It’s Time for Surgery on my Achilles Tendon

I am lucky enough to have my employer cover a majority of my healthcare. My wife and I are on a Kaiser HMO plan where about $100 or so comes out of my paycheck a month to cover the both of us.
My achilles surgery cost me $250.
My surgeon had scheduled my surgery for Monday, 3 days after the injury. After paying and checking in at Kaiser I waited in the hospital surgery room for a while before being called in to change into the surgery gown. I was then put on a gurney and hung out with the nurse, who was doing her routine checks, in a curtained area. A young dude came over and told me he was the resident surgeon on duty. He had to be about 25 years old or so. He walked me through what was going to happen after I was rolled into the operating room.
Then the operating podiatrist came over and introduced himself, Jason Neufeld, DPM. He is in his mid 30’s. I had lots of questions for him and he answered quickly and confidently. It really made me feel comfortable. Below are a few questions I paraphrased from our conversation.
How many achilles tendon ruptures have you repaired?
I have repaired 100’s of achilles ruptures over the past few years.
How many re-ruptures have occurred out of those you have performed surgery on?
None, that I am aware of. I follow and keep in contact with all of my patients until they have fully recovered from the injury.
[After giving Dr. Neufeld a brief background about who I am, what I do and what my active life is like] What is your recommended recovery and rehabilitation timeline?
With surgery, we keep the patient in a cast for 2-3 weeks and when the cast is removed the patient is given a walking boot. The stitches are removed when the cast is removed. The walking boot is in a fixed position with your toes pointed down similar to the cast. Patients will still need to use crutches for the first month or so after surgery and shouldn’t put any weight on their recovering leg. After that we slowly ease patients into allowing weight on their recovering leg in the boot with the toes still pointed downward. Depending on how that goes, we adjust the boot a few times until the foot is moved towards a position where it’s flat on the ground. Patients are in the boot in a fixed position for about 6 weeks total. Afterwards we keep the boot on, but allow patients to move their foot and increase their range of motion until we feel they are ready to remove the boot.
Each patient is different so this timetable is not in stone and will be adjusted depending on physical therapy and feedback from our appointments.
Do you have experience with the VACOcast boot? Do you recommend it?
I have had a few patients use the VACOcast. They all showed great results from using it, but a majority of our patients don’t use it. The reason they don’t use it is because it is quite expensive and not covered by Kaiser. The bottom line is you should recover just fine regardless of the type of boot you use. Recovery results depend on how well you follow our rehabilitation process.
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I asked more questions about the procedure itself including how long it took, what are the anesthesia options, how long it takes to wake up from the anesthesia, etc. I also asked about rehab and physical therapy which I’ll cover in another post.
What I was most satisfied with was the doctor’s overview of his recommended recovery path. That was the rehab plan that I had been reading about. It was exactly what I want to do.
I decided to take local anesthesia instead of general anesthesia. I just wanted to be out, then wake up when it was over. Both do that, but local anesthesia allows you to breathe on your own. General anesthesia requires a tube down your throat to help you breathe which can get complicated with this type of surgery since you are laying on your stomach.
They rolled me in to the operating room and asked what kind of music I wanted to have playing. I told them I’d rather have the surgeon have his favorite music playing–he’s the one who I want comfortable.
My drugs were kicking in and I was getting drowsy. I remember was Dr. Neufeld doing what they called a, “Timeout.” They went around and each person in the operating room took a turn, giving a status update. After the last person gave their status, I asked if I could give mine. I wished them good luck and asked them to bring their, “A-game.”
Then I asked if they had seen Rookie of the Year. “I want to come out of this surgery with a laser left footed (soccer) shot. Hook me up, boss!” That’s the last thing I remember.
4:12 am - 11-2-2013
Love the music choice!
Curious why both of you (patient & Doc) prefer a relatively long NWB period and ~10 weeks to get out of the boot — though it’s hard to argue with 0 reruptures out of 100s of patients. That’s never been documented AFAIK, though Exeter in the UK recently came quite close with a much faster approach. Their surgical-side patients were extremely close to 0% reruptures IIRC.
1:44 pm - 11-2-2013
Hi Norm. As noted in the post, the doctor was giving a high-level overview of the process. Each person is different and physical therapy is dependent on their responsiveness.
With that said, the doctor suggested that I don’t bear weight for 4 weeks, not 10. “Patients will still need to use crutches for the first month or so after surgery and shouldn’t put any weight on their recovering leg. After that we slowly ease patients into allowing weight on their recovering leg in the boot with the toes still pointed downward.”
During the NWB period of 2 weeks when I am in a boot, I’ll also be removing the boot for physical therapy.
2:15 pm - 11-2-2013
I think I got it right, alan, a long NWB period AND ~10 wks to get out of the boot. Those are BOTH several weeks slower than the successful and well-documented UWO patients, and the even faster and at least as successful Exeter group. Now that those are published and top the field in good results so far, I wonder why a sharp patient and a sharp OS choose to go slower.
I would have been less surprised if you’d described his protocol then said you were hoping for faster. We get a lot of that here. But instead you said it was just what you were hoping for. That’s not based on pro athletes, is it?
3:29 pm - 11-2-2013
Hi Norm. I’m still not sure where you’re getting 10 weeks from. The doc suggested my foot be in a fixed position for 6 weeks, then begin limited range of motion in a boot on pace to remove the boot around 8 weeks after surgery. Maybe if I put the timeline in a different format, it might be easier to understand:
0-2 weeks, non-weight bearing fixed cast
2-4 weeks, non-weight bearing fixed boot
4-6 weeks, weight bearing, fixed boot
Week 6, weight bearing, limited range of motion boot
If the 2-week pattern follows, I’ll be out of a boot and into shoes after week 8 (this was insinuated by my doctor but not addressed specifically. However, I did discuss it with my PT and the Stanford Sports Medicine Clinic).
I have consulted my personal trainer Analisa Naldi (MA, CSCS, SFG1, USAW, PN, BBPL3)’s recommended physical therapist, Paula Chan (MS, PT, ATC). I have also consulted Stanford Sports Medicine and Rehabilitation Clinic by phone. All agree with the timeline for the most part.
Again, please let me stress that this is just a general template that we will most likely deviate from depending on my achilles’ response.
Is this timeline format easier for you to visualize?
8:15 pm - 11-2-2013
Love the way your posts are laid out and organized. Awesome work!
I hope the surgery went well and am looking forward to hearing your
updates. Regarding boots, it’s a personal thing. I have 4, but love the Vacocast the most.
I am sure you will recover well and you seem to be very intelligent, organized and focused.
BTW, I will be putting up my protocol this weekend, which is somewhat aggressive, but can be customized. I also put up a blog on list of things you may need, etc.
Good luck,
Ron
9:08 pm - 11-2-2013
Alan, love your pics. Hope your surgery went well, and I am looking forward to reading your updates. happy healing!
2:43 pm - 11-4-2013
Ron and Dennis, thanks for the comments. Yes, surgery did go well!
Ron, I ordered the VACOcast due to the overwhelming praise for it that I have been reading here and in other sources. I’m looking forward to checking out your protocol.