Posts: 47
Joined: September 19, 2007
From: Vermont
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Whoa--long time since I've been in here.
I saw a 49 y.o. gentleman today in the clinic who apparently ruptured his Achilles tendon while playing Ultimate frisbee in August 2017. He did go to an orthopaedic surgeon shortly thereafter who apparently diagnosed him with an Achilles tendon rupture and advised he get casted. Unfortunately for my gentleman, he did not believe his diagnoses (neither did his chiropractor nor his natropathic physician) so he opted to wear a foot immobilizer and ride his bike for rehab. He states that since his initial injury he's experienced three 'popping' incidents when he's forcefully dorsiflexed his ankle. He states he doesn't really trust MRIs or surgeons.
He presents with calf atrophy, visible loss of Achilles tendon, positive Thompson's test, and no real pain in the area. He does have active plantarflexion (but gastroc doesn't seem to fire, even with forceful manual resistance), but he won't even try single-leg heel lift.
So I have two questions (maybe more): 1) Is it too late to immobilize his ankle? (I think so), 2) Is it conceivable that functionally he may do fine with optimizing the strength of his remaining plantarflexors, he just may not regain as much strength as he had prior to his injury? (kind of like somebody who ruptures the long head of their biceps tendon)
I've never seen this before, and think he should go get a second opinion from another orthopaedic surgeon, but wondered if anyone else has dealt with a client who had/has a deficient Achilles tendon.
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Joined: March 15, 2006
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The Achilles is never going to re-connect. Tom, dick, and harry are not big enough to do what the gastrocs and soleus do. IMO, he can either have it repaired (if it is even repairable any more) or enjoy a different level of function for the rest of his life.
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wondering wether this man's distrust of conventional medicine was so before first chiro contact, or if said distrust was fomented and encouraged by the chiro. Many times those with fixed or nacent unconventional ideas seek out those most likely to agree, thus reinforcing woo seeking behaviour. Some may have had poor clinical outcomes and fear another. Agree with Tom, if the tendon is ruptured completely, it aint coming back. If partial, it will likely repair though remain less than ideal, possibly breaking again. Either way, he's off the list for volleyball/tennis/sprint/dancesport.
The best solution for him is to get an Achilles Tendon Repair surgery ASAP. He cannot afford to wait around any longer because of tendon retraction. Eventually, if the tendon retracts or separates too much, the surgeon will not be able to connect the tendon. So, time is of the essence. You have to help him to get an appointment to book the surgery immediately!
< Message edited by CardioFlex Therapy -- April 9, 2018 4:40:36 AM >
Posts: 47
Joined: September 19, 2007
From: Vermont
Status: offline
Update to the situation: Gentleman returned to surgeon, who advised walking boot with heel lift for 6-8 weeks (that was in January). Pt now walking with a limp, still unable to perform single heel lift on affected side, and is fearful of re-tearing Achilles.
Note from attending physician stated she felt he had a partial tear of his Achilles.
Yes, it appears that his Ultimate Frisbee days may be over.
Whether it's a high grade partial or full year he needs to have surgery. First get him to get an MRI ASAP to assess the damage. Then if it's a high grade partial or a full tear then try to encourage him to book that surgery ASAP.
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