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Sunday, December 17, 2017

Achilles Tendon Rupture: Email Advice

Dr. Blake

I'm 4 weeks nonop, recovering from a full achilles tendon rupture (approx 7mm) that was sudden impact and not degenerative or sport related, no history of weak tendons, very fit and active 45-year-old male, very clean diet, no drugs or alcohol.  Over the past four weeks, aside from the pain and frustration that comes with the injury, I've dealt with what I've perceived as incompetence and/or lack of care from hospital and ortho specialist staff.  I was in a splint from the er for 7 days, in a cast from ortho for 7 days, and currently, have on a walking boot with wedges in it.  I also ordered a Vacoped/ Vacocast that finally arrived.
Dr Blake's comment: This all sounds fine. You want to keep the achilles plantar-flexed, like the pointing of the foot in ballet, for the next 8 weeks. You will then slowly remove the wedges 1/8th inch at a time over the next 3 months as you get stronger. Start strengthening now by contracting the calf and pointing your foot in the boot. These are isometrics to be done three times a day. You hold a count of 6 seconds, relax for 4 seconds, and repeat 10 times per session. See if you can wear a muscle stim while you are in the boot on the calf. As you wean out of the boot, you have a month of vulnerability where re-ruptures occur. Avoid dorsiflexing over 90 degrees, and especially placing your heel in a negative heel position for this next year. As you wean from the cast, you need to make sure the step you are taking does not produce any tension in the calf. I typically work with a PT at this point who is seeing the patient once or twice weekly to manage the re-strengthening while I see the patient once a month to check strength gains and flexibility problems. I have seen both over flexible and too tight, but once recognized, easy to get back on track. 

I'm anxious to begin rehabbing, but currently exercising patience and caution.  I am willing to give 100% to the right protocol.  My problem is that I can't find any consensus on what is "right".  I'm hoping that your expertise can help ease my mind and that you can offer some help on my path to finding an optimal recovery.
Dr Blake's comment: Feel free to ask questions, and I will place everything in this post. 

Thank you in advance, any advice would be greatly appreciated.

Dr Blake's response: Thank you for your email. First of all, here is the link to one of the previous blog posts on the subject. 

And here are the rules of treatment from my book "Secrets to Keep Moving".

The top 10 treatments for achilles ruptures are:

1.  Decide on surgical vs conservative treatment first
2.  Strengthening begins as early as possible with muscle stimulators or isometrics
3.  Strengthening of the achilles post rupture will take 2 years to complete
4.  Post repair (surgically vs casting) it is vitally important to find out if the tendon is too           tight or over flexible
5.  Control swelling as anally as possible with anti-inflammatory measures since it stops         the normal circulation for healing
6.  Strengthening goal (or you are not rehabbed!!) is 50 one-sided toe raises consistently,       however you need to start with the active range of motion exercises, then progressive         resistive strengthening like with therabands
7.  Deep calf massage started after the tendon is together
8.  Avoid any negative heel stretching
9.  Shoes should have heels or contain heel lifts and/or orthotic devices
10.  Orthotic devices are crucial with overpronators or over supinators

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.