bsx188’s AchillesBlog

Wilfus…. I did PWB with my cast the first time for the very reason you mention. I went non-op and was in a cast three weeks, then went to a boot. When I got out of the cast, my ATR “gap” was filled in (or at least better than it was). I felt great.

However, when I was moved to the boot, I reruptured. (My wedges moved under my arch because they weren’t affixed and my heel went down) I had surgery and am back in the cast, I’m not as aggressive being PWB to respect my suture, but I personally thought it strengthened my leg.

Good luck to you. Keep us posted.

@kellygirl, Thanks for your response. Definitely, makes me feel better with the path I’m on.

I would have a blog, but don’t know how to set it up. Sent a request in, but haven’t received any response. I guess I’ll wait, but I’d like to keep tabs on where I’ve been and where I’m going so that my experience may be helpful to others who are dealing with an ATR. I went from zero knowledge about achilles ruptures on July 17 to pretty darn informed. And that’s because of the wealth of information and experiences shared on these blogs and site.

@Wilfus: Your protocol sounds very similar to mine. You will be in the cast NWB for five weeks, right? Your next appointment (8/26), you should be allowed a walking cast or boot–am I correct? If so, you are not that far behind UWO schedule. Because of the position of my foot in the cast, there was no PWB for me. It was really hard to do anything except rest my cast on the ground at times. I pretty much skipped PWB and and went straight to FWB once I got into a boot. I’m sure you will do the same. HTH! You should start a blog so we can keep better track of you.

My last comment was in response to Kellygirl. Thought I was on her blog. Sorry.

I’ve caught up with your blog. Sorta sounds like I’m in the same position with my OS. He believes in the non-surgical route, it’s just that he seems way on the conservative side regarding the treatment/rehab protocol.

I’m in a cast until 8/26. Question, did you do any PWB with the cast on? I’m thinking that if I’m not in a boot, at least I can get some benefit of PWB that tracks somewhat with the UWO protocol. Any thoughts? Thanks.

I’ve caught up with your blog. Sorta sounds like I’m in the same position with my OS. He believes in the non-surgical route, it’s just that he seems way on the conservative side regarding the treatment/rehab protocol.

I’m in a cast until 8/26. Question, did you do any PWB with the cast on? I’m thinking that if I’m not in a boot, at least I can get some benefit of PWB that tracks somewhat with the UWO protocol. Any thoughts? Thanks.

@wilfus: I called around to OS’s in my plan to find one amenable to going non-op. He wasn’t willing to go as fast as UWO calls for but I was able to get out of a cast and into a boot FWB at week 5. While probably not optimal, it has worked out pretty well so far.

Wilfus, I don’t know of any source for OS-shopping as you suggest. And my suspicion is that most surgeons would not be keen to take over another surgeon’s patient. Maybe worse post-op, but servicing non-op ATR patients is a VERY slow way for an OS to get rich.
I would expect that after being confronted with actual evidence that faster non-op treatment actually produces superior results, most self-respecting doctors would acknowlege the truth and follow the evidence. Did you print out the entire UWO study for him? I would. You could email him the link if you’ve got an edress for him, too.
There’s also a new meta-study — a study that combines the results of lots of individual studies (randomized controlled trials) — that’s discussed in recent replies on one of my blogs about studies (either the old one or the newer “the case against ATR surgery” one). Unlike all earlier metastudies about ATR treatment, it differentiated between fast modern non-op treatment and old-style “conservative casting”.
Its conclusion: If you have to choose between ATR surgery and old-style slow “conservative casting”, surgery will significantly reduce you

Norm,
I got it and thanks for your response. You’re blog and comments throughout this site have been very informative. Yesterday was my first real conversation with my OS (having educated myself on ATR treatment) and without having a fall back option, I pushed hard but he was very clearly against putting me into a boot now. In fact he made a point of saying not to put weight on the hurt leg. So, the cast is on…for now.

Is there any resource on this site or otherwise, as to what OS in Virginia would already be amenable to the UWO accelerated rehab approach? Google doesn’t help you much, in this specific regard and most OS in the states since to be of the mindset that if you don’t cut, you’re in a cast for 6-8 weeks (based on what I’ve read here and other web resources).

@wilfus3: The evidence is clear that staying NWB more than 2 weeks non-op (maybe even 1 wk or even straight to “PWB as tolerated”!) is associated with HIGHER rerupture rates than the post-2007 modern studies with the fast non-op protocols — including bit.ly/UWOProtocol and a newer faster one with even lower rerupture rates ~1%! Older “conservative casting” like you’re getting had rerupture rates ~15-20%, so (1) your Doc has it backwards and hasn’t been reading the literature and (2) he’s taking you down a road that is scary as well as a Bloody Nuisance!

The entire 2010 UWO Study is available free right on this site, and you could hi your Doc with it — first figuratively then literally if necessary! Do it for yourself AND the next 100 patients!!

Thanks to all that have replied. Wilfus3 I think I was only in a cast for a week or so then straight into my big grey boot. I was useless with the crutches so I think I discarded them a couple of weeks after that. Take note of normofthenorth comments re too much too soon. Very wise as everyone different with their ATR. My consultant who was part of the Canadian research into the conservative approach actively encouraged me to weight bear in the boot a short way into my recovery. Be careful though and observe the protocol

debvn I’m glad you took heart from my post. I just forgot about calf raises then tried too many to catch up. A few often I believe is the approach I should have taken. Be careful but don’t forget them.

I eventually found cycling a great way to recover once past the 7 month stage although mountain biking another level. When I fall off I always instinctively protect my right leg - the one with the old ATR. The mind never forgets.

Keep inspired - happy recovery. It will happen

Awesome post and congratulations on the 216 mi ride! Guess what, reading this post inspired me to get out of my chair and do some calf raises! I’m nine months post op and what you said about forgetting to keep up with them is so true. It’s great that you took the time to update us on your progress, way to go!

Great to hear the good results. I’ve gone the non-surgical route. Was put in a cast on July 18, so I’m just a couple days short of 3 weeks post injury/cast.

Yesterday I was put in another cast, with a follow-up set for August 25, foot in plantar flexion. After reading this post from Neville and many other posts, I’m feeling rather uncomfortable with this non-weight bearing approach. I had really hoped for some sort of boot but the OS was adamant that I’m at great risk for reinjuring the tendon by putting weight on.

Will keep learning about rehab, but for others that have gone non-surgical is 5.5 weeks in a cast without weight bearing….approaching a too conservative approach that will slow down healing and increases re-rupture risk? All the best, this is a very good resource!

kellygirl it’s a pleasure. I know how tough it was in the recovery phase, with patience being the key word. If I’ve lifted your spirits then its a good job done. Best of luck in your recovery

Thanks for posting! Your story is like a beacon at the end of long, dark, winding, muddy, uphill tunnel! It’s great to read posts like this

Yes, thanks for the post. It is indeed encouraging although , while I am thrilled to be ‘two shoes’, I find the slowness of the recovery process now a little daunting. Looking pretty normal, I find it difficult to come to grips with the fact that I can’t yet ‘run, jump and play’ . However, after reading your post, I’m going to be a little more conscientious with my physio (it’s hard to self- motivate at home - the vision of me splayed on a table whilst trying to do a one legged heel raise is actually pretty comical). Anyway, thanks again for the blog. It’s onward and upward! I’m going to envision myself on your wonderful bike ride.

Great Post and thanks for the update. I was unfamiliar with your story but appreciate that you came back to share this with us. Inspiration for sure.

Hi Micah1
Good to hear from you. I’ve just read some of your blog and it really brings back the memories for me. From despair at the injury, to grit and determination to get back on my feet, the big grey boot, sleeping in the boot, showering balancing on 1 leg, going into 2 shoes for the first time. All distant memories but real none the less.
I believe your choice to go conservative is a good one. I have not regretted my same decision and on reflection have not suffered many of the surgery bi-products that others have faced. Right it wrong I walked a lot on my protective boot as I was told it stimulated the injured area to heal quicker. My point about heal raises earlier is that I really couldn’t do one on my bad leg for months after the boot was off. The calf muscle wastes away so quickly it is hard to get it back again. Once instructed by your physio keep practicing them.
My bike ride was awesome thanks. I was back on my mountain bike 9 months after the injury. This ride was a whole new level especially carrying your bike on your back up the mountain for the sheer pleasure of riding back down the other side. You can imagine t

Fantastic news for us injured relatively recently , thanks for the inspiring update Neville. Your bike ride sounds incredible too!

Hi normofthenorth
I agree 100% with your comment and I advised as soon as your physio is happy with progress. I remember 8 months after injury my physio advised little and often with the calf raises - do them waiting for the elevator to come, or whenever you get 5 minutes. I’d just forget and it becomes harder as the months pass by to recoup the calf muscle you once had. It never gets back to normal in my experience anyway. I’m just reflecting on what I could have done to aid my recovery
Regards

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Neville, we have had a FEW people here who’ve re-ruptured while doing calf raises, too many and too soon, so I’d urge everybody to consult a good protocol like bit.ly/UWOProtocol — and remembering to be INCREMENTAL, too! — before “not skimping” on calf raises. To everything there is a season and a time for every purpose under heaven!

Very good article. I am experiencing a few of these issues as well.

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Hi, just wanted to tell you, I enjoyed this blog post.

It was helpful. Keep on posting!

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Hey! This post couldn’t be written any better! Reading this post reminds me of my previous room mate! He always kept talking about this. I will forward this write-up to him. Fairly certain he will have a good read. Thank you for sharing!

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Thanks for reminding us of how well you’re doing, Neville, and Don’t Stop!

That’s great to hear that you have recovered well without surgery. I had surgery 2 weeks ago and am now in a boot. Ruptured mine playing indoor 5-a-side football.

Fingers crossed for Sunday against Italy!

Nice work Neville! All of us injured soccer/football players are wishing we were at your stage of the recovery!

Couldn’t tell from your post, but are you back playing indoor soccer?

When were you able to start working on the explosive moves that are required?

What is it about the heel lifts you did (or didn’t do) that hindered your recovery?

Oh, and good luck on Sunday against Italy

Thank you so much for coming back to “celebrate” the one year with us!
It is comforting and reassuring to hear you are healthy, doing well, and even running.
All too often people hang on the board for a couple of months, then disappear, leaving us to wonder how they are progressing.
I’m with starshep on the non op…Of five Orthopedic docs I interviewed at the time of my injury, four said surgery was the only way out of an ATR. Only one suggested non-op, and his protocol was old fashioned. I ended up getting surgery, but won’t do that when my other tendon goes.

BSX,
It amazes the professionals too that you can go non-op with this injury. My primary care doctor told me that I needed surgery to fix it. Fortunately my orthopedic surgeon was a bit more versed in the options. I had a new therapist this week substituting for my regular one, that was amazed I could go non-surgical. She said they were always told in their training that an ATR requires surgery.

Hope for all of us in the early stages, Congratulations on getting back. Its great to hear you back to running 5 miles, i cant wait to get back on the treadmill, but more importantly cant wait to get back on the football / soccer pitch. only 5 weeks in and missing it soooo much

Congratulations to you, hope you go from strength to strength

Good to hear from you. I’m doing the heal raises & more, but still at week 14 a bit away from jogging. It’s going. Still a problem but much less the mental burden it was just say 6 weeks ago.

Nice! Hard to know how aggressive to be with heel raises and stretches. Too little can cost you a bit of time, and too much can cost you a lot, or worse. And you can’t trust your leg to warn you soon enough when you’re overdoing, either, trust me!

It’s not a tightrope, because that’s symmetrical. It’s more like aiming for the out-of-bounds line in a court game.

+1 to your “Think carefully about surgery/non-surgery.” For sure, a blog site like this selects non-randomly for people with complications — i.e., there are many surgical patients who recover with no problems, but they tend to forget about posting on achillesblog.com more than those with problems. But there are definitely a bunch of big and small problems that come from surgery, incisions, scars, attachments, etc., that don’t afflict the non-op crowd. And non-op plus an aggressive rehab protocol is a great combo, according to the best evidence..

My only quibble would be that you’re recommending WB faster than any of the modern non-op rehab protocols has used — and therefore faster than has been demonstrated to work well with a large number of patients. I’d rather

Congratulations! I did my first race yesterday. I understand exactly what you are saying. I did have surgery but I have been aggressive with rehab and continuing to workout. I also have not done enough heel raises though. I need to.

I don’t even know how I ended up here, but I thought this post was great. I don’t know who you are but definitely you’re going to a famous blogger if you aren’t already Cheers!

Some really nice stuff on this internet site , I enjoy it.

Hi Neville.

Cracking report, and one I share - athough I am around 6 weeks behind you.

I’ve just posted on my blog, but I have just finished my NHS physio class. I can now do a very slight heel raise, but am some way off doing it comfortably.

Can you do a single leg heel lift on the bad foot, and if so when was you able to do it without thinking?

I’ve been riding my mtb in the garage on the turbo for 30 minutes at a time (clipped in), but it has got so boring I have now switched to the cross trainer instead.

The PT said I could look to ride my mtb out side in a couple of weeks, but to stay off the trails until I can at least do 4 or 5 heel lifts without pain.

I’m in no rush to get back to the trails tbh, as the weather is pants and I’m happy enough just being able to train on the cross trainer / punch bag / weights etc.

Ultimately though, I would agree with you and suggest non op recovery is wonderful. I’ve had no problems really and although the final recovery takes longer, I don’t feel it will impact my life much if at all eventually.

I went for the OP as was informed that it would give the stronger fix, although the stats show its only a few % stronger, it seemed to be worth the extra effort.
Since moving on from the ortho consultant and under the physio consultant things have progressed really well.
I’m yet to give the MTB any use in anger though have done a couple of test rides up and down the street, plus I use the exercise bike at the physio gym regularly.
The wobble boards have been my main tool, and the bottom stair. The rest of my physio is mainly normal ‘use’ and of course some stretching exercises.
I’m at nearly 18 weeks, about a week behind Ryan, and generally speaking its pretty much fixed. I do have to build the strength up as the one legged lift to make transition from flat foot to up on ball of foot is well behind that of my good leg. I can lift a bit and it’s improving gradually!!!
For those lucky enough to be somewhere warm, I would recommend stand up paddleboarding as a fun rehab exercise, combining wobble board and hydro therapy with a physical work out thrown in for good measure. Just do it in deep enough water so you don’t jolt when ’s

First Happy New Year to all.
I also went non-surgical and am a long way behind you at about 11 weeks since start of treatment. I agree with your comments on choice oif non-op, although as I am far older (69) it was probably a much easier decision. Like yourself I haven’t suffered any pain of any significance at any time - real pain seems to be surgery-associated. I got into aircast boot at 5 weeks and was FWB in a couple of days as like you was rubbish on crutches. Still supposed to be in boot but haven’t used it for about a week now but will for any outside walking of more than 100 yards or so (prob with one crutch) where I still feel uncomfortable in shoes. Drove for the first time a couple of days ago, just round the block - - and yesterday took my son to Heathrow (about 45 miles) without any ill effects that I can judge.
Thanks for the post - gives me a better idea on non-op progress. Most bloggers seem to have been operated on so its good to hear experience of someone else who has chosen the non-surgical route..

I read this early this morning Neville- and you inspired me. I pulled the mountain bike down, headed out to one of our local trails, and did a solid couple of hours on the bike.

It’’s been a few months since I’ve been on the bike (it’s ski/skate season here); but out snowpack is so poor, that some of the lower elevation trails are quite ride-able The time between rides made the improvements very noticeable. I could get out of the saddle- and power over hills and obstacles which previously I had to “spin” over. I got around this whole loop in my middle ring (not using the granny), which - even pre injury - was a bit of an accomplishment for me. I’m definitely feeling the effort tonight though

Great way to start the new year- thanks for the motivation!

Great to hear a happy story, Neville — and I doubly love the non-op happy stories. (Trouble is, I never remember who all the happy patients are, when somebody asks me for examples!)

Keep progressing! I’m finally having a blast back at volleyball — 2.5 hours of mostly 4-on-4 indoor beach this past Saturday night, YAY!!

I am 8 weeks post op, and a long way from recovery but reading this post is like letting the sunshine brighten up my dark days. Every so often I loose hope and I dwell on the difficulties I have endured since that dreadful day. So THANK YOU for posting this!
I am a frequent flyer, and I have a business trip coming up in February. I will go against my doctor’s orders as I can’t affort compromising my position.
Can you provide the name of those helpful socks?

Know what you mean about them “days off”. Its far too easy to get lax with the exercises. If you have trouble doing a set regime, follow my physios advice. Stand on your toes whenever possible ie. when chatting with people. You can do that a fair few times a day and it will keep working that calf. Still, would be better for us both to do a litle more !

Hey bcurr thanks for the support. I need to focus more on my weak calf and do the exercises set by my PT. I take too many days off in what I’m set to do to gain that strength. Jogging? I used to go every day. Now I’m not sure when the next day will be. When it comes round it will be in big bold letters on my BLOG. Good luck with your recovery too.

All sounds good Neville. Know what you mean with them heel raises and I’m sure half the problem is lack of calf strength and the other half is your brain saying “are you bloody mad!!!”.

Keep up the good work and no doubt the rest like jogging will be along sooner than you realise

I admire your dedication, sounds like the end is in sight for you, best of luck.