5-wk post-op from shortening surgery; 19-month update

Hi All,

It has been months since my last post, but thought I would add this for the benefit of all.

To recap, full ATR was Dec 2014 followed by non-op protocol.  In Nov 2015, a surgeon with much ATR experience confirmed via visual exam that I healed long.  I suspect long heal caused by loose plaster splint and too much early dorsiflexion past neutral.  Symptoms of my long heal:

- 1-2 cm heal lift max

- cramping, fatigue, twitching in calf muscles, especially after exercise; I could run 6k on treadmill, but fatigue and slight limp after this

- calf muscle atrophy (~3 cm smaller in girth)

Seven month wait from exam to shortening surgery on 9 June 2016; ~1.5 cm of tendon removed.  No pain and very little swelling to date.  Tendon is definitely tighter now. Here is a summary of protocol (surgeon’s ATR protocol)

- wks 0 to 4: NWB in casts with foot at ~30 degrees (surgeon increased this from 2 to 4 for me)

- wks 4 to 8: PWB in VacoCast at 30 degrees increasing to FWB; NWB exercises, pool exercises

- wks 8 to 9: FWB decreasing angle 5 degrees each day as tolerated (physiotherapist not familiar with VacoCast but after demonstrating, agreed to substituting an airboot and wedges with the Vaco); transition to 2 shoes at end of week

- wks 9 to 13: wear AchilloTrain Pro (soft compression ankle brace by Bauerfeind); range of motion, strength proprioception exercises; do not allow ankle to go past neutral during this and previous stages; no lunges, squats as these place excessive stretch on tendon)

- wks 18 plus: increase dynamic weight bearing exercises (jogging, weight training, etc)

- at 6-9 mos, if patient has regained 80% strength, return to non-contact, non-sprinting sports

- at 12 mos, if patient has regained 100%, return to running, jumping sports

Comments on protocol welcomed.  Thanks to Stuart for earlier feedback.  Really looking forward to getting this behind me and trying to be patient. Happy healing to all!

10 month update

It’s been nearly 10 months since ATR and non-op treatment.  I had an appointment two days ago with local foot ankle OS. With legs horizontal, she measured resting DF ROM three times in both legs and found about 6 degrees greater DF in injured left compared to right. This would suggest the Achilles has healed slightly long. She then measured the distance from behind knee to top of heel bone and found injured left to be about 2 cm longer. She has ordered an MRI to get a better measure of the Achilles in an effort to determine if it has healed long. It will take a few weeks for the MRI to be scheduled due to a wait list.

I have some tendonitis in my peroneal tendon and she agreed that this is likely due to the peroneal compensating for the Achilles. I think the peroneal became tender during eccentric exercises so I have backed off on these for now.

I may be a candidate for shortening surgery in order to improve push off strength and that would mean going thru rehab again.  The waiting and uncertainty of surgery are challenging.  From what I have read, accepting or not accepting a strength deficit is a personal choice.  I think some of my lengthening was the result of accidental DF (Achilles stretching) during the first two months.

My foot ankle OS has referred me to her colleague who specializes in Achilles, but is 4 hrs away.  I believe he is the closest OS that performs shortening surgeries.

Relief for calf tightness?

Hello fello ATRs

I am 9 1/2 months since start of non-op ATR treatment and I have been in two shoes for ~7 months (similar to UWO protocol).  I would really appreciate some feedback on how to relieve the tightness in my calf.  Perhaps there is a diet or vitamin(s) that can help?

  • one leg heel lift max is say 2 cm; strength deficit with injured leg and I can feel this and tightness during walking push off; I am also working at increasing push off strength and this has been a struggle
  • calf girth is 35.5 cm vs 38 cm on good leg and this has not changed for months
  • Achilles has thickened in rupture area, but this has reduced with time
  • I have a desk/office job but walk from my office when I feel the need
  • drinking water to keep muscles hydrated
  • soleus and gastroc are noticeably tight after being sedentary (sleeping, sitting, etc)
  • some mild pain in Achilles during walking push offs and heel raises
  • massage provides only temporary relief if any;  no relief from tightness during PT as this involves exercises and muscle stimulation

All comments welcomed!

Nine months…should I try surgery?

Hi folks,

I would appreciate input/advise…(thanks to Norm and Stuart for their kinds words at the ~7-month mark).

Full rupture of my left achilles Dec 1, 2014, nearly nine months ago. Treatment was non-op as is common here in Canada, 12 days in plaster splint, followed by Breg (make) boot with wedges.  I believe I have healed long and am looking for options to get closer to 100% recovery.  Rehab protocol was UWO, but that was during winter and I slipped on ice more than once and was using crutches during the first two weeks.

I met with a foot-ankle OS today and discussed options (1) shortening surgery or (2) more time to allow for healing.  The foot-ankle OS believes I healed long as there is less dorsiflexion resistance when she pushes up on my injured left foot compared to my uninjured right.  The treating General OS had similar thoughts during an appmt four weeks ago.  Range of motion is very high and similar in both feet.

I have read through TomTom’s blog and other veterans’ blogs on the healing long issue.

I am now 50 years old, 5-10, 180 lbs, and fairly active - walking, group road biking, exercising at gym, downhill skiing are main activities.  I visit with a PT 2-4 time per month who works on the scar tissue, dry needles (electronic pulsing) the calf, gives me exercises, etc.

Here is what I am experiencing:

(1) left calf atrophy: 2 to 2.5 cm smaller than right

(2) wimpy 1 to 2 cm heel raise and sometimes brings pain to left achilles

(3) 30 minutes of elliptical or running results in sore/tight soleus-achilles and some ankle stiffness, all in the next 2 day; similar result with 1+ hr of road biking or 3 x 15 sets of 2 up 1 down bent/straight knee heel raises on flat surface; there has not been any swelling for months.  Slight limp is present after a 30-min run.  OS recommends no running or elliptical for the next four weeks and wearing a ~1 cm or more heel wedge in an attempt to tighten the achilles (I have been trying with little if any success it seems).

(4) unable to hop up and down on injured foot (heel strikes floor)

Although I do not like the prospect of surgery and rehab, I also do not like the prospect of having a weak calf/long achilles for the rest of my days.  Perhaps I am being impatient as it has been only 9 months.  I have not had any significant surgery and so am also concerned about complications from surgery.  If I was not active, the choice would be easier - continue with the non-op recovery.

Thanks in advance.

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