Just ruptured your Achilles?
Here’s some helpful information for people who just ruptured their Achilles tendon:
- Should I go to the Emergency Room or instead go see my doctor (or orthopedic surgeon) as soon as possible? Here is a discussion regarding this topic: Emergency Room or no?
- WebMD’s nice overview on ATR surgery and whether it’s right for you.
- Revolutionhealth’s nice article on: Should I have surgery for a ruptured Achilles tendon?
- How much does it cost for the entire Achilles Tendon Rupture medical care? (With or without health insurance) Cost of Health Care
- PreOp Patient Education: Achilles Tendon Repair.
- Interesting article about new advances in Achilles Tendon surgery (Thanks Doc Ross!)
How to determine if you have ruptured Achilles: Thompson’s Test:
PreOp Patient Education Orthopedic: Achilles Tendon Repair: (Part 1)
PreOp Patient Education Orthopedic: Achilles Tendon Repair: (Part 2)
I ruptured my Archilles Tendon on Sat. playing basketball. My Group Health Ortho told me she does not believe in surgery so she casted my leg. She said it would heal the same as surgery. When I have researched online it appears that surgery is the best option. I do lead a very active life and need to return back to work as soon as possible. My concern is that Group Health is forsaking surgery to cut costs.
Do you heal up quicker with surgery or the nonsurgical cast method? My treatment right now is a cast which will be changed every 4 weeks for 12 weeks, then a walking cast for 8 weeks then a boot for 6 weeks. I need to to anything I can to speed up this process.
Vance
I think the tendon generally heals quicker with surgery. A nonsurgical approach is usually followed to avoid some of the possible complications of surgery (sural nerve damage, infection, blood clots). My understanding is that the paitient is generally able to get back to normal activity earlier following surgery. However, I’m sure that your doctor is doing what he or she feels is best for your situation.
Vance
You need to read the research on pros and cons to surgery vs. non surgery.
Did you have a MRI?…that will seal the deal in my opiinion..complete rupture needs to be repaired surgically.
Also I talked with a surgeon and he said if the patient is not very active than non surgical approach is fine but if the individual is young, active and wants to return to running sports than surgery is the way to go.
Sounds like you need a second opinion.
Sooner the better
Doc Ross
Vance-
I am in the hoopster group as well. I opted for the surgery and feel very confident I made the right choice. As Doc said if you want to get back to highly active life you should look hard at surgery. From everything I have read recovery time is similar if not faster…..when fully recovered chance of rerupture is much less with surgery. With no surgery your tendon works its way back together but it heals with mainly scar tissue. With surgery they use very strong sutures and many say after full healing the tendon is as strong if not stronger. While any surgery has its risks so does not having it.
vance -
You’ll find relevant information here:
http://achillesblog.com/atr-rehab-protocols/
Also:
http://achillesblog.com/posts-worth-reading/avoid-these-hazards/
Vance - I believe the incidence of rerupture is much higher for non-surgical patients…something like 20% versus 2-4%. There is some research on that somewhere on this site I believe. I am probably wrong on the numbers but the conclusion is the same.
In terms of total time, brendan’s worksheet indicates the time immobile, in a boot, etc.
Vance,
I received the non-surgical treatment and the treatment for me was 10 weeks in cast ( 4, 4 and 2).
I am currently at the end of the 2nd phase and due to get my final cast fitted on Thursday 24th at which time I will be able to FWB.
As far as I am aware there is no speeding up of the early recovery process, it’s just a sit it out and wait scenario.
Vance..
Just watched the video of my surgery again. There was a 1-11/2 inch space between the two ends of the achilles tendon…and it was by no means a tendon, just a mess of tissue. I cannot see any way that the two ends will migrate together over that space and be anything resembling a tendon.
Wish I could post it..Brendan/Dennis any ideas…its about 20 minutes long.
Doc Ross
Ross - I use a free upload site called Vimeo: http://vimeo.com/ You could try to post it here. My guess is that it needs to be compressed a little though. I’m not a video expert, but if you sent me the DVD in the mail, I could probably figure it out….unless there is anyone else on this site who has a better idea?
Ross - What format is the video in?
If it’s on a vhs tape, then it needs to be digitized. So that’s a little tricky and the process can get a bit involved. There are places where they digitize it for you. Probably some places where they develop film, etc.. (maybe some places online where you can send your tape.)
If you have a DVD of the surgery, then it’s a bit easier. There’s software out there that can do it. I think VideoReDo Plus is one of them.
You Tube?
Doc Ross -
If you are on a Mac and your video is on a DVD, you can use HandBrake to get it into digital format. Then you might need to compress it (I think You Tube’s size limit is around 1 gig). You can send it to me if you want, I’ve got all the software - I’m a web designer. I’m curious to see it!
Thank you for all the great info. I have been working with Group Health for a week now to get authorizaton for a 2nd opinion.
Vance - GET THE SURGERY! I had a doctor recommend the same ot me, but he was old and I think at the end of the day just wasnt comfortable with hte procedure. Your rehab will be much shorter. Also, you’ll notice that all major athletes ge tthe surgery…there is a reas on why. good luck!
I just ruptured my achilles tendon 3 weeks ago at a gym and I opted with a sport orthopedic surgeon to go non-operative. I am a 40yr very active person myself. I don’t jog or run much but I like working out at the gym (till now of course). I’m in a airboot cast now with a heel lift. I am really bored keeping my leg up watching tv,reading, gameboy, computer, etc. I want to go back to work but I’m out for the summer. I feel so helpless can’t carry anything on crutches unless w/backpack any ideas to cover this thing up so I could swim in a pool?
april - You might want to check out this section for the cast protectors for swimming: http://achillesblog.com/things-you-might-need/cast-covers-for-swimming/
I ruptured mine two days ago playing ball with the kids. I researched it and went to the ER for verification. The doc admited that he didn’t have a ton of experience with this type of injury but after a Thompson test and an ultrasound, verified my self-diagnosis of an ATR. He then made a call and I’m scheduled for Sugery Thursday (ATR +5days). After reading some of the great posts here, I’ve decided to get a second opion re surgery. A generic diagnosis and surgery call by a doc with no real experience with this injury just doesn’t work for me! I’m sure he is a great doctor but I need to be sure for myself here.
Keith, Did you ever see and orthopedist, or just the ER doc? The ER doc may have called the ortho doc and scheduled your surgery, but the ER doc won’t be doing the surgery. I would want to meed the guy cutting me before I had surgery.
Jim, I called another emerg to see if they had an ortho on call. Spent most of Canada Day waiting but yes, I did get to speak with a specialist. he gave me some good feeback and I opted for the non-surgical approach. I left with an aircast to hold me over for a few days and I got my leg cast on yesterday. needless to say, I cancelled the schedule surgery that the first emerg booked for me.
I can’t beleive that I actually miss the aircast! I see the ortho again July 14
Anyone here had a Partially ruptured achilles? Doc said it is only a partial rupture where the tendon meets the calf muscle…..No sugery….just rest and an boot cast for 3-4 weeks. He isn’t even talking about Physical Therapy yet and I am very active. I don’t want to heal so tight that I can’t get back to my sports and running soon.
I’ve just ruptured my achilles while rugby training, no contact, just snapped.
Ortho has recommended me non-surgical, 6 weeks in a cast, being changed every 2 weeks to raise my toes.
Can I go back to being as active as before (rugby, squash, jogging etc, or do I have to resign myself to the rugby retirement home at 32 years old?
I have come back to work as I have a desk job after 6 days.
Jonathan,
I personally see no reason in returning to your sport, but like us all it is down to what you put in at the PT on the return trail.
The recovery time for non surgical and surgical is similar i.e. 12 months.
I am currently 5 months 2 weeks after non-surgery, 10 weeks in plaster, and still to start running again, although cycling is not an issue.
Log on for a blog and shre your progress/story with us all.
Johnk
Cheers johnk,
I will try and sort out a blog, although gutted that I won’t be running for 6 months at least.
Ah well, nowt I can do about it now.
Jon
Hi guys
I was dancing at a friends birthday party when it felt like someone had jumped on the back of my ankle. I felp a pop and my leg just collapsed. The pain was intense. I hobbled to accident and emergency (uk) and they told me I had “probably” torn the soleus muscle and was sent home with nothing not even painkillers. I couldnt sleep for the pain. I went to my doctor two days later and she didnt examine it as she had the doctors report from the hospital, told me to elevate and rest and gave me painkillers. Now 4 weeks on the pain and swelling isnt getting any easier. I can feel a gap in the tendon just above the heel, I can flex my foot upwards with difficulty and pain. I am worried now that it may be too late for treatment and the damage will be permanent. Any advice you could give me would be grately appreciated,
Hi Karen,
you must have a test for an ATR as soon as possible. I would go to hospital and get it done now. Phone the NHS Direct helpline now (0845-4647 they diagnosed my ATR and sent me to hospital).
It sounds like you have had some poor treatment.
A normall achilles is well defined so the fact you can feel a gap (I assume no gap on the other?) doesnt sound good. Get an ATR inspection ASAP and let us know how it goes.
Elevate your leg and put cold packs on it (ice bag/frozen peas wrapped in a tea towel can work well) and rest it. Im sorry you are having such a rough time and hope it goes well. Its never too late, so get on the phone now. Good luck!
I don’t understand the non-surgical approach. How does a complete rupture heal? I had a complete rupture on APril 17th playing basketball. I am 26 years old.
I had the surgery on April 24th, and had a splint on and no weight bearing for 6 weeks after surgery. I moved to a walking boot with partial weight bearing, with or without crutches. Whatever I was comfortable with. I started PT during this time also. My range of motion was pretty good, so I primarily worked on strengthening my leg.
Now a full 3 months out, on July 24th, I am walking with no pain or swelling. I am in a regular shoe. I am on target. THe doctor said it was a 4 month process.
SO now its up to me to get my leg back into shape. I
I also monitored NBA player Elton Brand. He ruptured his completely in August 2007. He was back to practice with his team 5 months later in late January 2008.
He was cleared to play in real games in April of 2008. A total of 8 months between the injury and his return.
I just don’t see how this would heal on its own without surgery. If there is a huge gap, it is not going to magically jump back together. If it does I would think it would easily rupture again!
Darek,
I can shed some light on the nonsurgical approach. Around every tendon there is a sheath, a covering that encloses the tendon, that helps to bind the tendon. With ATRs the sheath is usually intact and lets the tendon heal within the confines of it. This apporach leads to a scar tissue formation that is haphazard in alignment, think big knot, that can lead to other problems in the future….bursitis, tendonitis. It is important with non-surgical treatment to adhere to a strick PT protocol and to continue with it for a year. I had my surgery videotaped and you can see the sheath being cut prior to repair. There was a gap of 2 inches, too long for me to allow a non-surgical approach.
Let me know if you have any questions.
Doc Ross
Week 9 - Non-surgurical
Hello, again everyone. This site is great with so many suggestions. I am now at the point in my recovery that I am starting to take off my boot twice a day stretching and walking good foot first for about 5-8 min. each time with crutches. I’m not quit able to roll my ATR foot into walking form yet, tendon too weak feeling and shakey. So half step for now as per physio directions. Swelling down alot over the weeks. Still have to put foot up alot but normal I`ve been told. Getting around more sure helps with feeling caged. I sure would love to hear any other non-surgical recoveries.
I have a huge question. I go for an MRI on Friday to find out how bad my tendon is. They think it is fully ruptured. My question though is can I move my foot or toes with it being fully ruptured? I don’t understand anything about this and I have researched it so much. All I know is my heal burns sooo bad and my calf throbs and I’m in a cast until my MRI. When I injured it I heard and felt it snap.
Angel,
I had a complete rupture as big as it gets said the Surgeon and I walked around for a few weeks before I had the operation. I was not and still cannot lift up onto my toes but was always able to flex the foot left, right and up and down. I have had terrible problems with heel pain right through until just recently you may have to learn to live with it. It was worse at night and did keep me awake.
Need any more information, create your own blog, you will find there is always someone on this site who is able to help and support you through the long process of healing.
Good luck
Annie
Annie,
Thank you so much for that info. That is what I was afraid of. Oh well it has been done and no reason not to still smile and get over it and learn to live with what comes. Good luck with yours and thank you again.
Hi Guys
Thank you for your reply jacksprat. Sorry I havnt been able to get back in touch but have been through hell and back with my tendon injury. Yes!!! it was finally diagnosed exactly 4 weeks after it happened. I had to go back to A&E because the swelling and pain were inbearable. I was in fracture clinic the next day and in surgery the day after that. I am now 4 weeks post op and they are slowly bringing my foot uo to 90 degrees. Another 4 weeks and I should be in a boot. Just wanted to tell everyone that if you suspect you have an achilles tendon rupture then please dont be fobbed off by medics who say stupid things like torn muscles etc. Leaving my injury for 4 weeks means that my recovery is going to be much longer (casted for up to 16 weeks) and more difficult. I am in the process of suing the hospital as it was clearly medical negligence and i will let you know how i get on with that and if you decide you want to do the same then feel free to e-mail me @kazbat05@hotmail.co.uk. Anyways just in case anyone is interested i will continue to post my progress. good luck every one kaz xx
Hi all,
Found this site doing some research into rehab. I snapped my achilles tendon three weeks ago warming up for kendo (I was doing some small hops back and forth). Classic case - 40yo male weekend warrior, left leg, recent increase in activity, felt like bat across back of leg then “crack” everyone heard it go. I went down like a sack of spuds, screaming WTF (the three letter acronym described in FAQ).
Got taken straight to ER, passed Thompson test, then decided to see my own othopod. He slotted me in next morning, confirmed the snap, explained pros and cons of surgery/nonsurgery (I focused on better quality healing outcome), put me on the end of his list and operated that afternoon so less than 24 hours after injury. I’ve had a plaster cast for a week, then replaced with a fibreglass one for the next five weeks, crutches, no weight bearing. Don’t know yet what happens after that.
I have not missed a day of work, have leg propped on another chair. Its not above the heart, so swells up a bit. I put it up as soon as I get home for next 12 hours. And all weekend. Hope this is ok.
Got a shower chair and camode chair. Got a watertight showerbag which has a rubber gasket seal around the thigh, its great.
cheers
Adrian
Hey there, I found this site looking for some info on recovery.
Snapped archilles just over 12 weeks ago playing netball, but looking back I think it was building up over a few years running without warming up. Had surgery too.
Looking for some excercises to get more mobile and want to know how can doctors tell it’s all fixed just by squeezing my calf!! I’m very paranoid now!!
Rovena
I had a chainsaw accident 3 days ago and took my achilles and the fibula out. Since i have taken about 3 cm of tendon out of my foot - is the recovery process similar to that of ATR?
Oh good grief, what a horrible, horrible accident.
Not sure about the time scale but I would have thought it would be about the same, but I really wish you well.
Annie
Mike
I am amased that its only 3 days… and you have the courage to surf the web… after such an accident….. its it like an ATR… no idea… what do the doctors say ?
Where and when do I take the club oathe? Thank you sir may I have another.
I was in AZ playing pickle ball with seniors when mine snapped. Talk about embarrassing, as I’m 42yrs old.
I wanted to wish everyone a quick n speedy recovery, and to also say thanks for all the useful information as well.
Cheers!
Craigar
Seattle, WA
Hi all,
Great blog site!
I ruptured by achilles tendon 1 week ago today, had surgery 2 days later and now trying to adjust to a sedentary lifestle that I’m really not used to.
I am paranoid about rupturing the tendon on my other foot now - both feet have been subjected to the same activity and stresses over my life. Has anyone out there had both achilles tendons rupture?
I hav a million questions but will browse off of these blogs as I’m sure the answers are in there somewhere…
Cheers,
Paul from Perth, Australia.
Hi Paul,
We were all in the same boat when we had out ATRs. Don’t feel that you can’t ask even stupid questions on anything on this site. Everyone on here is really supportive and will try and offer their assistance as treatments and recoveries differ from person to person.
Hang in there bud.
Jon
I ruptured my achilles tendon on Wednesday (today is Friday). I’m 28, very active and definitely want to have this repaired surgically (I have no movement or strength in the foot). I am going to see the doc on Wednesday (one week after the trauma), and his OR day is Friday (I am hopeful he can get me in that soon). My question is this- if I have to wait longer than one week and two days for the surgery, am I increasing any risks for failure?
I would guess that the sooner the better. There are several others on the site here who had their surgery delayed for one reason or another. I believe you should be okay. I had my surgery 14 days after my rupture. Check the blogs here I am sure you will get some of your questions answered. There are doctors and nurses here as well as all the others suffering from ATR. You can read my story —> http://achillesblog.com/maestro/
I was told by my doctor that the reason I or any of his other ATR patients are rushed into surgery (within a week of injury) is that the longer you wait the greater risk that your tendon will roll up into your calf. Consequently he would have to cut you open further to retrieve the tendon and the recovery becomes a little more difficult.
Well, nearly 2 weeks have passed since the rupture. Things I have learnt:
1. Don’t overdo things in these two weeks.
I was out shopping in crowded grocery stores (in a wheelchair with a raised leg), at a Halloween party and various other social events and climbing flights of stairs in those first few days after surgery - all of which really hurt my leg and put me at risk of a fall. After taking it easy at home with my leg elevated the last 5 days the pain and swelling in my leg had improved markedly.
2. Set us the house so you can move objects around easily without using your hands.
I have a trolley (an old TV stand with wheels) with two ropes tied on to it - one going to the kitchen, the other going to the couch. I make a cup of coffee, stick it on the trolley, then crutch back to the couch, where I pull the trolley to my position via the rope.
3. Working from home (if possible) is great.
I get so much more productive work done compared with going into the office, all from the comfort of my couch. If you’re an office worker all you need are a laptop computer, internet connection, a phone and an understanding boss!
4. Tighten the boot as it loosens due to calf muscle wasteage.
As you don’t use your leg muscles, the calf quickly shrinks and the boot became loose, which was painful for the area of my surgery when it moved around. Tightening up the velcro straps on the boot really helped.
5. In some ways this experience has forced me to slow my life down and appreciate the family and friends around me, relax and read a book. In normal life I would have seen sitting down on the couch as a complete waste of time when I could be out there doing something. But relaxing is enjoyable.
Cheers,
Paul, Australia.
PaulT,
So nice to have another aussie on board - well, as nice as it can be when we’ve all torn our achilles.
To anyone worried about making a full recovery because their surgery was delayed 2, 4 weeks or even longer, I’ll just repeat the advice my surgeon gave me when he saw me for the first time, about 8 weeks after my injury: you wil get to 100% eventually; it will just take a longer than the average. Of course, while I’d really like to take his word for it, I’m going to wait a year before deciding whether or not to believe him.
I really don’t like to not trust doctors 100%, but given that my general practitioner (what do you call them in the US? primary health provider?) and the physical therapist (physio to an aussie) he sent me to decided that it was just a minor tear that could be healed fully:
a. without a boot (they recommended that I wear supportive, high heels - I’m not kidding);
b. with physical therapy twice a week;and
c. daily exercises,
when in fact I was rehabilitating just a few strands of achilles that after 8 weeks snapped off completely when I rolled my ankle when walking across a busy New York City street, I am always, always going to seek a second opinion if I ever injure myself / have cause for health concerns, again.
Also, I note that karen is in the process of suing the medical practitioners who treated her in the first instance, as her surgery was delayed 4 weeks from injury. I’m a litigator and so don’t think that the thought hasn’t crossed my mind, but, trying to focus on my recovery, I’m just so unwilling to seek advice on it. That said, I can’t say I’m not reconsidering. Does anyone have any thoughts on this?
Hello everyone,
I ruptured my achilles playing basketball on the 19th of October. I was unable to get immediate surgery done on the injury. My surgery date was the 31st of October. I was placed in a cast till Thursday the 6th of November. After six days in a cast my doctor said I was healing nicely. Based on that and the level of fitness I was at previously, I was scheduled for immediate rehabilitation. Unfortunately the soonest appointment is the 12th of November. However he gave me a few simple exercises to perform till then. So far so good, my range of motion has definately improved and I feel little to no pain. I am anxiously awaiting my first day of real therapy.
Hi all, well I just ruptured my achilles tendon playing gridiron on the 8th Nov - pretty much went to the ER straight away then had surgery to reattach the next day… Now am sitting with my leg up in a Cast on day 2 after surgery
Pain’s alot better, but still getting used to those Clexane/anti-clotting injections :p
…something occurred to me tho as to how it all happened - I was wearing ankle braces during the game, and am wondering if they were too tight and high up, so that my calf movements were restricted (thus making my achilles overcompensate).. anyone got any thoughts?
fleaster - were you running backwards at all? that’s how I ruptured my achilles.
Hey Dennis, yeah I was playing cornerback at the time, so I was backpedalling, then planted a foot to stop, but when I pushed off I felt my achilles give out…
Ironically i was having tedonitis in my LEFT achilles before, but had never had some much of a twinge in my RIGHT one - but this is the one that ruptured… which is scarey, cause i could never see it coming…
I just ruptured my left leg. My first achilles rupture ocurred a year ago but to my right leg. It is hard to be patient about the recent injury!
Wow for a second I thought I was reading my own posting. I too have suffered two achilles ruptures. My right one on Oct 1/07 and the left one Oct. 25/08. Both playing basketball… I feel your pain and frustration literally!
This is so weird to read everyone’s postings because your story is SO similar to mine. My first achilles hurt before I ruptured it but then a little over a year later I was back peddling on defense (basketball) and pushed off to go forward and POP! I ruptured the other one
I’m five weeks off surgery now and not looking forward to the long road ahead, that we both know all too well.
I ruptured my AT on November 12, 2008 while playing soccer. I heard and felt the snap and I knew immediately what had happened. My surgery was on November 25, 2008. My doctor told me that my tear was not horizontal but more like diagonal - so it took him a little longer to repair it. They removed my sutures on December 11, 2008 and put me on the walking boot. I am scheduled to start my PT after my next appt. on January 8, 2008. In the meantime, I am doing exercises to get the blood flowing - moving my ankle back and forth…BTW - I admire people who decide to go back to work while recuperating from this injury. I would be affraid of a rerupture during my daily commute…
I ruptured my AT on 18 September, 5 days before my new son was born. It was not diagnosed until 28 October! A sad reflection on the UK public health system. I had AT reconstruction on 29 November including, because of the delay, borrowing a tendon from my foot (flexor hallucis longus). Wound breakdown and infection set in around 2 weeks following surgery meaning that my cast was removed and replaced every week to change the dressing. Have been on oral anitbiotics almost constantly since then. Into walking boot on 6 January. Readmitted to hospital 15 January for intravenus anitbiotics. Infection clearing slowly. Hopefully start some physio in another 2 weeks. It has been a slow and painful journey so far!
Surgery to repair a completely ruptured tendon took place on 12/23/08. I am a 58 year old female who has never had an injury in her life. This journey is and has been an eye opening experience. Never again will I underestimate those whose mobility is impaired in any way.
I live in a home whose bedrooms are UPSTAIRS. The demands placed on my family to assist me in dressing (couldn’t get the pants over my toes while wearing the fiberglass cast which went to my upper thigh); to provide me with enough food for the day (it seems my appetite worked only too well- I will have to remedy that as well as my tendon) and bathing (from a sink) required ready supplies and towels. They have been selfless in their care. I have trouble adapting to the lack of mobility.
I am now in a cam boot, 6 weeks post surgery, still no weight bearing with inflammation each evening. Anyone else inflammed at night?
Also, the early exercise everyone refers to- what form of exercise do you refer to?
Please tell me this gets better….I have had a problem with achilles tendonitis for about 5-6 years, kept getting worse and worse went to the ortho, he referred me to an ortho who specializes in foot/ankle/achilles tendons…scheduled an elective repair to debride the tendon and heel, and lo and behold, before we could have surgery done, I tripped over an object in the floor and ruptured it.
I have not ever felt such pain like this….am now 7 weeks post op, in a boot, physical therapy, one crutch, weight bear to tolerance…
I am at a point where I feel this will not ever get better, but that is not the case, am better now than i was before rupture….
Any words of wisdom, advice, etc? Could really use some at this point….thx
landlockedtxn - It’ll get better, just be patient. My advice would be to read blogs of all the others who are ahead of you in the recovery to get a sense of what to expect in the future. Start a blog and share your recovery story. We all understand some of what you are going through.
thanks, Dennis….
appreciate the words of wisdom….after surfing and reading this site and others, I realize how blessed I am to have two great orthopedists and that I didnt wait and see….
My main frustration is no house cleaning, no grocery shopping, hubby is doing a fine job, but I am at that point where I feel much better, just limited on motion.
My surgeon is one of the let’s not let the tendon get stiff believers, while the doc i work for is one of those let’s wait til 8-12 wks are past with a cast/boot/nwb…lots of confusion abounds…
However with that being said, I have noticed on other blogs, the longer you wait, it seems the harder the recovery is…so I am glad I am getting to move a little more…and I realize it depends on the injury as well.
I didnt rip the tendon in two pieces, I ripped 90% of it out of the bone in one piece with the other 10%still attached…surgeon removed the bone spur, debrided the tendon, used a suture bridge to reanchor…and here we are…..
If it is torn or ruptured get the surgery and do the rehab. You will be back 100%. Rehab is just as important if not more important then the surgery. Do The Rehab!
Hey Now,
I am one week post op. A complete rupture playing squash. I thought my playing partner had hammered me hard with his racquet. Ouch did it hurt.
If anyone our there is non weight bearing, you must rent or buy a knee caddy. This device has made my life significantly easier. (and easier on my girlfriend)
I was even able to grocery shop with ease. If you can find one with a basket attachment get it. These litlle buggies are a must!!
Cheersand heal well
KellyU
Ah Yea!!!
I’m three weeks post op and doing fairly well. Yesterday I was on the knee scooter and it slipped from under me and I stupidly used my bad leg to break my fall (full weight) but with cast. It hurt like HELL and very scary. Hopefully nothing happened. I called my P.A and he said not to worry if my cast didn’t break and I’m not in pain. Reminder, take it slow and carefully. The scooter is great but almost too fun because you can cruise fast down hills and at the gym.. BE CAREFUL!!!!
If anyone wants to talk one on one let me know.
lendoggg1979@yahoo.com
Good luck on the progress,
LEN
landlockedtxn, all I can tell you is to be patient. I am 13 week post-op and little by little I am starting to feel better. I wore the boot, full-weight bearing for about 8 weeks. I began wearing sneakers then and I am now starting to get used to dress shoes. I am attending PT, which I think is essential for complete recovery. I still walk with a little limp but I can feel my range of motion is improving by the day. Not everything is perfect though as I still deal with pain on occasion. Make sure you follow your doctor’s orders and make sure you go to Physical Therapy. You will be fine.
Ocall,
thanks for your resopnse….patience is the name of the game right now..Am glad to hear it gets better. This past weekend was very frustrating..
Am 8 weeks post op…PT is addicting cause it always feels better afterwards, and I have home exercises as well…
Am in two shoes one half a day with an achillotrain brace well worth the money….It makes me feel like I can conquer the world and then reality sets in…seems like I can only do a little then the soreness, tiredness set in…but with that said, I am at least upright, on two feet without crutches unless I have to go outside for something..am taking it day by day right now…I see a small, small, light at the end of the tunnel…
How did you tear yours?
I am nearly 12 weeks post op and have just begun to wear regular sneakers. I limp when I walk too fast and heel burn/discomfort comes when on my foot for more than an hour. I would appreciate any info or past experience from anyone who has had a ruptured achilles tendon before.
landlockedtxn,
Hello again. I hope everything is well with you and that you continue to feel better. I ruptured my AT playing soccer. I jumped for the ball and as soon as my left leg left the ground I heard the “pop”, sounded like a gunshot actually. I knew right away what had happened, luckily, the pain only lasted that one day. It didn’t hurt afterwards.
You are right about PT. I do feel a lot better after my sessions. Right now I am going twice a week and I am starting to focus more on weight training to build my leg muscles back up. Make sure you keep doing your home exercises, they really help.
keep us informed of how your rehab is going…just remember that there are going to be good days and bad days…don’t get depressed!
How much effect does the achilles tendon play in plantar fasciitis?
My podiatrist says all the pain is caused from the tight achilles tendon, is it true.
I was playing Netball in Jersey and ruptured AT on 28th Feb, surgery was suggested, but i had to travel back home on a plane on the 2nd March.
went to A & E at home and I now have to see the consultant on the 4th to see if I want the surgery, if it’s a partial rupture do i select the non operative method. I’m in a quandry?
Three weeks PO. Does anyone have input on early weight bearing? I am eager to try, but my surgeon advises not. From what I have read, all studies indicate a swifter recovery which equals better quality of life. I have heard of full weight bearing by week 3 and returning to competitve sports by month 5. Additionally, there is no evidence of higher incidence of rerupture. So why wouldn’t we all start earlier?
I had Achilles Tendon transfer surgery on Jan 26, 2009. At week 5, I was able to puit 50% of my weight on my injured foot. My doctor is not very forthcoming with his “plan” for my recovery and I don’t feel I am getting one story from him.
Can anyone tell me what I should really expect? I just want to know when I’ll be able to drop my crutches.
Frustrated!
I think everyone recovers at thrir own pace and Doctors take a diferrent approach. Some are more conservative than others. That being said, I had Achillies Surgery that required a tendon transfer on Jan 2, 2009. I was NWB until Feb 12. ( 6 long weeks). I transitioned to FWB (still in theboot) two weeks later Feb 26. I’ve been walking w/o the crutches since then. I don’t start PT until Mar 13. I think I should be in 2 Shoes 2 weeks from then.
I’ve finally gotten over my paranoia of standing in the shower bootless and while I feel some pain in the heel it is getting better.
I think we all have to get a grip on the length of time these things take to heat properly.
I hope this helps.
I’m partial weight bearing(50%) at 6 weeks postop. I just take things easy and slow, but still try extra weight on the ankle, stretching, and toning on my own. Standing in the shower without a boot, walk around the house without the boot on crutches to lightly stretch the achilles. My philosopy is to listen to your body, it will tell you when you are ready for more. If it hurts back off. Remember you can’t eat an elephant in one bite.
Kelly, My best advise is listen to your body and what it’s telling you. Of course you want to try weight bearing, just remember if it hurts back off a bit. My doc hasn’t told me anything I didn’t think I wasn’t more than ready for by my own light testing etc. Listen to your body and remember you can’t eat an elephant in one bite.
Thanks for your responses - they’ve helped. I did get my PT to talk to me some about the typical protocol. He said I could be FWB at 6 weeks and get moved out of the boot by 8 weeks, or he may keep me in the boot for another 4 weeks. So he doesn’t even know.
I’m going to talk to the doctor on MOnday - I hope to know what to expect.
Thanks again.
I’ve chose not to have an operation. i’m in a cast and have been for two week. any advise……i have even attended work. where i get total rest for my leg all day.
MoPo,
Was it a partial tear or full? If it was full then you probably should have gotten the surgery, that is if you want a strong achilles. No surgery means no true connection of the achilles and a lot of scar tissue as well as longer stretched achilles (less strength). Also rerupture rates are upwards of 20% (no surgery) VS 2-4% AFTER surgery. I’m 1.5 months post op now and am starting to walk again. I’m glad I got it done. If you are active then getting surgery is the best option for optimal recovery results. It’s a no brainer
i presume it a partial tear, it was the registrar that stated that it might be better to go for the non sergical route first. he stated that we could always review this in two weeks when i have the first cast off. as he will then have a better view of how bad/good the rupture is. Does that make sense to anyone..Please let me know. if it is only a partial rupture then it should heal fast. shouldn’t it.
mopo. Here’s what my doc told me. He goes the surgery route on all full 100% tears and goes non-surgical on all partial tears even if its 95% torn. that if it is partially torn most of the tendon should reconnect with full tears surgery is the best way to go. from what i understand the conservative treatment keeps you NWB longer in he beginning but after a few months you are caught up. hope this helps
Mopo,
I’m suprised you don’t know if it is partial or full rupture. Thompson test would tell you also and MRI would be a positive confirmation. You are wasting time in a cast if it is fully ruptured. I would definitely be more proactive in your care.
Also, Partial ruptures don’t heal faster than surgical… and they don’t heal stronger, this is for sure…. Bestof Luck.
LEN
Hello fellow ATRs
I torn my AT on feb.14 (nice valentines….).
Surgery on the 20th.
Front slab till apr. 3
walking boot with wedges since.
which leads me to my 2 Qs
1.when can I safely ditch my walking sticks?
2. I’ve been sleeping with my boot off (sounds creepy)
is this ok?
thanks and cheers fellow ATR
ps sorry for any blog breeches of protocol, as I am a blogger 101 (aka newbie)
Hello everyone,
Surgery will definately speed the healing process up. I was in a cast for 4 weeks, walking cast for 2 weeks, boot for 2 weeks then back into shoes. So in two months I was back in shoes. Walked with a limp for awhile, but therapy took care of that. Just came up on 7 months post OP. All is well.
Good luck
Glen
Jack,
I slept with my boot off. If you get up in the middle of the night, make sure you put your boot on. Yes it’s a pain, but you have to do it. Makes you think a little more as you get out of bed. Take it slow.
Take care
Glen
I’m 8 months Post OP. I’m glad I had the surgery. Seems that a non surgical process takes much longer. 2 months after surgery I was back in shoes. 4 weeks cast no weight. 2 weeks full weight bearing walking cast. 2 weeks walking boot. PT for 4 weeks. Today I feel great.
I’ve partially ruptured my achilles 50% torn near the top. I did it on a friday. Finally got seen at the hospital on Tuesday, they gave me a moon boot and told be I can go back to work today. Does this fit with what others have been told?
Ric - when I first ruptured, I was allowed to be FWB (full weight bearing) with the boot, as necessary (picking up our baby), until my surgery - my doc said I couldn’t really hurt it anymore than it was, but to use crutches and stay off of it as much as possible, Ice, evevation, etc to get swelling down prior to surgery. Are you having the surgery or going the non-operative route?
Hi Marianne
I’m going non operative. I’ve spoke to four doctors and the only one strongly for surgery was
the youngest and charging 3x the going rate for an op
I wasn’t aware surgery was so common until coming on here.
I have my foot on my desk at work and get a taxi home.
And as far as I know I keep the air-boot on for24 hours during the next 2 weeks and then I can start taking it off at night. At 6 weeks I take the boot off. I’m using crutches and putting no weight on it during this time.
Then I start physio.
It seems less complicated then anything else I’ve read on here. I hope it works
Hello all,
I think I ruptured my achilles today - jumping rope for a little exerscise - HA! anyway, I felt the pop and pain, but not really like described here. I didn’t go to the ER (swine flu, no insurance due to recent job lay off), but I can drive, put weight on it and it really just feels like a sore calf, like when you work out and it’s sore. I can’t walk normally, but if I bend my knees and walk I can walk pretty normally. I’m trying to figure out if I really did rupture it or just strech/pull it because it sounds to me from these posts like if it really did rupture, I’d be pretty incapacitated. Any thoughts from anyone? Thanks, any input is greatly appreciated.
Lucy, sounds like a rupture to me. Can you lift your heel off the ground onto your toes on the bad leg, if not you need to see a doctor sooner rather than later. I was able to walk on my leg for nearly 3 weeks before finally getting treatment. Don’t leave it. It will not go away on its own….
Annie
Lucy get it checked out. If it’s not bad they may be able to do therapy. But if you wait it may turn into a nightmare!!!
recovering from complete rupture and 12 weeks post op -right leg At what point can one resume driving and when does one stop using the boot
Toes feel numb at times and the foot has an ‘odd feeling’ at times. pins and needles feeling and just different than the other leg. Is this a common thing?
Still working with PT and the boot is at 2.5 on the plus side for position
I just recently ruptured my achilles tendon 3 weeks ago playing basketball and had ATR surgery two days later. Currently I have been in cast (the sweetest purple cast ever) for about a week and am told I would be in a boot in the third week. I’m only 20 years old and this couldn’t have occurred at the worst time. For the entire year I have had a two month backpacking trip in Europe booked a week for after my college graduation this June. The ortho already said it was probably not realistic to be able to do such strenuous walking in only 6 weeks after having surgery. I figure I’m young and I would go anyways and just would be cautious and take it easy. Plus I’ve always been very active, play sports and been an avid runner. However as the time nears I’m not so sure if this would be the smartest decision. I don’t want to risk re-injuring it while abroad or risk long term complications. I already have my plane/train tickets booked. I don’t know what to do but I have to tell my travel buddy soon whether I’m canceling or not. I have my heart set on it and am pretty torn, not to mention just extremely frustrated with this injury in general. However everyone I’ve talked has stressed the fact that rehabilitation is key to an injury like this.
Realistically, what would be best for me?
An - Really sorry to hear about your backpacking trip to Europe. I would really talk to several Physical Therapists and get their take on this.
Anyway you can delay for another month and go in August-September?
An - You should really speak to your doctor, but it’s probably best to postpone your trip if you plan on doing a lot of walking.
6 weeks isn’t enough time for a backpacking trip.
Sorry to hear about the injury/bad timing.
50 year old active thin female.. injured achilles area playing tennis 5 weeks ago. Little to no pain, iced for 3 days, had dr. look at it.. he said nothing was broken or likely torn.. to use crutches for a few days.. I have been able to stand on foot since day one.. and after 2 days could go on toes.. just can’t balance on just that foots toes yet… no pain, just alittle swelling in foot base if I work on my feet for more than 3 hours.. but its not completely healed.. and I am going on week 6.. does it sound like if I take care for another few weeks, it is healing well without surgery… or do you all suggest I get an MRI since its week 7 and I still walk with alittle bit of a limp…? thankyou
while at work i stepped down to a lower step on a locomotive engine when my calf gave out. the ultra sound showed no DVT, so they diagnosed me with a ruptured achilles tendon. but the pain is in my calf not my heel. i can stand on it can walk on it with pain for very short strides. i even tried to go fom flat foot to tip toes but cant even get the foot to move up. is this a problem anyone here has experinnced?
Chris I am a locomotive engineer and because of the climbing up and down and walking on uneven ground my doctor still hasen’t cleared me to work and it’s been 12 weeks. Good Luck
What does ‘active’ mean (in considering surgery or not?). I ruptured my achilles a week and a half ago playing netball, the doctor at A & E said that surgery wasn’t an option because I’m not an athlete. The orthopaedic guy (who spent a whole 5 mins with me) gave me surgery as an option but didn’t advise either way. The thought of surgery made me feel ill so I opted for a cast. BUT - now that I’m reading this site I’m questioning my decision.
I’m 36 and fairly active (play netball, tennis, jog, gym, pilates). I intend to give up the more jarring sports after this, but what does ‘active’ mean? Am I likely to re-rupture if I plan to do more hiking, walking and gym once I’m recovered? Should I be considering the surgery option? Is the surgery really horrible? Do they tend to operate under general anaesthetic?
Any advice?
Thanks, Berni
Hi Berni, I ruptured mine on May 21st while playing softball. ( I wanted to play like I was 12 , but my body reminded me that I am actually 34 and should know better, haha) I had my surgery on May 28. It was not bad at all. I was under general anastesia, and a bit groggy when I got home, but I am back at work (at my desk job) and now am in this cast for another 3 1/2 weeks. But so far, I have had no complaints about having the surgery. I just can not wait to get off the crutches!
Hi Alison, hmmm - you know I never really thought that 30’s was old - but, you’re right, we’re certainly not 12 anymore
I had a good chat with my orthopaedic surgeon and we’ve come to a compromise: he’s going to do an ultrasound next week, and if my tendon is knitting well, we’re going to continue with the conservative treatment, and if not, he’ll operate. I’ve done lots of research in the medical and sports science journals and it seems to be 6 of one, half a dozen of the other. I also can’t wait to get this cast off. I hate not being able to drive and having to be so dependent on other people. My friends tell me I’m learning a good lesson, ugh! Good luck, 3 weeks isn’t long to go.
Berni
Hi Berni, you are right, 3 weeks is not long to go, I should keep things in perspective. But as I am sure you probably understand, it seems like forever with a cast and crutches!!! I also do not know what is going to happen at that point, if I get another fashionable fiberglass cast, or something else. I can not wait to get this one off!! I agree it is a difficult adjustment to depend on others to do things that used to be so simple. (maybe this is a hint I need to slow down ” smell the roses” haha) Too bad that can’t be done on the beach!! lol
I hope everything goes well with your ultrasound next week and everything is healing well. If you do end up having the surgery, it is a piece of cake!! I checked in an hour prior to surgery, and was home 4 hours later with a good movie! Take care. Happy Friday!
Allison
Hello Berni - I was reading your story and I definitely suggest you have surgery, specially if you consider yourself an “active” person. I ruptured mine last year (11/12/08) and when it was confirmed that my AT was torn, I knew that surgery was the only way to go. I also consider myself to be a very active person and knew that surgery would give me a better chance to heal better and allow me to practice sports again. So far, no complaints, I was jogging 3 1/2 months after surgery. I am going to the gym every day now, I am increasing the speed in the treadmill little by little and somedays, I forget that I had this terrible injury. There is still some stiffness in the mornings but once I start walking, that is gone. Berni - in the end, it is your decision but I tell you, surgery I think is the best way to go.
Let me know how it goes man!
Good luck!
Hi Berni, did you have your ultrasound yet? How did it go?
Allison
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Ruptured my AT 2 weeks ago playing netball and had surgery the next day to reattach. Last Thursday the Doc put me in a walking boot as i looked “trustworthy” not to put my foot down. Have to see him in 4 weeks time but has warned me not to weight bear for that time or i will rerupture. I have read here that everyone was in a cast for approx 8 weeks before going into a walking boot. Should i still be in a cast?? Will this hamper my recovery???
Tina - that doctor’s phrasing sounds remarkably familiar - wonder if we are being treated by the same doctor….
SalW - If you’re an Aussie, we could be!! I don’t know what happens after the four weeks, what have you been told. How is your leg going in the walking boot?
I’m now at 22 weeks post-op. I’m able to walk and function however I am a bit concerned about internal scar tissue. If I plantar flex, it feels as if the tendon is still very stiff and at the junction where it meets the calf muscle I feel as if the tendon is pushing in. Visually I still see wrinkles where the scar ends.
I have had some ultrasound at PT. I am in the process of decreasing PT and increasing home exercises.
Has anyone experienced the same feeling as I described? How long does it take for the scar to soften up? If so what did you do?
Hi Tina - I am an Aussie (yay).
I ruptured mine in mid- May and I just went back to the docs and he said I could go without the boot and go onto physio. So - that was about 2 weeks in cast, and I’m just starting to partial weight bear on my foot with use of one crutch - so that’s what happens after the four weeks. But at least with the boot you can remove it to shower and do a bit of wriggling your toes and slight moving of the foot etc.
Wish we could compare notes and see if it is the same doc.
Hi again SalW,
NSW South Coast ring any bells?? Went back to my GP today and told them my calf was aching heaps, dizzy alot with low blood pressure, (not so good when on crutches hey!!!) so now i’m getting an ultrasound to check for a blood clot!!! Other than that, i agree about the boot being better for movement and washing. Scared to use the foot again though and to start driving! Wish it was the left foot!!
Hi rho1372 - not sure about scar tissue just yet but I’d imagine that there are things your physio could do to soften it somewhat. Can’t wait to be where you are though - walking!
Hi Tina. Nope - my surgeon was in Nth Sydney. Maybe they all get together and chat about what phrases to say to their patients. That’s not good about your calf aching and being dizzy - fingers crossed that there’s no clot and the symptoms will pass.
I’m off to physio this week so hopefully there will be some rapid improvement - maybe driving in a month or so.
Hey SalW - Found out i did have a large clot in my leg and am getting blood thinner injections. Just happened to mention the ache while at the docs with sick kids. Lucky eh!! Good luck with the physio, i hear it is going to be pretty extensive for a while. Let me know how you go driving, All the best for a speedy recovery!
Sorry to hear about your blood clot but lucky that you mentioned it and got some treatment.
Physio tomorrow - eek! Nervous but hoping it’s going to be a step in the right direction for recovery.
Just saw Tina’s mention of blood clot and thought I would get some thoughts on my ankle.
I, mistakenly, detailed my experience on the re-rupture site (http://achillesblog.com/re-rupture/, July 24), but in summary, I am a newbie to ATR (good fun), had the operation. Just got my cast, but soon after I had felt a lump building in the lower part of the calf (as if they put a ball there and then put the cast on). Didn’t think it was a blood clot because I could find positions where I didn’t feel it and it didn’t throb. Was getting more uncomfortable, and was intending to go to emerg early this morning…but when I woke up it seems to have subsided (although my leg was much more swollen than before). I figure this is better, but I still don’t know what happened or if I should be concerned. I am guessing that it was a blood blister of sorts and that my incision wept a bit because now it feels like my cast is sticking to my leg. Any thoughts?
I also had difficulties and much pain in straigthening my leg, which is not expected.
Jimbo:
In my humble opinion what you are describing is not normal. I would advise a trip to the ER like right now!!
Good Luck.
Hey Jimbo,
Its better to be safe than sorry re blood clot. I was in agony every time i stood up as the blood would rush down and stop at the blockage. They say you can feel lots of heat where the blood clot is but don’t massage it as it could break up. Mine was a large one and detected 2 weeks after surgery when i mentioned the pain to my local GP while taking sick kids to be checked out!! Very lucky!! I agree with Doug, check it out ASAP. Let us know how you go.
Tina
Thanks Tina/Doug.
After reading your advice and talking to others who had ATR, I went back to the doctor and, voila, he found a small intra-muscular blood clot (likely a result of the trauma I gave myself when I fell a week after my operation, not fun). He wasn’t overly concerned about it as it wasn’t in one of the major vessels, but put me back in the half cast and will monitor. It is a good thing that I went back, eh. Funny thing happened at the hospital though…when I got there and decribed my pain, the attendant took the cast off and upon seeing nothing on the outside they wrote me off with the “you just injured yourself so expect some pain” lecture and were going to throw me back in the cast. I did feel like an idiot after not seeing anything externally as I thought I would, (I very much don’t want to be there for nothing and have not experienced the joy of ATR before and so recognize that I am not the expert on how things should or should not feel) but we pushed to see a bit more to see the doctor…..got a really nice one who took some time and sent me for the doppler and the rest is history.
They also gave me arthrotec (an anti-inflamatory and analgesic…typically for joint pain, arthritis)….not sure how I feel about it though in terms of side effects (heartburn, gut discomfort, etc). I figure I will just wiggle my toes a bit more often
Thanks again for taking the time to provide me your throughts. Take Care and I will keep you posted. Jimbo
I was given anti coagulant for 2 weeks after the surgery. I guess it was useful.
Yeah, we know how they seem to think at the hospital that we are complainers and it is our favourite past time to go there….
No problem Jimbo. We all have to look out for each other, thats what this blog is all about.
So, I went back to the doctor to see about the small thrombosis and it just so happened that I had developed another pain up the calf a bit….nothing serious, no swelling, but thought I would mention it. Turned out to be DVT (deep vein thrombosis) behind the knee (so it was a bit on the move). Now I am on the wonderful world of anti-coagulant injections (1 week) and pills (3 months). Good times!
Hey Jimbo,
Glad they caught it, mine was in the same spot. I too mentioned calf pain to my surgeon but he just said it was from the surgery, mentioned it my local doc and she got an ultrasound and found the large DVT. Moral of the story, always speak up no matter how trivial you might think it is. Hang in there with the injections, you might feel like a pin cushion after a while with the blood tests as well!!! Lucky you getting 3 months, i’m on them for 6!! I am nearly 8 weeks post op and down to one crutch and working on no crutches so yay, a spare hand at the moment!! Good luck with the rest of your recovery. Tina
Just wondering about people’s use of a recumbent exercise bike whilst non-weight-bearing in a cast? Did you need consultant’s or physio’s go-ahead or have you just done it?
On the rucumbent bike…I asked my dr if I could ride it with just the good leg and not the ATR leg. He said sure…I have…but it’s sure harder than with 2 legs, LOL
just snapped it yesterday…sprinting after a street thief (yes i caught him)..partial tear of left tendon..about 1cm i have elected for surgery (i box a bit)…here in spain they gace me ultra sound and blood thinning injections for 30 days along with pain killers…thye seem to think i may have to wait a long time for surgery so it may heal in the interim..about six weeks….does this seem right to you guys?
got a heavy cast on now.. is there an alternative lighter cast? i have scoured the net looking for one but to no avail…
any advice?
Saw your blog and posted there but in answer to this…
I’ve had fibreglass casts the whole time - surprisingly light..
Didn’t have blood thinning injections though? Took the odd aspirin after surgery to help with potential blood clots but nothing else ever mentioned to me. Perhaps the heavier cast you have? Or tightness of it?
Yes after 6 weeks in cast the ATR should/could be healing itself, you don’t want to start the whole process again having surgery AFTER 6 weeks if you can help it.
Push for surgery sooner if that’s the route you want to take or just go with the casts straightaway.
Best wishes, Sam
Hi , rumptured my achillies tendant a week ago today playing football , the normal effect ,felt like i had been hit in the back of my leg.
went to the walk in centre (hospital) the next morning and diagnosed as a partial rumpture and was put into a cast for three weeks ,then another for 3 weeks and then one i can walk on after that, they said i should be in one for a total of 3 months ,,read loads of your blogs which answered loads of my questions, but still a bit unsure about what type of pain killers i can take as i read you cannot take aspiren or ibuforon? ,keep getting told its worse than a broken leg for healing! its the fact of everything being such a task with the cast on thats the worse. and not being able to drive is a nightmare hope you all recover well
mark
newcastle england
This is a very interesting Blog site.
My situation is a bit unusual - I’m a Foot & Ankle surgeon who just ruptured my achilles two days ago.
Having surgery Friday.
I have a new appreciation for disabled persons.
Esse
Esse - glad that you found this site. I wish you luck on your surgery, and let us know how it goes.
Hi I am a 26yr old female and ruptured my archilles 5 days ago playing netball, had surgery that night and now stuck with a huge cast for the first time in my life!!! It gets downgraded to a lighter one in4 days time, still a little unsure on wether I had a partial or full rupture, still on some pain relief and doing some work from home so I don’t go crazy, how do you stay positive if you are a person who leads a very active life??
Great website
Anna,
Sorry to hear you’ve joined the club, but welcome anyway, Best way not to go crazy is to log in here regularly and see that you are not alone - there’s loads of us in this boat! And then find new ways to be active. And then admire your new bulging shoulder muscles after a couple of weeks on crutches! And then realise what a great bunch of mates you’ve got and what a very resourceful person you can be when you have to be. It’s a sh***y injury to get, but you needn’t have a sh***y time while you get mended. Take care!
Smoley
Hi Anna, welcome to the club. Sorry to hear about your injury, but if there is one good thing going for you - it is your age: you are young so you should heel faster and well compared to most old timers on this site ! Good luck!
Thanks smoley & 2ndtimer for your inspiring comments
Found this site while resting in bed recovering from the ATR surgery a week ago. This site has been very helpful and the stories have been ispirational.
Like most people, I ruptured my right achilles while playing basketball. The surgery was performed the day after my injury. The doctor prescribed vicoden but elected not to take them. After three days of surgery, I am feeling an intense cramp on my right calf when I get up to use the restroom. Also feel escursion pain below the right calf and around ankle during night time. Is the normal because I am not taking the pain medication? (blood clot?)
I have been elevating my injured leg as advised by the doctor. Next doctor’s appointment is next week. Thank you in advance.
Hey Tom,
Go and get that leg checked out straight away as it sounds like my symptoms (when standing, blood rushing down and stopping at a point with massive cramping). Told the hospital about it and they weren’t concerned, told my local doc and had an ultrasound and it was a large DVT. Have been on warfarin (blood thinner) for 4 months now with another 2 to go. Its better to be safe than sorry. Good luck with your recovery. Tina
Tom take Tina’s advice, doesn’t sound right to me.
I never actually had much pain after the operation and certainly no cramp.
Get it check as soon as possible.
Tina and Annieh, thank you for your advice. I went in for a 2 weeks post OP follow-up today. Splintter was removed and a cast was put on. Told me to come back in 2 weeks for another cast. Discussed the pain with the doctor. He told it was expected due to the right calf muscle resting at this time. I am still experiencing a little pain around the ankle at night. Doctor said the pain is going to fluctuate like a “wavelength” through out the day. Will monitor for blood clot.
Hey Tom, glad you checked it out. If you get any more cramping or pain in your calf, don’t hesitate to go straight in. I thought the pain was from the op but it was high up in the calf and hurt like hell every time i stood up and just didn’t seem right. My DVT was discovered 2 weeks after my op, so keep on monitoring and i hope you have a speedy recovery. Tina
hi all just found this site while browsing i ruptured my achilles fully on sat playing football when running for the ball thought someone kicked me went down an relised there was noone there !and new straight away what i had done .now in a cast and seeing consultant on weds to decide on my options . i am a very active 51yr old telephone engineer ,so reading the site sways me to the surgury option . on crutches now forgot how hard work it was as broke me leg twice nearly 20yrs ago ..so here we go …
Andy, Just looked at your blog and similarly am a comms enginner who ruptured his achilles tendon playing football. Simply jumping to chest the ball down, landed with a sudden pop,acute pain lower calf and looking for the pot hole in the ground I suspected I had fallen in to, which was not there! A & E that evening after realising symptoms were not good , splinted immediatly. Op 5 days later with foot planted, then cast change after 4 weeks and foot levelled to nearly 90 degs.
Slight weightbearing at 4 week point. Removed cast post 6 weeks op, crutches and very careful walking . Now at 9 weeks post Op , theraphy ongoing. Everyday a little better but slow, too much activity your body soon tells you. Walking with slight limp, but gradually going. Hope to be running 5-6 months post OP, no more football or team games ..too scared….
Hi All,
I’m so glad I found this site, I thought I was the only one!! I ruptured my Achilles on the 5th Dec 09 Playing football (UK) I was told all sorts of horror stories in A&E, things like I would be in a cast for up to my thigh that I would never return to the football field as a player, (all bullshit!!!!!!) I opted for the surgery (best option) and was booked in to see my consultant on Tues 8th Dec, who did the thompson test and confirmed that I had ruptured my Achilles, had surgery the following morning and things couldn’t have gone better, I will be in an awful heavy cast for 2 weeks (23 Dec) the into a boot or lightweight cast, I have been informed by my consultant that I will come back stronger than ever if I do my physio and workout to strengthen it….. There is light at the end of the tunnel!!!! Just a note but I have had little or no pain (Aches sometimes) and have always had full movement of my toes without any pain. (is this normal?) Good luck to everybody on this site…. God Speed and a Merry Christmas!!!!!!!
Hi, Gary! I’m about a month ahead of you- ruptured on November 3- haven’t had much pain to speak of (although I did have a nerve block for the surgery) and I have always been able to move my toes with no problem. Don’t listen to the horror stories. I try to tell myself that this isn’t tragic- it’s just inconvenient. Hang in there.
Hi everyone,
Thank god i came across this site doesnt make me feel as though theres no light at the end of the tunnel any more.I ruptured my achilles tendon on the 4th dec(i live in uk) dancing of all things!!! heard a “gunshot” sound felt a heavy thump in my calf and down i went.Am in non weight bearing cast and go back to clinic mon 4th jan to have pot removed and another one on gradually moving my foot to diff angles .Thank goodness we have borrowed a wheelchair as this allows me a little independance,not too clever on the crutches although have stopped falling over as much!Trying to be optimistic and not have a miserable face but at least on here others know how you feel.Take care all julie x
Just did mine on Thursday, Jan 7 and am very thankful for all of the information on this and other ATR blogs. The info has lead me to see a foot/ankle specialist rather than the orthopaedic generalist I saw on day 2. I see the specialist monday with my MRI pictures and will chart a course from there. Like most I am sure, I hold out hope for a “minor” rupture and non-surgical repair. Does anyone have any guidelines in terms of gap for non-surgical consideration? 1cm?
There’s an article somewhere on this site, sorry can’t remember where, which is a study of the results from surgical and non-surgical treatment, re strength/flexibility etc.
From what I remember the best results for non-surgical were achieved if the injured leg was set in cast within 48 hours of the ATR.
The specialist should be able to advise.
Best of luck.
The article is HERE it was on Simons blog.
Pete I was told my achilles was hanging on by a thread (rupture is rupture) complete break I would say its an op job. I ruptured mine on 15Nov09. Chose non operation. The cast was on from pointy toes to part way up my thigh. This was to be on for 3 weeks. Couldnt stand it so after one week they cut it below the knee. After 3 weeks they move your foot so many degrees so that the tendon can meet. i couldnt fatham how it works and the doctor explained . if you put your fingers in between each other and then slide your fingers apart i.e. north south that is how the tendons rip apart to different degrees depending on the individual. Every two weeks they did this until my leg was 90 degrees (neutral) took 7 weeks, 3 days. I have been in a huge boot which I can take off at bedtime and bath. In the boot for 6 weeks. starting 5Jan2010 My first physio is on the 15th Jan 2010. I feel sorry you have done this just hope the info helps a touch take care annette. They say if you are really sporty and want to get healed quicker then the op with 4/5 % rerupture to 7/8 reruption for non operation. However the op will leave a scar and apparently as there is little blood healing can for some be difficult as with some who can get infection. Not to scare you this was told to me by my doctor. My consultant said when I asked him will this heal - he said of course it will!
Thanks for the article…think I had already seen it. I guess everything depends on the philosophy of your doctor. I have read waaaay too much already - hope the guy I see tomorrow knows as much as I do. Freaked out at the prospect of surgery, that’s for sure. General anasthetic would be the way to go for me, but the intubation aspect is terrifying as well.
When you guys had just ruptured yours, were you able to walk at all? I can shuffle around when I am “warmed up” (blood in foot for about 5 minutes) - is that bad to do? I am being very careful and sometime wear the walking boot I was given by the general ortho guy Friday (can you believe he didn’t give me crutches?)
Leiulu,
Thanks for sharing your experience…hadn’t seen your post when I wrote my last one. So did your docotor recommend no surgery because of the hanging thread? Was it age/activity related? I turn 38 today…some birthday. And the 7 weeks were in a hard cast, followed by the walking boot (that I have now) for the rest of the time?
Pete,
Before I knew I’d ruptured (misdiagnosis in A&E) I thought I was doing better putting my foot flat to the floor and being able to put a small amount of weight on it, with the use of crutches.
My surgeon was horrified that I was doing this and told me to elevate “sky-high” to get the swelling down for surgery.
I only had a small gap, and was offered either treatment but chose surgery because of the delay in proper treatment and because I has heard of a few people rerupturing after non-surgical treatment.
I had 9 weeks in fibreglass casts, 3 weeks in each position, then straight to 2 shoes with a heel pad and crutches for some time afterwards.
Yes, I have a scar but I;m glad I chose surgery - think I’d have been worried about rerupturing otherwise.
My blog is under sam66 if you want to read anymore.
thanks for sharing. hmmm, maybe I shouldn’t be putting weight on it with no crutches…swelling isn’t as bad as with the multiple ankle sprains I have had, but going from elevated to ground doesn’t feel good. I am still trying to convince myself that no surgery would be OK if the gap is tiny based on the studies out there…seems like there is far from concensus on any of this.
Hi Pete,
I was able to shuffle around after my rupture, until I saw the doctor at emerg - when he diagnosed me (Thompson test) gave me the crutches and told not to put weight on it. I could feel the gap when I touched it. But they took no MRI nor ultrasound. However he gave me a splint at 90 degrees that was not good I think…. 2 days later the ortho put me in cast with pointed toe… After 4.5 moths I re-ruptured it. Then I had surgery. What is the moral of the story? I do not know.
2ndtimer,
that’s about the scariest thing I have ever heard…tell me you did something out of the ordinary to snap it again? sounds like they mistreated you from the start though, even if they were going conservative?
I just made a wrong step in my bedroom when it snapped again. Probably it never healed properly. It felt solid when i got out of the boot (after 11 weeks) but as I started walking i had flare ups, swelling, pain in the tendon.
I did not get an answer what went wrong. I think even if the surgeon knew, did not want to implicate his collegue. Maybe the gap was too big. Maybe because I fell while in the cast? Maybe I walked too much once I got out of the boot? Maybe the lower the tendon breaks the harder it heals?
I was not offered surgery first because I am over 40 and do not do sports regularly. Or maybe the surgeon was too tired, it was the end of his day. Not many people seem to get MRI though. Too expensive.
The second time around the diagnosis was not simple either. First the emerg doctor thought I did not re-rupture, as it was pretty hard and swollen. He said I would not get surgery anyways, if I did not get it first time. But just in case ordered ultrasound. Then they diagnosed full rupture. After that they called down the ortho surgeon to emerg and he offered surgery.
I didn’t like the lack of knowledge from the general ortho I saw Friday, nor did I totally trust the thompson test. I wanted to know “how bad” the rupture is so I got an MRI (not to mention it will help them know where to cut in case I get surgery). I am taking the MRI to a foot specialist tomorrow morning…that guy had better know more than I do or I am on to another doctor. I wonder if I am no longer a candidate for conservative treatment given my delay in seeing someone competent and continued (careful) weight bearing. Fact is, the general ortho gave me a walking boot not crutches…what an idiot.
Frustrating isn’t it. My 2nd surgeon said the re-rupture rate with conservative treatment was 1 in 5. Hah. That is not what we read in the article above. I hope you get in good hands tomorrow. I had no health issues previously and this was my first surgery, so I was not enthusiastic about it, but it worked out well. Good luck.
Thanks. Yes it is frustruating. Surgery is what freaks me out. Did you go general or local anasthesia? I have played sports all my life, and while I am not in fantastic shape right now, I am in decent shape and lighter (weight) than I have been in 9 years. Plus, I wasn’t doing anything remarkable or particularly explosive when it happened playing basketball on Thursday. Guess I just want to get on with the healing process…wish I could include these last 3 days.
It seems to be always general anesthesia. (we have an expert on it here - see ultidad’s blog)
I think most of us did not do anything remarkably strenuous - just getting old. Over 40?
The thing about general is that I hear you have to be intubated to breathe…and until you wake up…which would be a living nightmare. I will go have a read.
I had the choice. Could n;t face surgery, Being female did not want a scar. Felt confident I could heal without it. The surgery is good for push off il.e. more control so if your a very active i.e. sporty person they recommend the op. I am not sporty but the atr was done whilst playing net ball. But I do like the gym, like to dance so does that make me active and should have had surgery - no thanks. Age perhaps does come into it as one gets older its harder to heal i believe but 38 is young.
Everybody reacts to things differently. I was so upset about the re-rupture the surgery was no concern anymore. Also I had no time to worry: diagnosed at 4pm - surgery done 4 hours later. I do not remember anything about the tube. Put the mask on my face and I was off. Waking up had pain - that was no fun, but was given morphine and after that it was lala land. Did not need any more pain killer after first day.
They let you go into surgery without fasting, etc…? Wow…wish I didn’t have time to think. I commented on that other guy’’s blog…hopefully he checks it to answer my anasthesia questions…although I suppose I will find all of this out tomorrow morning anyhow.
No, you have to fast a bit - he asked me when I ate last time, i think it was at noon, and not much, so 8 pm worked.
I think they give you something to calm you down in the iv.
It will be over fast. it is rather the 3-12 months to full recovery that you have to worry about.
do you remember anything at all?
No. I remember the nurses chatting among themselves but in half a minute I was out I think.
Maybe you need a glass of wine this evening and a nice long bath - you will not have that for a while with the cast!
don’t they make cast covers so you can shower? I did go get a haricut and shave yesterday in anticipation of next week.
Pete,
You may or may not have a cast, depends entirely on your surgeon. Mine doesn’t use casts for ATR so only ever had the boot, from the time I ruptured it until I got to FWB.
You can buy a cast cover or you can use large black plastic trash bags and gaffer’s tape. It took me a while but I finally got to where I could use the same bag probably a dozen times before it need to be replaced. The trash bags are a lot cheaper than the fancy cast covers too.
There will not be too many options for anesthesia. They will ask you if you’ve had it before, how that went if you did and if you have any allergies to drugs, but this isn’t the sort of thing that’s done under a local. At least I’ve never heard of it and I sure wouldn’t want it done that way.
The first couple of days after the surgery are the worst. Make sure you have pain pills that you know work. You may also want to have something muscle spasms. I had some really nasty muscle spasms after my last surgery and immediately called and go a muscle relaxant. The pain and muscle spasms only lasted a couple of days. After that I just took Ibuprofen.
I would be thrilled if my guy doesn’t use casts…will find out tomorrow. I have definitely heard of local…shots in the spine and or leg…awake for the whole thing. Not what I would like except for the intubation aspect of the general.
What is gaffer’s tape and where does one buy it?
Pete- I’m trying to post my answer to your question on my site, but I keep getting “Error: Please enter the anti-spam word”. Except on my blog, there is no place to enter the anti-spam word. Help, Dennis?
So, here is what I tried to post:
Hey Pete- sorry to have to welcome you to the club.
As far as surgical concerns go, I’ll let you get that info tomorrow. I would suggest taking a list - write it down - of your concerns. It is really easy to get overloaded w/info and forget to ask questions.
From the anesthesia standpoint, I hope that I can help you. My subspecialty is pediatric anesthesia and nearly daily I tell the parents of my patients that overall, from a statistical standpoint, it is safer for their child to have anesthesia than it was for them to get the child to the hospital. We (people in general) tend to underestimate the risks of driving because we feel like we are in control; we tend to overestimate the risks of anesthesia because we feel that we’ve lost that control. Very similar to the statistics of flying vs. driving
That said, there are a few decisions that you may or may not be presented with:
1. General vs. regional anesthesia:
General anesthesia means that you are completely unconscious, you won’t remember anything, and you won’t feel anything. GA is normally induced w/medicine given in an IV, although those of us in the pediatric world tend to have our patients breath anesthetic gas via a mask. Most of the time, GA is maintained with inhaled anesthetic gas, with the patient either breathing on their own or being controlled/assisted by a ventilator. The gas can be delivered by a mask, a breathing tube, or any of several other airway devices. Most GAs are what we referred to as “balanced anesthesia”, meaning that in addition to the gas, other medicines are given in the IV, such as sedatives, narcotics (pain medicine) and muscle relaxants. Currently, nearly all GAs also include the administration of anti-nausea medicine and antibiotics.
Regional anesthesia (for the purposes of ATR repair) normally means either a spinal or epidural anesthetic. These two techniques are very similar in that a needle is used to go in-between parts of the bones of the back (the bumps that you feel/see in the middle of the back) to get to a certain spot. With a spinal, the needle is advanced until the tip reaches that place where the spinal fluid is. Local anesthetic is then injected. With an epidural, the needle is advances slightly less than with a spinal. Again, local anesthetic is injected with similar results. Sometimes, narcotics are mixed with the local anesthetic with either technique. The extent of numbness with either technique is usually from the lower chest/upper abdomen on down. Regional techniques are typically accompanied by the administration of IV sedatives and/or narcotics so that the patient isn’t completely wide-awake during the surgical procedure, but is in a state referred to as “twilight sleep” (although I dislike that term). Depending on the technique, the medication used and the dosage, RA provides surgical anesthesia for 1-3 hours, with pain relieving effects lasting 4-8 hours after surgery.
2. Nerve block - yes/no:
There are several different nerve blocks that can be pertinent to ATR repair, but the one that is most frequently used is called a Popliteal Block. By “nerve block”, we mean that local anesthetic is injected around a specific nerve, causing cessation of nerve signals in that nerve - numbness to pain as well as inability to move. With the popliteal block, a needle is inserted in the area behind the knee to numb up the nerves that go to the foot and ankle. It is possible to do some surgeries on the foot with this block alone, but I don’t think that it provides adequate coverage for ATR repair (blocking other nerves higher up in the leg can accomplish this). Mainly, this block is performed to provide post-operative pain relief. The block is normally administered before surgery - usually before the main anesthetic is administered as well, although in pediatrics, we typically do nerve blocks after children are anesthetized. Usually some IV sedatives/narcotics are administered before performing the block. Although it is possible to perform this block unaided, frequently either a nerve stimulator or ultrasound is used to help with locating the nerve before the injection is done. These blocks can provide pain relief for up to 18 hours. When I perform nerve blocks, I always stress the importance of starting oral pain medicine before the block wears off. If you read enough of the stories here, you”ll see that several people have been awakened in the middle of the night with a great deal of pain. To me, this points out the pros/cons of the block: you wake up from surgery with absolutely no pain, but have the potential for more pain later than if you had been taking oral meds from the time that you woke up (as well as making sure that your pain was under control with IV meds before you leave the recovery room).
Overall, if you look at things from the perspective of 1 week post-op, there is no difference in patients depending on their anesthetic technique - GA vs RA +/- nerve block. Like most things in life, we all have our opinions about what is best in any given situation. My surgeon preferred that I not have the nerve block, so I didn’t push for it - a typical argument against the block is that it would mask symptoms of nerve damage potentially caused by the surgery. As far as GA vs RA, in an otherwise healthy person (which describes most of us who have this injury) there really is no difference in risk. Even being in the business, I was fully prepared to go whatever route my anesthesiologist recommended (I had GA).
I hope that this helps. I’m not going to re-post my email address, because I saw an upsurge of unwanted emails after I did, but if you have any other questions, you can find it here: achillesblog.com/gerryr/2009/09/23/third-surgery-scheduled/. Good luck, Ron
Pete-
OK, now I’ve read the above comments and I’ll add a couple of things:
1. Intubation is not as bad as it sounds. In nearly 15 years of practice, I’ve only had one patient remember the tube going in (a “crash”, emergency C-section and I warned her that she might remember) and I’ve had no healthy patients remember waking up w/the tube (I say “healthy” because some patients remain intubated after surgery, but they are usually sicker or having more extensive operations like open heart surgery)
2. If your anesthesiologist/surgeon combination thinks that a spinal or epidural is best (my father had a spinal when his ATR was repaired at age 58), it is highly unlikely that you’ll be wide awake during the surgery.
Good luck tomorrow, Ron
Thanks, Ron. I guess I would prefer GA but am concerned about intubation and remembering that or coming out of GA with tub in?
well…our posts crossed. Glad to hear that. Still freaks me out a bit as I am a large man 6′5″ 270 and have woken up before for other things like teeth extraction and endoscopy…
Gaffer’s tape is used in theater and also by professional studio photographers. It has very tenacious adhesive but doesn’t leave a residue even after long periods of time. You can also use duct tape but I found that gaffer’s tape worked better. You can buy it at professional photography supply shops and theatrical supply shops.
So…I am scheduled for surgery on Friday the 15th. I wish my new guy had spent more time discussion the MRI and “degree” of rupture so that I could have more seriously considered non-surgical treatment, but he did say that since I did it 4 days ago I have kind of already missed that window for getting the best non-surgical results. (would angle your foot right away, etc…) Curiously, he wasn’t appalled at the fact that I was walking…though he did say that after the surgery I wouldn’t be weight bearing for a bit. On the bright side, this guy seems to be aggressive in recovery. I don’t think I am getting a hard cast at all, which makes me happy. I guess I just need to survive the surgery now and try to get on with the healing. I am supposed to hear from the hospital re: anesthesia, etc…soon. The guy said I would probably have a mask with a tube that only goes to the back of your throat and that you would never be aware of or remember it?
Pete- the “mask with a tube that only goes to the back of your throat” is not really a mask, but it does go to the back of the throat, not all the way into the trachea. Its full name is Laryngeal Mask Airway and the word “mask” is in its name because the early ones were designed to be covered by a regular anesthesia mask. Google it to find out way more than you need to know. Without seeing you, but you being the size that you report, I would probably intubate rather than use an LMA. For the surgery, you need to be on your belly, and if your airway obstructed during the procedure, it could be a bear trying to correct the obstruction. Now, the anesthesiologist who you have for your surgery may take a look at you and say that (s)he is not concerned and you can have an LMA. Another concern that I have with LMAs and ATR repair is that sometimes the surgeon needs to have muscle relaxants given and it can be more challenging to ventilate a prone patient who has an LMA. As far as the “never be aware” part, there is really no greater likelihood of remembering a breathing tube vs an LMA. I do have to say that the only time I say the word “never” is when I say, “I never say never.” I’ve been doing this long enough to know that nearly anything is possible and I can’t guarantee anything. I do hope that all this info is helping, rather than giving you more things to ruminate over. The bottom line is that, just like there is no “best” way to treat ATR (surgery vs. non), there is no “best” anesthetic plan.
Thanks for all of the info, Ron. I haven’t talked to the actual anesthesiology guy yet…and yes, all of this stuff does freak me out. But at the end of the day, if I won’t remember any of it, I suppose it doesn’t matter once you are out. Not having the surgery until Friday is giving me way too much time to think about everything. I could have done it today but with 3 kids under 5, we wouldn’t have had child care sorted, etc….
Well, I made the mistake of telling the pre-op nurse that I might have sleep apnea (never diagnosed…snore loud). Super. Now I am told that I get to spend an extra 3 hours in recovery Friday. Ron, any way to reassure them? Might they change their minds in the moment or is it a set outcome based on the pre-assessment?
Sleep apnea has become a real attention-getter lately, mostly because people with severe sleep apnea are exquisitely sensitive to the respiratory depressant effect of narcotics, which means that they can stop breathing with doses of pain meds that would be easily tolerated by someone w/out sleep apnea. Ask your wife if you ever stop breathing, or if you just snore loudly - your anesthesiologist will probably ask something similar. If your wife says that you don’t stop breathing, you might be able to avoid those extra 3 hours. But if you do stop breathing at night and stop frequently, it might be safer for you to actually spend the night in the hospital, rather than just an extra 3 hrs in recovery. I gather that by now, you just wish that the surgery was over already!
My wife says she can’t really answer that question as we are usually awake at the same time and she was used to the snoring anyhow - but feels like I don’t snore much any more for what that is worth. I did get a mouthpiece a while back for tooth grinding issues, so that may have helped the snoring. I do wish I were on the other side of the procedure…read a post on this site that said the guy remembered a tube being pulled out of his throat - not what I wanted to hear…but maybe he had a bad anesthesiologist? As for me, do you think they will be able to tell anything while I am under in terms of apnea? Oddly, since the first operating venue determined that I have sleep apnea, I could no longer go to their facility as it closes before the 3 hour window would be over. I am now going to the hospital, and had to re-do the pre-op questioning today. Answering the same questions in the same way (and indicating the conclusion the other venue came to), this nurse said she didn’t think I have apnea and didn’t flag me as such…should I now be afraid? I suppose I will get to speak with the actual anesthesiologist before I go under anyhow, right?
Answers in order:
1. Not necessarily a bad anesthesiologist - guy might’ve awakened quicker than anticipated (like most things, response to anesthetics is a bell curve)
2.Doubt that possible sleep apnea would be detected while you are under - the anesthetic state, although compared to “sleep” is really a much, much deeper state of unconsciousness.
3. Sounds like the first venue was a surgery center. Since those facilities are usually not equipped for overnight stays, they tend to be overly concerned/cautious about caring for all but the healthiest patients. I don’t think that you need to be afraid.
4. As I’ve said earlier, I won’t say anything is 100%, but it would be highly, highly unusual for you to not meet your anesthesiologist beforehand. If if seems like they are taking you to the OR and you haven’t met an anesthesiologist, insist on meeting yours.
Pete - Just thought I’d offer some thoughts based on my experience with this injury, although it looks like Ron has already provided some really, really good and detailed information. I’ve had two achilles surgeries and had general anesthesia for the first and spinal block for the second. Both procedures went fine and I didn’t have any side effects. Going into the second surgery I was planning on having general again because I’ve never had a problem with it in the past, but after talking with the anesthesiologist prior to surgery, I decided to try the spinal block. They also administered a popliteal block to manage post-op pain as well as a sedative prior to the procedure. I was out like a light and don’t remember anything about the surgery. As I recall, I was a bit less groggy when I woke from the second surgery.
I mention my experience because it sounds like you have concerns with intubation. The spinal block was very effective for me and I know plenty of others have gone this route rather than general, and I don’t remember anyone mentioning complications. The spinal block may be a good option for you as it would avoid intubation. I would recommend you mention your concerns about the anesthesia with the nurse first thing as they prep you for surgery. Mention that you’d like to have some extra time to speak with the anesthesiologist.
Good luck with the surgery. I know the anxiety of the situation can be draining, but it will be over with before you know it and then the healing can begin. Try to keep positive thoughts.
Thanks for the advice, Tomtom. I am not sure I ever want a needle near my spine…how was the initial dosage of sleepy serum administered? And with the local, you don’t remember anything at all? No “tugging on the foot” or surgeon banter, etc…? Did your anesthesiologist recommend the local or just present the options? I think I would prefer to be totally out…but with the guarantee that I don’t want up until I am supposed to and not with a tube in my throat…if such a thing can be given. Ron, when do they take the tube out? In recovery right away, or does someone stand there and wait for signs that you are starting to come out of it and then yank? I do look forward to being able to start the healing, although I do see surgery as a major hurdle. Also, since I can shuffle around now and don’t have too much pain except when transitioning from lying down to standing up, I am bummed that I have to get worse first to get better…but that is the deal I guess. EXTREMELY helpful to read the experiences and get advice from folks like you…thanks again.
OK, I was not going to say anything but Ron probably won’t be around until much later. My younger cousin’s husband needed some relatively “routine” surgery a couple of years ago, actually heart surgery but a very common procedure, just don’t recall what. Like you the idea of someone cutting him open totally freaked him out. He was even considering not having it done even though it was absolutely needed. My wife is a psychiatrist and talked with him at length about it and finally told him to call his doctor and ask for a prescription for Xanax, pronounced “Zanex.” It is an anti-anxiety medication and it worked wonders for him. He later said he wasn’t sure he could have gone through with the surgery without it. BTW, he is also a big guy, 6′4″ or 6′5″. You won’t need a lot, just enough to get you through to the night before surgery. Your surgeon should not have any problem with it.
I appreciate the suggestion, Gerry…but won’t they give you something like that in your IV once they put it in? I probably won’t sleep much tonight, but maybe that will make me sleepier during/after the procedure. As you might guess, I am not a big fan of popping pills if I don’t absolutely need them.
Once you’re out, you don’t need anti-anxiety medication. This is to calm you down before you ever get there.
Pete - I can promise you I don’t remember a thing about the surgery. I was alert when they administered the nerve block behind my knee, but then I don’t remember much after that. The sedative was administered through an IV the nurse hooked up. I recall heading into the operating room and briefly speaking with the staff. I don’t know if the sedatives started to kick in or if the spinal block was uneventful, because I don’t really remember it. The next thing I know I’m waking up in the recovery room with my leg in a cast and propped up on a foam block.
The anesthesiologist explained both options but also recommended the spinal block. Not exactly sure why that was his preference, but he really pushed it. I actually didn’t care too much for the way he suggested I opt for the spinal, but I listened to him nonetheless, and it was very uneventful.
Also, you will likely have some post-op discomfort during the first 48 hours, but most people, including me, will tell you it isn’t that bad. As a word of caution, you will want to take your pain medication regularly for the first 24-48 hours and continue to do so if you’re still in pain. I’m like you in that I don’t like popping pills, but this is a case where you want to be proactive. It is more difficult to manage the pain if you wait to take the medication once the pain sets in. Your medical professionals will most likely go over all this information with you and your wife.
Pete,
I second everyone. I remember the anethesiologis singing a song to me in Russian which I thought was very funny and then I woke up in the recovery room. I also had a sciatic nerve block so I never took any pain killers as there was nothing to kill
The drawback, from what I understand, was that my leg was really numb for at least another day so I had to be really careful.
Good luck - you will do great
Marina
Interesting. so the chronology was: sedative, leg block, then spinal, then something else in IV to knock you out or cause you not to remember?
I have an unrelated practical question for recovery: How in the hell do you sit down on the toilet without putting ANY pressure on the hurt foot? Maybe it is because of my height, but I am going to have to be a contortionist? Or is light heel pressure OK?
Thanks for the well wishes Marina. Sounds creepy that guy singing in Russian just before sleepy time though. So they must whack you out on something else after the block is in? No pain killers? Does that mean that by the time you regained feeling in the leg there was no pain? Was that by design or did they overdo the block?
Pete,
Yes, this was by design. The anethesiologist had suggested that I get the nerve block but said it was my choice. He was a boyfriend of my friend so I trusted him. And yes, but the time the numbness wore off there was no pain. There was a discomfort from the swelling but nothing that required a pain killer. In fact I had 30 people over to celebrate my b-day two days after the surgery. I could not cook much, but was able to help cutting the salads
Pete - I believe the sedative was given after the leg block. I don’t know if it took a few minutes to kick in or if they gave me a second dose right before the spinal block. That part is pretty foggy. Like I said, I don’t really remember the spinal block at all.
As for the toilet, light pressure on the heel should be okay while you’re sitting down. You can also rest the injured foot on top of the good foot while sitting down.
If you are really lucky, the toilet is near a door. What you do is lean both crutches on the wall where you can easily reach them later. Then, while standing on one foot, you shut the door and lock it. Then you hold onto the door knob with one hand and reach down for the the toilet seat with the other. Keeping a grip on both you can both lower and hoist yourself on and off. Probably only possible in very small bathrooms like mine, where I could reach both at once. Admittedly unhygienic, but it worked for me.
I have been practicing a version of that…but it only works in the main bathroom where the sinktop is close enough to use as a proxy for the door in your example. I would tear the door off its hinges for sure in the bedroom bathroom…this is another one of those times where being big and tall is no advantage (another that comes to mind is airplane seats). I just hope I don’t mess up the other foot/leg with all of the acrobatics I am likely to be doing over the coming weeks.
http://www.amazon.com/Jobar-International-Deluxe-Toilet-Support/dp/B000H8Y9GG/ref=sr_1_3?ie=UTF8&s=hpc&qid=1263522604&sr=8-3
Here are some toilet grab bars you can buy on Amazon.com, or lots of other places online.
Good looking product…needs a higher weight limit though. I would consider it if I end up having complications that make me NWB for a prolonged period of time for sure. Thanks, Mary.
Gerry’s figured out that I don’t get computer time until after my kids are in bed :). Let’s see, as far as when the tube comes out differs for most anesthesiologists. Personally, I extubate (technical term) with the vast majority of my patients still deeply asleep - a technique that I was taught during residency, but use to a far, far greater degree in my practice. Most of the time during residency, our instructors made us wake patients up before we could extubate, so I imagine that if one were to be a patient in a university setting that had a lot of residents, that might be one’s experience. As far as the general vs spinal as well as nerve block vs no, there are a ton of factors that go into why a particular anesthesiologist would recommend one over the other, such as surgeon preference, room turn-over pressures, availability of ancillary staff, patient health/anatomy factors, etc. Sometimes it is simply “that’s the way we do it here.” Some of those factors also make it very difficult to predict exactly what the sequence of events will be on any particular surgery day. And re: the toilet issue, I just used my crutches to help me sit down, but I’m 5′8″, so I had much less of a distance to lower than you do, Pete.
Interesting…hope these folks use your technique…even though I will be in Boulder, a college town, I doubt they are crawling with interns - but I could be wrong I suppose. Someone suggested to me that my size might dictate the anesthesia choice - do you make any of your determinations that way? Does 6′5″ 270 put me in a category where a choice is forced? I won’t be able to bug you for much longer…Dday is tomorrow around noon.
Up in Boulder, you’ll probably have an anesthesiologist who is well out of training. As far as your size and anesthetic choice, I could make an argument for either way. The extent of spread of spinal anesthetic is determined in part by the patient’s height - taller people need a higher dose to obtain a similar level of anesthetic - although in ATR repair, the level is not as important (it is easy to get the legs and feet numb). That could be used as a reason to not use a spinal. However, you need to be prone (lying on your belly) for the surgery to be performed. Larger people are harder to position after they are asleep (if you had a spinal, even if you were sedated, you could at least help in getting your upper body positioned) and can be more challenging to ventilate when in the prone position. That could be a reason to not use general anesthesia. Stop me if I am sounding like Vizzini in “The Princess Bride”. As anesthesiologists, we are trained to be professional worry-warts, which is why I list negatives for each technique. The bottom line, however, is that your size is not an absolute indication for one technique over another. Hope that you get some sleep tonight - good luck tomorrow.
Well I got the popliteal nerve block and I was sure glad I did. Lots of blogs here about people having lots of pain for days and days after their surgery. I took one little percocet on Day 3 after my surgery, otherwise never needed any pain meds at all except for Ibuprofen. I also think that maybe having the nerve block was why my swelling and pain have continued to be so minimal- things never got “all worked up”.
I like the Vizzini reference: “And I can certainly not choose general because of the risk of apnea.”
“So you’ve made your choice”
“Not even close! You weighed in at 270, so I can clearly rule out spinal, but you are 6′5″, which makes it difficult to position you on the table regardless.”
I’ll stop there…guess I will find out in a few hours anyhow. If it’s all the same to them, I would rather be out completely and wake up with an unobstructed airway. I just hope everything goes smoothly and that I am back online tomorrow some time saying how easy it all was. Have a great Friday all.
Alive! Very happy to be alive, but I can’t say I feel great. I didn’t sleep for a single minute last night. The 5 mg oxycodon (take 1-3 every 4 hours) was/is entirely insufficient. It gives mild relief for maybe 1:45 out of the 4. Called the doc this morning and he said I could take more/more often and add in some ibuprofen. Any other tips out there?
In the end, I did general anesthesia…really wasn’t presented with another option, which was fine with me. I think they knocked me out with IV sauce and then did the intubation for the other stuff. My throat was sore waking up, but I don’t remember the tube which is nice. I am told my achilles was a pretty “clean” break and therefore lent itself to a good fix. If I can just get this pain under control I am on my way.
anyone have any tricks for lessening the pain of going from elevated foot to foot near the ground? I tried once today and it was extremely painful. Or should I not even consider moving about for a few days after surgery?
If you are still up and suffering, try alternating meds, esp if you have pills that just contain oxycodone with no acetaminophen (tylenol). I alternated oxycodone and tylenol every 3 hours because I didn’t know that I could take ibuprofen. You could try a schedule of taking something every 2 hours - oxy, tyl, oxy, ibu, repeat. That way, you’re taking the oxycodone every 4 hours, but have something else in between. The good news: time will make things better. Also, I found that for the first two weeks (at least), every time that I got up from having my foot elevated, I could feel the pressure of more blood staying in my foot. That lessened over time as well. Glad to hear that you made it through in one piece!
Sound advice, Ron. That is what the Doc said to do (with ibuprofen) and it helped a ton. Don’t know if it was the ibuprofen, the combo with Oxy or just time going by but it definitely got better. I still didn’t sleep like a baby, however. I don’t think my body likes that Oxy stuff at all - gives me a low grade fever I think. Anyhow, day 2 post surgery is here…more NFL to watch and perhaps even a trip to the restroom. I don’t even know when I am scheduled to see the doc again. Is that ususally a few days to look at the wound or a few weeks? This splint sure doesn’t seem very robust…hope it hold up until I see someone. On the bright side it feels much looser, hopefully indicating less swelling? I feel like I can move my ankle a bit if I want to…should I? Thanks again Ron for all your help/advice - I sure knew what to ask the anesthesiologist the other day. Doctors must hate the internet for that…
True, once my doctor laughed and said, “Sometimes I hate Dr. Google!”
I saw my surgeon first the first follow up at the 2 week mark, and that seems pretty typical based on what I’ve read here. Be very careful on those trips to the bathroom, they are treacherous. I swear if I could’ve used a urinal thingy I would have!
Truly, you have a dizzying intellect! One of my favorite scenes from the Princess Bride.
I think you should not even consider moving about at first. The goal is elevate and ice. So I kept my knee above heart, foot above knee pretty much around the clock the first 2 weeks. It seems paradoxical, but going slow now will help you go fast later!
It has been 2 days since surgery, and I just took my first trip to the restroom (the largeg gatorade bottle has been sufficient until now). That was an acrobatic feat…the worst part of which was having the leg below the heart…throbbed nicely. Mary, did you have a cast for the 2 weeks or just the splint? My splint seems awfully flimsy/loose…doubt it would make it 2 weeks.
Another question. I am trying to get away from the Oxy…and I think I feel like crap because of it? Did you have the same experience? My foot doesn’t hurt too much worse, I just feel crappy. How much ibupofen can I safely take, or should I alternate between Tylenol and Advil?
Hi, Peteco! I had the plastic splinty thing with the gauze wrap deal for 2 weeks, then cast for 2 weeks, then boot, of course. I only ever took one percocet the whole time. Painkillers makes me so nauseous (even with prescription compazine) that they’re not worth it for me. But I was taking prescription strength Ibuprofen for 30 days! (poor liver)- 800 mg 3X day. It also helped that my nerve block lasted forever. The time will go by faster than you think. Get better every day!
that’s right..forgot you had the popliteal (I am Pete who finally signed up as peteco)…I can see how that might have helped as that first night was pretty miserable. The ONLY good thing about it was that surgery was in the past. So far so good on the Oxy weeing…haven’t had one in almost 6hrs, but I am not sure 600mg of Advil is going to do the trick every 6 hours.
800 and ice, baby, ice
can’t really ice through this splint?
Yes! And of course you want ice that can actually wrap around the splint at the site (or where you guess it is.) I found these ice packs at the drug store that were filled with little spheres of ice (like frozen peas) and I always had one under the splint and one on top, with the one on top wrapped in a dish towel. Another thing I wish someone had told me- try to keep your calf turned to one side or the other, so when you are elevating you’re not putting all the pressure right on the site. Also, when in bed, try lying on the opposite side of the surgery with pillows between your legs so the leg is elevated but sideways to relieve the pressure.
can you even feel the cold through the splint? It is terrible if the wound gets wet, right? As for positioning, I think (obviously never seen it) the cut is towards the inside of the leg and not directly on the back…haven’t really felt the site yet, just general pain down there. I just hope I can sleep tonight.
True, you don’t want to get it wet, so don’t even mess around with real ice- and wrap the ice/gel thing on top of your leg in a dish towel- to catch any condensation. As to where it is, mine is just barely to the inside.
Good idea.
So I moved from bed twice today on crutches, but unless I keep my knee as high as possible towards my stomach, the pain is brutal. Does that go away? Do I need to give the leg longer to acclimate to full blood flow?
Hey there I have recently ruptured my Achilles Tendon and have an appointment to see the specialist tomorrow. I was initially misdiagnosed by my GP as I could walk reasonably comfortably although with a limp and felt no pain and he thought that I had probably ruptured my plantaris tendon instead. I insisted on the ultrasound which confirmed that I actually had a complete ATR but also that I had a highly developed plantaris tendon which was the reason why I could walk, support weight relatively easily and had quite a free range of movement in my foot. I’m just wondering if anyone else has experienced this? Also my GP said that by having this tendon hold everything in place it should help with my recovery.
TJ:
Interesting. I ruptured my Achilles and limped around for 2 months before it was diagnosed as an ATR (they called it a calf tear originally). My fault, I should have been back in 2 weeks when it did not get better, but hey, I was new to all this. My doc never explained how it was I was still able to get around with an ATR - maybe (a strong plantaris tendon) this is the answer.
Interestingly, they harvested the plantaris to reinforce the ATR repair (weaved it right in). The plantaris is unnecessary and is often harvested for all kinds of other surgeries. In fact, 9% of people don’t even have one. Glad I did!
I ruptured mine 4 weeks ago and had surgery 2 weeks ago. On my second cast but was wondering what other people have done at this stage (2 - 4 weeks after) surgery?
I want to get out some but don’t want to do something stupid. Drove to a meeting and was on crutches for a half hour a couple days ago and it was a disaster.
All my doctor said when I asked him what I could do is “use adult common sense”.
Any feedback?
jr,
Take a look at my blog page. You do pretty much nothing first 4 weeks. I’m at week 3 and just starting to move around on one crutch. Have not really left the house except to go to Dr appts and a party down the street. Canceled 5 business trips. I think it’s best to lay low and focus on healing for the first 4-6 weeks. That’s what I’ve learned from others on this site and my own experiences. Good luck and keep up the good spirits - it makes a difference.
Hi Jr…I can echo norcalsurf70’s message…first two weeks were literally on my back with my leg above my heart…drove me crazy. After that it was a lot of sitting with my leg up. I was FWB about a month after surgery but I still had to had my leg elevated as much as possible. when I was first in the boot FWB i noticed the leg would swell quite a bit when i was upright for a while…Slow and easy wins this race!! The more rest you get in the first two months the better….get as much sleep as possible…you will be amazed how your body can heal
Thanks for the feedback.
Not easy sitting around. Drove a couple times but can’t get a comfortable position for my leg.
Nice to hear from other people going through the same crap.
Sorry to have to post again but I went into some blogs and everyone seems to be in a different situation that me. My achilles was completely torn with a 3 cm gap in the tendon Had surgery 3 weeks ago tomorrow.
The doctor said after 2 weeks that he wanted to cast me for another 4 weeks and I can’t put any weight on the foot the entire time.
Seems like other people are getting boots much earlier and putting weight on the foot as early as 2 weeks after surgery.
Is my doctor being overly conservative????
JR,
Recovery protocols are all over the map. From reading this site, it seems to me that they favor casting for anywhere from 6-10 wks outside the US. Inside the US, there is a still a wide range, from the boot after a week or so up to and including various casting regimens extending out to 8-10 weeks as well. I seem to have an aggressive ortho, but maybe that is because he is a foot/ankle specialist. I hit 4 weeks today and have been OK’d for FWB since day 10 in the boot. I would say that there is no reason you can’t have a discussion with your doctor about being more aggressive. Some on this site have even taken studies in to their doctors to try to convince them to go out of their comfort zones in treatment. There is no WRONG way to go, but so far I am pleased with what my doctor has me doing. I feel like earlier movement/weight bearing doesn’t allow the calf and supporting muscles to atrophy as much, making recovery time shorter. Time will tell. I will blog again after I see the doc on monday.
jr, it sounds as if your doc is on the conservative side of average, and probably on the conservative side of optimum (or at least AVERAGE optimum). 8 years ago, when I tore my first AT (and got surgery), I fought with my conservative surgeon frequently, to get into a boot, to get into physio, etc., etc.
Mostly, he did what he wanted and kept telling me that he was a conservative guy and we didn’t want to re-rupture my AT. Eventually, I got into a hinged boot — the first patient of his who had ever done so. I loved the hinged boot, and I’m using it again now, since 7 weeks into the NON-surgical protocol for my second ATR.
This non-surgical protocol is 100% boot, no casts, and much quicker (physio, PWB, and FWB) than what I had 8 years ago. So far, it’s going fine, and I’m doing way more than I could at this time with the first one. I think I’ve also lost less muscle tone and balance and such than I did from 3 casts in a row in ‘01-02.
On the other hand, my first ATR ended up healing beautifully, and I returned to aggressive downhill skiing 5 months post-op, racing small sailboats less than 6 months post-op, and competitive volleyball about 10 months post-op, and all of them at the same level of strength and intensity as before the tear. A number of folks here have done a lot worse.
In fact, the only real problem I had that time was when I went too fast, not too slow. Check out my blog for details, but I lost a month (and it was a painful month, too) after a physio pushed me too hard, too soon.
So there are hazards on both sides. Slow and steady usually gets there, but there are usually advantages to getting moving and getting weight-bearing a bit sooner than your doc seems to prefer.
There’s a link on my blog, first post, to a recent study that produced excellent results with a pretty fast (and all-boot) protocol WITH and WITHOUT surgery.
I think the only thing I’d change about it is that I’d use a boot that can “hinge” (like the Donjoy MC Walker I’ve got) instead of one that can’t (like the AirCast Walker I’ve got). Soon after you can be FWB, I think it’s great to start walking around in a hinged boot, protected from toe-up dorsiflexion, but with the freedom to toe-down plantar-flex, without the nuisance or scariness of doing the “silly walk” in two shoes.
Just my $0.02 — but hey, I’m an expert by now!!
4th WEEK EXERCISES????
4th WEEK EXERCISES?????
Saturday is the end of my 4th week since sugery. I originally was supposed to see the doc but he is on vacaction so I am not going in until the 6th week. Still in a cast and totally NWB until the end of the 6th week.
Does anyone have exercises that they were given to do at this stage with a cast? I am worried that the docs vacation is going to set me back and I can’t imagine how bad my muscles will be without any use for 7 weeks (1 week in a cast before sugery).
Any suggestions would be greatly appreciated.
Hi all from sunny New Zealand!
Great reading all the advice. I did my achilles on Monday at tennis interclub. My opposite number tool me straight to Drs, who sent me to Emergency Dept at hospital, where they did what I now know is the Thompson test, and found a gap in the tendon. I was sent up to Orthotics Dept where they confirmed diagnosis and have been put in a cast for two weeks (nice purple one) and have to go back then. Having read blogs I phoned my Dr to ask about surgery option (he’s a family friend so knows my activity level well) but he says that it isn’t done routinely here unless you are a young professional athlete. As a 48 year old “weekend warrior” I don’t exactly fit the bill.
So here I am on crutches, (which seem to be the most painful part of the whole thing) trying to figure out how to cope with house and kids for the next 6 weeks while I am NWB. And boy am I worried about muscle tone after I’m done with all this.
I think your Dr’s advice — that the non-surgical protocol can be as effective (for strength and ROM and return to sports) as surgery — is correct. Or at least it’s consistent with the latest randomized controlled studies, including one from NZ and one from Canada.
But 6 weeks of NWB is quite a bit slower than the protocol I’m on, which was used in the Canadian study. They used a rigid (AirCast) boot, no casts, and went from NWB to “protected WB” at TWO weeks, then to “Weight Bearing As Tolerated” (WBAT) at FOUR weeks!
In addition to getting good rehab results, this really decreases the time you’re at risk from making false steps with your crutches. And it gets you closer to “normal” sooner.
My first blog at http://achillesblog.com/normofthenorth has a link to the Canadian study results and protocol.
I’m way older than you (64), but I’m guessing that I’m even more serious about my competitive volleyball (etc.) than you are about your interclub tennis. If I thought that surgery and its risks would likely bring me a better result in performance, I’d probably have gone for it.
My surgeon (the one who talked me OUT of the surgery!) is the chief surgeon of the local professional football team. NZ and Canada both seem to be on the vanguard in terms of following the evidence on this, while many parts of the world (esp. the US) are still doing surgery (and fighting infections) at full speed.
Check out my blog before digging your heels in to get the operation. (And there are lots of blogs here about surgical complications.)
But I WOULD dig in my heels about the speed of your rehab protocol! ALL the evidence — post-op and non-op alike — suggests that 6 weeks of NWB doesn’t have any benefit, and probably has serious dis-benefits. And that’s in addition to the extra nuisance and lifestyle disruption and risk of tumbling down the stairs!
And try to get a boot , too, CoolKiwi. My fave is a hinged boot like the Donjoy MC Walker (and there’s a much cheaper one that LOOKS the same online), but a fixed boot (like the AirCast) is still way better than a series of casts.
One more thing, CoolKiwi: Why are your crutches causing you pain?? Crutches are a bloody nuisance, and sometimes scary (e.g., on stairs or in snow). But they shouldn’t be painful.
If the “armrests” are hitting your armpits, they’re adjusted too high. The hand-holds can be padded, as can the verticals around them, which can be filed “rounder” and/or padded. And there are lots of tricks to substitute kneeling or leaning or sitting for crutch-standing-on-one-foot. . .
Hi there normofthenorth, and thanks for your replies. Re the crutches - that’s pretty much muscle soreness in my pecs, shoulders - am using muscles I don’t normally. Just makes getting around stressful. I’m having no pain at all from achilles/foot/calf ironically! (Not sure whether that’s a good sign or not actually!!) I have got an office chair which I’m using to roll around our kitchen/family room (we’re open plan with a wooden floor) but the nurse said I had to use crutches as much as poss.
Re the surgery - yesI will def read your blog after this reply. Seems that in US surgery is very much ‘the things’ whereas not so over here. The protocol here is current cast for two weeks, another cast for another two weeks, then ‘moon boot’ NWB for another two weeks, then start WB after this. Am very interested in anything that gets me WB earlier - will have a look at the hinged boot you suggest. Problem is here that I am in the ’state’ system, so it’s very prescriptive. However I do have a very good physio/acupuncturist who has sorted out my shoulder before, and am going to give him a ring re all this too.
Great to hear about options available - had problems having kids in the past and was amazed at info available online that never quite made it to our local Drs! Always good to be able to ask “knowedgable q’s”
I experienced same problem with crutches, don’t worry, you’ll eventually get used to them and stop causing you pain. I had no pain either on the tendon while in cast and boot, so I thought it would be pain-free all the way to healing, but guessed wrong..PT killed me.
hi all,
I’m new here.
I torn my right Achilles tendon when ski last weekend.
and that happened in ski firm boots - very rare.
the next day I got cast and now how to make design about to continue “passive” way or get the next week surgery.
I’m in 40th and like to be active.
somehow I feel that torn tendon parts already closed together as I can apply light pressure to force my foot touch bottom of cast (that applies down pressure to my foot to upper part of foot).
Is it nonsense to get it so fast in 4 days? I asked other person to check when I moved foot down to confirm it isn’t in my shocked mind.
No MRI was taken as doctor in ER and after in Kaiser Orthopedic dept run Thompson’s Test and said its torn for sure and no MRI is needed.
Now I’m worrying about that at surgery doctor has to cut tendon to clear from damaged rapture pieces and it has to start re heal again.
At first day I was unprepared to give answer if I want surgery or not. So now I’m confused even more.
Hello Mike, welcome to the club..
Maybe you ruptured it partially, maybe there’s still one thread of it still attached, but there are also nearby smaller tendons on your ankles that can make you move your foot a little. I got a Thompson test but also an MRI (probably the hospital wanted to make money) to confirm and also see the distance of the gap.
If you’re active and want to remain like this, I would suggest surgery. Not that it’s not happening without having it, normofthenorth has done both feet, one on surgery, other not, check out his blog if you like.
Hi Mike 753
After tearing my achilles I still had full range of motion and could walk with a limp. Doc could not find tear but MRI showed full rupture. If you have a strong lower leg which I expect you do, other muscles can still allow you to do these things such as ROM and pressure. After two weeks when I finally got surgery I actually walked into the surgery room and they stood at the table looking at me. I requested MRI because of my situation and got one but most of the time docs do not need them for diagnoses and they are costly. I think mine was important because the doc was able to pinpoint the rupture and limit the incision instead of searching around for it since he couldn’t find a rupture point. I did show a positive Thompson test at every attempt and my calf and ankle turned dark blue so I bled a lot. The body immediately begins to repair itself but four days IMO is very unlikely to allow reattachment.
thanks for the reply.
I have to make design by noon today.
Doctor told me I’ll be fine ether way.
With surgery I’ll NOT have early mobilization as they don’t practice this. And my estimated recovery time would be the same with cast vs surgery.
Another thing is I’m with Kaiser (HMO) and surgery would cost my insurance, not me. Kind of conflict of interest.
However, surgeon I think gets more money from doing surgery then “just looking around”.
So far in my case I don’t see much upside moving with surgery, based on today talk with doctor, if any.
With surgery I’ll get into boot after 7-8 weeks and phis therapy will start after 3 months only, the same as without surgery.
So far I already pass pain point and in healing. Moving with surgery will get me back to pain point and a week of setback.
What do I know?
Based on my experience (having done one each way!), I’d skip the surgery. Your foot motion is likely from the other tendons in your foot. And I’d stop hobbling around in shoes ASAP and get immobilized “in equinus” (toes down) to give the healing the best chance to get it done right.
Check out http://achillesblog.com/normofthenorth for my story. Jump to the bottom and there’s a link to “earlier entries” or some such.
I should have said “Based on my experience (having done one each way!) AND BASED ON THE LATEST RANDOMIZED STUDIES, I’d skip the surgery.” My first blog entry includes a link to the newest study, from University of Western Ontario (not far from here).
I also found a slightly earlier New Zealand study that gave the same results:
When randomized ATR patients are divided between a surgical and non-surgical protocol, both with relatively quick rehab progressions –
- from NWB to FWB @4 wks and
- from “equinus” to neutral @6 wks and
- into physiotherapy @~2 wks –
their results (in strength and ROM and re-rupture rates) are NO DIFFERENT statistically! There ARE usually differences in the rates of surgical complications like infections and DVT, the former probably VERY dependent on the specific location and professionals, and how well they do their hygiene and infection control.
(I wish this page allowed quick “edits”! But no.)
Marina’s advice is exactly what I was told 8 years ago, when I tore my first AT. And I followed that advice. My recovery was slow (”conservative” surgeon) but quite successful. (That AT is a bit shorter than before, but it works just fine. Back to competitive volleyball, a bit MORE aggressive than before, no apparent loss of “vertical” or other criteria, though I don’t measure except subjectively, by competing.)
Three months ago, when I went to one of Toronto’s top sports-medicine surgeons (the chief surgeon of the local pro football team!), he talked me OUT of the surgery, based on the latest studies. He had personally stopped doing ATR surgery 4 months earlier, and had already had good success with a few patients without the surgery.
There are lots of fine folks here, including Marina, who have had the surgery, and I sure don’t want to undermine their emotional well-being. (This recovery is difficult enough without second thoughts and self-doubts!!)
But the scientific evidence has started coming in, and (at least based on the two most recent careful studies), it no longer supports ATR surgery for us serious athletes who want to return to high-risk sports.
Good luck and good healing, whatever you decide!
I think it’s clear that BOTH protocols rely heavily on natural healing, despite the big bucks the surgeons get!
normofthenorth, thank you for such prompt reply
This is exact info I was looking for.
I think I’ll go with NONE surgery way.
I’d like to ski and play tennis, surfboard, bicycle (<10ml) again.
But, I’m not pro athlete for past 20 years any more and no plans to earn money doing sports.
Any how I can send you private msg? I don’t see such option on your blog or here.
very funny what avatar / icon I got
it’s exactly how do I look like right now
stay on one LEFT leg and scrabbling my head - what to do? what to do? looking around
And mine is like a nutty chicken running around! Can we choose these in our profile?
Good luck with your healing — and your eventual return to sports, too, if you can think that far ahead! (At 12 weeks after “the boot”, I’m starting to bounce athletically from foot to foot, as if I’m going to receive a serve or something!)
I’m hoping to live long enough to see some of the pro athletes go the NON-surgical route after tearing an AT. My surgeon and the authors of the U.W.Ontario study are pushing for it, as soon as one of their jocks tears one.
I don’t think there’s a PM function here, but I might be wrong. My name’s normrubin, and I’m a user of gmail. . .
update: after getting other opinions I opted for surgery and scheduled it for coming Tuesday
now I started warring - hope it will go well
expected combo anesthesiology
Tough decision, either way. Good luck with it! Are you in the States, Mike?
yes, I’m in US, San Jose, CA
this is near Stanford Medical center, but I’m not going there.
My health insurance with Kaiser and I’ll go there.
yes, it was tough - going from no pain to potential pain / risk again.
hope to move through it fast and smooth.
to bad I didn’t make my mind at the first day …
I had a complete break playing badminton just over a year ago when in the UK. I was seen by a nurse immediately and then went to the A&E room at the hospital. The ortho surgeon recommended non-surgical solution but the ER doctor advised I get a second opinion when I got home as all the data indicated better faster recovery and dramatically less reruptures if you have surgery. Sure enough I saw a Professor when I returned and he indicated surgery was best for a big break. I had surgery 5 days after the break and was in an airboot for 6 weeks, walking on it for the last week. I could drive again and went to Africa on safari a week after the boot was removed. The physio was very important and I did this once or twice a week for 3 months after the boot was removed and I still do the exercises when cleaning my teeth every day!
for most active people with a complete break surgery seems to be best. Don’t let one doctor put you off being sure it is not right for you.
Stephanie, I think everybody should have the right to choose their medical care, within reason. But “all the data indicated better faster recovery and dramatically less reruptures if you have surgery” is just plain wrong!
The most recent data from the first decent scientific studies that have ever been done — the first in New Zealand, and the second at Univ. of Western Ontario in London, ON (Canada), clearly shows that surgery adds NO benefits to a good non-surgical protocol. On average, statistically, scientifically, in a randomized study.
Details of the UWO study can be found at
http://www.medscape.com/viewarticle/588904 .
Of course, it’s also a fact that many surgeons and physios are way too busy to read the journals or keep up with the data. But they all have time to give their opinions, and make claims about the data. Pick any side of most technical debates — take Global Warming, please!! — and you’ll find confident appeals to “the data”.
On the early pages of my own blog, we had some funny discussions about Evidence-Based Medicine vs. the more popular alternatives, including Eminence-Based Medicine!!
My first ATR was repaired surgically 8 years ago, because EVERYBODY knew it was the way to go for a serious “jock”. When I tore the other one in December, the fanciest sports-med-ortho surgeon I could find talked me OUT of the surgery, based on the latest, best data.
My surgical cure turned out great, and I hope yours does, too. But people shouldn’t be herded into surgery based on misconceptions.
The reason the OLD data showed better results from surgery was (IMO) because we used to compare the results from two very different patient groups having two very different treatments: The so-called “conservative” cure was applied to the old and infirm, and the surgical cure was given to the young and fit and motivated.
Probably even more important , the “conservative” cure was VERY conservative, and kept patients immobilized WAY too long, leading to a bunch of bad outcomes, including a high re-rupture rate. Meanwhile, post-op patients got moving quicker, and got physio and exercises — partly because they were getting better care, and partly because they were concerned about returning to their sports.
What’s new in the new studies is that the “cures” are selected for individual patients randomly, and that both kinds of patients are getting exactly the same rapid rehab protocol. So the only difference is surgery. Does it make a difference? Yes, in complications, but No, not in strength, Range of Motion, or re-rupture rate!
In an excess of fairness, the UWO study did find a small and non-statistically-significant difference in re-rupture rate, in favor of surgery — something like 3 re-ruptures vs. 2, out of around 85 patients in each group. That’s nothing like the rates that some surgeons tell their gullible vulnerable desperate patients. It’s also very low, and every one of them may have an explanation, like somebody falling or otherwise screwing up. Scientific studies don’t deal with such “excuses”, just the facts. And statistically, those two rates are equivalent.
That’s what the data says, and I wish the world’s medical (surgical?) establishment would admit that it exists. Check my first blog page, or the linked study, for a comparison to religion!
Anecdotally, I’ve been following the non-surgical protocol used in the UWO study (with a few minor changes thrown in by me and my health pros). I had a relatively large AT gap (I think they told me 6 cm, a bit over 2″!), relatively low. So far, my recovery has been on schedule, which is WAY faster than post-op 8 years ago. At 12 weeks post-non-surgery, I’m pretty sure that I’m very close to having a real “push off” at the end of my stride, and being able to do 1-legged heel raises. (At 12 weeks post-op, I was still in a cast, waiting for a boot! Times have changed, Thank God!)
Thank God for the Internet and websites like this where patients can learn from each other, too! Without it, the surgeons and physios would still be quoting 1960s data 100 years from now!
Good luck Mike. Tough Decision but I chose the same route as you. I’ll be 4 weeks post surgery Monday and feel good. Worked in the yard for six hours today and sometimes forget I have this boot on but don’t get me wrong I am hoping to be able to take it off in two weeks. If your surgery is like mine they will give you a nerve block in your leg and then put you to “twilight” sleep. I am no doc but I would try to encourage your doc weightbearing in boot after you get your cast off 10-14 days post surgery. I hardly have any atrophy and my leg/calf feels strong. Also keep the leg elevated first 72 hours and for me the nerve block slowing wearing off was the worst part(about 8 hours post surgery. After that the pain subsided and was off any meds the next day. If i remember correctly the doc said to stay away from advil because it will make you bleed and can inhibit fast heading. Use tylenol once off oxy or vic but obviouslycheck with doc. I felt set back at first but baring no infection you should heal fast. You’ll need some help while your in the cast but once you are weightbearing I went back to work right away 13 days post surgery.
While we’re on the subject of taking stuff, I trust that anyone who is down for surgery takes arnica tablets before and after? Reduces swelling, brusing etc. We take them as a matter of course in New Zealand, but unsure of how homeopathic support is viewed overseas? On a similar point, I will be seeing my chiropractor as well as a physio as soon as I back into shoes.
I’ve been surprised how many people here (above) have been given Advil (ibuprofen) or other NSAIDS for pain control after ATR surgery. (I was also surprised a few weeks ago when I had oral surgery and my periodontist recommended high-dose Advils. I didn’t have bad pain, so I didn’t take many, so I didn’t bother quizzing him.)
Sure, it’s an anti-inflammatory drug and there’s lots of inflammation, but it’s also a blood thinner and an anti-platelet drug. I paid BIG bucks to have some extra concentrated platelets (”PRP therapy”) injected into my torn AT, to encourage the kind of clotting and scar-formation and healing and mending that we all need more of. (During that time, I was specifically told to AVOID all NSAIDS.)
Everything I’ve read about NSAIDS like Advil/Ibu suggests that they’re not good for torn tendons. Anybody here got any good solid info to the contrary?
thanks every one for answers to me
I plan to ask for local / nerve block and IV - fuzzy sleep.
I got IV once and was just fine after it - didn’t remember a thing, but doctor said he spoke to me at that time and I responded … I hope I didn’t say anything bad …
How about Vicodin? Is this Ok for post ATR surgery?
Not sure I can speed up my post surgery treatment schedule as doctor said he’ll follow standard time table - 2 weeks + 3-4 weeks cast.
Also been told that I’ll sleep better later as I’ll not have double thoughts about re rapture and why I didn’t choose surgical way - this is more on mental side.
normofthenorth,
Thanks for the info
pls. don’t take it wrong - in my local SFBA most people got ATR surgery vs no surgery. It could be local or surgeons “pushing” for this way or else - I don’t know. My surgeon told me 50/50 - ether way I’ll be Ok and I have to make the choice. All friends of my friends went with surgery, no I don’t know personally those.
they gave me vicodin but I never used it. Took oxycodeine while the nerve block wore off but went off it the day after surgery. The first hours you will have no pain because the block takes time to wear off. The doc will tell you to stay ahead of the pain and take meds right away because when the block wears off it throbs/aches pretty bad. The protocols for these injuries are very different per doctor. Obviously you’ve got to listen to your doc but there is a ton of evidence toward early weightbearing beneifts with boot. It also lets you get back to as close to your normal routine as possible soon after surgery. My blog and others have some info on this.
I was told no Advil before surgery because it thins the blood and could imped the actual surgery. But after surgery, the same doc who said no before said fine after, for what it’s worth. For me, the oxycodine stuff made me feel more weird than pain free.
First, “what mikeJ said”! Early WB is a Good Thing, and early mobility (initially w/o WB) is, too.
Second, mikek753, you’re at a FASCINATING moment to be making your decision where you are, because the tide is just starting to turn in the most “hip” parts of the US, including the San Francisco Bay area. Just that fact that a US surgeon told an athletic person that the decision is 50/50, instead of a no-brainer in favor of surgery, shows that the new scientific studies are starting to “get through”.
If you go back to your surgeons a year or two from now — e.g. with the OTHER AT torn (God Forbid, but it happens!) — I bet they’ll tell you to avoid the surgery, as my “hip” top-level sports-medicine surgeon told me in December.
These things take time to change, but facts are facts even when some people haven’t gotten the memo yet, or are too comfy and set in their ways to believe it.
Me, I’d still advise you to be an early adopter of the newly-revealed facts. Knowing what I know now, I wouldn’t let my sister have ATR surgery.
For Mike and Stephanie and others who still think “the jury is still out” on surgery vs. non-surgery - -or worse yet, that surgery is the obvious way to go for serious athletes who want to return to top performance. . .
I just reviewed all the recent studies I could find online, and posted the results at
http://achillesblog.com/normofthenorth/2010/03/08/a-more-complete-review-of-the-options-surgical-vs-non-operative/ .
Folks, the jury has returned, and surgery — at least the kind of ATR surgery that’s practiced widely in the USA and a few other places — has risks but no benefits. The evidence seemed to prove the case for surgery until around 2007, but the studies since then have been more scientific, and they’ve ALL shown that the non-surgical protocol works as well or better than surgery!
(In all the studies since 2007, I only found one single data-point on performance that was significantly different at all, and on that one, the NON-surgical patients came out STRONGER!)
There may well be times to do the popular thing in your neighborhood, whether or not it really makes sense. But submitting to useless and risky surgery doesn’t strike me as one of those times, even if all your pals are doing it. . .
Dear Norm
I have a friend who went the non-surgical route 10 yrs ago. Today that leg is a fraction of the other, non-injured side.
He was playing tennis with me when I ruptured mine and advised surgery. Yesterday we played light softball practice (pitched - hit - no lunging for catches) in a group of 15 players at exactly 6 weeks post-op, in sneakers. Was walking 2-3 miles/day for weeks in boot/cast.
Norm or anyone: Does anybody know of a detailed progressive physical therapy protocol written up anywhere? I’m having trouble finding anybody in my area who has experience with an accelerated rehab for a non surgical repair. thx
Gunner, if you click on the link I included above (to my latest post) and click on the study linked there (I think it’s #3b in my outline), you’ll find the reasonably progressive protocol I’m following now.
The study used it on both sides, for non-surgery and for post-op. The other modern studies (2007-09) that I linked there also give some idea of their protocols, but maybe not as detailed.
Lou, I’ve got a friend like that, too. He’s made peace with his skinny calf, and gave up squash, too.
Ten years ago, the non-operative protocols were all very “conservative”, and the results were pretty bad, even worse than 10-year-ago surgery. Strength, ROM, and re-rupture rates, all pretty rotten by today’s standards, and compensated only by the lack of surgical complications. (”Conservative”.)
We all have tiny amounts of personal data (even those of us who’ve been through this TWICE, like me!), but it’s super-important and vivid and dramatic to us, so it’s natural to over-interpret it. The orthos and physios have a bit more data, and they naturally tend to over-interpret it and over-generalize from it, too.
That’s why the carefully controlled and randomized studies are so important, if you care about the real truth. And one great time to care is when you’re choosing a care protocol for an ATR!
I just read on the BBC that David Beckham has “torn” his left Achilles Tendon during a match. I wonder if he’ll have surgery or not? Will he show up here?
Yesterday I’ve read that David Beckham had his surgery done in Finland. Apparently he has heard about that Prof./Dr. and elected to do it there.
Hi there can I use some of the information from this blog if I reference you with a link back to your site?
My cousin recommended this blog and she was totally right keep up the fantastic work
wow It’s a great blog. I love it.
Hi, where did you get this information can you please support this with some proof or you may say some good reference as I and others will really appreciate. This information is really good and I will say will always be helpful if we try it risk free. So if you can back it up. That will really help us all. And this might bring some good repute to you.
top shoes, it would be pretty helpful to know to whom you are addressing your questions. You might try going to that person’s blog and asking there instead of here.
Dennis, this place feels as if a big tour boat just docked nearby! Did you just change the way Google lists it or something?
I downloaded Tom Clancy’s Rainbow Six Vegas torrent from http://www.games-iso.com about a week ago and, even though its a”dusty” game, its the best PS3 game ever made in my opinion
The spammers have found this place and are trying to load it up with their trash, like Heath Leavenworth and I suspect top shoes as well. It appears there isn’t in “anti-spam” word required to post this either.
The missing “anti-spam” word is allowing all these dirtbags to post their garbage.
I think Dennis can enforce / limit comments to registered users only.
Actually, you can require that anyone posting to your blog must be logged in. I made that change this morning. It is under settings then discussion.
If Dennis can require prior registration on these general pages the same way we can on our blogs, I think “It’s time!”
I appreciate the info.
Norm and GerryR - Ok, finally fixed it! I’ve enabled the spam words again, so spam comments shouldn’t be as a big problem as it has been for the past few days. So even if you don’t require registration for people to comment on your blog, you should be getting same amount of spam comments as before.. (which was very small).
Considering that there’s at least one spam post after the anti-spam word was enabled again, I think it is time to allow only registered users to post.
Hi guys,
I ruptured my Achilles tendon playing basketball just under two weeks ago now. Wasn’t doing anything out of the ordinary just went to push off my left foot and POP! I then was driven to the hospital where the doctor performed the Thompson test. Diagnosis was full rupture! I then was scheduled to see the surgeon 1 week later.
After speaking with the surgeon about the options available to me. I chose the “conservative method” (Non-surgery). I was until this a very active 26 year old..now retired basketball player who coaches for a living professionally. I just wanted to know how long it takes for an Achilles tendon to heal naturally? So I can get back on the floor and coach without crutches!!!
Glad you found us and welcome to the fairly exclusive club of people who didn’t have surgery. I had surgery on August 3 and have since had three more to correct complications generated by the first. If I had known then what I know now I would have refused surgery. I was told that if I wanted to return to cycling and running I had to have surgery and my wife who is a doctor, said that might be true. Needless to say that surgeon will never get near me with a scalpel again or anything else for that matter.
Be sure to click on the “Create Your Own Blog” at the top of the page so you have your very own place. It really makes things so much easier and since you went the non-surgical route it is even more important for those who come later.
The questions you have are best addressed by your doctor, but there many different rehab protocols, some take a long time and some do not. What has your doctor said about how long it will be before you can ditch the crutches? Mine outlined a very specific plan prior to surgery so your doctor should have a plan. The person here with the most experience with the non-surgical approach, don’t call it conservative, are normofthenorth and
(accidentally clicked submit) Norm will be around. Also check doug53’s blog for his very aggressive rehab.
Good luck and go get your blog.
Yup, I’m here, and so is my blog. One of my pages (with tons of replies) is about the latest studies I found, mostly about surgery vs. non-surgery. And I posted (linked from one of the replies) the exact non-surgical rehab protocol I followed, which my surgeon got from the people at U. W. Ontario who did the latest study.
Two others here (mike753 & gunner) said no to the surgery based on those studies and have followed that protocol pretty closely, and are both doing pretty well, as am I. They may both be working harder, and regaining strength faster, than I have, and I’m doing pretty well and having fun, with amazingly little “suffering”.
I don’t think there’s any good reason to go any slower than the protocol we’ve been following. Going faster might or might not work well, it’s a gamble, with no study to establish the “odds”.
If I were starting again, I’d only change a few little things: I’d use a hinge-able boot (Gunner loves his fancy high-tech waterproof one, check his blogs), and I’d make the withdrawal of heel lifts more gradual. Actually I DID a bit of both of those (as outlined on my blogs “in real time”), but I might start a bit sooner with both, I’m not really sure.
Kennedy, have you retired from basketball because of the injury, or independently before the injury?
If you haven’t gotten a clear schedule, roadmap, protocol, whatever, either insist on one from your Doc, or present him with the one from the UWO study that the three of us have followed. (It’s linked from my blog.) If your Doc’s protocol is either significantly slower or untested in a good study (or most likely both!!), then convince him to “let” you follow the UWO protocol, preferably with a hinge-able boot like Gunner’s (or at least my lower-tech non-waterproof one).
And start a blog page and keep us informed. And avoid false steps!
Norm,
Where specifically is the link to your PT protocol? I’m going to be restarting PT in about a week so I might as well take them one that is fairly aggressive.
Gerry, my actual protocol (from the UWO study) is at achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/ . It’s linked from one of my own comments to my March blog page “A more complete review of the options — surgical vs. non-operative”.
That whole page, with comments, is also linked from the “ATR Rehab Protocols, Publications, Studies” link on the main page here, though it’s buried among a bunch of other items (some of which I highly recommend, others “not so much!”)
I’d be interested in your comments on the whole thing, including the PT protocols. I find the latter a little vague, and only a hint of what my PT actually did to me (while following that protocol)! E.g., he spent a lot of time applying gizmos to me (Difference Current muscle stimulation, Lasers, and Ultrasound), none of which are mentioned in the protocol.
Norm, I met a gentleman from Jacksonville, Florida, wearing an airboot. Obviously, I enquired about his injury.
He ruptured his AT while excercising in the gym-jumping, I think he said- a little less than 2 months ago (April 19). His “surgeon” put him in an airboot right away. He gave him an excercise regimen- no PT. I was impressed that he walked without unaided a limp.
I encouraged him to join this blog and give us more information. I hope he does.
Ifixteeth, I hope he shows up here, too.
When you say “he walked without unaided a limp” I assume you mean in the AirCast boot? According to the UWO protocol, he should have been “weaning” off the boot starting a couple of days ago, into two shoes, after 8 weeks (assuming he got into the boot on April 19th).
About a week before I got out of my boot at 8 weeks, no surgery, I was walking with a bunch of my young sailing friends, from a club meeting to a pub. As luck would have it, I was walking so fast that they couldn’t keep up with me on the sidewalk! I had switched from the AirCast to a hinged boot (Donjoy MC Walker), and in order to keep talking to them while we were all walking, I spun around and started walking backwards, still at high speed. I immediately discovered that walking fast backwards on a recovering AT (in a hinged boot or 2 shoes) is VERY different from walking fast forwards — much more strenuous and scary!! I quickly spun around again and resumed walking forwards!
I think almost everybody who’s on a reasonably aggressive/modern protocol should be able to walk very well in a boot (forwards!!) well before 8 weeks. All that really takes is upper leg strength and the ability to be FWB plus a bit. (If you’re limping in a boot then, it’s probably because your other shoe is too thin/low, and you’re out of alignment.)
The trick after that is being able to walk without a limp in two shoes, which usually takes quite a bit longer, because it depends on calf and AT strength.
Hi Guys
I ruptured my right achillies tendon playing badminton 4 weeks ago. Heard a pop when I was standing ready to serve. Didnt think it was a serious injury until I got to the hospital A & E. The doctor performed the thompson test and said it was a full rupture.
I was given a plaster that night and given an appointment to see the orthopedic surgeon the next day.
After speaking with the surgeon, I was offered surgery or non-surgery. He said both option is much the same recovery time. However he did mention the non-surgery have a much higher rate of re-rupture and with surgery there could be complications & wound infection. I opt to go for the naturally healing method.
I am now in my 4th week in the cast. Can anyone tell me when i will be on my feet and drop the crutches. When can I go back to sports?
Stephanie
You will find some great stories on here which should give you a guide to the timescales involved - my recent experiences of rupture then re-rupture are on my blog.
You will also notice that experiences and timescales differ widely, as do the treatments - there is a healthy discussion about the pro’s and con’s of the various approaches. Again, take a look around (but take particular notice of norm’s blog / comments as these tend to be the catalyst for much of the current discussion).
If i could presume to give a piece of advice, it would be to become informed and take control - push your medics for answers based on being informed about other people’s experiences. Often during my recovery time i have been prescribed an approach by medics, only for that approach to change markedly based on me asking simple / informed questions.
For what it’s worth, my non-surgical repair was based on 6-7 weeks in plaster then into a ROM boot for a similar period (curtailed by re-rupture). I ruptured playing squash, and initial prognosis for return to the sport was minimum 6 months, possibly a year.
daviduk
Hi Stephanie,
Rotten luck.
Feel free to check out my blog - it’s at this address:
http://achillesblog.com/kevinh/
I haven’t updated it since the five-month mark (I reached the seven-month milestone just two days ago), mainly because nothing dramatic has happened; I’m now seeing my physio for a clinic session (massage, ultrasound, assessment) once a month and attending a gym to work on rehab exercises. I can cycle easily (and have been for about three months), jump, jog (treadmill) and even play a bit of gentle football, so it’s going fairly well.
But my blog will give you some idea of timelines - I went non-surgical and - off the top of my head - had roughly six weeks in cast and crutches (with foot moved at different angles every 2-3 weeks), then three weeks in an Aircast boot. But the detail’s all in the blog - hope you find it useful, and good luck.
Thanks Kevin. Will definitely check out our blog. Glad to hear you have also opt for the conservative route and now back to exercising. I will be getting my 2nd cast on monday 21st june.
Thanks for the “plug”, David!
Stephanie, your Doc was wrong about the different re-rupture rates, non-surgical compared to surgery. When the patients are streamed RANDOMLY (instead of “jocks get surgery and crocks get a cast”!), the re-rupture rates are statistically indistinguishable. Strength and ROM, too. The 4 latest studies — the ones that randomize the treatments — are all linked from one of my blog pages (the 3rd or 4th most recent one now, if you go to achillesblog.com/normofthenorth and scroll down).
The timelines question is different, with two huge variables: (1) what your Docs prescribe for you (or rather “what you do”!), and (2) how your “personal” body reacts and heals. Both of those variables are hugely variable.
The protocol I followed — the one used in the latest study (and most modern studies) — is quicker than the one you’re on so far, and has produced excellent results, on average, with AND without surgery. There’s a link to it in a comment to the blog I mentioned above. I would recommend following it, with only a few minor amendments (which I outline toward the end).
After only TWO weeks, “we” were starting physio and beginning “protected” (aka partial) weight bearing, and at only FOUR weeks, (full) “Weight Bearing As Tolerated”, so the crutches get ditched soon after 4 weeks. The heel lifts get ditched — all at once, which I’d change — at SIX weeks, and the boot gets ditched (”wean off”) at EIGHT.
I can’t see any good reason for anybody to go more slowly, now that THAT pace has been found to produce excellent results.
About strength and returning to sports at close to 100%, there’s a fairly wide spread — again, probably partly depending on how much “work” you do, and partly on more mysterious and personal factors. Any specific timeline on the calendar will be only a rough guideline that might not apply to you, in either direction.
I’m a bit of a gardener, and when somebody says “plant these seeds on May 1st,” I say “maybe”. But when somebody says “plant these seeds when the Maple trees are in full leaf,” I believe it, because it sounds sensible, related to reality.
The rule of thumb I was give after I tore my first AT (yup, I’ve done ‘em both now, 8 yrs apart — same sport, same move!) sounds sensible to me in that same way. My Doc said I could go back to “scary” high-risk sports when I could do a bunch of 1-leg heel raises without grunting or groaning. I’m not sure exactly when that happened, but it had clearly happened by around 10 months, which is when my Volleyball season was getting started again.
Several people here have started back at their sports sooner, but usually (a) the sports are lower-risk, less explosive, like running instead of basketball-soccer-football-squash-badminton-volleyball-etc., or (b) they’re not competing “flat-out”, letting the good shots go, etc.
Your story of rupturing “when I was standing ready to serve” is unusual. The classic move, that probably tears 45-50% of ALL ATs, is switching hard from “reverse” to “forward” gear. There are lots of other “moves” vying for second place, though I tore BOTH of mine doing exactly that.
But the worst ankle sprain I ever got was on the squash court, standing on the “T” and waiting for my opponent to hit the ball! Sounds a bit like yours. . .
Good healing. If I were you, I’d print out “my” protocol and maybe one of the modern studies, too, then roll them up, and slap your Doctor around with them, until he speeds you up to that protocol!
Thanks for the advice David. Can I ask how you re-rupture the 2nd time round. Opting to go for the non-surgical route does make me worry if there could be a 2nd time for me.
Stephanie
I re-ruptured whilst walking through my kitchen! Long story short, we have a dog and, walking in bare feet, i stood on one of his toys and went over on my ankle - and bang!
One of the things i have learnt on here is that the transition from boot to shoes is a risky time - exposing one’s repaired tendon to the world again, without cast or boot, is a time to be careful. I am approaching the same sort of period in my recovery again, taking the first tentative steps out of my boot. This time i am being very careful!
daviduk
Hi Stephanie: After a tennis ATR and no surgery, I went from the boot to the Vaco Cast at 3 weeks, and feel strongly I could have gone at 1 or 2. With a good boot/cast (strongly recommend you look at the Vaco Cast) which permits walking you can immediately begin to transition from crutches, provided you can elevate your good leg to match the boot setting on the healing leg.
I agree with what David said - don’t allow your doc to control the process. Become informed and take charge yourself. Get the recovery protocol on Norm’s blog, take it your doc/PT, and negotiate a path forward.
happy healing. gunner
Stephanie, the randomized trial reports say you’re no more likely to rerupture after a good non-surgical rehab than after a good surgical one. Of course if you’re the 1 in 100 (as David was, unfortunately), the world will look different. But the statistics say the results (inc. re-rupture rates) are no worse without the surgery — and better, if you include the surgical complications.
Getting slapped into a series of casts for months is NOT a good rehab, with or without surgery!
Hi Norm
I will definitely print out your recovery protocol and take it with me to see the doc on 21st of june.
Great. I think your priorities are (1) to get into a boot, no more casts — and a HINGED boot if you can, too! And (2) to get some agreement on where you’re heading, like a written road-map (or agreement from your Doc to follow the UWO-study protocol you’ll take to him), so you can have some info and certainty and “say”.
Make sure he knows that this isn’t just “my” protocol, but one that was used on around 150 patients (half surgical, half non-) in a randomized study, and the results were excellent overall (e.g., only 3 re-ruptures in ~150 patients, if that’s what he’s most worried about).
If he wants to see a compilation of the studies on surgical vs. non-, send him to my blog, where I’ve discussed and linked them all. If he wants to see a compilation of the studies on faster vs. slower protocols (most of them after surgery, unfortunately), Dennis has gathered a bunch of them together in his page (linked here and on the main page) on “ATR Rehab Protocols, Publications, Studies”.
The modern scientific info is out there, and we’ve even made it pretty easy to review!
Dennis, I know you set this all up a couple of years ago, when “jocks” had to get surgery (the way you and I both did, my first time around), and I would have done it the same way after my first ATR when nobody knew any better. And changing it could be serious work, which you’re not getting paid to do. But the world has changed a lot since then, and it’s changed the answer to the most important and urgent question a new ATR patient has to face!
The most important and urgent info somebody needs who “Just ruptured your Achilles” is whether or not surgery helps!! And with all due respect (and I love this website, as you know!), neither of the two authorities you link above — that “nice” WebMD article, and Revolutionhealth’s “nice” article (from 3 years ago!!) — has that info right, in June 2010. They are both totally oblivious of the latest FOUR scientific studies on that subject, which are the ONLY studies that randomized patients into the surgical and non-surgical streams! (The earlier studies, until 2007, really only proved that “jocks” heal better than “crocks”, but pretended to prove that ATR surgery produced better outcomes!)
And as you know, all four of those studies found that the surgery adds NO statistical benefit — NO increased strength, NO increased ROM, and NO lower re-rupture rate! (And it still does increase the rate of serious complications, of course.)
Can you please re-jig the links at the top here? Me, I’d kill the WebMD link and the Revolutionhealth link entirely. (If they were paid ads for ATR surgery, they’d be vulnerable to a legal attack as “false or misleading advertising”!) And please add some links to the 4 new randomized studies. The biggest and latest is summarized in an easily readable article at http://www.medscape.com/viewarticle/588904 entitled “AAOS 2009: Nonsurgical Rehab After Achilles Tendon Rupture Better Than Surgery”. If that’s the only link here on the subject, it will steer people in the right direction, so they’ll at least be tempted to learn more, and question the guy with the white coat and the scalpel!
This site has done a world of good to a lot of patients over the years. And I may be biased (Lord knows!), but I think helping to educate mike753 and gunner enough (under pressure!) that they could skip the surgery and follow the science, is among its finest hours. The links at the top should make that education easy, not tricky, IMHO!
Hi everyone. Just found your blog. Ruptered my Achilles 4 weeks ago and had operation 3 weeks ago now. Been in a back slab cast since then and going to my fracture clinic today to get a boot. I noticed a few people rerupturing when going from boot back to shoe. Has anyone tried ankle brace or rigid support as I want to get fully mobile asap. I understand I have a bit of time to serve in a boot but want to get mobile again.
All - thanks for the great posts, the stories and the varied insight.
I’m a very active, athletic male into week two of non-surgical rupture recovery from a freak basketball injury. My ortho has already changed the first cast, realigned the foot 15% and wants to see me every seven days. From some of the other posts I’ve read that seems a little agressive. Anyone else seeing their doc that often? Thanks.
Welcome to recovery world and congrats on chosing the non surgical route. Several of us are very pleased with that decision and hope you’ll have similar results. I’ve seen the doc, who is a good friend also, only twice since my ATR 18 weeks ago. My advice, get into the boot by week 2 or 3 and get to a good PT who will start you on the modest therapy you begin at that time. You can find more on my blog and Normofthenorth’s. I’d recommend you print out Norms recovery protocol and take it with you to the doc to get agreement.
I also encourage you to start a blog and keep us posted. best of luck.
hi all i ruptured my achilles 4 wks ago playing soccer got stitches out after 10 days at 3 weeks moved my foot up to neutral position and was wondering is this good progress to have in neutral after 3 wks.
dave,
Sounds reasonable so far, should be moving to PROM, AROM, and mild exercises pretty soon, assuming no complications.
The key is to read as much as possible about your injury so you can make a self assessment and be ready to challenge your doc and therapist if appropriate. Everyone’s situation is a little different. Most of the info or links to the info can be found on this website. With the right info you can be proactive if you feel confident directing your own recovery.
jski,
im in a fibreglass cast for another 8 days at least, so hopefully after that i will be able to start some ROM,
the doc has mentioned heel raises for my shoes but no mention of the removable boot once the cast comes off i imagine i will be nervous about this, im in ireland so protocol probably varies in different countries.
dave
dave and jski, I’m three weeks in a fiberglass cast for non surgical recovery. During yesterday’s appt. my doc says another two weeks in the cast then if all continues to look good, a transfer to a walking boot. He had me perform some very slight ROM movements yesterday and said he could feel the tendon re-attaching (i hope so).
So you’re correct, style and protocol differs with in each case. Good luck.
Ejerone, I had a similar experience- a plaster cast for 2 weeks and a fiberglass cast for another 4. Hearing about the advantages of EWB, I started to put some weight on, with the cast on for the last 2 weeks. Seems that many doctors don’t want to”risk” putting you in a boot earlier.
Ejerone: I’m at 20 weeks post ATR and non surgical. I would recommend you get in to a high quality boot as soon as possible. The VacoCast which I used is identical in safety features to a fiberglass cast, can be hinged to change the flexion, allows walking with no support (provided compensation is made to the other heel elevation), and most importantly, can be removed for therapy which you could be doing already.
Good luck to you
Ejerone, the modern UWO-study protocol, which is pretty quick and conveneint but produced excellent results in a study with 145 complete-ATR patients in it (half surgical, half non-op) is posted at bit.ly/UWOProtocol .
The (long) discussion about the studies, including that UWO study, is at bit.ly/achillesstudies . Or you can check out en.wikipedia.org/wiki/Achilles_tendon_rupture, go to “treatment”, where the 4 modern studies are linked to footnotes 4-7, with the UWO study at #7. (At least until somebody re-edits that Wikipedia article!)
The idea of a personalized rehab protocol — based on frequent examination or testing of your particular leg — sounds very attractive. But the 145 patients in this study did remarkably well following a “stock” protocol that didn’t even change based on whether they’d had an operation or not!
They had only 3 re-ruptures in 145 patients! I doubt that it’s possible to to get the re-rupture rate much lower than that, given the “background” risk of falling down stairs on crutches, or slipping on a banana peel on crutches, or otherwise accidentally re-rupturing a vulnerable AT. . .
With the results they got, I don’t think there’s much justification for going slower — which is what surgeons usually recommend when they get “hands-on” involved. Going slower sounds “conservative” — like a good way to avoid re-injury. But the studies all suggest that a slow rehab isn’t really safer.
I snapped my achilles on April 12th 2010 and have spent 8 weeks in a plaster cast.
2 1/2 wks later with 2 shoes , walking and driving my leg gave way and I had re-ruptured it again.
This time had surgery , but no the normal way.
doc said he couldn’t pull the 2 pieces back together (bout inch gap ) as the tendon was so thick with scar tissueand was like a piece of wood.
therefore he cut further up calf and pulled another tendon down and attached this.
problem is i will only have 75% strength in achilles.
Has anyone else heard of anything like this before??
cheers
jamie0168
Jamie, I’m very sorry for your loss! Having a surgeon apply a graft to the repair (either from part of the AT or another tendon of yours, or from a cadaver) is not very unusual. But having a 25% strength deficit as a result is unusual. If the deficit is really all in the tendon, I wonder if your calf muscle will be “smart” enough to stay 25% weaker, too, or if you’ll always have to take it easy. Ouch!
Good luck and good healing. I hope your surgeon is wrong!
jamie0168,
Sorry to hear you’ve had problems and may not come back 100%. I have read about your procedure, pioneered in Japan I believe, but not in the context of a re-rupture.
Thanks for sharing your personal story, it beats reading about a statistic in a medical report and it may help others evaluate the various risks of different treatments in making that difficult decision on what is best for their situation.
I ruptured my right achilles tendon on 4th of July playing tennis. Classic symptoms. Stepped forward to return a serve, brain said WTF, and I fell to both knees from the horrible pain. I thought the fence surrounding the court fell on my achilles. We all laughed. I alleviated my leg on a bench, with a cold one under it, and drank a cold one. Not wanting to be a drama queen I waited until July 6th for normal doctor office hours. X-ray negative. Thompson test positive. See an ortho tomorrow. I’ve decided to have surgery unless my ortho provides me with a compelling reason not too. My question to you all: How does an ortho know that you haven’t damaged other tendons/ligaments at the same time that need to be repaired? After a week in a wonderful splint, I got the hebegebes and ripped it off last night. I have ring around the foot! A bright purple/red bruise starts on the inside of my right ankle and runs the length of my foot, where my toes meet my foot is black and blue, and the bruise then runs down the other side. Oddly enough there is nothing on my heel or up the back of my leg?! So I’m wondering it is really my achilles or another tendon?
Heyteacher, I think it’s common to have a lot of internal bruising during an ATR, and to have it migrate and show up in different spots. On average, if you keep the foot down, the visible bruises often move down, at least in my experience.
Your positive Thompson test is pretty strong evidence that your AT is torn.
There’s arguably no “compelling reason not to” have surgery, though my fancy ortho surgeon and I found four very recent scientific studies — all since 2007! — that demonstrate that there’s also no longer any compelling reason TO have the surgery! Most patients recover well with it or without it, and the results (IF you get a good modern rehab protocol) are essentially identical in every way, except for some surgical complications — many of which you can find described anecdotally in blogs on this site. The surgical cure is (much) more painful, but usually only for the first week.
My first ATR (in late 2001) healed up great after surgery, and my second one (Dec. 2009) is coming along fine (all healed up, still some calf-strength deficit) after no surgery. The new studies were done in-between, and my fancy Ortho Surgeon (the chief surgeon of the local pro football team here in Toronto) actually stopped doing ATR-repair surgery after seeing the latest study and talking about it with the authors.
I’m glad he talked me out of the surgery, and I think most surgeons will eventually “get the memo” and stop doing the surgery, too — or maybe the US insurance companies will stop paying for it first. And for the same reason, i.e., it doesn’t seem to convey any benefit that you can’t get more easily and more safely without it.
It is very rare for our kind of “normal” over-stress ATR to damage other tendons/ligaments at the same time that need to be repaired. With or without surgery, they’ll all get the longest “rest” they’ve ever had, for one thing! Some people do ATRs falling out of trees, or getting sliced by a sheet of glass or a chainsaw, and they obviously can damage LOTS of things. Their cases weren’t tested in the new studies, and I think they should probably all go under the knife. You, “not so much”, based on the way I read the evidence.
The clearest summary of the new evidence — with links to the four studies — is in a paragraph (which I wrote!) in the Wikipedia article on ATR, 4th paragraph under “Treatment”. The four references (#4-#7) will take you to more detail on the four studies (NOT written by me!
).
Whatever you do, good luck and good healing! And start your own blog, and keep us posted, too.
hi,just an update on my progress visited my consultant today 5 wks 3 days post op they took my fibreglass cast off and then for docs to assess my AT to my relief they said it looked great and scar had healed well, i can get my foot past neutral position so they said no more cast and told me i can ease into walking with shoes and heal raise of 1cm i was bit surprised at this aggresive approach.anway im delighted to be out of cast,just got out of bath what a great feeling to WASH my bad leg despite dead skin everywhere.
Dave
Norm,
I believe there is a compelling reason not to have surgery and that is the possibility of complications; like MSRA, other infections, and rejection of the non-absorbing internal suture material.
Gerry, I was thinking of you when I said ARGUABLY no compelling reason not to have surgery! You KNOW which side of this argument I prefer to “argue”!
Hey Gerry and normofthenorth,
I’ve read both of your threads throughout the page. I totally appreciate your thoughts on surgery. I’m going into for surgery at 2:30. I’ve given it a lot of thought. For me I believe it is right. The ortho said say much about the blood pooling. She was able to provide to me that there is no other damage, and that indeed it is torn. Sheath she believes is intact. She is really conservative in the when I get to WB. Two months. I’m gonna have to direct her otherwise. She said to “bring in the protocol” on found on this site and she’d love to work with me on it. So I’m gonna print that out. Take one last sip of water, and pray that I made the best decision for me. Perhaps I will start a blog! Thanks again dudes!
Good luck Heyteacher.
Said a little prayer for you as it is almost 2.30.
Am presently waiting to see the “surgeon” for my 4 month check up(non surgical). I usually have to wait for 2 hours before I see
him and I’ll be lucky if I get more than a couple of minutes of his time. Wondering if I have to keep seeing him if all is going according to schedule according to my fellow bloggers. Besides giving me the option of no surgery, which I am gratefel for, he has just been monitoring my progress. I have got a lot more help from this site, especially from normofthenorth. Hey Norm, have you ever thought of teaming up with your “surgeon”. I am sure it would free up a lot of his time and it will be a valuable help for ATR patients.
I was happy that I managed the 2km walk to the hospital quite easily although I did bring my cane along as the limp gets more pronounced as I tire.
Good luck from me, too, heyteacher. I can pray for your speedy recovery while disliking your decision, no problem for me!
And good luck with reforming your surgeon’s ideas about rehab. I hope you get enough access to her post-op to have some influence.
Ifixteeth, I feel like I’m teaming up with (and sometimes against) ALL surgeons by blogging here! My own Doc doesn’t spend that much time with his (non-op, mostly happy) patients, and he gave me good answers quickly whenever I saw him, so I don’t think there’s a lot of time to be saved. (I’m also sure I’ll eventually move on from my current addiction to blogging on this subject!)
espana,sorry to hear about your AT rupture, and congrats on spain winning world i was delighted they won because of holland’s dirty tactics.im 6 weeks post op now got cast removed 13-o7 and walking now with aid of crutches.
dave(ireland)
Thanks for the well wishes. Surgery was great. Got a nerve block behing Again great, great job!!
Dave glad to hear your walking.
Hey everyone, just want to follow up on a message I posted a week or so ago. Had AT surgery (open surgery) 4 weeks ago, had stitches taken out about 2 weeks ago (ortho said healing went very well, no infection) but the uncomfortable pins and needles and burning feeling in the ankle/heel has not stopped and is uncomfortable enough that I can’t sleep (2 percoset does not help) and the ortho has now prescribed me something called Lyrica since he thinks is Sural Nerve is irritated. Has anyone else had this medication, or knows anything about this medication? Supposedly its really for epileptics but can be used for people that have nerve problems. I only really plan on taking this to go to sleep but am somewhat concerned that 4 weeks into the surgery and its not getting any better. Any thoughts?
Hi all,
6 weeks post op now and back in two shoes and would like some info on what are the best type of shoes/trainers to wear after AT rupture.
thanks dave.
Have you got a pair that fit the injured foot? That was the biggest problem I had when I finally got to 2 hoes, my left foot was quite a bit fatter due to swelling. I bought a pair of Crocs and wore them around the house and also at work, although I didn’t wear them to work. Crocs, running shoes and hiking boots are all good bets.
gerryr
my bad foot is not really swollen luckily, the swelling is more around my ankle i went to the shops today and bought some trainers with a good heel on them and there pretty comfy.thanks for your info dave.
I’m four and a half weeks post ATR, going for the non-surgical option of recovery, and just had to fight with my Ortho surgeon to get into and air cast (he hadn’t ever heard of a hinged boot) as he wanted to put me into another fiberglass cast with my foot at 15 degree dosiflexion for another 4 weeks (no way). He wasn’t even going to come in to do any sort of physical assessment, he just gave instructions to the cast technician. In the end, he acted like a little boy who didn’t get his way and was less than professional about the whole thing. I left feeling very disappointed and belittled. I’m a nurse and work in the OR at another hospital in town, to which I am planning on transferring my care considering his poor quality treatment.
Now that I got that off my chest, I’ll get to the question I was intending to ask: now that I’m in my aircast, I find it hard to accomodate for the height of the boot. It feels good to be in a platform shoe, but not so safe, especially when I come in to work (they have me doing a lot of data entry, policy revision, and error corrections). What have some of you used? Especially the men who wouldn’t just have a couple of pairs of platforms in their closets!
I had the same problem! In fact initially I had to have my boot at quite a high angle (I had to insert 5 heel-wedges for comfort - am down to 3 wedges now). At first I wore sneakers on the good leg, but I was walking lopsided and the arm on the bad side started to feel numb - probably some sort of nerve injury. So I wore sandals on the good leg - not high heels, nothing pointy, but platform-soled-wedges, with a buckle at the angle. I had to go through all my shoes to achieve the equal height as the bad leg. Sure I got horrified looks but seriously, what are you supposed to do. And I stayed quite well balanced, and in addition felt tall for once, which made me happy. Now I have to find a shoe for the 3-wedge-height.
How dare you question you Surgeon Kris, I have spent almost 5 minutes with my surgeon split between 2 visits and I feel like my questions are not welcome. Thank god this website.
Hey all. I don’t update enough for a separate blog - so here we go. My last post was on July 10th. I’m five weeks into non-surgical recov’y of ATR. Yesterday I visited my ortho for my fourth scheduled visit in those five weeks (his recommendation - not mine). He got me out of the fiberglass cast and am now in an Equalizer Pre-Inflated Air Walker (manufactured by Ossur), anyone familiar?
For the next three weeks he suggested I gradually ween myself off crutches while wearing this. ie 25% pressure first week, 50% second week and 75% the third. Then totally off those sticks after that.
Needless to say, I’m already cautiously moving around without the crutches somewhat while in the house. No pain at all. Actually haven’t had any pain since the initial reputure on the basketball court on June 20th when this happened. Just wanted to give some of my flavor to the peeps out there since we’re all in this together. I enjoy everyone’s updates and I’ll keep praying for you all and I ask that you keep me in yours too if you so incline. God bless.
Regards,
Kris, I’ve outlined my ways of elevating my uninjured foot up to the level of the injured-and-booted foot elsewhere, including on my blog. One gizmo I used is usually called a “cast boot” or a “cast shoe”. It’s designed to wrap around a fiberglass “walking cast” and add a non-skid sole to it. They’re quite cheap items in surgical-supply stores and online. (I had one left over from my third cast after surgery for my first ATR in late 2001.)
For me, especially for indoors, a little “exercise sandal” slipped inside that “cast shoe” worked well, and that’s what I used indoors. For outdoors, I had a pair of low-cut boots. (Merrell makes similar slip-on low-cut boots with deep and aggressive treads.) Adding some footbeds inside one of those got me close enough to the height of the boot — an AirCast with 3cm heel lifts=wedges.
Ejerone, there’s no mimimum frequency of updates for a blog, but it keeps most of your comments and reponses in one place, and if you install the widget at http://achillesblog.com/dennis/2008/03/08/achilles-timeline-widget/ , it also lets us easily check where you are, which foot, how long ago you got into this, etc., etc.
That boot seems like a good basic fixed boot (not hinged) with a “special” liner, and at a very attractive price. I’m not sure what’s so great about “pre-inflated” liner myself, but if it’s comfortable and stays that way, they you’re ahead of the game.
You seem to be “catching up” with the UWO Protocol after 5 weeks in a cast. I’d recommend “cautious and sensible impatience” as you do that. You’re probably relatively OK — there are risks everywhere in this rehab — accelerating the WB some, as long as you stay in your boot and Watch Your Step! The boot should protect your AT from being externally over-stressed, but (e.g.) if you strip and start falling, you would need the inner control of a Buddhist Monk to keep from trying to catch yourself, and that could include using (and flexing and stretching) body parts that aren’t ready for thoae move yet.
When you get out of the boot, you’ll probably be at even greater risk for several weeks, even though your AT willl be stronger (and your ankle more stable) by then.
Hi everybody,
I started a blog on wordpress but not sure how I can link to this site, here is the link:
http://firstdayofsummer10.wordpress.com/
ATR 5 weeks ago, non-surgical treatment.