Hi all, just thought it would be good to post my protocol and rehab. As it is now 8 weeks ago, it is quite a long story. I suffered a full ATR on the left during a tennis lesson on February 2nd. I had been out of sports for around 12-18 months, whereas I had always been pretty active (rock climbing, fitness, running, ice skating, tennis). At some time I started suffering from Achilles tendonitis, which dropped my activity further and further while increasing spending time on finishing my PhD thesis. Still, I tried to get more active and my tendonitis was successfully treated with curetape, and of all sports I started to play tennis at a little more active level than before. The second active lesson, my Achilles tendon did not appreciate me trying to step towards a forehand, and it snapped. Although it did not really hurt, I immediately knew that I had suffered a tear from the tendon. I tried the calf squeezing test, and I imagined that my foot was going up and down, so I was kind of hoping it was not a complete tear, and called a friend who is a PT. She had a look at it and told me it was a complete tear and that no curetape could fix that…
I went to the ER, and there the diagnosis was similar, complete tear, but that they did not know where it had teared, because there was no swelling, redness, pain whatsoever. So, on my question, “How do you know then where you have to make the incision?” they told me, “we don’t do surgery”. The high risk of complications outnumbered the minimal increase of rerupture by their experience. So, I was kind of happy not to get surgery, but I was not really convinced that it would be the best, because I wanted to be active in sports again. It should be no problem they said. So they told me the protocol was 6 weeks in a cast, in which they would adjust the foot angle towards neutral. So, a plaster cast was installed and I was dismissed for a week.
Still a bit unsure if the protocol would be okay, I did some internet and medical literature searching, and finally I was convinced that it was a good option. One thing I had to arrange, was to make sure that they would take me out of the non-weight bearing cast within 2 weeks. Sow ith the one-week appointment in my mind, I thought to lighten up a little bit and concentrate on managing the two crutches, plaster covering in the shower. At the end of the week I could move my foot up and down in the cast, and I did not feel any pain when I put some sleight weight on it, which made things much easier. But I made sure not to overdo that.
So, at the 1 week appointment, I asked if they were sure that I would be in the NWB cast for 6 weeks. And, good for me, the answer was, no, you will be FWB as soon as possible. They handed me the protocol to be followed from now on: 3 weeks of fiber cast in a bit of an equinus position, followed by the same cast in a removable form for another 4 weeks. I got a plaster fiber cast, the foot was put at 70 degrees or so (that hurt for a bit) and was dismissed for another 3 weeks. So, If I adjusted one of my older shoes in which I could fit the cast, with a 1.5 cm heel lift, I was good to go. I arranged myself the 1.5 cm heel lift with the local shoe specialist, and hopped for the next 30 minutes on the crutches NWB, followed by 30 mins PWB, after which I decided I was confident enough to put the weight on the foot (in shoes actually, but with cast). From that point I could walk, really slow, but hands-free. I could start working again. My employer approved a taxi to get there. The only physical activity I had at my work was getting coffee and attend meetings anyways, so that was okay. In the next weeks my “walking” improved impressively, and I managed to get around quite well. However, I was a bit shocked by the muscle loss in the upper leg after one week of NWB. This muscle loos subsided pretty quickly when my “walking” improved again. At this time, I was already good to go to a party in town (by taxi), and after 2 weeks I could walk for a few hours, although still slow.
At 4 weeks, I got a new removable plaster fiber cast with straps, enabling removal of the brace for bathing and showering. On my question if I was good to go and do some PT, the surgeon somewhat anxiously said that that was way too early. And he told me to take showers while sitting on a stool or something. I decided not to do that, because I had been showering standing on the foot strapped in a bag which was way more comfortable. I started massaging the spot twice daily with some homeopathic gel to stimulate healing and blood flow. Also, I did my own careful ROM exercises, making sure not to stretch the tendon over 90 degrees. After 2 weeks, I was allowed to take the brace of during the night, which I did. At that time, I already had carefully started “walking” without the brace in my home, and standing in the shower without the brace hadn’t been a problem after some days of ROM exercises.
The protocol I got also mentioned that I would be allowed to ride my bike at 8-10 weeks. Well, that was a bit late I guessed, and in the meantime I was really fed up with the taxi and being dependent for every little movement. So, I decided to give that a try with the brace on. The first time was a bit too soon and I was not very enthusiastic, and waited a few more days before a retry. But, at 5.5 weeks I was riding my bike pretty confident with the brace on, making sure to have lots of time to hop on and off the bike.
At 8 weeks, last Thursday, I had another appointment, with the 3rd different surgeon. He asked if I was doing any PT already and how things were going. Well, no PT (because one of your colleagues was a bit conservative), but furthermore things are going well. He thought it looked good, and got me a PT prescription to work on balance and strength. I was sent off with an appointment in 4 weeks, which I could skip if things are going extremely well form now. So we will see. And, because I drive a standard (left ATR), I asked when I would be allowed to drive again, the answer was “if you can walk okay”. So, now, that is 3 days ago, and the walking is improving very much. Indoors without stairs I walk without the brace at all times, and at work I put the brace on when it starts to hurt (lots of walks) or when I have to take the stairs. The brace time is declining more and more, so I think that is good. I started PT exercises in the car, to get the pedal pressing going, and it actually feels really good and I am confident that I can drive safely, in addition to the improved walking. Next Monday I will visit a sports physiotherapist, and hopefully the recovery will progress as smoothly as it has been.
