9 month post ATR surgery/embolism update
I haven’t posted here much, but have gotten so much helpful information (especially norm) and support from everyone, I thought it was about time I posted my full experience here and where I am in my recovery 9 months later. For those that are in the early recovery stages, I hope this helps in terms of light at the end of the tunnel and also not to be afraid to be a bit more aggressive with your rehab protocol. For those that just experienced an ATR and haven’t seen a doctor yet, some warning signs and advice to follow.
My ATR started on 11/6/10 playing flag football. I was backpedalling, tried to break forward to defend a pass and everyone knows what happened next. It was a Saturday and I pretty much knew I had an ATR so didn’t bother going to the ER. I already had an ortho doc who scoped my shoulder a couple of years ago and emailed him for an ATR surgeon recommendation. I propped my leg up on my ottoman and proceeded to watch football all weekend long. The bottom of my leg was still in considerable amount of pain, but so was my calf.
I saw the ortho first thing Monday morning and he confirmed what I had suspected, but he also found it strange that my calf was swollen and hurt more than my AT. Turns out the swelling from my ATR had blocked a vein in my calf and clots had formed in only a very short period of time. I was immediately rushed to the vascular department where I went through a series of ultrasounds and was told to start giving myself blood thinner shots 2x a day. 2 days later, a clot had moved through my leg and into my lung and I experienced a pulmonary embolism. I was hospitalized for 2 days and under observation. I was told the only way I could have ATR surgery was if I had a filter inserted through my jugular vein to catch any subsequent clots so that I could be taken off the blood thinners temporarily to have ATR surgery. Given I had didn’t have any alternatives, that’s what I decided to do. Now when I first got injured, I tried to adhere to the RICE principle: Rest, Ice, Compression, Elevation. I skipped the Ice part and was told that could have been key in preventing a clotting scenario. So, for those newbies out there who haven’t seen your doctor yet, if your AT is swollen: ICE IT! And, if your calf is in a lot of pain, insist on an ultrasound to make sure you don’t have a clot.
After having the filter installed, I was able to undergo ATR surgery on 11/22/10 and was back on blood thinners a few days later. I was told that standard protocol is be on the blood thinners for 6 months. Some of your doctors may prescribe blood thinners post surgery anyway since you will be inactive for 4-6 weeks post op. My ortho’s usual protocol was 4 weeks NWB and then into the boot and directly to FWB. But, my incision had not completely healed and he feared that if I was FWB I would put stress on the incision and it would not close. So, I was NWB for another 4 weeks, while in the boot. By the time I was allowed to be FWB (8 weeks later) my calf was tiny.
Once I got over the initial pins and needles of FWB, everyday I started to walk a little further and start taking wedges out of my boot every week until I had no wedges 4 weeks later. Another week went by and I was told by my ortho that I was ready for 2 shoes and PT. Once I was in 2 shoes (I had a 1/4 inch heel lift on my bad side) I started walking as far as I could until my gait would fall apart from fatigue. Within a couple of weeks, I was able to walk 3-4 miles but would have to elevate and ice in order to manage the swelling. Most of my PT with exception of ROM and stability exercises didn’t help because my calf had atrophied so much I spent the bulk of my time doing calf presses. I left PT and decided I would return when my calf was strong enough so that I could work on more plymetrics that would help me get back to explosive sports. I would continue to walk 4-5x per week for 3-4 miles with a compression sock which reduced the swelling considerably as well as icing when I got home.
Once the swelling was under control, at week 24 I tried a jog for the first time. Given my ROM wasn’t back to normal and my calf was still a bit weak, it was more like a shuffle, but what I realized is that my calf was extremely sore and had been worked out thoroughly for the first time in months. I only jogged once a week initially and then slowly started 2x per week. The more I jogged, the more my calf was sore and I started noticing the difference in my calf strength. Also after the gym, I would do a set of assisted calf raises 3-4 days per week. I also ended up getting a trial membership at a gym that had a pool (pool access in manhattan costs an arm and a leg) for 2 weeks. I nearly went everyday to do heel raises in the pool at different depths to exhaust my calf.
I’m now 9 months post op and can run (not jog) for about 2-3 miles at a decent pace. My lungs and heart are probably more of a contraint than my AT. According to my ortho, my AT is fully healed and as long as I don’t do anything stupid, I should be good to go. I have been hiking for 3-4 miles every other week now which works my calf a bit and leaves it moderately sore. I can do 1 very weak one legged calf raise and that has been the most frustrating part of the recovery. I work my calves incessantly and still seem to not be able to gain strength fast enough. That said, I am progressing, just at a slower pace. The extra 4 weeks of NWB while my incision healed really set me back. I feel that had I pushed my rehab protocol more aggressively, I would be further along. Regardless, I feel that i’m close to a full recovery and it’s just a matter of time before my calf gains all of its strength back. Then I’ll plan on returning to PT to start working on more intense exercises to hopefully get my AT back in shape for more rigorous activity. I also was allowed to get off blood thinners as the doctors felt it wasn’t a blood disorder, rather a sports injury that caused the clotting.
Thanks again for all the good information, feedback, and advice everyone has shared. There were times when I felt extremely discouraged and frustrated with my progress, but tracking other’s recoveries kept me going. I feel the recovery process sometimes can be frustrating where you spin your tires for a while and then all of a sudden you get traction and breakthrough another barrier. I plan to keep on truckin’ and hopefully will be back with a 12 month update where multiple one legged calf raises isn’t just a dream. In the meantime, good luck to all of you whatever stage of recovery you happen to be in.
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Great to hear you are making good progress. It sounds like your patience will pay off soon.
Cellblock…great stuff, scary stuff as well! Glad u made it through! So, do you actually think you were ready for FWB at 4 weeks? I am at 4 weeks 4 days and I can’t imagine bearing weight…most due to the tightness in the AT. I am not quite to neutral, boot set at 15 degrees. I am ever so slightly bearing weight with the crutches however. VERY lightly…I have my first PT and 2nd follow-up with my surgeon this Friday. We’ll see how it goes!!!!
Unclebuck,
I couldn’t imagine FWB either, but after reading other people’s recovery blogs and being frustrated with crutches/knee walker in the city, I was ready to give it a shot. The initial pins and needles feel weird, but your body quickly adjusts. Your heel might kill you for a couple of weeks, but it goes away. And it seems to be that in the boot, your AT is relatively safe so once you are FWB, I would try walking around as much as possible. It’s still annoying given your legs are aligned differently because of the boot height.
Striking the right balance between letting your AT heal a bit, but not letting your calf atrophy too much is key. Like I said, I feel as though I’d be so much closer to 100% now had I been a bit more aggressive. Obviously, your doctor knows best and can tell if how well your AT is healing. And, ultimately the downside of a re-rupture far outweighs the upside of doing activities a month sooner, but I felt comfortable given I had surgery.
I didn’t have a boot that set specific angles, it just had 4 wedges which I took out 1 once a week, but I was FWB with my foot at those angles. So, I assume your boot doesn’t have to bet to neutral for you to be FWB? Also, I was told my foot was much closer to neutral than most coming out of surgery.
Good luck with PT and the follow up.
Great summary! Nice work! I’m @ 9 mos. post-op, myself, and am feeling great. The heel raises haven’t been quite as elusive for me as for others, but they’re still not perfect, and getting the combination of quality AND quantity is still a goal of mine. You had quite the battle. The embolism is scary, and I think it is fantastic that you are communicating that informaiton to the group, as it could be very, very helpful in saving someone grief, or even their life?!?? Anyway…nice work, keep it up and update us at 12 mos! I’m sure it will be even more inspiring!
hey iski7b,
thanks. you certainly encouraged me to go for my first jog so i really appreciate that. good luck with your progress.
will post update in a few months.