billb44’s AchillesBlog

Sue, you should start a blog page of your own, so we don’t have to keep meeting in the alleys behind other people’s houses! And if you install the ATR Timeline Widget, we’ll also get a quick update on your dates, which leg, where you are, etc.

Yes, fire that PT!

Your “weight bear only on my toes not through the heel” sounds weird to me. Without a boot, you would ONLY be able to bear weight on your heel. With a boot, its rigidity allows you to bear weight on your toes, by transferring the stress your AT would normally bear, to your shin. But your heel should be just as capable of WB as your toes. What many of us started doing around 2 weeks post-whatever, PWB, is “rehearsing” our gait, but (a) in the boot and (b) with the crutches still taking most of our weight when the injured leg is doing the walking.

Slip-ons could be scary, or not. Many of us loved wearing Crocs when we first got into 2 shoes, because the squishy gel was so friendly to our sensitive soles and heel-bottoms. People with wounds also have to be careful not to rub them the wrong way, with their shoes. And while you’re in the boot, building up your other

I ruptured my achilles on the 3rd Feb playing netball for the first time in 2 years. Went to a physiotherapist the next morning who told me it was a torn muscle. I then spent 8 weeks exercising and limping before going to my doctor who diagnosed a ruptured achilles immediately. Then came an ultrasound and MRI. Diagnosis of a 4.7cm injured area…. Surgey on my 56th birthday the 27th April. It is day 13 and just had bandages removed this morning. Wound is healing well and my black adjustable boot has been adjusted closer to a right angle and I am allowed to flex my foot within that boundary ( pointed to nearly normal) and weight bear only on my toes not through the heel! Crutches and partial weight bearing for the next 4 weeks is the plan. But then I need a built up shoe. Am I right in thinking I need a pair of flats that are firmly attached to my foot not slip ons? Coping well with it all as the end is now in sight… after a small amount of time spent cursing my ex physio!

I hope your “up to 4 months” ends up like those “save up to 75% off” sales in some stores!

Your Doc’s right that there are no big studies on long-delayed ATR surgery, but all the big studies that HAVE been done (mostly on “normal” ATRs) show that slow conservative immobilization is neutral (aka useless) or negative (aka harmful). Many or most surgeons still over-immobilize (and over-NWB), because it’s so easy to imagine that longer babying will be helpful, even if the evidence consistently shows the opposite. Harrumph!!

At least at FWB, you can carry stuff around, even if your choice of footwear is way limited! I don’t suppose you were lucky enough to get a HINGED boot? Either way, make sure your uninjured side is “built up” as high as your boot side, so you don’t destroy your hips and knees and spine walking off-kilter for “up to 4 months”.

great news on the 90 degrees! besides being able to take the boot off to do basic ROM with your ankle, there shouldn’t be much difference between the cast and boot for the next couple of weeks anyway. just try to enjoy the downtime and keep reminding yourself that you’ll be back on your feet in time for summer…

Looking forward to you posting a pic of that scar when you get the cast off. If you are set at 90, that is great. It took two casts to get my foot to 90 so you are already ahead. Can’t get the doc to go for the boot at 4 weeks total? We all have different time lines and you are on your way now. I think my hardest days mentally were getting used to moving around with the cast and doing day to day stuff. Just rest and elevate as much as possible. If you keep the swelling down that will pay off in the end. Good luck and keep us posted!

The sound of the crutch IS a dead give away gimp is a comin! The real world feels good even if it is work I bet.
Monday you will probably get your stitches out(if you have them) and a first look at your doc’s handiwork. It’s kinda exciting in the AT world. You have to take your jollies where you can get them at your stage.
Let us know what happens and what your doc’s protocol is!
Have a great weekend warming the couch!

Thanks for the advice. I’m making a run at going into the office. I have one co-worker to drive me in and another to give me a ride home. They have a wheelchair in the office if I find that I need it. I think a single day will be alright for this week. I’m actually get a lot done sitting at home.

I’m hoping for a boot. I have my 1st post op visit on Monday. My Dr said that he makes the call at that visit based on what he sees. The study supports the boot but as norm mentioned their subjects were fresh ATRs.

Hi there,

I concur 100% with norm. I was in a boot FWB with five wedges at week 2 there is absolutely no pressure on the tendon in that situation. All of your body weight is taken up through the heel, you still have to be uber careful though if you fall forwards or slip off the kerb there is still a chance you could re-rupture your AT. The other thing to watch for as well as the swelling is the incision opening up and becoming infected. I had to have a second op to remove an unwanted suture which has set me back about three weeks. The main thing is be patient, you are going to take around 12 months to get back to normal. You may be walking after about three months but you wont have a calf muscle so you’ll walk with a pronounced limp. The strength returns slowly week by week. I am just over 6 months from surgery and am probably about two weeks away from doing a quality single heel lift. Mind you if I lost a couple of stone that might help!!!

All the best mate — Andy

Fight for a boot! “Neutral” isn’t necessary or relevant — the best boots can hinge and lock into a fixed non-neutral angle, and all the simpler boots can accommodate hard-rubber heel wedges that do exactly the same thing, for the first few weeks. My fave protocol — bit.ly/UWOProtocol — uses 2cm of heel wedge for the first 6 weeks, then neutral. It also gets you exercising and into PT and PWB at 2 weeks, gets you FWB walking at 4 weeks, and gets you out of the boot (”weaning”) at 8 weeks. I don’t think there’s much excuse to go slower, given their excellent results (with and without surgery, though their patients were all admittedly “fresh” ATRs).

Returning to work is up to you and your employer (and your wife, if she’s doing the driving!). Many people travel while booted, or even on crutches. The main accommodation is usually sitting and elevating a lot, until you get the swelling under control. That part of the schedule is hugely variable among individuals — I personally posted a blog page with a title like “This swelling is getting OLD!” Post-op patients have to think about not “angering” their healing incision, lest things

sorry to hear you’ve joined the club, and best of luck. I was able to work from home for 2 weeks after my surgery, and then took 2 weeks of vacation before returning to work at 4 weeks in a boot. by the time I went back to work I was able to get around in just the boot without the crutches, much to my ortho’s disappointment. if the need had presented itself, I could have worked out of the office those first 4 weeks with the crutches, although my wife would have needed to drive me (I ruptured the right achilles).

according to my ortho, the biggest driver for boot or cast is whether or not your foot will go to “neutral” at the first follow-up - mine did, and so I was able to go straight to the boot. my brother, on the other hand, ruptured his achilles a couple of years ago and was in a series of casts for 8 weeks before finally moving into a boot.

it will sound absurd, but enjoy the down time for the next couple of weeks. you’ll be back on your feet before you know it.

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