Posted by: brendan | March 31, 2008

Discussion Topic - Other AT/Re-Rup?

So I got to thinking yesterday, I read somewhere, maybe on this site, that once you rupture one of your AT’s…..the chances of you rupturing the other one goes up significantly.   Alright…maybe your are thinking, “Why the heck do you want to talk about tearing your other AT during recovery?”….well, I’m a bit of a perfectionist…and I don’t want this to happen again…apparently, unlike this guy:   

 http://news.bbc.co.uk/sport1/hi/football/teams/o/oxford_utd/3654558.stm

 The discussion topic is:  What types of things will you do/change to try and prevent this injury from happening again?   Here’s my list so far:

  1. Never play Basketball, Soccer, Volleyball, Tennis, Raquetball, Squash, Badminton, Football, Ultimate Frisbee again :(   Stick to bike riding, golf, and gardening.
  2. If I do play those sports again, take a few months to slowly get back into “game shape”..do this everytime I take more than a month off of these activities.
  3. Adequate warm up - 5 minutes of stretching not going to cut it…take 3o-60 minutes to stretch, ride bike, practice, etc before “gametime”
  4. Daily stretches, isolating the calf/ankle/AT.
  5. Work strength exercises into routines, isolating calf/lower leg to keep that muscle strong.
  6. Do nothing…it’s all genetics you goofball!

I also think it’s worth pointing out as we all are progressing nicely in our recoveries, not out of fear, but out of the reality of our situations, that re-rups happen.   Although, back to Johnskiers post about survival of the fittest…fear is not necessarily a bad feeling, you don’t necessarily want it to run your life, but having ”fight or flight” is deeply rooted in our hypothalamus….it’s what keeps us from walking in front of that car speeding down the street!

A guy on a forum out of Australia, gathered some re-rup data on the people that were posting and he came up with:

http://www.marfell.me.uk/nuke/modules.php?name=Forums&file=viewtopic&t=723

my observations:

1. all the reruptures listed here happened within 5 months of surgery and 82% of them occurred at around 3 months or less.

2. a) out of the 5 reruptures in the conservative group, 3 were just walking, and 2 were doing physio when the 2nd tear occured.
b) out of the 6 reruptures in the surgery group, 4 were falling accidents, while the other 2 were just walking and climbing stairs. furthermore, out of the 4 that were accidents, 2 happened even before they were supposed to bear weight on the tendon.

these are the reported incidents:

conservative treatment / 5 reruptures:
1) at 2.75 months- walking in the street
2) 2.75 months- climbing stairs
3) 3 months- walking on the beach
4) 3.5 months- physio (going on tip toes)
5) 4 months- doing physio

surgical treatment / 6 reruptures:
1) at 3 months- walking in kitchen (toe push off)
2) 3 months- walking up stairs
3) 3.75 months- accident, twisted while stepping in hole in yard
4) 5 months- accident, tripped on curb
5) 2 months- accident, crutches slipped
6) 3 weeks- accident, tripped

Again..not trying to be “Debbie Downer”….just want to get us all fully recovered with no major setbacks.   Let’s hear your thoughts

Responses

That’s a good list, and definitely something to think about. We wear seat belts because there is a risk of vehicle collision, and we do that to reduce the risk of injury. If you know where danger lurks, you can do your best to avoid or lower your exposure to it. So I don’t think you are being a “downer”. Some other factors that I would like to know on the reruptures are, what other medical conditions if any, bodyweight, age, type of surgery, smoker, diet, just to name a few. One thing I do notice is that with surgery there are no ruptures in physio for this sample.

So the question is, what can we do to minimize our risk? Could the person who ruptured in the kitchen have been wearing a different type of shoe? Is there a brace that helps? I know bodybuilders can tear tendons because the muscle grows faster than the tendon. Is it best to keep the muscle “weak” for a while? Would some sweet high tops or boots be better footwear than just shoes? Blah, blah, blah, and blah. You get my drift. On to the next stage of information gathering!
Jim

That definitely makes me want to wear the boot again. Yes, it’s probably wise to be back in the boot..

[...] has posted a fantastic discussion topic!  Here is the link.  I knew my response to the topic would be lengthy, so I thought I would write a post rather than [...]

Life is meant to be lived not sitting on the sidelines. Quality of life means that you are doing the things that you love. If you are consistly analyzing on how to prevent things than we would not eat, drink, drive, or have a pool in our backyard (Freakonomics). I plan on getting back to racquetball, but for a year I need to swim, golf, bike and give my body time to heal. As for genetics, definitely a factor, both uncles ruptured thiers at the same age as me.
Remember an ounce of prevention is a good thing but a pound of it….no way
Have a great day, and we’re one day closer to the end.
Doc Ross

i was just talking to my hubby about this before i signed onto the blog
it’s one of my worries too
my good foot is sort of aching probably because of the hopping and it compensates for my left foot
my achilles hurt too, i need to ice it everyday
i hope it’s just normal…as anyone experienced this too?

dennis was mentionning that it would be wise to get back in the boot
what do orthopedist usually recommend?
once you FWB (8-10 weeks?) the boot is off
is it recommended to still wear it?
so many questions…

now i’ve read the links you sent us brendan
there’s one that i like:

http://ajs.sagepub.com/cgi/content/abstract/33/1/119

it basically explains that chances or re-ruptured is much higher in athletes 30 and younger
that was a relief for me!!
almost nil for older folks like me
so…let’s not worry about it and let’s nurse our foot
take it easy…recover
get back into business in 1 year…

Nancy - Brendan and I both commented a few weeks ago about our other achilles being a bit sore (and I was slightly paranoid about hurting that one). Once I stopped hopping around so much that subsided. Pretty good now…no worries.

Are you thinking of getting “back in the boot” because it’s sore? That sounds like a good question for the doc.. Maybe it’s overworked a bit and needs a rest?

Nancy - like johnskier said, I too experienced some good tendon soreness and ankle pain in my good leg. I did notice it was after lot’s of crutching that day..so now I just take it easy…and if I have to crutch a long way, I go slow and make sure to do full heal to toe steps, making sure not to come down on my toes (putting more pressure on the AT). I also ice and massage a bit at night if it’s sore.

Brendon,

I would like to input my timeline. How do I do that?

Today is day 7 post op. Lots of twitches in my calf. Anyone else have that? My knee is killing me (the AT side) but little to no pain in the AT.

I took my first shower yesterday, using a cast cover. It took a lot of time, but felt SO good! Baby steps.

I have been able to wiggle my toes from day one, and can actually move my foot a bit in the cast. It that a bad idea to do this early

First post op Dr. appt. tomorrow. He takes stitches (or staples) out next Thursday and a new cast.

I am neutral foot position (flat foot) in my cast. Any idea of why? Does it mean a quicker recovery? Anyone else like this in their cast, or is everyone toe pointed down?

I am a tad depressed, as the length of recovery is suddenly slapping me in the face. The main problem is that I cannot watch my little 4 1/2 year old (have shared custody) and I miss having the light of my life around her Daddy.

Well, this is my third day of being alone, and am faring very well. Thank God baseball season is here!

Mike

Mike R - I believe the calf twitches are pretty normal. You may try drinking more water. The only downside is more trips to the bathroom!

Every doctor seems to have a little different protocol for recovery. I think the idea behind pointing the toes down for the first several weeks is to reduce the tension in the tendon. But, it doesn’t seem like all doctor prescribe to this. Being in the neutral position now may mean less stiffness when you get out of the casts/boot.

Hang in there, you’ll be running around with your daughter before you know it. Until then, use this blog network and baseball as a distraction.

Good luck with your appointment tomorrow.

Mike R,

I had both the calf twitching and sore knee for about the first two weeks (I am now 3.5 weeks post surgery). The calf twitching is normal according to my Dr. I think the knee pain is a result of the wierd positions in which you put your leg in order to keep it elevated or to keep it off of the floor while crutching around. My knee has started to feel better now that I am PWB and able to keep my leg down more often. It all gets better with time! We’ll all get there eventually.

Drew

same here mike
like drew said, it gets better i would say at week 3
hang in there!!
once you get more comfortable with it all, taking care of your daughter will be easier, believe me, i had to spend 2 weeks of spring break at home with my two kids…week 3 post op…i managed to to lots around the house and they helped me lots too
but my hubby was around for dinner time, bathtime, bedtime too, which helped lots too.
take care

thanks john
for the boot, i was only replying to dennis’ comment on “maybe i should get back in the boot”
wasn’t sure if that was the normal thing to do

nancy -
I was being impatient since I am not supposed to be out of my boot until next week.
After reading Brendan’s post about re-rupture, I decided that it’s wise for me to continue following the protocol.
I’ll continue walking around without the boot at home, as I don’t have to deal with stairs now to get around.

Mike R

Hang in there. I went through all the things you describe, and wondered too if they were normal. I can’t believe I’m as far as I am. I was certain the clock had started to move backwards. I saw my neighbor today and told him my time since surgery and he said “wow, that long already, time really flies”. I must have given him a look like I was going to limp over and choke him out because he quickly came back with “I mean time is relative and all”. It was quite funny. Someone had mentioned lots of water, and I have to agree, I have been drinking a lot of water, and I think staying very well hydrated really helps.

Jim

Dennis

How does the Amazon order box on the site work? Do I have to search using this, or if I already have some things in my cart, can I just go through this to Amazon to buy. I hope my question makes sense, I just want to make sure you get credit.

Jim

Whats a good sign you are making progress?

You can’t remember where you put your crutches!!

This happened to me just now. If you aren’t there yet, you will be.

Jim

Jim -
Thanks. I think how it works is that you use the search box to search for the product to purchase first. Once you’ve done that, then when you add it to your shopping cart and purchase it, then it’ll be credited as being referred from achillesblog.com

If you’ve gone to Amazon directly and added the product.. then I guess you could remove the item from the shopping cart, go through the search box to find it, and then add it back to the shopping cart. :)

nancy -
I’ll try to get the full text of the paper for you. It’ll take a few days:
http://ajs.sagepub.com/cgi/content/abstract/33/1/119

Mike R - you can just comment or make a post on your blog with your info and I will capture it on the spreadsheet. Hope you had a good day…I find that mornings are toughest, both physically and mentally. I haven’t been able to carry my 10 month old for a month now…and I know how hard that is to not be able to care for your kids. But there is a time in everyone’s life in which we have to be cared for…and that is now…this will be a blip on your radar soon enough. Hang in there!

good ideas brendan, i crutched remembering to “heal to toe” and going slow…it helps
wish i had read this earlier

I totally agree with Dr. Ross on this topic. I still cannot pedal on single track (only flat stuff) until late June or July — that was news today at my three month post-op appt. Poohey. So, it’s taking it easy until late summer/fall, then I will be mtn. biking like crazy when the doc says, go. The sports I do involve speed (mtn. biking and snowboarding) and I did my ATR snowboarding due to weird snow conditions and sitting for too long in freezing snow with my foot buried before I crossed that fateful bump that I didn’t see on time… everyone said to me, thank god you’re alive, as we all know how many people hit their noggins skiing and die. By the way, I am a yoga freak and always stretch - sometimes things just happen …

Anyway, I will have to be in a wheelchair for me to stop doing these activities, and even then I will find a modified wheelchair ski or bike. It’s all about being in the mountains and the cardio is a bonus. It’s all about how much you love those sports…if any of them is your passion, I say play them again when you’re ready. You may get hit by a car or get cancer anyway!

Maya

Ruptured my Achilles tendon in Sep. 6, 2008.
Had a surgery a week after.
Had pain consistently since the surgery.
Every time I brought it up when seeing a surgeon he told me that everything looks fine.
After 3 months of cast and walking boot started physiotherapy and walking in sandals (couldn’t feet my bad foot in to a regular shoe).
The pain and swallowing continued.
After 3 months of therapy there was some progress but the pain and the swallowing persisted.
Talked to my PT, but he wasn’t sure why I’m still in pain and limping.
Talked to the doctor, he just told me to take a brake from therapy.
Finally got frustrated and made an appointment with another doctor.
He checked my ankle and saw the lump in the back of my ankle.
He told me that the tendon may be re-ruptured, but he didn’t want to guess and sent me to MRI.
A week ago I went back to see him.
The MRI report and the doctor’s diagnosis is that I have a Severe Achilles Tendinosis.
In his opinion I need another surgery to fix it.
So here I am, 7 months after the surgery facing a prospect of another one to fix what it seems like a failed first surgery.
Did any one have a similar experience?
Any input will be greatly appreciated.

Arieh - Sorry to hear about your hiccup in your recovery. Most of us here are 4 months or less into recovery. Where exactly is the “lump” in your ankle? I think you made the right choice in consulting with another doctor…but I think I would consult with 2 or 3 more if I needed to decide to have another surgery. Let us know how it goes, your information will be valuable to us.

(sigh)… after getting the cast off back on Oct. 9th and doing VERY well in physio I accidentally fell on Oct. 16th and I was back in the ER. I tore open the wound and will see on Thursday if there has been any damage to the tendon.

I returned to the Fracture Clinic the following day after tripping on my front porch and the team examined the tendon by hand… could not detect a break or any gaps… oh please!

This was one of the lowest moments in my life… my PT called to tell me that I was given the green light to go FWB the following day. AGhh!

I’ll post an update shortly on my blog… I’m just not up for it right now. I’m trying to minimize movement and stay firmly strapped in my walking boot so I can help the wound heal. A little spotting of blood in 2 areas since I fell.

Wow - this makes me feel better. Tore my right AT on March 20 doing resistance running at my gym. Surgery next day. 2 slab casts and a walking boot with wedges in it, on crutches at six weeks, I fell and retore it. Luckily not enough for more surgery. It’s almost 8 months and I still have pain, some plantar fasciitis and scar tissue “bump”. I read about people running at 5 months and can’t imagine it. I’ve been doing religious PT and osteopathy, but I really do overdue it walking and lifting during the day. My husband thinks I should be way farther along, but my physio says I just push it too hard - how do you know where you should be and how much is too much?

I ruptured my achilles playing soccer three weeks ago today and had surgery two days later. the hard cast was removed after a week and replaced with a boot, and i began light therapy. everything seemed to be healing well, but two days ago, i had my boot off (just for some air to my foot) and was walking with my crutches (stupid) over to my kitchen a couple of steps away, and i fell and landed on the injured foot. the pain felt almost like the first rupture, but without the snap. i was devastated and convinced I had re-ruptured. but it seems like i can move the foot still. i see the doctor for prognosis first thing tomorrow morning, but from the other stories of re-ruptures he has told me about, i would guess he will be disinclined to do surgery again. does anyone have any advice about whether a 2nd surgery is a good idea? it has not even been three weeks since the first surgery, but perhaps its best to have the problem corrected now? i will know more tomorrow once i have the docs prognosis. i welcome any advice from anyone who has gone through this.

Hello, I am new to this site and have found it very informative. I ruptured my Achilles July 10 playing basketball. I went up for a rebound and heard a pop and felt like someone hit me in the back of the heel with a hammer. Two days later, while waiting to get the Achilles operatd on, I decided to go to the gym and get an upper body workout. I ended up tearing my left bicep muscle..complete rupture. I got both the Achilles and bicep muscle operatd on the same day. I’am approx 3 1/2 weeks post op.

I was in splint for one week and then put in boot. NWB for another week (4 wks total) and then back to doc where I hope he lets me go WB and PT. Anyway, the last couple of days I have been removing my boot to sleep. Has anyone else done this? Has anyone had a doc that gave them the okay to do this? I appreciate the input!

Kevin:

My doc asked me to keep the boot on while sleeping for at least 3 weeks. He’s fearful that I’ll get up and try to walk in the middle of the night and re-rupture. Seems to me that would be likely to happen after 3 weeks too, but he’s the doc.

Truthfully, I have had no trouble sleeping in the boot, so I think I’ll keep it on. I have two young kids and I live in fear of a body-dive from one of them at any moment.

I do take it off for naps, it’s nice to get a breather

Kevin

My doc actually did tell me I could take the boot off to sleep at the same time as allowing me to go FWB. I was actually very nervous about it and did not do it for nearly a week after he gave me the go ahead. I’m not a sleepwalker, but was very worried about catching the foot in bedclothes etc…

I have to say though that since I have been taking it off at night it’s been great. The airflow has really helped my incision heal and I actually feel like the light resistance from sheets etc… has helped strenghten the ankle a bit (this may be in my head).

Probably best to check with your doctor, but I would say go for it unless you are a sleepwalker or don’t trust yourself not to accidentally get out of bed and try to walk on it.

Mattachille & Tom, I appreciate the input..thnx!

Tom, I am not worried about my daughter jumping on me while in bed..she is very careful concerning my foot and bicep, which is also in a sling. However, I do have two Bernese Mountain dogs who like to jump on me, so they have been sleeping outside in the kennel since my injuries.

I am not concerned about sleep walking, etc., but more about not keeping it in the same position as when I have the boot on with the wedges…I currently have three wedges in the boot.

Mattachille, like you I feel the airflow to the incision has helped concerning the healing process as well & I sleep much better with it off. I also work on ROM while I have the boot off moving my toes and working the mobility of the ankle.

I would call my doc and ask him, however, the ortho group I went to is VERY popular regarding their sports medicine & trying to reach my doc via the phone is next to impossible. He did a great job concerning the surgeries and is very thorough when I see him in person, but if I am not in his office I can’t seem to get any info.

I think I will continue to take the boot off at night and when I see my doc in two weeks see what he has to say.

Thanks for the input!!

I have a question with regards to Re-ruptures. Did you immediately know you had re-ruptured? I ask because I am at 5 months and throughout the PT process..most of it…I have had pain in the area behind my tendon. I have mentioned to my doc but he says “just keep going to PT”. I attribute most of the pain part of muscle regeneration - just working my foot out again.

Was there any one thing that made it obvious you had re-ruptured? I am seeing my doc in a week, he scheduled me sooner than regular because I complained that the pain was only on push-off and that it was constant (only when pushing off) but not really getting better.

Hmm.

I would echo George’s question and add, I did not feel pain but I definitely heard a pop and feeling there myself on Monday night. Awaiting an appt now on Friday to assess the achilles. Anyone experienced this or anything stories of working thru scar tissue in rehab?

Not dealing with extra pain or swelling but wonderin what else it could have been. Mine was at 10 weeks post-op and my 4th PT session.

We shall see…

Is it possible to re-rupture your achilles while in a hard cast?

The other day I had a very violent calf spasm on my operated leg. This is only 4 days after surgery, and I’m still in a cast.

I had a dream like I was falling, and woke up with sort of a jump/spasm in both legs, with the operated leg feeling like it was in considerable pain. My follow up isn’t for another 6 days, and I’m wondering if I should push to move it up in case something did happen?

Any help would be greatly appreciated! Still early in the road to recovery.

Allen - I have never heard of anyone re-rupturing in a hard cast while having a spasm. It is common to have spasms though and especially while sleeping. I would not worry.

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