My first post
December 2nd, 2009
I have been reading all your stories for the past 7 weeks. I simply slipped down the last two steps at home and heard a rifle typr crack, terrible pain and collapsed. I had surgery the next day and after 3 casts in 6 weeks went into a boot last Friday…still NWB for another 3+ weeks. I am finding the boot a pain in comparison to the cast..is this common?
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I just ruptured my achilles tendon with a 75% tear and my orthopedist advises that I go with non operative procedure. I am now in a cast for 5 weeks with about another 7 weeks to go. I will then go into a removeable boot for about another 4 to 6 weeks. I was told I had many other tears in the past when they read the MRI. they felt my body seems to heal the tears. Is this a wise decision to go or should I of gone with the operation. Any advise will be welcome. I am somewhat active in sports but I am 60 years old and i play racket sports.
kareno, several other people here have been bothered by “the boot” at first, but most (all?) have come to love it and much prefer it to a cast. Obviously it has functional advantages, like being able to adjust it and remove it and clean it and your leg. If it’s hurting you, try adjusting something. Or it might possibly be the wrong size. Boots are “off the shelf” and often need to be “tailored”, while casts are all “custom”.
I’d say that both of you, kareno and jeffry1000, are being immobilized way too long for your own good — for your leg’s good (based on the best scientific studies) and for your overall good (based on obvious facts and common sense). Check the discussions and links at my blog here ( achillesblog.com/normofthenorth ) for a few versions of rehab protocols that go WAY faster and produce good results.
I think the issue of “speed” in rehab is especially important for you, jeffry1000, because the results from long slow “conservative” immobilization without surgery have been shown (for decades!) to be second-rate or worse.
As you’ll see from my blog, I’m on my second ATR, and I’m a few years older than you. My first was repaired surgically and my rehab was fairly slow — 3 casts then the first boot my ortho surgeon ever approved, after lots of arguments with me — and it eventually healed pretty well, and I returned to competitive volleyball at the same level or better.
This time, I was talked out of surgery by one of Toronto’s best ortho-sports-medicine surgeons, based on the newest studies that show that there is actually no benefit from surgery compared to a non-op protocol, PROVIDED that all the patients get put into removable boots and get access to early mobilization (physio etc.) and early WB (weight-bearing).
Not only did both kinds of patients get treated with a relatively quick and aggressive protocol (the one I’ve been following, so far with good results) — they also got treated with exactly the same protocol, whether they had surgery or not.
So I’d advise you both to print out some of those studies and their protocols, then roll up the printouts and hit your doctors over the head with them!! Forehand AND backhand!
We’re talking about TWO weeks of NWB (Non-WB), immobilization by boot, not crutch, physio and gentle exercises starting at TWO weeks, FWB “as tolerated” starting at FOUR weeks, weaning off the boot into shoes starting at EIGHT weeks. Counting weeks from surgery or from first immobilization (non-op).
BTW, this is FAR from the “edge” of aggressive ATR therapy. Check out doug53’s blog for a much more aggressive post-op protocol. And there’s a new study from Japan where two surgeons have been skipping casts and boots completely, and starting physio the day after surgery — so far with excellent results.
The “old wisdom” (still often repeated, though there’s no excuse in 2010!) was that the results of non-surgical “conservative” treatment were bad, significantly worse (on average) than the results after surgery — especially for people who were active and serious about their sports. Non-op treatment produced more re-ruptures and lower strength and bad ROM (range of motion). This view persisted for many decades because it had more than a germ of truth to it: PROVIDED that the non-op patients were immobilized way too long (which almost all of them were), the results of the non-operative approach were bad.
So get out of your casts into a boot ASAP, because you’re both overdue already, and start moving toward FWB. And find a physiotherapist who’s willing to follow the mobilization protocol I’ve been following, more or less. It’s been proven to work well for surgical patients and non-op patients both, and there’s no reason to spend extra weeks on crutches and in casts!!
That doesn’t mean to throw caution to the wind, of course! Rerupturing is still a Very Bad Thing. But you’re not improving your outlooks by overdoing the immobilization and NWB, on the contrary.
jeffry1000, I was told similar (though confusing) things about my latest ATR, based on ultrasound — that it may have been partial, and it may also be multiple. I don’t know if it’s true or not, and I personally doubt the partial thing, based on the Thompson test and my own experience with the “pop”. But I don’t think it matters AT ALL for the non-surgical protocol I’m following, so I don’t really care! (If a surgeon is going to slice and stitch and doesn’t find all the ruptures, that could be important, but I’m pretty sure Mother Nature will find the parts that need to be repaired!)
Good luck, and good healing!
My first post as well:
Total rupture last Fri. 10/8 while in a Pilates/Cardio class that I’ve done for years. Saw the OS on Monday, headed into surgery this afternoon. Lucky to have a one of the docs that attends our Olympic Nordic Combined athletes. Everyone’s information has been so helpful!