Whoa! That’s a Long Incision

It was 2 weeks from my surgery yesterday and I had my first post operation check-up. The splint was removed, stitches were taken out, and I got a cast.

I was really anxious to see the stitches. From what the surgeon told me, it sounded like the operation would require a long incision. I was right. I was amazed to see how long it is. It’s about 12" long!

I’m curious to know if any other ATR veterans have ever seen a longer incision. This must be some kind of record!

I wish I had taken a picture right away, but she put the little tape strips on before I had a chance.

I still have some swelling and the skin feels a little numb. I don’t have as much movement in my ankle as I thought, but at least I’m able to place my foot nearly at 90 degrees from my leg.

The doctor verified that all looks good. There are no signs of infection. He then took me over to get a cast.

I’ve never had a cast before. I had about 8 colors to choose from. Being a Florida Gator fan, I chose neon orange! I don’t want anyone to miss my cast.

While the nurse was putting the cast on, I made sure to minimize my foot-leg angle as much as possible. I would estimate that I have it at about 95 degrees. I was pretty faithful in doing my stretches since the surgery. So, I think this is pretty good.

Astute observers will notice something unusual about my toes. That is not an illusion. My second and third toes really are joined together. I haven’t had much opportunity to show off my webbed feet. Everyone will get to see them now.

I will be in this cast for 2 weeks, then they will evaluate whether I should be in a walking boot, or another cast.

Even though, this is a non-walking cast, I’m able to walk around a bit in it. I will do so for short distances, but will use the knee scooter for wood floors and when walking far.

I remembered to get a handicapped permit. I’m happy to be able to get the good parking spots for the next 3 months!

(Editorial note: I’ve tried to figure out how to move the pictures to the right and have the text wrap around them, but Wordpress doesn’t seem to let me do that. Any tips would be appreciated.)

9 Responses to “Whoa! That’s a Long Incision”

  1. kkirk Says:

    Whoa your incision might have mine beat! Mine is close to 12″ (See my blog for pics) also because of the retraction of tendon, since I had such a long delay between injury and surgery. Glad everything looks good now on to the next step. Happy Healing Hurricane.

  2. wacaine Says:

    Yikes that is a long incision. Only advise I can give you is when the doctor clears you start working that incision do so. I definitely notice some adhesions around mine which is no where near as long as yours. Massaging it has made it better over time. Happy Healing.

  3. kkirk Says:

    I 2nd what wacaine says. I used deep tissue massage (with Cocobutter)on my incision from 5 weeks to 2 months three times a day and now I do it every night before bed. My scar has very little noticeable adhesion and I believe that my diligence with the massage paid off.

  4. Hillie Says:

    That is quite an incision and would suggest some complication regarding the damage done! I can see that in many cases, surgery is essential to the repair - complexity of the damage, position of the rupture, delay since actual injury, etc. In other cases of course, it is a less desirable and potentially more troublesome choice of treatment - or am I wrong? Is or should surgery be first choice for treatment for an atr?

  5. hurricane Says:

    Hillie, Yes. My complication was that I waited 3 weeks to go to the doctor. My surgery was 29 days after the rupture. Fortunately, the incision has had no infection and I’ve had no pain. I’m at 4 weeks from surgery today. I’ll be blogging soon about the removal of my cast.

    To answer your other question, yes. Based on my experience and what others have written, surgery should be your first choice for a complete tear. A partial tear is another story, though.

  6. Ali Says:

    Umm yep it is long, I have seen one as long on the blog - it was a girl who had some kind of french technique carried out, I can’t remember her name of the name of the surgery. I had 2 incisions, as I had a graft further up the tendon - one was about 6 - 7″ then a gap of about 2″ then another incision around 3 - 4″ long but in total not quite as long as yours. So good there is no infection. Happy healing to you.

  7. Hillie Says:

    Hi Hurricane

    29 days is a long time to surgery but I have seen even longer during my 8 - 9 months here. You must be looking forward to getting out of that cast - 4 weeks is a long time.

    I see that some surgeons are now using boots immediately after the operation. I had my hinged Vaco Achilles boot 2 weeks after diagnosis - I was non-op and subsequently followed an aggressive rehab protocol which was the same regime as used for surgical patients. Basic physio work started at just over 2 weeks, and fairly quickly stepped up, increasing after hospital sign off, and heavier stuff at 4 - 6 months. Then it was off to a sports physio for a few weeks. Modern protocols for non-op appear to be giving repairs as strong as surgical although unsuitable for cases like yours. I’ve been back hillwalking for many months now and trips cover many miles and many steep slopes. Going non-op was a borderline decision by my ortho consultant but he certainly made the right call.

    I posted a few weeks ago about posts sometimes being predominantly about types of boot, sometimes mostly op v non-op. In the latter case, some posters admit being influenced towards non-op so long it was the modern rehab schedules which give more mobility sooner and with strength. Also seems to vary by country, with USA mostly going for surgery, with UK, maybe Canada etc tending to follow a non-operative route if surgery not needed. Standards and surgeons’ knowledge/preferences vary massively.

  8. Hillie Says:

    Hurricane, forgot to add that my injury was a full rupture too. I saw the scan and was surprised at the gap. So high too.

  9. normofthenorth Says:

    Canada is all over the block for ATR treatment. Public health insurance, but apparently no guidance for ATR care. My fancy sports-med OS gave up doing ATR repairs after hearing a pre-pub presentation from the UWO study’s authors. But many of his colleagues at the same big teaching hospital in downtown Toronto didn’t get that memo, and are still stitching ATRs together. There’s no social pressure about it or anything, they’re all pals, nobody wants to fight about ATR treatment. MAYBE if it was heart surgery. . .

    The main disadvantage to putting post-op ATR patients straight into a boot is that they “leak” for the first week or two, so the boot liner would need to be washed (at least). So it’s more common to spend the first week or two in a plaster (absorbent) cast, or an absorbent splint.

    A long delay before treatment (immobilization NWB) is a great reason to get ATR surgery. If the AT has separated from the heel bone (calcaneus), that’s another one — especially if a chip of heel-bone came with it. That happens, and it also shows up on the (otherwise useless) X-rays that many ATR patients are sent for. Of course, there are also some bad reasons, like balancing the books or maximizing profit in a medical practice or clinic or hospital. And there are natural human biases that distort the choice, too — mostly in the direction of surgery, IMHO, though (a) opinions may differ and (b) the pendulum may be swinging in the opposite direction, notably in NZ. But the decision is usually guided by a SURGEON, and nobody became a surgeon so they could slap an injured patient in a boot without surgery. “If your only tool is a hammer, all your problems look like nails.”

    Also increasing the number of surgeries are these factors: (1) ATR is a “boring” ailment for a surgeon, sometimes called “the tonsilitis of the leg”, so if you have time to keep up with the literature on SOMETHING, it’s probably not THIS. (2) Most OSs (not all) believe that surgical results improve if the surgery is done very soon after the injury, so many patients head for the OR before finding this site or getting any other kind of “second opinion”. And (3) The weight of op-vs-non-op evidence clearly recommended surgery for active patients until remarkably recently — 2007 for the first good modern randomized trial that showed no stat-sig benefit from surgery! This super-tanker isn’t going to turn on a dime, for sure!

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