ATR; 22 years old, Conservative Treatment.

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Hi, 22 years old; Playing football, sharply turned and heard a pop. Thought I had been kicked from behind but when looked to my amazement no one there. Surprisingly wasn’t in a great amount of pain. Went to stand up and zero success as you can imagine, left heel was what I can only describe as a slinky. 29/9

Went straight to A&E where was told Achilles Tendon Rupture, but in his words ‘it could be 80%, could be 30%, it’s hard to say’, at this point I had movement in my foot. Having recently graduated from university I was due to start a new job on the Monday, I feared the worse but this was delayed till the Thursday after I saw a consultant. I am using crutches to the office. Placed in cast at an angle, returned to see a consultant 1 week later, she confirmed the Rupture and now have leg in a Vacoped Boot. In terms of the treatment she advised me Conservative would be better with the implications that come with surgery, however from everything I read… with me playing a lot of sport I am unsure this was the right option? I am due to see consultant in 4 weeks time with a Physio appointment days before, an appointment I was told would be 2 weeks prior.  

Quite in the dark by quite a lot of things and reading this forum I thought would be the best place to find some answers; When taken out of the cast last week, foot went into a spasm, moving forward and back for minutes, is this normal? Also what can I expect in terms of a recovery time? And if so is there anything that can be recommended to ‘speed up’ the process? At this point my last concern is running or re-joining sporting exercise, I have come to realisation that will not be happening anytime in the near future however I would love to walk again soon.

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  • Posted

    Seth,

    Im sorry to hear about your injury. I opted to have surgery. Im 23 and had a complete rupture April 25 of this year. I decided to have surgery because I am very active as well. My doctor informed me that, with surgery there is a higher chance of success, letting it heal on its own is much lower, and you are un able to know if it is healing correctly.

    Not sure what to say about the spasm, I did not experience that. Its a pretty serious injury, i would ask a lot of questions at your consult.

    I also started a new job in may, and I bought one of those medical knee scooters to get around it was very helpful.

    Wish you the best

    Erika

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    • Posted

      Thanks for the response Erika.

      It seems surgery would have been the better option given my age and lifestyle. However I guess that’s something I have to put to the back of my mind and move on, they seemed quite reluctant to go ahead with the surgery anyway.

      I don’t really mind using the crutches due to me being in an office and not really moving too much. Out of interest, in terms of time periods, when were you able to walk again? I understand this may be completely different with me going through the non-surgical approach. Something I also can’t really get my head round is the lack of pain I seem to be experiencing, slight tingling at times around the area seems to be all.

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    • Posted

      Well, mine is definitely different then yours. But I was non weight bering for 8 weeks. Didnt actually start walking with out my boot till 10 weeks. And I had a limp up in till end of September.

      It was pretty rough. I did read a while a go a partial non surgical was maybe 5 weeks. I dont remember fully.

      What was the reasoning they gave you for not going through with surgery?

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    • Posted

      I can imagine it was a rough period Erika, from what I have read it limping seems to be a common occurrence throughout recovery. How long did the limping continue for? And also do you have any tips on how to ‘deter the limping’ that you found worked?

      I’m not totally sure if the rupture is partial, I actually presume it is a total rupture with the consultant describing the ‘gap’ she could feel, the pop I heard and the protocol I seemed to have been given is for a full rupture, even though originally told it wasn’t’.

      The consultant seemed fairly adamant surgery wasn’t the best way forward, informing me of the complications that come with surgery. I was actually rather baffled she didn’t want me to have the surgery after informing her I play a lot of sport etc… Oh well!

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    • Posted

      Seth,

      Its hard for me to hear that everyone around you is telling you take the non surgical route. I am from the US and when i ruptured mine i became very depressed, and was fortunate to find this site.

      Many of the discussions i have had through here have been abt 50/50 on which route was taken.

      Im not a doctor, and not trying to be, but I wish you would reconsider your options. Many people who are older and are not planning on going back to demandimg sports/activities or have a partial rupture take the non surgical route. With how you described yours, the hole and the pop. Exactly like mine at first I was told it was a partial, and then found itwas a full.

      I ruptured mine April 24 and did not have surgury till May 1st. It is still possible.

      There is a greater chance that you will have a re rupture, if you let it heal on its own. I know ppl have told you that there are complications with surgery, which can be true for any procedure. At least with surgery I knew they but the achilies back together. My scar is tiny, and I acctually have had no complications.

      I am nearing 6 months when I may be cleared to go back to sports, which I cant wait for. But my biggest concern is that this never happens to me again, and I believe surgery is what has made this possible.

      But to answer your question, i did not stop limping un til about 4.5 months after surgury. This is because you want to keep the achilies tight for the first 12-16 weeks. Walking/running, you need to have flexion in your ankle, and mostly to make sure the achilies is strong there is no stretching until four or five months.

      I hope Im not to forward, just really care.

      Erika

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    • Posted

      This sounds like you've gone straight back to work on crutches? Thats odd.. I was signed off work for a month and told not to put ANY weight on it.. this involved crawing around and bumping upstairs and down on my behind. It was only after the first 4 weeks could i start using crutches much. I only went back to work after a month off.

      On another track i wonder if the funding of the NHS (by taxation) in Uk and insurance in the US (I may be totally wrong on this.. please correct me) affects the approach to this injury. Conservative is cheap, surgury isnt...

       

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    • Posted

      Hi Erika, thanks for your concern!

      To be honest I have distinguished the idea of surgery now, it is actually three weeks today since the incident. I begin Physio this time next week with a second consultancy appointment a few days after that. Looking into it into quite a lot of depth has been re assuring as it if often suggested with early mobility exercises, non-op treatment can produce similar re-rupture rates to op treatments, of course I am just regurgitating information I have read.

      4-6 Months of limping sounds tough but it’s better than nothing. Sport wise prior to this I played football 3 times a week and ran or went to the gym on certain days when I felt necessary, I understand it is going to be roughly a year until I can reach them heights again. Throughout the early stages of walking, did you wear any type of support or brace around the Achilles to help function?

      Tim, that’s right, a day later after having the boot fitted, I was back in the office. Over the past 2 weeks have had my foot elevated whilst sat at my desk however throughout the past couple of days have just rested it on the floor with no real dis-comfort. Id regard myself as quite an agile individual so crutches haven’t seemed to be a problem, I ‘hop’ around the house and up the stairs too which my right leg is reaping the rewards.

      In terms of your other point, if your suggesting providing me with surgery may not be high on the priority list of the NHS then I wouldn’t be one to argue against you!

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    • Posted

      It does sound a bit suspiciously cheap, but for me its worked very well; I'm realy surprise you've been so active, but again, youth heals quicker? Hopefully you won't have the calf muscle degeneration that I had, so double good on that as well
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    • Posted

      Last night I took my boot off for a weekly clean of my leg as instructed. To my surprise my leg was swollen is quite a large way, around the whole ankle and not just the Achilles area. A lot more than the previous week, I presume this is because of the lack of elevation I have been giving it and me being ‘so active’. il have to rectify this. However while lay there I was able to generate some movement of my foot, moving my toes forward and back without any pain. After a couple of minutes and a little confidence, I began gently pushing my foot slightly forward and I could feel it almost ‘pulling’ on the area of the tendon, at this point put the boot back on.

      Good news is Tim, after 3 weeks calf muscle is actually looking reasonable ok, no huge loss of muscle yet, may I add I was not blessed with large calf muscles anyway. With you undergoing physio and this whole situation before, does this all sound normal to you?

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    • Posted

      BE CAREFUL!! You don't to put yourself back while its healing! Those boots are great being able to scratch and wash and not get too stinky.. rather than a cast.

      The swelling sounds like its casued by the lymph circulation, or lack of it.. thats what my physio said. The fluid gets pumped round by muscle contraction and its the calf muscle that does a lot of the work. The swelling started to go down as soon as i resumed walking.  I did try an electrical muscle stimulator to help get muscle mack but to honest that didnt work for me.

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    • Posted

      Oh don’t worry, il be waiting until I see the physio next Thursday before I try anything else. Im hoping he gives me exercises to do daily in an attempt to strength the tendon as soon as possible, I am under the understanding that good physiotherapy is key to a returning strong tendon! Out of interest, what protocol did you follow in terms of physio?

      Thanks for the information regarding the swelling, I think anti-inflammatories and elevation are key over the next week.

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    • Posted

      HI Tim.

      I'm from Canada not the UK but here is my two cents. I totally ruptured my AT in the Azores Islands in the middle of June. The local Dr. said I needed surgery. Called my insurance company who had a US based Dr. look at my scans, he said surgery. Flew home to see my local Orthopedic surgeon. He said they don't do surgery any more on this injury in Canada. He told me that according to statistics my chances of re-rupturing the same AT whether I had surgery or not was only 1 % greater. At the same time, my chances of rupturing the opposite AT are 40% to 60% greater. 

      I was 7 weeks in a non weight bearing cast and 2-3 weeks in a boot. My first day back at work was Monday. Had I had a sit down office job, I would've been back to work as soon as I had a cast put on. My brother ruptured his AT this spring and only missed a couple of days of work.

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    • Posted

      Hi Seth.

      I was only limping for 3 1/2 months. Now I only limp when my right leg starts to get tired. Monday was my first part day back at work. I was in for 4 hours and started having difficulties after 2 hours. All the muscles on the right side of my lower back to my knee started complaining. Ankle was fine though. I did another 4 hours today and went an hour longer before those pains started again. I expect to be fully back at work by the middle of November. You should have it a little easier than this 55 year old though.

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    • Posted

      Interesting; it seems this is one of those medical conditions that doesnt have a really clear "this happens, do thais and it'll fix it" solution. Can I ask how old you are? The weeks in a cast sounds miserable.. did you have any anti-coagulant treatment during that spell? I was self injecting every day for a month; a bit of surprise but easy and painless to do.
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    • Posted

      I'm 55 for another 5 months.  Yes, having a cast was miserable. They sound fun when you are a kid......

      I had to do self injections of anti-coagulent for four days. Two days before I flew home and the two days that it took me to get home. No mention of doing more after that.

      Swelling was the most problematic part of being in the cast. I spent most of my day laying on a couch with my foot elevated way over my chest to try to control it. At least with a boot I would have been able to adjust it to allow for the swelling.

       

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