My ATR

August 24, 2010

Hi everyone.

Thanks for reading.  This is my first post although I ruptured my left AT on Monday 19th July.  I have been reading other people’s blogs pretty regularly and have found them to be a great help. I’m 31 and live in London.

I ruptured my left AT playing 6-a-side indoor soccer.  I felt a sharp pain as if someone had kicked the back of my ankle, usual story, no-one behind me, hobbled off the pitch - game over.  I actually managed to walk home (very slowly), once home I put some ice on the foot, popped a couple of Ibuprofen and went to bed thinking it was just a knock and that I’d be ok in the morning.  The following morning I went to work as usual, limping heavily but not in much pain.  I decided to get my foot checked out at lunch and went to the local walk-in medical centre where the nurse took a look and told me to get straight to hospital as I had ruptured my AT.

At the hospital (Fracture Clinic) my ankle was put into an open cast, I was given some crutches and booked in to see the consultant on Friday 23rd July.  The consultant explained the 2 available options - surgery or no surgery - but recommended the surgery given my age (31) and that I wanted to return to sports activity as soon as possible.  I decided to go for the surgery and the operation was performed on Sunday 25 July.  I had done some reading online prior to the op so knew pretty much what to expect.  The op went well - I was kept in the hospital overnight and went home the following day with my leg in a fibreglass cast up to my knee and my toes pointing down.

I spent the following 2 weeks at home, resting up and keeping the foot elevated as much as possible.  I was lucky in that I felt almost no pain - just a mild itch at times.   The follow up visit with the consultant was scheduled for Tuesday 10 August.  He checked my wound - said it was looking good and healing well (I had the dissolvable sutures) and then the plaster technician put another fibreglass cast on having moved the foot ever so slightly towards the neutral position.  The consultant recommended that I did not return to work until my next follow up visit in 2 weeks when I would be given the aircast boot.

So another 2 weeks at home.  I’m lucky to have a wonderful fiancee who was been looking after me.

Returned to the hospital this morning for my 2nd follow up visit.  I did not see the consultant this time only the plaster technician.  The cast was removed and I was given the aircast boot (VacoPed).  The foot was set at 30 degrees and I was told that I could put a little weight on the foot when walking.  Having had the boot on for a few hours I must say it does make getting around a lot easier than the cast.  However it is very heavy and I have been told to keep it on while sleeping.

My next visit to the hospital is in 3 weeks on 14 September,  where I’m told that the plaster guys will move the foot to teh 15 degree position.  I won’t see the consultant until 5 October (10 weeks post-op) when my foot will be placed in the neutral position in the boot.  I was a little disappointed to find out that there’s every chance I’ll still be in the boot 12 weeks post-op.  Having read a lot of blogs on this site I was half-expecting to be in shoes around the 8 week post-op mark.

I’d appreciate your comments on whether you think I should try to bring forward my follow up visit with the consultant.  I really don’t want to be in the boot any longer than necessary!

4 Responses to “My ATR”

  1. jla2010 Says:

    Ho joelondon, The main thing I’m noticing about your casts and boot is how long it’s taking to get your foot close to neutral. My own experience was that I was casted plantar flexed for 3 weeks followed by a second cast that was nearly at neutral (maybe 10 degrees) for three more weeks. When I got my boot, I had heal 2 one centimeter heal lifts that probably put me at about 10 degrees. I removed one heal lift a week and was at neutral in my boot at 8 weeks.

    I have been wearing shoes in the house since week 8 but my doctor wants me to keep the boot on when I’m outside until 12 weeks post-op, which I think is a good idea. (In my blog, I posted a recommendation for making it easier to walk in a boot.) Even after 12 weeks, I’ll follow the advice of others here on this site and wear my boot if I’m going to be in crowds or on precarious, uneven ground.

    Ask your doctor about shoes in the house at about 8 weeks and see what he/she thinks. No matter what, be very careful when you get to two shoes.

  2. kaston Says:

    hey there joelondon. i’m also 31 and tore my 2nd AT playing 6 a side indoor about a week after you did. as you probably know, AT treatment seems to be one big crapshoot depending on who your doc is and what has worked for him/her in the past. for my last AT 6 yrs ago, i was in a hinged boot for about 8 weeks with gradual angle decrease. this time i was put in a cast at 90 deg 2 weeks post op and told to walk on it right away for 4 weeks. by 6 weeks post op i’ll be in 2 shoes. go figure. a lot of the literature suggests that the faster you can start exercises, the faster the recovery, so i’m obviously hoping that this more aggressive protocol is better but we’ll see.

    12 weeks in the boot seems excessive to me, as does 10 weeks to get to neutral. i would ask about speeding things up. maybe your doc will listen. otherwise, i suppose you can always adjust the boot yourself.

  3. normofthenorth Says:

    Hit your Docs with the UWO Protocol, and ask them if there’s any evidence that their slow approach produces better results than those 145 patients got. (We both already know the answer.) bit.ly/UWOProtocol for the protocol, easy to print out.

    Next time, skip the surgery and the weeks off work. What you were told about surgery is exactly what I was told 8.5 years ago, and it was generally considered true then, based on the latest research. All four studies since 2007 — randomizing patients into surgery or non-op, and using the same modern fast rehab protocol for ALL patients — have found essentially identical strength, ROM, and re-rupture rates without the blood and guts and scars and complications.

    Too late to go non-op with this ATR, but NOT too late to go with a modern proven rehab protocol! Any 31-year-old who gets immobilized, NWB, and off work longer than I did — with no sutures and in my 60s — is clearly a wimp, no? Or maybe somebody with a morbid level of respect for the authority of one overworked doctor. . . Shake it off! The leg is yours, the evidence is in — though two of the 4 studies are still “forthcoming” for formal publication. (Stick with your Doc’s advice and you MIGHT be in 2 shoes by the time they’re published! ;-) )

  4. elsurfer Says:

    Joe, My surgery was four days before yours on the July 21st. I went from a 20 degree splint, cast to a neutral cast in exactly four weeks. The first couple of days in neutral felt really tight, but now feels pretty normal. At least you’re in a boot and can remove it to itch and wash.

    After my surgery, I was back to work within 24 hours (but I sit behind a desk all day). As people are suggesting here, the treatments vary so widely, as do the different devices doctors decide to use.

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