uk achilles recovery

Spectacular article…..would like to hear more on this subject.

After surgery, laser treatment is recommended to decrease scarring. Pimple remedies involving phototherapy are already shown to get rid of pimple for months with results better than benzoyl peroxide. This involves shining ultraviolet and red visible light on the acne areas twice weekly at least, daily for best results.

Sweet blog! I found it while surfing around on Yahoo News. Do you have any suggestions on how to get listed in Yahoo News? I’ve been trying for a while but I never seem to get there! Cheers

Parisgirl, I’m not sure how many 6-month and 12-month ATR “veterans” — post-op OR post-non-op — are still around to answer your question. In addition, many of us got diagnoses of how “complete” or “partial” our ATRs were, that are suspect or worse. (E.g., I was initially told that my second ATR was complete, based on a Thompson test and the first of 3 UltraSound exams to guide PRP injections. But after the second US, the same Doc said it looked like a PARTIAL tear, and after the third one, he said it looked like a partial-but-multiple tear. So what kind of tear was mine?!?)
It’s true that some Docs apply a non-surgical approach to ATRs they think are partial, as well as complete tears that are unusually high, near the AT-calf join. But others (like mine) guide most of their patients to a non-surgical approach with a fast modern protocol, and a few (maybe mostly in the UK) still recommend non-surgery with old-fashioned slow “conservative casting”. And of course many guide the vast majority of their patients under the knife.

The modern studies (discussed above, and refs 4-7 in the Wikipedia ATR article) all dealt exclusively wit

I’m curious…how many people who took the non-surgical approach had a full rupture as opposed to a partial rupture and what is their activity level 6 months and 1 year after the injury

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Gerryr - deleted!

HEY DENNIS, there are 6 spam postings in a row here. How about deleting them?

On the one hand, Simon, answering your question about exercise would make an interesting study. On the other hand, both you and Gareth got a rather conservative conservative approach! I.e., the modern studies producing good results from a non-surgical approach (including the latest 4 studies comparing that approach to surgery — see my blog page) all move much more quickly than you two did, especially from NWB to PWB to FWB and into physio. And they all do it with boots, not casts, which is HOW they do the early physio and exercises!

So one question is whether the kind of super-physio and uber-exercise that you and Gareth did can make up for the muscle atrophy — and maybe even poor tendon healing (like high re-rupture rates) from long immobilization and NWB — the treatment that was traditionally associated with the “conservative” approach. I’d say “Maybe” for sure!!

Now that the newer studies have ALL shown that non-surgical immobilization with relatively quick and aggressive rehab produces results that are statistically identical to surgery with that same rehab, somebody should probably write a PhD dissertation on how the O

I just thought I would add my few pence worth to this thread as I too have returned to sport following non-surgical treatment.

I ruptured my right achilles about a year ago now and followed a pretty standard non-surgical approach here in the UK, spending 10.5 weeks in a cast with the foot in various positions.

I had a few problems early on, particularly a lump around the site of the rupture which was causing discomfort with every step I walked. It didn’t really stop me doing things, but just meant I could never forget the injury.

The pain did reduce to nothing over time and the lump has pretty much gone - with progress primarily after my physio started ultrasound treatment on the area weekly.

Much like Gareth, I too did enormous amounts of exercise, going to the gym to (over time) swim, cycle, walk on the treadmill, use the stepper, and finally jog. I also did some light weights on my legs. I used to go five or six times and week and had one or two hands-on physio appointments a week.

I guess my question is, is undertaking a lot of exercise important in a full recovery following non-surgical treatment?

Gareth, I’m very glad you posted that. Your story is amazing, and your insights are wise and delightful!

Badminton, like squash, tennis, football (both versions), basketball, volleyball, ultimate — all the sports that involve aggressive fast stops and starts and reversals of directions, and “getting faked out” — are all very tough on ATs, and a great way to tear one! As a result, they should naturally be the last thing we return to as we heal.

BTW, I’ve been very serious about squash and tennis over the years, and somewhat serious about badminton and (N.A.) football. And I’ve been nuts about volleyball for a few decades now.

Eight yrs ago, my first-AT surgeon told me that the time to return was just after I could do a bunch of 1-legged heel raises without groaning, and I think that’s a reasonable rule of thumb. Cycling, jogging, skiing, lots of less “violent” activities can come much sooner. And activities like those, where you don’t have an opponent working hard to fake you out and MAKE you reverse your momentum ASAP (and load up your AT), are surely a bit more controllable. (I may change my mind about that in 4 weeks, t

garethcope - Thank you very much for sharing this with us. I can’t agree with you more that Norm has done much contribution to this site! I’d suggest we should give him a big kiss/hug/high five/etc over the Internet (pick on as you wish!), although he called me a “wimp” earlier today and I’m not sure if I still want to be his ATR friend, though.

When I was reading the last part of your post, I smiled a lot because every little progress you described sounded like what parents with a new-born baby would talk about. We feel happy for others when they post their progress even if it’s so tiny and we know our progress report will be welcomed by our friends here!

Do we think that “walking exercises” means that he’s PWB already? It’s possible.

Sounds like not. Here’s a quote from an AP story — from AC Milan, not his Doctor or hospital:

“The plan includes a complete recovery in six months, at the end of which he can play again,” the club said in a statement, adding that Beckham shouldn’t put weight on his injured foot for two weeks and can undergo physical therapy in a pool after six weeks.

It doesn’t sound as quick as doug53, though it’s quicker than most ATR patients here, with or without grafts.

TURKU, Finland – David Beckham was walking on crutches a day after surgery, joined by his wife in Finland and beginning a rehabilitation in which he is expected to play soccer again in six months.

“I’m feeling positive and now concentrating on getting back to full fitness over the coming months,” Beckham said in a statement Tuesday.

Dr. Sakari Orava told The Associated Press that Beckham is feeling fine and will spend another night at the clinic in western Finland. His medical team is drawing up a rehab program for the 34-year-old player following Monday’s operation to repair a totally torn left Achilles’ tendon.

“These walking exercises are the first day’s program after surgery,” Orava said. “After that he will get a detailed program for further rehabilitation, and then, (Wednesday) probably, he flies to London, and then to the U.S.”

Looks like early mobility is part of his program…though I can’t imagine he will be casted for 6-8 weeks as was originally reported.

Interesting stuff, Smish! It isn’t obvious to me why a graft would take longer to heal than the unusually slow ATR recovery, but I’m just an armchair Internet “expert”!

I don’t think the world is ready for a Beckham to get “the boot” yet — and if the best and fastest surgical protocols advance significantly, it might never be ready. Eventually, there’s clearly a limit to the fastest speed of a non-surgical cure, and surgery SHOULD be able to go much faster. (Unfortunately, that’s got NOTHING to do with what most of our fellow bloggers here are actually getting for treatment.) Then “magic” chemicals and nano-technology could give the non-op protocols the edge again, some day.

I’d be curious to see if what you’ve been told — “that the non-surgical approach to an ATR is less successful in people who have had long term tendonosis” — is backed up by any evidence, or if it’s just the same kind of “conventional knowledge” that the newest studies have been disproving! In this field, if it sounds logical, it MIGHT be true — or not!

I watched a video of Beckham’s doc talking about his surgery. He mentioned that he had to augment the tendon with a part of the calf muscle. It takes a little more recovery time when you are hoping for a graft to take hold. I would guess that is why Beckham’s recovery period jumped from 3-4 months up to 6 months. I am also guessing that any other doctors, including the Japanese duo mentioned in an earlier post, would probably have had to make the same decision if they were actually the ones that did the surgery and had to do a graft. Everybody’s situation is different.
I have also been told that the non-surgical approach to an ATR is less successful in people who have had long term tendonosis. My doc said healthy tendons tend to make a tighter bond on their own. Beckham has had Achilles problems for a while. He even had a partial rupture on his right side in 2006. If all this is true, this may also be why one of the best orthopaedic surgeons in the world did what he did.

Gareth sent me his amazing story by e-mail — in response to those foolish “[WORDPRESS HASHCASH]” error messages that appear in my messages. Gareth you should post it here — or at least cut and paste what you mailed me!

I haven’t read anything about Beckham except what’s been posted here, but I’m shocked that the best AT surgeon in the world wants to immobilize him in a cast for 6-8 weeks.

If I were managing a Beckham, I’d probably send him to the Japanese duo that just published a new article I linked and discussed on my page. They don’t even use casts OR boots(!). And maybe Doug53 should supervise his rehab, to make sure he doesn’t lose any time unneccesarily. He’d probably end up playing in the World Cup!

Their article is “Novel Approach to Repair of Acute Achilles Tendon Rupture: Early Recovery Without Postoperative Fixation or Orthosis”. Am J Sports Med February 2010 vol. 38 no. 2 287-292, Tadahiko Yotsumoto et al. The abstract’s at ajs.sagepub.com/content/38/2/287.abstract .

http://www.youtube.com/watch?v=cgOemKqIzEE

Just watched the footage again…as in my case, he wasn’t doing anything explosive, no sprinting, no jumping…just a simple change of direction under no pressure/urgency. Crazy how it just happens.

Beckham’ injury was a carbon copy of mine! First step started to run half speed, slightly bent leg-snap!

Beckham’s surgery was successful, in a cast for 6-8 weeks. still don’t understand why some docs opt for the cast, others don’t. dang glad mine did not. it sure was nice to air out the whole mess / flex from time to time.

Sorry to hear about Beckham, but I’m looking forward to reading normofthenorth’s comments on his decision to have surgery…

I feel really badly for Beckham and wish him a speedy recovery. I have to admit though that this gives me a perverse sense of comfort about having ruptured my left Achilles playing soccer about 11 months ago. If it can happen to a star like Beckham, there’s nothing to be ashamed of when it happens to a 50 year old duffer like me. As far as him returning to play, I have no doubt of it. Though obviously at nowhere near Beckham’s level, I was able to return to playing limited minutes 14 weeks post-surgery and a full 90 minutes about 18 weeks post-surgery.

It was only the other night I was at Old Trafford welcoming Becks back home. He reminded us of the good times witha ferocious volley and some pinpoint passes. Classic Beckham. I am glad I got to see a United legend (yes Im a massive United fan) in the flesh but am bitterly dissapointed he won’t be at the World Cup.

He has worked so hard and to get so close must be crushing. I was in tears back in Septmeber when the docs told be no 5 a side with your mates till next summer. I can’t imagine what it’s like to be told you will miss your last World Cup.

Becks, your a legend, and have already left your mark on England, hope your recovery goes well. I’m in LA later this year and hope to see you playing again at the Galaxy.

I would hope such experts would have a world class athlete running in three months. I was running at three months, and I’m an arthritic old fart who made up my own rehab as I went.

Doug

Re. Beckham: Poor bastard. Looks like he has “the” doc for this kind of thing, though. I’ve read a couple stories re. how they plan to have him running again in 3 months! I believe it too. he’s a world class athlete to begin with (fit as all get out) and has the best doctors and trainers in the world. best of luck to him.

2ndtimer,

Sure, you can get treated by Dr. Orava, if you spend it like Beckham.

Okay, that was a bad joke.

Maybe future Achillesbloggers will try to mend it like Beckham?

Doug

Welcome Chris and sorry you have had to join us! Though presumably you won’t be missing a world cup as a result? Good luck with the surgery and keep us informed about how it all goes. I’m three weeks into non surgical recovery (seems the norm for non US people!) and I found this site to be really helpful and supportive.

Gareth, I don’t know how far you’ve come on your road to complete recovery, but it’s just conceivable that some of those modern non-surgical protocols could still help speed you along. . .

[WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

Yes, all the best to David Beckham, even from across the pond here!

cterzian, while DB and his fancy Finnish surgeon may end up setting records for the fastest post-ATR rehab in history, you should check the results from the latest randomized trials that compare surgery to the so-called “conservative” approach — at my blog, achillesblog.com/normofthenorth — before scheduling your surgery.

I say “so-called conservative approach”, because the current state of the art is for a relatively rapid progression from NWB to FWB, from immobilization in equinus (toes down) to neutral, and from total immobilization to physio and exercises, and then to “2 shoes”.

The latest FOUR studies all randomized a bunch of patients into the two streams — surgery and no surgery — and then kept them on the same, fairly quick, rehab schedule. And they all found no significant difference in re-rupture rate, strength, and ROM! (Well, actually, ONE of the studies found a significant difference in ONE of the strength measurements — and the “no surgery” patients measured stronger!!) And most of the studies found a significant difference in surgical c

I feel for Beckham - mainly since it’s likely he won’t be making the World Cup, but also because I burst my achilles at just about the same time as he, today, in my soccer match - same leg, and doing the exact same thing… just dribbling the ball. I thought someone took a cheap shot from behind and kicked my achilles with all their might, before realizing from the ground that no one was around me. After my initial shock from trying to figure what just happened, or who shot me from the sidelines, I realized what must have happened. The crappy thing for me is I just passed the 1 year anniversary of my ACL replacement surgery on the same leg, was feeling stronger than ever, and have progressively better games each day including this one. Now this. After feeling sorry for my self and RICE’ing myself on the couch with the laptop looking for my next surgeon, I saw the Beckham story on line. As crappy as it is for both of us, it made me feel not so bad for myself. After reading these blogs, I again feel hopeful, despite knowing firsthand the challenge ahead of me having recently finished PT for my ACL surgery not so long ago. I’

That’s terrible! He was clearly working hard to get ready for this year’s World Cup. Hopefully he will be back in MLS if not elsewhere. I know I will be following his recovery.

yep, we certainly feel his pain…

now I know where to go for the best treatment next time!
“will fly to Finland this morning to visit Dr Sakari Orava, professor of orthopaedics and traumatology at the Mehilainen Clinic in Turku, who is expected to perform surgery on the player’s left tendon this afternoon.”

Hi Gareth, sounds as if you are going through the wringer with the NHS. I had ATR treated conservatively 12 months ago, and am back to playing cricket… so I am a big advocate of conservative treatment - though there are a few bloggers who have not been so lucky.

Without wanting to worry you any more than you will have been, your treatment does sound a little unusual for the NHS. The foot would usually be immobilised in equinas (ballet point) in plaster or adjustable boot for the first few weeks. This is to allow the severed ends of the tendon the best chance of finding each other and knitting back together - the lengthier version of what surgery does. It is possible that your boot has inserts that angle your foot, but each time you remove the boot - and presumably move your foot - I would suggest you run the risk of separating the ends of the healing tendon.

Those who try and weight bear through a recent ATR are usually on aggressive programmes following surgery.. usually overseas. You may be on such a programme in the UK… but it would have been nice to have been told!! It may be worth asking next time you are in to the cl

What a nightmare!
Hope everything goes more smoothly from now on.
I’m 8 days post-op/4 days after getting cast and still getting used to it - no pain, just a bit of aching and occasional stinging. Trying to elevate as much as poss.
Everything I’ve read on this site seems to point towrds taking things slowly especially the first couple of weeks - I’ve been told no weight-bearing at all for 3 weeks even after having the op rather than going down the conservative route.
I too had no pain in the ankle post-ATR and pre-op although it ws bruised and swollen, but could put no real weight on it and needed the crutches already to get around.
Do be careful.
Sam

Gosh that sounds a horrendous few days. NHS failed me initially and I walked for three weeks before getting second opinion. Then I had the op.

My concern with you is that you are putting weight on the leg, not a good idea! Do try and keep off it as much as possible as rest and elevation are central to getting a good repair.

You would think with all the problems with MRSA that there would be a standard at all hospitals.

Anyway, good luck and KEEP THAT LEG ELEVATED!!!

Annie

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