Hi,

I am a 34 year old physiotherapist from the UK and I ruptured my Achilles Tendon playing football 7 days ago. It was my first football match in 7 years and I lasted a full 5 minutes! I went to push off from my left leg to go from standing to jogging / running and felt a sudden pain in my left Achilles and heard a ‘pop’. I remember thinking someone had kicked me from behind or thrown a water bottle at me that had exploded. As I was falling down I looked behind and didn’t see anyone. By the time I had landed on the floor I knew exactly what I had done!

Whilst waiting for a lift to the local A and E  I spoke to a friend that had been involved in recent research on Achilles’ tendon rupture protocols. His advice was conservative management and early weight bearing in an orthotic boot locked in plantar flexion and gradually decreased. I was 500 yards from local A and E department when it happened so was taken there. I generally avoid this hospital and recommend to friends, family and patients that they go to the local teaching hospital with a large orthopaedic department. This wasn’t an option unfortunately.

The accident and emergency doctor gave me the option of surgery or a cast and non weight bearing. I mentioned recent research and weight bearing in an aircast boot with heel wedges. He advised this maybe an option in an orthopaedic specialist hospital but not there. He then made arrangements for me to attend the next day to see an orthopaedic surgeon.

First thing I did the next day was to call the teaching hospital and ask if I could be seen there. Not without a referral from the hospital where I attended A and E was the answer. I tried talking to the secretaries of the foot and ankle consultants of the teaching hospital and got the same answer. Also was advised that if I was referred from the other hospital I would be on a long waiting list. This isn’t acceptable with an Achilles’ tendon rupture. I then even contacted the local private hospital where the specialists from the large teaching hospital work but got no response.

The options I was given were for surgery and rehab or the old fashioned conservative management of none weight bearing in a cast and serial casting. The research gives better outcomes for surgery with these 2 options. The orthopaedic surgeon I saw (shoulder specialist) advised a 2% rupture rate with surgery compared to 15-20% with ‘conservative management’. He also advised that conservative management would leave me with decreased power. Given these options I opted for surgery as I am keen to get back on my feet as soon as possible, do not want a further rupture and want as close to full power to enable a return to an active lifestyle. If the conservative management of early weight bearing in an functional orthotic brace was an option I would have gone with this.

I was then seen by the orthopaedic nurse who advised I would likely be for surgery the next day. He asked me to fast from 8 am and they would call at 9am to let me know what time I would be in. I called them at 10am and they did not realise that anyone asked me to fast and that my operation would not be until the middle of next week. I received a phone call from another member of the orthopaedic team the next day requesting I brought Callum in to the children ward as they could do his surgery that day. Who is Callum?

Anyway today was the day of my surgery. I spent half of last night looking at the research for modern early weight bearing conservative treatment compared to surgical treatment and couldn’t understand why this wasn’t an option. I arrived at the hospital this morning and was admitted. I met the anaesthetist just after lunch and agreed on a spinal block. I changed into my fashionable hospital gown, had a black arrow drawn on my left leg to indicate which to operate on (this gave some confusion as all my notes said it was the right Achilles I had ruptured) and had all my obs taken.

I then met my orthopaedic surgeon for the first time (foot and ankle NOT shoulder). He wanted to know why I was so keen on surgery. I advised him of what had happened and the options that were given to me. He said he hadn’t operated on an acute achilles tendon rupture in over 2 years. All the research suggested that conservative management was as good as surgery but without any of the complications. He does 2 weeks NWB in a POP followed by an orthotic boot with wedges that are gradually decreased. He stated if it was his achilles tendon he would treat it conservatively but he would operate if that was my wish. At last someone at the hospital that talks sense! I quickly put my clothes back on and made my escape to the plaster room to change my back slab for a lightweight cast.

I am back again for a review with the consultant in one week. I will then be placed in the aircast boot with wedges. I have looked into the Orthped / orthocast boot and mentioned this to the OS. He would be happy for me to use one of these instead of the aircast boot but this is not available from the NHS trust I am at. For anyone that has tried to Orthoped / orthocast, is it better than an aircast boot? If it is more comfortable and lighter I would be happy to pay the money as I will be in it for a while!

Kristian


Comments

7 Comments so far

  1. Mr WordPress on April 21, 2015 8:41 am

    Hi, this is a comment.
    To delete a comment, just log in, and view the posts’ comments, there you will have the option to edit or delete them.

  2. kristian on April 22, 2015 3:52 pm

    How do I put the marathon thing at the side of my blog>

  3. eyceman on April 22, 2015 4:02 pm

    Wow what a story. Felt like an action movie with a touch of drama. I am non op and at 10 weeks FWB with slight limp. Calf muscles are firing and so far so good. I was 4 weeks in cast NWB and then straight into a boot. You can read my story in my blogs. Godspeed on your recovery!

  4. herewegoagain on April 22, 2015 5:03 pm

    What a roller coaster of a ride, you must be feeling a bit dazed!

    I am 7 months into a non-op recovery and my experience is 100% positive and successful. I had surgery for ATR 15 years back and have happily skipped the added pain this time around.

    I used a vacocast boot and really liked it- lots of people are happy with the aircast though and if that is covered by your medical system it may be worth trying it out.

    I think the marathon widget is something you can select if you chose a theme for your blog- maybe in settings?

    Really looking forward to following your recovery- I am a huge fan of PT and feel that ATR recovery could for the most part be managed and supervised by an experienced PT rather than an OS- I spent a total of 20 mins with my OS, just fairly routine checks were all that were needed.

    All the best
    Lisa

  5. kristian on April 22, 2015 5:21 pm

    I was tempted last night to cancel today, cut my own backslab off in a week, order a boot and follow one of the rehab protocols from the research.

  6. donna on April 22, 2015 6:38 pm

    YAY you! I am so glad you got a good OS who was up on his research! Lots of great support here for non-op! In a few weeks you’ll be in your boot and no pain from the incision!

  7. herewegoagain on April 22, 2015 9:05 pm

    I am not surprised you were planning to go it alone. If an emergency doc told me that the hospital was not specialized enough to handle non surgical recovery I would be really really worried.

    I didn’t meet my OS until 2 weeks in a cast had passed by so I was worried I would be given serial casting. I bought a boot in advance and printed out the protocol prior to my appointment and was relieved it was well received. I was totally prepared to manage my own recovery if not.

    I am not encouraging others to do that, maybe the second time around gave me the confidence to take this on!

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