charlie45’s AchillesBlog

Hi Beanie
Thank you for your much appreciated comments to which I can totally relate to. My pain also comes when sitting still while resting. When the pain flashes through my Achilles I have no other pain or discomfort and when rubbing the Tendon all feels normal. The pain feels like a nerve spasm which takes your breath, but as you say it is most likely growing pains after the Achilles being worked. I am due to leave the boot behind in two weeks time [after 6 weeks] and get into two shoes and learn to walk again.

I’m at 8.5 weeks and have also experienced random sharp aches that don’t last very long. I mostly seem to get them when I’ve had boot adjustments or I’ve done new or a different amount of exercises. I usually get them when the foot is resting. After the move to neutral in the boot I got them quite a lot, so I think that they are caused when the tendon gets stretched and then probably heals or adjusts for the stretch. I’m not sure. For me they go away 2 days after the adjustments. My achilles still seems connected when I test it, so I try not to worry about them too much, I assume they’re like growing pains. Good luck! I hope yours go away soon too!

Probably a good question for your doc or PT but since it has come after a wedge has been removed and there is no other pain during exercises then I would not be overly concerned. Sometimes there are adheasions as the tendon heals or scar tissue and as you put more pressure on the area these break away and cause pain. For some it happens quickly and they think they have re-ruptured. It could also be nerve pain. If it continues for more than a week then I would consult your doc. You are 12 weeks locked up which is a bit long so you are travelling a very conservative route. How long before 2 shoes? Once at that point you should start catching up but you will have to wake all the muscles up. Probably in for some more pain and your re-rupture period will be slightly extended. If it is scar tissue then it has had a bit longer to take hold and you could feel it let go.

Hello Charlie-
Sorry about the PE…..at least you are only taking the warfarin for 6 months which is most likely when you will start feeling like yourself while healing your Achilles. I know it’s not much but hopefully soon it will be done. Best of luck.

Hi Charlie, this is Jay. Sorry to hear of your blood clot. I actually developed DVT in my leg as a result of the trauma experienced by my ATR itself. Immediately they put me on Xarelto and delayed my surgery because of the swelling. As much of a setback it seems on your healing Achilles, please take the blood clot seriously. Avoiding pulmonary embolism is totally more important than strengthening Achilles.

Charlie sorry to hear about the clot in your lung. In the grand scheme of things, a blood clot in your lung is MUCH more serious than an Achilles rupture! Take your blood thinners and get that thing resolved! Your Achilles will heal with strengthening exercises that you do in PT, so stick with PT as your doctor allows.

Charlie, as others have already written here, the NHS doesn’t have a standard protocol - I doubt whether most countries do.

However, Exeter’s Orthopaedic Centre is NHS and could be considered a benchmark for others. I was non-op but the rehab protocol was the same for surgical cases.

I have just responded to another post with the link achillesblog.com/
suddsy/2013/06/24/end-of-wk-2-wow-progress which you might find interesting.

Protocols will always vary, and that is good. We want specialists who push all the time for better solutions for their patients.

H

Richard - I did not have surgery although it was offered to me tongue in cheek. At A&E I had a temporary cast fitted and returned next morning to see the Consultant for confirmation of my full rupture. He then put me in a non weight bearing cast for two weeks, and I then had a Stirup fitted at the bottom for a further two weeks. This situation was much better being able to gain some stability. At the end of week four I had a piece cut out of the cast on the top of my foot to allow some upward movement. I am now at the start of week five but feel more vulnerable now that the cast has been cut. I will be in this situation now for the next four weeks before having the cast removed and who knows what will be next.

Charlie - use pain and swelling as a guide to weight bearing. Increase the weight slowly as tolerated to the point you do not need crutches.

Stuart - Thanks you for your support. Having had the cast cut away from the top of my foot it feels very odd is if I could fall out of tha cast. I do not have any pain when walking with crutches but can I over do the weight bearing at this stage? I have been advised by the hospital to exercise the tendon by slowly raising my foot upwards at regular intervals while sitting.

Charlie - The tendon has joined together it seems but healed takes a bit longer. After 12 weeks the risk of re-rupture slides away but if you sit around and do nothing then it seems that risk is extended. Tendons like work within reason and the healing tendon needs work to assist the formation of Collagen type I which alligns with the direction of force. They way they are doing things will work but putting you in a boot now would work as well and you would be way more comfortable. The important thing is you are happy with your progress. Incrementally increase your weight bearing as this will help the collagen.

@Charlie45, did you have surgery? I’m also in the UK and I was in a cast for 6 weeks. I didn’t have the front of the cast cut away, but was put in a boot at 6 weeks. I posted on my blog so you can read it there.

Stuart I had the piece cut out of my cast yesterday to allow me some slow uplift of my foot. When the piece came off they asked me to try and move my foot up which I managed. They confimed then that the tendon had healed but also stated that I was now in my most vulnerable period during the next four weeks during which time the tendon wiil gain strength.

As I was about to say, there is no standard NHS treatment and it sounds like you are being treated a very old way but if it works and you are happy then all is good. At least it is free. NHS is tending a non surgical approach more now due to cost but not sure which way you have gone. And I read into things you have been encouraged to weight bear which is good as well. Some docs prefer to keep people locked up and a cast as it is a sure fire way to stop people trying to walk on the healing tendon without support. At least you have an idea from your daughter of what to expect.

There is not standard NHS

Hi Stuart thank you for your thoughts on my impending treatment. I agree that the first two weeks were awful but then after that I had a stirup fitted to the bottom of my cast to allow me some weight bearing during the past two weeks, and tomorrow I visit hospital again to have the top of the cast covering my foot removed. I have been informed by my Doc that after the eight weeks in cast I will have a boot fitted for a further four weeks before Physio.

Hi I am new to the procedure when blogging. The cast will be cut away from the top of my foot to allow some gradual lift of the foot. My Daughter had a complete rupture last year and she had the same procedure carried out perhaps it is the practice of our local hospital here in Ipswich, UK.

Charlie - firstly you seem to have put your narrative in the title of your post. No big deal unless you intend to write a huge amount. Secondly, I am not sure why they are cutting the front of your cast away. I recall maybe one or two where this has been done but it is not the usual and seems a bit counter-intuitive as you will allow more dorsi-flexion and the tendon is not protected. I suppose the tendon is protected from explosive movement by the bottom of the cast and it will allow some active flexion but there are better ways. The first to come to mind would be to put you in a walking boot and start some weight bearing. You could also take it out of the boot to do some active ROM. I always felt the first 2 weeks was the hardest to get through and from there it seemed like I was making progress which lifts the spirits. I would ask questions of the doc as to why they are doing this. There may be some good reason. Could be a cost issue?