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Achilles Rupture and Recovery: The Orthopaedic Consult (Part 3)

This entry is part 3 of 4 in the series Achilles Rupture and Rehabilitation

This is the story of how I ruptured my achilles and followed a conservative rather than surgical approach to manage it that resulted in hiking the mountains of China 5 months later.

The Consultation

It’s amazing how the way you are treated can change so quickly. And equally amazing how the way you are treated can change the way you feel.

I was rushed through the ward, given a private room, asked about my levels of pain, brought a glass of water and told that a consultant would be with me soon.

As I sat in the private room watching the tv I realised that the pain had decreased once again.

Where it had been building to the point of completeness in the hallway, here in this room of peace and football commentary the pain was all but a fading thought.

The consultant came in.

A registrar that was fiddling around with an ultrasound near my achilles was told to clean it up and take it way.

And for the first time I was listened to. The consultant was a tendon surgeon, she had only recently come to Australia from the UK and she listened with all ears to what I had to say.

She asked what I knew about achilles injuries.

I replied that I knew a bit and then reeled off two studies that I had read about in the hallway.

The first one she dismissed as having had terrible methodology. The second one, she had authored.

I rapidly realised my place in the world and was thankful for it. Here I was in the presence of a surgeon that wrote articles and recommended caution when it came to operations.

She explained that whilst 50% of surgeons would recommend surgery that the research was leaning more and more to conservative management.

That was enough for me, surgery is bloody scary.

And so I was plastered from toe to knee, with my foot firmly locked into a pointed position that was remarkably similar to the position one kicks a football from.

It’d be 14 weeks until I’d walk without some form of plaster or moonboot.

Background to Achilles Surgeries and Orthopaedic Surgeries generally

For many many years the default management of Achilles rupture surgeries had been to operate.

The surgeon would open the person up from mid calf to heel and try to find the two ends of the achilles.

But the achilles doesn’t snap cleanly. The achilles is like a tightly bound horse’s tail. When it snaps the ends fray into a bazillion strands.

A surgeon can’t weave the strands back together and so instead they shave off either end until they get down to something that can be stitched back together.

Which means there is a solid connection between the two ends but also it means that the achilles length is greatly decreased.

A patient of mine is a retired world class triathlete and she has had 4 surgeries to her achilles. Her foot is now permanently pointed down. Her achilles is about 1 cm long. Essentially her calf muscle attaches to her heel. And due to this she can no longer run because the risk of re-rupture is so high.

It was cases like this that made a group of surgeons think about other approaches to achilles ruptures. They looked at immobilising the leg and having the two ends of the tendon as close together as they could.

It worked. The body very cleverly places a huge amount of scar tissue down between the separated ends and gradually remodells the scar tissue into a new tendon.

The last 5 years has seen dramatic changes in the approach to achilles ruptures. In fact, at the Albury hospital on the border of NSW and Vic in Australia they haven’t done an achilles surgery for 7 months. Their rates of re-rupture have plummeted.

In a way this is a nice allegory for the nature of orthopaedic surgery. A lot of it is based in the experiences of the surgical profession. But until recently these approaches were never tested against conservative approaches or even against placebo groups.

Think about knee arthroscopes or spinal fusions or rotator cuff tears. Each of these surgeries were the done thing for many many years. And yet when compared to some good old rest and rehabilitation they prove to heal slower and have far higher reoccurrence rates.

Even the age old popular ACL surgeries are being queried as a study released early this year (2018) has shown that functional and pain outcomes for non surgical groups to be as good as those that receive the surgery.

Why? Because the body is pretty clever at healing when given the chance.

Errol St Osteo: Is As Amazed As Anyone Else That The Body Can Regrow Tendons

Series Navigation<< Achilles Rupture and Recovery – The Hospital (Part 2)Achilles Rupture and Rehabilitation – The Long Road Home (The Final Episode) >>
Posted in : The Body Detective Series
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