durwood’s AchillesBlog

Durwood, that sounds like pretty good progress to me. You’ll never get back the time before the rerupture, so write it off, forget it. My first OS (post-op) was ultra-conservative, and insisted that I be able to do a bunch of 1-leg heel raises WITHOUT GRUNTING OR GROANING(!) before I went back to competitive volleyball (the sport that gave me both of my ATRs). For me, that took 10 months, which was when the Fall volleyball season started anyway. I played, and I noticed no deficit in speed, agility, vertical, etc., so I was happy.

For my second ATR, non-op, it seems that I’m never going to get back to ONE proper 1-leg heel raise, much less a bunch, and my volleyball return was delayed a year by open-heart surgery (valve replacement). But I have been back to competitive volleyball, beach and court, for almost exactly a year now, and I’m having a blast at it, including lots of 2-on-2 beach ball.

My Competitive 4s co-ed league team just finished our first 9-week season solidly in first place, and the playoffs are next Monday, should be good. (Mind you, there are THREE Competitive 4s leagues, and ours is the bottom one, so we’re s

Hey good to hear from you…I’m sure you’ll get there in the end, does sound frustrating though….this will be me too!

Hi Durwood,
good to hear from you. I thought I’d post here in case you missed it if I replied on my post.
I am two weeks today and all feels fine actually. No real pain, the odd fleeting twinge now and then. I do have to elevate a lot though. I see my ortho on wednesday and I am going to fight for my boot. If he argues that the tendon graft requires a cast then I guess I have to back down but I don’t want to hobble around in a bloody cast for two more weeks unless I really have to.
You sound great and I bet that re rupture feels like it never happened now…
Take care.

Hi Durwood,
How are you? Not posted in a wee while. would be good to hear from you….

Sheena, hi

We’re waiting with bated breath, and my ‘good’ leg has aching and cramps in sympathy.

H

Thanks…I am just about to write my blog…interesting have a look if you get a moment.

Hi Sheena,

I remember the Doc surprised me with how soon I was able to take it off for bed. Having said that, I can’t remember exactly if it was at the 1 or 2 week point. But I think I actually kept it on a little bit longer just because I felt more comfortable protecting it. But I didn’t go too far beyond his recommendation.

Good luck!! Did you meet with the surgeon yet?

Durwood

Oh and how long did you sleep in your boot for?

Hi Durwood,
thanks so much for coming back to me. Interesting that you were in a boot after one week and FWB after two weeks. That is fantastic. What sort of boot did you have? Was it hinged? I don’t think so because you had heel wedges. How many heel wedges did you have?
I am not going to let them keep me in a cast for six weeks as they did last time. I’m going to move it on quickly you have been.
Thanks for your help.

Sheena,

I’m sorry to hear about your setback. No doubt that a rerupture is a terrible thing to deal with…especially if you had been making good progress. I know from my experience the rest of that first day was really hard on me mentally.

I just couldn’t imagine going through that whole process again and having the same thing happen so I never really considered the non-op route again. Plus my doctors advised me that surgery was the best chance at getting it repaired properly. Part of the problem was that 4 weeks elapsed from injury to diagnosis & non-op treatment the first time around, so I probably should have had surgery to begin with. After the rerupture it was pretty much a given.

The good news is that at least for me the post-surgery recovery process has been a success. I was NWB in a splint for 1 week and at my 1-week check the incision was healing well enough that he put me in a boot (with heel lift) and said I could go to PWB right away and WBAT in a matter of days. So by the end of the 2nd week I was without crutches which was a tremendous relief.

I was fortunate enough to have time off from work

Hi Durwood
I know this is a late response to an old post but I re ruptured last night and wanted to ask you how you’re getting on now. I have an appointment next week and I’m guessing they will offer surgery. Did you look into non op a second time at all? If there was any way I could avoid surgery I would but I don’t think I have read of anyone going non op a second time.
How are you getting on now? I was walking up a slight incline and pushed off without thinking and it just popped. I thought of you and how awful you must have felt because I feel devastated. Hope your recovery is going well?

Im right at 5 weeks (almost 6) with you. Difference is I have been going to PT since the 3rd week (2 times a week) YES heel hurts wiht the lifts in. good idea wiht the swimming.. Im goign to try this weekned. Hang in there

Norm, I’m with you. I guess I was expecting a greater result on the T-test. It’s not like it’s a hard test to replicate at home–even without numerous years of med school & training!! And as I said previously my other leg responds very well to my at-home test.

Ryan, I was pretty surprised that I was in the boot 1 week after surgery and WBAT. I used crutches for a few more days and then went to one crutch for a couple of days. By the end of week 2 I was FWB. Seemed pretty aggressive but the Doc said not to worry. I’ve been doing foot flexes, toe wiggles, and then the swimming. It feels terrific and looks good from the outside…guess I’ll have to see what the Doc says week from tomorrow.

Cheers,

Durwood

Or, better yet, get them out of a cast, and into a boot ASAP (like 1 week post surgery). Have them start doing no-load mobility work - things like writing the alphabet with their toes - right from the very start.

No wedge solution here, other than “be creative”.

I’d expect a post-op leg to pass the Thompson test at any interval post-op. You know that your AT is continuous from the sutures (even if there’s been zero healing, God Forbid!). Heck, maybe they should do frequent and early Thompson tests on all post-op ATR patients to keep them from developing post-op attachments! (BTW, I think I’m serious! After infections, pain, scars, and non-closing wounds, attachments are probably the most significant post-op complication, and it makes sense that making the adjacent layers of tissue slide over each other while they’re still healing could be an easy way to keep them from healing together in a non-layered, non-functional clump.)

Sorry forgot to say, sounds like good news there Durwood.

Sorry the Bledsoe boot is giving you some grief, would the wedge from the previous boot fit? Can you use it?

Happy healing

Have you tried squeezing your good leg? I know what you are saying about twisting around to see your feet…but my good foot responds quite well to the test!

I try giving my self a Thompson test all the time and it is always non responsive, but when ever the surgeon does it he is happy, I think you have to be facing away so giving yourself the test doesn’t work, so don’t worry!

Wow! Right now, where you are with the re-rupture sounds wonderful to me! I’d love to be looking forward to a swim & to be rid of my training legs! All a matter of perspective. Hoping the rest of your rehab is non-eventful & you see full recovery without further mishap!

wish you the best on recovery!

Take a moment and think about kicking in the pool. You’ve got an up-stroke and a down-stroke.

On the down-stroke, flexing your quad, kicking your leg straight, the water force on your foot is trying to create plantar flexion. You work the muscles on the front of your shin to resist that force- the same muscles that pull your toes up. Your Achilles and calf are relaxed. I think you can kick that direction as hard as you want without any risk of damaging the Achilles.

On the up-stroke, you flex your hamstring, and pull your foot up. As your heel drives through the water, to get “maximum power” you’d want to point your toes, flexing your calf and Achilles. That’s going to hurt. But, this is rehab… we’re not trying to set an Olympic record. You can relax your foot during this side of the stroke, and kick your heel up without pointing your toes. Your foot may get pushed towards neutral (~90 degrees) by the water- but no more. The closer you get to 90 degrees, the less torque the water will put on your ankle. So, pointing your toes just a little bit, doesn’t take much force at all… it’s a pretty good way t

Good Luck and Good Healing, Durwood!

wow-glad to hear you are progressing and so quickly. 3 weeks in, I’m frustrated enough with the first round.. can’t imagine a re-rupture!

Hi Sheena, I’m glad to hear you are progressing without surgery but understand completely what you’re talking about as far as living in dread when you have a small stumble around the house! It’s such an awful injury to recover from and none of us has the luxury of living in a cocoon for 6 weeks to let it heal without the daily demands of life! Fortunately my family has supported me tremendously since surgery and I was able to basically sit in my big chair with my foot elevated for the past week. However, just yesterday my sandal caught on the front steps while I was hopping back up and although I didn’t land on my bad leg it did cause my body to tense up and I felt the skin tighten up down on my ankle–it didn’t feel great and I am wondering if I did anything to the incision. I guess I’ll find out tomorrow at my checkup.

Hopefully I’ll continue moving forward with my recovery. The surgeon departed before I woke up (I was his only surgery that day) so I’m interested to hear firsthand what he found in there and how the repair went.

Good luck to you and I hope you continue to get well and heal up strong!

Durwood

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Hi there,
sorry it’s been so long. News was good. It was healing so he put on a second cast hopefully going into boot in one week. I have taken a couple of stumbles though and put weight on it. He doesn’t want to see me early but I live in dread that I have gone back to square one. No body knows better than you how that feels.
How are you now? I think you’ve been so brave after all the time you stuck with things and had to start again.

Not too bad…nerve blocker wore off in middle of night and that really got my attention! Haven’t slept much since then but all in all doing okay. Thanks!

How about you? Did your hematoma resolve or do they still want to operate on you?

Durwood

How are you Durwood?

Hiya Norm, too funny! It was no big whup when it was all said & done. They stuck a mask on me, I remember making a scuba joke and I kinda figured when they couldn’t understand what I was saying that I was on my way to la-la land. And, just like they said, I woke up in the recovery room wondering where the rodent disappeared to that apparently crapped in my mouth while I was out!!!!

The nerve blocker was dy-no-mite until it wore off at 3 AM this morning. Even though I started the oxy-goodstuff before it wore off the pain was pretty intense and woke me up. I haven’t been to sleep since. Hopefully this sharp pain doesn’t last more than a couple of days. I do have one of those ice water pump things that is strapped on top of the splint bandages and although I can barely feel it I hope it is helping with the swelling.

I might get brave later today and venture out of my lazyboy and get my blood circulating by crawling upstairs to get in the shower.

Thanks for the support!

Durwood

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Good luck and good healing! When I was heading for open-heart surgery a pal said that the difference between MAJOR surgery and all the other surgeries is whether it’s being done to YOU!

Thanks Kim & Sheena,
Today wasn’t bad but no doubt due to nerve blocker. I’ve been home for 7 hours and still can’t feel a thing in my leg! But I did start the 12 hr pain meds and will take another before sleeping because the blocker will probably wear off at some point in the night.

Leg is elevated on several pillows. Follow up appt is a week from tomorrow.

Thanks again for all the positive thoughts.

Durwood

Well done!
First knock out for surgery is scary! Hope it’s not too painful and I’ll be watching your recovery. Keep us posted. It has been a long haul for you. I’m non op in the UK so have read your enitire blog….Hope it goes really quickly for you this time.

Congrats, Durwood! I hope all continues to heal quickly this time around. Don’t get behind in the pain meds - it hurts for the first 24-48 hours after the block wears off! Elevation helped a LOT!

hey Durwood .. good luck tomorrow .. hopefully the surgical option will work out fine .. Im a little over 2 weeks post-op and it’s going ok so far … hope tomorrow goes well .. recover fast

Mark

Hey durwood,
I am glad you have come to peace with the given choices. Hopefully, everything is best case and your recovery can proceed without any more complications.

Thanks Durwood,
I will bear that in mind. I had an ultra sound at week one which showed a haematoma around the join area. I think that was the only concern about it not healing. I am going to have another ultra sound on Monday so that they can see properly. I also had a bad calf cramp a few days back and it’s been sore since so I’m worried that has yanked at the newly healing tendon. We’ll see Monday. The OS said from day one if it wasn’t ahowing signs of healing on ultra sound that he would operate. He knows I really want to go non op and it’s his default, he doesn’t operate unless he has too. This is the NHS he gets paid come what may. Is your op Monday? Good luck.

Sheena,
Thanks for the support! Good luck to you too. Is there something your docs are saying that will require surgery after only 2 weeks? At my 2 week check I was barely registering any response on the calf squeeze test. My ortho wasn’t all that surprised though, and two weeks later (4 weeks into rehab) I showed a ton of improvement!

Also, my ortho said she had another non-op patient that didn’t show anything until week 6! And they were just about to give up and schedule surgery and he started showing a good response.

So I think it reinforces the notion that these injuries are different for everyone and that includes the healing process. Two weeks sounds premature to bail on the non-op strategy unless there are other circumstances about your injury.

Good luck to you with whichever method you choose!

Durwood

Hi there,
I have read your whole blog and know what you’ve been/going thru.
Good luck to you!
What a pain this is to us!
Please let us know how you get on. I am two weeks non op but may need surgery when I go in on Monday if it’s not healing. You have been thru an awful lot and I think you’re coping really well.

Durwood I take Cissus Quadrangularis, I take @ 2.8g a day 1.2g in the morning when cortisol levels are highest then 800mg mid-day & 800mg before bed…when I was doing ultrasound therapy 3xs a day I would usually do the therapy after taking the cissus as ultrasound brings blood to the site, then hot bath with massage in tub, after followed by ice on the atr, with periods of rom exercises…God bless Durwood, I’ll pray for wisdom for you & your Docs Bro. P.S. I get my Cissus from Swanson, it’s reasonably priced and comes in capsule form.

Missed your post(s) ’til now, Brian, sorry. Your 2 arguments may have merit, but I think I’ve seen some evidence going against both.
(1) Re prior tendonitis/tendinosis being fixed surgically: It’s been oft-repeated here by reliable posters (doug53 pops to mind), and I ASSUME it comes from real evidence, that ATR recovery, with or withOUT surgery, very often clears up prior tendonitis/tendinosis.
That said, of course there are conditions and situations that indicate surgery, so don’t imagine that I’d ever deny that simple truth. There also some conditions and situations that will only be detected during surgery! That makes some people fear non-op treatment for apparently routine ATRs — me, not so much.
(2) I think I HAVE actually seen some studies comparing grafted ATR repairs to simple open surgery, and found no benefit. Of course, the surgeries do change, and the current fave seems to use the patient’s own big-toe tendon, which wasn’t the surgery in the study I saw. So maybe that one has provable benefits, for a future randomized trial…
(3) On my own “studies” page, I referenced an early report from a new kind of ATR surgery

Thanks Norm & Ultra,

Norm–as always, I can count on your posts to distill the dilemma(s) into simplistic terms. You hit the nail on the head (again). So we’ll just have to see what the foot & ankle specialist says.

I did get a call from my normal orthopedic PA that had been seeing me (she was off last week) and she said she’s going to goose the referral system to make sure I’m seen within 72 hrs. So hopefully this week I’ll know what I’m going to do with this. And if it’s surgery, then maybe I’ll have a date set.

Ultra–thanks for the kind words & positive thoughts. I considered us kindred spirits given our similar timeframes, circumstances, and non-op treatment. I’m very glad to hear you are not just getting by but THRIVING. I cannot believe you are running like that at this point. That’s fantastic.

What supplement were you taking? I’d be interested in getting some myself!

I think in hindsight I should have slowed down these past couple of weeks and truly weaned off the boot rather than getting into two shoes & staying there. There were a few days where it was a little swollen & s

Wow, durwood very sorry to hear of the setback you’ve suffered…Just wanted to throw my two cents in, I too was very delayed in beginning of my treatment much more so than you in fact…I was over 2 months down the line before I began the non-op treatment. I would say that my leg feels and act as if it’s almost totally recovered, I’m 16 weeks into treatment and have already began running again, 14 miles 3 days ago…I just wonder if the difference between our situations may be the treatments themselves, I have taken a specific supplement that nourishes the tendon & daily ultrasound therapy. Also a lot of early mobility, compression, ice & heat and massage…We both had similar starts & I am very happy that I went non-op as all the surgical risks and costs are very scary & people that have surgery re-rupture as well…I met a emergency room nurse a few weeks back that shared some of her ER horror stories associated with atr surgeries and she was delighted when I told her I was non-op…I feel so badly for you & I know I’ve dreaded even the thought of re-rupture so my heart goes out to you. I’m going to pray for y

Durwood, your main Q is a good one: does your failed initial ATR regrowth (probably because of the initial delay) indicate bad odds starting now?

Your life would be simpler if there were a great (evidence-based) A for that Q, but no. All we’ve got is logical-sounding answers — and they have a habit of being disproven by evidence in this field! I think the logic works like this: After a trauma like an ATR (or AT surgery), our bodies respond with a flurry of intense
Inflammation and tissue formation. Successful ATR rehab — post-op and post-non-op BOTH — relies on that response. Your first time, you’d already missed the most intense 3 weeks of that response — 1 more week than the “stalest” ATR in the UWO study, and probably 2 more than average. That made you a bad non-op risk the first time.

And now? OT1H, you’ve caught the full “wave” of healing response this time. OTOH, your earlier phases may have done bad things — e.g., hardened up and matured your torn AT ends, so they aren’t super-receptive to re-forming into one strong continuous AT (even after re-rupturing), without being trimmed (=~re-injured and renewed) with a sc

You might want to skim over some of my posts since they are better informed than my memory.

Originally I only waited a few days before splinting for non-op; however, I pushed things way too quickly, so both waiting too long to place original splint and rushing protocol contributed to poor healing.

I didn’t even consult a surgeon after re-rupture because I new what they would say. I just laid there until my crutches were brought to me and iced it for about an hour then put on my boot at 30 degrees plantar.

My conclusion was to chill in the beginning because the gains in time of recovery are far outweighed by the risks of poor healing and re-rupture.

I was really depressed when I was at your place and didn’t know if it would ever work right. I am certainly not 100 percent, but I am doing normal or better in recovery.

Certainly every rupture is somewhat different, but mine seemed really messed up and seems to be healing okay. All the talk of grafting, etc. kinda freaked me out, so I thought I would let it ride and see if non-op worked out before going crazy with surgery. I have had doubts along the way, but now I am g

Pk,

Thanks for sharing your insight. How soon after your original injury did you get it diagnosed and begin the non-op protocol? That’s my big dilemma right vis-a-vis surgery or not. I went 3+ weeks before diagnosis so I’m wondering if the delay will always preclude non-op from doing the trick.

Because it had been healing very well I’m unfotrunately in 2nd guessing mode right now wondering if I did overdo it by rushing into two shoes and not weaning off the boot more gradually. It just seemed like more activity was better in terms of building up strength just by walking but maybe it was too much too soon?

So will non-op work again and the only change is to take it easier? Or did the original delay create conditions that were preventing non-op from really ever realistically succeeding? Tough choice indeed.

Hopefully surgical consult will help but I expect I know what he/she will say…I mean, surgeons get paid to do surgery, right.

Good luck to you in your continuing recovery!

Durwood

Hey Durwood,
I am really sorry for you . . . I was in a similar place and went non-op again.
My Achilles partially ruptured at 13 weeks and I kept pushing through pain until it fully ruptured at 19 weeks. I believe the partial rupture complicated the healing process; it was half tore at 13 wks and then the other half at 19 wks. Anyway, I am 11 months down the road and I am doing pretty well. I am cycling hard, slow jogging and walk uninhibited. I believe the key is to get it set in a boot or splint in plantar flex ASAP after rupture. If I understand you correctly, then you have done this. Tough decision to face, but I couldn’t bear the surgery option.
In response to Einstein’s quote; you might consider how many people have had really bad experiences w/ the surgery option too. So, your re-rupture is unfortunately something that just happens occasionally regardless of technique.
I sincerely hope the best for you regardless of which option you go with. pk