Chuck’s ATR part deux
Well here it is 4 1/2 years since I broke my left achilles and now I have ruptured the right one. A cruel joke? God’s way of keeping me in balance?
It happened Sunday night December 22 two days after I had been to an orthopedist that had been seeing me off and on for a year and a half. I had informed her that I had been experiencing fairly severe pain in the achilles and calf attachment as I walked for the past two months. I told her I had felt a slight tearing in two instances when I stepped once in the snow and once on the stairs. She examined my tendon and declared that it was sound but said I had tendonopathy (what they used to call tendonitis I think). She said my tendon was solid, in no danger of rupture and prescibed physical therapy for 6-8 weeks 2x per week. Never made it. I was walking up to bed on Sunday night and my heel just dropped. Pop goes the weasle. Pain was not as bad as first one. Swelling started immediately. My wife came running and I started to shake like a leaf. I couldn’t believe this was happening again but immediately became angry because I had a feeling I was headed in that direction. Contacted the ortho office 8:30 Monday AM and explained my situation. They said they would get back to me. They did at 2PM. On-call doc arranged an MRI the day after Christmas and agreed to see me tomorrow Tuesday Dec 31. I’ve seen the MRI and it looks like some strands are left but what do I know? Operation? Conservative splinting? I’ll find out tomorrow I guess.
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Sad — and Been There Done That, though without any previous tendinopathy or pain. The good news is ATR rehab and healing USUALLY clears up those prior problems, op or non-op. (That’s been widely reported here and repeated as true, though I’ve never actually seen any other evidence that it’s so.)
If you’ve still got a boot, get yourself into it ASAP, NWB, at an appropriate equinus angle — like with 2cm of heel wedges if its a fixed boot, following bit.ly/UWOProtocol . Then if you do decide to go non-op, you’re already into your rehab.
I skipped the surgery for my second ATR (8 years later in my case), and I found the rehab a breeze by comparison — especially because I followed that UWO protocol, which was MUCH faster than the schedule I followed post-op after the first ATR. Going slow non-op (so-called “conservative” treatment) is about the only common treatment that clearly has inferior outcomes, so Don’t Go There. But well-proven modern fast protocols (like UWO and Exeter) are producing excellent results, statistically indistinguishable from post-op, without most of the complications, and with no scar or scar-tissue adhesions.
My Dad always used to tell a story about a friend of his who dropped dead shortly after an annual doctor’s exam that found he was fine. Stuff happens, experts are human, and forecasts are difficult, especially of the future!
Norm, thanks for the great advice. I met with the new doc today and he confirmed the rupture from the MRI in 2 seconds.
He laid out my options regarding surgery and non-surgery. I told him that I felt positive about an aggressive non operative approach and he agreed. He had me set my boot to 30 degrees plantar flexion (down angle), assigned me to PT in 2 weeks and a return to him in 4 weeks.
Rules: NWB and sleep with das boot.
As someone who tried to avoid surgery, without this blog and with poor results - partially because of the doctor I was seeing at the time - I do not feel that it was wasted time, money or effort. I am not someone who prefers an invasive treatment if it can be avoided. After surgery, I was sure I had done the right thing and found, 90 miles away, the right doctor. Just follow the protocol that your doctor and gut feels right, get educated on the protocols and relax and hopefully we will all be walking soon!
Good luck, Chuck. Keep your eye on the good protocols AND on where your walking, too. And watch out for wet crutch tips on shiny floors when coming back indoors!