icky’s AchillesBlog

Hi all,
I have a question, I’m 11 weeks or so no. Op, is there any indication at this stage if your healing to long or to short I’m on hols so not seeing pt for 2 weeks.
RRR

Hi Tina
Is your left at got problems since the ATR, if so I found the same when clutching I was being too explosive pushing off with my good at, so was careful not to put too much force on it, so did a smaller stride on crutch even slide my good at on tiled floor to save it some push off, also I’ve heard people on here using a knee scooter or hands free crutch.
Good recovery
RRR

hi, i had my right at done last Wed, trying to get from sofa to toilet is hard work as iv got problems with my left at to, any ideas how i can get around easier, as im no weight bearing at mo, thanks for any help

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norm has some good suggestions. I bailed on PT just before I hit 6 weeks due to travel, and have been handling the rehab on my own. here’s what has worked best for me (I think):

1. walking, a lot of it. one week walking around San Francisco did more than those 6 weeks of PT.

2. basic “wall stretch”, where you put one foot in back and one in front and stretch the back calf and achilles. the key for this one (which my PT pointed out) is (a) you should point your back foot in slightly, which ensures a more even stretch, and (b) you should do the stretch straight-knee’d and with your knee bent, to stretch both the gastroc and the soleus.

3. heel raises, lots of ‘em (I do sets of 72 on two-legs and 36 on one leg, even if I have to lean on a kitchen counter for the bad leg to finish off the 36).

4. the stair stretch norm suggested - stand on your tip-toes on a step, support yourself on the bannister or somehow else, and let you feet “hang” down as far as is comfortable.

5. self-massage of the achilles and ankle. as gross as it sounds (and feels), I can actually feel myself pushing up the fluid that has built up from th

Icky, it’s relatively rare for any of us to lose a lot of DF ROM through our treatment, and many of those people have a surgeon who shortened their AT on purpose — like mine from my first AT. Having it heal short after non-op rehab is possible, but it could be fixable, either with more stretching or with more aggressive inflammation control.

First, measure your lost ROM. The standard test is to face a wall, plant your uninjured foot on the floor aiming straight at the wall, and push your knee into the wall. If you hit it, plant your foot farther back. “Rinse and repeat” until you can just barely touch your knee to the wall, and measure or mark or memorize the distance from your toe to the wall (or baseboard). Then try your ATR leg, and see how much closer to the wall your toe has to be.

That’ll tell you the difference. Ideally you’ll be able to make up the difference, but quite a few of us (mostly post-op) could not, and I for one never had a hint of a problem from the decreased ROM, including lots of sporting activity, so don’t obsess.

Early in rehab, patients concentrate on active DF (using internal leg muscles), then ge

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I told the Dr. I’d be wearing a heavy duty pair of hiking boots that prevent any ankle roll overs and allow only minimal dorsiflexion… He said, “OK. Just take it easy and don’t be stupid.”

I plan on letting my brother and father carry everything … AND Collect all the fire wood … I’ll just walk very slowly and carefully… and once there I’ll just have a seat and enjoy the peace and quiet of it all.

Icky, I’ve been thinking that maybe open-heart surgery to get a new heart valve isn’t that big a deal, but that’s not a popular opinion! Like you, I had very little pain through BOTH of my ATRs and recoveries. My second one especially — with no surgery, and a nice fast rehab protocol (only 4 weeks on crutches) — was remarkably “easy”. But lots of people have a lot of pain and discomfort.

Also, the psychological “pain” we feel from being sidelined for weeks and months varies hugely from person to person. Interestingly, it’s largely under our own control, but it sure doesn’t seem to be at the time, for most of us.

Your progress sounds good. I’d be very careful on the camping trip! Doesn’t your R ankle still feel very vulnerable to twisting and rolling over into a sprain? When I first showed up at my sailing club last April (maybe FOUR months post-non-op), the place was covered in huge pine cones, and my ankle kept saying “Yikes!” — maybe every time my EYES saw one coming! I’d expect a lot of hazards like that on a camping trip, too, so. . . Watch Your Step!!

Icky, TRYING to dorsiflex in a cast, using your leg’s internal muscles, is not very risky. Most of the protocols say to stay below the neutral position for another few weeks — but iIn your cast, that position is guaranteed. The muscles and tendons that dorsiflex your ankle aren’t injured, or vulnerable, so exercising them in below-neutral positions should be fine..

Your “best” chance at hurting your AT in your cast is by trying too hard to plantarflex, pushing the ball of your foot down. That move is primarily done by your calf muscles (gastrocnemium and soleus) pulling on your AT, which in turn pulls on the “calcaneus”, the place where your AT is attached to the back of your heel bone. At least in theory (and maybe in practice, too), if you could try THAT mmove hard enough, you could get your calf muscle to over-power your still-vulnerable AT. Muscle spasms might get you there, or an instinctive reaction to a loss of balance. (Instinctively, we’d all rather re-rupture than fall down!!)

The hazard of dorsiflexion isn’t from TRYING internally (the PT folks call this “active” exercise), especially while your angle is limited by

I too wiggled my toes whilst in a cast and think it helped. Also it felt so good. I had my cast off at 4 weeks and it didn’t do me any harm. But you do what you feel comfortable with, this is as much a mental battle as a physical one. Carry on healing

I was in a cast rather than a boot, despite my waving the research and protocols at my doctor. Each time I was recast , the cast would become loose after a bit, partly due to my calf muscle wasting and to me wriggling around and moving as much as I could within the cast. You need to keep wiggling your toes as much as possible to keep the circulation going in your foot(helps to keep your toes warm too).
I came to no harm wriggling my foot and ankle, in fact I’m sure it helped me to get moving again once the cast came off.
You can’t really do any damage while you’re in the cast as your movement is so limited, so I say - go for it!

Thanks for the encouragement.

What’s the problem with dorsiflexion? If I’m in a cast and I try to pull my toes up, would that be a problem?

If you were in a boot, you’d be taking it off for the past 2 weeks to do gentle foot-wiggling exercises! In every direction except dorsiflexion = toes-up. So pointing your toes down is part of the best programs, like the UWO protocol I’ve linked on your page a few times already.

You should show the best modern protocol and the associated study (with results that he may drool over). He didn’t get 100% in school any more than you or I did, and nobody has time to specialize in ATRs — except us ATR patients, of course!!

If you were getting open-heart surgery, and you could afford it, you might fly to a big fancy Mayo-Clinic or Cleveland-Clinic place, to get the best medical care. With non-op ATR care, you can get World Class care anywhere, just by logging on and following the best recipe — but it’s got to be in a boot, not a cast, or your leg is trapped inside, and your PT is locked out.

For now, start wiggling your foot inside your sloppy cast, and don’t make your leg wait until your Doc gets the memo from the 2009 conference of the Am. Assoc. of Orthopedic Surgeons! If not for yourself, do it for the next few dozen patients

I did it again last night… I dreamed I was stretching…. more than once… and I woke myself up… more than once…
Not sure if I was actually stretching and hurt myself so I woke up…
…Or maybe I realized I was dreaming it and woke myself up anyway…
No pain today, though… so… I supppose it’s all good.

Icky, I agree with snapdragon. I am in my second week of recovery and I have to say that there have been several occasions where I have lost my balance on the crutches, largely due to the vicodin–it completely messes with me, and even when I have caught myself while falling, I have had severe pain in my calf and foot following the fall. I have not put much weight on the foot at all, but it has gotten knocked a few times. The doc has me in a fiberglass cast now and he did an x-ray to make sure there has not been any damage from falling. So far things look fine, but the doctor has told me that he is concerned that I could damage it. I have another appt this Tuesday so we will see if the cast comes off.

I went to work 2 days after…

Interesting about you new “problem”… Sorry to hear that!
Thanks for the headsup

Be well soon

Hey, I went back to work 8 days after my ATR. Sedentary job, but basically it was too boring to stay home (and nobody to carry my coffee haha). I never really elevated my foot much and had very little trouble with swelling and no real pain at all - until NOW (16 wks). Now i get what everyone has been talking about. Its the first time I used ice. Bizarre. And not even sure what triggered it! I suspect that as Norm said at one stage, it is just something that comes and goes…

Take it easy, Icky. You have a long way to go and you do not want to “complicate” matters. All the best.

I suppose I might be pushing my luck… I think that’s why I’m asking in the first place
But I really haven’t had ANY problems… perhaps this has left me with a false sense of security???
I’ll continue to take it easy… I haven’t had any more dreams where I’m pointing my toes or anything… so, that’s gone…
Thanks for your comments

No I think you’re fine. I was the same at your stage. NWB means just that your not putting weight through your AT in the action of walking or standing. Well that was my understaning please free to correct me.

Not really a problem. Your cast should be holding the tendon ends in close proximity. But you do sound like you are pushing your luck.
Surgery might reduce the issue of minor nocturnal contractions but probably not really an issue either.
Until further notice probably means until about week four. You should ask for timeline for recovery so you can get your life planned and your head round their expectations.
I certainly had weird aches pains twiches until week 4 or 5.

Sorry to hear of your troubles, Snap.
I really have not had ANY discomfort at all… NONE.
I fell just fine and want to go walking (although I know that’d be insane).
What can I say?

I dont understand how others have managed to work so much and so early - I was told to elevate my foot above heart as much as possible for first four weeks…
Have been working a little or studying at home since day 6 but my crutch induced shoulder problems have also complicated matters.
At 7 weeks my leg aches if I have been sat for two hours… resolves after a few hours elevation… then recurs after an hour… so for me that is limiting factor.
I think it just varies. Maybe we should add time to work timeline widget

Sorry about that philc (and everybody else!)

I work in a pharmacy… I used to stand in one spot for 9 hours a day slumped over a keyboard… after about a decade of doing this things started to hurt, so now I sit at a keyboard all day… The design of my pharmacy requires a little bit of walking (see here: http://www.bondurants.com ) from one side to the other, but for the most part my employees can do this… I’m able to get through the day without having to stand up much… I have one of these: http://www.abledata.com/product_images/images/10A0652.jpg to help out (knee walker) …
But the only bathroom in the building is upstairs. I have crutches to help me navigate the stairs, but I try to limit my trips to 1 or 2 a day…

Anyway… my chair sits up high and my leg hangs down most of the time… If I get uncomfortable I’m able to lift my leg up and put it on the counter top… that helps.

But I really haven’t had any discomfort or trouble thus far, so I’m gonna keep on working

“Should I NOT be working? What gives?”

LOL

sorry for laughing but , what a question or questions .

Depends on your job , so maybe if you had of said what you did for a living !!

take care

I’m a primary teacher who would be on her feet all day, so couldn’t manage. Apart from which the school isn’t insured to have me on site in a cast or on crutches!!!

I sit behind a desk all day. Had surgery on a Wednesday. Work emails Thursday night, Worked from home on Friday, back to the office on Monday.

If you’re on your feet all day, ie. Nurse, delivery person, service jobs etc… it would be tough and might require disability for weeks. Desk Jockeys like me no prob. I was lucky however, my AT pain was also minimal, I only took pain meds 1 time as a precaution the day after surgery.

It depends on your job, I work in an intensive care unit in a hospital 35 minute drive away. I’m on my feet for a good part of the day , there’s no way they would allow me on the unit in a cast or on crutches. I also need to be able to drive to work.
I have spent time updating resources and reading journals, but my job is mostly hands on one to one patient contact, and they can’t come to me!
Good to hear that you’re able to work, it does help to stave off boredom.

Thanks for your input, everybody!
I’ve not had any of those kinds of dreams since I blogged about it… perhaps the act of blogging exorcized the problem.

Now I think my calf is beginning to atrophy. my foot and leg move around a little more inside the cast than it used to… I just try to minimize my movements and elevate when I can… but with NO swelling is it really necessary to elevate?

Hi Icky, I find I stretch loads more since my ATR. I often wake in the night because I find myself in an extreme stretch. I have done it from early on and worried about it too. I haven’t done any damage yet and to be honest I notice it less now - maybe I did it before but it didn’t wake me. I’m sure your cast will protect you. To be honmest, I think we worry constantly about our AT, thers’s nothing you can do so try not to obsess about it. Easier said than done I know. Good luck with it.

Your calf muscle is certainly a threat to your healing AT, in theory and sometimes in reality, too. For example, when an immobilized ATR patient (casted or booted) falls or trips, I believe that one of the main mechanisms that can cause injury (including re-rupture) is our instinct to “save ourselves”, using whatever muscles we can. Saving ourselves from falling, and saving our AT from being over-stressed are two very different things, and we’re “hard-wired” to do the former, and have to be very good and very lucky to be overcome that and “go with the flow” instead.

Similarly, strong calf-muscle spasms, whether caused by physio-chemical spasmodic mechanisms or by dreams of falling or jumping, etc., can also pose a threat to a weak and vulnerable AT. This is NOT something a cast is designed to protect yourself against, though your muscle atrophy does tend to protect your AT some.

Like missteps during healing, almost all of us experienced low levels of calf muscle contractions while healing. It’s obviously a matter of degree. If you think you’re experiencing (or seriously at risk of experiencing) contractions that might hurt you

Seeing as you’re in a cast,it’s unlikely that you will do any damage. I often woke up in the night with cramp in the early days and I’m sure I tried to move my ankle in my sleep. I think this is probably quite a normal reaction by your brain to this unaccustomed immobility.
It did nothing to damage my AT, and I’m making good progress.
Don’t worry- it’ll be OK!

But that image isn’t on my iPhone… I’ve searched a few times…
Very odd…
Furthermore, I don’t get this on any other emails from any other sources… only from Achilles.
:/

icky - I think it’s your iPhone interpreting your email address. The “From” address is from you, so I think your iPhone sees this and adds the picture. That image probably is on your iPhone somewhere, or from whatever email address that you are using.

I don’t think there’s a PM function, but those notifications you’re getting usually include the e-mail addresses of the poster.

Dennis monitors the site, and especially when his name is mentioned, which we’ve done a few times already, so he should be responding, either here or to you privately.

Welcome, icky, and Hi to the others. A coupla things:
I’ve only seen one (small) study on the effect of ATR gap size (measured with Ultrasound) on clinical results without surgery, and that study found there was NO effect! The large gaps healed just as well non-surgically — strength, ROM (=~ healed AT length), and re-rupture rate — as the tiny ones.
It’s written up (abstract) at proceedings.jbjs.org.uk/cgi/content/abstract/91-B/SUPP_II/244 , if you’re a study geek. It also found no effect from different LOCATIONS of the tear — the treatment worked just as well on low, medium, and high ATRs.

unluckysquashaddict, all of my fave studies that showed identical results with and without surgery (and several studies that showed the contrary, esp. pre-2007) limited themselves to COMPLETE ATRs. It “sounds logical” that partial tears would heal better without surgery, but I don’t think anybody’s ever tested it in a good study. They HAVE tested different approaches with FULL tears, and the studies with the best non-op results (like my fave, the UWO study, report at bit.ly/UWOStudyPub and protocol at bit.ly/UWOProtocol ) produced excelle

Hi Icky, I would agree. I just phoned in to my
surgeons office to make sure I’m doing what I should
at this stage (6 weeks out). They reaffirmed keeping the leg
elevated, and in my case iced periodically, since I am still
swollen around my ankle. Best of luck to you. I’m officially
FWB as of today.

OK… how do I find Dennis?
Does this site have a way to PM (Private Message) to members?

Not sure Icky, I get the e mail notification but not with an accompanying photo. Ask dennis he may be able to help you.

Can’t say I’ve experienced that but in the firts weeks I did get lots of strange sensations it was a mixture of your body healing, becoming used to being motionless and skin drying out and having no where to go. Elevation was always my way of dealing with it all. I don’t think you can underestimate the powere of elevation with an AT injury. It is mt default position these days on the couch with my leg elevated on pillows. I don’t need it so much now but I still do it. Sorry can’t help with the worms sensation. Keep healing

OK… So, here in Lexington, KY we have a University (The University of Kentucky)… Besides research and medicine the University is known for Basketball (Kentucky Wildcats)… There is also a football team… And this region is pretty full of athletic types…

According to my Osteopath there are various clinics around that treat Achilles Tears differently… some more aggressive than others… He says they pretty regularly (several a year) who come to them after suffering setbacks or reruptures due to therapy that’s too aggressive…

One fella ended up with an achilles that was too short (not yet stretched long enough) and his therapy was too much…and he reruptured it… Fortunately he was able to take the nonsurgical route (leaving about 6mm gap) which healed nicely and his achilles was the right length.

Anyway… he says they have fewer complications over time by just going slow and steady…

Apparently I could be out of the cast more quickly if I took the surgery…

Apparently I could begin therapy sooner… and even have more strength at the 6 month mark…

But, after 1 year there’d be no differenc

Just got back from the Doc.
No surgery! Yay!
He’s been at this for 20+ years… His Father for 45+ years… And their foot and ankle Doc is one of the best in town (approximate 15 yrs)

Slow and steady… First cast off on Dec 29th…

Busy now…. Details later

Hi Icky.

Sorry to hear about your rupture. Like yourself I am 40 with two young children. I ruptured my tendon 4 weeks ago but I am only 3 weeks post surgery.

Surgery was the only way to go for me because it was a complete rupture & the re-rupture rates were lower.

From reading other peoples blogs we are on a slow path to recover. I look forward to your future blogs.

By the way I had no pain. Could be the signs of a complete rupture like me. My sister in law who is a physio could me that tendon have a poorer supply of nerves and blood compared to muscle. This also may be why the pain was not that great.

Happy hopping