Achilles Tendon Rupture Website c.2016

A quick reference all text, mobile friendly resource for people or persons recovering from a Achilles Tendon Rupture Injury
Week 0

 

The Rupture

For most this is a sporting injury, perhaps you where reaching for a ball whilst playing tennis or squash. Perhaps you landed awkwardly from high ball in football or rugby. Either way you are in for a long and tedious recovery that will require life changes for at least 3 months, probably 6.

Diagnosis

A good test to see if you Achilles is completely snapped is to squeeze you calf muscles. If you squeeze the good leg the foot will twitch, if it is still attached! When squeezing a calf that is not attached (i.e. the Achilles tendon is snapped) then the foot will not twitch.

Operation?

No. The Achilles even if complete snapped will heal by itself, but you will not be able to walk as well afterwards. The Achilles will heal at a significantly longer length than it should be. This will result in a shortened calf muscle. Muscles are designed to work a specific length, and as a result of a lengthen Achilles, you right foot will not be able to push down as far. This will result in a limp or increased use of you toes whilst walking.

In general for sporty active types or those with a physical job a tendon repair is much favored. And as many top grade sports people will vouch, will return you to pretty much perfect functionality so long as you are patient and listen to all advice from surgeons and physiotherapists.


Before the Operation


Before you have your operation, you may be in pain or not be in pain. I did not have any pain. In fact I could walk around sort of, so long as I did not put any weight on the ball of my right foot. All weight had to be transferred trough the heel, otherwise . . .pain.

This was working OK for the first 24hrs, but when you visit the hospital they will likely want to put you lower leg in a splint so as to prevent further damage and to make sure the ankle is at a good angle for surgery. The splint in none weight bearing and so you will not be able to use you affect foot. So you will be on crutches. Although this may be tricky for the first day or two, it gets easy very quickly, it is also quite tiring, which if you are used to having lots of exercise, helps soften the loss, of you work out regime.

Staying Useful

In the kitchen where you need your hands to cook etc. try kneeling on a chair, you can kneel with both knees or just the bad knee. Either way this will let you work at a work top in some comfort. You can also shuffle the chair around whilst kneeling on it with you bad knee, and this do all sorts of jobs that require both hands. A padded dining chair is preferential.

It is impossible to carry a cup of tea or coffee whilst walking with crutches. An easier way is to make a flask of tea, by the kettle and then pop it in a bag (shoulder or rucksack) and carry it to where you which to drink it. Alternately take a book with you and drink it is the kitchen! Another alternative to to place all of the items in a small trolley, and push this along with you crutches. But unless you have children you may not have a small trolley. Investigate Knee Scooters if you have to keep moving.

Provided you have a soft chair or stool to kneel your bad leg on, there a lost of jobs you can do. Carrying things around is the most difficult thing. If other are around to help position things then ask them, it will make them feel good for helping.

Staying Fit

  • As this is a sporting injury for most, then we can assume that most will want to try and do some exercise. Any exercise involving the bad leg is off the menu for 3 weeks post surgery realistically, but there are lot other thing to do in the mean time.

    There are lots of videos on YouTube that show how to do upper body leg free work outs and are quite good (or "no feet work out"). There are no where near as good as going for a run or a bike ride, but this is a compromise that must be made. If you over use you healing leg, then you will delay your recovery, perhaps considerably. So don't be stubborn.

  • Staying Clean

    If you want to stay clean buy the following as soon as you have been injured.

    Waterproof Cast Cover

    You will also need to keep you cast dry. As soon as you can order a waterproof cast cover from the internet, they cost about 15 ($30) and are a very good investment. Get one with a rubbery seal around the top of the cast cover. Limbo make a good one.

    Perhaps one of the most dangerous part of the day is having a shower. Using crutches on a wet surface is lethal, and not for the faint hearted. Make sure your crutches have very grippy rubber end and keep the crutches absolutely vertical at all times.

    Size G Tubular Bandage

    When out an about, say in the streets or shops, I think it is good to try and keep clean. So I have bought so tubular bandage to cover my cast and keep it clean, alternatively you might consider some "over boots" made a motocross riding by OMP. As these keep rain and mud off of you cast / splint.

    Spare Crutches?

    I personally do not wear outdoor shoes in the house, so being over fussy I have got hold of a spare pair of crutches to use outdoors, and keep a clean set for indoors. This may not worry you but I feel happier this way.

    Driving - Part 1

    If you have injured your left foot, lucky you, you can get a note from your doctor to say you are "fit" to drive an automatic. Your work might provide you with an automatic car, so as to get you back to work. This will be cheaper for them thank paying your sick pay.

    In the UK, you can not drive with a cast on your right leg. You can take a test so that you can drive an automatic with your left foot, but you do have to take a test.

  • If your job involves a lot of driving this puts you in a bit of spot. The problem (even if you think you can drive) is insurance, as you have to be "fit" to drive. And if you were to crash, then any claimant could maintain that your inability to drive properly was a result of you leg being in a cast.

  • A suitable alternative might be an e bike. You do not need insurance for one of these. You will need a "twist and go" e bike as you will not be able to pedal for 2 weeks post operation. If you are worried about the school run, then some e bikes can seat 2 or 3 kids on a large rear seat. So you can pick up the kids and do shopping just as you would with a car.

  • Also think about home delivery for shopping. This avoids having to drive.

  • Can you work from home?

  • The Operation

  • After 1 week on a waiting list I sitting in hospital waiting for my operation. The week leading up to the op was wasted time healing wise and I was very glad to be there. There are numerous surgical procedures for reattaching the two end of the Achilles tendon. Which involve stapling or stitching the ends together.

    Some times if the heel end (distal) of the tendon is very short then a bone anchor may be used to tension the stiches against. The common method is percutaneous, which means a small cut (incision) is made which reduces risk of healing problems.

    My repair was carried our under general anesthetic, I was given morphine before general anesthetic which was lovely. Some may opt for a nerve block during the procedure, which numbs the whole lower leg. However, this can take long time to wear off, and I was keen to leave hospital on that same day, so I opted for no nerve block. Consequently I was in a small amount of pain when I awoke from by general anesthetic at 2pm in the afternoon, but this has become much lessened by bed time, and was pain free when taking 2 parcetamol (1000mg).

  • Week 0 to 2
  •  

  • Immediately After the Operation

  • Weeks 0 -2 (post operation) are the worst time, in terms of immobility. Be prepared to watch lots of TV, although if you work at a computer you may be able to get some work done, provided you can get to work and can keep your leg elevated.

  • It is important to keep you bad leg elevated, that is propped up on something. Aim to keep you foot above the level of your heart. You will probably want some cushioning on the chair or stool you are using. Whilst sitting on a sofa for example a dining chair is a good height. Other wise you may need to stack some cushions on a foot stool to get to the correct height. If you do not keep the wound elevated then your foot will swell, and this may put pressure on the wound.

    Unlike before the operation you are unlikely to be able to spend 30 minutes making coq au vin, as the pain will increase for the longer you stay standing up. Factor on 2 - 3 minutes trips between getting your foot up, at least for the first few days.

    This regime will likely continue for 3 - 10 days.

  • Choice of Pain Killers

  • There are some studies, based on animals, that show that healing is slowed down by taking ibuprofen or other NSAIDs such as aspirin. So you may want to think about sticking to paracetamol if you can. If the pain is too much perhaps ask for some opiate based painkillers such a codeine. But these have other problems such as making you constipated.

  • Your 2 Weeks in a Cast

    This is much like the time you spent pre-operation, although you may be in a little more pain, and you will know have a wound on the back of your heal. Depending on the system used for rejoining you tendon, there may also be some puncture marks where the stiches were passed through the tendon from the outside (i.e. through your skin). Of course you will be able to see any of this as your leg will be wrapped up in bandages.

    Please see section on "Before the Operation" with regards to keeping clean, mobile and useful.

  • Be Careful!

    But know your tendon has been rejoined you will have to be very careful. When healed your Achilles tendon will be a strong as a steel cable, but right now it is stitched together with thin surgical stitches, which are very week by comparison.

    Try to rehearse in your minds eye what you will do if you trip . . . you can not put that leg out to stop you! Is is better to fall on you knees or shoulder? That is a decision you will have to make.

    Do not rush. Even if you have a lot to do. Do not rush. Any time saved by rushing will be paid for 100 fold if you trip or slip, and have to go back in for another operation. My surgeon said that sometimes when they repair a re-rupture (when you break the repaired tendon again) they have to take a tendon from your big toe to make the repair. So again if you would like to maintain full function of your big toe, then do not rush.

    In a study conducted at Exeter Hospital UK, out of 243 patients in a study, 4 people re-ruptured their tendon, all from slipping in the shower! So that is the time to be extra careful.

    Staying Sane

    If you are normally out and about and doing all kinds of busy then you better aim to keep your self busy whilst not having the use of you leg.

    Weeks 2 to 4

    This is when things will start getting a bit easier. And you life start coming back a little towards normal.

    The VacoPed Boot

    The Vacoped Boot is a fabulous thing. It resembles a ski boot, but with Velcro straps and is more open in design. It comes with a sloping sole that is used in the weeks 2 to 6. This sloping sole keep the foot at a 15 degree and or 30 degree angle, which for the first 2 weeks post fitting is 30 degrees (similar angle to foot whilst in plaster). The good thing now is that you can put weight on your foot.

    I will not go in to detail here with regards to the boot as you can look that up on the VacOped instructions.

    Increased Mobility

    When you are first fitted with the boot it will feel very strange, after all you have not put any weight on you foot for four weeks, so walking on it again will feel weird and uncomfortable. . . .

    Walking

    Walking at  first will be difficult and after being fitted with your new boot you will almost certainly need to use crutches for a minimum of 24 hours. This is as much a trust exercise as it is a practical learning thing. But although it may be quickest to get around on crutches in the first instance it is important that you do put weight on the foot, this is all part of the healing process. The theory being that the gentle use of the tendon, whilst in the boot helps the scar tissue for in the right way, so that you will develop optimal movement in the weeks o come.

    Washing

    This is still a dangerous time, and you risk going back to square one if you slip in the shower (see Be Careful! - above). The safest bet it to put a plastic chair in the shower and sit on this whilst you take off you boot, then have a shower, get dry, and put the boot back on whilst still sitting on the chair in the shower.

    It is worth mentioning at this point that you will likely have quite a lot of dead skin accumulated on the sole of you foot. Yuck. So a scrubbing brush to get this off is good. DO NOT scrub your wound!

    Driving - Part 2

    How easy it is for you to keep driving will depend on which Achilles you have ruptured (left or right).

    Note on Insurance

    Being able to physically drive, and being able to legally drive are two different things. After all I drove myself back home after rupturing my Achilles (right foot), so you can do it, but not legally. The problem being insurance. If you knowingly get in to a car and are unable to apply the brake. . . and this leads to an accident. . .then your insurance will not cover you. You bad leg will be a "contributing factor". So if you drive car with a inoperable right foot, then you are essentially (simplified) driving without insurance.

    Left Achilles Rupture

    If you have snapped / ruptured your left Achilles and you drive an automatic, then lucky you you may be able to drive if your doctor will sign a chit to say it is OK for you to drive. Your work may rent you an automatic car rather than have you off sick for weeks at a time, so that is an option too. If all else fails then why not buy an automatic car. . . . .

    Right Achilles Rupture

    Oh dear. There is one thing you can do to keep driving. That is to take a specialised driving test, so as to drive an automatic with your left foot. I did have the idea of renting a car with hand controls, but again this would require you to take a special driving test. BUT if it is this or go bankrupt then best get on with it.

    Cycling

    Perhaps your saving grace. Just 4 or 5 days after fitting my VacOped Boot I was cycling. I have done a blog post on this "Cycling in a VacOped Boot". I am not sure if this a good idea or not, but it can be done. Even in your 30 degree boot. You will need fairly wide pedals, preferably with metal spikes on them to stop you foot slipping off (particularly in the wet). If you live in a flat area then I would have no hesitation doing this, as you can pretty much cycle with your good leg on its own, whilst the bad one is carried around on the pedal.

    E Bikes

    I am not sure on the detail here, but you do not need insurance for an E Bike (Bike with electric motor) so one of these rented with a "twist and go" throttle setup may save your bacon if you need to get to work. You could even buy a kit and modify your existing bike.

    Quick Guide to Renting an E Bike: Ask for: Twist and Go Throttle, Upright Ride & Bags to Put Stuff In (Also ask "Is the battery big enough to get me to work and back?")

    Flying

    I was told I would need a doctors note, to explain why I was wearing a boot. I flew to London City and back absolutely fine. You may be asked to take off you boot and put in through the scanner. But whether you do or not you should be fine to fly. You can also ask to be wheel chaired around if you want whilst in the airport.

    Weeks 4 - 6

    Four weeks post operation, your boot will be adjusted to 15 degrees, with the wedge sole still in place. This allows for a little movement in the ankle, and makes walking easier.

    The Wear in Period

    When it is first adjusted, it will feel strange and will take some time to get used to. I needed crutches to get back to the car (which my wife was driving), this wear in period becomes a running theme through out the recover process. . .  every two weeks expect to take a step back wards in terms of mobility in order to move forward. Keep you chin up this will get hard as the weeks grind by. Just as you become comfortable with a particularly way of walking, you will have more pressure put on your Achilles tendon and the discomfort will return.

    Mobility Weeks 4 - 6

    To give you some idea of mobility at this stage I managed a site seeing trip to Scotland, with walking around town (Royal Mile), and along the beach etc. for short distances. 1 mile max.

    It is still awkward showering and you still have to be very careful.  I found that my leg would ache quite a bit, when I was using it or when standing. Again you can do anything you have managed to do so far. But just bearing in mind if you overdo it then you will now loose 2 months, if you re-rupture.

    At the start if week 6 my physiotherapist advised me to switch to the flat sole (rocker sole) for the VacoPed Boot. This made thing immediately uncomfortable as it places more strain on the heel. And this discomfort remained until I had the boot adjusted at the end of Week 6.

    Try to go for a short walk everyday. I managed about 500 meters in one go and then head home, so about a 1km (1/2 mile) round trip.

    Symmetry

    Having one leg longer than the other is very annoying, and make walking more tricky than it should be. You can buy a thing called an "Even Up" which you can wear on your shoe (good foot) so as to lessen the difference. An alternative is to pack a few insoles or layer of thick card in to you boot / shoe, to raise up you good foot a bit. Simply remove your shoe's insole, draw round it (card, camping role matt, dense foam packaging) and cut out the shape. Pop this under your insole. I should imagine this increases the chance that you will twist you ankle due to "roll over" so be a bit careful.

    Weeks 6 to 8

    I was wishing away the days to get to this point . . . I found it an anti-climax. With the boot in neutral it is easier to walk but not much better than weeks 2 - 6. So do not expect miracles. I did not manage more than 1 km walking as with weeks 4 - 6.

    At this point i was supplied with a large elastic band, which you use to do exercises with. It was at this point for me that I realized how weak my leg had become, you can just about stretch out this elastic band whilst it is looped around your foot. BUT fear not in just few days the strength will start to return, at least enough for you to show that elastic band who is boss!

    To see you calf muscle working again is a nice sight. I kid you not.

    Week 8

    At week 8 the boot is adjusted, and I was told this would "allow for step through walking" I can not find these phrase on line, so I guess it means walk like normal. But in reality I found this difficult. The boot although excellent is no replacement for you ankle, and so you can still expect some discomfort, as it does not allow the freedom of movement you bodies joints do.

    Swimming!

    My physiotherapist said I was allowed to go swimming at this point. Although she did say maybe wait until week 9, which I did.

    Just as your calf has got weak. . . so has the rest of you. Swimming a couple of lengths of front crawl nearly killed me, although I really didn't care because it was so lovely to be properly out of breath. It is also a good thing to walk up and down in the pool, providing the water is deep enough to cover your nipples. This way you can practice walking without putting your full weight on your foot. I had time to go swimming twice a week. My physiotherapist said "2 or 3 times a week". Don't wear yourself out you are still healing.

    Swimming also loosens up you calf muscle in the most glorious way. My leg felt excellent after a swim, and that was enough of a reason to go on its own.

    Week 9

    With swimming used for fitness, and increasing stamina, the distance you can walk will start to increase. I would say that it is important to go swimming, as getting fit will help your recovery. My stamina for my daily walks increased range wise quickly up to 1.5km after a few days, which is a 50% increase in distance.

    It is at this point you can start wearing a normal shoe (indoors only) on your right foot with heal pads inserted to slightly alter the angle of your foot. The heel pads raise the heal and slightly shorten the calf, so as to put less strain on the Achilles tendon.

    The reason I was told that I could only wear normal shoes indoor, and not out, was because of trip hazards and curb / steps etc. However, our house is littered with kids toys and other rubbish, and so took a decision to wear shoes out doors as well, provided I was not doing anything strenuous, like cycling or mowing the lawn. I walked only on roads, and never took my eyes off wear I was putting my feet. My main reason for taking this course of action was:

    1. Inside my house is just as dangerous as outside.
    2. My boot was still proving to be uncomfortable.
  •  

  • When you start walking without your boot, remember to take extra care of you ankle, it is weak, and folds over easily especially on rough ground.

  • Week 10

    You can now officially use your shoes outdoors (with heel pads), so that is good. There should be some strength in your calf now, which means you can go back to:

    Driving

    If you ruptured your left Achilles, and you have an automatic chances are you will have been driving for a number of weeks, but if it is your right Achilles that was ruptured then this will be the first time you will be able to drive.

    But you have to be able to do an emergency stop. . . . this involves pushing hard on the brake pedal. I would say it was week 11 before I could operate the brake properly, but I did drive before this, and it was scary as hell, and more importantly I was technically driving uninsured. So wait until week 11.

    Walking

    Now you can really start do a "bit" of walking. By the end of week 10 I was walking 3km (1 & 1/2 miles) although my calf muscle felt like jelly when I got home. It is Ok if you calf muscle aches (apparently), but if the Tendon start to sting or burn then rest up. You might not have to rest for long, so don't worry just sit down and look at the view for 30 minutes and then be on you way.

    One comical side effect of hobbling around all over the place is that people are always trying to help you. I have never been offered a lift so much in my life, perhaps 50% of the time. The human race . . awesome.

    Do not over do the walking. If you make your Achilles sore you will start to limp more heavily. We are trying to stop the limp, not make it worse.

    Swimming

    Keep up with the swimming. Just remember that your whole body is now weak, be careful not to pull muscles etc.

    Week 12 - 16

     Weeks 12 - 16 allow a greater variety of exercises, but some are still not allowed.

    Good Exercises

     Weeks 12 - 16 allow a greater variety of exercises:

    Swimming

    As above, just ease in to it gently.

    Walking

    This gets easier all the time, but you have to be careful not to over do it. When you push yourself too hard walking, your bad Achilles leg will get weak, and you will start to limp. The idea is to get rid of the limp, so onlt walk for as far as you can without limping, other wise you are not helping yourself.

    Static Bike or Flat Road Cycling

    Provided you have low gearing and keep your foot forward on the pedal (most of weight through the heel) you can do so quite good cycling, even in hilly areas. Be prepared for you left quadratic (thigh) to let you down and cramp up.

    Aerobic Gym Work (Treadmill / Stepper)

    Surely this is the same as walking, which I prefer to do outside in the fresh air. I have never been to a gym outside of a hotel, so I am not the person to comment on this.

    Gentle Weights

    I presume this is for the upper body!

    Note

    Note that jogging is not included. Advice is to avoid jogging for "4-5 months post injury", we are already at 3 months so no jogging for at least another month at this point.

    Bad Exercises

    To be avoided for 6 months from surgery date:

    Week 16+

    At 16+ weeks you should be starting to do some a great variety of Pysio Therapy, and this is where people ability to heal will put them ahead or behind the average in terms of healing so from here on in, the weeks post operation have less meaning. Set out now are the exercise sets given to me spread out between 2 week appointments with my Physiotherapist.

    It is important to realise that these exercises are set out according to my progress, and not yours. You may well be get on better or worse than I was at this time. I am not a physiotherapist, and I have no clue as to why I have been given this particular set of exercises. The general emphasis is on strengthening, that is all I can really say.

    I have included the below so you can see kind of things you might be doing, but I would not do any of these exercises without talking to a qualified physiotherapist.

    Exercise Set 1

    These were the 1st set of exercises that I was given to do:

    Tip Toes

    This one involves standing on tip toes whilst leaning against the wall, with both hands in front. At first you will need to use you good leg a lot in order to get on tip toes, but over the course of two weeks, you will find that the bad leg (ruptured Achilles) get stronger, and so by the end of two weeks the load is spread more equally between the 2 legs.

    These Achilles strengthening exercises are done in set of 3, say 10 repetitions, followed by 8 repetition and then 6 to finish, with 2 minutes rest between each one.

    Funny Walks

    Walking backwards, or pretending to limp with the other leg, walking sideways . . . these all help fool your brain to in walking normally. You have been limping for months so getting you brain to make you leg work normally is a job in its self.

    Exercise Set 2

    Tip Toe Swap Over

    This one involves rising up on tip toes using both legs. Hands are rested on a counter top / table to take some of the weight, and then you lift you good foot off of the ground allowing your bad leg to take the weight. Remember to keep some weight on your hands. Stay on the bad leg for 3 - 4 seconds and then back down for a 4 second rest before the next repetition.

    These Achilles strengthening exercises are done in set of 3, say 10 repetitions, followed by 8 repetition and then 6 to finish, with 2 minutes rest between each one.

    Foot to Foot

    Briefly (but smoothly!) transfering weight from foot to foot.

    Jogging on the Spot (Low Feet)

    This hard to do at first but it is a nice feeling once you get used to it.

    Environmental Consultants London


    Fire Prevention Plan 

    Illustrator Devon