Achilles tear in ski crash?

[Shorty_J]

Didn't think that one would be possible but I found out today that it is.

The fall was from stuffing one ski and basically hyper-extending that leg before the binding let go (dins only at 8.5).

Guess I'll resort to corn chips and masturbation for the next 6-8 weeks to get my cardio in.

[sierraskier]

Didn't think that one would be possible but I found out today that it is.

The fall was from stuffing one ski and basically hyper-extending that leg before the binding let go (dins only at 8.5).

Guess I'll resort to corn chips and masturbation for the next 6-8 weeks to get my cardio in.

Welcome to the club. Did mine in almost the exact same way last January. Only I went over the bars violently. I was skiing again in May. Find a good ortho, get surgery, and get serious about rehab. But understand that no matter how badly you want to accelerate it, it needs time to heal. My ortho gave me a PRP injection as well...hit me up if you want more info.

[Shorty_J]

My crash was pretty violent too... hit my head on something hard enough for slightly blurred purple vision for a little bit.

The local emerg really seemed to try to steer me towards non-surgery recovery (casts replaced every 2 weeks in different states of ankle flexion), but a co-worker recently had this injury and her research suggested the non-surgery route is 5 times more likely to re-rupture than the surgery route.

What's a PRP injection?

[sierraskier]

Platelet Rich Plasma injection. During surgery, they draw blood, spin it in a centrifuge, then re-inject the plasma back into the tendon at the wound site. It is not well understood and relatively progressive procedure but the platelets in the plasma are believed to aid in healing process of the soft tissues. I think it is becoming more mainstream because of the positive results. Google it.

I think I heard surgical and non surgical success rates were about equal, but the surgery allows you get back to activity/off crutches, back to rehab/weight bearing much quicker than non surgical. And while you do your research on treatments and success rates keep in mind that 80% of all statistics are made up

[rod9301]

I had the same injury last may, tumbling about 600 ft in a very steep couloir. Had surgery a week later, in aboot for 12 weeks, but riding after week 6. Skiing now, can do everything, but can only lift my heel halfway doing a calf raise. Still some pain, not the achilles, but all the tendons and ligaments in the ankle.
Anybody know how long it takes to do a full calf raise? Inj, other oneured calf is 15 1/4

[rod9301]

Sorry for the garbled last sentence, doing this on my phone.injured calf is 15 1/4,other one is 16"in circumference.
I am doing weight work on my calf 3-4 times a week.

[Sinecure]

Tore mine in hard snowboard boots (basically the same as ski boots) in 2005. Everything I've heard says don't rush recovery or you risk re-tearing. I had surgery a few days after the injury (which happened Jan. 2, 2005) and was back on my motorcycle in the summer. Of course then I crashed the bike and broke my hip in August, but that's a different story.

[newe english]

shit buddy, take your time and heal up. good luck.

[iscariot]

Don't get any on the corn chips...

[PassTheDutchie]

Sorry for the garbled last sentence, doing this on my phone.injured calf is 15 1/4,other one is 16"in circumference.
I am doing weight work on my calf 3-4 times a week.

I blew my achilles 3.5 years ago and my "good" calf is still noticeably bigger/40% stronger than the blown one. I still work the blown one maybe once a week--in addition to usual cardio/exercise (tennis/b-ball, etc.), but progress is slow. Stay aggressive with it--it's easy to get sidetracked once you're fully (more or less) functional again.

[avacadotoast]

Welcome to the club! As strange as it sounds (because you hurt it skiing), skiing is about the easiest sport to do when you're back because of the support you have in the boot. I skied at 3.5 months post op -- skiing hard by 4 months. Just don't tell my surgeon

3 years and I still have a little gimp calf and can only do half a calf raise. Chicks dig the gimp calf so it's not all bad!

[avacadotoast]

Out of curiosity, what boot where you skiing? I'm convinced that I would not have ruptured it if I had been in a stiffer traditional boot. My Krypton Pro tongues kinked and folded right in half when I hooked a stump in mid hockey stop and flexed hard to stay vertical (which I did). I didn't ride the kryptons again until the next season.

[sierraskier]

I was also in Krypton Pros when I did mine and think that you're onto something. Seems like it would be physically/mechanically impossible to tear an achilles tendon in a boot without the boot folding significantly. Although in my case, the ski punched into the snow almost up to the binding as I was going over the tips, essentially keeping the ski stationary. I'm pretty sure that mine was done more because of extreme hyper-extension than from your typical achilles injury (loading up the tendon and then sudden force/push-off). Either way they both have the same net effect: extreme sudden force stretch concentrated on the achilles/calf resulting in POP!

I am back on newer krypton pros, which I love, but I still have the feeling/fear that I could bend the boot in half under extreme conditions.

[El Chupacabra]

On the Krypton vs overlap boot -- PM jfost and see what his buddy was using when he tore his achilles on the cat trip in March. I don't remember what his boots were.

[KBP]

I had a complete rupture of my AT the end of January. Had to wait 2 weeks for swelling to go down before I had surgery, then 10 weeks in walking boot. Started pt yesterday. My doctor recommended surgery for faster heal time and reduced probability of recurrence. I was taking Avelox (Fluoroquinilone) for a sinus infection prior to the injury , and believe that was a major cause of rupture as the tendon basically exploded during minimally stressful skiing on a powder day. Patience during recovery seems to be important as you can't speed up biology. Rushing may lead to a stretched tendon which could result in permanent weakness.

[Elder-ito]

Out of curiosity, what boot where you skiing? I'm convinced that I would not have ruptured it if I had been in a stiffer traditional boot. My Krypton Pro tongues kinked and folded right in half when I hooked a stump in mid hockey stop and flexed hard to stay vertical (which I did). I didn't ride the kryptons again until the next season.

I was wearing Dalbello Axion 11's. The flex is rated 110-120 I think. I had just turned them down to "soft" that day, and I turned my DINs from 8.5 to 10 because I kept ejecting prematurely and I'm 6'1" and 285 lbs (the shop set them at 8.5). Maybe that's where I went wrong? I don't know because I have snowboarding for 20 years, tele ski for 10, and I never alpine skid but I finally wanted to try it. Also I was skiing my typical terrain... steep, deep, and technical and I wasn't necessarily all that smooth with being "locked down." What do you think? Where did I go wrong? Also what do you think is safer for the achilles... alpine, tele, or snowboard?

[KBP]

I was wearing an alpine ski boot, Tecnica Diablo. The boot flexed fully, and the AT ruptured completely high up on my leg, approximately 10" above my heal.

[Shorty_J]

Don't know why I just looked at this thread again, but I was wearing Flexon's... I see a trend here that's worrying.

I bought some flex 10 tongues recently thinking that would offer more protection but I haven't skied that boot again yet.

I purchased a used pair of boots that are too big for me so I could fit my swollen foot/lower leg into it. I was thinking of going back to the Flexon's but now I'm not so sure.

[XXX-er]

My crash was pretty violent too... hit my head on something hard enough for slightly blurred purple vision for a little bit.

The local emerg really seemed to try to steer me towards non-surgery recovery (casts replaced every 2 weeks in different states of ankle flexion), but a co-worker recently had this injury and her research suggested the non-surgery route is 5 times more likely to re-rupture than the surgery route.

did you get surgery?

I have a buddy who tore the achilles just by coming to a fast stop in wet snow carrying a 70 L pack staying upright ... he didn't even fall

The Surgeon told buddy the same thing that going non surgery the achilles would be very likely to re-rupture (consider lifestyle) OR it could be fixed 100 % with surgery ... buddy has since put 6 years of guiding on those achilles and he sez they are 100%

[Shorty_J]

I didn't get surgery.

Every single doctor I saw in Calgary kept trying to push non-surgery, and when I asked pointed questions they were answering them politically... which is to say, they weren't really answering them.

Through the entire process I felt like they were withholding information and I couldn't figure out why. I'm not happy with the medical system.

[circustrainer]

just thought id chime in on the surgery/nonsurgery thing. I blew both of my AT's and had them both fixed with surgery. My brother blew his and didnt have surgery. He re-tore his 6 weeks out. He has been so freaked out about tearing it again that it affects his ability to do stuff.Ive been full bore with both of mine since without re injury.Skiied for 40 years.Blew mine with the over the handlebars fall the first time and tried to launch over a stream bed at high speed but didnt make it and crashed into the side of the bank. . Had rossignol racing boots one time and dynafit boots the first time. broke the boot each time. LOL. If anything I think it is a phycological benifit for surgery. Also statistically speaking if you blow one of your tendons the likelihood of doing the other one are quite high. Maybe that has changed in the last 10 years.

[Orthoski]

There's a lot of debate about operative vs. non-operative treatment of achilles tears in the medical community as well, and people historically compare increase rerupture rates with non-op mgmt vs. much higher complication rates with operative treatment (a wound infection is a huge issue given the thin skin overlying the tendon). One of the issues that confounds discussions is that we used to immobilize achilles tears in a cast for a long time, and we've recently increasingly understood the benefits of motion in tendon healing. Along this line, a recent landmark study found equivalent results among operative and non-operative treatment if done in conjunction with early motion (see abstract pasted below). Some surgeons now coach patients to have surgery if they are athletes participating in jumping sports who want to return to the same level of push off, while others have really started adapting their practices to non-operative treatment. I thought the following would be useful for the TGR community (its from the Journal of Bone and Joint Surgery, which is the major orthopedic surgery journal - article is from 2010):

J Bone Joint Surg Am. 2010 Dec 1;92(17):2767-75. doi: 10.2106/JBJS.I.01401. Epub 2010 Oct 29.
Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation.
Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A.
SourceFowler Kennedy Sport Medicine Clinic, 3M Centre, The University of Western Ontario, London, ON N6A 3K7, Canada. kwillit@uwo.ca

Abstract
BACKGROUND: To date, studies directly comparing the rerupture rate in patients with an Achilles tendon rupture who are treated with surgical repair with the rate in patients treated nonoperatively have been inconclusive but the pooled relative risk of rerupture favored surgical repair. In all but one study, the limb was immobilized for six to eight weeks. Published studies of animals and humans have shown a benefit of early functional stimulus to healing tendons. The purpose of the present study was to compare the outcomes of patients with an acute Achilles tendon rupture treated with operative repair and accelerated functional rehabilitation with the outcomes of similar patients treated with accelerated functional rehabilitation alone.

METHODS: Patients were randomized to operative or nonoperative treatment for acute Achilles tendon rupture. All patients underwent an accelerated rehabilitation protocol that featured early weight-bearing and early range of motion. The primary outcome was the rerupture rate as demonstrated by a positive Thompson squeeze test, the presence of a palpable gap, and loss of plantar flexion strength. Secondary outcomes included isokinetic strength, the Leppilahti score, range of motion, and calf circumference measured at three, six, twelve, and twenty-four months after injury.

RESULTS: A total of 144 patients (seventy-two treated operatively and seventy-two treated nonoperatively) were randomized. There were 118 males and twenty-six females, and the mean age (and standard deviation) was 40.4 ± 8.8 years. Rerupture occurred in two patients in the operative group and in three patients in the nonoperative group. There was no clinically important difference between groups with regard to strength, range of motion, calf circumference, or Leppilahti score. There were thirteen complications in the operative group and six in the nonoperative group, with the main difference being the greater number of soft-tissue-related complications in the operative group.

CONCLUSIONS: This study supports accelerated functional rehabilitation and nonoperative treatment for acute Achilles tendon ruptures. All measured outcomes of nonoperative treatment were acceptable and were clinically similar to those for operative treatment. In addition, this study suggests that the application of an accelerated-rehabilitation nonoperative protocol avoids serious complications related to surgical management.

[Shorty_J]

Orthoski:

I've read similar reports stating the favourable stats IF surgery is accompanied by early motion (only in doing research after non-surgery was chosen), but none of the doctors told me this when they kept pushing non-surgery, didn't offer ANY stats on re-rupture rates either way, and never asked me what level of activity I wanted to return to in order to guide their recommendation. How can they even have a recommendation without that discussion? The fact that they didn't make any effort to elaborate on my options, and they way in which I was talked to really lead me to believe they had their own reasons for that advice... they could never really justify it. They'd say things like "if it was me, I know what I'd do"... and then they wouldn't say what they'd do. It was pretty fucked, actually.

And most importantly, the benefits of early motion if going non-surgical should be conveyed to the patient and a similar philosphy needs to be adopted by physiotherapy. Problem here in Canada is that doctors say nothing about physiotherapy other than I should get it. They don't talk about when, for how long, with what frequence, and what strategy... they just absolve themselves of all responsibility in regards to recovery after my last follow-up.

If these two groups don't work together, how the hell am I supposed to even know what's the best course of action, let alone know I'm going to get the treatment I need?

[circustrainer]

the thing that grabbed my attn with that article is the possible infection you can get with surgery. Thats such a huge negative if you are unlucky enough to get it. But even with that said I would elect for surgery. 2 other things I dont see mentioned in the article are the ages of most male AT ruptures and the thing that my ortho told me was the high possibility of having the other AT rupture at some point if you still are highly athletic. I can attest to the fact that he was right about that. I wonder if that stat still holds true though. If i had to give any advice after the healing process I would say get in a lifelong exercise program to keep the legs strong.

[PassTheDutchie]

How is your recovery coming shorty? When I blew mine, they didn't even mention a non-surgical option. It was simply, "how soon can you have surgery." Difference between U.S. and Canadian healthcare? (don't mean that last bit to be in anyway political.) Is there a difference in treatment/outcomes if one has a "tear" (I know they come in degrees) vs. a full rupture?

Trying to get the lowdown for when I blow my other one.