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Archive for March 10th, 2009

3rd Dr. visit-Positive Progress-Early Motion Treatment

My doctor is moving me along now a bit faster than originally discussed and I am very happy about my progress.  I am following the plan outlined in an article titled, “Early Motion for Achilles Tendon Ruptures: Is Surgery Important?” written by Bruce C. Twaddle and Peter Poon and published in The American Journal of Sports Medicine, Sept. 20, 2007.   You can read the abstract here (the full article is available for a fee).

Here is a summary of my treatment plan so far and what is still to come.  I did not follow the plan in the article exactly from the beginning but plan to from now onward.  I’ll  first describe what I experienced and then give a quick rundown on the plan from the article.  Hope this helps.

My experience to date:

  • ATR playing basketball on Jan. 27
  • Surgery Jan. 29, spinal block, outpatient. 
  • 2 weeks in a splint, toes pointing down @ 25 degrees, Vicodin for pain 3 days, then Advil/Tylenol 2 more days, lots of elevation and ice
  • 2 more weeks in a fiberglass cast, toes pointing down @ 20 degrees. Advil/Tylenol for cast discomfort/agitation
  • Moved into a boot, 15 degrees pointing down for 1 1/2 weeks
  • Today–boot moved to neutral position (5 1/2 weeks post op) with partial weight bearing allowed 

Plan going forward: 

  • Boot in neutral position, partial weight bearing moving to full weight bearing over next few days/week based on comfort level, daily exercises include moving foot up and down, massaging scar area, and light stretching with towel behind toes gently flexing toes, ice/heat as needed, no boot needed at night
  • Continue with boot in FWB for until 8 weeks post op (2 1/2 weeks from today)
  • Move to two shoes at 8 weeks and then begin PT, do toe raises with good leg supporting bad leg
  • Next Dr. visit at 12 weeks post op

Now after reading the article I realize my treatment has been a combo of the more traditional approach of immobilization and this newer approach of early motion.  For those just starting out, you may want to research this further and talk to your Dr. before you start.  The study really impressed me as it makes the case for early motion and the results of this study showed similar results for both operative and non-operative treatments.  It seems that most people on this site have opted for surgery and according to this study the non-operative group did equally well as the surgical group.  It seems that the non-surgical method when combined with early motion may become the preferred method over time if more studies can confirm these results.  This is all very fascinating to me to see treatments vary so much among doctors and how they continue to find new and better ways of treating the same injury.

Here is a summary of the treatment as I understand it from the article (please read the full text for details).  The same treatment was given to both the operative and nonoperative groups.

  • 10 days cast
  • Move into a boot with 20 degrees of plantar flexion (toes pointing down) non weight bearing–here’s the cool part–every hour, remove boot and with leg hanging off the edge of a bed or something so your foot is off the floor, flex foot upward toward neutral  but not past neutral and allow gravity to let it fall back down.
  • At 4 weeks–still non weight bearing, foot brought to neutral position, same exercises as above
  • At 6 weeks–partial weight bearing, no boot at night, same exercises, moving to full weight bearing over time
  • At 8 weeks–two shoes, toe raises using good leg to support bad leg, starting PT once able to do toe raises on injured leg
  • no significant differences were found between the surgical and non-surgical groups using this method according to the study

I am now just about at 6 weeks and will be following this method going forward so it seems I did not lose any ground by being in the cast for 2 weeks as I am now in neutral position and starting PWB so I am hopeful that I can follow this protocol going forward and have a complete recovery.  I also got the okay from my Dr. to register for the Chequamegon Fat Tire Festival (a 40 mile mountian bike race) scheduled for Sept. 2009 in Hayward, WI.  She seemed to think I would be fine to ride so I am going to submit my application (they have a lottery drawing to limit the # of racers) so we’ll see if it’s meant to be or not.  It would certainly give me motivation to get back in shape.  So it was a great Dr. visit and I’m feeling positive about my progress so far.  Cheers!