Physiotherapy post Achillies tendon rupture.

Discussion in 'Training, Fitness and Health' started by Night Train, 18 Jul 2012.

  1. Night Train

    Night Train Maker of Things

    Greater Manchester
    Sorry for the long post.

    A few weeks ago I ruptured my Achillies tendon in my left leg. The damage was high up in the calf where the tendon fanned out into the muscle and, with hindsight, was probably a progressive tearing away over a week before the final snap.

    It was decided that no surgery was required and that the tendon would be left to heal on its own due to the location of the damage and my leg was put in a cast. I then broke my big toe on the same leg when I fell over with the crutches when returning from the hospital. The cast was then removed and an inflatable 'Beckham boot' fitted.

    That was six weeks ago now with my last hospital check up two weeks ago.
    No advice was given regarding physio except the consultant asking why I hadn't already been putting weight on my foot and moving it. He had told me on my previous visit not to put weight on it at all and to keep it immobile.:rolleyes:
    I have also been told to gradually remove the heel wedges from the boot, each 10 days, to bring my foot back to a normal angle from the toe down position.

    So apparently I now have to put weight on my foot, which I have been trying to do and can now bear maybe 1/3 of my weight on my foot with the boot on and maybe 1/10 without.
    Though I was told I was not to remove the boot, I was also told I should remove it and move my foot.:huh:

    I have had no guidance, other then some youtube and google findings as to what to do.

    I have elected to remove the boot for an hour or so each evening to exercise before taking a shower.
    So far I have been moving my foot up and down and have gained enough movement to be able to lift my foot, from its toe down position, enough to stand upright. I have about 3" of movement at the toe (down 3", up 0" from standing) compared to over 9" on my good leg (down 5", up 4" from standing).
    I can tilt and rotate my foot left and right a little and so have been 'writing' the alphabet by pointing my foot, A-Z and A-Z in mirror writing, to catch all the movement and control.
    For one week now I have been sitting with my feet flat on the ground and pushing down with the ball of my foot to raise my heel. I can only just get my heel to leave the floor. After 4-5 repeats I get a sharp and lingering pain in the calf muscle area.

    Any suggestions as to what I should be doing, if different, and how I deal with the pain barrier?
    I am uncertain as to whether I should ease back or work through the pain.

    Some of the exercises I find online are beyond me due to the broken toe. My foot is also quite swollen, and tender under my heel.

    Thank you.
  2. gary in derby

    gary in derby Well-Known Member

    get back to the Docs. and give him hell. sometimes you need to scream to get things sorted. demand to see a specialist. I broke my ankle about 22 years ago. its never been right since and is now to late to do anything about it. So, go and hit him over the head with the boot and dont stop till you get it sorted.
  3. OP
    Night Train

    Night Train Maker of Things

    Greater Manchester
    Cheers, I'm back at hospital next week.

    The thing that has got me down, and less assertive and considered about what I need to know, is that I have ended up sitting about for near 3 hours waiting to be seen. I am asked to get there early for my appointment and then the appointment is delayed over 2 hours.:rolleyes:
  4. Nihal

    Nihal Veteran

    I guess you calf muscles are either sore or rusty after being unused.Did the Doc advise you to put weight on it so quickly:eek:
    It would be much simpler to sit on a chair and slowly put pressure pressure on the balls and try to lift the heels,this would put less pressure on the Tendon which i would think you are stretching too,well,lets say,quickly

    And yes,Hospitals,always the same:rolleyes:

    GWS NT
  5. OP
    Night Train

    Night Train Maker of Things

    Greater Manchester
    At the first consultation I was told to keep all weight off my leg and to not remove the boot except for washing every couple of days. I wash daily so it came off daily.

    At the next consultation, the last one I had, the conversation went like this, make of it what you will:

    Mr Consultant: Have you been putting weight on your foot?
    Me: No.
    Mr: Why not?
    Me: Because I was told not to.
    Mr: Who told you that?
    Me: You did! :rolleyes:
    Mr: Oh. Lets take your boot off to have a look.
    (Boot comes off)
    Mr: You still have all your heel wedges in. Why have you not been taking them out?
    Me: Because you never told me to.
    Mr: Have you been exercising, moving, your foot?
    Me: No, only moving it very slightly when I take the boot off to have a shower.
    Mr: So you have not been taking your boot off to exercise? Why not?
    Me: Because when I asked you if I should take the boot off you said only once every two days if you need to wash, otherwise keep it on! :rolleyes:

    (Later on)

    Mr: OK, so you have three heel wedges. You can take one out today, and another out in 10 days and another 10 days after that. Then, when you come for the next appointment in 3 weeks time, we may be able to take the last one out.
    Me: :huh: :blink:
    Mr: Don't forget to move your foot to exercise it.
    Me: How often do I remove the boot to do that?
    Mr: Don't remove the boot, the boot will keep your foot stable.
    Me: :huh: :blink:

    Mr: You should be able to walk on the foot putting weight on the heel to protect your [broken] toe.
    Me: OK

    I don't have much faith in the consultant even if I was to hit him on the head with the boot, hence asking here.
  6. OP
    Night Train

    Night Train Maker of Things

    Greater Manchester
    This is how I am doing that, in a seated position, so that my knee lifts up and down.
  7. Nihal

    Nihal Veteran

    :eek: :eek::eek::eek:

    Are you sure he was not drunk or anything.He seems to have a relly bad memory for a Doctor.And directly putting weight on the heel...........:stop:
  8. Nihal

    Nihal Veteran

    Oh, i thought you were seated on on the ground sorry:blush:

    I had broken my arm,snapped the Ulna in half two years ago.The Doctor was a good guy.He made the whole things rather less painful.But the physio who came after ther removal of the POP:cry:.I still fell sharp pains on the connection between those bones to date,because that idiot asked me to return it to normal use assuming it was completely healed,now two years later................:cry:
    And i had to stop swimming because of this:angry:
  9. OP
    Night Train

    Night Train Maker of Things

    Greater Manchester
    Maybe just overworked and under pressure? I don't know, I'll see next week.

    I have been able to hobble a bit and put weight on my foot while using crutches but only with the boot on to spread the weight over my whole lower leg.

    Sorry to hear about your arm, any chance it will improve or is it now set like that for good?
  10. Nihal

    Nihal Veteran

    Been swimming for a few days now.Lost all the speed that i had.I visited the same Doc(not the physio),hes a family friend,He said it will get better in time.......but that could mean a few days,months,years???:headshake:
    BUt for now its quiet good.

    Good luck with your foot,and be careful on taking those advices into consideration:thumbsup:
  11. TheJDog

    TheJDog dingo's kidneys

    My elbow was the same sort of story. When I broke it, the doc in casualty gave me a sling and told me to keep it immobile.

    When I got to see the specialist (probably two weeks later), he said how's the movement coming along?, assuming I'd been trying to move it around, which I had not. Now I have an elbow with a metal joint, chronic arthritis, and very restricted movement. The surgeon's solution is to remove the head of my radius (again), but this time not replace it with anything. I am rather skeptical of that. I've totally given up on it, to be honest.

    I also had a soft tissue achilles injury in my early twenties - I put up with limping for nearly two years before I eventually got it mostly sorted. Running makes it flare up again, but running is hard work.

    Strongly agree with Gary. Shout shout and shout again until you are happy. Or you'll end up with years of misery.
  12. VamP

    VamP Banned

    I would add that it pays to keep educating yourself so that you end up knowing as much as possible about your condition and the rehab that you need. Nobody else will take ownership of your injury in the way that you can.

    I have come across the rehab protocols of eccentric exercises being particularly effective in the treatment of tendinopathies - all through my own research, neither my consultant or physio mentioned these or even seemed to know about them when I brought them up.

    Read this and this, and do your own research from there. Obviously your biggest challenge will be getting the load and recovery periods right. If you can find a physio with specific achilles tendon injury experience he will be worth his weight in gold to you.
  13. TheJDog

    TheJDog dingo's kidneys

    I had electro-stimulated acupuncture on mine and it was a marvel.
  14. ASC1951

    ASC1951 Guru

    +1. In fact the NHS simply isn't set up to deal with sports injuries. Most people don't do sport, GPs aren't taught sports medicine and if it doesn't affect your ability to work the system doesn't care. The £gazillions we pour into the NHS is mainly spent on treating the symptoms of poor lifestyle and diddly squat on prevention or the active promotion of good health </rant off>

    The first link is broken - you mean - although they are both academic papers and rather impenetrable. I use a good set of eccentric exercises on this and several other common injuries from here
  15. VamP

    VamP Banned


    Thanks for fixing the link. I like academic papers :shy: granted, it's not for everyone, but it really gives me confidence knowing why I'm doing something, rather than just being told to do it. Having been told to do things that made things worse in the past makes me quite distrustful of that approach.

    The Alfredson study in particular is a heavily referenced by researchers into tendinopathies and appears to reflect the gold standard in their treatment.

    At OP, there are tons of eccentric exercises available so you don't need to follow the Alfredson protocol, a quick google will provide a handful of options.
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