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Achilles Rupture

 
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Achilles Rupture - December 22, 2017 3:26:53 PM   
pappawheelie

 

Posts: 42
Joined: September 19, 2007
From: Vermont
Status: offline
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.

Thanks!

_____________________________

Ted Lamb, MSPT
Post #: 1
RE: Achilles Rupture - December 27, 2017 5:54:56 PM   
pappawheelie

 

Posts: 42
Joined: September 19, 2007
From: Vermont
Status: offline
Found this helpful in my decision to insist he return to the orthopaedic surgeon.

http://www.intechopen.com/books/achilles-tendon

"Achilles Tendon", book edited by Andrej ÄŚretnik, ISBN 978-953-51-0264-9, Published: March 9, 2012

_____________________________

Ted Lamb, MSPT

(in reply to pappawheelie)
Post #: 2
RE: Achilles Rupture - January 5, 2018 9:34:02 AM   
Tom Reeves DPT ATC

 

Posts: 1153
Joined: March 15, 2006
Status: offline
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.

(in reply to pappawheelie)
Post #: 3
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