Hi, I'm Ali! I’m one of the physios from treatmyachilles.com. Treat My Achilles is an
online virtual physiotherapy service specialising in Achilles tendon problems, where we offer
initial assessments and then rehabilitation programs where we can follow you through
your rehabilitation as your symptoms improve and you get back to activity. The information about
our service can be found below, underneath the description of today's video. What I wanted to
talk today about is when you should seek urgent attention in regards to an Achilles problem.
So, urgent attention to us is something called "red flags". So, when we speak to you,
in our history, when we're having our assessment, we would be listening for the following things
in your description of how your Achilles pain started. So, if you were walking around or moving
and suddenly you felt a sudden increase of pain, so, a sudden onset of pain. So, that means
something that's had no real warning signs before, and it's just all of a sudden just started; that's
one thing we would be thinking, “What could this mean? Could this mean that there's been a tear in
that Achilles tendon?” - whether it is a total tear, which means like a rupture, so the tendon
is now in two pieces, or is it a partial tear, where some of that tendon may be torn and some
of it still may be intact. So, the next part we're looking for in your ... how you're describing it
to us to make sure we're not missing one of these tears, would be a feeling like a gunshot or a
kick in the back of the leg, or a sudden popping sensation. Again, that fits with that description
of this possible tear. So, once we've got this information from you and we're thinking, “Are we
suspecting this?” or you're listening to this and thinking, “Yeah, that's what's happened to me!”
a couple of things that we would be looking for now is: Can you raise up onto your toes and walk
on your toes across the room for quite a while, depending on the space you've got. So, what we're
looking at there is, yes, okay, you might be able to still raise up on your toes even if you
have a tear of your Achilles, but to sustain it and not drop your heel down to the floor,
it's been … is something that gives us a clue that this Achilles may be either a partial tear or more
intact. So, one of the tests I would ask you to do is then, can you walk up and down on your tiptoes?
The second one is, if you are walking and you just feel like you can't raise up onto your tiptoes,
you can't push off to make that next step. And again, that would be indicative of a tear or a
rupture. Now, we have got a really nice video that Maryke has done in the past to discuss what to do
if you think this has happened, and that link to that video will again be in the description
underneath. So, if you've had this sudden onset of pain, the popping, gunshot, kick
kind of sensation, weakness in that pushing off or raising up and sustaining it, then what we
would say is, please go off and see a doctor or a physician where you can get referred for a scan.
And those scans would be an ultrasound scan or an MRI. Now, an MRI tends to be less accessible and a
bit more expensive, and an ultrasound scan seems to be more accessible and less expensive. So,
that seems to be the route that we would suggest would be the most popular at this present moment
in time. What we're looking for on those scans is how much of a tear there is. So, are there again
that partial tear, where some fibres are intact, or is it a total rupture? And what is the distance
from one end of that Achilles tendon to the other if it is a rupture? This then will guide what
happens next. So, your doctor or your physician that will have organised that scan should then
give you information what to do. And it's only after you've received that information would
we then suggest that you would seek rehabilitation advice or come to us to ask about what to do next.
Just an aside note: an X-ray doesn't show what we've been talking about in these scans. What
it does, it shows your bones, it doesn't show your tendons, and therefore wouldn't be able to give an
accurate diagnosis of a partial or a complete Achilles tendon problem, and it wouldn't be able
to measure that distance. So, if you're sitting and thinking, “Oh my goodness! This is me here,
and I'm not going to be able to get one of these scans or go and see a physician or a doctor for
quite a while, what can I do?” Well, what you can do is try and take the amount of time you're
on your feet and walking, and decrease that as much as you can – pottering around rather than
long walks, and preferably using crutches. What we would be trying to do is stop you going into
what's called a dorsiflexed position. So, this is your dorsiflex position here. So, this is the
stretch position for your calf and your Achilles. If you think about an intact calf and Achilles,
when you're stretching it, those ends are coming away from each other. So, if you had a tear
or a rupture and you're taking the ends further away from each other,
it's not encouraging healing. So, you would be looking to try and keep your foot
into a more plantar flexed position whilst you are seeking treatment. And the important part is
that you are seeking that treatment and you are going for a scan. To be able to keep your foot
in that plantar flexed position, you would expect a physician or a doctor to tell you to put it into
a boot or put heel raises or have something that you would wear to hold you into that position.
Again, if you're waiting for that period of time, something where there are heel raises in your shoe
or a shoe with a high heel-to-toe ratio, so again, it's holding you in that plantar flexed position,
would be a good suggestion whilst you're waiting for help. So in summary, if you have weakness on
pushing off, a history of sudden pain, a feeling like something's popped in your calf or a gunshot
kind of feeling, these are things that I would want you to go and see somebody urgently about
and ask for a scan in regards to an ultrasound or an MRI scan, and this will then help to know
what you should do in the future. Thanks very much. Take care! Goodbye!