic feeling quite down and luckily caught the consultant before he left. Luckily I hadn’t re-ruptured and was told the feeling was probably minor muscle fibres tearing as I slowly mobilised the ankle again. I told him I didn’t think I could walk in the hinging boot, he explained it would get easier as the tendon stretched and offered to lock it out in dorsiflexion with no hinging. I decided to try and stick with it.
Apart from the initial rupture I think this was the lowest day of the whole healing period. I may have had unrealistic expectations about suddenly being able to walk in a boot. I knew that I hated the hinged boot. I found the way it stretched my Achilles quite sore and was tempted to see if I could buy an aircast boot with wedges and get that fitted instead. I tried leaning against a wall and putting my bodyweight through the boot with my foot in dorsiflexion. It felt like I was putting a ton of weight through the foot and it all felt very weak. By night time I had managed a short shuffle across the kitchen without crutches.
The next day I decided to ditch the crutches and just walk in the boot. It was a pretty horrendous walk, with the left foot shuffling forwards in a poor impression of a fencer. I could get nowhere near neutral and was very slow too. Still it was nice to be able to shower properly. The first few days I used ibuprofen but found I didn’t need it much after that. There was a lot of swelling around the ankle and socks would leave a lovely imprint in the skin. I controlled the swelling with nightly ice packs and regular elevation. A few weeks later I bought an inflatable ankle compression cuff with a gel ice pack. I can highly recommend these for taking down swelling.
Things improved steadily after that. Walking got a bit easier, still with a shuffle and not much hinging. A week into the boot I went to a wedding and even managed a bit of dancing! Having traded in my car for an automatic I returned to work and this helped with progress as I’d exercise the tendon more. I’d try to exercise the ankle by doing the alphabet with my toes. Having initially hated the hinge boot, I grew to like it as I believe it allowed me to stretch and exercise the tendon more than a fixed boot. I think the first day was such a shock as I was suddenly allowed to go from an equinus position to neutral. Reading some of these blogs I notice that some people are gradually recast into neutral or near neutral positions. With the help of active stretches in the boot I was able to get to neutral in the boot after 10 days and walk at a decent pace and with less of a weird gait. Well no chance of healing long I suppose.
The Boot week 6
The boot was adjusted to allow for 7.5 degrees of dorsiflexion. I had some good news too as swimming was allowed and walking in the pool. It was great to be able to do some cardio and the tendon didn’t feel too bad although walking bootless around the pool was a bit scary. I was due to go into two shoes in two weeks but being a bank holiday the appointment was delayed to the next week. By 7 weeks I’d stopped sleeping in the boot and started doing gentle theraband exercises after chatting to some physios at my workplace. At week 8 I decided to try two shoes with trainers.
The first thing I noticed in two shoes was how stiff my calf and Achilles felt. I felt it was more flexible in the boot, which I still wore if going outside. I was still a lot slower at walking and verylimpy. It felt good to ditch the heavy boot though. At week 9 the surgeon was happy with my progress and I saw the hospital physio who gave me some bodyweight exercises to do, (squats, lunges, side squats, balances, double calf raises) before referring me to an outpatient physio.
Week 9
The next few weeks were slow progress. The Achilles was very tight and quite limpy and I regular iced the swollen ankle at night. Exercise was mainly stationary bike, swimming, walking and towards week 12 cross-trainer. The tightness would be worse in the mornings and gradually ease a bit over the course of the day.
Week 12-17
I started seeing my new physio every two weeks. He was by his own admission was quite conservative in his treatment of ATR’s in the early stages. I was given variations on the exercises I was already doing. Single leg calf raises were very hard with hardly any lift at all at the start. I found a good way to practice was in a swimming pool and going up on tip-toes and transferring weight between the two feet.
By about week 15 I could walk with almost no limp. However if I had been on my feet all day I would be limpy by evening. Week 16 I managed a walk in the welsh mountains which ended up being 10 miles long, it was tough by the end and my Achilles was sore but it was great to be able to do finish it. There would still be a bit of a limp and stiffness of the Achilles first thing in the morning, but my ROM was looking pretty good. By about week 16 there was no longer any need to ice my ankle at night as the swelling had pretty much gone.
Week 17
My physio decided it was time to move things on a bit with eccentric, heel hanging, calf raises. I also confessed to having a little jog on the beach at week 16 just to see how it felt. It felt okay although I was protecting my ankle a lot. He had originally told me to not expect to run for 6 months. He agreed that I could run at a gentle pace on a treadmill or soft ground. Single leg balances were carried out on a bosu trainer. I thought these things were brilliant so I went out and bought an unofficial copy. I found them great for balancing and performing squats and lunges on.
I ran for about 20 mins every other day on the treadmill. There was no pain or discomfort apart from initial stiffness which would wear off. I was careful to listen to my body. Strangely I became paranoid about the occasional twinges in my healthy Achilles and started to worry about that rupturing. By about 20 weeks I could manage a pace of 11 km/H. When running around the park I normally do about 12 km/H. It was a great feeling to be able to run again.
Week 20 to Present
Things progressed more with the physio sessions moving on to hopping and jumping. We moved onto single leg eccentric calf raises which were possible but much harder. I was advised to up my running pace and duration, no sprinting yet, and cleared to run on hard ground. The main exercises were now to be running, bosu balances, hopping on the injured leg and single leg eccentric calf rises. The next day I tried a 6K route around the park, after initial tentativeness I soon got into my stride and there was no discomfort during or after the run.
I’m very happy with my progress. I’d say my ROM is almost on a par with the good ankle. The heelraise height is at about 70% of normal. Since week 12 I have been massaging the tendon almost every night with bio oil to help break up the scar tissue in the thickened tendon. I’ve also been taking cod liver oil and glucosamine supplements which I’ll stop taking after 6 months. I heard they can promote tendon healing and joint health. I have no idea if they’ve made a difference but I felt they couldn’t do any harm. After initially waking in the mornings the Achilles is still tight but loosens off quickly. I hope to return to outdoor fitness at the 6 month point.
It is a horrible injury mainly because of the recovery time. In the early stages I found it hard to imagine that I could ever return to sport again. Some will take longer to heal than others but reiterating what other on this blog have said, we all end up at the same point eventually. The plateaus are frustrating but even then healing is going on. I have spoken to friends who have had much worse ATR’s and longer recovery times. All of them have returned to full fitness and sporting activity with time.
