beardedmurray’s AchillesBlog

Thanks for the nice post. Exercise with proper diet and lifelong commitment is the key to success. I have put together a website on Paleo Diet and lifestyle that you might be interested to checkout……. keep up the good work. - Laura

Met with the OS last night and given the all clear on pretty much everything based on pain tolerance and no fear of rerupture by regular activity (no basketball!). Said the tendon feels great!
I was surprised to hear that, as he has been on the conservative side, but it gave me the confidence and must have broken the mental block I had. I’m no longer limping without the boot and taking longer strides today so I shoveled snow in 2 snow boots this morning. I don’t think I will use it at the airport or from now on. Amazing how the mental aspect plays such a big role.
Also said the discoloration is normal as it will still swell for another 6 months or so with use.
My PT attended the appointment with me with the OS to give the update in person, I really thought that was pretty incredible to have them discuss the progress made and PT moving forward. Looking forward to PT tonight to try the new exercises.

My leg sounds like yours in the color department. In fact, I snapped a picture of it this morning to show my PT.

Good luck in the airport and safe travels.

Many of us experienced asymmetrical leg colors. I think mine started BEFORE my ATR, and I’m not symmetrical now either, after rupturing BOTH of them! So I choose to believe that this is a trivial, normal, and harmless thing, though based on not much other than (a) that experience and (b) the fact that any MD I’ve mentioned it to responds by saying “Next!” (I.e., next item on my list of concerns.)

If the boot helps with your discomfort from standing or walking too long, you could certainly wear it. I don’t think my boot helped much with that, so I might take a folding camp stool in a backpack, and sit down on it in the long slow lines.

Alternatively, airports (like hospitals) are comfortable with people in wheelchairs and people who need lifts in their various electric vehicles. I don’t know if they have loaner wheelchairs like hospitals do, but a phone call should answer that question.

Don’t forget that long flights AND ATRs (esp. op) are BOTH risk factors for DVT, so drink water and stand and walk during the flight.

My PT has pointed out the adhesions and really works on them for me during therapy, I am meeting with my OS today for the 12 week follow up and racking my brain for any questions for him, I am mainly going to ask about pushing my rehab and warning signs to look out for. I also noticed my ATR leg is quite a few shades darker (almost purpleish) than my other leg some of the time and not sure why the circulation is so poor, want to be sure its nothing serious.

I am going to travel in the next week and am worried about the airport and walking/standing in line forever as it is always busy at OHARE, wondering if I should just use the walking boot to avoid potential issues…any experience there???

Not much to add.

As you know, all the modern protocols (op and non-op) wean off the boot well before 12 weeks. If you’ve got a hinged boot, and it’s free to hinge, I don’t think it’s holding back your progress very much.

In 2 shoes or barefoot, you can still get a full-length stride on one side, even if you have to shorten it up on the other. That asymmetry is harmless and useful, AFAICT.

Have you noticed any scar-tissue adhesions? I.e., do you notice your skin moving or puckering when you flex your ankle to its limits? If so, point them out to your PT and challenge him/her to break them up, because they’ll limit your ROM.

I had no idea what the Alter G Treadmill was so I Googled it. What a fantastic looking device! I especially like the pants you put on before you climb aboard. I doubt my PT office will have something that fancy. I will let you know if they do.

Vicki

The progress comes pretty fast where you’re at, at least it did for me. I just noticed today that I’m not really having any of the pains I’d been complaining about along the sides of my heel - tightness is my main calf and achilles complaint these days. (about 16 weeks out)

Thanks Viki congrats to you as well with your progress!
rdola I am at Athletico in Oakbrook Terrace Id like to hear how you like the AlterG when you get to that point. Thanks for the advice thats what I really wanted to hear about my part time boot wearing! If anything the nice weather today will ensure there is no ice patches or snow to deal with I think I will carry my walking boot to the car after work!

Sounds like you are progressing nicely, BM. And it is like reading my timeline. I am 13 wks post op for full ATR tomorrow, in 2 shoes for 3 weeks. Tendon and front of ankle still a bit tight but small improvements every couple of days with the PT. I am going to athletico in niles, IL (see you’re in the Chi-town area), they have an AlterG there but I’m not on it just yet, need a bit more calf strength. I ice every night for swelling as well, but again, every couple days it gets better. You may want to ditch the boot if you can, your gait should come back quicker. But of course, do what your body tells you. Good luck! I’m sure you will hear from n-o-t-n or janis shortly

Congratulations! Sounds like you are making progress. I just started in 2 shoes on Friday and go to my first PT appointment on Wednesday. Super excited!

Keep up the good work.

Vicki

10 Weeks and walking fine, there was a huge leap in progression from writing this to the end of that week able to walk into a store without crutches and now very comfortably walking long distances on the boot.

Keep up the good work! I can tell you that if you keep working, it gets a little better every week. Sometimes you can notice a leap in progression even over a couple days’ time.

And make sure you build up your uninjured foot so it’s as high off the ground as your booted one. That may be tough with 5 heel wedges, but it’s important.

And install the ATR Timeline Widget if you can, please.

Hi BM,

Biking at 8 weeks is good (I started at 7). The one thing that is a bit strange to me is still having 5 wedges while FWB. By the time I was FWB (week 6), my PF was at 0 (no wedges).

That said, you should be moving faster and faster as each day goes by, as long as you keep up your PT.

While ROM is great for general PT, it takes muscle and tendon strength for gait\walking, etc. So be sure to step it up regarding PT, and not just ROM work.

Either way, keep us posted and good luck.
Ron

I just started using the Even Up shoe leveler it is a world of a difference it feels way more natural now and minutes ago i was able to go without crutches for a short distance, it is not smooth yet but it is pain free. Progress.

If your boot is snug enough and stiff enough, you should be able to walk fine and fast with no pain — at least none close to the ATR. Some of us were super-sensitive on the bottom of our foot after weeks of NWB, tho that’s usually worse in 2 shoes or barefoot than in the boot. The trick to boot-walking is to use the curved boot sole to roll from heel to toe, pushing your knee forward as you do. The boot should transfer the force a normal AT applies, from the ball of your foot to the front of your shin — i.e., from the front of the boot’s sole to the top-front of its cuff.
I think RyanB has a good video, and I’m sure YouTube has more. When I was used to my boot, I could walk faster than all of my friends! (Then you slow WAY down when you “graduate” to 2 shoes! ;-( )

BTW, I consider using 1 crutch to be the Work of the Devil, and I avoided it. Tried a cane for a day or two, then blissfully started forgetting where I’d left it. With 2 crutches, it’s possible to walk completely normally except for your weight being shared between your healing leg and your arms/crutches. With 1, you’re always lopsided.

A propos: As you approac

…also OS doesnt want me to use a stationary bike, and the PT said he wont go against doctors orders and stated that i would be firing on my calf muscle which might disrupt the surgical repair. I have read others accounts of stationary biking once boot is on and was hoping to do so for cardio. Did you just do it or was OS/PT supportive of it????

@Bearded: I was a nervous Nelly when I first got in the boot. I think that is totally normal and to be expected. I think the best thing to do is just gradually start putting more and more weight on the boot–you can use two crutches at first and then drop down to one. (I skipped the one but I think you are suppose to use the crutch on your good side.) Make sure that your foot is securely fastened into the boot–that’s my best suggestion. Once you relax and get the hang of it, you won’t be looking back. Hope that PT helps you sort it out. Good luck!

6 Week visit yesterday and received a walking boot finally… it is really heavy and bulky but so glad to be able to start washing the layers of dead skin off!
It is stationary with heel wedges. I am to leave the wedges in place for 2 weeks then remove one every 3 days. I am WBAT and have not been able to T yet. Feels very awkward trying to put weight on the foot with a boot on, a lot of tightness in the tendon area along with pain in heel/foot/calf. Very timid to try it so far. Seeing PT for first time tonight as well so hope they can help me thorough it. Any advice on first few days WBAT with a walking boot?

Hi beardedmurray, it really is disappointing when you don’t progress as you expect to isn’t it? Especially when it seems to be a very quick decision by the doctor and they don’t explain what it’s based on. And of course since he mentioned you’d be in the boot last time he saw you, it’s a real knock when you have to wait longer than you expected.

Hopefully these two weeks will pass quickly for you anyway and your tendon will feel strong once it comes to putting weight through it in the boot. Good luck for your next appointment!

Ohhh I’ve been where you are and I felt the same way you do. I agree with Stuart 100%.

I am a rerupture, so I didn’t really have a leg to stand on (pardon my pun) when I balked at having to be in a cast for 6 weeks post op. So 6 weeks in a cast, and 5 weeks in a boot. I don’t think any of this impacted my recovery. I’m 6 months post op now, I’m running at 62% of my bodyweight (I’m up to 6 miles & 7.5 mph) and can do a single heel lift. In many aspects I am much better off than before my injury.

Everyone heals differently, but I found the most important thing about this recovery (for me) is grit and attitude.

I think they don’t wash the leg when they change casts, is because it was sterilized from surgery. I finally asked if i could wash my leg when I went for my 2nd cast change, and the nurse wouldn’t touch it, she gave me a towel and a bucket with water.

My defiance was walking in my cast.

Sometimes it takes a huge storm to clear the sky and then the sun comes out. Your sunny day will come soon.

Take care!!!!

That is disappointing! For what it’s worth, even though I was in a boot from day of surgery, I wasn’t supposed to WB for much of that.

Your post brings back memories. I remember feeling anxious about getting out of the cast and into a walking boot. My queries fell on deaf ears too. Sounds like you are keeping in shape and making the best of the situation. Two more weeks and you can start WB–while not optimal compared to some of the people around here, I have a feeling you will make up time on the other end. Hang in there.

Murray - I know it suks when you read about so many others who have got into shoes quick or out of the casts but I really would encourage you not to worry. I have trouble with casts and convinced my doc to let me get a boot after one week. The evidence is there for early weight bearing and motion but from what I have read, given good PT you will still have a good result. One study I read (linked to my page under further reading - Xplora) said the real difference was in quality of life in the early stage and there was little difference in results after 2 years. I know this early stage is on your mind at the moment but in real terms this is the shortest phase of recovery. Try to be patient and think of the end game. The hard work will be starting soon. The anit spam word was optimism. Sometimes it is very appropriate.

Hi BM,

If you can move to a boot, do so. My splint also caused all types of issues and I had no feeling in my big toe for a week or so, but it came around. I am not sure the extent of your rupture, but the quicker\more you can move your toes and feet, the better.

I’m sure Norm and others will also have better advice, but hang in there and be a little pushy because Ortho’s don’t offer a lot regarding recovery\rehab, just surgery.

Good luck and keep us posted.
Ron

I asked my father with the knee problems and he noted that it was his opposite knee of the ATR that is bone on bone. I imagine this might be more common as you heavily overuse the healthy leg during the 6 month period or so. Personally my healthy leg hip joint is killing me every morning now for about a week from one leg standing/squatting to sit and get up, hope that isn’t a sign of more joint pain to come.. but I dont know anything about shortening of the tendon that sounds like it could throw off body mechanics though.

FWIW, I’ve had two hernia surgeries and one open-heart surgery, and my one ATR repair was the most painful, IIRC. (The big one was probably the LEAST painful. I turned down all the morphine, just regular Tylenols for a day or two until one of the surgeons said I didn’t have to take them! Shocking!)

Anyway, anybody who pooh-poohs the pain that ATR surgery CAN cause, has never had a painful one. OTOH, I’m sure lots of surgeons would rather ignore your pain until “tincture of time” cures it. So be your own Patient Advocate to make sure you don’t have a problem that’s being ignored.

My only ATR op (ATR #1) was about 10 yrs ago, so I’ve forgotten a lot. But I do remember staying in bed and moaning and groaning — and peeing into a cider jug — for close to a week. I was in a plaster cast-splint for that time, and then some. (Then a cast, then another cast. . . eventually a boot. . . conservative surgeon, not interested in any research I’d done.)

I don’t remember the kind of intense pain you describe. More like the feeling that my leg would explode every time I lowered my foot.

Your installments are GREAT!

So sorry for your pain. My first two weeks horrible also. My felt like my ankle was being choked. I actually ripped off my surgical dressing in my ambien sleep so I got my cast a little earlier than scheduled. (Halleluyah).

For me, the first two weeks were the absolute worst. If you can make it through that, you’ve got this.

Congrats on the birth of your son. I will say, you did give me a good giggle. Your toe will get better.

Take Care.

I will be 5 weeks post op tomorrow and toe still numb I’m on my second cast which arent as tight as the splint, plus I massaged the hell out of my leg trying to get some feeling in my toe while my cast was off but nothing yet. Working my way up to next set of blog update but still concerned about the toe and doctor is really downplaying it.

Wow, that sounds terrible! I had a block and minimal pain when it wore off.

I did have some big toe numbness, around the tip off and on, the first couple weeks postop. I think it had more to do with swelling than anything.

Fascinating stuff, Murray! I’d love to hear a recording of everything your ATR-obsessed OS told you — including the pitch on non-op, as well as the surgeries. I think most OSs are more ATR-bored than ATR-obsessed, and have one way they do the op, not two. Some have switched to minimally invasive, usually with a plastic guide/jig to help guide things. (I think 2 others have recently logged in here with that op, unless I’m double-counting you!)

I think most of us find that lying down flat IS elevating, and we wake up without any/much swelling, even if we don’t use extra pillows. All less so in the first short while after surgery than later, of course. Some people are sure that getting the ATR higher than the heart is vital; me, Not So Much. The higher it is, the lower the blood pressure and inflammation, but every bit helps, and if the swelling is down, it’s down.

BTW, a year after my second ATR (non-op that time) I went under the knife to get a heart valve replaced, and I discovered a similar discussion around full incision vs. smaller versions. I went with the biggie to make my fancy senior heart surgeon as comfy as possible,

Yes Chicago area. Non-op was brushed over as I insisted I needed to get back to pre-injury condition and it sounded like non-op was for people that didnt want to jump again, and I really didnt look into it before my surgery decision. I feel like I had quite the experience and my installments are very detailed so they will be coming slowly but surely.

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

Can I guess that you’re in the US? There’s a whole long page on this site about ER treatment of ATRs, much of it dangerously wrong. I think the majority of people here who’ve had problems dealing with chronic untreated ATRs got their start in an ER.
Now I’m betting your OS didn’t give you a full timeshare-sales pitch on the new (post-2007) evidence about fast non-op ATR treatment either — but I’m getting ahead of myself. When do we get the next installment?