Achilles tendon - rehab support please

[Moorland Canine]

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Hi everyone - really hoping for some advice - I'm a Galen Canine Myotherapist in the UK specialising in soft tissue mobilisation, so not a rehab professional in the same way as you guys are.

I have an ex-racing greyhound client who damaged his Achilles in November last year when another dog ran over the back of his leg mid race, despite the damage, he kept on racing. The extent of his injury was only discovered later and he was dumped by his owners at the Galway SPCA the following morning.

From what we understand as this happenned in Ireland, the orthopaedic vet and x-rays ruled out fractures, his leg was put in a cast and he was treated with crate rest, strapping and some physiotherapy. His notes recorded that his hock did not drop, and indicated that the Achilles did not rupture, and a bad strain was assumed.

Ted did not do well in kennels responding badly to stress and he fell a couple of times and it was decided that foster care in the UK would the best place for him.

Ted still favours taking the weight off it when at a pause on walks or standing, but appears to be walking and trotting well enough. I am assuming the tendons of the Achilles have tightened giving the impression that his foot does not touch the floor.
His myotherapy treatment has focussed on settling him into his (now failed!) foster home and on building flexibility and strength to his injured leg, as well as tackling the compensatory issues that have arisen due to his altered gait.

I have watched some of the appropriate video's on this fab site so in addition to his muscle work I have advised owners to do some exercises to flex and stretch the tendon (SDF). Ted is sometimes now leading with the affected leg when jumping up and will take his weight to pee - but is still not weight bearing consistently when standing.

As this is not really my area and I am fairly new to therapy, I wonder if there is anything else I or they could be doing to encourage the lengthening of the tendons, although I have found owner compiance to be hit and miss! - or is it too late in the recovery period?

Sorry if the post is long - and I hope I don't come across as too much of an idiot! All help greatfully recieved - and feel free to patronise! x

[lehughes]

Hmmm! Very interesting indeed!

So, I am thinking that the damage has been to the gastrocs component of the achilles tendon and that the superficial digital flexor tendon is starting to overwork (resulting in the foot not getting to the ground, and the contracting / hyperflexing of the inside and outside toes.) The middle two toes are interesting! I think they have (at some point in time) had damage to the SDFT (avulsion from the P2)... so that would normally make them appear longer. However, in this scenario, I think we are seeing the deep digital flexor tendon take over for these two toes. (I'd appreciate other peoples 'eyes' on this... maybe I'm crazy. I'd love to get my hands on the dog to confirm!)
Watch the Video Training 42, and compare the feel of each tendon on the affected leg and compare it to the opposite leg.)

As well, there appears to be a bump and then a divot along the achilles tendon, again, leading me to believe that one of the tendons that make up the achilles has detached and is retracting upwards.

All in all, I don't think you can make this dog 'normal' again.
However, I would consider some kind of a brace to help support the limb so that a further injury does not ensue. (Therapaw - in the UK, contact Nycky Edelston (edleston@hotmail.com), or consider something more rigid. I think Orthopets has a UK division. I prefer Hero - but they are US-based... )

I'm not sure what to tell you about stretching the SDFT... I don't think it will get you anywhere, and the whole reason they tighten is because they are doing the job of two tendons. So does stretching cause more harm than good? Is it beneficial in this case? I'm not so sure. I do think that dealing with all of his compensations (in the muscles & joints) is key to his feeling good / stable / balanced.

That's off the top of my head anyways!

Best of luck!

Laurie

[Moorland Canine]

Hi Laurie - thank you for replying so quickly!

I agree the weight bearing toes do look like they're the only ones he has! and the limb itself looks almost shortened - I will look into your comments more thoroughly once I'm at home with my notes. As well as watching the training video. Will also look into some kind of support for him.

I too would love you to get hold of him, it does seem outside of my experience
I gather there is no opportunity of uploading any video footage? - I have a couple of him walking and it might help.

Thanks for your help in the meantime, and maybe some other members will be able to help offer some experience too xx

[lehughes]

None of us have figured out how to upload video onto this forum (so I'm thinking it doesn't work), but if you upload it to your YouTube account and then post the link here, that works!



Laurie

[Moorland Canine]

Hey Laurie - thank you for the training video, I now have more understanding of the individual effects of the SDFT and the DDFT on the digits.

From my photo's then, digits 3 and 4 seem to have lost their flexion and are flattening at the PIP joint (maybe a previous issue), yet are not overly lengthend at the DIP joint - maybe as you say, pulled in by the DDFT doing the SDFT's job as well as resisting the dorsal ligament?

I will follow your demo and try to ascertain any specific discomfort when I see him next - its not very regularly as he's a rescue not a paying client! (I will never make any money!!)

I totally get what you're saying about stretching and it is probably somethng I will not continue to recommend. If the SDFT has been damaged distally on the toes, it still needs to do its job in supporting the damaged gastroc tendon, so stretching to accomodate the toes is counterproductive if there is already damage there? - and particularly if the DDFT has stepped in.

Thanks for the tip off about the video's - I forgot I have them on Vimeo - here are the links if you have the time, you may need to open the links in a new window

https://vimeo.com/227734901
https://vimeo.com/227704646

Really do appreciate your help, Sarah x

[lehughes]

Hi Sarah,

Very interesting gait! I'd say there's something going on up higher as well. - SIJ, lumber spine, iliopsoas. I'd look around for a second issue as well.

But if all you find / come up with is the Achilles tendon, then you are likely looking at dealing with the compensations for the lifetime of the dog.

Laurie

[Moorland Canine]

Thanks so much for you help Laurie - he's off to an orthopedic specialist now too, so X-rays will be done for a better idea.

Your help has been invaluable xx