Day 17: Pain

• Day 03 in a cast
• Round-the-clock pain killers for pain in the heel and right side of foot
• Rescue pain killer taken early morning
• No pain on injured calf or lower leg
• Sleep disruption
• Slight fever 37.4
• Requested early doctor visit to check. 
• Rescheduled for November 6 instead of November 10 (Could not go earlier due to long Halloween-All Saints Day break)

Purchase: Forearm Crutches (Regular)

Forearm Crutches (Regular)

Shopee Online Store Price:

P700 ($13) /pair

All You Want to Know About Crutches - Forearm and Underarm Crutches

https://www.friendsofpolarbear.com/post/all-you-want-to-know-about-crutches

Day 14: 2nd Visit to Orthopedic Surgeon: Decision

Decision: Conservative Treatment (Non-Surgical)

• Foot put in a fiberglass cast
• Doctor suggests weight-bear on the installed heel
• 3rd Visit set for Day 28 for followup checkup

Purchase: Forearm Crutches (Foldable)

Forearm Crutches (Foldable)

Shopee Online Store Price:

P1,200 ($22) /pair

All You Want to Know About Crutches - Forearm and Underarm Crutches

https://www.friendsofpolarbear.com/post/all-you-want-to-know-about-crutches

Day 10: MRI Results

"Complete tear of the plantaris tendon with evidence of tendon retraction."

Day 09: MRI

4:52am

Sunday Morning at Hospital

MRI Schedule (6 am)

Day 07: 1st Visit to Orthopedic Surgeon

• Surgical and Non-Surgical options discussed. Surgery can wait if decision is leaning towards non-operation. Told that patient can wait for even a year. This is in contrast to ER ortho doctor saying the decision for operation has to be done within two (2) weeks.
• SpeedBridge operation discussed as an surgical option to take. This is a new procedure (3 months old in Manila) and was made known during an international orthopedic conference. 
• SpeedBridge Repair Info https://www.arthrex.com/foot-ankle/achilles-speedbridge
• MRI to be done to determine extent of tear.

Information: Surgical Protocol (Achilles Tendon Repair & Rehabilitation)

Achilles Tendon Repair & Rehabilitation

Phase 1 (surgery to 2 weeks after):

Splint/Boot: Locked 20-30 degree plantarflexion for two weeks

Weight-bearing: Touchdown weight-bearing (TDWB) with crutches

Cardiovascular: Upper body circuit training

Patient Precautions:

• Keep elevated
• Keep incision / splint clean and dry.
• DO NOT push through the pain

Progression Criteria:

• Two weeks post-op.
• No wound complications.

Phase II (2-6 weeks after surgery):

Physical therapy appointments begin one to two visits per week.

Goals: Protection of repair and achieve active dorsiflexion (DF) to neutral

Patient Precautions:

• Post-op weeks 2-3: boot at 20 degrees, sleep in boot, TTWB with crutches, no active DF.
  
• Post-op weeks 3-4: boot at 10 degrees, sleep in boot, TTWB with crutches
• Post-op weeks 4-6: if the PT can reach neutral PF/DF comfortably, then neutral boot with small heel lifts, sleep in boot, WBAT (based in pain, swelling and wound) with crutches and boot, active DF to neutral.

Therapeutic Exercises:

• Ankle range of motion (ROM) respecting precautions.
  
• Pain-free isometric ankle inversion, eversion, DF and submaximal PF.
• Open chain hip and core strengthening.
• Cardiovascular upper extremity circuit training.

Progression Criteria:

• Six weeks post-op.
  
• Pain-free active DF to 0 degrees.
• No wound complications. If you have a concern, please consult with Dr. Roe.

Read More: 

Stony Brook Medicine

Read Other Source:

Mass General Brigham

IMPORTANT: Orthopedic Surgeon / Doctor may have a different surgical protocol. The default patient protocol is to follow what doctors recommend as they know all the information of the patient.

Information: Non-Surgical Protocol (Achilles Tendon Conservative Management Weightbearing)

Achilles Tendon Conservative Management Weightbearing

What to expect?

Phase 1 (injury to 4 weeks after):

Rehabilitation Plan 

• Wear the boot with 5 wedges all the time, including at night.
• Use your crutches and put some weight through your foot when you walk
• Remove the boot once a day to wash your foot and change your socks
• DO NOT stretch your calf muscle
• You will see a Foot and Ankle consultant 4 weeks after your injury

Phase II (4-8 weeks after injury):

Rehabilitation Plan 

• Remove one wedge from the bottom of the stack each week and replace the top of the stack into the boot
• Follow advice given by your Foot and Ankle consultant.
• DO NOT stretch your calf muscle
  

Phase III (8-10 weeks after injury):

Rehabilitation Plan 

• Remove the last wedge from the boot at week 8.
• Wear the boot alone for a further 2 weeks.
• You will have your first physiotherapy session 9-10 weeks after your injury.

Read More: 

Virtual Fracture Clinic

IMPORTANT: Orthopedic Surgeon / Doctor may have a different non-surgical protocol. The default patient protocol is to follow what doctors recommend as they know all the information of the patient.

Information: Conservative Treatment vs Operative Treatment VIDEO

Excellent video to watch for Operation or Non-Operation Decision

(Physio and Orthopedic Surgeon discusses options)

Link: Video: Achilles Rupture: Conservative treatment vs operative management. What is best?

Information: Crutches (Underarm or Forearm)

All You Want to Know About Crutches - Forearm and Underarm Crutches

https://www.friendsofpolarbear.com/post/all-you-want-to-know-about-crutches

Day 02: Crutches (Underarm)

Crutches have so much history.

INFORMATION: Surgical or Non-Surgical Treatment - What Do I Choose?

Surgical or Non-Surgical

The Achilles tendon connects the calf muscle to the heel bone.

Achilles tendon ruptures occur most commonly in 30-50 year olds. It is common in the recreational athlete.

The reason for rupture is when the tendon is rapidly loaded when it is already under tension. Common mechanisms include jumping from a height, pushing off for a tennis shot, or tripping on a curb.

How is it diagnosed?

The diagnosis is made by clinical examination.
Ultrasound is not required in most situations

What are the treatment options?

• Non operative
• Operative repair

Both options have been shown to provide good outcomes in compliant patients.

In some situations one option is preferred.

Day 01: Achilles Rupture - Basketball Game

• Basketball game injury. 2 minutes into the game. No contact rupture. Right leg.
• X-Ray and Thompson Test done.
• Thompson Test - A provider will squeeze your calf muscle on the back of your lower leg to see if your heel moves. Usually, your heel will move a little with your calf msucle because your Achilles tendon connects it to your heel bone (calcaneus). If your heel doesn't move, your Achilles tendon may be torn. 
• ER doctor suspected partially torn achilles tendon. Recommended seeing orthopedic surgeon within 2 weeks for surgery timeline. ER doctor said surgery must be done as soon as possible if surgery is the option. Reason given is to avoid scarring.
• Foot is put in a fully bent downwards (equinus) position to put the tendon ends as close as possible to each other. Fiberglass splint is placed on top of leg to keep the equinus position.

Information: Calcaneal Positioning in Equinus Immobilization