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!
March 10th, 2009 at 7:21 pm
Hi Sweetie! You are doing great! We are so proud of you for working through this! XOX
March 11th, 2009 at 1:16 pm
Hi Bode
Thank you for posting the above.
I rutpured my left achilles on the 1st Feb and had the op on the 5th. At my 2 wks post op appointment the Doc said that I would be in a cast for 8 wks and no boot as ‘boots are to expensive’.
I was furious and demanded a 2nd opinion from a different doc who put me in a boot at 3 wk post op.
So now I am 5 wks post op and in a boot pwb.
The above info is fantastic and that is the programme I am going to follow. I am going on my holidays to Oz on the 1st May so hopefully I will be walking then
take care
Robby (UK)
March 11th, 2009 at 6:56 pm
Hi Robby, Thanks for sharing your story and great work getting the 2nd opinion–you made a good move on that one. The key for me with the boot is to be disciplined and wear it 24/7 except for the motion exercises and even then I am very careful–I don’t even stand up to take a hop without the boot on just to be safe. Good luck with your recovery and being able to walk on your holiday!
March 11th, 2009 at 7:45 pm
Hey Bode–I’m a Fargo, ND guy–so not too far away–also suffered my ATR playing hoops. The parallels don’t end there–I was also on an aggressive recovery plan; I was in two shoes at about 5.5 weeks post op, still using crutches as necessary and 2 heel lifts. To make a long story short I am now 16 weeks post op and have loved the aggresive route, and found it to work well in getting me back. No hoops yet, but I am running on a treadmill…funny, it’s my lungs and the rest of out-of-shape-me that is the problem now more than my repaired AT.
March 11th, 2009 at 8:16 pm
Thanks for sharing! Good luck on your recovery!
March 12th, 2009 at 3:54 pm
my doc is kinda different, he first told me that i would be NWB 6 weeks, but bumped that up to FWB at 6 weeks. i was splinted for 1.5 weeks cast for 2 weeks and boot with no heel lifts or planter(or dorsal) flexction going foward. I get to start PT after 6 weeks (I am 5 weeks today). My opinion is this. I think that old-school thinking is to keep it immobile for a long time but new school is to get it mobil soon. my doctor is maybe 38 years old so he seems very aggressive. the sad thing is we havent discussed 2 shoes, and I dont see him again until the beginning of April. I miss my right shoes. Funny side note, i can find 2 of them. All my left’s are present and accounted for. 2 rights are AWAL I was looking for my tennis shoes and i cant locate the right. So i started looking for all my right shoes and i can’t find another dress shoe.
March 12th, 2009 at 4:19 pm
Hi Matthew, Thanks for your comment and the shoes gone missing story, too funny! It sounds like you are on a good pace going to FWB at 6 weeks. I just started FWB today which is exactly 6 weeks post op. I did PWB for 2 days after my Dr. gave me the green light and said I could go FWB whenever I felt comfortable. I am so sick of crutches that today I finally tried walking in the boot and it was okay. My calf muscle is sore already and I haven’t really walked around much so I think I will pace myself and not try to walk too much too fast but I do want to keep this recovery moving so I can get back to 2 shoes. Good luck finding your shoes!
March 12th, 2009 at 4:25 pm
Hi Andy-Thanks for the update on how well you are recovering at 16 weeks. That gives me hope. How did you like that last winter storm? I heard you got pounded pretty bad up there in Fargo. We only got an inch but the cold sailed in -4 this morning. Can’t wait for spring and being able to get out and walk, run, ride.
March 12th, 2009 at 6:54 pm
Hey Bode,
We share a date we won’t soon forget. I’m a Jan. 27th guy too. Went to two shoes today and what a feeling. Happy to hear that you have a race on your schedule. I am thinking of doing the same to give me some motivation to get me back into an exercise plan. I am happy to hear that you got your plan modified and are making such great progress. Good luck!
March 13th, 2009 at 10:47 am
Bode, glad to hear your recovery is going so well. Keep up the good work!
My surgery date was also on Jan. 29th, so we’re right on schedule. I think the only difference btw me and you is that while you were put into a fiberglass cast at 2 weeks, I started with the boot at 15 degrees for a total of 10 weeks. Yesterday, I was cleared to FWB (exactly 6 weeks post-op) and my boot was moved to neutral. I also got my PT scrip.
Hobbling around with a cane is SO much better than PWB (even though I am slow as molasses). There was no mention of 2-shoes just yet, but I’m just excited to be “walking” again.
March 13th, 2009 at 11:49 am
Hey Fammin, Glad to hear you’re FWB and recovering so well. I just tried FWB yesterday and again today and I’m totally with you on the “slow as molasses” bit. I was able to move pretty fast on crutches and using my leg caddy, now I’m back to creeping along. It is good to be hands free though and walking about with the boot. I’m really trying to be diligent about the hourly ROM exercises but it’s a lot of boot off, boot on, boot off, boot on…I do feel like it is helping so I’m keeping at it. Thanks for your update! It all helps me stay positive!!
September 10th, 2021 at 3:49 am
Will it work fineWill it work fine, I will try it for my work, waiting for more posts from you., I will try it for my work, waiting for more posts from you.