Q: I always enjoy your medical advice, and now I need some help as there’s very little coming from my hospital. I am 76 and recently damaged my Achilles tendon, standing on a rubber boot in the garage which jumped up and hit the tendon. I was in plaster for 10 days, which was then removed for an ultrasound scan, showing a rupture. I was put in an aircast boot with two normal shoe sized wedges. I then bought the aircast wedge pack myself and have three in the boot; next week it comes down to two. There’s no pain unless I walk a little too far, then it burns a little.
The problem is, I am supposed to wear it in bed and I am just unable to do so. Do you know of any night splint I could wear? I also have back pain because I am walking in a lopsided manner, and would be most appreciative if you could help with any advice. When do you think I might be able to get back on my bike?
Derek Kitchener
A: The Achilles tendon attaches your powerful calf muscle to the back of your heel – it’s the biggest tendon in the body. Ruptures are most common in men between the ages of 30 and 50. It’s thought to be a combination of degeneration over time and sports which predispose – namely those characterised by sudden, explosive contractions of the muscle (such as badminton or football) – although direct trauma to the Achilles tendon can be a cause, as in your case.
Depending on the exact nature of the injury, treatment can be by plaster immobilisation alone or by an operation and plaster, the latter giving lower rates of re-rupture, but increased rates of infection. The general principle of non-operative management is to slowly bring the foot back up to neutral (90°) over a period of weeks, allowing the tendon to regain its original length without putting undue stress on the injury.
Wedges are great for this, but will make you lopsided – the only solution is to put wedges on the good side too. Aircast boots make a good removable protective cast but can be very cumbersome. A less bulky night-time alternative is a thermoplastic ankle splint: essentially a few thin layers of fibreglass plaster-cast material, moulded to the correct shape behind your calf and under your foot. Your orthopaedic outpatient department should be able to fix you up with one of these.
Your return to cycling should be gradual, guided by your consultant or physio, and should be done on a stationary bike at first. The sensations from your ankle will also guide you.
Shoe choice shouldn’t make a difference, but being aware of not dipping your heel down too low – over-stretching the healing tendon – will. Temporarily wearing wedges in your cycling shoes, or raising your saddle a little at first, can help prevent this from happening.
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