Avoid These Hazards
I’ve been reading others’ ATR experiences on the internet and this is a compilation of “worth reading” postings that I’ve found. Some possible complications to keep in mind and hazards to avoid. Please also keep in mind that these complications are usually rare, and not limited to just Achilles surgery.
As my anesthesiologist told me, The chances of complications is lower than the chances of getting into a car accident on the way to the hospital. But, as I’ve always been told, hope for the best, be prepared for the worst.. within reason. (Disclaimer: These are other’s ATR experiences, nothing more. It’s just something for you to keep in mind. Ask your doctor for qualified medical advice.)
General running theme of all these experiences is: Become Your Own Advocate for Health Care Services
For the sake of better organization, this page has been moved over to: How to deal with complications
You really need to be our own advocate and as my wife pointed out, have someone there who is an advocate for you. Research, question and if uncomfortable, insist, as Kelly did. Docs are not gods and don’t know your body as well as you do.
I’m told one 325mg aspirin per day to reduce risk of clotting.
A valuable lesson on being too quick out of the cast/boot. The tendency is to want to get after it as soon as possible but with this injury patience seems to be a virtue.
I just partially re-ruptured AT after 17 years of having a full rupture at the age of 31. I live in Geneva Switzerland now and I am just getting used to the health care system. After an MRI, my primary healthcare physician called an orthopedic doctor on the phone and told him of my condition, in French, which I only know a little. The response was just stay off of it for 2 months. No need for a boot, or exam by Orth Dr., here are some anti inflammies, walk on crutches when you need them, get a heel lift, see you in about 2 weeks. Are there degrees of partially ruptured ATs? Shouldn’t I demand to be seen by an orthopedic doctor. Any ideas of what questions I should ask? I have not been participating in any extreme activities, just some moderate weekend hiking. I stay away from steep hills as much as possible which is difficult in Switzerland. I wear orthodics and sensible shoes, actually, hiking shoes almost every day. I walk to work and back, but that is only 12 minutes each way. I stretch the calf and tendon almost every day, but I have a feeling that I either havent done enough or I am doing it wrong. I am scratching my head on how this could have happened again. Thanks in advance for any good feedback.
Hi all. I ruptured my tendon playing basketball Fathers day weekend. I am 47 and pretty fit and very active. My son plays Strong Safety for Kansas State and i was playing with him and his friends. Pretty stiff competition and my wife is angry with me for playing with them. I am scheduled for Surgery July 1st. Couple of questions. I am considering the I walk Free Crutch as i need to work as soon as possible. I am also wondering which boot i should look to get assuming my Dr allows me to go into a boot. I feel confident in my Dr. He is a sports medicine ortho and was a football player in college so he understands athletes.
Hi Tony,
Reputations and past experience don’t always translate into a more modern, aggressive approach. My surgeon was the doctor for the USA hockey team at the Vancouver Olympics, but he planned to have me non-weight-bearing for over six weeks after my Achilles surgery. I rehabbed my own way and had a nice, quick recovery.
Good luck,
Doug
Tony,
My advice is forget surgery. If you want to read the horror stories of what can go wrong with the surgical approach, just read my blog. Infections and abscesses don’t care who did your surgery, neither does MSRA. If I had known a year ago what I’ve known for the past several months there is no way I would have agreed to surgery. Just say no.
I’d also recommend that you review the studies that have compared the results of surgery to the results of the same modern fast rehab protocol without surgery. They found no benefit from the surgery, and some disbenefits, like Gerry’s experience.
My ortho surgeon — the chief surgeon of Toronto’s pro football team (OK, CANADIAN football!!) — told me he’d stopped doing ATR surgery altogether, after seeing a presentation by the authors of the latest of the four studies, and discussing the results with them!
I’ve posted details of those studies, and links to them, on my own blog, and also the protocol my Doc got from the ones who did the study. If you have trouble finding it, just ask. So far, I’m doing well with it, and mikek753 and gunner are, too. My calf strength is still a little sluggish — just starting to get to a normal but not-very-high 1-leg heel raise at 6+ months — but Mike is doing a pretty good one at 16 weeks, which is faster than most folks here after the surgery. Gunner’s coming along a bit faster than I am, too, on the same protocol, no surgery.
We’re at a funny juncture in ATRs, because every surgeon learned “truths” in Med School that the latest and best 4 randomized prospective studies have essentially disproved! If this were a model of a car, we would have recalled them all and fixed them, but there’s no comparable process to “fix” all the surgeons who know things that turn out not to be true.
Most of them are too busy to keep up with the latest articles in general, and reading about ATRs is like reading about tonsillectomies — everybody knows how to fix them, and nobody specializes in them, so they’re a minor (and boring) sideline, when they’re not doing “sexier” operations.
But these decisions are REALLY important to US, so it’s mostly US who are reading and discussing the studies!!
With or without surgery, I’d recommend a boot that can HINGE. I used the Donjoy MC Walker, which works fine, and gunner highly recommends his new-fangled high-tech (and waterproof!) VacoCast. I’d probably try the VacoCast if I were starting now.
With surgery, I’d probably start with it hinged and Full Weight-Bearing As Tolerated from the start. Without surgery, I’d probably stick to the protocols that have been tested — 2 weeks fixed boot, NWB, then 2 weeks Partial WB, then FWB As Tolerated. I went hinged only at 7 weeks (the newest study used fixed boots, partly because AirCast sponsored the study!), but I’d probably start sooner, maybe 6 weeks or less.
Ironically, most surgeons who operate put their post-op patients on protocols that are slower than mikek753, gunner, and I have been following without surgery, which is nuts! Doug53 made it up as he went along, and came out fine and fast, but nobody knows if his happy experience can be duplicated over and over, or not.
Hi Tony: I’ve also had good results without surgery. My advice: Do not expect your ortho to have much sympathy for considering a non operative course. I hope I’m wrong, but expect resistance, be prepared and make him convince you that, because of the nature of the tear, you are not a candidate for non surgical healing.
Also, I would be armed with Norm’s protocol, and get agreement on removing the initial cast no later than 2-3 weeks out to be replaced by an advanced hinged boot, like the VacoCast I used (an amazingly effective and comfortable device).
Good luck.
As gunner stated you will likely meet resistance and the resistance will come from your surgeon but may be actually directed from above. It is a hell of a lot cheaper for the patient to not have surgery, several thousand dollars cheaper, but also a lot less lucrative for the surgeon and for their practice/partnership/clinic/whatever. The good news is that ATRs represent a pretty small % of their business and is one of the few, if not the only, orthopedic problem that can be effectively fixed without surgery. So it isn’t like a non-surgical approach to ATRs will start a trend toward non-surgical interventions for hip or knee replacements.
If the surgeon says he only does surgery and won’t do anything else, I would highly recommend finding one who will. Far too often we all take the easy way out and make an appointment with someone because they have the first available slot or because someone we know recommended them. My first surgeon was highly recommended by a respected friend. He might have done an OK job, but his initial work started me down the road of infections and abscesses. My second and third surgeons were also highly recommended. You have every right to interview these people and that’s what I did when it started looking like I would need a fourth surgery. By then I knew exactly what questions to ask. The third surgeon didn’t get a chance to do my final surgery because he wouldn’t listen to me and wasn’t interested in my questions. I picked a guy who listened, answered my questions to my satisfaction and more importantly said “We need an MRI to see what’s in there,” when others weren’t interested in doing that, like it was costing them money. The MRI showed the abscess that two other surgeons said I didn’t have. When pushed they would only said it didn’t “feel” like there was an abscess.
Guys,
I think it really varies on if you require surgery or not. Not having surgery isn’t always an option. I can speak from experience. I snapped mine playing racquetball.
When I saw my surgeon he commented that in most cases they don’t perform surgery anymore, but mine broke much higher and there was a couple of inches of separation. After a couple of doctors reviewed the MRIs they both suggested that I get the surgery (as well as a 2 other doctors I know that are family).
I would say you need to see a doctor to determine your recovery options. While all the booting, and casts, and all the other stuff I had to deal with since April 15th (I joke the tax man took a piece of me), I have pretty much had a flawless recovery from surgery.
I have full range of motion, and definition is back in my calf. I have some scar tissue on the back, but it doesn’t affect anything. Do your physio, do the exercises, and things will get better.
While there are horror stories, I think more people post about bad experiences than good. Just because you read a 1000 horror stories doesn’t mean it’ll happen to you.
Good luck Tony with what ever you decide.
Jeff, it’s possible that you’re right, that gap size and location are important variables that change the relative risks and benefits of surgery and non-op rehab. It’s also possible that your doctors have figured out the relationship between those variables and the risks and benefits.
On the other hand, (1) the stories reported here about unusually high ATRs, near the calf muscle(s), are primarily about surgeons who did NOT want to operate on them, and recommended non-surgical rehab instead (including your grandfather’s “conservative casting”), and (2) the only study I’ve ever seen on the relationship between those two variables and the outcomes from NON-operative rehab, found NO relationship, and very good results REGARDLESS of gap size and location!
Admittedly, it was a small study — done on the ~1/3 of the 75-ish randomized non-op patients in the UWO study who got their ATR gaps measured with UltraSound before treatment — but it suggests that there’s no good evidence that what your Docs say is true, and some semi-good evidence that it is false. (Even the phrase “Evidence-Based Medicine” can still often start a fight in medical circles!)
Meanwhile, I agree 100% that the blogosphere tends to concentrate bad news over good, in general. But my experience with ATR surgery AND with non-op rehab for my recent second ATR have both been positive, no horror stories from me. But the non-op rehab was quicker and easier, less painful, and much less disruptive to my personal and professional life than the surgical one. If I were paying for them myself (instead of living in Canada), there would also have been a huge difference there, in the same direction.
Finally, Tony has already opted for surgery and has started his own blog, so you can read about his progress (and his difficulty with two OSs) there.
I’m new to blogs and new to ATR.
My achilles ruptured 10 days ago and is high up in the calf. The orthopedic surgeon (formerly ortho for the Cleveland Browns) did not require ultrasound or MRI before recommending a conservative approach. 3 different casts for 3 weeks each followed bt physio. I pray he is right and hope my recovery is permanent and complete. I do not want to go through this again.
Hi Jazzbo, I would recomend that you set up your own blog, that way you can share your experiences and benefit from the support and wisdom of our ATR community. Good luck with your healing. At the beginning every one worries they’ve made the right decision but in the end we all seem to be fine. I, along with many others went the non op route and have been really happy with the progress I’ve made. Good luck. LL
Jazzbo, do set up a blog if you can.
Most Ortho Surgeons have difficulty operating on high ATRs like yours, hence the non-op approach. Unfortunately, most Ortho Surgeons think that a good non-op approach should be “conservative”, i.e., SLOW, and the evidence shows that’s an old myth, just wrong. Check out the protocol from the study that seemed to show the best results without op — at bit.ly/UWOProtocol — and the study results at bit.ly/UWOStudyPub . Share them with your OS, who probably hasn’t seen either, and ask him if you can get with that proven-successful program.
Part of that is switching from 9 weeks in casts to 8 weeks in a boot, with exercise and PT starting at 2 weeks, and FWB starting at 4 weeks. It’s faster, it’s more convenient, and it produced great results!
They also checked to see if the location of the ATR had any effect on their non-op results, and it seemed to have no effect (though the sample was small), so it should work fine for your high tear.
Good luck, and good healing, and keep posting!
Hi
I ruptured my achilleson my right foot playing badminton 1st November - I have been playing competitively every week all my adult life -and opted for the non-surgical route on the advice of the surgeon. Partly probably because of my age -56 - but also risk of infection. The clincher was that surgery would leave a scar on the heel that might irritate in a ski boot.
Progress has been good, and after 7 weeks I am now in a boot and light weight bearing.
My best call was having a temporary left foot throttle pedal fitted to my car so that I could carry on driving. Left foot throttle and brake takes some getting used to but having freedom of movement is just fantastic. It cost £300 to install and took about 2 hours . This is an easily removable fitting so other people can drive the car without any problem.
I am due for a walking boot in 2 weeks time so the end is near, but I am aware that the physio then starts.
Hi Andy,
I too opted for non-surgery treatment of my left Achilles tendon rapture which I sustained a week ago ( dec 13, 2010) playing basketball. I’m a certified athletic therapist therefore will be doing my own treatment and rehabilitation ( of course with a guidance of my orthopaedist). As of right now still working full time using a boot with 6 inch heel lift and crutches(nwb) and when I’m not working or at home I’m using half a cast placing on the front of my leg with a tensor to keep my toes pointed down. And most important using ice and elevation as much as I can. I’ll be doing this for the next 5 weeks then rehab (hopefully) after that. Well good luck to you and everyone else! Cndianboy27
LOL….I have such a queasy stomach just reading this stuff makes it feel sick.
I cannot wait to see the surgeon who operated on me to find out where my rupture was….still new to all of this but at the time it happened there happened to be a nurse in the gym. I was talking to her this week and she said she knew it was bad because she could actually see it curled up close to where my knee bends….yuck. I also had severe pain high up on my calf….not sure what all this means but two doctors and said surgery and two nurses told me I’d probably need it.
Kind of late to 2nd guess everything and there really was no time to do any research…so I’m hoping for the best.
The hardest thing for me right now is that I don’t know what’s going on inside the cast. The superpower of x-ray vision would come in handy right now.
When I read about blood clots and things like that…I keep wondering how I would know if that is happening…my toes are a healthy colour and no swelling….and nothing seems to hurt more than it should.
Is there anything I should be aware of?
LOL…I love this site!!!!
Janet, you sound pretty normal to me. Many people get rushed “under the knife” before doing any research. The good news is that the surgery works well for the vast majority. (The bad news is that skipping it can work just about as well!
)
Whenever an AT is ruptured “normally”, by being overpowered, it’s natural that your calf muscle will “overshoot”. Imagine a tug-of-war when the rope breaks: both teams go flying backwards, right? That leaves your calf “balled up”, near your knee. In a repair operation, the ends are surgically approximated and stitched together near the original length, so as the ankle is brought from “equinus” to “neutral”, the calf is naturally stretched back out. (In the non-op cure, this generally happens, too, though the process is still poorly understood/explained, AFAIK.)
One reason (of many) that boots “beat” casts is that you can examine your leg and foot easily. In general, if you don’t feel or see anything that scares you, you’re probably coming along fine. If something is borderline, just ask here, and/or call your Doc’s office.
Im having surgery on on my achilles in 10 days. i have a pre op visit this week..not sure what to expect at this visit…..any ideas of questions I should ask?
Thanks Cyndi
My surgery includes 2 incisions one up higher and the other where it inserts into the ankle bone to shave a spur off.
Hi Gerry etc
Can I ask you when you say forget surgery is this for a partial rupture? reason why ask this how can a total rupture repair itself as when the tendon is ruptured it is slowly pulled further away i.e. further up the leg. How can it re-attach itself (broken elastic band)
I ruptured my achilles in Jan and was advised to have surgery asap, however I waited 10 days reason I was given (NHS uk) was the were waiting for a special piece of equipment to come in which would help reduce any damage to sural nerve and also was minimal invasive technique scar is less than two inches. I am now due for cast removal this wednesday 23rd march 6 weeks post op cant wait. I would aslo say that we are all different meaning it may work for me but not anyone else.
There have been people here who had complete ruptures and no surgery and did just fine.
I have had achilles tendinosis off and on for 18 months. Thought it was gone, but it cme bck doing a lot of yoga. Podiatrist did MRI, recommens surgery. Any thoughts? Where can I find the study?
I’m almost 4 weeks into my non-surgical recovery for a full tear of my achilles playing platform tennis. I wanted surgery and like certacito, I just could not understand how this could reattach itself - but after speaking to four different surgeons who ALL stressed no surgery - I opted for that. Dr Tuesday told me that it is healing perfectly, no scar tissue and that I’ll lose my boot by week 8. The next day, my physio person pushed it a bit and now I feel a ton of tingling. It of course is making me nervous?? Should it be - any advice out there?
Hi, sooooooo glad to have found this site.
I have had problems since November with both feet, plantar fasciitis L foot and achilles tendonosis both feet, but predominantly the right foot. I’m told I have a split in the right achilles, that it looks about to rupture and I will need a tendon repair and graft. Has anybody any experience of this?? Any clues as to where the donor site will come from?? I will ask this when I see the surgeon next week but trying to get prepared for this. have got various ideas from articles I have read but grateful for all advice.
Also told I will use a moon boot or a below knee cast post surgery. I love the idea of having the boot post surgery, but I don’t want to take any risks. If it is better to have the foot imobilised to facilitate healing, then it is worth it. Has anybody got any thoughts on this?? I guess it depends if the foot needs to be in plantar grade position. I think from what I can gather it will be in neutral position, but Im guessing it might be hard to be specific until the operation.
I have been wearing a boot for about 3 weeks. It has made a HUGE difference to my comfort.
I was told initially I didn’t need the boot. I could stand for only a few minutes before needing to sit down and I think the boot has enabled me to stand up a bit longer.( I also wonder if the boot MIGHT work re. healing the tendon without surgery ).
Still in loads of pain - this has been going on for about 6 months. Have lost loads of muscle bulk and have put weight on. Very depressing, but its also tiring thinking about nothing else!!
My family, friends and work colleagues have all been brilliant, Im only at the start of the journey. Bit worried as I live on my own, but have faith it will be ok in the end. Also been told to avoid going uphill, seriously hope this is not long term ( I have hypermobile joints Im told) as I can’t stop thinking about mountains….
Grateful for advice…..!! Sorry other people are going through it but also glad Im not on my own!!!
Alison, I can’t advise on the surgery, but boots are better than casts in every single way but one: If you’re irresponsible enough to take the boot off when you should have it on, and then do damage, then. . . you should get a cast (or a brain transplant!
).
Plantarflexed or neutral, the boot can do it all, usually as securely (or more so) than the cast, and almost always more comfortably. It’s POSSIBLE that a cast will fit under your pant legs more easily than some boots — OK, that’s two possible exceptions to the rule, but that’s my final offer!
I’m a big fan of boot-based non-surgical healing of ATRs, but I’ve never seen any evidence that a split AT will re-join from being rested and immobilized. That kind of split reminds me of an inguinal hernia, where parallel tissue fibers separate, and I’ve never heard of successful non-surgical healing of those, either.
LOL Hi, thanks for that. i would way rather stick to the boot if at all possible.
I am well aware of the risks associated with surgery but……6 months of conservate treatment later… ..thinks….
Much appreciate your advice!
Norm of the North!
With your nonsurgical ATR…what was your pain like when you resumed some weight bearing? I’m currently in the protocol week to start full weight bearing - I’ve only done it a little bit and at night…well, I’ve had a kid…and the pain was comparable to child birth! I haven’t had pain at night in three weeks and now it’s excruciating….any experience with this??
Sara, I’m sure my blog “remembers” the details better than my almost-66-yr-old brain, but I don’t think I ever had pain at night from FWB. My sole and (esp.) the bottom of my heel were sensitive to pressure initially and for a LONG time afterwards. Squishy surfaces helped a lot(footbeds and Crocs), and rolling my heel over a golf ball also seemed to help. IIRC, even a few months after the start of FWB, walking barefoot on flagstones or concrete was no fun at all, as was wearing “exercise sandals” (with the “bed of nails” texture, in rubbery plastic).
Everybody’s different, but I think my experience was reasonably typical here.
It only ever hurt while I was walking. Is your pain at the bottom of your foot, or somewhere else?
Hey Norm
did the bottom of your foot ever hurt driving. I did a 4 hour drive today and mine HURT on the bottom, where the heel touched the floor (the calf ached too, so i guess the position of the foot is awkward, I have big enough feel for a chick but I think accelerator pedals are made for man feet!).
thanks Norm! I decided to use the medical system for what it’s there for and checked it out…apparently it’s pain from torn scar tissue (at least not torn achilles again!) - still killing me BUT at least I know I’m still on the mend!
The non surgical repair option for me was not a good one. The mental side of not knowing if my tendon had reattached itself magically would have been unberable. I could not imagine waking up eveyday wondering if the tendon was really healing with no surgery. Once I had the surgery I felt like every day was a day gained. It was a positive feeling to follow everyone’s progress on the blog since surgery and compare it to my own progress. I am sure the non surgery option works well in most cases but for me I am glad I did the surgery.
i had no choice but have surgery due to procedure carried out.
i dont know much about ATR and what everyone means when they talk about it being a high tare or anything like that.
all i can say is that with surgical repair/alteration to my AT i would quite happily go back and have my other leg done tomorrow if required. no pain which was my main fear and have progressed well (avoided the dreaded infection) which i read so much about prior to have operation which means wounds have healed quicker than first thought.
Good luck to everyone who is recovering whether is in a cast after surgery or a boot if goin down the non surgical route
Hey Tony +folks!! There’s a lot of factor MD’s are considering when deciding on a non-surgical approach…number one is the extent of the damage. Sounds to me Tony that you have a Total Rupture or Complete Rupture as some would call it. Other considerations are if you have an underlying conditions that would put you on a higher risk of infection, say for example diabetes also if you are overweight. I have a complete rupture AT and spent a total of 9 weeks on a cast (6) and a boot (3). I am now on my 12th week and have been discharged by my MD with 2 more PT sessions. I am gaining strength on my calf and thigh as I am a cyclist…been riding at least 50 miles a week now. One of the risk of a non-surgical approach to keep in mind is re-rupture. You have a tigther bond if you re-attached both ends of that Tendon than letting it just heals on its own. I am fit as well…44 and in top shape 5′10 179lbs. If you are completely healthy and follow a good diet regimen upon getting a surgery you will heal really fast. I say invest on getting a surgery.
Would like to see some references to good results from merely casting a complete tear. This makes no sense as without physically attaching the torm ends you get a stretched tendon heal, a compressed tendon or a normal tendon! Seems like gambling to me.
Howard - I think I understand where you are coming from (correct me if I am wrong) but there is considerable evidence to show non surgical repair is effective. A range of motion boot is prefered these days over straight casting but results for those in a cast for 6 to 8 weeks have also been good in the long term. For best results many doctors would like to see the tendon ends touching with the foot equinous or 20 degrees plantar flexion before considering no-op but the best expert on non-op here is Norm. I had surgery but am not against the other way. There is plenty of scientific information (links) contained within these pages and on the net to back up the non op way but straight casting for 6 weeks or more is becoming less popular.
I also am interested in seeing MRI results or anything like that in a non-op situation when there is a sizable gap. In my situation, the ends of the tendons were over an inch apart.
From a reasoning perspective, I can’t see how that would ever be the same again going non-op. I obviously can see how scar tissue may close the gap, but that would not only lengthen the tendon considerably, but also make it far less elastic. I don’t see how the strength or power in that leg would ever return.
I’ve seen the claims, but I’d like to see true evidence of tendon length, explosive power, etc when there is a sizable gap at the site of rupture, ie an inch or more. I just can’t believe it otherwise…
I have basically put myself up as a guinea pig regarding this. I am 20 weeks from the event with no surgery, inch gap, and treating myself via info from this site. I can walk normally and am working on building strength back into my calf. So far I seem to be on par with most of those making good progress. My gut tells me that this will be a year long process and then probably another year to get to were I was prior. If I can’t recover the power I’ll get an MRI to see just what is going on. At 54 it’s not going to be a life changer either way.
Thanks so much for all the posts. My rupture happened a month ago and MRI showed a 3cm gap. My doctor said surgery would be the best option. I’m four days from surgery. Was on NWB in a soft cast until today, received a cool boot that has several wraps and pumps with air for stability. I’m to take it off three times a day and start light plantar and dorsi flexion exercises. Next week, staples come out and I should be cleared for physical therapy. I’ve really appreciated everyone’s posts and agree that surgery for me marks a clear beginning to recovery that I mentally needed. I’m not sure if I’d feel the same about non-surgical options.
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My Achilles tear happened 8 years ago when running hills with a friend. Foolishly, we didn’t warm up correctly on a 10 degree Fahrenheit 5am morning run. The tear is at the very base of the Achilles where it joins the bone.
I’m afraid all efforts to heal have not been successful. It’s more painful now then when it happened. With children who have needs I can barely afford, I don’t have the money for surgery so I haven’t attempted to go that route. I don’t have advice for others other then tell you want doesn’t seem too work in my case.
I’m a runner and it seems to worsen without activity. If I walk and lightly jog for short distances (5 to 6 miles) the pain is bearable and even subsides enough to enjoy the run in parts. If I garden first for at least 4 hours the tendon seems to be stretched enough and warmed up enjoy to allow me to actually run.
Every day and every step is a painful process and I won’t wish this on anyone. Thankfully, my insurance situation has improved (no longer an impossibly high deductible) and I’m scheduling my first visit with a doctor this month. Does anyone know if there are treatments possible for someone who has been living with this injury for 8 years?
Hello All, I guess I’m the newbie now. I tore my Achilles tendon playing flag football about 4 weeks ago, and I’m about 3 weeks post op now. I start phys therapy tomorrow, so I’m anxious but nervous to see what the schedule will include.
It’s interesting to read the posts here over the past few years as well as the pre/post op pics. The new procedure (at least for US mil doctors here in Germany) is to minimize the possibility of surgical site infection by making a small horizontal incision rather than filleting the lower calf open with a long vertical incision. The docs & studies have also shown “aggressive PT” is more advantageous to recovery and less odds of re-rupturing. I’m not sure what “aggressive” PT truly includes, but I’ll find out this week I’m sure.
Additionally, as my wound heals quite nicely, I have a weird “tingling” but sometimes annoying/painful feeling on the top of my foot on the outside portion as well as some pain right at my heal. When I rub or touch these areas, they are very sore….so it makes me wonder if the cast that I had on for 2 weeks didn’t allow proper blood circulation or it was simply too tight.
The info and posts here are motivational; I’m happy to hear how many people have successes in their recovery and I pray that others continue down their own road of recovery.
TK
I had the minimally invasive repair for my completely ruptured achilles, basketball injury Dec 13th. One incision and used a jig to sew both sides back together, rerupture rates are as low as the old fashioned full incision. Doc has me immobilized with a cast through week 4 and I am seeing information all over the place as far as when their doctor allowed movement and PT. I am very anxious to get PT going as I am nearly 32 years old and in my physical prime still as I kept very active, former college football player. The issue I have so far is I feel my other achilles ache all the time now, not sure if I am paranoid or if something really wrong. I asked my doc on last appt and he said it feels strong… And have lost feeling on the upper half of my big toe on the surgery foot… doc says the feeling will come back most likely but that it is weird since all the nerves run along the top of my foot and up the front of my leg away from the surgery area so must have been my first cast tightness??? any similar issues?
Hi Everyone,
I’m just into week 2 after ATR whilst closing a shipping container.
Originally the dock medic diagnosed me with a torn soleus muscle, advised to rest it and see my GP when I got home.
Following day I drove home from Bristol (UK) to Macclesfield to my GP who sent me straight to Accident and Emergency dept.
They diagnosed the ATR and put me in a cast (back-slab) and gave me crutches.
Next day I was summonsed to the hospital for an Ultrasound scan, and booked into the fracture clinic for a week later.
Arrived at fracture clinic, it was explained that I couldn’t have surgery because of the partial rupture being at the tendo-muscular joint.
Was then fitted with a very crude boot (actimove walker) with foam inserts at the heel (which incidentally were fitted upside down) and told to come back in a month!!!
This all seems very different to the treatment people are talking of on here! Any thoughts?
Also - since getting this boot on, I feel a lot more pain than I did in the partial cast I had for the first week.
Look forward to blogging and chatting once I get set up!
Cheers all!
Jibs3, getting non-op treatment (preferably in a boot) is pretty standard care for very high ATRs, partial or complete, because most OSs don’t want to try to get sutures to hold in a calf muscle end. And the results are generally fine, IF a fast modern protocol is followed — like say bit.ly/UWOProtocol .
Going slow non-op — your (grand)father’s “conservative casting” — had high rerupture rates back then, and it still does. But fast non-op care like UWO or Exeter or the new Irish study seems to give consistently great results on average, including near-zero (<=~3-4%) rerupture rates, virtually identical to post-op results without the complications, regardless of the location of the rupture.
Many ATR patients (esp. in the US) are rushed into surgery, for the same reasons as 10-100 years ago, but the scientific justifications for that rush have gradually faded away recently, starting in 2007. Old ideas die hard, especially when they underlie the carreer choices of the professionals involved. My Dad used to say “If you go to a carpenter, he’ll tell you make it out of wood.” Somebody else said “If your only tool is a hammer, all your problems look like nails.” ‘Nuff said. Most of the UK hospitals have “gotten the memo” about the benefits of non-op care, though some are still using old slow unacceptable protocols. Don’t Go There!
Two things about your boot:
(1) It’s vital that the heel wedges stay put under your heel! One of the gang here was well into a successful non-op cure when she was fitted with a boot, and the tech neglected to Peel and Stick the heel wedges in place. They slipped forward under her foot, where they made her ankle flex into the exact position the boot was supposed to prevent, and she immediately reruptured. (She probably would have WITH sutures too, tho’ we’ll never know for sure.)
(2) If a boot is the right size, properly fitted and properly adjusted, it should be snug, protective, and supportive, but NOT uncomfortable! Some people with badly fitted or adjusted boots develop sores or other problems, and all are slowed down and annoyed. So figure out WHY and WHERE and HOW it’s hurting you, and see if you can fix it. As long as you don’t change the basic angle of your ankle, you’re “allowed” to add whatever padding etc. you need to make it conform to your contours, or to stop rubbing you the wrong way.
Thank you for the reply normofthenorth, I appreciate it!
Ive just returned from an impromptu visit to the fracture clinic (as the pain this morning was immense. Lay in bed all was fine, but whenever I was vertical it felt like a stake was being driven through the top of my knee down toward my foot.
Anyway, my Ortho doctor said ‘its because men aren’t used to having the balance centre changed (like women wearing heels)’ and told me to take ibuprofen.
I asked then why I was in a boot so quickly when it seemed like everyone else had a cast for longer.
She explained then that it wasn’t necessary to keep me Aquinas as I only had a partial rupture and the heel raise within this walker boot was sufficient.
I did ask how I could go about getting one of these Vacoped (Vacocast in US I believe) to no avail - they don’t have them.
So there we are for now. Next appointment 3 weeks away.
Cheers
jjbs3,
I think it is a good sign that they scrap the cast early, and give you a bot. especially for non-op, faster seems to be better when it comes to the boot.
Regarding the boot, I used a generic ROM walker, and was actually very happy with it. Sure, it’s heavier and uglier than the vaco/air models, but mine worked fine.
When it comes t your pain, I would have considered getting a second opinion, just in case. If there s something to be learned from my experience, it is that you better get a second opinion quickly, in case you have other issues that can be treated together with your ATR.
Tord, many thanks for the reply!
It’s re-assuring to hear your thought on early transfer to a boot.
As I understand it ROM boot is a range of movement boot? I’m not sure whether this one I have is one of these. The frame etc is fixed, and the heel has foam inserts forming a flat raised heel with a ‘ramp’ down towards my toes within the liner, which I guess they will reduce over time? Feels odd in that my heel is horizontal and then my forefoot ‘bends’ over the ramp?
As it happens, two normal strength ibuprofen have left me pain free for a 4 hours now, so here’s hoping that’s what I needed.
I was hoping to get a referral to another nearby national trauma centres orthopaedic consultant (where my fiancé works as an orthotist) but I’m still waiting on that. Incidentally, this consultant fits vacoped boots as standard for these injuries despite the extra cost, as he believes they promote faster stronger recovery……
I just don’t know, apart from the fact I wanna get it right first time!
Cheers very much!
Hi jjbs3, where are you located? The VACOcast Pro Achilles (VACOped) is available in the US and Canada through our webstore if you are interested in getting it directly from us.
http://www.vacocast.com | You can contact us at hello@opedusa.com if you have any questions.
Best of luck with your recovery!
jjbs3
I see from your earlier post that you are in the UK - for Oped (the manufacturers of VACO products) you can look at oped-uk.co.uk and facebook.com/oped.ukltd. They are based in Devizes and the guy I dealt with was Jason Caulfield Ware, and he was absolutely 100% as far as customer care was concerned.
Lots of ATRers have found these boots to be very good. Maybe they are the best but most of us have been fortunate enough (lack of injuries I mean) not to have tried others. Some of course have had more than one injury and can compare more easily.
Take a look at Suddsy’s blogs where he has compiled his experiences and others have posted too. Look at my Exeter protocol on there - Suddsy’s almost identical although he was surgical and I was non-op. Both of us used Vaco boots. Mine was on the NHS.
I would definitely try for that referral.
Hi guys, apologies for not responding earlier, have been away from my computer.
VACOCAST thanks for the info, I’m UK based so shipping could be an issue but thanks anyway.
HILLIE , thanks also for the info, I’ll definitely have a look through your experiences, and eventually I’ll get round to creating my own blog.
I’m still in the actimove walker boot which I was initially sceptical about. I have the good fortune of a fiancée who is an orthotist and her connections within her hospital, orthopaedic surgeons and consultants. Apparently they are in agreement that my boot will do the job based on how my AT ruptured. I’d still like to get into one of these VACOPEDS though for sure, whether or not I can justify the cost is another matter.
I have another appointment with the clinic in a couple of weeks which will be week 5 since injury. Based on what happens there, I will make the call on getting referred elsewhere and trying to get a vaco boot.
Cheers for the replies everyone. My blog should start soon.
I’m sure that the boot that you have will be absolutely fine. I liked my VACO boot because it had the increasing ROM and the hingeing system which I felt helped to maintain flexibility and reduce atrophy, and the fact that it was so light and easy to keep clean, especially the liners. You could try eBay as they do appear on there. Also lots of YouTube videos on line.
More important though is early, active mobility and support from a good physio, ditching the crutches as soon as you are able, and getting some exercise in that leg. Also make sure if you can that your hips are level by wearing a thick shoe or Even-up (Vaco Devizes will sell you one - see their website) on your good side. This will help to avoid straining your hips, knees and lower back.
Hi,
i was just diagnosed by MRI with severe tendinosis. I’ve been put in a non weight bearing cast for 6-8 weeks. Extreme?
smar11 - I would not call it extreme more like not particularly helpful in the long term and probably a waste of not walking for 8 weeks. I don’t know what you have done to now for treatment but here is an article for you to read. Just at the w’s in front (this avoids moderation) ncbi.nlm.nih.gov/pmc/articles/PMC2658946/
The article mentions corticosteroids but I would avoid this. Eccentric loading programs seem to be the most successful but if that fails it is generally surgery unless other treatments work. I have had some success with radial shock wave therapy. My best advice is to start researching treatments for this problem. Casting is still a treatment offered but if the problem is severe then I doubt it will have any significant effect long term. The resting of the tendon may give you some short term benefit and enough for you to start an exercise program. Not being a doctor or having your history makes this hard to call.
xplora-Thank you for your reply. So far I have done physical therapy. I have researched eccentric heel drops, but really haven’t followed through with them. Sounds like that is really the most successful treatment to try first.
I’m irritated with myself for allowing the doctor to cast me. In the back of my mind I didn’t really think that would be helpful, but he’s the doctor so I just went along with it. I’m scheduled to get the cast removed on Tuesday. He is planning to recast me, but I am going to refuse. I’ve found a different doctor who I think would offer more effective treatments. I plan on making an appointment with him.
I am new to the ATR world. Did mine 3 days ago. My doctor immediately ordered an MRI and within a few minutes of results scheduled surgery for Thursday. Of course I do not want nor am I looking forward to surgery and rehab. Mine tore off the bone and is resting 3 inches above in my calf. Surgeon who is also a friend says surgery is only way to repair and have a normal active lifestyle. We discussed treatment without surgery but in my case he says I will have no tendon if not repaired. Just wondering if anyone else has had same injury and surgery or non surgery for repair
Hursey, if you are unsure, get a second opinion today. But your age and activity level also are to be considered…
Good luck………. Manny
hursey - tendons will not reattach themselves to the bone so for you surgery is the only option if you want to be able to walk properly again. I am sure this is what you have been told. Usually they use screws to affix it to the heel. Sometimes a piece of bone comes away with the tendon and that is called an avulsion fracture. If the tendon has been damaged badly they may have to cut a bit away to get good enough tissue for the screws. This may leave you a bit short in the tendon but it should not be too much of a problem. The tendon near the bone is a little bit like bone so if that part is cut away all then the newly attached bit has to morph and the whole tendon has to glue itself back to the bone. Early weight bearing is discussed here a great deal and it is good for most AT ruptures but it may not be as beneficial for you. Make sure you discuss this with your doc. Hope it goes well for you. It is less common but I have read of several here who have come out well. You probably have more in common with those who have had heel spur surgery and maybe you have one too which can be fixed at the same time. There are many here who have been through this. regards, Stuart.
hursey, maybe my ATR situation was similar. My doctor at first suggested skipping surgery but then changed his mind after looking at my MRI. He said my tendon had torn so close to the bone that it wouldn’t heal well without surgery. He ended up reattaching the tendon directly to the bone. I’m 10 weeks post-op now, and the recovery is going well. I can walk now without discomfort and feel like I have most of my normal life back. The athletics will take a bit longer, but for me anyway, the recovery hasn’t been as bad as I feared.
Thanks for the comments. I had surgery 2 days ago. Not only was tendon torn off the bone it also had a tear and had to be lenghtened. Surgery lasted over 3 hours. Thankfully I have a great wife and kids because it has been no fun. Pain is worse than I had anticipated. I was able to wiggle my toes today and scoot around the house a few minutes. Tomorrow hopefully a bath and sit in a real chair. I’m going to take it slow so that I can get back to my active life sooner. I run 4 restaurants, a catering company, and work out 5 days a week. Hate all of us are going thru this injury but this site is very encouraging.
Welcome to the involuntary membership in the Achilles Clan, hursey.
I joke around a lot, but our very long rehab process is a serious matter. The good part is that we learn a lot from the experiences, and the forced rest.
I admire your great activity level, and, forgive me for sticking my nose in your business, I also suggest you get someone to be your “right hand” (and two feet) for the coming three months (at least).
Most of us who have gone on regular work hours have had a tough time of it. Knee scooters are great for those who have no pain or issues, but some of us have had a hard time meeting work requirements. As an entrepreneur, I know how much you have to move around (do you do the produce purchasing yourself at the markets?), and how much love and attention your 4 restaurants and catering business must receive from you. “Manage and delegate” could be your mantra for the next couple of weeks…
OK… end of busy-body message.
Feel free to read everyone’s posts here. We are an eclectic group and there are lots of suggestions and cause-effect comments here. And, since you work out regularly, Check out Bonnie and Stuart and Bobbie, who have lots of great info on exercises. Of course, I forgot many names, but you get the idea. And, if anything comes up surgery related, Metonia’s blog posts are a wealth of knowledge and links.
Please do post your experiences and how you adjust to this year long recovery. As an entrepreneurial promoter and coach I’d love to know how you use this lemon life gave you to make all sorts of wonderful dishes, and not just lemonade!
Manny
Manny, thanks for the comments. Work takes up to 80 hours a week for me especially during catering season. I travel up to 6 hours away to cook for people. I love my job. Thankfully we are a family business with great employees. I’m looking forward to my son and a few others stepping up and realizing they can do the job. Of course next few months i will be in a different role. That will be good for me to learn how to turn jobs over and trust my employees. I know they can do it cause I have trained them well.
I’m so looking forward to Wednesday to see my surgeon. Get the first of many cast off.
What’s the easiest way for me to start my blog. Helps me knowing I’m not alone in this recovery
Hursey
You are most welcome, Hursey. See if your surgeon will give you the CAM boot (also known as Air Boot), which gets you up on your feet quicker.
It takes a few days, and then you are up and running! 
Practice the sad face in the mirror saying “You’re in charge of this, now, and I’m sorry I can’t help you” and remember not to laugh as they walk out of the office or living room… LOL
as for setting up your blog, the instructions are at the top of the main Achillesblog.com page.
Manny
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