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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 46959
Experience:  Board Certified Physician
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12.4.14 Hi I need to speak to a specialist in completely

Customer Question

12.4.14

Hi

I need to speak to a specialist in completely ruptured achilles tendon. I am a 55 year old active woman of asian extraction who attends gym up to 5 times a week (for about 45 mins of moderate cardio and strength/core exercise) and would like to continue to do so. I ruptured the tendon falling off a step I didn't see. Now day 15 after rupture. My leg was put into cast in equinus position same day as rupture. Had MRI scan day 8 which shows gap of about 2.7cm in equinus position. Consultant is recommending surgery but I would like a second opinion as I am never in favour of invasive procedures. Tendon has 'sprung' up (wavy) and this is what MRI radiologist says:

There is complete rupture and avulsion of the Achilles tendon from the posterior calcaneal tuberosity site with proximal retraction of the torn end of the tendon to the extent of about 2.7 cm. The entire Achilles tendon extending up to the musculo-tendonous junction is rather wavy in outline and there is surrounding oedema of the soft tissues and a minimal collection is seen at the rupture site. There is no bone narrow oedema present of the calcaneal tuberosity as such. The musculotendinous junction itself does not show any evidence of tear, the other included bones and joints are normal.

Other info:
- I am not now diabetic (to my knowledge - last tested Oct 2013) - but was diagnosed as such in Oct 2012 - my body cured itself with exercise and reduced portion sizes.
- I feel the cold, and my need to be warm has resulted in permanent mild skin discolouration to my ankles (toasted skin syndrome?) from using a blow heater.
- I am semi-retired
- I want to walk/exercise until the day I die.

It may be that it would be mad not to have surgery...

Please do not answer this unless you have experience of both conservative and surgical treatment of completely ruptured Achilles tendon.

Many thanks
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.

Dr. David :

This is Dr. David

Dr. David :

I would agree with your consultant.

Dr. David :

you need to have this ruptured achilles tendon surgically repaired.

Dr. David :

or else it will not heal properly and you will not have proper flexion and extension of your foot.

Customer:

Thank you for your reply. Please advise why you are so certain of this. Many people seem to do well with conservative treatment - the problem is, when you read their accounts, you do not know what size of gap they had

Dr. David :

2.7cm is larger than an inch gap.

Dr. David :

this is a large gap and if not surgically repaired will not heal properly

Dr. David :

and you will have decreased range of extension.

Dr. David :

it can be hard for you to use things like the eliptical or stair master in the future if you don't get this repaired.

Customer:

Thank you for your reply. I could see (after payment) that you are a cancer expert and I was hopeful of a reply from someone with direct achilles tendon rupture experience. I respect your opinion nontheless, but I'd like to know why you are so certain that surgery is the best option.


 

Dr. David :

http://www.ncbi.nlm.nih.gov/pubmed/16539896

Dr. David :

10mm or less can be treated with conservative measures.

Dr. David :

larger than that should be treated with surgery.

Dr. David :

2.7cm is 27mm

Customer:

Understood. Thanks for your help.

Dr. David :

you are welcome

Dr. David :

good luck to you

Dr. David :

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Dr. David :

you can always reach me as Dr. David if you have other questions.

Dr. David :

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Dr. David :

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Dr. David :

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