Achilles tendon rupture: great diligence required

What does an Achilles tendon rupture have to do with a pregnancy in the ninth week?

Chantal (our patient’s name for the purposes of this story) knows the answer, because she’s lived through both. And it also explains why surgeon Dr. Karsten Reichmann learned about her pregnancy even before the gynaecologist – and anybody else.

Sport is part of life of Chantal. She was a top-class handball player for many years, until a cruciate ligament rupture confirmed the end to her career that she was already considering. Back in 2014, Karsten Reichmann operated on the injury and treated Chantal in Dr. Karsten Reichmann and Andreas Schlüter’s joint practice in Alter Postplatz, Waiblingen. And she was completely satisfied. After surgery and her post-op treatment, she was as fit and as capable to play sport as ever.

And then it happened whilst playing badminton with a former teammate. “It was as if I’d snapped my ankle.” Chantal didn’t hear the “crack-of-a-whip”-like sound that Karsten Reichmann often describes as going hand in hand with an Achilles tendon rupture. But she knew that something was fairly wrong down there. She rang the practice that evening and made an appointment for the very next morning.

The ultrasound scan confirmed Karsten Reichmann’s suspicions: an Achilles tendon rupture. “Shall we operate immediately?” But Chantal didn’t want to agree to the procedure all that quickly – she was pregnant. She hadn’t told anyone up to this point - Dr. Reichmann was the first to find out.

Whilst Chantal informed her family that she was both injured and pregnant, Karsten Reichmann got in contact with his anaesthetist, as well as a gynaecologist, as it wouldn’t be possible to use the customary general anaesthetic due to her pregnancy. Instead, Chantal was going to receive spinal anaesthesia for the operation. The type of anaesthesia involves injecting local anaesthetic into the subarachnoid space at the level of the lumbar spine so that nerve signals in the lower half of the body are blocked, therefore eliminating pain. In medical terms, it’s no big deal, explains Reichmann, “the main thing is that the patient can’t move and can’t feel pain.”

Diese Sehne ist quer gerissen.

And so the operation was performed promptly after the injury, as after an Achilles tendon rupture, the tendon needs to be prevented from shrinking back into the muscle.

It goes without saying that part of the crucial preparations for surgery involves sterilising the environment. Both the patient and operating table were washed and covered accordingly. The actual operation began with an incision at the level of the rupture, which then enabled Karsten Reichmann to look and confirm what he had suspected: the tendon had ruptured lengthwise, making things a little more difficult. After inserting a basic suture using robust stitches, Reichmann then inserted many single sutures with thinner stitches, finally stitching the paratenon into which the Achilles tendon is inserted. “That has to be performed with the utmost care in order to ensure that the tendon functions properly again after surgery.” The doctor uses dissolvable stitches for all sutures, meaning they don’t have to be taken out afterwards.

Finally, Karsten Reichmann stitched up the surgical wound itself. Chantal’s leg was then held in place for ten days using a splint. After these ten days, she received a specially-made shoe lined with plenty of air cushions and wedges in order to take weight off the soft tissue of the Achilles tendon. The wedges were then removed little by little over the course of the recovery process, six weeks after surgery at the latest, as according to Dr. Reichmann, that’s when patients should be able to walk with their injured foot back on level ground. Chantal had already come so far after just four weeks.

The night after her surgery, Chantal slept at the Central-Klinik, located in the same building as the joint practice in Alter Postplatz 2. Looking back, Chantal emphasises how diligently she was treated by the doctor and how comfortable the nurses made her feel during her care.

Patience was needed during the following weeks. Naturally, the injury itself, the specially-made shoe and the crutches (used for seven to eight weeks) all restricted her ability to move – for a longer period of time than if the injury were a cruciate ligament rupture. Furthermore, weekly ultrasound scans took place during this period so Karsten Reichmann could monitor the recovery process.

At the same time, Chantal started to carry out physiotherapeutic exercises, attend physiotherapy sessions and receive lymph drainage immediately after surgery, every step monitored by and discussed with the doctor. Chantal laughs about this today, saying that these exercises are “perhaps what I have to thank for not suffering the problems that usually arise during pregnancy, such as nausea and back pain.”

Even Karsten Reichmann was impressed with her recovery after all the hard work involved in an Achilles tendon operation. At any rate, pregnancy didn’t complicate matters in Chantal’s case and shortly after the birth, the new mum had come so far in the recovery process that she could play with her daughter without any complaints.

That’s the objective of every medical procedure in Dr. Karsten Reichmann and Andreas Schlüter’s joint practice: enable the patient to move with the same freedom with which they were able before they were injured. From Chantal’s perspective, that has been optimally achieved: “The manner in which Karsten has dealt with the situation has been great.” She felt, and still feels, that she has been in the best hands and received the best care in the joint practice, making an explicit reference to something which larger clinics cannot provide: “Medical care all under one roof.”

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