Treatment Protocols

CanuckintheUK on http://www.injuryupdate.com.au
Some interesting info on early weight bearing protocol.

For me it happened while playing soccer at lunch; just standing guarding someone and turned and then felt a tremendous pain in my ankle. This went away after a few minutes but I knew I had done something bad to my ankle while trying to walk. A few minutes of Googling later and I was certain I had ruptured my AT. I went into A&E and they confirmed the diagnosis and sent me away with a cast until I could be seen in the fracture clinic. So, being a scientist by trade, I started reading papers published in scientific journals which dealt with AT ruptures. There are quite a few good ones, though in some cases you need to have access to the journals through a university library account. There was a very good review in 2002 (reference below)

Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of achilles tendon ruptures. Am J Sports Med. 2002 Jul-Aug;30(4):565-75.
PMID: 12130412

It describes in detail a review of 5300 AT ruptures, how they were treated and the outcomes. It also describes in some detail the various techniques used for treatment and the pros and cons. Having been able to read through this, I found I was much better prepared to speak to the orthopaedic surgeons at the clinic. The first doctor I spoke to (and in fact most I spoke to) said that there was no big difference between surgery and conservative treatment in terms of outcome. In fact this isn’t really true; it is quite clear that the “functional outcome” of surgery is better in terms of mobility, rate of rerupture, and duration of recover. It is true that not having surgery avoids some risks such as infections, but similar rates of wound/general complications exist for conservatively treated patients as well (clear from the review, but not from talking to the doctor). The problem is that doctors only have so much time to keep up with current research and there are so may specific problems they have to deal with on a daily basis, it’s ultimately unrealistic to expect them to know everything about every aspect of your condition. The senior registrar at the clinic did not know of a study published by his co-worker about the benefits of early weight bearing (discussed below) after AT surgery; had I not done my own research, I might have been stuck wearing a hard cast (and crutches) for 8 weeks, rather than (if all goes well) an air-cast after 10 days. It’s hard to get access to the information, but where possible, you should try and find out and understand all of your options first and then speak to a doctor about what you want to do, not just what the doctor says. As I am a physically active 34 year old, I likely would have been recommended to have surgery regardless, but the first doctor seemed keen to have me in a cast and out the door.

Anyway, having a 2 year old and a new born, I am keen to get walking as soon as possible again, so I was also interested in articles which dealt with early, weight bearing mobilization after surgery. There was recent study published (by a orthopaedic surgeon who coincidentally works at the clinic I went to!) showing that early weight bearing after surgery actually reduces the rate of rerupture and complication rate as compared to surgery and immobilization (this is also clear from the 2002 review). Presumably the increased blood/lymph flow from muscle use helps in recovery, although it’s not specially stated why this is. Although it should not have taken as much effort or convincing as it did, I was able to get the senior registrar to agree that I could follow the early weight bearing protocol; he just needed to talk to the doctor a few doors down and find out exactly what he does. So at the moment, I am 5 days post-op and waiting to get out of my current cast and starting my long road to re-hab! In summary, my advice is to try and be informed as much as possible when talking to a doctor and even then, get second/third opinions until you feel satisfied that you are getting the treatment you want. Whether you are an elite athlete or not, it is just you that has to live with the injury, not the doctor, so make sure you are happy with your decisions.

CanuckintheUK on www.injuryupdate.com.au

Hi there Mumofmany,

You should really speak to your surgeon/GP about your concerns; that may involve being very persistent in calling his office/hospital to try and get another appointment to speak to him. There is no reason that he should not be able to speak to you and most surgeons will want to see their patients after surgery anyway. Anyway, nurses don’t decide on the course of treatment, doctors do, so ask to speak to him in person and ignore the grumpy nurse! Just seems a bit strange.

As you have probably read, there are a wide range of treatments for this sort of injury ranging from complete immobilization for 6-8 weeks to be fitted with a walking boot right away. The decision about how to treat the patient usually seems to rest with the doctor, but you as the patient still have the final say (although it sometimes does not feel this way). For patients immobilized in plaster casts (with or without surgery) the *usual* protocol is to recast the leg every two weeks, gradually moving it from equnius position to neutral. There are some scientific papers that have been published which indicate that there are benefits for early mobilization and weight bearing (the weight bearing is thought to allow the proper orientation of the new collagen fibres across the repaired tendon). Despite this, many doctors (including my own!) would prefer to treat the patient more conservatively by not having them weight bear until they are out of their cast. This works well in theory, but the practical day-to-day considerations do not enter into their decision. It’s all well and good to tell someone to take it easy and stay off their legs if you’re not the one who has to take care of their kids in the morning!

I am 4 weeks post-op now and after 2 weeks in a plaster cast with my foot in gravity equinus, I was fitted with a walking boot (AirCast is the tradename) with 3 - 1.5cm heel wedges (which keeps the tendon from coming under tension). One heel wedge is removed every 2 weeks, allowing the tendon to be stretched back to the neutral position in stages. This treatment regime was one I had to *convince* my doctor to follow as he tends to not use walking boots at this stage. I should also say, I didn’t invent this treatment protocol, it was published in a decent scientific journal of sports medicine and one of the authors was at the same clinic where I am being treated!! This paper, and other similar ones that looked at the benefit of early mobilization and weight bearing, showed that the re-rupture rate drops from ~2% to ~1%, the return to normal walking, stair climbing is much faster than without weight bearing and there is a much lower complication rate compared to surgery and immobilization in a cast. So it seems strange that it would be so much of a hassle to get one doctor to do what another one down the hall does, particularly when there are clear benefits, but doctors tend to get set in their ways. In a 2002 review , ~5300 AT ruptures (from many different locations) were examined in retrospect and ~4000 were treated surgically and of these ~350 had early mobilization, so the meta-analysis had a large sample size (i.e. it’s not just one lucky individual who benefited from early weight bearing) and the differences in outcomes are statistically significant. Having said that, you could always be the very *unlucky* rare case that has serious complications or re-ruptures even when it should be very unlikely to happen. My doctor laughed when I asked him about how nobody seems to do the same thing and agreed that there was a huge range treatment types for this injury; if you have a strong preference for treatment, you just need to understand the implications are of that treatment and ask your doctor to do it; if they refuse ask them to justify why they don’t want to.

In my case, being able to wear the boot (full weight bearing with no crutches) has been a huge advantage as I can shower on a regular basis, I can do 90% of my normal work around the house, I can carry my own coffee to the table and I don’t have to worry about putting a bag over my foot when it rains. On weekends, my wife and kids can go back to going for afternoon walks and outdoor play at the local parks.

I wish more doctors would spend time reading the current literature to try and make their patients lives a little easier but in a way, I suppose they are trying to do whatever they can to try and make sure their patient does not have a re-rupture, even if this means being inconvenienced for a few months at home and having a bit of muscle/bone atrophy in the process…

Canuck

mumofmany on www.injuryupdate.com.au

Thankyou ‘canuckinttheUK’ - I took your advice and called back the Dr’s receptionist - well I got my husband to and I actually ahve an appointment with the specialist next week. But the receptionist is insisting that he ‘only deals in plaster’. We shall see! I am going armed with some documents that cover other forms of treatment - otherwise it’s like I am being held hostage by him.

Thanks for the sympathy ‘Max’ - I spent yesterday trying to get another specialist to see me, but it seems because I have been operated on already I am ‘off limits’ so to speak and it is deemed inappropriate to see another surgeons patient

I mean my surgery was classed as ‘emergency’ as I was sent by my GP to and ER and then admitted that way, so the most discussion I had with the surgeon was for about 2 minutes before he operated - I spoke to the anaesthetist for longer. I mean really who knows anything about achilles injury and treatment until you are affected by it!

Choz on www.injuryupdate.com.au

Hi mumofmany,

I am in a similar situation to you, I am now 2.5 weeks post op, I spent the first two weeks in a half cast (on the front of my shin) that was bandaged on. At the 2 week mark I went and saw the surgeon, he check the wound healed ok and put me into a full fibre glass cast. I had the cast on for one day and it just didn’t feel right, it was digging into me and felt really tight, anyway I decided to action this myself, I went into an emergency department and they ended up loosing up the cast and replastering it for me, Feels so much better. The doctor that replastered me said that any time you have discomfort (well abnormal discomfort like tightness, rubbing etc) with plaster then you are best to get it adjusted. He was adamant that I did the right thing, and no after the plaster re-adjustment I am glad that I went and got it redone. In terms of the debate about the boot or not, it is definitely dependant on who you are seeing. I am in the cast for 6 weeks, then will start my physio etc, this is just the way my surgeon does it, and I think because he has had some good results he is sticking to that way. My personal opinion, is to try and get the best of both worlds, sit in a cast for 4 weeks or so, then move into the walking boot, this way you have had enough immobilisation and can slowly get back into walking etc. I’m happy to stay in my cast for 6 weeks, then I will consult with my physio, surgeon and local GP on their opinions in moving forward after this period. Best of luck with everything, I hope that you reach a full and speedy recovery. By the way I am in a fibre glass cast, weight isnt to bad.

CanuckintheUK on www.injuryupdate.com.au

Hi Mumofmany,

Glad to hear to were able to actually talk to your doctor! If your doctor “only deals in plaster” then ask to see another one; I understand you were trying to be seen by another specialist and that this was frowned upon (I had a similar experience) but if the surgery has already ben done, there is no reason why the rest of treatment should *have* to be tied to the doctor who operated, although it often is. If your doctor refuses to do anything other than put you in another plaster cast (and you don’t want that option (and it is just one treatment option!)) then ask him to transfer you to the care of another specialist who will treat you according to your wishes. Doctors can tell you what they think is best for you (i.e. which medicine you should take) but the don’t have the right to force you to do what they say. I should say, I’m really not anti-doctor at all!! I have a lot of friends who are doctors actually as we get along fine. I just don’t like doctors who treat patients as though they are ungrateful trouble makers if they question the procedures that doctors prescribe (or suggest different ones).

Canuck

p.s. If possible go in with your husband for moral support.

26 Responses to “Treatment Protocols”

  1. nancy, on March 17th, 2008 at 1:26 am Said:

    dear canuck
    do you have the title/webpage of the literature you read about early weight bearing ? i’m seing my surgeon in 2 weeks for my first visit after surgery and would like to support my opinion with good literature…
    is it at week 2 that you got your boot?
    and gradual weight bearing/ no crutches?

    thanks and good luck
    nancy

  2. dennis, on March 17th, 2008 at 1:49 am Said:

    Hi Nancy,

    Canuck was on the InjuryUpdate forum, and I think he’s stopped posting as he’s recovered. I haven’t seen his posting since. Please check here: http://achillesblog.com/atr-rehab-protocols/
    for more info.

    Many literature require $$ to get access to unless you have some sort of academic affiliation or you are a doctor.
    Check the main site: http://achillesblog.com/ and on the left sidebar, there are lots of resources. You just have to read through them carefullly.

    best of luck. ;)

  3. nancy, on March 17th, 2008 at 1:58 am Said:

    thanks dennis
    i was just reading everything on the sidebar and copied a few
    thanks for the links
    i really want to get back on my feet quick, enough of those crutches!
    what about you, did you go with early weight bearing or not?
    nanc

  4. michael, on March 22nd, 2008 at 1:04 pm Said:

    I’m scheduled for surgery on Monday, 3/24. Had chronic Achilles tendinitis from tennis and last Saturday, while skiing (actually, while falling) it ruptured. My doc is a board certified orthopedist but doesn’t specialize in feet and ankles. All of the doctors I’ve spoken to have told me that ATR repair is essentially the appendectomy of orthopedic surgery; all orthopedists do it but no one actually specializes in it. Does that sound right?
    I’ve emailed my doc the current literature on early weight bearing because he is making conservative (lengthy immobilization and no weight bearing for 4-6 weeks) treatment noises.
    Needless to say, I’m anxious about the surgery and recovery. But, as a very active individual ( I work out 1 to 1.5 hours daily, biking, rowing or swimming for cardio, weight training 2 to 3X?week and a lot of tennis) I don’t see any option other than surgery. I just hope I can have a dialogue with my doc about realier weight bearing than he seems to be thinking of.
    I’ll keep you updated.

  5. dennis, on March 22nd, 2008 at 1:37 pm Said:

    michael -

    sorry that you are taking this detour like the rest of us here. Glad to hear that you are doing your homework, and feel free to ask any of us our experiences with the ATR and our treatments if you have any questions. There are a lot of great information on everyone’s blogs here, as well as the resources that I’ve been compiling on the main site with the help of everyone on this site.

  6. brendan, on March 22nd, 2008 at 1:39 pm Said:

    Hi Michael -

    I was really nervous about my surgery too…it was my first one. I think I was most nervous about what I would feel like after the surgery…there are plenty of good postings on various blogs on this site about how that goes. You are lucky to find this site before your surgery…I didn’t discover it until a few days after my surgery….and it would have helped relieve a of my pre-op/post-op anxiety that I had.

    My ortho doc does specialize in feet/ankles, not necessarily ATR’s though…..he said he did 2-3 ATR repairs a month for ~15 years…so I knew he’d done a lot and I trusted his techniques. I did consult with another surgeon who I opted not to use…but both did seem to talk about the repair like it was a piece of cake. That said, I think it’s important to ask how many they’ve done, and what their success rate is with their rehab protocols.

    Take it easy this weekend…get your “space” ready to go. Let us know if you need anything.

  7. michael, on March 22nd, 2008 at 2:32 pm Said:

    Bendan, Dennis -

    Thanks for the info and especially this blog. A friend and tennis partner who had ATR surgery about 18 months ago has loaned me these high tech crutches called Strutters (if you google crutches and Strutters you can find out all about them). I’ve been practicing with them. I’m just trying not to drive myself crazy over the weekend. Fortunately, I’m in no pain, haven’t had any real pain at all since the rupture and I’m getting around well with a boot. It’s one of those situations where I’m going to feel much worse leaving the OR than when I go in. Oh well, not much I can do about that. I’m off to enjoy the nice weather.

  8. Tom, on March 22nd, 2008 at 4:00 pm Said:

    Michael - Try not to worry too much about the surgery. There will probably be some moments afterwards when it’s painful or uncomfortable, but it subsides pretty quick. My surgeon was also not a foot & ankle specialist, but as the others have mentioned, the surgery is not very complicated and you should be fine.

  9. brendan, on March 23rd, 2008 at 11:39 pm Said:

    Michael -

    Good luck with your surgery tomorrow…let us know how it went when you are feeling up to it.

  10. julie, on May 28th, 2008 at 7:07 am Said:

    Hi! I am new to this site, just stumbled accross it whils recovering at home, bored out of my skull!!
    I ruptured my AT 11 weeks ago, jumping up and down at a gig! I was taken to A&E where despite me telling them it was my AT and not a brake, put me in plaster. I returned to see a specialist and was advised to have a full leg cast for 8 weeks then a series of half leg casts, changed fortnightly to straighten up my foot. No-one asked about help and support at home etc, it has been a nightmare. I feel totally dependant on my partner, who is exhausted caring for me.
    I have 2 weeks in plaster left and not much idea what happens next other than physio, i have not seen a consultant since my diagnosis. What can i expect for my recovery?? I was really active:rugby/running/gym 5 nights a week… feel so miserable!

  11. dennis, on May 28th, 2008 at 7:00 pm Said:

    julie -

    I hope this site has been helpful. I think Johnk also went the non-surgical route, and he’s been doing really well. You may want to check on his blog. Keep us posted on your recovery.

    By the way, for some strange reason.. I just had an urge to look up the band House of Pain that had a hit song called Jump Around

    http://www.last.fm/music/House+of+Pain/_/Jump+Around+%28LP+Version%29?autostart

    It’s really bizarre how mind associates things.

  12. Mary Mekko, on July 12th, 2008 at 5:34 am Said:

    Just had my ATR surgery done June 25th here in Oakland, CA, and now have a cast, only 14 days after surgery, where the doctor says to WALK on it! In all my reading on the net, I haven’t seen such an early walking case yet. I am afraid and use the crutches, not putting full pressure on the foot. This surgeon had many, many years of experience as a senior orthopedic surgeon for four hospitals. Does anyone find this exceptionally soon to walk? He even said that I do not need the crutches unless I want to keep them for balance! I am terrified of rerupture.

  13. fourleaf, on August 23rd, 2008 at 4:37 pm Said:

    Ruptured mine Fri July 4th water volleyball. Had surgery Wed July 9th, had soft cast for 2 weeks then hard cast 2 weeks, then went to walking boot. The day they removed hard cast I started PT (9 sessions so far) and going to gym and swimming daily. Ride stationary bike (with boot) and swim with legs only and tread water 30 min per day. This has given me pretty much full range of motion and walk with severe limp in regular shoes (with heel lift). They tell me 2 more weeks which will be 8 and boot may be history.
    My surgeon is cautiously agressive and says I will know when to quit. PT says agressive but sensable daily working the injury will provide quicker results. They all say be cautions but do something daily.

    Hope this helps, reading other comments helps me guage my success and keeps me from getting down about the injury. One of the worst injuries I have ever had, not only pain but the anticipated recovery.

    “Day by Day it gets Better”

  14. paulorange, on October 1st, 2008 at 6:56 am Said:

    Hi,
    I ruptured my AT while playing badminton, two weeks ago. I had surgery three days after the rupture. And the only information I got from the Doctor was that with surgery I can continue playing football(soccer) and badminton.
    After the surgery I was told to see him after two weeks. No other information.
    I’ve got a plaster only on the front side of my leg. It’s held by a bandage.So I am really worried/confused about what is going on. I live in Paris, and my French is not so good. Getting any kind of information here is hell. Perhaps hell is better:)
    I am able to move my toes and I notice the loss of muscle on the calf. Any suggestions?Cheers.

  15. marilynrd, on October 1st, 2008 at 11:05 am Said:

    Hi Paul,

    Sorry to hear about your troubles. This is a great resource so keep coming back. Most have had ruptures, but some have had “reconstruction” of the Achilles as they were heading to a possible rupture….my guess is that the rehab is about the same.

    I did a Flickr PhotoStream of my recovery which is here:

    http://www.flickr.com/photos/marilynrd/ as it was easier for me. I also link every picture back to this site. I hope it helps you and others. If you have trouble seeing the set, “Achilles Surgery” let me know.

    In answer to your question:
    My muscle is improving with rehab that I started at 4 weeks. The tendon that attaches your muscle to the bone is cut and naturally going to need rehab. It is alot of work, but for the first four weeks, I devoted my days to rest WITH pain meds, :) and a daily baby aspirin to prevent blood clots, in order to let my surgery lines heal. I had more sewing (I think) than some others.

    Take good care, Paul, and keep us “posted”.
    Best,
    MarilynRD

  16. normofthenorth, on June 19th, 2010 at 2:41 pm Said:

    Not sure if anybody reads this far down on this page, but here goes:

    Only one “fact” repeated above seems to be Just Plain Wrong, and it’s VERY IMPORTANT! Specifically, the modern NON-SURGICAL protocols have recently been proven to produce the SAME or BETTER results than SURGERY!! As of now (June 2010), there have been FOUR randomized studies, starting in 2007, that have disproved the myth that we jocks should really have the surgery if we want good results. If you’ve just ruptured your AT, and you’re being steered toward surgery, read my blog, or read the studies I link to there, and then skip it!

    The stuff above about the patient taking charge, getting informed FAST, is PURE GOLD. The stuff about early Weight Bearing having medical and “life” advantages (and the links to studies elsewhere on this site) is PURE GOLD. The assertion that most surgeons don’t bother to read and internalize the latest studies (even when they’re written by their colleagues down the hall!!!) is unfortunately true, as is the assertion that most surgeons keep following THEIR protocol (as long as it works reasonably OK) rather than the BEST protocol. (And most surgeons tend to cut, just like most carpenters tend to build stuff out of wood!)

    But CanuckInTheUK’s assertion that “it is quite clear that the “functional outcome” of surgery is better in terms of mobility, rate of rerupture, and duration of recovery” — a reasonable summary of that 2002 metastudy of a large number of patients — has been proven WRONG by newer and better studies. (BTW, I had surgery on my first ATR in late 2001 based on the old understanding, and I SKIPPED SURGERY on the other leg in late 2009 based on the NEW understanding!)

    The problem with all the old studies which were “meta” combined in 2002 (and again around 2005 with the same results) is that the two streams of patients (op and non-op) weren’t RANDOMLY assigned to the two treatments. Basically, “jocks” got surgery, and “crocks” got slapped into a long series of casts. The jocks did better than the crocks, DUH!!

    The studies ACTUALLY proved that jocks do better at recovering after ATR than crocks! But the results were INTERPRETED to “prove” that surgery produces better results than non-op immobilization (which it turns out it does NOT!). These were DEpendent variables that were misinterpreted as INdependent variables — it’s a classic pseudo-logical, pseudo-scientific blunder, in hindsight, but it seemed logical at the time, and there was no solid evidence to prove it was wrong.

    Fortunately, in 2007, some smart researchers decided to put this important assumption (myth) to the test, and randomized the patients into the two treatment streams. They found NO statistical differences in strength, ROM (flexibility, related to healed tendon length), and re-rupture rate!

    Shocking! What we all believed to be true — and many of us carry the scar from that belief — could NOT be proven true in a careful scientific study! The only significant difference between the two groups was in the rate of complications, as predicted.

    Since then, mostly in 2009, three other randomized trials were completed, comparing ATR surgery to a modern (and pretty aggressive) non-op rehab protocol.

    In all 4 of these studies (AFAIK), the patients were not only randomized into the two treatments, but the two treatments were IDENTICAL except for the surgery itself and some gauze wrap for the surgical patients. It’s impossible to do a “double-blind” test of this question, because anybody can see whether the patient got surgery or not, but this is as close as we can come.

    ALL FOUR of those studies found statistically IDENTICAL functional results — strength, ROM, and rerupture rates — with only two exceptions (a) the rates of complications were generally significantly higher in the surgical group, and (b) one single strength measurement in one study was significantly different. In that one strength measurement, the NON-surgical patients were actually STRONGER than the ones who’d had the operation!! (I think it was at 6 months, measuring “isokinetic” strength at 90 degrees-per-second flexion.)

    More details and discussion and links to the studies (or at least the free summaries) can be found on my own blog, at achillesblog.com/normofthenorth/2010/03/08/a-more-complete-review-of-the-options-surgical-vs-non-operative/

    And the protocol that was used in the most recent of the studies (and which I and mike753 and gunner here have been following) is posted at achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/ . (If I were starting over, I’d make two modifications: (a) Get a HINGED boot, and start hinging it some time well before 8 weeks, I’m not sure just when, and (b) make the removal of the 2cm of heel lifts — the transition from “equinus” to “neutral” — gradual rather than sudden.)

    Check it out — FAST if you’re facing ATR surgery, and/or a slow rehab protocol — and make an informed decision!!

  17. normofthenorth, on July 8th, 2010 at 3:00 pm Said:

    The modern fast protocol that worked well with BOTH surgical and non-surgical patients is now quick-linked at bit.ly/UWOProtocol . I don’t think any patient here should spend any longer on crutches, or non-weight-bearing (NWB) or pre-Physiotherapy, than this study-tested protocol calls for!

    The page where I presented the modern studies that prove that a modern protocol works just as well WITHOUT surgery (strength, ROM, and re-rupture rate) and without the surgical complications, is now quick-linked at bit.ly/achillesstudies .

    For the picky scientists here: Unlike what I said directly above, there DO seem to be some pre-2007 studies that compared surgery to a non-op protocol, AND that randomized patients into the two streams (and found better results from surgery). So the pre-2007 “truth” about the benefits of surgery wasn’t completely based on non-random “selection bias” (jocks got surgery, crocks got casts, jocks healed better, so surgery helps).

    In those studies, the misleading pro-surgery results had to be the result of the fact that the non-surgical patients got a slow and “conservative” and counter-productive rehab protocol, instead of a modern fast one like “mine”, at at bit.ly/UWOProtocol. The four modern studies — all of which found identical functional outcomes and lower complications without surgery — all used fast modern protocols and applied the same fast modern protocol to ALL their patients, surgical and non-surgical.

    Both factors — selection bias and overly “conservative” treatment of non-op patients — obviously helped to prolong the misconceptions, but I’m pretty sure that several pre-2007 studies (including those combined in the big 2005 meta-study) were randomized.

  18. judydeb, on August 27th, 2010 at 10:51 am Said:

    hello normofthenorth.
    I have to thank you for summarizing and indicating these research studies. Saves me a ton of time and is helping me a lot. Also reassures me that this weight bearing is a good thing. On we go
    judydeb

  19. Free Sheet Music, on March 29th, 2011 at 10:56 am Said:

    I love to play the violin! I find it truly helpful…

  20. pamg, on May 31st, 2013 at 11:09 am Said:

    I ruptured my left Achilles tendon on Monday evening - I do boxercise once a week (have done for about 4 years) and was sprinting and felt (and I think heard) something pop and fell. I realised I had no strength in my foot - couldn’t flex it but could wiggle my toes slightly. My trainer told me to keep my weight off that leg and packed ice around my ankle whilst I arranged transport home. I reapplied an ice pack at home and kept my weight off that leg all evening and at no point have I put any weight on it since.
    I saw my GP the next morning who did the Thomson test and sent me to A&E with a ruptured tendon, where they repeated the test and agreed. No scans or MRI done, presumably not necessary.
    I’m nearly 50 and was told that that hospital tend to treat ATRs conservatively. I’d done some reading prior to going in so was happier to avoid surgery if possible. I’m healthy and reasonably fit and active, but am quite happy to act my age from now on and slow things down a bit if I have to.
    I’m in a plaster cast to my knee with my foot pointing down as far as it would. I’ve to go back in 4 weeks, when the cast will be removed and healing evaluated. I was left with the impression that they may operate then if things are not going well. All being well, I will be given a WB with wedges for another 4 weeks and then physio.
    I’m ok, no pain; an ache now and again, coping with the crutches and boredom (feeling very guilty sitting around to be honest). I do have some muscle spasms but I’m not sure if that’s because of inactivity?
    My questions are:
    Am I right to sit with my leg up as much as possible?
    Can I lay my leg on a side or should I keep my toes pointing up - I find it hard to sleep on my back?
    Can I do any damage to the tendon whilst in the cast - I often feel like I’m tensing my calf muscle (try hard not to!)?
    Is there anything I should be doing to help recovery?
    I’m worried that I might unwittingly do something that will hinder any progress.
    I didn’t think to ask these questions and no advice was offered so I be very grateful for any advice and suggestions you experienced fellow suffers can offer.

  21. micah1, on May 31st, 2013 at 4:10 pm Said:

    Hi Pamg, sorry you have joined our club. I am currently 11 weeks and seem to have had a similar management that your hospital are planning for you, although I was only in plaster for 3 weeks.
    Yes you need to elevate your leg when resting, above the level of your heart is advised to prevent it becoming swollen and tight. I was advised to wriggle my toes to keep some blood circulation.
    You can sleep on your side, I found that having a pillow between my legs made life more comfortable.
    I think many people get some calf spasms in those early days, and it makes us all worry that this may be causing harm, but it seems not to.
    Forget the guilt, make the most of the time to just sit and read/catch up on films/plan a holiday etc!
    You could even start a blog so that others can read and learn from your experiences.
    best wishes
    Micah

  22. pamg, on May 31st, 2013 at 5:16 pm Said:

    thanks Micah, your comments have put my mind at ease. I shall try to relax and catch up with the piles of books and tv recordings!

  23. wearingthe45, on May 2nd, 2014 at 9:56 pm Said:

    Hey guys. So I started weight bearing in a boot today at 45 days post op. Doctor told me to use 1 crutch for a few days to get used to it. Is the heel tingling normal? Does it go away. Not really painful just a weird feeling. Also I’m very awkward with walking its like I’m intimidated. Can someone give me some insight.

  24. rajiv, on June 20th, 2017 at 4:45 am Said:

    I ruptured my achilles tendon on Jan 28th playing badminton. I’m 55 yr and my surgeon recommended non operative route and put me in a cast for 10 weeks. It’s been 5 months and I am still walking with a limp, unable to do single heel raise on my injured side. there appears still to be a gap on my left side. I feel that surgery would have allowed me to be more active sooner. I hope that eventually I will be able to walk without a limp.

  25. agnesatr, on June 20th, 2017 at 4:14 pm Said:

    Just a note Rajiv, even with surgery, if your doctor put you in a cast for 10 weeks and did not recommend rehab afterwards, you might be in the same situation, unfortunately.

    Sorry about your struggle, but as I mentioned in my other comment, you might want to get re-evaluated by a doctor that follows latest protocols for the injury and can advise you on a correct course of action now. Your leg was immobilized for over 2 months and being NWB for so long there was no stimulation to the leg, which promotes collagen creation in the re-growing together tendon.

    It might take bit longer for you, but hopefully with the correct medical and PT help you will get back to normal soon! Good luck to you!

  26. mikerhaord, on March 7th, 2018 at 10:11 am Said:

    Thanks for the post.You need to control your daily meals to prevent overweight. This resource will be very helpful for you as well.

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