Snapped achilles tendon

A snowHead

Non-surgical due to age and other profile elements, including the risks of surgery during Covid.

A snowHead

It's now been 4 weeks, so a short update. The boot now has a range of movement from the 30 degree downward angle it started with to now allowing it to move through 30 to 20 degrees. I can't really feel much difference, but from the middle of week 3 I dispensed with the crutches and was able to walk around unaided. Stairs are still something I consciously think about and take carefully, and I still spend much of each evening and most of the night with my foot elevated on a large bean bag. Outdoor walks are rare and limited to about 100 metres, otherwise my heel starts to hurt from pressure on the wedge of the boot.

The bruises are now just about gone, and the only real issue now is if I get too hot the leg gets very itchy in the boot. That's easily solved at the moment by standing outside for a few minutes, so I'm glad I didn't do this in the heat of the summer.

I'm also now more than half way through the 45 day course of blood thinning injections, so I'm now able to stab myself each evening with something approaching proficiency. Maybe I can get an extra job as a vaccinator...

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Had a complete rupture of the tendon In 3rd week of July a few years back the consultant said it was the worst he had seen (dr Bircher now has a private practice in ashtead Surrey ) had it operated and put in plaster .
I was back on skis in 3rd if the following January . Was 38 and overweight . You must do a full rehab , exercise everyday .
Am sure you will be on the slopes sometime . If things go well April trip may be possible .

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well, if skiing is out, you can always move to the darkside Toofy Grin

Funnily enough, this week repeat of Ski A&E was a snowboarder who snapped hers & she made a full recovery.

Anyway, snowHeads is much more fun if you do.

@Mr.Egg, I’d always assumed that boarding would be harder on the Achilles than skiing given the need to angle the feet - is that not the case? Not that I’m likely to try it - too much sitting around for my liking

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After 55 days of self-injecting Dalteparin to thin my blood and avoid deep vein thrombosis while I have the plastic boot on, today was the last injection. It’s not something I’ll miss - there’s something deeply unpleasant about sticking a needle in your own waistline.

Last checkup at the hospital coming up on Christmas Eve, and then I have a final appointment with the consultant to be signed off.

Yesterday we had an annual walk at the local National Trust property which is part of a family tradition. Not fancying this in a plastic boot, I strapped up my ankle and tried on my walking boots, and after an hour of walking around the house I was confident that it would be OK to wear them outside. The two mile walk around the damp and muddy grounds was our slowest ever, but it was completed without issue, so things are looking up.

Then you can post your own questions or snow reports...

@ousekjarr, yay! Very Happy

After all it is free

New year, and a new start - or maybe not. The good news was that I completed my time in the plastic boot and was seen by the consultant on Wednesday who confirmed that the boot was no longer required as I was fully weight-bearing and had a normal range of movement of the ankle.

The bad news is that he asked me to stand on tiptoe on two feet, which I did with no issues, then on only my injured leg, again without issues, and then to stand on tiptoe on only my injured leg, which I could not do at all. It was impossible for me to even lift the heel off the floor. His opinion is that this is symptomatic of two possibilities - that I have lost so much muscle mass/tone in the right leg that I don't have the strength to take the weight, or that the achilles tendon has only partially repaired and is incapable of providing the required force. The only way to confirm which it is is with an MRI scan, which is now in the request queue and will hopefully be scheduled for sometime in the next couple of weeks.

Based on the results of the scan, I will either have physio and strengthening exercises to regain the strength in my leg, or will be referred to an ankle specialist for followup which may involved a surgical reconstruction. Needless to say I was very disappointed at this, but as my weight has always been higher than it should be I suspect that is part of the problem and resolving that has to be part of the solution as well. Surgery would be very much a last resort, but if it is needed then I'll be back in the boot for a further 8 weeks.

On the plus side, I now have an elliptical trainer and today I had my first session on it with an initial 10 minute seated bike followed by another 5 minutes standing and using the handles as well. No real issues apart from I can definitely feel that my right leg is considerably weaker than my left, and I tired very quickly as a result of 10 weeks without exercise.

@ousekjarr, when I get to weight bearing after my TPF I couldn't stand on tiptoe on that leg for months. Fingers crossed it is just due to muscle loss

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I've been around a bunch of these....they take a full year, but they do get there.

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Thanks both, fingers crossed...

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I snapped my achilles in 2010, when I was 40 (I'm 51 now), playing squash. After a few weeks in a boot, I had a 3-hour long surgery to repair it (they had to graft in some of the tendon tissue from further up my leg to fill the gap where the tendon had torn), followed by 3 months in a cast, and a further 3 months wearing a boot and intensive physio. It was hard work - there were many times when I thought I'd never get full mobility back in my leg, and the ability to spring off that foot and run, jump etc. But it did eventually start to improve and after about another 4-6 months it was a lot better. I still can't flex that ankle forward as much as my other one, but it hasn't stopped me skiing or doing any other sport or exercise. I was nervous the first time I skied after the injury, but in many ways the ankle being protected in the ski boot makes it feel safe. Stick at it, persevere, work hard at your exercises and stretching and it will improve. It's a rubbish injury but you'll get there eventually. Best of luck.

@Rosey44, thanks - I've seen some improvement over the last week as walking and using an elliptical trainer has started to restore the strength in that leg. When the boot first came off, I was walking up one set of stairs in our house sideways because the treads are narrow and my heel was overhanging the edge of the tread which just wasn't possible for me. After a week, I'm now OK to go straight up those, so that's a clear sign of improvement. No word yet on the MRI appointment, but it's not exactly the best time to be visiting hospitals so unless I see a significant reversal of progress I'm not in any particular rush.

By evening time each day I have some swelling around the ankle, and I typically spend my evenings with the foot raised as before to address this. By morning, everything is normal, so I have to assume that this is to be expected and will improve over time.

This morning I had a 2 mile walk which included some muddy slopes and uneven surfaces, which passed without difficulty. It's getting there...

You know it makes sense.

I am in week 3 after snapping my Achilles playing football not Skiing, they have not recommended surgery and although going private they seem to always recommend surgery recent research shows that both ways are just as successful with out the risk's of an op especially in covid times and you still have the boot for 8-9 weeks. My Physio was also against surgery and said the process was the same.

I have just had the boot adjusted to 15 degrees after 2 weeks at 30 degrees, it hurts a bit today and i'm not confident putting weight on the leg but i'm hoping this will ease.
Never done this before so reading the messages makes me think this is defo a long process but you need to follow the advice.

Any advice is welcome.

Otherwise you'll just go on seeing the one name:

been there. Done that. (Although with surgery)
it is a long process and the process does not end when the plaster cast (as it was in my case) comes off. You need to carry on with the physio. It is 30 years since i snapped mine - a complete clean break rather than a serious strain) and my calf muscles are noticeably different in size even now

A snowHead

Very similar post snap experience here. Keep active and fanatically do all the physio. Skied a year later no problems. The healed tendon feels better than the other normal one.

A snowHead

@Big Don, sorry to hear you've also had this experience. My original post was almost exactly 8 months ago, and it is now nearly 6 months since I got out of the boot. The good news is that I completed (most) of the West Highland Way in the May half term (83 miles out of 96) over 7 days and carrying a day sack, with the longest day being 18 miles. My right leg now looks similar to my left (it started 5-10% bigger, and shrank to maybe 50% of the size), and the muscle mass is still improving.

The bad news is that while I can walk, I can't yet jog - I've managed about 10 strides at a time on grass, but I'm still lacking stability in the ankle and there's still a pronounced weakness in some positions. It feels like the angle of my foot is wrong on the damaged side, so I always land flat-footed rather than with my toes pointed downwards. Running is probably 3-4 weeks away at best, and could be 2-3 months still. The angle thing could be a mental thing, trying to protect the weakness - some of my clearest progress has been noticed when I'm in a hurry and I forget to be injured, e.g. when I skipped down the stairs to answer the door and then stopped to wonder how I had done that. Same with going up stairs - it started with a sideways crab movement, then became left foot first on all steps but going straight up, then alternate feet but holding on, and now I can trot up without really thinking about it.

My MRI was an interesting experience. When I finally got to see the consultant for the results and was able to read the report, it turned out that despite every check done on several hospital visits which said I had snapped the tendon, it was very much intact and showed no sign of a rupture. What it did show was evidence of several previous injuries consistent with acute tendinopathy, which contributed to the big event, and that the event itself had been a longitudinal tear in the tendon of 5-10cm length behind the ankle, i.e. from bottom to top, not across the tendon. There was also minor damage around the site, probably from turning the ankle as I landed on it on my way to the ground.

My experience of NHS care was not all roses - despite asking during clinic visits about physio, I was told that at my age and in my condition there was no need for it. Having hassled the consultant on this point, and armed with published treatment plans from 3 other NHS hospitals (thank you Google!) which called for mandatory physio for all patients, he agreed to refer me for a physio appointment in what I presumed was simply a way to get rid of me. The physio read the notes, asked me why I hadn't had any physio before that point, and on being told that it wasn't considered necessary, shook his head in despair and told me that the earlier the physio starts the quicker the recovery will be, for all patients. Apparently tendons don't magically recover naturally - they need to be exercised and stressed to encourage them to strengthen, so don't miss out on any of the physio.

My physio experience has also been mixed - the exercises have been pretty basic, and delivered via a 10 minute video call, so that's not been ideal. I've done them fairly much as asked, but with some adaptations around other stuff - the advice I was given was to make sure it was every other day at most as rest and recovery are important, that doing them in the late evening was best as any swelling or pain didn't then impinge on the day, and that overnight rest was ideal for the recovery. I mainly stuck to that, but it is a challenge to do the exercises if you've been active during the day as you'll already be tired.

The physio also advised against doing anything repetitive (like walking long distances rolling eyes

) until I had regained full strength in the tendon and leg. That specifically put the elliptical trainer on hold, and his advise was to keep walks to under 3-4 miles at most. As you can tell from the first paragraph above, I partially/wholly ignored this and worked on the principle that anything which didn't hurt during exercise or afterwards was probably OK. In retrospect this has been important for me to recover the muscle mass, and that's what has helped me the most I think.

I was (mainly Embarassed

) sensible and built that up slowly - when the boot was first removed, I was limited to about 50 metres of walking. Then 100 metres the next week, then 500, then a walk of about 1.5 miles, and then building up to 5, and then 7, then 9, and up to 12 before I had to make a call on whether our (booked in August) walking trip was on or not. I also did two days of 10 miles back to back to be sure I could do more than a one-off. As 12 miles had been OK, I started the trip with the idea that I could drop out or do part days, and in the event that's what happened - I dropped a half day on the afternoon of day 3 primarily due to blisters and knowing just how rough the terrain was going to be from previous experiences, skipped the first third of the following day, did the same on the day after, then did all of the remaining parts of the route. That included a climb from 800ft at the east end of Glencoe up the Devil's Staircase to 2200ft, which was fine - the descent on the other side was much harder on my ankle due to the downward angles, and on my leg generally due to the muscle loss.

I haven't been back on skis yet for obvious reasons. With walking boots on it felt very stable except in extremes (e.g. stepping on a rock which wobbled), so I have no reservations about skiing. I have week-long trips booked for December, January and February so far, and hope to fit in a March trip as well NehNeh

Well, the person's real but it's just a made up name, see?

Also, I was fully weight bearing on the boot after 10 days, and dispensed with the crutches entirely after 3 weeks. If you have pain now, that could be due to the angle change which is designed to stretch the tendon, and that will ease - or it could be due to pressure from the boot. I had no pain on the angle changes, but I did have a pressure sore on the top of my foot and also on the side of the heel. I had weekly checks at the hospital to change the liner and wash the foot, which also allowed for the sore bits to be dressed and padded, and this helped.

If you've not yet done so, get a LimbO waterproof cover for your leg - https://www.amazon.co.uk/gp/product/B0056PQPKS/ref=ppx_od_dt_b_asin_title_s00?ie=UTF8&psc=1&tag=amz07b-21 - this gives a good degree of protection for showers, which I found really difficult at first. With the boot on you can be fully weight-bearing. Once you remove the plastic shell, you really won't be, and it will hurt a lot if you try (it's not a great idea...). I tried standing on one leg in the shower and leaning against the wall, but it is very tiring and not very safe. The problem was solved with a garden stool placed in the shower - sitting down was so much easier, and much more secure. Getting in and out was still "interesting" at times. After about 6 weeks I started removing the whole boot to sponge my foot, because it stank, and because it was very itchy if it overheated - I'm glad it happened in winter, and I sympathise that you are going through this in June and can't escape any heat we may get. After 8 weeks, I wore the boot only outdoors, and at 10 I was out of it.

Here's the treatment plans I used as a sanity check on what our local hospital were doing - it still seems strange to me that the NHS doesn't have a single national treatment plan which everyone uses... The Berkshire plan starts with a plaster cast before the boot and changes to 15-30 degrees at 4 weeks, the Kent plan starts with the boot and changes angle at 5, and so on. Both show physio from 7 weeks.

https://www.royalberkshire.nhs.uk/patient-information-leaflets/physiotherapy%20foot%20achilles%20tendon%20rupture%20management%20and%20rehabilitation
https://www.ekhuft.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=490433

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Thanks for the info.

Help!!

Snapped achilles tendon

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