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!