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Achilles Tendon Rupture - Conservative treatment

Discussion in 'Injuries' started by coachgary, Nov 19, 2010.

  1. coachgary

    coachgary Regular Member

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    I would be interested to hear from anyone who has experienced a full achilles tendon rupture and used the non surgical conservative method of treatment.

    September 11th 2010 was a bad day for me as I ruptured my left achilles after landing from a clear to push forward to the net. (rupture is 40mm up from the heal)
    The surgeon suggested that I use the conservative method of “non surgery”. This involved a fibreglass cast up to my knee with my foot pressed down into planterflexion for 4 weeks. After this it was 3 weeks with my foot in a more neutral position/slight dorsiflexion. Then two weeks in an aircast with heal wedges. After 9 weeks I went back into my trainers.

    After 10 weeks my left calf is now 2.5 inches smaller than my right. I have limited movement in the soleus muscle and very little action of the gastocnemius (larger outer muscle). 1st Physio session today and the therapist was impressed at the range of movement and repair made so far. I have to admit that I was very sceptical that non surgery would work as I my GP friends, and later a different surgeon, suggested that for a sportsman "you have to have surgery". Well, in making this decision I had to bear in mind a previous leg infection from a skin graze after falling from a ladder. I didn't fancy an infection post surgery! So I made the choice, telling myself to be prepared for 12 months of zero competitive badminton.

    The main lesson of recovery so far is “take it easy”. I’m still on court coaching so it’s not all doom and gloom.
     
  2. Cheung

    Cheung Moderator

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    Interesting story. 20 years ago there was a debate on wether conservative treatment or surgery was better. Over time (and probably clinical studies), surgical intervention won as giving a better outcome. I'd say it's still early days for you and the results will not be known until much later.
     
  3. visor

    visor Regular Member

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    I'd hate to sound gloomy, but I'd be more fearful of a re-rupture in the future from the non-surgical approach. This fear itself would prevent me from playing at 100%.
     
  4. coachgary

    coachgary Regular Member

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    This is my worry too. It's difficult to find recent research studies for this type of conservative treatment. The ones I have seen aren't the same however they show a re-rupture rate of 8% as compared to less than 4% with surgery. The biggest factor in most is the time to return to their sport. With surgery it's faster, maybe 7-8 months as opposed to 10-12 months conservative.

    I'm nearly 3 months post injury and I'm about 15 degrees from full dorsiflexion. Once I have full range of movement, then strenghtening exercises will begin.

    I'm having two sessions per week at the NHS Physio, yes NHS, and very impressed with the sessions, ultra sound, massage and a range of exercises for stretching etc. A mixture of passive and active stretches.
     
  5. coachgary

    coachgary Regular Member

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    Well I'm now past 4 months since injury. Walking normally with full range of movement but not enough power or strength for going up on toes one legged.
    Now that I full range of movement the Physio will allow more strengthening exercises to start. The chief discomfort comes from the soleus and not the achilles as one would imagine. The achilles has thickened somewhat but is not painfull anymore.

    The Physio assures me that with regular stretches and exercise the bottom of the soleus will soon free up, although he did infer caution as over confidence could lead to over working the muscles causing injury.

    There we are, a small update of non surgical therapy of full rupture of Achilles.

    Will update again after 3-4 weeks of calf raises!

    Gary
     
  6. johnlowe88

    johnlowe88 Regular Member

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    Gary,

    Hi. I cannot tell you about the non-surgery approach but I do have experience with the surgical one. I ruptured my Achilles during the 2009 Sydney World Masters Games. Second day of competition for my team. Surgery for me 2 days later, part of the bone had come off the heel with the Achilles attached and some tearing. 2 months in a full cast, then 1 month in the aircast boot, further physio, then 6 months or so after injury, I could play badminton again - but of course taking it easy. Right now my Achilles is about 3 times the thickness of the non-injured one. It is taking a long time to get fit again - not sure why, but losing 10Kg should have helped. I can still play competitively but seem a bit slower - maybe old age is catching up.

    Anyway, I wish you well and get back to badminton soon. I think that was the worst part - feeling like I could play, but the doctor saying not to until he gave me the go-ahead.

    -John
     
  7. coachgary

    coachgary Regular Member

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    Hi John, thank you for the reply. The frustration factor is the biggest danger I'm facing at the moment. I'm nearly to full strength with calf raises although to date I haven't got the confidence to land on my left foot. Therefore body rotation in overhead forehands are somewhat manufactured!
     
  8. Sentinel604

    Sentinel604 Regular Member

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    Coachgary

    Just wondering if you experienced any sort or pain before your achilles tendon ruptured

    I'm just kinda worried cause sometimes I feel pain after badminton around the achillies area

    Was it just something that was just totally unexpected?

    I'm worried cause I have a physically demanding job to go to the next day. Can't afford to sit on my ass for a year to recover
     
  9. coachgary

    coachgary Regular Member

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    I had no pain previously or any indications that this was going to happen. It's possible that you have some tendonitis and worth getting a doctors opinion in the first instance, thereafter if you're not satisfied that ask for a referral to a physio/specialist.

    You need to be sure that you haven't sustained any significant tissue damage before playing again.

    Regards

    Gary
     
  10. Sentinel604

    Sentinel604 Regular Member

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    I'll be sure to get a doctor's opinion

    Get well soon

    Thanks!
     
  11. johnlowe88

    johnlowe88 Regular Member

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    Gary,

    It has now been some more months. Do you have an update for us on how you are now? Back to 100% yet?

    -John
     
  12. coachgary

    coachgary Regular Member

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    John. Thanks for the reminder of this thread. i posted the following in a similar thread regarding operative treatment so I'l lre-print here.

    I had a lengthy discussion with the consultant who was quite relaxed about either way of treatment. My achilles ruptured aprox 25mm above the heal connection. This he explained was a good thing as the gap between the ends was very small thus with immobilisation in plantarflexion for 3 weeks would be sufficient for the tendon to connect. After the 3 weeks it was time for a new cast with my foot pressed into dorsiflexion as far as was physically bearable in terms of pain! I think my foot moved all of 5 degrees! Same thing happened again, every week for 3 weeks. After six weeks I went into an Air Cast with 2 heel wedges and this is when the physio began. After 8 weeks no wedges, and another 2 weeks I was into my shoes at last. Physio and strenghtening exercises carried on. I changed from NHS physio to private practitioner to have deeper frictional therapy about 6 months post injury. This was due in the main that the calf muscles, soleus and Gastroc were complaining from the strengthening exercises and needed to be freed up to reduce the stress on the achilles. I got back to gentle running around the athletics track after 8 months and now I'm back playing badminton to 70% pre injury performance although I reckon the other 30% is split between pychological and fitness.

    The achilles is healed (excuse the pun), I still have minor aches n pains and I'm told by a doctor friend that the scarring can take upto two years to dissipate.

    Another reason for the conservative method is that I had only recovered 8 weeks previously from a serious infection in my other leg after a fall from a ladder. High doses of two different anti-biotics were prescribed. I had been visiting my mother in hospital for a number of weeks and probably should have been tested for MRSA at the time, however I suspect my GP kept quiet about the type of infection. One of the anti-biotics was Ciprofloxacin which was probably the cause of my achilles rupture. See here. http://en.wikipedia.org/wiki/Ciprofl...dverse_effects
     
  13. London_Player

    London_Player Regular Member

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    Hi Gary.

    Reading your story is very relevant to me now, as I havejust done the same as you. Been playing for the last 22 years when I hadunexpected rupture on last Sunday morning, our usual session. Never had arupture before but had tendonitis a few years ago but then it stopped recently.When the rupture happened, I felt someone had kicked me on my ankle it was notthat painful but still very uncomfortable. Then later that day went to A&E deptand they confirmed it was a rupture. Then the hospital staff put a plaster caston my right leg just below my knee and gave a pair of crutches to move about. Gaveme an appointment on a sealed envelope to see a specialist in fracture unitnext week.

    I would prefer to have a ‘conservative treatment’ as Iam worry about operations, which I never have had. I am 44 and don’t think operationis suitable for me, as I read it’s mainly for younger people and who’resportsmen. Though it early days yet, and no doctors suggested what I shouldhave. From reading your comments, it seems it would take several months beforeI can go back to court again
     
  14. Cheung

    Cheung Moderator

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    Your last paragraph is particularly interesting. That risk of tendon rupture with ciprofloxacin is something I hadn't heard of before. Always learn something new!
     
  15. pretzel

    pretzel Regular Member

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    The first orthopedist I went to just shook his head and asked when I wanted to schedule surgey. I got a second opinion from a doctor who actually gave me options and pros and cons. I went the non-surgical route. Previous posters made good comments. You'll have to weigh for yourself, but let me know if you have questions.
     
  16. johnlowe88

    johnlowe88 Regular Member

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    Gary,

    For me, it has now been a little more than 2 years since my Achilles surgery (Oct 2009). My right Achilles tendon is still about 2-3 times thicker than my left Achilles. I was also told that it could take at least 2 years for the scar tissue to dissipate, but obvious that is very optimistic. I am playing at around 100% now in terms of speed, agility - but as you say, there are a few more aches and pains - not around the Achilles but elsewhere so maybe that is not the tendon. My right calf is still noticeably smaller than my left calf. But all in all, I am playing.
     
  17. coachgary

    coachgary Regular Member

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    Hi,
    Mine was a full rupture in september 2010. You need to ask the specialist if he has a good experience of the conservative treatment. The older method was to just leave you in a plaster for a couple of months. Mine was a fixed plaster for 4 weeks in plantarflexion, then it was adjusted and pressed into dorsiflexion every week for another 4 weeks. I then moved into an aircast boot for another 2-3 weeks with heel wedges. Wedges removed then into my shoes/trainers.
    Physio began once I was into my shoes, so we're talking nearly 12 weeks. The nhs physio didn't perform any frictional massaging/stripping of the tendon at all but they used ultrasound, stretching and exercises. After about 7 months I returned to very gentle play on court and walking and easy jogging. I had 6-7 sessions with a private physio whom I have to say was amazing! He's gave me confidence to push my training a bit more although I think I am only just now over it mentally.
    There are some great video's on youtube http://www.youtube.com/watch?v=LwQA9HcnLMU&feature=related. this chap had surgery but the blogs are great and will give you some inspiration.

    Another badminton player here snapped his 3 months after me, had surgery, and was back to international badminton after 9 months. But hey, he's only 24! I'm 43 this year. His achilles looks normal, didn't lose much calf muscle, whereas i lost 3 inches around and the tendon is still twice as thick as normal.!!

    All in all I'm happy with my re-hab. I still have scar tissue in my soleus and a certain amount of stiffness because of it but the tendon is stronger than before.
     
    #17 coachgary, Feb 10, 2012
    Last edited: Feb 10, 2012
  18. London_Player

    London_Player Regular Member

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    Hi Gary,

    Thanks for your feedback. At the moment my plastercast in set in tiptoe postion to heal the tendons before I get to see the 'fracture unit' on Monday. I'll update as to what he suggests and hope the NHS treatment is updated from 'old school' method for conservative treatment. I'm scared of surgery anyway, never had one, don't need one for this. Your information gave some valuable info. Thanks.
     
  19. King's

    King's Regular Member

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    The GP might have prescribed Cipro to prevent infection, specially taking into consideration the fall and injury on the other leg?:)
     
    #19 King's, Feb 12, 2012
    Last edited: Feb 12, 2012
  20. London_Player

    London_Player Regular Member

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    Got back from the hospital. They removed the temp plaster cast, which on a for a week, and replaced with an all round plaster cast in the same tip toe position. The Doctor saw me briefly and suggested conservative treatment. He did not get an x-ray or scan for me, as he said this rupture was confirmed by initial assessement at A&E and the classic way it occured. Then I was moved to plaster room, which was in next room and the nurses put the cast on.

    I would get the plastercast replaced in two weeks time and they would change the anlge of my feet each time. My employer is upset that I'm away for 6 weeks, even though I got a 'not fit for work' note from him. My manager now has arranged a meeting with thier Oc Health next week.
     

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