Trip to private hospital for 2nd opinion on surgery or not.
I have private medical with work, so decided to use it and seek the opinion of one of the best foot consultant/surgeons in the area.
She examined me and said that the tendon appears to have knitted together and although there is still substantial bruising, it all looks good so far.
Perhaps suprisingly she also said that the Vacoped system is the way for me to go, as surgery is not always the best way to an uncomplicated life. Apparently this Vacoped system is not like conventional ‘conservative’ treatment and shouldn’t be used as such in comparisons and medical references.
I have mixed feelings on this, but take heart knowing she is one of the best and has no hidden agenda in the reccomendation of it or not. (Being private she could subject me to surgery and not worry about the cost if she thought that was the best way).
I also had to wait 2 hours for a scan on my leg for clots as I am feeling pain in the middle of my calf muscle. This scan proved clear, although slightly intrusive with a man, some gel and a cold machine very close to the nether regions… lol.
I am now awaiting information from her as to whethe the NHS will release me (and the key to change the vacoped boot) into her care, and will find out what happens from there.
Thank god you didn’t have the op then as you have under your betters swabbed. Oddest thing ever for me lol
With regards non-op, expect a visit from normofthenorth soon, a great advocate of e non-op advancement. In the meantime you can read the short version of why he likes it here, which is probably similar to what your consultants have based it on:
http://bit.ly/UWOProtocol
Good luck!
Have you read up on the UWO protocol (link on Normofthenorths page) yet? A healed tendon is a healed tendon and you should be able to do everything you did before. The trick at this stage is not to do more than you should. Having surgery means you have something artificial holding your tendon together until your body lays down the collagen needed to join it. As I said before, you are well on the way to that. In the following weeks you will become familar with terms such as active ROM (using your own muscles to move) and passive ROM (using something arficial to your body to move). There will be a temptation to just try a little harder or test the water. At times this will be OK but at this point it is definitely not. Read up on how tendons heal and it will help you understand what and when you can do things. With regard to MTB - I started some soft trails about week 15 but haven’t clipped in to my spd on the trails. I am using a 50/50 pedal so I can wear shoes. I clip in on the tar but you have to think ahead before you stop. That twisting of the foot is a bit harder until the strength comes back. Do you think being clipped in may have had a bearing on your injury? I have been thinking about heading out to the local XC course to give some single track a go but still a bit hesitant about using my spd’s. There is no magic bullet but if you do everything you should then you have a high probability of a good outcome.
Looks like you got the best start with ATR getting into the Vacoped boot so early. When are you due to get the angle changed? Are you keeping the boot on all the ti e even when in bed, bath and putting clothes on?
Hi, folks, sorry I’m late!
Bcurr gave you the link to the UWO protocol, but the early rave reviews of the study can be found at bit.ly/UWOStudy . And now the fulltext of the published study itself are available (free!) on this very site, linked in the “ATR Rehab Protocols, Publications, Studies” page (which is listed near the top of the Main Page).
I think the main difference between today’s (good) non-op treatments and your Father’s “conservative casting” isn’t primarily the Vacoped or other specific boots, but the speed and aggressiveness of the rehab. In the olden days, it made sense to think that slower was safer — more “conservative” — and that non-op patients especially needed to be immobilized and NWB for a long time. Unfortunately,that logical assumption was wrong, and those patients only came out “fair”, not “great”, with ~15% re-rupture rates and often with large strength deficits — both results significantly worse than post-op. They did avoid surgical complications, but at a significant cost.
More recent studies (>-2007) have shown that faster protocols — even faster than many post-op patients get — produce much better results, with strength, ROM, and re-rupture rates that are comparable to post-op and at least “very good” if not “great”. (This fact is the main reason I hate it when the word “conservative” is applied to the non-operative option.)
Boots beat casts partly because they’re more user-friendly (and usually more comfortable) for the patient, and partly because they permit early mobilization (gentle exercise) and early PT, both of which are usually included in the studies with the best results. I like a boot that can be set to HINGE in the latter stages of boot-use, though some of the best results (including UWO’s) have been produced with fixed boots like the AirCast (a co-sponsor of the UWO study).
Norm - another word that is thrown around here a great deal that I personally don’t like is ‘aggressive’ when it comes to some of the faster protocols. It does not really convey the correct meaning to most of us. Aggressive can be interpteted as push harder and harder while conservative we see as taking it easy.
Perhaps the terms conservative/progressive would be better.
Hi all. Many thanka for the helpful and incitive replies. :o)
It is good to find others opinions and thoughts to your own, and this is one area the inernet comes into its own.
One can find no end of horror stories when searching for said opinions, as most threads on forums are only there to whinge.
Now I see the power of a blog, as it not only records those down moments, but shows a timeline to the eventuality and 90% of the time a good outcome :o)
Relating to me and mine, as it stands at the moment the only time the boot has come off is during the consultation this week.
I shower with the door closed on my leg and the foot resting on the sink. Not really a problem with the support the boot gives me, although I wouldn’t like to do it in a cast.
I’m only wearing baggy shorts at the mo and these easily go over the boot, so no problem there.
The whole speed of rehab vs rest and isolation is an interesting debate. I’ve been through similar already as I herniated a disk in my lower back some time ago. I was bed ridden for two days when it happened as I simply couldn’t move, but on the Monday I got some horse pills from the GP and was up and about 6 hours later.
Took it easy, but was up and about. Had a series of weird feeling root block injections and carried on as normal. Still aches if I do something silly, but in general doesn’t affect my life.
My friends step dad did the same disks 20 years ago. He was in traction for 10 weeks and never really recovered.
With regards to my ATR, so far it seems to be going ok. Since the consultation I’ve had slight pain in the rupture area (like an irratating nettle sting), but nothing that suggests anything other than it has been ‘played with’ a bit.
The Vacoped boot is an interesting concept and I seem to be getting on with it. Two things are annoying. 1 is that the front section doesn’t seem to quite fit properly, and is either too slack around the forefoot or puts too much pressure on. For the first 10 days or so I didn’t change the straps at all, and when I undid the front as I was in a lot of pain, the top of my foot stung like hell. I had to tighten the strap up quickly to relieve the pain and then loosen it slowly.
I believe this was blood rushing around as I released it (although nothing was a funny colour), so now I release it 2 or 3 times a day and take the front completely off. Then let the air in, reposition front and start again. My foot and leg doesn’t move in this and the consultant seems unphased by me doing this.
The 2nd problem is embarrasing as the damn thing stinks. Because I was told to keep going as I normally would in life (within reason), I have been dragged around shops etc on my crutches. 30 mins and I’m knackered and sweaty. This has all gone into the nice fleecy covering and doesn’t come out too well… oops.
I have a spare cover that I can use to replace the existing one and wash it, but my wife has not got the confidence to help me change it and thinks I should wait for the next consult to do so. She is probably right.
One question I have that I forgot to ask the consultant, is what are the thoughts on elevating the leg for periods of time?
I naturally do this as our sofa is reclining, but as I get more back into work and sit at a desk this won’t happen as often as it does now. No mention of elevation has been suggested to me by the medical profession, so I am assuming it isn’t really an issue if I am getting on and about ‘as normal’ ?
Sorry Stuart, I forgot to answer tour questions on the MTB and pedals.
I’ve used SPDs with solid carbon soled shoes for around 15 years and never had a problem, so I think it was only the crash itself that caused the problem.
Maybe having my foot clipped in didn’t help as if it wasn’t I suppose it would have simply slipped off the pedal. The force from the sudden stop had to go somewhere though, so perhaps if the AT didn’t take it another part of my body may have been injured to a similar degree. Bits meeting frame and/or bars doesn’t bare thinking about, so I am thinking I might have got off lightly .. lol
I’m not 100% sold on getting back on the bike with them though, as the position of the foot in SPDs clearly gives the AT a hard time over rough terrain. How rough this is when stood up and being bounced down a rocky trail at 30mph for 30 seconds plus compares to say playing football I don’t know.
This s something I’ll look further into as time progresses, but I have no plans of giving up my favourite hobby.
Hi Adam, happy healing. Sorry you had to join the club
I understand ‘conservative management’ to mean a less invasive procedure rather than the velocity of the protocol. (I work in health care, I might not be technically correct but its what I understand).
I’m sure you are not worried about semantics right now….its frustrating but hang in there, its amazing how quickly the time goes.
Hi, I replied before I saw your update. Yeah, elevate as much as you can. I got a foam wedge for overnight, that was great but you might not need that, Ive improved so I use pillows now.
Hi Adam
There are definitely lots of horror stories out there but one thing I would take out of your mind now is that you can get this sorted quickly. If you check around the blogs you can see far too many examples of people doing well and re-rupturing at 15-18 weeks just because they tripped up. Its horrible, but its just one of them things where you cannot power through and everything will be OK.
The nettle stings are something I had as well. You get lots of weird pains at times and it can be quite daunting, especially the more you read about re-rupturing.
Smelly boot is a crap way of life. Luckily for you that you have a spare cover.
If it helps, I was moved to a boot at 2 weeks post-op.
I continued to work from home but when evelating my leg, I took the boot off.
Just take it easy and you’ll be OK and then you can get that liner washed!
Also, with regards elevating, if you aren’t raising the injury site above the heart its not doing what its supposed to so say using a couch recliner as intended is not classed as elevating it properly.
With regards for how long. I have only read that the more you do it in the first 2 weeks, the better you are in the long run. Whether thats true or not I don’t know. What I can say is that its what I did for the first 2 weeks in cast and then first 2 weeks in the boot and I seem to be doing pretty well (fingers crossed!)
Thanks bcurr.
Yes there are many horros stories about re ruptures etc and tbh most of them are simple trips or mistakes as you say.
As the recovery involves using your foot and AT as nature intended, I suppose their is quite a large risk of more problems - especially as humans are clumsy beasts by design.
Still, I’ll take it as it comes, and if it happens then so be it. I’ll be back eventually, which is not always something said after accidents - for this I am gratefull.
On the leg raising issue, the consultant said my AT seems to be recovering well, but nobody to date has told me to elevate the leg at any stage !
The NHS guy that fitted the boot just said to get on as normal and the boot will take care of my foot.
How I sit in the sofa upstairs and how much it reclines does actually place the foot above my heart, but only just. In bed I sleep as normal with nothing to raise my foot.
With regards to the actual boot itself, I have found that I need to place the outer front shell section underneath the boot ‘wings’ before I fasten it. If I fit it as shown on the website, it is far too floppy and my foot/leg doesn’t feel supported at all.
Might need to speak to the NHS and see if I have got the right size. Currently in a large and have size 10 feet.
Taking as it comes is definitely a good attitude to have. The one I was trying to veer you away from (if you had it) was trying to push too hard as it really doesn’t speed much up and just leaves you open to a greater risk of re-rupturing. If you check out my blog from the beginning I tried to go quickly at the start thinking my natural “get well quicker” ways would be fine and I had a scare at one point.
From what little I know, the raising is to relieve the area of all the building up of fluids and to get blood moving round, both of which help the healing process.
Also, as much as think the NHS is a fantastic service, you do seem to only get the bare amount of information, especially compared to our private care based American cousins. For example my 8 week appointment when moving out of the boot to shoes lasted all of 2 minutes with about 20 seconds of that being “OK, use shoes now, don’t try and balance on steps on your toes”. Thankfully a site like this exists so you can work out a lot yourself, especially from the UWO Protocol Norm links to.
Your boot does sound strange.
On mine I had a soft wrap around covering at the front, then a shell, then velco straps to tighten it all down. Took a while to get the right level of feeling secure, but not also loosing feeling!
It is worse at night as well so dont be suprised to be woken up with your heel or top front of the foot feeling sore where the weight of the boot has been resting.
Adam - as you may have read on MTB’s page, I had my first single track ride yesterday but didn’t clip in. I also had my first off. The reason I asked about the whether the injury may have been induced by the spd was more to help me make up my mind whether to use them or not. My bad foot slipped off the pedal a couple of weeks ago and hit the ground hard and at that point I thought it would have been better to be clipped in. I am still unsure but I know my tendon can take a bit of force now. The way forward will probably be a little at a time. That tingling feeling could be due to nerves reconnecting. Regarding the elevation - I am with everyone else here. Put it up whenever you sit. Put it up as much as you can. Your calf muscles act as pumps to move fluid as you walk but since they are not working fluid will build up. Elevation just helps get rid of it and it will make you more comfortable.
Thanks Bcurr and Stuart.
I agree that whilst the NHS are generally ok, they are deffinately on the side of being generalists.
I have my second appointment with them through and it says I will only be seeing a member of the team and not a consultant, as they only need to make sure it is healing ok and reset the foot angle.
This doesn’t give me any feeling of being looked after in the best way to suit my needs, so I am glad that I have asked the private consultant to take over my care. Just waiting for a phone call from her receptionist now to get me into her care properly.
She is wanting to start the foot manipulation slightly quicker than te NHS and is familier with all the trials and UWO protocol, so I am awaiting the next visit with baited breath :o)
As for my foot itself, I am getting very odd sensations and feelings in it. The sole of my foot is occaasionally very warm and tender feeling, and the AT area sometimes feels numb, sometimes tingles, sometimes tight and always annoying lol.
All part of healing I suppose.
Stuart, your bike riding sounds good. Must be daunting clipping in for that first time, and especially clipping out. Have you moved your cleats further back at all, or are they still forwards as before?
Adam - I have left my cleats as they are and started with easier gears and no hills. The twisting in and out was a problem at first but got better. I did some exercises specific for that to assist. Still not sure if I can get my right foot out fast enough on a single track. Sounds like a good move for you. You need to have confidence in your rehab and a good therapist/doctor will speed your recovery.