3 week’s update
It’s been 3 weeks since the big “pop”. It all happened on April 13, 2014. I was playing a badminton competition on that night and it was already the 3rd game of my 3rd match. I was just about to move back to the center of the court after returning a drop when I heard a loud pop. My right leg felt like planted into the ground with a sharp pain like cramps. After a rest and the pain was gone. I thought it’s just cramps so didn’t take it too serious. (Of course I quit the game after that.) I even walked back to the bus stop and took a shower by myself.
Now that I look back on that night, I suspect the culprit of my ATR might be the new socks, despite of the rainy and cool weather. I was wearing a pair of new socks that night which is a bit tighter on my ankle than usual. As what we learnt from the physics, even exerting a small force in the middle of a tight rope, the total force on the rope can become huge and thus can easily break it. I am not sure if that is the reason with my case. I shall definitely be more careful with what I wear for sports from now on.
Anyway, on the next day, even the pain was gone, I was still worried about the loud pop and suspect it might be the ATR. So I went to see a GP and she referred me to take an X-ray and ultrasound and confirmed my fear. I went to the hospital in the afternoon and got my foot into cast with a pair of crutches.
On Wednesday (April 16), I went to the Orthopedic department of the hospital and discussed with the doctor about my treatment. At that time, I was convinced that you need surgery to heal the ATR. So I was quite inclined to take the cut. However, after chatting with the doctor and did some online research on that night, thanks to achillesblog, I acknowledged the non-op method can just achieve similar results as the operation. Since I just moved to a new city by myself early this year, going non-surgical seems more suitable for me.
I was put into the boot “Maxtra” right on my appointment while asked to wait for the decision on my operation schedule. So I declined the surgery the next day and hence started my NWB for the first two weeks.
On my second appointment (April 30), 2 weeks after the first one, I was told that I can start TWB (Touch Weight Bearing) with crutch and my boot was adjust to PF(Plantar Flexion) 30’ to 45’. Norm mentioned that it may be a little more and earlier than other non-op protocols, so I guess I should also post the protocol I got for you guys to compare and comment. I guess the thing about this early hinging may not be too big a problem, as most of the time I just rest my leg on my foot as TWB. Besides with such fixed angles, you really cannot put much of your body weight on the foot anyway. But I do have a question regarding the PWB in other protocols. Should I do PWB as often as I should? Are there other exercises I should begin in week 3-4 for the next stage?
RBWH (Royal Brisbane and Women’s Hospital) Achilles tendon rupture protocol – Hinged
Updated 4/4/13
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Achilles tendon – Non operative Mx |
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Stage 1 – Controlled functional rehab |
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0-2 weeks: PF(Plantar Flexion) 30’ fixed (hinged ROM boot or plaster cast) NWB crutches |
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2-4 weeks: PF30’ to free PF (hinged ROM boot) TWB(Touch Weight Bearing) crutches |
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4-8 weeks: PF15’ to free PF (hinged ROM boot) TWB |
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8-12 weeks: 0’ to free PF (hinged ROM boot) FWB Start exercise bike Remove boot at 12 weeks and regular shoes with heel raise for 3 months |
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Stage 2 regular shoes with heels raise 3 months |
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Start swimming Increase bike NEVER assisted DF (DorsiFlexion) Progress proprio and sports specific rehab |
References:
Fowler Kennedy Accelerated Protocol – Sports Med clinic
Text: ’Achilles Tendon Rupture – Current Concepts’. Niek van Dijk et al. 2008
