No More Moon Boot!!!

It’s been three weeks since the last time I saw the doctor and thanks to the physio exercises I can now walk almost normally now. I can finally walk outside without the boot! What’s interesting is that I found the transitioning to walking much easier this time compared to the first time when I got out of a hard cast. The leg in general is feeling stronger. My goal is to be back in top shape for the summer rugby season and I believe I am well on my way to accomplish it.

Let the Therapy Begin

Had my scheduled appointment with my doctor the other day. Everything seems to be on track, I can now walk around the house without wearing the boot (still have to wear it outside), all heel lifts are gone, and apparently I should be able to ditch the boot all together in about 2-3 weeks.

I won’t officially start physio until I head back to university at the end of the thanksgiving holiday but in the meantime I am just practicing walking and moving my foot around as much as possible.

I’m certainly going to take it much slower than last time (i.e. will be avoiding heel lifts for a while, ill-advised by my last PT). But if everything goes well doctor says I should/can begin to “run” in a month’s time. Obviously I will be avoiding any twisting/pivoting movements when I reach that phase.

Wish me luck!

Update - Phase 2

Went back to the hospital for my scheduled appointment. The doctor says I’m coming along fine. They decreased the height of the wedge in my walking boot by half, so its a little less awkward to “walk”. I started doing FWB with my walking boot at about 4 weeks (i.e. last week) and will continue to do so until I am able to get rid of the boot.

I have about 5 more weeks of walking with the smaller wedge before I go back to 90 degrees. The doctor initially said to come back in four weeks but I had some scheduling conflicts so I had to push it a week back. My doctor says the extra week will not make a big difference.

The real challenge for me is seeing how I adjust once I head back to university next week. I guess I will have to be an even more disciplined student to ensure I’m not late for classes.

New Doctor, New Protocol, New Mindset

After I re-ruptured my my Achilles I ended up waiting in the ER for SIX hours before I was told I had an appointment at the fracture clinic the next day and the ER doctor didn’t even take a look at me! I mean come on. I know the hospital I went to deals with a lot of traumas so granted I would be pushed down to the bottom of the list but I mean if its just for me to get an appointment I shouldn’t have to wait SIX hours. Anyways I was back to the unfortunately familiar fracture clinic at my hospital. This time I got a different doctor since I was there on a different day, so different shift I assume.

The new doctor was very personable, unlike my first doctor who barely talked, and he had them do an ultrasound scan of my Achilles.  It was a complete rupture with two cm of separation. My new doctor gave me the choice do a non-op approach very similar to the one discussed in the UWO protocol or to do surgery. I picked the non-op approach as my logic was if I don’t need to cut myself open why bother.  So the doctor had me remain in my walking boot except added in these four pads for heel lifts to close the gap in my Achilles. I going to have this for five weeks, go back to the hospital and they will take out two of the pads. I assume it will be a few more weeks before I get the final two out.

By this point I had done a little more in depth research and knew about the different protocols and asked my doctor about them while I was at the fracture clinic. He told me since he was a UWO grad he would have never casted me but he would have put in a walking boot with heel lifts instead. I also asked him if my re-rupture was because I was overeager in my healing process and he said it was possible but that it was more the case of doing calf/heel raises too soon considering I had the uber “conservative” protocol. He also said he would just have me work on ROM for the first month of rehab.

After going home I began second guessing my decision to go non-op. I knew from my research that non-op can do just as well as surgery but that was for initial ATRs not re-ruptures. I became very concerned and that is when I began posting on this site seeking help.  Unfortunately the responses at the time just made me worry even more so I decided I was going to contact my doctor again. The fracture clinic was closed so I could not call, instead I googled my new doctor’s name in hopes I would find his e-mail. I found it since  my hospital apparently has a very comprehensive website for the fracture clinic as it has all the staff and their contact info/mini bio. I felt on a roll so I did some more digging about my new doctor and the first one I had. Turns out the first doctor I saw who gave me the “conservative” approach specialized in SPINAL injuries whereas my new doctor specializes in hip & knee reconstruction and LOWER EXTREMITY TRAUMAS. After reading that I was a little pissed off that I got a doctor who did not specialize in my kind of injury but at the same time I was a little more confident in the new protocol and doctor.

I was still on the fence about whether or not to do surgery so I sent my new doctor an e-mail asking what does he normally do with initial ATR patients and re-ruptures. He was extremely good about responding as I got an e-mail back later that same day. He said that he normally treats his initial ATR patients with the non-op method but that in the case of my re-rupture the choice between non-op and op was 50/50. He did however go on to say that he believes the non-op method should work well for my re-rupture since the gap was relatively small and that I still had movement with my foot. My mind was put to ease after reading that. My mom also had me talk to my cousin who is in his residency in the States to become an orthopedic surgeon and he also said that if he was in my situation he would go with the non-op method as well.

Reading the stories and comments of others on this site has taught me that I can’t always take an “experts” word and that I should always do research and ask questions whenever I am unsure. That said I had only one more concern which was addressed very quickly by my new doctor once again through an e-mail. He mentioned that I could do FWB with the walking boot and I told him I did not feel comfortable with that. In his e-mail he said that its was OK if I did FWB but I was free to whatever felt comfortable. I decided to go NWB for the first two weeks, though I do put my left foot on the ground for better balance when standing still with crutches but ALL the weight is still on my right leg. Eventually I’ll move to PWB for the next two and FWB after that.

Physio, Re-rupture, and the Worst Summer of My Life

So as I stated earlier my doctor prescribed “gentle ROM - dorsiflexion and calf strengthening”.  The physio I went to had me do stretches with one of those elastic bands for a while, very light leg presses (only at the clinic) with my right leg spotting, and of course he stretched the tendon out. Everything seemed to be going extremely well, after a few days of stretching I was able to somewhat walk and with continued practice my walking got better along with my ROM. Naturally there was also ultrasound treatment/shockwave therapy, new stretches, and some other light strengthening.

Then about two weeks into my physio/rehab process sometime around the end of July, DISASTER. My physio had me start doing some calf raises/heel raises and though I was concerned at first, when I did the exercise at the clinic I had my right leg spotting as well as my arms and it seemed fine at the time. So  he said I could do these at home along with all the other exercises he showed me. He also stated try and do it for a minute or as many reps as I felt comfortable with. Of course this ended up causing my re-rupture, on the second time doing it at home. After bringing my foot up without any pain I heard another snap/rip/unusual loud sound from my left leg and I knew right away what I had done but hoped it was something else. My heart sank.

Now I don’t totally blame my physio entirely because I was doing this exercise at home so I certainly take responsibility for it. However I do maintain that I was doing exactly what my physio showed me but that it is possible I may have over did it. It was one of those moments that was very hard to remember because I was in shock so everything seemed to go so quickly. Yes in hindsight it seems or was COMPLETELY idiotic to do calf raises but you have to understand my state of mind at the time. I am fairly young and this was my first major injury ever, so I guess  through my naiveté and eagerness to get better quickly my attitude was to trust the experts and do whatever they say as that will help me get better.  On the flip side I was also very fearful to stray away from anything the doctor or physio said thinking that it would lead to a possible re-rupture.

In the end I believe I was done in by several things. The initial protocol my doctor treated me with combined with his vague/loose physio prescription, my physio’s failure to understand how the doctor’s “conservative” protocol may affect my rehab process, my failure to do in depth research, and as mentioned earlier my naiveté.  In the end I lost the two months and half of progress and I am now back to square one.

My Intial ATR and Healing Protocol

Hi Everyone,

I never actually blogged before so forgive me for any deviations from blogging protocol if there is such a thing.  Anyways I had my intial ATR back in May of this year. It was during rugby training while we were doing some sprints/suicides for conditioning. I already completed 3 or 4 sets so I was warmed up at the time and was feeling fine.  Just so happens during the next set on the last rep of the sprints I hear a loud pop or bang as I transition from stop to go.

I know a lot of people describe it this way but it really felt like someone kicked me from behind! At least that is what I was hoping but as soon as I turned around and looked behind myself, only to see nobody, it dawned on me that I probably had an ATR.  A few of my teammates helped me out and drove me to the nearest hospital. I sat around the ER for about four or five hours before a doctor finally got to me and put me into a splint for the meantime.

Next morning I went to the same hospital’s fracture clinic where the doctor essentially provided me with two options surgery or the “conservative” method.  This being my first major injury ever, I deferred to the experts and did not ask to many questions.  The head orthopaedic doctor there at the time suggested that I go with the “conservative” method due to the location of the ATR. So I did.

I was put into a cast in “plantar flexion” for about 2 weeks and then had my foot raised closer to 90 where I was casted once again. The second cast was on for five weeks. At the end of those five weeks the doctor put me into a walking boot and said that I could begin physio instructing I work on “Gentle ROM - Dorsiflexion and Calf Strengthening”.  A week later I started my physio since that was the earliest date I could get at the time but I’ll talk more about my physio process in the next post.