Just out of surgery

Hi, everyone. I am writing my first blog post less than four hours after surgery began. It all went well. I had tendonitis in the heel area for several years, then a full rupture on Setember 20th. I am 52 years old, reasonably active, former competitive athlete. I stepped into a hole while crossing a field at my son’s cross county meet and had the popping experience many people have described on here. Decided to do the surgery and it was a good decision. My rupture was a bit unusual according to my surgeon. Part of the rupture was a tear in the place where the rupture usually occurs — about an inch or two above the heal bone. But most of the rupture occurred right at the heal bone. The tendon broke right off of the bone. Therefore the surgeon had to do two repairs. First, he reconnected the torn portion of the tendon back to the other part from which it tore away. Then, he re-attached the other part of the tendon back to the heal bone with two titanium screws. The process took longer because it was two separate repairs, but he said recovery and rehab should be the same. Maybe more pain with the screws set into the bone, he said. I needed a bit more pain med in the IV before I left the surgery center, but I’d say I have a two on the pain scale right now, so not bad. Starting oxycodone in about an hour. I’m kind of wiped out — did not sleep well last night. But overall I am very glad to have the procedure behind me and especially glad for the expertise of my surgeon. Having full confidence in the doc is a big plus psychologically on the road to recovery, I feel. Sorry about the typos but i am still woozy and wanted to post this in real time. Good luck to everyone out there and wishing you a full and rapid recovery.

14 Responses to “Just out of surgery”

  1. I just wanted to add that the orthopedist said that the non-surgical option would not have worked for me, now that he has had a look inside Sometimes the tendon can reattach itself to the remaining section of tendon, but when the tendon pulls away from the bone the best practice is to reattach it surgically. I have full confidence in him, but I will be doing some reading on this just out of curiosity.

  2. I think your orthopedist is probably quite correct about treating an AT that tears off the calcaneus (heel bone). Often when that happens, the AT takes a bone chip with it, which shows up on the otherwise superfluous X-rays most of us were sent for.

    I don’t know what the UWO study and other randomized trials of op vs. non-op did if they diagnosed a tear off the bone, or if they just got tossed into the randomized mix and included in the results. I don’t recall any of them mentioning it as an exclusion criterion. The UWO authors analyzed their data to see if AT gap SIZE or LOCATION (which they clasified as high, middle, or low — but I don’t know how low “low” went) had any impact on non-op results. They concluded that it did NOT, though the sample was pretty small. (~75 total non-op patients, and only 25 of them had pre-treatment UltraSound exams that were good enough to measure and locate the ATR gap).

    Of course, none of us is merely a statistic, but it’s possible that non-op treatment — which produced re-rupture rates and strength results that are at least “statistically not different from” post-op rates in UWO and several other randomized trials — could produce even better results (clearly superior to post-op) among those ATR patients who are the most suited for it. I.e., if pre-treatment screening and streaming could be significantly smarter than random streaming, it’s logical to hope that overall results could be improved. Alas, every time that logical hope has been put to the test — in two studies I’ve seen, both related to the UWO study — it has not produced any benefit.

    I’ve got another puzzlement about your case — and a few others (maybe including my own left AT!) that have been diagnosed as MULTIPLE-site ATRs: Have you ever torn a string, a rope, etc., and had it sever at TWO places? Have you ever heard of anybody pulling on a piece of string, and having it tear at two different spot, leaving a little “island” in-between? I haven’t, other than these ATR cases. As a (long-ago) trained physicist, it seems mind-boggling, since the tension on the rope/string/tendon drops to zero at the instant the first spot fails. So both ruptures have to happen at exactly the same moment, and the tension and displacement have to be large enough to create both tears. It sounds like something that should be virtually impossible, yet it has been observed, so it must be possible, somehow.

  3. Thanks for the thoughtful reply, normofthenorth. I agree that it seems anomalous. But in my case I think I know what is going on. About five years ago while playing softball I did something to my achilles. I thought of it as a strain, because it was painful but I did not lose stability or the ability to push off with my toes. It ached a lot in the years since, so much that I basically dropped running and started biking. i got massages on that area when possible, and kid of resigned to living with it. i basically thought i had chronic tendonitis. then, i had the injury last week and the surgery this morning. Putting it all together i now wonder whether maybe the first episode five years ago was a partial tear, and the trauma last week was a full tear. Maybe i am not being clear, but in the recovery room the doctor drew a little picture of the repair. In the picture he showed me that there was only a thin cluster of fibers attached to the calcaenus. And that cluster was only a few cm in length. The rest of the tendon completely tore off of the calcaenus. But there were a few strands that ended farther up, apparently terminating approximately in line with the thin cluster that was still attached to the calcaneus. So . . . he had to stitch those fibers together, and then in a second phase he also had to reattach the main portion of the tendon directly to the calcaneus with two titanium screws. So my understanding is that it was two separate surgical tasks. The procedure took two hours - about 45 minutes longer than expected. So in a nutshell, it was probably not two simultaneous breaks, which I completely agree with normofthenorth seems hard to explain as a matter of physics. For me it was probably one small strand breaking years ago, and then the larger strand finally giving way last week. When the large strand gave way, it did not break at the same spot as the smaller strand. It pulled off the bone instead. I must have been compromised for these last five years and of course did not know it.

    Does that make sense, or is it that an illusion caused by codeine?

    Thanks again, normofthenorth. i have a lot to learn, but fortunately i have some unplanned couch time for the next few weeks!

    Wishing good results to everyone else out there. I am now only seven hours post op, but and psychologically and emotionally I feel light years ahead of where i was pre-op. I expect there will be ups and downs, but it feels great to be on the mend.

    [All typos and errors above are strictly the fault of the narcotics!]

  4. Hi joinaine,

    Sorry to hear about your honeymoon mishap, that’s so unfortunate.

    However, congrats on a successful surgery, and I know what you mean by getting it done, so the healing\rebuilding can FINALLY begin (Mine was over a month later).

    While I know nothing about the bone-related tear, I do know about the other - I am going on a month post op.

    Sounds as if you are strong, so I expect you to fly through this and get back to normalcy quickly.

    Just get through the first few days of pain with meds and the first week of NWB. Maybe look at some extra pillows, knee walker, crutch pads, etc., and keep in mind that water and crutches don’t go together. :-)

    Check out my Protocol post to look at different protocols out there via pdf and show them to your doc to see what lies ahead.

    Good luck and I wish you a quick recovery.

  5. 24 hours post-op and all is well. I’m taking two oxycodone every 4 to 6 hours but feel that I can back off of that because there is little pain. Will do so carefully however. I’m sitting at my desk and will soon resume my position in a reclining chair to keep the foot elevated. Still looking for information showing whether or not my type of injury — mostly a calcaneal avulsion, but a small bundle of fibers that also had to be sewn together — has the same timeline and protocol as a pure ATR tear. I’d love to have reliable information that the bone attachment heals faster than the tendon self-attachment, but I’m probably wishful thinking. Anyway, thanks again for creating this blog and for the helpful posts already. I’ll keep reading — it is all interesting stuff.

  6. Hi Joinaine,
    I had a full avulsion ATR and had surgery 7 weeks ago tomorrow. My surgeon inserted 4 screws into my heel to reattach the tendon and used a fifth screw to further support the Achilles using my big toe tendon. I was in a cast for 10 days and then into the walking boot. So far, the recovery has been VERY conservative.Little to no weight bearing, still using crutches. I have been in PT since 9/13. The PT has also been VERY conservative. I see my surgeon this Friday with the hope I can start learning to walk again. Take it easy and make sure you supplement your diet with vitamin C, it helps with collagen production!

    Good Luck!


  7. Thanks, Steve. I was hoping the avulsion might heal faster, but i guess i will have to be patient. And thanks for the tip about Vitamin C. I will get some asap. Good luck to you too.

  8. Joinaine, I didn’t have an acute ATR; mine was chronic tendonosis with degeneration of the tendon, plus a Haglund’s deformity (bone spur). The surgical procedure I had was a lot like Steve’s, even though the cause was different. My AT was detached from the calcaneus, the bone spur was shaved/ground off, all the scar tissue and other useless material in the tendon was removed and my AT was anchored back into the calcaneus. Because less than 50% of my AT was salvagable, I also had the tendon transfer that Steve did, though my surgeon used bioabsorbable anchors instead of titanium screws.

    So far my protocol has been pretty consistent with the somewhat more aggressive protocols and at PT, I’m following a standard achilles rehab program. I don’t know that we’ll heal any more quickly than other surgical cases, but I would be interested in knowing if we’re less likely to rerupture than those whose tear was purely tendon in nature. Bone has a **much** better blood supply than tendon does, but I don’t know if anyone has really studied the question. Maybe normofthenorth does?

  9. Five days post surgery. I went to the doctor to have the dressing changed this morning. No sign of infection and it seems to be closing up pretty nicely. I have 11 more days in the splint, and then I get the fiberglass cast. I am scheduled to get that off on 10/29, which is four weeks and one day post surgery. I believe if all goes well I will be PWB at that time in a boot. This has been an opportunity to reflect. On the one hand, it is frustrating to be incapacitated, and to have no control over the course of my progress. On the other hand, it is amazing that the body heals itself and that there is a pathway to full recovery. That makes me feel like one of the lucky ones.

  10. Hang in there joinaine! Once you get the boot on and are able to get around the recovery gets much easier. Stay patient and listen to your body!

  11. Joinaine!

    As klaake said, hang in there. My recovery was on the conservative side until this past Friday. My surgeon cleared me to full weight bear in my boot and to have the PT get more aggressive. I am 8 weeks post surgery today with almost an identical surgery as yours. I even took some steps out of the boot. What I am finding is that once you are walking in your boot, it does get a bit better each day. Good luck!

  12. I had my surgery on November 4 for an almost complete tear about 2 cm above the calcaneous. I am in a splint and get the stitches out on November 15. It is my understanding that I will be put into a cast for about 9 months before transitioning to a boot.
    I am a 70 year old triathlete/tennis player. I stopped running and competing in triathlons about two years ago because of chronic retrocalcaneal bursitis and calcium buildup in the tendon. Tennis did not seem to hurt it as much and I could live with it with ice and ibuprofin. However, the tendon degraded so much that it popped while playing tennis.
    I sure hope that I can make a full recovery and get back to competing in triathlons and tennis. It is nice to see a site where there are folks that are as committed as I am to get back to pre-rupture condition.

  13. Bill, did you mean 9 WEEKS when you wrote 9 MONTHS? I hope so. Even 9 weeks in an orthotic appliance (cast or boot) is slower than the most successful trials, and 9 months seems like torture. You’re only a few years older than I was when I tore my second AT 8 years after my first — I was going for symmetry! ;-) — and I went at the full speed of bit.ly/UWOProtocol , one of those most successful trials. I haven’t noticed any significant relationship between age and ATR recovery time or success — maybe especially because many of us who tear an AT in our “dotage” do so while playing competitive sports and are in good shape.

    One of the problems I had even (actually “especially”) with my first ATR at a young 56, is that my OS treated me like a geezer rather than a jock. He was also conservative-slow by quasi-religious preference, and was laboring under the (logical-sounding) misapprehension that slower rehab improved outcomes and decreased rerupture risk. At least within the range of common rehab protocols, the obvious is clearly demonstrated by the evidence.

    Good luck. There may be an arguable case for prolonging the rehab of somebody with your history of AT problems — though I’m almost 100% sure it’s not based on actual evidence. But 9 months immobilized is way outside the bounds of normal variation.

  14. Bill, There is no reason I can see that you can’t fully return to your previous level of fitness and activity, and I salute you for maintaining your althleticism. I’m 52 years old and had a very similar experience to yours. I have had tendon pain for about five years and then a complete rupture. In my case, the tendon did not break. It just tore off of the bone. So the healing is a bit different but the process of recovering from the atrophy, etc. is probably similar. As Norm reports, most in the medical profession are conservative. And for me that includes my physical therapists. I have no pain and my ankle flexion easily surpasses 90 degrees. But instead of accelerating my physical therapy, my therapists sees that as a reason to slow down. The doctor said no more than ninety degrees, so he thinks he has to slow me down. It has now been nearly seven weeks since the surgery and I don’t wear the boot or use crutches. I just haven’t needed them since week six or even before. For me the most sensible advice I have heard is to let your body be your guide. Set backs and re-ruptures can occur, so anyone would want to be careful. But isolating a muscle system from activity for too long has its risks and drawbacks as well. I fully expect to be better than normal — less tendon pain than before the injury. And I hope for the same for you.

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