August 12, 2010
My ATR
Posted by jhc121 under UncategorizedHello everyone.
This is my first post. It happened on June 24, 2010 while taekwondo sparring. I was moving around and then BAM! I felt an enormous pain in my left ankle. It was as if I was struck by a 2 by 4 made of concrete. As well, I thought the floor beneath my left foot collapsed. As I fell to the mat, I heard a grumbling sound in the ankle. My first thought was…fracture? But when I saw an indentation, about 3 inches above the heel, I knew it was the achilles tendon. After confirming the injury in the ER at Cedar Sinai Hospital, I made an appointment with an ortho at UCLA. After seeing the ortho on June 30, 2010, I was scheduled for surgery on July 8, 2010. It was a complete tear.
The day before surgery, I rented a knee scooter. Check it out. It sure beats crutches, especially for distance mobility. Surgery was at 7:30 am. Once they rolled me into the hallway to the OR, I knocked out. It must have been a couple of hours when I awoke. As I opened my eyes, I felt chills which must have lasted a good 10 seconds. I saw that my left lower leg was in a splint, wrapped and slightly elevated. The pain was about an 8 out of 10, constant and throbbing. They would give me morphine for the pain, but it would
only last for a good 10-15 minutes. I was discharged at noon with vicodin. The vicodin was no help though. The pain was still throbbing, which continued through the next day. Amazingly the pain dissappeared on the 3rd day. I was instructed to NWB and unable to shower because of the splint. Until my follow-up I used baby wipes to clean myself.
With the help of the knee scooter, I was able to go back to work the following Monday. I had my first follow-up with the ortho on
July 19, 2010. The splint was taken off as well as the sutures.
Taking out the sutures hurt like !!!!! I was fitted with CAM walker adjusted at 15 degrees in plantar flexion. I was instructed continue NWB until the next follow-up which was 2 weeks later. I also started PT, consisting of passive ROM and scar tissue mobilization at 2x/wk.
I had my next follow-up on August 5, 2010. I was given the green light to start gradual weight bearing and wean off of the crutches and knee scooter while continuing PT. Presently I am walking to a certain extent, but my left lower leg is obviously still quite weak from the muscle atrophy resulting from the non use.
I’ll post my progress when I have more.
August 12th, 2010 at 9:32 pm
JHC,
I’m about two weeks behind you on my ATR but my protocol is different. I’m bummed to hear that you did it doing martial arts as I was planning on getting back to Karate sooner rather than later (even if it means being on the mat in a boot). Update your ATR profile here using the widget and we can compare notes.
I’m going to try and convince my OS to put me in a boot next week and PWB as I think my healing has gone extremely well.
August 12th, 2010 at 10:28 pm
I think I have a different opinion from most people here. I don’t think you should have to “convince” your doctor to put you in a boot or to use a specific rehab protocol. You have the right to say you will not agree to anything short of using a boot rather than a cast and you also have the right to whatever type of boot you want. This is your tendon, not theirs, and it’s been my experience that the surgeons are very quick to lose sight of that fact. They often have way too much “pride of authorship” and of course they cannot admit they were wrong because that could leave them open to a malpractice suit. You need to take ownership of your Achilles tendon away from the surgeon.
August 13th, 2010 at 2:26 am
The widget elsurfer is talking about is at achillesblog.com/dennis/2008/03/08/achilles-timeline-widget/ . It’s VERY handy!
JHC, did anybody at Cedar Sinai Hospital ever explain the non-op option to you? I mean, in modern, post-2007 terms, not just the old-fashioned “we slap old and infirm people into casts, but young fit people should have surgery because the results are so much better” stuff?
August 13th, 2010 at 7:50 pm
normofthenorth,
The doc at Cedar Sinai was the attending ER doc. He squeezed my calf and saw no response with the foot. So he determined it was a rupture and would need surgery. No mention of the conservative route. He recommended that I see an ortho immediately. When I went to see the ortho at UCLA, she squeezed my calf also and recommended surgery, not conservative care. From her observation, the tendon was completely torn and would require surgery for a full recovery. If the non-op option was mentioned, I don’t feel I would have chosen that route. I don’t see how just casting would allow the superior portion of the tendon(which is probably further up the leg after detachment) to reconnect with the inferior portion that’s attached to heel. If it was a partial tear, maybe I would consider.
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August 13th, 2010 at 8:09 pm
GerryR,
I think my ortho was more conservative than aggressive with my achilles. She put me in a splint for 10 days, then in a hinged boot set at 15 degrees equinus while still being NWB for an additional 2 weeks. You do have a point when it comes to rights. That’s why asking questions is vital in understanding what’s going on. If a doc wants to proceed in a particular path, especially if it’s surgery, I would assume that it’s pretty important to ask questions, if one has any, regarding the procedure.
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August 13th, 2010 at 8:38 pm
elsurfer,
I’m very new to blogging, so I’m not sure what you mean by using the widget. Where is it? My knowledge of widgets are the ones on cell phones.
Once you’re in a boot (preferably the hinged one so the degrees may be adjusted as you progress), you may still want to be cautious about weight bearing and placing too much weight on the injured side. And if you’re placed in a hinged boot set in plantar flexion, I wouldn’t recommend attempting any weight bearing at all. Out of the boot, I would suggest doing passive ROM exercises as well as wiggling your toes. This is pretty much what I was doing. After a couple days of passive ROM, I began some active ROMs, but not beyond 90 degrees. You’ll definitely feel tightness to your achilles. I was also doing longitudinal massage strokes, lightly of course, along the sides near the tendon.
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August 14th, 2010 at 2:17 pm
Hi JHC,
It took me a few tries to figure out how to get things to display, but it’s a function of this blogger engine called Wordpress.
To get your blog to display your ATR information:
Go to your own blog after logging in.
At the top of the screen, click “dashboard”.
left side you’ll see a menu bar and an option called “users” click that
then click “your achilles profile” - fill it in.
You can use “00/00/whatever year born” to tell your age without disclosing your full DOB.
then “update options” to save it.
Next on the left menu on the dashboard
Click “Plug Ins”
select the “Achilles info display” check box
select the “NYC marathon widget” check box
bulk actions “Activate” select and apply.
You’re almost done. I noticed that the default web page may not display those widgets so you may need to select a “page theme” which will include those widgets you enabled.
From the left menu bar
Select “appearance” then “theme”
find a theme you like, click it, look at it.
If you like it, look upper right hand corner select “Activate {your theme}”
You’re done!!!
August 14th, 2010 at 3:28 pm
jhc121 - I’ve setup your Achilles Timeline and ATR Marathon widget on your blog. Please let me know if you have any other questions.
August 15th, 2010 at 1:30 am
JHC, you should check out the 4 recent randomized studies that compared surgery to non-op, with the same modern fast protocol for BOTH, on COMPLETE ruptures of the AT. They ALL found NO benefit from the surgery, and increased complications. If you go to the Wikipedia article on ATR, they’re references 4-7, so you can read abstracts of the studies online.
Yes, it IS hard to believe that the two tendon ends can pull together and rebuild a tendon that’s the right length. That’s why they measured ROM in all the patients — and found NO significant difference between those who’d been cut and stitched, and those who’d just been slapped in a boot! Those are the facts, and everything else is theories and guesses and intuition and astrology.
August 16th, 2010 at 1:21 pm
Dennis,
Thanks. Getting it going slowly but surely.
August 16th, 2010 at 1:24 pm
Elsurfer,
Thanks for your help. I should hope to get better organized.
October 1st, 2010 at 7:50 pm
jhc,
Would love to hear an update on how you are progressing. Let us know how you are.