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ATR; 22 years old, Conservative Treatment.

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SethRollins
SethRollins

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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  • tim50stroud
    tim50stroud SethRollins

    Posted

    Sorry to hear this, but you have youth on your side and your body still repairs itself much quicker than my 65 yr old one! The NHS website says "Surgery may be an option for some tendon injuries, but this is often only considered as a last resort because it's not always effective and carries a risk of complications such as wound infections, scarring and rupturing of the affected tendon." Which was basically what my consultant said with my partial rupture 13 months ago. If it doesnt heal satisfactoraly then surgury is still an option down the line. I had zero pain after I stumbled walking across a field. I went straight into an air boot for 4 weeks, NO weight bearing, then 5 partial weight bearing on crutches. Physio to get me walking again and getting back balance. The worst was the loss of strength in the calf muscle; i still cant stand on tip toe on the healed foot, but walking is now ok, no limp. Slight numbness of the ball of the heel, where there was some nerve damage round the tendon. BUT I did walk 9 miles in sponsored walk last month and no problems. It does take time, and you need to call in support from friends / partner in the early stages. Give it time to recover. When you can partial weight bear, i took the boot off when sitting down and gently started rotating the angle and using bungee cords to exercise .. Check with consultant first!!!

    Patience is the big lesson on this one, but it will get better. Good luck!

    • SethRollins
      SethRollins tim50stroud

      Posted

      Thanks for the response Tim, I appreciate the optimistic thoughts!

      It sounds like our consultants carried similar points of view! The fact you had a partial rupture really intrigues me, in the occurrence of your injury did you hear the dreaded ‘pop’? And also were you given any indication of how bad the partial rupture was?

      I am actually currently using a Vacoped boot which I presume is similar to the air boot, currently in my second week and will be seeing a consultant at 4 weeks where I am hoping to begin weight bearing. I am assuming it will be another 4 weeks after that until I can walk in my own shoes from then?

      The loss of strength in my calf muscle is a worrying factor for me and the fact that you have said you still cannot stand of the tip toes of the foot. Great to hear you were able to complete the 9 mile walk with no issues and are not limping. In terms of physio, how often did you visit? And from what point did you begin motion exercises again?

    • tim50stroud
      tim50stroud SethRollins

      Posted

      I went by what the consultant saidl ie partial rupture, and he diagnosed by feeling the break; i could certainly feel the broken bit compared to the good leg.. weird. No scans.

      After the 4 weeks on no weight, i could take the boot off at night, and start wiggle the foot (ne weight still) after another 2 weeks. Thats when i started using bungee cords to GENTLY take some pressure.

      After the 5 weeks of partial, the last consultant appointment gave the all clear and passed me over to the physio people. They saw me after a further 2 weeks and got me out of the boot and into shoes.

      I did have some swelling of the foot stil.. aparently due to the lymph fluid not being pumped back up the leg as you walk. Thats mainly the calf muscle.

      I saw the physio once a week for 5 weeks until he'd got me walking and balancing again properly, but still not walking properly.. just takes a long time to get back up tio strength and you need to do the exercises. In fact I had a couple of private sessions with a sports therapist wh gave e more exercises.

  • SethRollins
    SethRollins

    Posted

    Just an update and some good news, attended my first physio appointment today, 4 weeks and 2 days after the initial incident.

    After looking at the foot and having a general ‘feel’, he confirmed the rupture had heeled and it was now time to begin strengthening, giving me exercises to do 3 times a day and to begin fully weight bearing on it. First with crutches for guidance but as soon as feel comfortable to ditch the crutches.

    I will see the physio every other week at this point altering the angle of the boot which currently remains at 30 degrees.

    The only issue I have is that the scheduled time from this point (4 weeks after rupture) to remove the boot would be over the next 6 weeks;

    2 weeks - angle altered to 15.

    4 weeks - angle altered to 0.

    6 weeks – boot off.

    However I have read most people suggest quicker alterations to the boot to improve strengthening the tendon, any recommendations or guidance on this would be much appreciated!

    • timinbc
      timinbc SethRollins

      Posted

      Hi Seth,

      Here's what I did.

      Cast for 6 weeks then put in a boot with two wedges. Physio started the following week. One wedge came out on the first visit, I removed the second wedge 3 days later. My PT was going to remove it on my second visit which would have been one week after my first visit.

      I used my boot full time for two weeks and stopped using it. I found it to restrictive and as I wasn't working due to the rupture I didn't feel I needed it to manouvre around the house. 

      On my 3 month check with Orthopedic Surgeon, he was surprised to see me out of the boot and when I asked him if I should be in the boot he said not if I didn't need it. The patient he saw before me had ruptured his AT 2 weeks before mine was still in a boot. 

      Do what feels right for you. You will know when you've done to much while you rehab. 

      I started a graduated return to work 2 weeks ago. I need to stop every couple of hours for a few minutes for a rest but I can see improvement every day I work. My AT is not the problem now, it is the rest of my leg from my hip to my knee that I am rehabbing. Those muscles forgot how to work after 4 months.

    • tim50stroud
      tim50stroud SethRollins

      Posted

      Sounds a very similar protocol to mine. Do as you are told, do the exercises!
  • SethRollins
    SethRollins

    Posted

    Just a quick update, yesterday was my 4 week consultant appointment. Quite a landmark in the Achilles Tendon Rupture injury timeline, meeting the woman who id met 4 weeks ago, confirmed the rupture and given me the Vacoped boot.

    Appointment was relatively quick, boot was taken off and asked to do the Thompson Test. No pain endured and to my joy my foot showed movement when she grabbed my calf and she confirmed the rupture had repaired.

    The angle of my boot would be then changed to 15 and told to carry on what I was doing.

    She will now see me in 8 weeks to see how everything is getting on and I presume to discharge me but from the sounds of things, it is now down to the physio in terms of the rest of my recovery.

    It has been 5 weeks since the initial rupture so I’m hoping to be walking in my own 2 shoes in the next 3 weeks, fingers crossed!

    • tim50stroud
      tim50stroud SethRollins

      Posted

      SOunds like good progress - acording to my notes I was foot wiggle at the ankle and gently stretching with the bungee cords. If like me, you'll be passed onto the physio  and let the consultant consult more busted tendons. Good luck... you are getting there
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