Mar 14 2012
ATR Newbie
I ruptured my left Achilles Tendon doing box jumps during a Cross Fit Class. I was on round 6 and on my 14th going into my 15th jump when…bam! I heard a loud pop and turned around to see who had kicked me in the ankle. I hoped around in pain for a while holding my leg, before I collapsed. I am currently waiting to see a podiatrist. I have an appointment next Tuesday which will be 12 days after my injury. Not happy about having to wait that long. I am learning a lot from this website while I wait, and trying to stay positive and count my blessings.
Glad to meet you Jennifer, and sorry that your here…
Bummer about the long wait - good luck with the initial visit, keep reading around on this site before you go, there’s alot of good info and help with questions you might want to ask once you finally do see someone. I would think the first question is surgery vs. non-surgical approach… I went with surgery based on re-rupture stats from my doc which was backed up by my internet research. I also live in Vail, CO where we have some very good orthopedic surgeons. There’s also a good contingent of non-surgical folks on this site (and through some of the external links) who have had good results.
Good luck!
Hi Jennifer, welcome. As above, make sure you make a note of any questions you want answers to before you go to your appointment. Like myself it sounds like you are doing a lot of research and learning in your ‘waiting’ period which is a good thing and in my experience was appreciated by my consultant. Like pablomoses, I also opted for surgery but I am currently week 3 in an aircast boot.
Once you get to your appointment, embrace a plan and get on the road to recovery things get a little easier mentally, be sure to keep us posted, stay positive and good luck at your appointment!
Thanks for the encouragement and words of advice. You don’t how much it means to me. Or maybe you do, as people probably welcomed you to the group when you first joined. I will do my best to pay it forward and encourage other people and share my progress. I was just able to reschedule my consultation for Friday, so I am really happy about that. Good luck with both of your recovery’s!
Hello, Jennifer! Sorry you’re joining the club but it happens. I think the mental game — staying positive and counting one’s blessings — is as important and challenging as the physical recovery. Whether you take the conservative or surgical treatment option, the physical recovery and rehab is fairly straightforward for most people. Protocols differ, but they seem mostly to differ between okay and optimal — not right and wrong. The leg should heal barring any further accidents.
But staying positive, finding other ways to stay active now this part of your life is on hold, and realizing you’ve still got some road ahead on this — that might leave you with an occasional downbeat day. You’ll recover.
Crossfit is an intensely social activity. If you’re committed to it, missing your fellow Crossfitters might feel as bad as missing the WODs. Obviously, you’re not going to be able to bang out any WODs as RX at least for a few months.
When things do improve a bit, I guess you could work on say pull-ups (and even muscle-ups if you’ve already got the pull-ups going well). If your coaches are open-minded, maybe you can find ways to do some core and upper-body work, and maybe later some rehab, by doing modified versions of the WOD.
I wish you the best w/ all of it. Take care, and keep us posted.
Jennifer, I think you’re at risk, sorry. If you’re hobbling around with an unprotected ankle (no cast, no boot), and not seeing anybody for 12 days post-injury, you’re probably missing the boat on the best pain-free, scar-free, relatively complication-free option, i.e., going non-op. (The latest studies, like UWO 2010, have delightfully low re-rupture rates, BTW.) Even many O. Surgeons don’t like operating on ATRs that are more than ~12 days “stale”, so you might even have trouble with that option.
At the least, you should be in a boot or a cast now, in a toe-down (”equinus”, “ballerina”, plantar-flexion) position, and NWB, i.e., putting no weight on that foot while you get around on crutches and the like.
The definition of “podiatrist” differs in different places. Here in Canada they can’t do real OR surgeries like ATR repairs anyway. Is that different in the US? If not, I’d get a FAST reference to a real orthopedic (or sport’s-medicine) surgeon. Most of them will rush you in same day, once you explain that you almost certainly have an ATR and it’s already a week old.
Our fellow ATR patients have many negative stories about ERs, but if a local ER can get you casted or booted and on crutches — and on your way to see an OS — that would help.
If you can get started fast, the non-op approach with a fast modern protocol should probably still give you an excellent chance at full recovery with low re-rupture rates. If not, you’ll be left with the surgical-repair option, though your surgeon may grumble about how long you waited.
J, I just noticed that you’ve rescheduled the podiatrist for tomorrow, which is better. But if podiatrists can’t do OR surgeries, you’ll still have only one of the two choices (op or non-op) available to you without seeing somebody else, probably after the weekend. Tendons don’t take weekends off, but most surgeons do. Have you spoken to your GP=PCP? I’d start today with SOMEBODY. . .
Thank you for all of your advice, Norm! I failed to mention that I am in a boot. New to the whole blogging thing. I ruptured Thursday Night and went to the doctor Friday morning. He fit me with a boot in the equinus position right away. I live in California and have Kaiser Permanente insurance. Here, only podiatrists do surgery, not Orthopedists. I was very worried, eventhough I had the boot, that I wasn’t going to be able to consult with a doctor about surgery vs. non surgery for 12 days. I called a friend, who is a family practice doctor with Kaiser, and she assured me that all was proceeding at its proper pace. They do not like to do surgery here until the swelling has gone down as there is less risk of complications and they can better see what is going on. However, she did manage to switch my appointment to tomorrow which has given me great peace of mind. I have a boot, crutches, and a wheelchair.
Oh, phew! So your options are still wide open, and I’d urge you to bone up on the new-fangled approach to the non-op cure, and seriously consider it. There are several versions of the UWO study results, including bit.ly/UWOStudy , which reports the authors’ pre-pub presentation at AAOS 2009. But the best source is the actual published study, which is available (only, for free) on this site. Click on “ATR Rehab Protocols, Publications, Studies” near the top of the Main Page, and look for UWO or Willets and click.
They randomized ~150 complete ATRs, all within 14 days of the rupture, into two groups. One group got standard “open” surgery, the other got non-op immobilization. Both groups got early exercise, early PT, and early WB, on exactly the same schedule. The results are there: Nice low re-rupture rates in both groups (2 post-op, 3 post-non-op), and “statistically identical” strength and ROM results in every category but one, IIRC. OTOH, the raw strength results are consistently a bit better on the post-op side, again IIRC. The complications were biased toward (against) the post-op patients — as usual, since non-op patients never have nasty scars or non-closing wounds, and they seldom get DVT, either.
It’s your choice, and recent advances and studies have made it more of a choice than many surgeons like to admit!
Norm,
Just looked through the UWO study again. One thing I don’t see addressed is “healing long”. I don’t think it would show up in plantar flexion strength measurements, unless they specifically measured strength at the “end” of the motion. Did they have zero healing long complications in 144 patients? Is the complication really that rare? Or, did they not measure/detect it?
I just figured I’d ask the guy I know to be most familiar with that study-
Ryan, I haven’t read that study as carefully as I wish I had, truth be told. But I believe the follow-up ROM and strength measurements are the proxies for detecting “healing long”. Heck, none of us actually knows, or cares about, our tendon lengths, except as they affect our functions, right? An AT that heals long will decrease plantarflexion strength — yes, most significantly at the end of the motion, but not exclusively, IMHO — and typically increase dorsiflexion ROM. I believe both of those outcomes were treated as negatives in the UWO study and almost all the other recent studies.
Jennifer,
I also ruptured my Achilles tendon on a box jump. Mine was March 2nd. I am also in CA. I opted for surgery. I have not started a blog yet. Just found this site. Unfortunately I have found box jumps to me a major culprit for this horrible injury. I could use the support as well. There is so much to learn and the mental part is the hardest part of this so far.
Courtney,
I have been doing some research online and have also found out that ATR’s do to box jumps are on the rise. I also read that they now recommend people step off the box instead of jumping off. I have been telling my fellow cross fitters to stop jumping off the box. I don’t want to see this happen to anyone else. My surgery is scheduled for this Tuesday, the 20th. I have never had surgery and frankly, I am scared. The doctor says I will have to keep my leg elevated above my heart, for 45 minutes out of every hour for 5 days. That is going to be very difficult. After that I have to keep it elevated for 30 minutes out of every hour for 5 more days. Slightly more managable. Have you had your surgey yet? Any tips on fighting off the boredom and possible insanity? Keep me posted on your recovery. You’re right, the mental part is the hardest. I have a wonderful husband, 2 kids, and a large circle of friends all offering help and support, but none of them knows exactly what I am going through. This website has been great! You should start your own blog too! It’s wonderful to log on and see that people have responded to your post and offered support. Makes you feel less alone.
Yes, I am a part of a group of friends that have been very active for over 10 years and no one ever suggested stepping down. We were all doing the filthy fifty when it happened to me. I wish I had known and I am also trying to get the word out. I will start a blog later today. I have the time! The surgery is not that bad. I opted for an epidural. It is the boredom of the recovery that is tough. I have a husband and 6 year old but it feels like our lives are on hold for a while. And, they dont know what i am going through so this site is helpful. I have always used exercise to stay sane so I can’t wait to get back. The long road ahead feels so daunting.
Hi Jennifer, the surgery is okay, I had not had surgery since a broken arm when I was 11, 23 years later things were easier! I had a general, 1 hour 15 minutes from being being asked to count to 10 (I got to 4) and waking in recovery, and it is like an instant moment, it seems like 3 seconds between the 2 events! Felt fine after and was home by lunch. Keeping the leg elevated really helps with healing apparently so it is worth putting up with the boredom. For me it was keeping the TV remote, XBOX remote and Kindle within easy reach. Patience is the key, the time will pass, I promise! Good luck, keep us posted!
Hi Jennifer, Jimminyc is right the surgery is ok. Actually not as bad as I thought it would be. I had read a lot of stories of complications, which scared me. I was amazed that the paid was not as bad as I had thought, it was manageable with medication. The Dr. told me to start the muscle relaxants and paid meds as soon as I got home from the surgery. She told me to be religious about it for at least three days after surgery then I could wean off. She was right. The hardest part was when I got home getting into my house the main living area is on the second floor. Dr. did not want me to crawl up the step but to try to scoot up on my butt. I had six adults trying to tell me how to do it and put no weight on my foot. I was still loopy from the meds so it was quite a sight. Hardest part for me was the no weight bearing and they mean none. At two weeks they took out the stitches and removed the cast and put me in the dreaded boot. It is so hard to sleep in. At three weeks she let me just rest the foot while I was standing with crutches, but no weight. At four weeks I was switched to partial weight bearing while using a walker. Hopefully the PT will be able to get me strong enough for a cane. Computer, tv remote, & my kindle fire have been my source of entertainment these days. I so long for the day I can drive, I work full time so being off was nice at first but I am ready to get things rolling. It was so hard for me to sit still and ask for help. I have always been the caregiver for everyone else. My favorite comment to friends and family is that if you have never gone through this injury “they just don’t understand”. Praying your surgery goes well.