My Achilles Tendon Rupture – a personal experience
This is a reflection and account of dealing with my own foot & ankle injury. I can’t help but point out the irony of a podiatrist dealing with a severe injury to one of the most important tendons in the foot & ankle. Whilst having an injury has been far from ideal, it has given me valuable experience and perspective on how debilitating a foot & ankle injury can be and the limitations it can put on someone.
My Achilles tendon rupture – how it happened
On May 20th 2023, I was playing Australian rules football. Shortly after half time, during a passage of play, I fell to the ground in a crumpled heap. The feeling I could describe was that it felt like someone behind me had blatantly kicked me in the back of the leg. Although I didn’t know for sure at the time, I had ruptured my right Achilles tendon. If there was any pain, it must have left as quickly as it came because I don’t remember experiencing much at all. I was able to hobble off but found it very difficult to lift my right foot off the ground as I tried to take a step.
As I was processing the shock of the injury, I recall thinking that I hoped it was a calf tear or bad strain, but something in me thought that couldn’t be quite right given the lack of pain. As the trainer examined the area, we both realised an area of the Achilles tendon was soft and mushy that shouldn’t have been. Later, as I went to have it scanned, the way my foot was flopping around up and down from the impact of using crutches I knew there was not enough resistance on my foot for my Achilles to be well enough intact. Shortly after, the scan revealed a complete rupture of the right Achilles tendon.
It sounded like a gunshot
In an Achilles rupture, the fibers are torn and separated so badly the tendon cannot perform its normal function. It often affects people from the 3rd-5th decade of life and notably a loud crack or snapping sound can be heard at the time of acute rupture. My father, who was a last-minute call up to be a goal umpire for our game, can attest to this as he told me it sounded like a gunshot went off at the ground.
Below is a comparison of the ultrasound scan of my right Achilles tendon (left image), compared to a normal scan (right image). The ruptured area is circled red. The normal path/structure of the Achilles is illustrated in blue on both images but you can see some disruptions on the injured one even in the non-ruptured areas (blue).
Surgical repair of the Achilles tendon
I was able to consult with an orthopaedic surgeon two days later to discuss management options. It was strongly recommended that surgical repair was considered and performed, due to the long-term issues that non-surgical management can lead to. These included significant reduction in ankle strength, reduced flexibility, reduced range of motion and a lot of scar tissue formation. Obviously, surgery has its risks, however, in my circumstance the benefits far outweighed them. I had the surgery on the following Wednesday night, 4 days after the injury.
Post surgery recovery
Post surgery, my lower leg was in plaster for just under two weeks, with my foot in a pointed down direction (plantarflexed). I had to keep it elevated for most of the time. I had purchased a leg elevator online to help me elevate the leg whilst being consigned to couch/bed rest. I used two crutches to get around, and as a result of this I had no use of my hands. I would struggle to get myself a glass of water or even make a basic sandwich for lunch. I had to use a shower seat and a large waterproof cover to ensure the plaster didn’t get wet and cause wound healing complications. I couldn’t work for 5 weeks, until I was only partially relying on crutches to move around.
CAM Walker and gradual loading of the Achilles tendon
Once the plaster was removed, I was put into a CAM walker, with 4 extra heel lifts approximately 10mm high each, to build up the height under my heel. The protocol is to remove a wedge every 1.5-2 weeks, gradually increasing the pressure put through the foot in combination with reduced reliance on crutches.
I changed from underarm to forearm crutches, to allow me to progress slowly in taking small steps through the foot with the CAM walker. The first 2 weeks involved 15% loading through the foot and basic non-weight bearing range of motion exercises. The next stage after 2 weeks was to increase to 40% loading with the removal of one wedge but to still use both left and right crutches. I then progressed to some semi-weight bearing exercises.
The following two weeks after was a big milestone; I was able drop down to only a single crutch and remove another wedge. I was able to load up as much as I wanted provided it was pain free; whilst balancing using the single crutch. This was such a large milestone for me, as I was able to have a whole hand and arm free whilst standing up – which meant I was able do basic things again such as make myself a coffee, pick up and move things around the house and even cook again. My exercises were adjusted to theraband resistance-based exercises and standing on the foot barefoot for the first time in nearly 6 weeks. A week later, I was able to stop using the single crutch entirely and a few days after that remove the second last wedge. I was now able to walk around pretty much as normal, just with the CAM walker and final wedge.
Roughly 10 or so days later brings me to Sunday 23rd of July, 2 months and 3 days post-surgery. The final wedge has been removed and now I am walking around in the CAM walker only. I will be able to start phasing myself out of the boot over the next few days, which involves wearing supportive runners and an ankle brace around the house, whilst still using the boot when out and about and at work but gradually reducing this time in the boot over the next 1-2 weeks. But the biggest win, is that I will have strength enough to be able to drive again, which is a major relief.
I had a few things go my way; my wound healed very quickly and without complication. This meant I was able to start my rehabilitation earlier than planned and progress through the weekly stages quicker. I was able to remove wedges every 10-11 days instead of 14. Every day counts as I am leaving for a 4 week holiday at 11 weeks post-surgery.
The long road to recovery
There were a lot of difficulties and restrictions, especially early days post-surgery. Sleeping with the plaster whilst trying to elevate the foot and then with the CAM walker took the better part of a week to get used to. Waterproofing it whilst showering was a hassle but made easier through purchasing a thick plastic protector online. My wife, who was an amazing help, had to work full time whilst looking after me and getting things done around the house that I just literally could not do. The loss of independence to not do basic things for myself took a lot out of me mentally. The first few weeks at home were a novelty but soon turned into frustration as I felt like I was doing nothing and wasting my time. I had to rely on lifts from friends, family, colleagues and plenty of Ubers.
I will still have a lot of rehabilitation to do to get back to full function, strength and to return to sport. This can take 6-12 months in total depending on the demands of the activity. My primary aim long term is to be able to go to the gym to do weights and outdoor cycling this summer. In the short term – I just want to be able to walk around Europe complication free, which I am on track for, so I hope that continues. All in all, it has been an experience for sure and it will help me keep in mind how debilitating foot and ankle injuries are whilst trying to help all of my patients. Hopefully, this is the last one I will have to deal with personally.
Do you have an Achilles injury?
At our Melbourne foot clinic our podiatrists are experts in the management of sports injuries of the foot and ankle, including Achilles tendon ruptures.
So if you suffer from a painful Achilles tendon, book an appointment with one of our friendly podiatrists today!