Tendon healed a little long, but OK

Hello all,

I know this site is about Achilles injuries, but it was interesting how similar my finger extensor tendon tear issues were to Achilles issues. In particular, don’t rerupture and don’t heal long. Well, my autistic daughter got out of control about two weeks in and, while getting her into her safe room, my finger splint came partially off, messing up my healing tendon in the process. It is now out of the splint and functions well enough, so it’s fine.

I see there has been some discussion about faster rehabs here lately. I believe faster rehabs can be done safely. The key is being aggressive, but in a very gradual and careful way, I think. In my case, I did a lot of pushing early, then backed off, once my goal of being able to handle my daughter’s meltdowns was reached. Once I had enough range of motion to walk fairly well in my shoes at four weeks, I didn’t stretch any more for some time. I worked the strength fast enough to be able to hold up my weight with my calf at eight weeks, but didn’t work at anything “explosive” for some time after that, and then very gradually. Again, I had reached my goal, so the risk was no longer worth it. That path worked for me. We all have different lives and goals, so it makes sense that we rehab at different paces, at least when we have a chance to do so.

Best wishes everybody,

Doug

4 Responses to “Tendon healed a little long, but OK”

  1. Hi Doug

    I agree a rehab can be done faster and it can also be done quite safely. What sticks out to me though is that the increased risk to rehab faster is far greater than the increase in time to get back to fully functional.

    What I mean by fully functional is doing what you could normally do before so break into a run if you want when crossing the road, reaching up high on your toes to get something off a shelf, or just to play a sport. All this without thinking “if I do this, what are my chances of re-rupturing”.

    I think for those of us that are new our focus is on healing as quickly as possible and “2 shoes” seems to be the beginning of the end of the rehab. What you find out personally is that its not even close.

    For example, if your goal is to be mobile on 2 feet (which in both of our situations is what we needed, in my case my wife is disabled so needs lifting etc) then wearing a boot resolves that. I didn’t even need a boot really, a walking cast would have been fine as I managed it in my non-walking cast.

    When taking this into account the length of time from “2 shoes” to “fully functional” is a long time and far greater than the time it took to get into shoes from the injury.

    As mentioned in another post, what would be better I think is to not have PWB/FWB/2 Shoes as the only goals but to add more, eg:

    * PWB
    * FWB
    * “2 shoes”
    * Walking without limp & with normal push off
    * 2 footed raises
    * 1 footed raises
    * Jogging
    * Controlled jumping
    * Full on sports/plyometrics type activity

    I’m sure there are others but personally, until I hit that last one I will not consider myself healed, just a work in progress :-)

  2. Doug - It may be in years to come a version of your rehab becomes the norm but you have said that you ‘healed long’ and I wonder whether the things you did earlier than others had some bearing on that. I can fully understand your need to get things happening early. Your reasons were not trivial or selfish and I have an idea you understood the risks. For some people, the need to get back to their formal ‘full on’ life will push them to look for any glimmer of hope and without sufficient medical understanding things could go horribly wrong. I know from my own experience that in the early days I was convinced I could do this faster than everyone at the hospital told me and any evidence to the contrary I discarded. In the end I found a good balance and a good physio and my progress is going well. There are so many ideas on how this injury should be treated but surgically there are also so many methods still used and this can have an impact on how fast we can get things moving. The suture method, type of sutures, the skill of the surgeon, the location of the rupture and the extent of damage or degeneration of the tendon, whether a graft is used and if so the type of graft, all have an impact on how fast we can get moving again. While anecdotal evidence is often the basis for new studies it is not yet clinical evidence and although it has worked for you I would issue caution to others to understand the risks long and short term before taking a similar path. I will say here that the overwhelming evidence from clinical studies is that early motion and weight bearing is beneficial. I have not seen any studies that indicate early passive stretching and strengthening have aided healing but would be very interested to read one if anyone has a link to share. Maybe this will come in time and the evidence will be there to support it. You have taken great care and time to detail your rehab and you have said it is for those who want a faster recovery. My concern is for those who are less concerned with the detail and more concerned about healing fast. How much is too much and how fast is too fast? Fast can obviously be done but can it be done safely by everyone and how do we judge who is able and who is not. In the end it is up to the individual to decide. The best way to decide is to have an understanding of all the facts.

  3. Hi Stuart,

    Most of what you say is true, but I think you missed the key point that I was talking about a tendon in my finger healing a little long, not my Achilles. My Achilles is fine.

    Doug

  4. BTW, I also tore an extensor tendon in a finger (right ring, volleyball again!), and I also have a residual “swan’s neck indicating that it healed long.
    Nobody ever operates on these hereabouts, it’s just immobilized in a little splint. And if the injury is on your dominant hand like mine, putting that thing back on without letting your last finger joint flex is NOT easy! And unlike a FLEXOR tendon like the AT, there’s no way to approximate the torn ends ( without breaking your finger), so healing long is the rule, not the exception.
    Mine didn’t even heal the first time. A hand specialist put me in a stiffer splint with tape instead of Velcro for another 8 weeks. I was more careful (I skipped volleyball for the 8 weeks this time!), and it healed, though long. No functional problems, but now I won’t be a leg model OR a HAND model!

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