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Achilles Tendon Rupture Treatment - Postcode Lottery?

Posted , 24 users are following.

david97308
david97308

Hi All,

First time poster here.

I wanted to find out a little more about various NHS trusts treatment of Achilles Tendon Rupture (ATR).  I'm especially interested as I get the feeling the treatment on offer to me is not optimal and I wonder if I'm the victim of being under the wrong trust.  One that is trying to save costs.

My Background : 44 yo male, healthy and fit, with suspected ATR.  currently 3 weeks in short leg cast.

I have an Ultrasound tomorrow (4 weeks after incident).  No Surgery being offered at all, Consultant says they only provide conservative treatment with cast as surgery gives to many risks. Treatment is 3x3 weeks of short leg casts, final cast is 90 degree to floor. It seems no load to be applied at all during this time.

My main concerns are :-

(1) Risk of re-rupture seems to be on average 20% with non surgical option.

(2) 1 in 3 patients on non surgical never recover function fully.

(3) No option of Airboot being offered to me.

(4) Various studies show that early restricted mobilisation of ankle in non surgical option reduces chance of RR to same levels as surgical.  This will obviously not be available if I'm in cast for 9 weeks.

(5) I don't see how I can be offered a set treatment path prior to Ultrasound.

I've never heard of 3x3 weeks cast only option.  What are you being offered?  I'm absolutely not going to settle for walking with a limp or a weakened leg because my trust are watching their pennies.  I will be taking a private second opnion but also wanted to hear your thoughts?

Thanks

David.

 

1 like, 109 replies

109 Replies

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  • danny25168
    danny25168 david97308

    Posted

    I've not seen harsh stats like that on non surgical route.  Where where the 20 percent and the one in three stats derived?  A boot is offered after the cast?  At some time right?

    I had surgery.  I was given a choice. But I was not given information like that.

    I'm a 46 year old American.  I'm 7 months post opp.

    • danny25168
      danny25168 pacehuman

      Posted

      Yes a lot of swelling.  I've still got some fluid or swelling in my ankle now.  My Dr said to expect to see some there for up to a year.
  • wm16931
    wm16931 david97308

    Posted

    From what I have read, early mobilisation is the key to a good outcome and a speedier recovery.  So the earlier you are able to do weight bearing the better, which is why many people are given the rigid boots to wear.  I had a complete rupture of my Achilles tendon and therefore had to have an operation.  I have summarised the treatment I received below:

    Following my accident I went to A&E and after being assessed my leg was put in a plaster cast.  The following day I attended an outpatient clinic and was given an ultrasound scan which confirmed that it was a complete rupture and that I would need an operation.  One day later the hospital called me to say that I was booked in for my operation in two days time.  So from having the accident to being operated on was four days.  My operation was a day case and I went home with my leg in a plaster cast with crutches and was told to put no weight on my leg whilst it was in the cast.  Two weeks later I attended an outpatient clinic, the plaster cast was taken off and I then saw the consultant that operated on me and was fitted with a rigid boot with four heel lifts. I also saw a physiotherapist and was given some very simple exercises to do at home. I wore the boot for thirteen weeks and did exercises at home as specified by the physios.  During that time I saw the consultant one more time and had regular pysiotherapy appointments. After the boot was removed, for the next two months I attended regular physiotherapy sessions at the hospital which culminated in six lower limb exercise classes to complete the treatment. I was then signed off by the physiotherapist.  It took six months from the accident to completing the treatment.

     

    • wm16931
      wm16931 pacehuman

      Posted

      Not now I don't, but whilst I was receiving treatment my foot and ankle were swollen for a long time.  It was only towards the end of my treatment, after I had been mobile for a while, that the swelling disappeared.  The swelling slowly subsides as you do more activity.

       

    • pacehuman
      pacehuman wm16931

      Posted

      I had partial rupture and its only 5 days plaster came off, and walking now.. But swelling is still there and limp when i walk 
    • wm16931
      wm16931 pacehuman

      Posted

      I'm not sure how long you've been in plaster but I found that after being in plaster and a boot for such a long time I needed to gradually increase my activity levels once out of the boot as my muscles had weakened quite a lot.  My physiotherapy exercises at home and sessions at the hospital helped a lot with this too.  Are you having any physiotherapy sessions and have you been given any exercises to do at home to help build your muscle strength up?  Maybe your limp is just due to your muscles being weak given that you have only been out of plaster for 5 days.  After getting out of my boot I started doing some regular walks and bike rides, increasing the distance each time if I felt able to do so.  My physiotherapist recommended doing short bike rides on alternate days as a good form of gentle exercise (but not to stand on the peddles so as not to put too much pressure on the tendon).  I suspect if you were given regular exercises to do things would improve and the swelling would eventually go down.  The swelling can take a long time to disappear.
  • svetlaking
    svetlaking david97308

    Posted

    Hi, David! I have been treated with the same careless attitude. Put in a plaster with no scan, haven't even been seen by a doctor- just a nurse. Appointment for the fracture clinic in 12 days???. While waiting I did what probably all of us who haven't been given any information about their condition and possible treatment do: I googled it. And decided to go home/ I am from Bulgaria/ , where I can see a specialist . After seeing me, the doctor took me in the hospital for urgent surgery - the same day. He said it was a crime that I haven't been operated straight away. The operation should be done within the first 48 h. I am 44 years old, fit and healthy and I am so disappointed with NHS, because I felt as if I had been chucked out. It is a negligence and I do intend to sue them when I recover and come back to UK.
  • david97308
    david97308

    Posted

    I had a scan last week (4 weeks after the incident).  It showed a full rupture with the tear at 3mm.  So after 4 weeks there's still no binding.

    I'm still in my first cast (full equine?), which I think is far too long.  I see the NHS Consultant on Monday.  Hopefully he should put me in the next cast with an increased angle.

    I have to say I've been so disappointed with my treatment by the NHS. I'm sure I should have moved into my second cast on week 3 or at least week 4.  As it stands I'll be nearly week six by the time I get moved.

    • pacehuman
      pacehuman david97308

      Posted

      Full rupture is a MUST surgery, they are wasting your time, tell them you need surgery asap. 
    • mandy1956
      mandy1956 david97308

      Posted

      Hi David

      I am also very fed up with the NHS

      i have a Full Rupture ( i think- everytime i ask they say ' Probably ' what does that mean !!

      I am at 4.5 weeks.

      on the day it happened accident and emergency put in in plaster - with my toes pointing downwards and was told to make an appointment at the fracture clinic for 1 weeks time.  I could not get an appointment for 11 days. 

      I attended that appointment and was told that i was to be in plaster for another 9 weeks, with the plaster being changed ever 3 weeks.

      Yesterday i went back to the fracture clinic after my first set of 3 weeks, they simply told me to go to the plaster room and have my plaster changed, i had to actually ask to see the consultant!!  He was very off hand with me, I asked if i had a ' Full Rupture' and he said ' Probably '

      They have now replastered my leg at a slight less angled position and said to come back and have in replasterd again in 2 weeks times ( not 3 weeks as originally told ) again i will not see the consultant - just a change of plater and they will angle my foot at 90 degrees.

      I am them to go back and actually see the consultant in 4 weeks time.

      I asked when i would be able to walk and he mumbled something about being able to start walking  in plaster ( i assume in 4 weeks time) this will have been 8.5 from my accident.

      Won't hold my breathe though as no one consultant says the same thing.

      I asked yesterday if i was going to have a scan - his reply was a simply- NO.

      When i asked - what if it is not healing ? he said that 95 percent of people do !!!

      I am really fed up

      Mandy

    • pacehuman
      pacehuman mandy1956

      Posted

      Hi Mandy

      You should make a complaint. Because full rupture is 100% surgery and without US how can they say its full or partial rupture!!

    • mandy1956
      mandy1956 pacehuman

      Posted

      Hi i have just called my consultants assitant and told her that i want to know if it is a full rututure of partial , she said that it didn't matter as it woudl be treated the same anyway !! I have told her that i want a scan , to confim , she said that the consultant is in theathre all day today and she will get back to me on Monday. I am also calling the Patients Liason Office at the hospital to make a complaint, got through to there voicemail and am waiting for them to get back to me.

    • pacehuman
      pacehuman mandy1956

      Posted

      Hi

      Dont leave nhs like this playing around with humans!! Assistant is totally wrong, and you know that yourself to.

      Ask them to have a US asap.

    • mandy1956
      mandy1956 david97308

      Posted

      Hi David

      I am with the Surrey and Sussex Health Care Trust

      I have just has a heated converstation with my consultants secretary , when i asked how do they know it is healing if i don't have a scan or even see a consultant for weeks on end , she said that the person who puts the plaster on can tell !!! can you believe that !!! I am so angry

    • mandy1956
      mandy1956 david97308

      Posted

      Hi David 

      can I ask what NHS trust you are being treated by

       

    • karen42768
      karen42768 mandy1956

      Posted

      I believe I will be having a similar discussion when I see my doc next week. I want to push for a scan if not will have to pay privately. Want to know these past 9 weeks haven't be for nothing not to mention these injections!
    • mandy1956
      mandy1956 karen42768

      Posted

      Hi Karen, can you let me have your phone number??

      can you private message on this forum?

      would love to have a chat with you x

    • karen42768
      karen42768 mandy1956

      Posted

      Email :_____ then can phone

      Patient Moderator Note: I have removed an e-mail address from this reply as it is the policy of patient.info to not publish these within the forums. If any user is interested in this removed information they should contact the author via the Private Messaging system requesting such. Thank you for your cooperation.

      What is / how to use Private Messaging? See patient.info/forums/discuss/private-messages-226361

    • karen42768
      karen42768 mandy1956

      Posted

      Have just emailed my address but message is waiting to be moderated so not sure if can? 
    • karen42768
      karen42768 mandy1956

      Posted

      Went onto messages don't know how to send you a private one? Do you know how to do? If so send me one and I'll call you.
    • mandy1956
      mandy1956 karen42768

      Posted

      Hi Karen, no don't know how to send private message on here, I do on Face book...are you on face book ?.
    • mandy1956
      mandy1956 karen42768

      Posted

      Hi Karen. Can you send your phone number to this email address:-    _____

      Patient Moderator Reminds: You provide / exchange personal information at your own risk.

    • Ploddingon
      Ploddingon mandy1956

      Posted

      Hi to send a private message here, click on the envelope picture under the avatar, under the star or you can click on the person's name at the top of a post or anywhere and it will take you to their profile and there is a button saying 'message' or something like that.

      They won't let you,post email addresses on the public forum, for safety and privacy,or websites, other than NHS or UK Govt sites, I think

      good luck

      plodding on

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