consi’s AchillesBlog

I had my ATR on the 20th and I did RICE for 4 days and wore an ankle brace with plantarflexion till today when I received my Aircast boot and made my own 2cm heel lift. My question is can I take the boot off to shower if I am careful? I don’t have insurance so I opted for the non-op protocol. Boot kind of hurts my toes and heel right now. Hopefully I will get used to it.

early march partial rupture, back on roller skates for 5 weeks, absolutely the best therapy there is. strength increases each week, doing front cross overs for two weeks now, but keeping it mellow

I am 18 days post rupture and following the Cdn non-surgical treatment, recommended by Otho Surgeon. Not quite sure why, I’m 43 still active and run 12-15miles a week. What I’d like to know is does the non surgical treatment get me back on my feet and able to work nearly as quick as if I’d had surgery. I work three 12-hr shifts/week and am on my feet around 70% of the time. How many weeks out will it be before I can stay on my feet a majority of the day? How long before I can return to running? I’m now wondering if I shouldn’t have demanded to have a surgical repair.

Hello all, Phil again

Hey Chantelle, are you experiencing kinda like a burning
tearing feeling? because I am feeling this as well. but the back of the ankle is feeling a little more stiff, but a good stiff.
man, this is a bugger of an injury!

Greetings All,
I am 2 weeks (tonight) into a partial tear, I went to our local clinic. (I don’t have insurance) and received a boot as well,
but no instructions on therapy or anything. So this is a going to be a great resource for my healing process. have started taking glucosamine and vitamins and eating more protein.
but how soon should i begin to do rehab of any such? thanks and best of luck to all! .
Phil

ps. Hi Chantelle

I think you’re about half a week ahead of me in your recovery.

I too had really bad pain in my lower calf, I think due to incredible cramp. I mean, it was literally constant for the first two weeks and would reduce me to tears in the morning.

Could this be what you’re feeling. Baths, tonic water and bananas all good cramp-fighters And i massage my injured leg’s calf every morning.

Hope you feel better soon, keep in touch

Lauren

Hi all - I’ve been addicted to this website since I ruptured my achilles 2 weeks ago, and I wanted to start interacting with you all.

My surgeon elected for non-operative treatment, and has told me to expect to be in the Aircast for 8weeks ish and then we’ll take it from there. He said I can FWB from as soon as I feel ready.

In the first week this was just not possible AT ALL. But suddenly, hitting week 2, I began to PWB with crutches and now am feeling stronger.

That said, I think I’m still coming to terms with everything and am suddenly on a massive low. I’m female, 21, and am so eager to regain my active lifestyle (as I know everyone is).

I read on this site a blog of someone who was still in immense pain and struggling with walking at the 4month mark and it’s stayed with me all day.

Is there anyone who has received non-operative management who is a year or so on and can vouch for what they think is an average timeline in weeks of when they were able to flex the heel, then have their boot off, then walking, then walking/running??

I want to stay realistic and positive about this and not beat myself up too muc

I have no idea how to make a post other than leaving a reply, so if anyone can tell me, please do.

I’m 3 1/2 weeks into recovery of a partial rupture, non-surgical recovery. I have pain on the upper part of the tendon, moreso what I think is the bottom of the soleus, maybe gastrocs. I think soleus though and perhaps more medially.

Does anyone else experience the pain, tenderness, weakness on the lower end of the middle of the calf?

I’ve been non-weight bearing this whole time. Started taking off boot mid-night due to major discomfort. Still icing, elevating, and doing dorsi/plantar flexion Guess I should start doing the alphabet too. The only hydrotherapy I get is a hot bath with epsom salts and moving my ankle back and forth in the water. Would like to get to a pool. Except, what am I to do - crawl in a swimsuit? Crutches on a wet, slick surface is NOT safe!!!

I guess, I feel worried that there’s more damage in the muscle (of the soleus) than just the tendon. I did hear the big POP though. So did everyone else!

I appreciate feedback.

Thanks,
Chantelle

Norm, that reminds of another truth… Practicing somewhere in the world: is the worlds worst dentist.

Rosethorn, did you rupture and twice re-rupture the same AT? (Yikes!)

Deciding how slavishly to follow our Docs is one of the trickiest things we do, maybe esp in this injury. OT1H, being “bad” can easily lead to reinjury or healing long, etc. OTOH, this is an area of medicine that gets little respect from most Ortho Surgeons, and where “Eminence Based Medicine” (you’ll do what I say because I’m the boss!) often takes precedence over Evidence-Based Medicine. We’ve had a few cases here where well-informed patients have changed the ATR-treatment practice of their Docs, and (at least once) of an entire hospital!

Virtually all doctors mean well, but a full 50% of them graduated in the bottom half of their class. (Naturally, that’s never the Doc who treats US, right?!?)

It’s always best to follow your doctor’s orders… but don’t hesitate to ask that doctor a million questions! Specificity is the key when healing an injury as complex as a full ATR.

I learned during my first healing process (non-op) that I shouldn’t have been taking any anti-inflammatory drugs and after a second rupture two weeks into walking (2 shoes) I learned that smoking is highly detrimental to the healing of such an avascular area.

After my third rupture in one year, I realized anything I want to do pretty much requires hassling my doctors for information, especially since surgeons have the tendency to be so distant.

I’ve posted the “Canadian protocol” at bit.ly/UWOProtocol , and I think you can also get the official published version by finding the study among the others (from the Main Page here), then clicking at the link at the bottom. They’re virtually identical — my version was the one the authors faxed to my Doc after they delivered their results as an AAOS2009 paper, but before they published it in 2010.

Either way, you get to “FWB as tolerated” at FOUR weeks, the wedges come out at SIX weeks, and you “wean” off the boot at EIGHT. (Your docs seem to be making you go slower, which is NOT how the UWO/Canadian study got their good results!) The exercise schedule is there, too, for you to follow.

If you’re not sure about the meaning of the exercises, you should probably take it easier, but going slower on FWB and wedge removal doesn’t seem especially “conservative” or extra-safe to me, FWIW.

At 7 weeks i was still in the boot with 2 wedges in. Initially I had 3 x 0.5 inch. Wedges and they came out one at a time at week 6, 8, 10 and I was to be out of the boot fully by week 12. That was the protocol called for.

And I started walking around slowly, carefully in wedge clog shoes from week 7 onwards gradually increasing time out of the boot at home. I also used the cane. Physio also had me out if the boot for treatment. The walking was going so well that by week 10 I felt like I could manage without the boot.
My advice is take your time walking without the boot until you feel more solid it was more limping and shuffling initially and my shoes were heels of the
same height as my boot was at so the Achilles didn’t over stretch. Also if your house is risky- pets, kids, toys, stairs like mine is be extra vigilant ESP at night if you are bootless. Best wishes.

I was a little confused on your post. Did you say you got out of the boot in 7 weeks or that you were still in the boot with the heel wedges removed. The wedge I have is only one and it is maybe a 1/2 inch at its peak. I saw some posts that said they had a 2 inch wedge is that possible ?

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I have been sleeping without the boot for 10 days or so with no issues. I also have been putting full weight some times again with no issues. I have taken just a few steps with the boot to measure just how weak the achilles is and it IS weak. Other than the removal of the boot at night and the FWB without crutches (which I have dumped in favor of a cane) I am following the Canadian Protocol as outlined by my Otho Dr.

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Hi I am also non-op at 17 weeks and following the Cdn protocol. I say be patient and follow the protocol as long as you can. I have had great success with my ATR recovery and most of that is because I stuck with the protocol and wore the boot, slowly weaning off the wedges from 8 weeks and gradually and safely walking around at home from 7 or so weeks on. I was to be weaned out of the boot by 12 weeks but I got out of it fully by 10 weeks. I was getting impatient and had a couple of scary bad steps that luckily didn’ t injure me. It was enough to realize at 6 weeks I was still weak.
I have been religious about physio and working out and I am happy to report that I am now running and jumping ( controlled , 2 footed) and have returned
to almost normal exercise (bootcamp) routines. I still have work to do but I feel I was both diligent in following the protocol and lucky I didn’t have any accidents or falls along the way. I fully advocate the non-operative approach to recover from this injury!!

Whats the rush? I’d play it safe, whats 2-3 extra weeks if you have to start from scratch?

I havent worn a boot since I left my 1 week post op; mainly because I havent moved and just kept my foot elevated.

Its great to hear that youve been able to walk so early but i’d be careful. After I ruptured they told me I could walk with the boot before the surgery. Well two days later and I almost had a bunion. Reality is the achilles & other muscles arent strong enough and your foot will bear the majority of the load and may give you other problems.

Good luck….sleeping with a boot seems insane; as does a boot when you have it elevated as youre doing nothing except elevating. Last night I woke myself because my foot was convulsing or something but the boot at noght seems a stretch.

Thanks for the information. I just returned from 4 week check up and I am remaing in the boot with the heel lift. I return in 2 weeks. Merry Christmas

I agree with Norm, I too felt lots of sensitivity on the bottom of my foot. I also experienced all the skin peeling off due to no pressure or wear and tear. I am over a year on with the non surgical method and couldn’t be happier. I too used the air cast to good efffect, a little slower that you admittedly but still with great success. As Norm says just watch your step, Good luck with your progress LL

There are some tricks to make the boots more comfy. If you can put a sock on that foot without scaring yourself silly (or hurting yourself), that often eliminates chafing. Most of us had discomfort or pain on the bottom of our booted foot (often worst under the heel) when we started FWB, and squishy footbeds help for that.

Sounds like good progress, Consi, don’t stop! And don’t stop Watching Your Step, either.

The UWO protocol left 2cm of heel lifts in for 6 weeks (and got very good results). 4 weeks might also work fine (or even better), but it’s never been put to a rigorous scientific test, so it’s a crapshoot. Some time after FWB, it’s time for 2 shoes. Not yet. ‘Til then, you’ll stay in the boot, at least most of the time. I think hinged boots are a useful tool for making the transition, just based on my experience and common sense, no convincing studies, AFAIK. It’s usually not worthwhile to buy a hinged boot after buying a fixed boot like the Aircast. (Hinged boots can be made fixed, but not t’other way ’round.)

PWB means you’re putting some weight on it, not just resting it on the floor. It’s usually a gradual thing, starting with very little weight then more and more as you feel comfortable and confident.

Has your Doc told you when he thinks you should start ditching the crutches (= FWB)? The UWO study started “FWB as tolerated” at 4 weeks post-whatever (post-op and post-non-op), and they got excellent results, on average, with both groups. So that doesn’t seem to be too fast, IMHO. (If your Doc hasn’t seen the UWO study, I’d print him out a copy. It’s on this web-site, for free.)

Do you get up in the middle of the night, like to go to the bathroom? If so, I’d wait a few weeks longer before sleeping bootless. Otherwise, 5 weeks is probably a reasonable average answer from our various Docs. I think I noted that milestone on my blog when it happened, but I don’t remember when it was.
Sleeping with a partner seems scary, but hardly any of us have actually gotten hurt that way — I’m talking about Achilles Tendons here, not broken hearts. . .

Consi,
There are a few posts in this blog regarding the subject of sleeping with / without the boot.
In my case, I took the surgical route, and the doctor said I should sleep in the boot for 5 weeks after surgery. I was only allowed to remove it to shower and apply topical antibiotics.
It was good advise, as one night I tripped and fell putting full pressure on the injured foot. I was going to the bathroom half asleep, and would have definitely done damage had it not been for the boot.
In my opinion, if you move around or sleep with a partner or pet, you must keep the boot. Just be patient, you will be able to ditch it soon.

It is best to do all the stuff from the site then everything is available for others to read. You don’t have to log in to comment, only to edit or post. Forget about the emails. Think of them as a message telling you there has been some activity on your site. After a while, when you are visiting this site less it will be helpful. You should also set up your personal profile (after log in) and then add the time line widget. It helps the rest of us keep track of how long you have been going. After log in you will see a tab ‘users’ on the top line. The scroll down menu will have ‘Your Achilles profile’. Fill it in and then I think the widget is added but there are links to help on that page.

Again new to this bloging. I believe that I have respond directly to your e-mail accounts on your posts. If I am in error on this please forgive me. But again thanks for everyones advice.

Consi, if your ankle has been immobilized at NO angle, i.e., at 90 degrees or “neutral”, then I fear you may have a problem — and quite possibly one that will need surgery to cure, unless you can address it promptly.

OTOH, one of the most successful studies on non-surgical treatment of complete ATRs (of varying gap sizes, with NO statistical relationship between measured gap size and non-op clinical success!) used only a relatively modest amount of ankle angle — 2cm of heel lift in a fixed (90-degree) AirCast boot, for 6 weeks. (I’m referring to the so-called “UWO” study, aka Willets et al 2010.) So excellent results can be had (on average) without surgery with only that modest amount of plantarflexion.

Like the logical (but apparently false) relationship between AT gap size and non-op success, there’s a logical fear that insufficient plantarflexion will lead to increased healed AT length.

For sure, “healing long” is to be feared and avoided, but the mechanism is either poorly understood or not understood at all, AFAICS. The simple fact that non-op patients (e.g. in the UWO study) show NO significant difference in healed

An MRI is the best way to see the gap. There is still time but I would not change the treatment after 3 weeks. They are not cheap and you will probably need a referal from a doctor. There is also time to increase the angle of the foot if it is needed. It may not be needed so don’t go worrying without getting the facts. Regarding this getting old determining the type of treatment. My father’s surgeon decided non surgical AT treatment for him because he was at a higher risk of infection but he also said that he needed to have good mobility and strength. He was still very active for 81 and had plenty left in him even after the fractured neck of femur 12 months ago. We need every bit of strength as we get older. Our strength naturally will decline but to have it sucked away by poor treatment will only put us in a walking frame earlier so treatment for older people is MORE important. Doctors do not like to have their opinion questioned so you will have to be gentle but make sure you get anwers that will satisfy you, if not then think about getting another doctor. After all that, please do not think I am telling you to have sur

Hello Consi and welcome,
Get an MRI. If the gap between the two ends of the tendon is too large (as in my case, 6 cm), you will get better results with surgery.
Read my story. After injury I saw four doctors and got conflicting information. The MRI helped me make the best decision for myself.
Good luck on your recovery.

I would suggest that if the two ends of the tendon are touching then the angle is sufficient. If they do not touch then the body will naturally fill the gap and there is an increased chance of elongated healing and a significant strength loss when healed. Surgery will ensure the ends touch but there are other complications. Surgery has worked for me though I would not advocate it for everyone.

Welcome to the ATR club, although sorry you qualify for membership

It’s impossible to speculate whether the angle of your foot is correct although presumably it is. Having said that I would strongly suggest being an advocate for yourself with your doc and all the professionals you will be seeing in the months ahead.

Don’t be afraid of asking “too many questions” or insisting on explanations about why you’re being treated in such and such a way. Certainly don’t be concerned about ruffling any professional feathers, after all it’s your leg not theirs and the quality of your recovery will be with you the rest of your life.

And, be aware that there is a tendency to assume ATR patients >50 yrs don’t need an aggressive recovery since they are older and not active (I’m 57, and definitely not a couch potato).

My experience is similar to yours, I tore my achilles tendon on a Sunday and on Tuesday was given a cursory examination by the ortho. Heard the same pros and cons to surgery schpiel and then told I’d heal the same way regardless with a slightly higher risk of re-rupture at 9 to 12 weeks taking the non-surgical rout