jules’ AchillesBlog

Well 4 week visit with consultant this morning. My foot has been at 60 degrees for a week since my last visit and I was hoping to get to 90 degrees and in a walking boot after today.

I was a bit too keen. My consultant checked my tendon and was very pleased how hard and solid it felt. However he insisted on another 2 weeks in cast with heel. Then a walking boot for 3 more weeks. He reasoned it was too risky if i slipped or had a mishap while showering or doing something without the boot on. To be honest i’d rather wait 2 weeks than mess up and go back and start again. The good news is that even though i’m in a cast I can PWB or FWB as I feel confident. My foot was moved to 80 degrees without pain just a little tightness In the tendon. Cast has a built in heel to compensate for the 10 degree of 90.

Strange looking at my foot between cast changes and being scared to move it. Eventually did a few light flexs while waiting for my ortho. Calf was thin bit not too bad i was surprised better than expected. Scar is only about 8 cm and curved around the side near the heel so not to rub on the back of my shoe.

He was vindicated about a cast, as no sooner as I came out of the hospital, crutches slipped on wet pavement and my foot went out. Without the support of the cast would have been nasty !!

So a little further forward on my journey back to normal. Can’t believe how nervous I am to put any weight on the heel. I think the cast moves slightly against the skin and it feels like the whole calf is taking strain.

Order a vacoped for my walking boot. Looking forward to my next visit when I use it…..

Happy healing.

Hi, I felt I had to tell my findings as it has helped me chill out and understand what is going on inside, the forces involved and to get realistic in the speed of my recovery. I naturally just want to get back to normal in weeks rather than months…

After my ATR I was scared as to what the future would hold. After reading links and blogs here I didn’t know what protocol my consultant would follow ( because I hadn’t meet him yet after the surgery) and if it would be right for me. I did meet the registrar who was at my operation and he said they made a really strong join ???

So I spent far too long reading blogs, links to research and articles on anything to do with ATR, what it did do was give me info to evaluate my situation.

Rerupture ? I’m 3 weeks post surgery and still in a cast as I write, but knowing what I have read I’m fine with being in a cast because it will stop me doing something crazy. So how much force do I need to re rupture my tendon ? We all recover at different speeds so lets look at immediately after my surgery.

They stitched my tendon together. There are various methods of stitch (Krakow, Kessler etc) but they appear in tests to be all pretty similar in strength. Tension Tests have been done to failure on repaired Achilles and no suture pulled out of the tendons. Failure was due to the suture snapping.

So how strong is the suture? More tests showed that the strength of the repaired tendon was proportional to the number of sutures crossing the join. So if your surgeon put two Krakow sutures it would be twice as strong as one. In one research paper, listed on this site, in tests a double suture to failure and it snapped with 46 Kg of force.

So how much force goes through the tendon? More reading but roughly it seems running can produce up to 8 times body weight and high explosive sports up to 12+ x body weight. So for an 80 kg guy we are talking roughly 1000kg of force. Your calf can produce up 1000kg force. Wow impressive!

If my surgeon did a double Krakow for example then any more than 46kg and I re rupture. Well that’s just 4.6% of my muscles capabilities! Suddenly I understand that I don’t want to get out of my cast too soon…. I can’t guarantee I won’t exert 5%..

Now I realize what the registrar meant by “we made a strong joint” I didn’t know what I do now so didn’t clarify how just how many sutures were a “strong joint”. We know there is minimal blood flow to the tendon so healing is slow. In the early weeks in my case I have just the sutures holding everything in place. Even if I had 3 sutures my repaired joint re ruptures at 69kg force that’s only 6.9% of the power of my calf! If I trip or push off in the wrong way it will be easy to exceed 6.9% = re rupture.

Without surgery I presume you have to be even more careful in the early days, before any natural healing has taken place, not to over stress the tear or rupture site. That’s not to say no WB on the heel but more the angle of the foot. So the UWO protocol of no dorsiflexion until after 6 weeks seems to me a very important point.

I don’t know if anyone has re ruptured while in a boot or cast? It seems to me that’s its once your foot is out of the boot you have to be very careful. Once I am in a boot I presume I can loose the crutches= Champagne time !

I may be completely wrong, but after understanding all of the above, I am happy to take things slowly. It has helped me relax and not push things too fast. Of course I want to get on two shoes asap and that’s why I have magnets wrapped around my ankle but that’s another story……

Well that’s the colour of my new cast after my visit to the consultant today.

First just want to say what a great source of information and inspiration this site is. Great to hear from people who have already gone through the marathon and come out the other side while also comforting to know we are not alone.

Its been 3 weeks since my surgery and I haven’t had any pain or swelling which has been good but I have tried to keep my foot up most of the time apart from when I was on my adventurous trips to local supermarket..

So the old cast was removed and I got a chance to take a pic of the scar ( I’ll have a go at posting it) I asked to see the consultant directly as had lots of questions. Meanwhile I feel the guy who puts the cast on is an invaluable source of information concerning your progress shortly after surgery. He deals with all ATR’s and can certainly tell how you are doing relative to others.

Consultant came over when the cast was removed and answered all my questions. The protocol he prefers is 6(2,2,2) weeks cast and then walking boot for 2-3 weeks and starting PT. I asked about getting into 2 shoe sooner but he explained in his experience, yes you can start earlier but the risk of re-rupture from random events eg tripping over etc is too high to justify.

After reading some of the blogs here I did tend to agree with him and are not pushing to get in to 2 shoes too early. As long as I can walk in a boot that’s fine.
It’s a marathon not a sprint

Consultant is away in two weeks time when I would normally return so we agreed I would go back next week ( as I want to see him and only him) to change the cast to normal standing position. He said if it didnt hurt we could maybe even try a walking boot. That’ll be a result ! They moved my foot a little closer to standing position, wow did the tendon feel tight!!
Then it was the choice of colour, as here in the UK the NHS give us the choice of numerous colours for the cast.

Magnets ! I also asked about the use of magnets in my recovery. Looking online there seems to be a lot of Horse Magnets and info on using them to help treat tendon injury on horses but I couldn’t find anything to do with ATR for us two legged humans. Maybe I was looking in the wrong place but there’s plenty of info. on using magnets for healing human bones but not soft tissue etc. Surely horses cant be that different so if it works on them should be ok for us. My consultant said it would be part of PT progress. Anyone know more about this topic ?

At least my upper body is getting a good work out from the crutches. Getting quite quick on them. I have one last question for those in the USA. Do you have the sort of crutches we generally get here in the UK which don’t go under the armpit. All the weight is on your hands. I see from pictures and read in some blogs about people armpits hurting etc. Just wondering …..

Happy healing everyone and thanks Denis for setting up this site.

Jules

Well what a surprise! I hobbled out of bed for my first appointment with the consultant this morning. Have been sleeping well and find it best sleeping on my side in the recovery position and foot on a pillow (at the bottom of the bed).

So consultant asked for my plaster of Paris cast to be removed to check the healing. Lovely guy in the plaster room explained to me that they had many ATR’s but not many from squash. Cut the cast off turned me over and I was examined in the plaster room. I had healed well even though only six days from operation. So much they took the stitches out there and then. Redressed the scar and put a nice Chelsea blue cast on me.

Rough plan is two weeks in this cast with foot a max angle, then two weeks set nearer horizontal , into walking boot for two more weeks. From discussions it appears that first couple of weeks in walking boot is when mist re ruptures occur.

Also asked why they use plaster of Paris for the first cast. Apparently plaster will absorb any blood or seepage after surgery and modern synthetic casts won’t.

Hope this gives some light, hope, reassurance, to anyone here in the going through the UK NHS.

Now I have to get home somehow…..

Jules

Its Jules here, i managed to join the ATR club last saturday during a squash club morning. I’m fit and play frequently 4 times a week at high intensity. Been playing sat for a couple of hours on and off,  ’was warm and stretched etc and towards the end of a two game match. I lunged to retrieve a ball and…. it felt like someone had hit me in the back of the lower leg. Rolled forward and over and hopped up on one foot, tried to put my foot down and nothing. I had to check my foot was still there as it felt like it’d be cut off !! ( checked David Beckams video of his ATR and there’s no way i could have put my foot down and held my ankle) Hopped off court and sat and took stock. Other people around believed it couldn’t be an ATR as i should be doubled in agony, plus i didnt hear a crack or pop. I was in agony  but  lucky to have a high pain threshold.
Some how managed to drive home, have a bath and then get girlfriend to take  me to hospital. A&E saw me within 25mins and performed a Thompson test. I failed and had leg put in an half plaster with my toes pointing to the ground. Appointment booked with a consultant for following Wednesday first thing. In the meantime i was sent home with crutches. Found your website and other regarding ATR info. From my initial research i decided i must have surgery. I have had surgery for broken bones and other injuries and so are not worried about going under the knife. MY logic was simply, i had previously fractured my clavicle into 5 pieces and the only way to recover back to normal was to have the bones all plated together. The bodies an amazing thing but it does sometimes need a little assistance.

So at the fracture clinic the Consultant took one look at the leg after the cast was removed and said we have too options surgery and non operative. Surgery offered better re-rupture rates and push off power and was recommended for young and athletic people. So that was it I was booked for the next day surgery on the trauma list. If they couldn’t do it Thursday for any reason it would be Friday defiantly. I was advised by other consultants that i know that surgery   is recommend for active people. I left hospital in a air walking boot that they gave me to at least ease the discomfort until the opp the next day.

Thursday admitted late morning to Hospital and was operated on at 14.00 under a general. Out and back in the ward at 17.30 with a full cast. Overnight stay and discharged Friday eve. Have not taken any pain killers before or after opp.

Since then i have had time to read your excellent site and read other peoples experiences. There appears to be a dedicated UK page and I would like to contribute to it so as to help other people in my situation and give some feedback on treatment in the UK. I have a follow up with the consultant tomorrow.

I’ll post how it goes. At present foot feels a little looser in the full cast and i have been trying to move my toes as much as possible

Jules

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