Hi - an update to make you smile

It has been a while since I’ve been on this site and even longer since  I posted anything.  It’s good to re-read my blog to remind myself where I was with my injury and how far I’ve come in the 26 months since.  As an update I had a full rupture of the right achilles and being an active oldie was as frustrated as the next man at not being active and the prospect of not doing the sports I had previously done.  I was conservatively treated and did not have surgery.  I questioned how this gap in my leg would heal and carry the 95 kilo lump standing on it.  The miracle of the human body - it has healed like a dream and I have been very active.

It took me 7 months after injury to start jogging again, 9 months before I was back on my mountain bike but eventually, with patience, I got there.  I am still nervous of doing some sports.  Even a knock around tennis game with my kids I don’t run too hard after the ball as the injury is still in the back of my mind.  But I have been hard on the gym circuits this past 15 months which hits the legs pretty hard.  I’ve recently just completed my biggest achievement post injury - a 216 mile Coast to Coast mountain bike ride for charity from St Bees Head in the English Lake District to Robin Hood Bay on the Yorkshire Moors.  Over 6 days it involved over 25,000 feet of climbing uphill, was mainly off-road up and over mountains, dales & moors, involved carrying my bike and lots of stretching of the achilles pushing or carrying my bike up the hills.  Riding up some of the hills was pretty brutal at times and the hard pedal strokes puts a lot of pressure on the achilles.  Well I’m happy to report - not even an ache or niggle from my naturally-repaired achilles.

Hopefully my post will give hope to those who think they will be less active once the achilles is repaired.  Much of it is in the mind. I was very active with my protective boot on and would walk for miles just months after injury safe in the knowledge my bad foot could not move and was protected.  My right calf is still slightly smaller than the left one on my good leg - do your calf raises folks as I didn’t do enough of them when I should have.  My injured achilles has repaired with twice the thickness of my good one.  I’m assuming that’s good and giving me a leg twice as strong! I get no pain from my once bad leg.

In short, the conservative non-surgical treatment is fantastic - amazing how the achilles repairs itself.  Be active as early s possible once your protective boot is on.  Don’t skimp on your calf raises once your physio tells you that you are good to go with them.  Lastly keep smiling as things do change around and you will be active again and back doing the activities you love to do.

21 Responses to “Hi - an update to make you smile”

  1. 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!

  2. 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

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

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

  4. 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 the stretching on the Achilles during the climbing & riding, and yet the Achilles was as strong as steel and it didn’t enter my head until the end of the ride that I had an ATR in the first place.
    I hope you’re healing continues and you’re back to an active lifestyle
    Regards Nev

  5. 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.

  6. 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.

  7. 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 :)

  8. 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

  9. 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!

  10. 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!

  11. 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

  12. @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!!

  13. 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).

  14. 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 your risk of rerupture. But if you get to choose between ATR surgery and fast modern non-op treatment, there’s a good case for choosing the non-op.
    For reasons I totally understand (but I still think they’re nuts!), serious researchers — including the authors of that new meta-study — refuse to state simply that the evidence proves that fast non-op rehab produces way lower rerupture rates than slow non-op rehab, though it really does. Instead, they say that fast non-op rehab produces rerupture rates comparable to surgery, while slow non-op rehab produces rerupture rates much higher than surgery(!).

    The difference is subtle, and meaningless (or absurd) to normal people and ATR patients: Each of the studies compared some form of non-op treatment (fast or slow, but not both) to surgery. NONE of the studies directly compared slow non-op to fast non-op, in a randomized control trial. THEREFORE, it’s considered a logical leap to make the obvious and inescapable conclusion that fast non-op produces way better results than slow non-op. In fairness, the authors of this new study come a hair’s-width away from stating that obviously true conclusion. . .

    Let’s see, if A is equal to B, and C is much less than B, are we REALLY SURE that C is much less than A?!? I’m pretty sure I am!!

    Back to your quest: You will probably be better off going to Sports Medicine Clinics, and/or clinics or Teaching Hospitals associated with Universities, because they’re more likely to have been paying attention to the science. It’s still not a sure thing, but more likely. . .

    Good Luck!

  15. @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.

  16. 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.

  17. 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.

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

  19. @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.

  20. @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.

  21. 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.

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