The First Follow-up visit. Suture Removal
My follow-up visit was after 2 weeks and 1 day.
The nurse removed the cast, and I finally got to see my left heel, stitches and all. Here is a nice picture of it:
It was a relief to have the cast off since I was able to scratch regions around the incision. It’s been bugging me for a couple of days.
The sutures were removed, and it felt like quick pin pricks. So it’s not too bad. I’ll take that over nauseousness or dizziness and day.
This is how it looked after she was done:
Overall my heel looked good, and luckily there was no infection in the incision area.
I waited a few more minutes and the physician’s assistant walked in. I was hoping to see the surgeon, but he was busy. The PA recommended 3 more weeks of cast in neutral position (90 degrees) allowing for about 20 - 30 lbs of weight bearing.
This is my new cast. I don’t think it’s quite 90 degrees, but close enough.
After that, I’ll be moving into a CAM boot with steadily increasing weight bearing until it’s full weight bearing with the brace in the 2 week time frame.
Normal shoes at 8 week mark.
I asked the PA about early weight bearing protocol, and he advised against it. He didn’t give me any concrete reasons why, admitting that the rupture rates are not any worse according to some reviews.
I also asked if I could go into a CAM boot right away, but he recommended that I don’t since people get tempted to take the boot off and if you get sloppy, you might hurt yourself while you have the boot off. As for the cast, it’s on for good, and from the doctors’ perspective, they can be sure that I won’t be hopping around without the boot.
I thought about it some more and decided that I didn’t feel comfortable with the strength of my achilles tendon now anyway, so I asked that I be put in a cast for 2 weeks, and then I’ll move into a CAM boot. The PA said that was a good compromise, and the nurse put on another fiberglass cast on me.
I also asked the assistant if I could see the doctor, but he said that the surgeon was in surgery, and if I really wanted to see him then I would have to wait for a while. I did see the surgeon walking around before, and he did see a few other patients, but I suppose the timing didn’t work out.
I’ll make sure that I see the doctor next time.
I guess this doctor’s recovery protocol is moderately conservative, and I am not in a cast for too long. I am happy with partial weight bearing for now.
Earlier, my friend advised me to get a copy of the Operative Report and Discharge Summary, so I asked for it. The PA said that there was no discharge summary since it was an outpatient surgery, and he was happy to make a copy of the Operative Report for me. After a couple of minutes, he handed me a copy of the Operative Report, and he also filled out my temporary handicap permit form that I brought with me.
Overall I was happy with the visit since the incision is healing nicely, and I am at the partial weight bearing stage. Two more weeks in a cast, and then I should be able to slowly walk in the CAM boot.
I’ve discussed my first visit with other ATR recoverers, and it looks like I received a fairly standard treatment. A lot of them do see their surgeons though so they are able to talk about what the condition of the tendon was like and how the surgery went.
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Hey there! Your site has been invaluable to me as I ruptured my achilles in 3 spots 3 weeks ago. Had to wait one week before surgery…surgery was on April 14th…so totally now i’ve been in a splint for almost 3 weeks. Is is true that i’ll have another 2 mths in a cast before the boot? YIKES! I’m trying to take it easy..but i have 2 small kids so caring for them doing the every day things is hard. Definitely makes me sympathize with those many other folks that are permanently disabled or are going through terminal diseases. Good days i keep saying this too shall pass…:) So, the PA recommended i take pain meds for my Monday appt because they are taking my staples out and she warned me that it would hurt. How bad of hurt are we talking?
And, also, can you give me some advice on sleeplessness i’m experiencing. I’m trying to be active in the day. But i’ll sleep good maybe one night, but then have 2 nights where I am so tired but I can’t sleep…up all night. I’ve taken Tylenol PM but that didn’t help yesterday. I stopped taking Vicatin bec i thought maybe that was keeping me up. Any suggestions for getting some sleep would be great. Again, your site has been AMAZING for me…nice to read other’s share same experiences like leg twitching or claustrophobic feelings. Lastly, will the cast be lighter than these spint things i’ve been wearing or will they be comfortable?
Kristen - Welcome to the site. Glad you are finding it useful. I found reading everyone’s stories to be extremely helpful, and calming, while dealing with this injury. I experienced some of the sleeplessness you speak of, however, I’m not sure I have any good tips. For me, I would fall asleep, but then I would wake up in the middle of the night without being able to fall back asleep. I contributed the sleeplessness to anxiety. It took about a week or two before I started sleeping normal again. Hang in there, it should get better.
Assuming you get a fiberglass cast, it should be lighter than the splint. That makes it a lot easier to carry around your injured leg while on the crutches. However, I wouldn’t say it’s “comfortable”.
BTW, how did you rupture in 3 spots?
Kristen - I too experienced the sleeplessness you mentioned, I think most of us did. I just kind of struggled through it the first week…and it got much better when I got out of my splint and into a fiberglass cast. I think I slept one night that first week, and it’s because of the extra vicodin I took (don’t recommend it)…but I didn’t like the other side effects of the pain pills, so I stopped those fairly soon after. One thing that helped me was to sleep on my side of the good leg, and put 2-3 pillows between my legs, thus elevating the injured leg. It was more comfortable to sleep…especially for me as I’m not a back sleeper.
Hope all is well..there are many of us on this site with young kids, so I can empathize with that…watch out for toys and wet spots in the bathroom..it’s how I slipped on my crutches a few times!
Thx so much for your response. Good to know that my fiberglass cast will be better! Yeah..only a couple more days to go. Funny you mention to watch out for things. The day before my surgery I fell down all 10 of my hardwood stairs. I was getting good at going down the stairs holding on to rail and hopping down with crutches on other side…well..I always had a tennis shoe on…So, what do you think happens when you hop down on one foot with a sock on hard wood stairs? Fortunately only my tailbone was bruised…I didn’t want my good foot to be injured or my bad foot…thank goodness for that splint protecting it. And, thx for sleep advice…I hope you are healing great and back to sports. Me, no US Open in tennis for me this year. THX AGAIN!
Hey Tom. My ortho said it was a total rupture but that sometimes the tendon stays as one when it ruptures and sometimes it separates. And he said the three places were twisted too. You can tell…I don’t know much about this yet.
This site is helping me learn all I need to know. My ortho literally comes in for a sec and never tells me what to expect…so I always have questions and now I can come here! Have a good evening.
Kristin
Sorry to hear about your rupture.
The first few weeks are tough on the sleeping. I ended up staying on the recliner with my leg elevated throughout the night. Helped with the throbbing and swelling. As time goes on it gets easier to manage. The fiberglass cast will be lighter, may feel tight initially due to the swelling but if you elevate it within 4-5 days it will feel loose to you.
Doctor insight…try and make your future appointments first thing in the morning. We are just starting, not running behind and feel as if we have more time to spend with the patient. In tha pm Docs are more than likely trying to catch up and therefore cut down on patient interaction.
Hope that helps.
Good luck and let us know if you have any questions.
Doc Ross
Ryan and Kristen sorry to hear about your injuries
I am now not quite 2 full days post-op. I slept a lot better last night compared to the first now home from the hospital. The throbbing is most certainly killer if the leg is not elevated. I am trying my best to keep it as high as possible. I’ve got this cast on so obviously I can’t see the site. I hope it’s not bleeding or becoming infected. I wish others the best in their recoveries, thanks for the site, and I’ll be keeping you guys posted.
Kristin - sorry about your injury. I had percocet for pain but maybe used 3 or 4 days…hate it. I also had a scrip for Ambien for sleep and used that for maybe a week. Helped a ton. I’m with Brendan…used pilows in the bed to elevate and liked one between my legs when I was on my side. I also found it helpful to have the foot out of the covers (no weight on it I guess).
Lamar - good job making the decision and going for it. Better to get it over with, it gets better. I truly doubt it’s bleeding or infected. Follow your doc’s directions on care.
My other suggestion is ice like crazy. I had an auto icing machine (which the insurance company called a “convenience” and declined to pay for it…I was not happy). The machine is called a “Game Ready” and ices 30 minutes on and 30 minutes off. I’ve seen other brands on-line. They pump cold water through a bladder which is wrapped around your foot. I like it because it’s really cold and is on a timer and also provides compression. Another idea is “Dura Kold” ice packs…which work great. There is one specifically for ankles although I just use one designed for knees and it works great.
Lastly - have your list of questions when you go in…you can quickly get the answers you need and the docs like it if you’re organized. My doc would stand up and say “anything else” as a signal that he was ready to move on but generally he’s good about listening and I didn’t feel overly rushed.
Take care guys.
Hey Dr. Ross! Thx for your reply. Yeah..funny….I’m always first appt in the morning..but ortho just likes to spend 5 sec’s always. But, I continue to ask questions…and this site is great because it provides much more than my ortho appts! Guess I need to make a big donation huh? I know everyone’s protocol is different…I’m hoping I won’t have to spend a ton of time in a cast. I’ve already been in a splint 3 weeks. I had to wait 1 week for surgery so was splinted then while I waited for MRI and dr to return from vacation. What’s an average length of time in the cast before the boot? And, last stupid question…are you an ortho doctor or a vet? heheheheh…I am SO funny
Kristin..
When you read each blog you will see that each doctor has their own timeframe on the cast issue. I would venture that 3 weeks of casting is average. A lot depends on extent of injury, conservative vs. aggressive, proactive vs. reactive, etc.
Stay positive… I am at 7 weeks post op, in two shoes, slight limp due to muscle weakness, no stamina but fortunately no pain.
We are……….one day closer to the end
Doc Ross