Avulsion for once

30 Weeks post ATR

October 4, 2009 · 6 Comments

Oct 1st - Simple Progress

There isn’t much left to report on so at best I’ll probably be dropping down to monthly posts - if that often. Nothing spectacular or stunning is happening and progress is slow so not exciting.

I’ve started back at the gym twice a week, once with a trainer and once on my own. I also have decided to do as much as boredom will allow me to do on the bike trainer. Its deadly dull but its the best thing I’ve got in the house to help me rebuild my calf, if I can manage a half-hour a day or more I should be back to the strength I need to get back to commuting by mid November, after the death of Darcy Sheppard I’m actually looking forward to getting back on the road, I know at least one aggressive driver is off the road for a while.

Unlike most of the people I read here I’m not involved with a Physiotherapist in any capacity, my personal trainer does know a fair bit but it isn’t his forte. My initial idea is to follow the protocol outlined by the Carleton University Sports Medicine Clinic for the rehab for Chronic Achilles Tendinitis. Which is ironic because I suffer from that in my left foot.

My surgeon was understandably conservative with my rehabilitation, what with considering my age… rotten bugger. But I believe this is the first time he’s done a repair on an Achilles Avulsion which also made him a little more conservative. Apparently I am supposed to avoid gastrocnemius-soleus strengthening exercises ie calf-raises, but I’m pretending that I haven’t heard that. My surgeon did say I was ready to return to the mosh pit…

The waste and profile of my calf have pretty much returned to my pre-injury look, but the strength is definitely lacking - I’d put it at about 40% of what I expect. Still I’m hoping the cycling will handle that - I’m a hill climber (at least in comparison to the other aero-bellied old men I ride with) so I want that strength back soonish.

If I get enough sleep then I typically can make it through the first half of a work day without pain, without the limp and without needing the handrail’s assistance on the stairs.  I’m hoping that between a change in schedule at work, a more disciplined attitude towards food (and beverage) and more physical activity I’ll achieve something.

As it stands I continue to rip my LPs, try to figure out how to get Garmin Connect to accept rides that don’t have GPS data and rebuild a kitchen table.


The bulk of the suture as it appears after a day of walking around.

The bulk of the suture as it appears after a day of walking around.

This is what the scar looks like 6 months on. There happens to be a little irritation but thats because I spent the whole day walking around in steel toe boots before taking this picture. There is a tiny bit of swelling but the bulk of the misshapeness is from the sutures and suture pins.

Notice that the holes that were drilled through my heel are completely gone. not even a scar left.

Notice that the holes that were drilled through my heel are completely gone. not even a scar left.

The heel, all healed. In fact there is no indication that there were two holes drilled through my foot 6 months ago, and that even though I haven’t built the callous back up!

music used to inspire this post - public enemy ‘millennium collection’, nine inch nails ‘pretty hate machine’, the prodigy ‘experience’, metric ‘fantasies

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6 responses so far ↓

  • clive // Oct 5th 2009 at 7:10 am

    wow interesting reading, I am in week one of my achlles avulsion rapture.

  • assumptiondenied // Oct 9th 2009 at 7:55 am

    post on up clive, or keep some detailed notes - my timeline is a little skewed because I wrote this up so much later than it happening. I wasn’t able to find much of anything on Avulsions when I started out so by posting something you’ll be increasing the online support for others by a significant percentage!

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

  • ultidad // Oct 9th 2009 at 8:43 pm

    Stunned that you never had PT prescribed…guess I know less about the Canadian system than I thought.

  • assumptiondenied // Oct 11th 2009 at 5:37 am

    I think this was more a case-bound decision. I know my surgeon uses physio for all of the other patients I talked to but for a reason I never asked about he decided that it wasn’t meant for me. My speculation is that he didn’t want the physio to influence the adhesion of the tendon to the bone and that normal movement was adequate for rehabilitation. I surprised him every time he measured foot strength and ROM and I walked into my final appointment without a limp whatsoever (it was early in the day) and without any worries about pain so it seems to me he thought I was well on my way. This week I surprised myself with suddenly being able to walk up stairs on the balls of my feet - last time I tried I was nowhere near strong enough.

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

  • clive // Oct 30th 2009 at 7:53 am

    I cannot believe how quickly time goes when you have nothing to do. You mentioned about the surgeon having not done this operation before, the Hospital I went to had never seen this injury before, the xray technichion said OMG never seen that before.
    Had the staples removed two weeks ago 19 of the buggers, had a new cast put on (the original one was not very good I think it musthave been done by one of the porters, and got really uncomfortable). The x-ray showed they used sutures that looked far bigger than what was needed. Comment from consultant was “if you have a small piece of wood and put two big screws through it what happens to the wood?” Well we all know the answer to that one, it splits. next appointment is three weeks to have the bolts out and then we will see.
    The thing that really suprised me was muscle wastage, I lost four pound in a couple of weeks. I would work on my legs with weights and had fairly muscular legs, don’t get me wrong they were not huge but muscular if you get my drift. Now they are skinney. I have been trying to work them with leg raises, leg extensions, leg pressing no weight obviously just fresh air. But because there is no weight the wastage still continues.
    Up to this stage I have had no pain, everyone I speak to say “wow that must be painful” when it happenend it was but since the op its been fine, the only discomfort is when the head of the sutures press against the cast and that is aways when trying to sleep.
    Looks like your heel is well on the mend, is there any stiffness now and do you have full range of movement?
    I found your blog really interesting and it gives a good insight to time scale. If I thought I could do one as interesting I would.

  • assumptiondenied // Nov 4th 2009 at 12:34 am

    Its a pretty unusual thing to have to live through and its a bit scary when you’re confronted with people who have a theoretical appreciation for what you have and no practical experience.
    I too suffered quite a bit of atrophy in the leg and it wobbled like a jelly mold when I got out of the last hard cast, but it does rebuild volume fairly quickly.
    There is some stiffness and pain and I have no idea how long it will last but the worst occurs only after a workout so I at least know when to expect it.
    Unlike a rupture the avulsion doesn’t tend to do as much damage to the tendon itself so range of motion is less of an issue. Not that there won’t be some loss, but recovery of ROM should be fairly quick. I would suggest that you get in touch with a physio therapist as soon as you are able and if at all possible set yourself up with a stationary bike or indoor bike trainer, its boring as all get-out but even at a dead slow easy pace the motion helps and the elevated heart rate helps clean the blood out of the swollen tissue.

    And I want to encourage you to post your experiences, it took forever to find any information on avulsions and the more posts that come up the more likely this site turns up in the search engines and the more people get to experience the community and support.

    One last thing - you’re likely to need to move up a shoe size for the first month - I had it easy since I could do sandles but winter is coming. You also want to make sure the heel cup on the shoe isn’t too concave and pinches in.

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