The story so far

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.

5 Comments »

  1. julesjames Said,

    April 3, 2011 @ 9:21 am

    Hi Anne,

    Sounds like you are making good progress and making your own protocol up which is what I have been doing as well. Biggest frustration is not being able to just go somewhere without asking for help etc. I’m 4 weeks post surgery and still in a cast (my 4th) but PWB to FWB.

    When you had tendonitis was it on the same side you ruptured or the other ? I’ve been a bit too active on my crutches and going for long expeditions and my good foot is starting to ache around the lower calf/tendon.

    Happy healing
    jules

  2. anne33 Said,

    April 3, 2011 @ 10:09 am

    hi Jules,

    tendonitis was on the same side as the rupture site. It got worse and worse even when doing nothing.
    Actually in the first (and luckily only) week on crutches, my good foot started to ache feeling the same as when my tendonitis (other foot) started. I mentioned that to my doctor later on, but he was not worried about it and told that it probably was due to overuse. But that aching went away when I got the first walking cast, so hopefully you will experience the same, Good lcuk!
    Anne

  3. julesjames Said,

    April 3, 2011 @ 10:29 am

    hi thanks for that i have been worried about having both feet out of action. I mentioned to my consultant last week and he too didnt seem worried.

    Managed to get out on the scooter around london today :) Girlfriend on the back holding my crutches. We looked a sight.

    I’m looking forward to walking boot in 10 days time and then PT.

    keep healing fast.
    Jules

  4. normofthenorth Said,

    April 3, 2011 @ 4:41 pm

    Anne, it sounds great, and I love your style!

    JJ, most of us have worried about “doing” the other AT while we’re on crutches, etc., but I don’t think anybody here ever has. No guarantees, but at least you’d be the first ever! ;-)

    Anne, you didn’t mention building up your uninjured foot/shoe to match your casted foot. But if you haven’t done something to balance your stance and square your hips when you walk, you definitely should.

    Good Healing, all!

  5. anne33 Said,

    April 3, 2011 @ 4:52 pm

    hi Norm,
    The cast was extemely thin, like 3-4 mm. but at the beginning it was pretty rigid, and I had to cut one of my Quickie’sneakers apart to fit the thing in. So I was unbalanced for a few days, afer which i decided to go through life with 2 different shoes, one big hiking shoe with a thick sole and the tiny sole with heightened heel of the quicky sneaker. Then, after another bright moment i tried to put the casted foot into the other hiking shoe with an appr.15mm heel lift inside and that fitted well too and felt much more stable and balanced. Probably because the cast had softened a bit on the parts where they did not put any splint material.
    Now, without cast, I still use the ugly hiking shoes that don’t fit my wardrobe too well, but at least they are comfortable. I hope that i can use somewhat more representative shoes soon :)
    Cleared to start playing golf, but still have to postpone my tennis aspirations for 4 months…
    Good luck everyone!

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