#454 Torn Achilles: Should I use crutches? - DOC

#454 Torn Achilles: Should I use crutches?

I just found out that I tore my Achilles tendon. The emergency room physician gave me crutches. What should I do? Well, that’s what we’re talking about today on the Doc On The Run Podcast.


Listen, sometimes I get comments from listeners who think that I made these things up, but this is one that I did not make up. Just this weekend, I got a call from somebody who said that she was out on a run, she felt a pop in the back of her heel, she went to the emergency room and she was told that she has a partial tear in her Achilles tendon. I’m not really sure if they did x-rays or an MRI or an ultrasound or anything to confirm that, but the doctor seemed very confident that she had torn her Achilles tendon. And so, she said that all they did really was they gave her some crutches and they told her to see a specialist, which is why she called me.

Now, what she asked was actually kind of shocking to me. She actually said what I just told you that she had been to the emergency room and she was told that she had a rupture of her Achilles tendon, to go see a specialist and that they gave her crutches. And then she asked me, and she literally said in all seriousness, “Should I use the crutches? What do you advise?” And I actually laughed out loud and I said, “Well, I can’t actually advise anything without seeing you and seeing what’s wrong with you and confirming whether or not it’s a partial rupture, complete rupture, maybe something like an interstitial tear where it’s barely perceptible, but it’s just swollen and angry because of that, but I mean, are you kidding? They gave you crutches. They told you to use the crutches I presume and you’re really asking me without even seeing you, if I should tell you to not use the crutches? I mean, do you think I’m going to tell you to go for a run and leave your crutches at home? I don’t know exactly what you want from me.”

She said, “Well, I just thought you could give me some advice.” And I said, “I can. I’m going to give you the same advice that the emergency room physician gave you. You should see a specialist. You should use the crutches to keep the foot off of the ground and not make it worse until you see the specialist.”

Now, if she wants to see me, that’s fine, but if she wants to see somebody else, that’s fine too. But if an emergency room physician is concerned enough that they don’t want to give you any advice beyond use the crutches, don’t step on it and go see a specialist, you should definitely see a specialist. And of course, you should not step on the foot and you should use the crutches just like they told you.

Now, having said all that, the bottom line with Achilles tendon tears is really simple. There are kind of three different versions. One of them is a small tear within the tendon, that’s what we call an interstitial tear. A lot of times you can actually stabilize it, do some stuff to decrease the stress on it and still walk on it, but it depends on how bad it is.

Then you can have a partial rupture where it’s basically a rip on the side of the tendon that’s maybe a third of the way across or halfway across or something. Many times you can get these to heal without surgery pretty effectively, but you have to be very careful about not making that gap bigger.

Then if you have a full rupture where it’s completely torn, you have two options, and it’s kind of debatable on which of those you’re going to do depending upon who you talk to, you could either do surgery to sew it back together or you could immobilize it in cast or a special kind of boot that’s made to immobilize the Achilles tendon after it tears, but you have to figure out how severe the problem is and how severe the intervention should be to match it appropriately.

Like I’ve said before, if you wear a fracture walking boot and you don’t need one, you’re going to get weaker and stiffer unnecessarily. If you can walk on it and maintain some of your strength without making the Achilles tendon worse, that’s better, but it depends on your evaluation.

Saying that it’s torn really doesn’t give you enough information, so you really need to get the full picture, you really need to make sure that you know how bad it is and then you can decide what level of intervention, what level of restriction and what activities you can actually sustain while you heal the Achilles tendon based on all those things, but you’ve got to figure that out first.