heeling’s Achillesblog

Hi everyone
I haven’t been on the site for a while, which is evidence that my injury has taken a back seat…. but just a little report to say that I am 6 months post-injury and pretty much back to normal life. I just started running (gingerly) - I do about 4km, and walk some of it, and the other day I played tennis carefully. I do not plan to play badminton (the source of my original injury) yet - if ever again! My achilles does get sore after activity, but I’m taking this as a good sign. I have been signed off by my UK NHS orthopedic team and physiotherapists, but am continuing to see a sports physio privately as I don’t want to become complacent. I am also finally keeping my promise to write an article about the treatment of achilles tendon rupture for the US doctors website I work for, Medscape. This has to be done in between my day job (which is writing about diabetes and endocrinology) but I will finish this article, hopefully within the next few months so will post a link once it’s live. Best wishes to all of you struggling with this injury - if you are in the early days, hang on in there, follow the advice on this blog because it’s fantastic, and ask people for support if you need it - it will be invaluable.

Just wanted to say Happy New Year to everyone - if you are in the first few weeks of recovery from an ATR, hang on in there! Things will get better. After initially feeling frustrated at 8 weeks back in 2 shoes, the last month has been much better. Weeks 9 and 10 were still tough but I tried to take it easy, following my physio’s advice to go back to using 1 crutch to help eliminate my limp and doing calf raises. I’ve also been swimming as much as I can, and hiked a few miles on a holiday for new year…. Now I’m 3 months post injury, I can start to ramp things up a bit although will wait another couple of months before trying to run….
I’m incredibly grateful for all the advice I’ve received from people on this site - I’m back to the orthopedic doc tomorrow and will be handing them all the research on non-op recovery - trying to persuade them that they don’t need to try & persuade people to have surgery.

I have just gotten into 2 shoes but instead of being happy about this, I just feel depressed since it’s taking me so long to try & walk anywhere. Compared to zipping about on my knee scooter, this feels like a backward step (although I know it’s one I need to take). Does anyone have any tips for exercises to do to help speed this up a bit. I have another physio appointment in a week (UK NHS). For now, I’ve been told to stretch the tendon gently with the theraband. I’m also swimming (& on a positive note can now at least drive myself to the pool) and doing Pilates. It’s hard to tell if it’s the tightness of the tendon that is obstructing me or the weakness of my calf, but it’s probably both. Any advice gratefully received! I might go to private physio as well if i think it will help …
Happy healing everyone!

Almost week 6 - ortho told me to take out last 2cm wedge on Monday (week 5 exactly) but it felt too much like it was pulling on the tendon. So I’m varying it & taking last wedge out for a while each day then putting it back in.
I also went for a swim yesterday, very gingerly, but again the doc said I could (although aware he may have less clue about what’s ‘right’ than I do). But it felt great to swim! Did anyone else swim this early?

Doc also said 2 shoes at 8 weeks, but he didn’t mention any inserts. He said, ‘just wear trainers’. Any advice welcomed. Is 8 weeks too soon (non-op) for 2 shoes?

Also, if I’m comfortable in 2 shoes at 8 weeks, can I drive? We have just started renovating our house too, so driving will be even more useful than usual for lots of things! Although I still have my knee scooter: am loathe to give it up until I can walk a bit faster.

One other interesting thing my doctor said was that I only had a partial rupture, according to the ultrasound I had at 10 days post injury. While I would be happy if this were true, I don’t think it is since I failed the Thomson test the first night of the injury when I went to casualty. I also failed it a week later when the first cast came off. I suspect that the tendon had just started to knit together by day 10 and that’s why it looked like a partial tear on the scan …

Hope everyone is healing well: I have my days of feeling down, especially having to deal with renovation too & work as usual. But trying to stay positive & see light at the end of the tunnel!

I’m now entering week 4 and wondering if I should reduce the heel lift in my air cast boot by 2cm further, so down to 2cm from 4cm, as per UWO non-operative rehab protocol? But Wallace says 4cm to week 6. Am thinking I might do what I’ve been doing all along & average it out so wait until week 5 and then go to 2cm. In fact I have appt with OS at week 5 so can ask him (although I think I know more about non-op recovery than him at this point!)…
In other news, my physio appt last week was ok (uk NHS)- she agreed that all ankle exercises as per UWO protocol are good and she also recommended spelling out the alphabet with my foot as a way to alleviate the boredom of circles! She also gave me hip/gluteal exercises but doesn’t want to see me again until week 6 - she says the real physio only gets going once the boot comes off. Am seeing another sports physio tomorrow privately so will see if he says differently.
Finally I STILL cannot get the timeline widget to work despite repeatedly trying to install/activate. Sigh.
Happy healing everyone!

Entering week 3 after opting for non-operative protocol based on my own take on all the research & the helpful comments from all of you. I have my first physio appointment tomorrow, which is quite impressive on the UK NHS. But this is just an initial assessment so we’ll see … Have also booked a private physio appt at sports clinic for next week so can decide later whether this is worth continuing (& paying for). And got a call from my OS secretary today saying he wants to see me at week 5 (prior to this I just had an appointment for week 7). She also said he advised me to remove 1 wedge from boot (ie go from 6cm to 4cm lift). Told her I had already done that! Am doing ankle and other exercises every day as recommended by UWO protocol & have started PWB on crutches. But still using knee scooter for big trips out.
Am also enjoying a week off work as the children are on holiday here, and getting out & about is helping lift my spirits! I normally work from home so it’s great to have a break although know I am lucky in this regard as have not had to have a single sick day off work so far.
Wishing everyone a good recovery.

If anyone is interested in accessing this, it can be found at:
http://fowlerkennedy.com/
professional-portal/
treatment-protocols/
ACHILLES TENDON RUPTURE Accelerated Functional Rehabilitation Protocol (see below)

This is intended to be used by medical professionals so you need to know what these exercises are before doing them! I’m not a medical doctor or physiotherapist so please be careful - I have a physiology degree but not much use now as can’t remember any of it.

Does anyone know what “Active plantar and dorsi flexion to neutral, inversion /eversion below neutral” is? I’m going to ask my friend’s husband who is a PT in Canada so will report back.

0 – 2 WEEKS
 Aircast boot with 2 cm heel lift
 NWB with crutches
2 – 6 WEEKS
 Aircast boot with 2 cm heel lift
 Protected weight‐bearing with crutches as required
 Active plantar and dorsi flexion to neutral, inversion /eversion
below neutral
 Modalities to control swelling
 Knee/ hip exercises as appropriate
 NWB fitness/cardio work
 Hydrotherapy (within motion and weight‐bearing limitations)
6 – 8 WEEKS
 Aircast boot
 D/C heel lift
 WBAT
 Dorsiflexion stretching, slowly
 Graduated resistance exercises (OKC, CKC, functional)
 Proprioceptive and gait retraining
 Modalities as indicated
 Fitness/cardio to include WBAT
 Hydrotherapy
8 – 12 WEEKS
 Wean off boot
 Return to crutches/cane as necessary; then wean off
 Continue to progress ROM, strength, proprioception
>12 WEEKS
 Continue to progress ROM, strength, proprioception
 Retrain strength, power, endurance
 Increase dynamic WB exercise, include plyometric training
 Sport specific retaining

I will be at week 2 post-injury tomorrow. (normofthenorth have managed to get NYC Marathon widget working but not ATR timeline - maybe this doesn’t kick in until I put in a date for PWB?). Anyhow, any tips gratefully received (I went back in and updated my achilles profile with dates and that’s how the marathon widget appeared successfully. But somehow, in the meantime, the ATR timeline widget has disappeared from my options ….).
I know I have a long, long, way to go in recovery and will continue to take strength from what I read on here. At 2 weeks, i am already in a boot with 3 wedges, which gives me 6cm under my heel. I’m not weight bearing and am staying this way for at least another week due to what I have read/advice from Richard Wallace and you guys. I have booked a PT appointment myself for week 4, as my referall from the hospital to physio will not come through before this, I don’t think. After seeing the foot and ankle surgeon last week, I now won’t return to ortho until Nov 19th - which will be 6+ weeks after my injury. The ortho told me on the phone to keep 6cm wedges until then and “weight bear as tolerated”! Hopefully starting PT at week 4 will get me a bit more specific advice.
I am going stir crazy at home though - I’ve been out twice this weekend however, to a quiz at my daughter’s school on Friday night (husband dropped me off in the car) and today I did quite a major sweep around our local town with my 9-year old on the knee scooter - so can’t complain really. It was very tiring today, but I’m thinking that at least I’m getting the blood pumping around my body and exercising my heart, lungs and left leg! I also got some funny, bemused looks on the knee scooter - don’t think anyone here in my town (Bromley, southeast London) has ever seen one. Some people are genuinely curious and i tell them what it is and what I’ve done. Others just stare rudely. Although I obviously cannot begin to comprehend what it must be like to be permanently disabled, I find myself massively humbled when thinking about people who are in wheelchairs permamently - how much planning ahead they must have to do for all kinds of things in life…..

So today I go to see the foot and ankle surgeon at 8am, he fitted me in before he started to operate for the day. He acknowledges that there is a lot of controversy re surgery versus non-operative treatment, but still insists return to sport, recovery, will be even better with surgery, and risks are low. However he can see that I’m not for budging so at this point he sort of loses interest and says, “come back and see me in 4 weeks.” In the meantime, I have no advice on whether to weight bear on the boot I was fitted with after 1 week etc etc -other than the advice I have gotten from you wonderful people.
Luckily, I have e-mailed some of the authors of the best studies you guys have pointed me towards - got a reply from a lovely physio in Denmark, who said that I could feel free to e-mail him anytime. I also got this reply from Richard Wallace in Belfast, the orthopedice surgeon who has now treated close to 2000 patients conservatively.

“I routinely keep my patients in an equinus cast non weight bearing for 4 weeks. Occasionally I would shorten this period where appropriate. The period in the pneumatic walker is 4 weeks. During this time weight bearing is allowed, but only while wearing the boot.
For the first 2 weeks in the boot you should have 4cm. heel raise and for the 2nd two weeks half this, to 2 cm.
During the time using the boot remove it regularly for active ankle exercises – this is very important.
I am not convinced about DVT chemoprophylaxis, but use it, as appropriate after “risk assessment”.
If this regime is followed the results are excellent. I have now treated over two thousand patients this way and still get slightly better results than published for surgery.”
Richard Wallace.

i then panicked, because i have had boot on for 3 days (since week 1) and have been partially weight bearing on it, so fired another e-mail off to him. He then picked up the phone and called me, reassuring me I was ok in the boot as long as I didn’t weight bear, so have now gone back to using 2 crutches. My knee scooter also arrived yesterday (available to hire by the week in the UK for 15 pounds a week) so will be using that a lot too. I know some of the SCandinavians remove the equinus cast after only 2 or 3 weeks; Wallace said he just sticks with his original formula “because it works.”
it was so reassuring to get this call, and I am so stoked that this man picked up the phone. Please don’t all e-mail him as he will probably kill me! but I hope the advice as above helps reassure someone else.
if I get any other tips from anyone else will share.
And finally, as an interesting aside, my husband - who is not from the UK but from Indonesia - keeps reassuring me that all will be well. He looked at me aghast when I first said, “I might have to have surgery.” He said he saw many people with this injury when he was younger: he was in the military (national service) and did martial arts. They all got better without any surgery or fancy boots.
Feeling calmer now, on day 10
Thanks everyone for all your help and advice

I just got a call from the orthopedic surgeon I saw 2 days ago, who talked to his boss. They want me to go to the hospital at 8am tomorrow, to see the head ortho guy and potentially be ready for surgery. I really don’t want this but will go in and see what this guy has to say. Advice from recovering people please!