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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

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  • robert_77
    robert_77 david97308

    Posted

    well where do i start i have been seraching the internet for ATR ruptures help and advice and of course recovery . i stumbled upon this site and read quite a few replies from everyone it does indeed seem that it is a lottery on where you live mine in county durham NHS.

        A little on my CV for my ATR i will apologize first as its a little longwinded , it all happend that fateful night of been invited to a wedding where alcohol and dancing were invloved , i will say here and now its me own fault.

         at the age of 46 i should reall know better but as most men dont grow up they just grow older sorry i digress. after it happend off i troops the nextday to A/E to have them look at it , it appeared all black and blue around the outside edge of my foot , i could walk but very flatfooted . at AE they examined it and had an xray to which they replied only sprianed no breaks . off i went home with orders to rest it up and take pain relief. Two weeks later i could not walk properley and went back to A/E and was seen by another nurse, this time they tried the thompson test , i am sure it was called that he then said i am sure you have ruptured your achillies tendon .

         next day was back at the hospital to  see the consultant who did confirm rupture not sure wether partial as was small amout of movement or full i did not quite here him confirm either  way, so  i had  have a plaster fitted and take clexane injections oh how i love these not, the palster was below knee with ballet dancers toe pointing. this was to stay on two weeks then come off to have a adjustable leg brace starting off at minus 20 degrees then lifting the angle every two weeks to zero flat footed .

        After the 6 weeks this has now came off during that time i had ended up with DVT due to imobility so had to take blood thinning and still am taking the tablets not warfarin a new drug rivoxoban? ( there lies another story about costs grrrr)

    the clots have now gone i hope .

       now i have foam inserts in my shoes and can walk but limp my  lower leg  knee down is very  swollen a lot during the day at work office based, at home its rested up with it above hip level .

         sorry is was a long one but wanted to try find out about others and how it progresses with recovery . in the beginning the consultant said that he prefers the conservative method over surgery due to possible infections and other possibliities . i am at his mercy like everyone so heres hoping. i have a few questions if any one can answer or help i would be most apprceiative.

      the swelling is it normal even after now which would be the wedding was 22nd august it happened ?and two weeks after that it was in plaster.

       its worrying i cant walk propelrly only limping is this correct .?

    the million dollar question will it take much longer to even have the pressure on me toes , it seems when i walk i am still trying to protect the injured tendon and compencating for it.

    thanks in advance 

    rob

      

     

    • tim50stroud
      tim50stroud robert_77

      Posted

      I pinged mine end of september, from the same sort of cause.. not quite falling over drunk but it didnt help. 9 weeks in, using an Aircast boot, off at night and the evening, but foot is still swollen after a day at work. I start physio in 1 1/2 weeks and I'm told getting the confidence back can be a problem, getting back to normal walking. To be honest, I'm hoping for mid Feb

       

    • robert_77
      robert_77 tim50stroud

      Posted

      hi tim i had the angled boot on for 6 weeks i think it just came off last week , its the swelling thats concerns me it may be normal but doctors /nurses are very cagey in their replies , i think it must be the blame culture but i only wany an honest answer thanks 
    • tim50stroud
      tim50stroud robert_77

      Posted

      I've found a few physio leaflets from various NHS regions, and they all talk about coping with swelling during the physio recovery phase; not sure why it remains swollen for so long though... its one of the questions I want to ask when i start. The usual recomendations; Ice, elevation, anti-flamatories. I suspect it might be the muscle inactivity that causes a fluid build up; same reason for the DVT protection; I was self stabbing for the month of no weight.. weird experience, but didnt have any problems
    • robert_77
      robert_77 tim50stroud

      Posted

      thanks for that tim , the swelling was my main concern at present maybe it will go with time it is rested up at night but you never know if this is enough , its a case of wait and see. i have to go back in six weeks i been told i think this is phsyio or to see the conslultant . i will give it until then see how it goes thanks again 

      rob

       

    • tim50stroud
      tim50stroud robert_77

      Posted

      Google "achilles physio swelling" and you should get some hits
    • samantha_16366
      samantha_16366 robert_77

      Posted

      14 weeks on I still have a bit of swelling I think must be quite normal because physio said my swelling wasn't that bad as some she's seen are quite bad 
    • robert_77
      robert_77 Wholefruit

      Posted

      hi emma i was in a cast (fibreglass wrap style) for two weeks then after that an angular boot for six weeks with the angle changed every two weeks 
    • Wholefruit
      Wholefruit robert_77

      Posted

      I think i'd like that boot rather than a cast. I wonder if thats postcode lottery too?
    • tim50stroud
      tim50stroud Wholefruit

      Posted

      I've only had a boot since the start; seemed to fix it after 4 weeks no weight and 5 weeks (so far) of careful moving
    • robert_77
      robert_77 Wholefruit

      Posted

      ha ha it could be emma , the consultant i seen he said can we get him in the walker boot the nurses reply after been shown on the net sorry we dont have them , i think he meant the aircast one as its been widley discussed on use here. also the facts of costs on my blood thinning treatment (warfarin v rivoxoban (sp) but thats another story .

      rob

       

    • odette06380
      odette06380 Wholefruit

      Posted

      I had 2 casts at 2 different angles aquinas? I think they call it for 2 weeks apiece and then the walker boot which inflates I felt secure wearing it but couldn't actually walk in it as it had a rocker foot, it got very hot and sweaty during the summer but it was great to take it off to sleep. My leg went totally thin and wasted and had the power of a wet noodle! that's where the physio comes in.
    • Wholefruit
      Wholefruit odette06380

      Posted

      Mmmm - from reading on here I can't really see if there are any benefits to any of the boots over the cast. I had thought the boots allowed weight-bearing much quicker but it doesnt sound as if that is so. 

      As well as postcode lottery i've also realised how differently each consultant treats in tne same department. There are 3 in mine who a) a FULL leg cast the whole time B) boot from beginning c) mine - half keg cast for 9 weeks. Very different approaches. 

    • tim50stroud
      tim50stroud Wholefruit

      Posted

      Never had a cast, but the boot can come off for scratching and washing and changing the sock, and the pressure can be adjusted for comfort and support as needed. It can be removed at night for sleeping after the first NWB month.
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