Too Much, Too Soon - my Achilles Tendon Rupture

This is my ATR Resume (CV in UK - Curriculum Vitae; we love Latin ). The purpose of this page is to simply and clearly record what has happened regarding my ATR/recovery and when. I plan to update it until I feel my recovery is as good as it is going to get.

Hopefully an ATR Resume allows any newbies to get a quick picture of what might be in store for them.

Also I encourage every ATR lady and gent to write their own ATR Resume. At least you will have an accurate record for yourself and maybe our ATR Resumes could form the basis of a future gathering of some statistics about ATR injuries? It also may help compare treatments, exercises and the effects they have.

Prevention is better than a cure and while we are able to share our ATR journey and get tons of info on ATR treatments and aids thru’ fantastic sites like this (thanks again  Dennis for your hard work) there is very little on how to asses the AT condition to recognise if it is at risk in the first place. Wouldnt that be great! Hopefully as time goes by that might become possible and it can be shared via great sites like this.

PERSONAL INFO (at time of injury)

Sex               - Male
Age              - 42 years
Weight         - 195 lbs / 14 lbs overweight
Condition    - Low fitness
History        - Previously very sporty and active
………………….. Gym @ 4 per wk; weights, jogging & rowing
………………….. Regular tennis games
………………….. 2007 no activity all year
………………….. 2008 started jogging 1.5miles in 15minutes @ 3/wk Jan-Mar
………………….. 2008 regular gym (3 months prior ATR): -
………………….. > Skipping 20 minutes @ 3-4 per week
………………….. > Rowing 5.0 km max setting (10) in 25min @ 3-4 per week

INJURY

Leg           - Left
Type         - ATR
When        - 02 July 2008 time 18.06
Activity     - Soccer

Response  - walked off pitch; drove home; phoned medical helpline

If someone has a suspected ATR get medical help ASAP.
The following is what helped me until I got treatment: -

1) do not walk on the ATR leg if possible

2) if the ATR leg is used for walking I used only the heel to contact the ground keeping the foot as relaxed as possible

3) elevate the ATR leg as much as possible

4) apply a cold pack (e.g. forzen pea’s in a towel) to the leg

WORK

I tried to return to work on 2 occasions in first 2 weeks post Op.
Each time large and painful foot swelling occurred.
I decided doctors were right (!) and rested completely (no work) for 2 weeks post op.

After this I was able to attend work but at reduced hours because foot swelling was still occurring. Initially for 3 hours per day but by week 5 (post op.) I was able to do full days with only minor swelling.

DRIVING

I started driving again in week 5 post op. My ATR was in the left leg operating the clutch; with the boot I was able to operate the clutch with no problem, taking care to apply pressure using the leg and not the foot/ankle rotation (this kept my AT relaxed and let the boot take the strain). Be careful to check that driving with a boot does not invalidate your insurance.

MEDICAL TREATMENT

General Comments

I was relatively pain free apart from the actual ATR occurrence. 1st Night post Op required pain killers and sleeping difficult. No pain killers at all required after this.

1) intial 2 weeks post op. essential to elevate leg & rest (no work)

2) initial PT exercises although simple were very effective; I performed them daily at least in the evening immediately before bed, for about 20 minutes (no straining)

3) by week 6 I was actually able to walk comfortably in the boot with no crutches for short distances; longer distances caused aching in the ankle (not achilles)

4) received boot at start of week 5 and instructed to remove boot for sleeping

5) was able to walk without boot since week 6/7 (indoors); this carefull practice appeared to help greatly increase flexibility to ankle/tendon and strengthen leg; immediate continuous improvement noted

Standard Local Hospital Post-Op Procedure

Cast              - for weeks 1 - 2
Boot              - from weeks 3-8; start at 20deg; heel wedges as required
PT                 - from week 4
NWB              - from weeks 1-4
PWB               - from week 5
FWB               - from week 8
Full recovery - from week 26

Procedure Used

Initial          - Reported to Hospital 3 hours after injury
……………………. diagnosed ATR
……………………. leg placed in a cast
……………………. returned home
Cast-1        - week 0 (i.e. prior to Op.)
Follow-up   - Checked by surgeon Monday 07 July 2008, 5 days post ATR
Operation    - 6 days post ATR (08 July 2008)
…………………….. remained in hospital for 2 nights
1st Post Op. - week 2 (i.e. 2 weeks after surgery)
……………………… reported good recovery recommended boot at 20deg
……………………… technician fitted Cast against instructions
Cast-2        - weeks 1-2
Cast-3        - weeks 3-4
Boot-1        - week 5; 20deg; 3 wedges fitted
PT-1           - week 5
……………………. basic assessment
……………………. ROM assessed as good (but movement was small)
……………………. given exercises foot rotation up-down as comfortable/daily
……………………. given exercises foot rotate in-out as comfortable/daily
……………………. given 3 massages to perform on incision scar: -
……………………. 1) place a finger each side of scar and push inward to scar
……………………. 2) make circles with finger while moving along the scar
……………………. 3) run finger along scar
………………………. * use moisture cream, e.g. E45, for massage
……………………. permitted PWB 50%
……………………. scheduled next session for 2 weeks later

Boot-2        - week 6 (12 Aug. 2008)
…………………… boot reduced from 20deg to 10deg
…………………… heel wedges reduced from 3 to 2
PT-2          - week 6 (15 Aug. 2008)

……………………. ROM had increased greatly during 1st week with boot/PT-1
……………………. Requested 2nd PT brought forward to assess
……………………. ROM/walking/driving
……………………. Given all clear to drive long distance/attend
……………………. football matches
……………………. Demonstrated walking without crutches
……………………. Must use 1 crutch until FWB at 8 weeks to be safe
……………………. Ankle stiffness limiting foot raise (AT is good)
……………………. Massaged ankle & lower leg; small gain in flexing
……………………. Dont exercise too hard, risk tearing ATR repair

Boot-3        - week 7 (19 Aug.2008)
…………………… heel wedges reduced from 2 to 1
…………………… leg feels very strong, ROM nearly normal
…………………… can walk (leg straight) without boot or crutches
Boot-4        - week 8 (26 Aug.2008)
…………………… heel wedges reduced from 10 to 0
…………………… AT feeling near normal; reduced tightness with exercise, etc.

PT-3          - week 8 (27 Aug.2008)
…………………… Very good progress in ankle ROM
…………………… Foot can flex up 5deg beyond 90deg
…………………… Leg feels strong; can walk without boot and crutch
…………………… AT stiffness during exercise non-existent
…………………… Some PT to reduce ankle lateral stiffness
…………………… Swimming moderately permitted

Boot-5        - week 9 (02 Sep.2008)
…………………… boot angle reduced from 10deg to 0deg

PT-4          - week 9 (03 Sep.2008)
…………………… ankle still mildly swollen & bruised
…………………… advised to keep leg raised as often as possible
…………………… ankle stiffness minor; ROM 90%
…………………… given 2 more exercises to perform daily: -
…………………… ( hold for 10sec, 3 reps each)
…………………… 1) stand facing wall toes (ATR leg) against wall;
…………………… try and bend knee to touch wall
…………………… 2) stand toes & knee (good leg) against wall;
…………………… place ATR leg behind as far as possible; straighten ATR leg

…………………… Scar sticking to tendon; must keep massaging scar area
…………………… AT feeling stronger each day since using boot

2nd Post Op. - week 10 (15 Sep.2008)
…………………… Due to remove boot & crutches; FWB
…………………… (delayed by 1 week due to clinic closure)
…………………… tbd

To be continued

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