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Posted on 12-19-2013

BLOOD CLOT FROM ACHILLES TENDON RUPTURE

Good morning!

Deep vein thrombosis (DVT), or a blood clot (thrombus) in a deep vein usually occurring in the legs, is already associated with many orthopedic procedures and is a significant source of patient morbidity and mortality. Now there's more reason for foot and ankle specialists to be on alert: according to a recent study in the Journal of Foot and Ankle Surgery, patients who experience Achilles tendon ruptures face a high incidence of deep vein thrombosis (DVT), both before and following surgical treatment.

DVTs are problematic for many reasons, not least of all because the symptoms - dilated veins at the skin's surface, often accompanied by pain, swelling and redness in the area - are often overlooked or attributed to something less serious, like a superficial type of thrombosis, a strain or even a leg cramp.  "Regrettably, several of these alternative diagnoses can actually coexist in the presence of DVT, making the correct diagnosis all the more critical. A long list of potential causes can lead to both leg swelling, including DVT, peripheral arterial disease, venous stasis, trauma, and cellulitis," according to an article on EB Medicine. 

The Makhdom et al study underscores the importance of patient and practitioner awareness and due diligence. Monitor for warning signs both before and after surgery, the study's authors suggest, while recognizing risk stratification. At greatest risk are patients over 40 years of age, those who present a hypercoagulable state or those who have had DVT previously.

There are no strict guidelines regarding foot and ankle DVT prevention, says Bradly Bussewitz, DPM, a fellowship-trained foot and ankle surgeon in Iowa City, Iowa, so preventing DVT is based on risk stratification. Dr. Bussewitz provides patients with postoperative aspirin while emphasizing patient education and early mobilization. If the patient presents additional risk factors, he initiates low molecular blood thinners for 21 days post-surgery.

Dr. William DeCarbo, a fellowship-trained foot and ankle surgeon in Pittsburgh also supports early mobilization of operative and non-operative legs with or without weightbearing. He recommends being active with the upper body.

According to the Podiatry Today article in which both men were consulted, Dr. DeCarbo "will use compression stockings on the non-operative leg [for treatment]. For low-risk patients, he will use EC aspirin 325 mg for 30 days postoperatively. For high-risk patients, he prescribes enoxaparin sodium (Lovenox, Sanofi Aventis) 40 mg SC daily for 21 days postoperatively. Dr. DeCarbo says the vast majority of his patients do not receive prophylaxis."

"Our most important strategy involves a strong, quick repair, allowing confidence in protected early weightbearing," says Dr. Bussewitz in the same article.

Folks, this information is critical and can save your life.  If you have onset of swelling and significant cramping and pain in your calf and particularly at the achilles tendon just above your heel…get yourself to the emergency room.  Afterwards come in and see us to find options to give support to the injured tissues including the use of a dynamic gait scan.  With this scan we can assess structural problems in the feet (fallen arches, etc) that may have played a roll in the injury.  

NOTE: DURING THE MONTH OF DECEMBER CALL WELLNESSONE FOR A FREE GAIT SCAN!  (NORMALLY $20 VALUE)!  To make your appointment click HERE or call 530.243.9464.

It's your future…be there healthy with WellnessOne!  Have a beautiful blessed day!

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