Achilles Tendon Rupture

"Oh no what kicked me in the leg..?"  Nobody there?  Perhaps you have ruptured your achilles tendon?

Achilles tendon ruptures are common. Most athletes describe a sudden feeling like someone kicked them in the leg - or a similar acute event with a 'popping' sensation and pain in the Achilles tendon.  The treatment of achilles tendon ruptures is the subject of much debate.  We are often asked about whether this injury needs surgery.  There are pro's and cons with both surgical and non-operative treatment.  The bottom line though is that as long as the tendon heals at its normal length it probably doesn't matter.  In reality there is no best solution for everyone and treatment decisions are made on an individual basis with the patient.

It is important to get early treatment and to be placed in an equinous cast (a cast with the foot in a pointed position). The more definitive treatment options can be discussed at a later date.  Most of the time imaging, like MRI and ultrasound, is unhelpful.  Ultrasound especially can confuse the issue.

At Axis we often use an accelerated non-operative treatment program for managing this injury. We have had good success with this regime in both recreational and elite athletes. This protocol uses a moon boot - rather than the plaster of paris cast which is generally used. The advantage of this protocol is that it allows you to do some basic ankle and foot exercises to limit muscle wasting and joint stiffness. In the later stages we are also happy for you to remove the boot for sleep.

If you would like to consider using this protocol ask your primary care provider to refer you to one of the Sports Physicians to see whether this might be appropriate for you.

Achilles Ruptures – Sports Physicians' Protocol

  • Equinous cast immediately for two weeks.
  • Non-Weight Bearing (NWB) 30° equinous AAFO boot for one week During this time the boot can be removed for range of motion (ROM) exercise for five minutes an hour. It is important that you do no stretching and that the foot is not flexed up beyond neutral.
  • NWB 20° equinous boot for 1 week – still wearing this at night and still no stretching. NWB 10° equinous boot for 1 week – still wearing this at night and still no stretching.
  • NWB 0° equinous boot for 1 week – still wearing this at night and still no stretching.
  • From six weeks post-injury you can weight bear in the boot. Can remove the boot in bed at night.
  • By eight weeks the goal is to be weight bearing fully in the boot.
  • From eight weeks you can come out of the boot and start a strengthening program.
  • When you can support your weight on one leg your strengthening program can be more aggressive. 
  • Be very cautious with stretching.  In most cases the achilles tendon heals a little long.  Stretching makes the muscle and tendon longer still and compromises your function. If the Achilles appears to have healed long we will arrange for you to have a heel raise for your shoe.

A review and clinical check with your doctor at each stage of the protocol is needed to make sure that the tendon is healing normally. Whichever protocol you use to treat your Achilles tendon rupture you are likely to require some form of immobilisation for about eight weeks. It is likely to be a minimum of six months before you are back to playing sport.

 

Ice Massage

Ice is a powerful natural anti-inflammatory and analgesic (pain killer). Ice massage is a great way to get the best benefit from this treatment and can be a great way to manage acute and chronic injuries.

Concussion Guide

If you have recently suffered a suspected concussion we have developed a important guide so you can take care of yourself before being seen by the experts at the Axis Concussion Clinic.

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