What happens if my Achilles is Ruptured?

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What will happen in A&E?

Your injury will be assessed and if an Achilles tendon rupture is suspected then you will be put into a tip toe position with (usually) a plaster cast bandaged in place. This is so that at the back of your leg the two ends of the torn tendon will sit together and can start to heal. You might be fitted with a boot incorporating a high heel instead. You should be given crutches to help you walk.

Blood thinning medicine is usually advised in order to prevent a blocked vein (thrombosis). Arrangements are made for you to see a specialist for further care.

What will the specialist do?

When you are seen by the specialist, the plaster cast is removed to allow the injury to be re-assessed and the diagnosis confirmed. Occasionally the Achilles tendon is normal and a similar more minor injury (e.g. calf muscle tear) is found instead. Sometimes there is no rupture, just tendinitis of the Achilles.

Often an ultrasound scan is performed. This is not to check the diagnosis, but is to ensure that, in the tip toe position, the two ends of the tendon meet. Occasionally (about 10% of the time) they do not. Blood or other tissue can get between the tendon ends. This situation leads to a discussion regarding the merits of surgery. The goal of surgery is to remove the debris from between the two ends of the tendon and stitch them together to allow healing. The repair is not strong. The rehabilitation is the same for surgically repaired tendons as it is for those managed without an operation.

The ultrasound scan also checks that there is no thrombosis (leg vein blockage) in the leg. After the ultrasound scan a special boot with heel wedges or hinges is fitted to replace the cast. This must be worn for a total of 10 weeks, to allow the tendon to heal. During this period the tip toe posture is maintained in the boot. If you remove the boot and stand up, the ankle will bend upwards and the repairing tendon is torn again.

Sleeping in the hot and heavy boot is the most common complaint from patients recovering from an Achilles tendon rupture. The specially designed Achilles Rupture Night Splint, from Thetis Medical (www.thetismedical.com) solves these problems.

The recovery is like the game Snakes and Ladders (Shutes and Ladders) – each week sees you closer to the finish. But one small mistake is like landing on the big snake that takes you right back to the beginning, with a re-rupture.

How many check-ups?

A clinic appointment may be recommended after 5 weeks to check healing and give instructions for gradual adjustment of the boot. Referral to physio is arranged. Further scans are not routinely required.

Depending upon the type of boot you are using, instructions regarding changing the heel wedges or adjusting the hinge are now required. The position of the foot is gradually adjusted until you are walking almost flat in your boot (week 8-10). After 10 weeks your tendon is sufficiently well healed to discontinue the boot and start physiotherapy. However, the tendon has not reached full strength yet. It is advisable to put the boot on if you are going anywhere crowded, where the terrain is unpredictable or if there is any other reason why you might stumble or trip. Re-rupture of the tendon at this stage in recovery is extremely frustrating.

When should I see a physio?

Physiotherapy starts 9-10 weeks after injury. A specific rehab protocol is used by the physiotherapy team. Building up calf muscle strength is the key goal. This requires lots of exercises in between visits to the physiotherapist. It is important to NOT do vigorous stretches (even if the tendon feels a little tight) because the tendon can stretch out too much, resulting in long term loss of power in the leg. You can expect any tightness to gradually resolve over time and with normal activity.

Should I take blood-thinners?

An Achilles rupture is a relatively high-risk injury for developing a blockage in the leg veins. For this reason, blood-thinners are often recommended. Injections or tablets can be used. Different hospitals have different policies in this regard. No-one really knows the best duration to take blood-thinners for. After a new hip or new knee operation blood-thinners are often recommended for 6 weeks and many Foot and Ankle Surgeons recommend this duration of preventative treatment for Achilles rupture patients.

If you have not been given any blood-thinners then 150mg of Aspirin a day is something you could consider taking until you discuss the issue with your specialist.

Remember that even with blood-thinners it is possible (though very rare) to develop a thrombosis/blocked vein. Swelling of the whole leg up to the knee should prompt medical review even if painless.

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