Dog Achilles Tendon Injury: Surgery, Brace, or Both?

A dropped hock (your dog's ankle sinking toward the ground) is often a sign of an injury to the Achilles tendon, the thick cord at the back of the ankle (vets call it the common calcaneal tendon). For a complete rupture, surgery to repair the tendon is the usual recommendation, followed by weeks in a cast, splint or brace while it heals. Sometimes, though, the brace ends up being the whole treatment. Then it has to hold that ankle up every day without hurting the leg, which is harder than it sounds.

Surgery, a brace, or both?

For most complete ruptures, the answer is both. A surgeon repairs the tendon, and the ankle is kept from bending while the repair heals: first in a cast or splint, and often later in a brace. Recovery takes months, and the American College of Veterinary Surgeons explains what the surgery involves. Without surgery, a fully torn tendon can't hold the ankle up on its own, so a brace-only plan is the exception rather than the rule. That decision belongs to your vet, or a surgeon who has examined your dog.

A sinking ankle is also easy to mistake for a knee problem. If that's where you are, our guide on whether your dog is a candidate for a knee brace covers the knee side.

Where I come in is the brace, after surgery or instead of it. And with a dropped hock, the hard part isn't holding the ankle up. It's holding it up without causing sores.

Sasha: a complete rupture, and a brace that kept hurting her

Sasha is a mini Aussie with a complete Achilles rupture. Surgery wasn't part of her plan: the brace has been her entire treatment. When her family came to me, she already had a custom hock brace from another maker. It was static, with no hinges, and it kept giving her pressure sores.

The cause is the biomechanics of a dropped hock. The ankle never stops trying to sink, so with every step it pulls against the straps above and below the joint, and that pull ends up pressing on one place: the front of the shin. Sasha's first brace from me ran into the same problem, and we worked through it:

• Pads on both sides of the shin. I placed padding on the inside and outside of the shin to take the load off the front, where the pressure was highest. Once the shin was offloaded, the pressure sores stopped.
• A redesign around the shin. I then rebuilt the brace so the entire shin is padded, while keeping padding everywhere else to a minimum. Padding where it isn't needed only adds bulk.
• Hinges with a stop strap. That brace was hinged, with a dorsiflexion stop: a strap that limits how far the ankle can bend before the brace takes the load. We later built her a second, static brace on the same setup.

Sasha has been wearing these braces for over 10 months now.

What makes a dropped-hock brace work

Sasha's case comes down to a few details that matter when an ankle pulls against a brace all day:

• Pad where the pressure is, not everywhere. The shin takes the pull, so that's where the padding goes. Everywhere else, less is better.
• Reinforced straps. A dropped hock pulls on the straps constantly, which is why I use reinforced Velcro rather than the regular Velcro some braces use.
• Alignment and a rocker bottom. Both of Sasha's braces have better alignment and a rocker bottom, a curved sole that helps the paw roll through each step. It also reduces the uneven wear you'd otherwise see on the tread.

If your dog's hock has dropped, start with your vet, and ask about a surgical consult if it's a complete rupture. If a brace is part of the plan, after surgery or on its own, it should be built for the way a dropped hock pulls, not just shaped to the leg. We cast and fit custom hock (ankle) braces across Southern California, and work alongside your vet; there's more on that on our page for veterinarians. Contact us to talk about your dog.