kjjet’s AchillesBlog

I hate the whole cast thing. I ruptured my Left AT about 7 years ago and was in a boot post-op. I was out of the boot in 4 weeks and in two shoes. From there I didn’t do PT and my achilles is stronger then ever. With that said, I just ruptured the Right AT last Saturday. I already had surgery and currently sitting on my couch in a boot. I fully expect to be FWB and in shoes in 4 weeks.

My surgeon is aggressive with treatments if you are a fit individual. If it is like my last time, I expect to begin some range of motion exercises after my follow up in 10 days.

One thing surgeon said last time was to follow your gut and listen to your body. If you feel nervous maybe you should try and find a boot on craigslist or just buy one outright from a medical supply store. With that said, after seven weeks you should have a repaired tendon. I realize everyone is different, but I expect to be walking in 4. I hate the cast because it limits you from stretching the tendon before you are thrown into the deep end of the pool.

I would try to assume that it is repaired and begin working and stretching though range of motion exercises. Howe

Kjjet - this is good to hear. Slips, misteps and falls are dangerous but don’t confuse that with sitting around doing nothing until your tendon heals. Your tendon does need that incremental loading to become strong again. The collagen fibres need to align in the direction of force. The initial collagen that forms is weak and disorganised and it is replaced by the good stuff as you start working it. Trust your health professionals as they seem to know their stuff. Not all do though and I have seen some weird treatments come through these pages. We all understand the feeling of sitting around. It seems like a long time but in fact it is the shortest part of this recovery.

I went non-op on the re-tear, my tendon doesn’t really swell much ankle does a bit. No pain either, DF to 5 and 0 pretty easy, theraband exercises produce no pain. I was expecting more advice from my OS but it seems clear that its the PT and I now, so just trying to get in that mindset.

I hear you on the frustration, I’m at the 8 week post op mark and even with the re-tear the PT has me on track as if there was no 4 week re-tear so I’m itching to ditch the crutches.

I am a bit concerned about his plan to FWB for about a week at zero and then into shoes if I tolerate that well, seems quick but I trust him and he’s a pro so I’ll roll with it. Maybe I should pay more attention to how it feels than (some) arbitrary protocols that might have a 1-2 week difference (mass general’s vs ohio state for example)

Sorry to hear about your re-tear. It happens so fast and there is no backing out. What is done is done. It makes you realize how fragile the tendon still is until it is healed.

I had no pop or tear (mine was non op). PT performed the Thompson test and it was ok. There is swelling of the tendon and I have been doing ROM exercises all weekend and the rotation is coming back but with moderate pain. I do think your pain threshold changes during this ordeal, I think what would have been a 5/10 pain level before would now be a 2.

I haven’t gone back to the OS or my doctor as I still had control of my foot. It was just sore. As this was a Non Op recovery the most they would have done is put my back in a cast. I have a boot now and have been using that with and without crutches.

One thing that is constant on this blog is that you can’t rush it. It takes time and I guess I am running out of patience with myself. I need to step back, regroup and follow PT orders. It is frustrating for me to watch my snow machines taking off without me. I can see the ski hill from my house and all I am doing is sitting here looking at it, arrg.

So I had a partial re-tear at 4 weeks post op bc I fell off my scooter.

If you didn’t feel a pop or a tear or hear either then that’s a good sign, if the wound didn’t bleed that’s also a good sign.

I experience a pop sensation, a partial gap when touching it, and some bleeding.

We couldn’t tell the extent of it on the MRI b/c of the previous surgical trauma and the DR was very apprehensive about just putting me back on the table “just to see” (healthy 34 yr old) and said he would back a non-surgical route fully.

That was a hard call for me. So far it seems to have been a good decision. I don’t get into right and wrong in hindsignt, you can only make a decision based on the evidence and info available (and your own personal factors.

Have you gone back to the OS after this mishap? Perhaps an MRI is in order?

Did the PT do the thomson test? what did that reveal?

Good luck, I know the feeling.

Slips can be quite dangerous at this stage of healing. If the movement and strength you had does not return in the next 2 weeks then I would advise more investigation. For now you can rub your thumb and index finger up and down the tendon. Use a bit of cream to reduce friction and feel for any gaps. After what you have described I would also suggest speaking to the Doc to see what he thinks. I am not trying to alarm you but feel it is better to be thorough. If your PT really knows his/her stuff then they should be able to check for a re-rupture but normally people go back for an MRI after a slip with notable pain and significant loss of function. I hope it is all good for you.

Thanks for all the advice everyone. The way my OS has treated this injury doesn’t seem to follow any others that I have seen on this site. And I am not too impressed. Went to my first PT Thursday, he is very experienced in ATR recovery. He was surprised with the OS response to put on a shoe and walk out of the hospital. He took all of the necessary measurements and we are starting PT.
I had a slip this week, it was nothing more than getting off the couch wrong. The pain was immediate and intense. I don’t know if I am being a wimp or what but there is no way I can walk on my leg. I thought I had re-torn the tendon again. I had been performing ROM exercise all week and was able to move my foot to 90 with no pain. I was able to put full weight. Thought I was on my way. Then I slipped and lost 80% of the movement I had gained and my ankle swell back up.

PT was surprised at the loss of size and definition of my calf, as was I. But I haven’t used it in 9 weeks so I guess its to be expected. He says it should return quickly. He said that I should see good results in the next 2 weeks. I told him about the slip and he said that the pain w

I hope you are doing okay. I see you posted this over a week ago. I was out of my cast in 2 weeks, into a boot full weight bearing, then into shoes at 6 wks. The fact you were in a cast so long is strange to me. I’m no professional but I did have one of THE top OS in our region do my surgery. With the different protocol seen here on the blog, one thing is consistent: everyone transitions to shoes through a boot. If you haven’t sorted it out, I’d get a second opinion. You could seriously re-injure yourself without proper support before you are ready.

Kjjet, my advice is still to try to follow the evidence. Your doc seems to be an outlier. Following an outlier rehab post-op doesn’t seem to change outcomes very much, even in large studies, but following an outlier rehab non-op definitely changes the odds of success vs. failure. As I wrote to you before, the good news is that many patients succeed pretty well non-op even with weird rehabs that produce too many failures (reruptures). But a bad rehab non-op clearly makes it more likely you won’t be one of the lucky ones. The good rehabs would have been much faster for you in weeks 2-7, and wouldn’t put you in 2 shoes until week 8, after 4 weeks of FWB in a boot. If you’re super careful and super incremental in shoes now - and a bit lucky - you may come out fine. If you can hook up with a doctor or a PT who’s read the evidence, your odds may improve.
It’d be great if there were a way to weed out Doctors who just make stuff up. Malpractice suits probably help do that in litigious societies like the US, but even Americans don’t seem to sue much over lousy ATR care, and Canadians sue less in general. So the Doctors just keep doing what

I’m 6 weeks post op (2 weeks minor re-tear that hasn’t pushed us back at all luckily) I’ve been in a boot since 2 weeks post op starting at 30 then going to 15 and within the next week zero to shoes/heel wedges.

I know there are spirited debates on different protocols here, non-op/op/early wb/aggressive pt, etc but the boot seems like a common thread throughout all options.

How experienced is this surgeon in Achilles injuries and recoveries? Is he a foot and ankle specialist? Seems quite odd I’d go for a second opinion prior to getting into shoes..heck I’d buy my own boot in the meantime, I can’t imagine going to shoes (did he even advocate heel wedges?) right after casting (esp for 7 weeks)

No sudden stretching? Going right into a shoe is going to increase the chance of that exponentially, that’s exactly what a boot prevents in most cases.

Odd advice, might be time for round 2 on opinions.

I’m 3.5 post op and started minor pt this past week. The best exercise I’ve done is ankle pumps. Basically ” pumping” your ankle up and down. In the first week of PT, I am about 10 degrees from 90 degrees. When I first started at the beginning of the week, I was 19 away from 90. So progress has been good and I expect to be at 90 this upcoming week. Doc doesn’t want me going past 90 for a few weeks though.

Not going into a boot seems odd to me. I’ve been in mine for close to two weeks with PWB and it has helped me quite a bit. May be time for a second opinion…

Hello,

I agree with you and your wife that it does not sound right. I was in a cast for a very long time as well. While it might have been “clinically ok” to go straight to shoes, it would have been very difficult for me.

When I was switched from one cast to another and started weight bearing, I was timid in the surgeon’s office. The nurse was rather callous and said “you can walk now, go ahead”. So, I have lots of empathy for you.

As you will see in my blog, I am on a “slow roll” with my recovery. When I went to new stages, I took my time and made incremental changes. Do not be shy about continuing to use your crutches for a while until you have some PT. I found that using crutches and slowly adding pressure to be very effective.

Best wishes for you.

I’m amazed at the range of protocols and options that have been prescribed……and the casualness with which they are done by the OS……….not sure I understand it, but am getting to the conclusion that between week 3 - 10 is where the discrepancies lie and at week 10 it may not matter what path you took. Just an anecdotal observation. I am at about 6.5 weeks post op and I have been asked to be in a boot since week 2 until week 8, no PT, worked myself to FWB since about week 5.5. Upon calling my doc’s office, about some random pain, the PA suggested that I do unassisted DF and PF, 2-3 times a day but he stressed that I do no sideway movements around the ankle. My initial attempts at DF were pretty poor….could hardly make it to passed neutral (20 deg) and saw minimal calf movement….has steadily been improving and can get to 90deg now and can also feel the calf getting activated…..so may be this where you may want to start hope it helps.

KJJET - I had surgery and was in a splint for 5 weeks NWB because of a tear at the heel. At Week 4, my doctor provided simple ROM exercises to start to get my foot to 90 degrees DF for a boot brace. At the time, my ankle was very stiff. If you cannot find a PT immediately, you can try to do the following. Three times a day perform simple clockwise or counterclockwise circles of your foot. No use of hands or band unless you are under care of a physical therapist. You can try to flex your foot DF (gently flex your toes towards your ankle, no use of hands or band). At first, you will not be able to do much movement, but it gets better. I was able to get to 90 degree DF after 1.5 weeks on my own. A PT will be able to help you with joint mobilization. Good luck and I hope you get the care you need soon.

Welcome life with ATR…smiling. I too couldn’t have gone through this without help…as a result of this injury my relationship with my guy had really deepened. YAY for our angels!

Linger should read longer. If you activate AJAX Editing in your Settings, we’ll be able to fix our own typos for the first few minutes.

Kjjet, the good news is that non-op ATR treatment has recently been shown to work as well as surgery, after many decades of being “proven” to be suitable only for geezers, with unacceptably high rerupture rates. Three recent studies demonstrating brilliant success with non-op ATR treatment are summarized and linked at AchillesBlog.com/Cecilia/protocols. Worth a look!

The bad news is that the key to the recent success of non-op treatment in all the new studies - all of them >=2007! - is fast aggressive rehab. For many decades “everybody knew” that non-op treatment had to be slower than post-op, and that going slower was safer because it gave the ruptured ATR linger to heal properly “by itself”. Well, “everybody” was 100% wrong, actually backwards! That’s bad news for you because you’re on the old slow track, sorry.

The silver lining in this dark cloud is that the old bad slow non-op “conservative casting” approach still had “only” around 25% reruptures, sometimes lower, so at least 75% escaped without rerupture. But the results were probably inferior on other tests as well.

So… if I were you, I’d familiarize myself wit

Thanks for the Welcome. At the moment I am NWB and will be like that for at least another 10 days as that is when my next appt will be. I was hoping to be PWB at my last appt but was not given the option. I barely get a chance to talk to the OS. By the time he checks over my leg and I roll over on the bed he is lone gone out of the room. The one time I did talk to him, he said that with the last 400 of these injuries he has seen this is the best way for my type of injury. I have asked my Dr about it and she said it just takes time. And I am starting to get fairly bored. Haven’t gone back to work yet as I am unable to perform my job on crutches.

I have tried to put lite lite weight on it with very un-favourable results.

I know that when they cut off the cast and my leg is hanging over the end of the bed. It feels like a bag of sand dangling off of my leg. With it being my right leg I also can’t drive. (my car is a standard). This works for our youngest daughter, the car is always available for her. I am going to have to de-teenager it when I get it back to driving.

Welcome!!! Like you, at 49, I too had my ATR playing squash…I was into it for close to 90 min when it happened. Apparently, according to my OS the average is 42 min into the game…..Not sure how they keep track of that

Sorry to hear that you’ve joined this club, but good to get a new blogger. Was just curious as you don’t mention anything about whether you’re still NWB, PWB or FWB? This coming from the perspective that the surgery vs non-op being equal is based on the “modern” protocols (especially for non-op), and according to them you should be at least moving towards FWB by 6 weeks. Generally it’s irritating when an OS doesn’t give you the options and a choice, normally this tends to go towards surgery, but it seems to be reverse in your case…

Hi - I had two ATR injuries from my accident. One is AT at the heel and like you, my doctor was conservative regarding the ATR at the heel. Before 12 weeks, most of my rehab consisted of simple PF, DF, and ROM exercises. At 12 weeks, I got very vigorous massages and joint mobilization/flexing by my therapist because the AT is considered healed and strong enough. I agree with Donna, momentary zings at the heel that can repeat for a short while should be monitored, but is probably okay. If it is hurting or repeats due to a specific activity, I would check with the doctor or therapist. My therapist tells me to stop an activity if I have pain and she provides a different exercise to accomplish the same function. At 18 weeks, I still experience the momentary zings and throbbing at the base of my heel and can usually correlate them to a specific activity I did that day.

I can only speak for myself & what my PT told me. She said that the odd little pains are part of healing. I get what I call little zips, zings, zaps…she said they are nerves healing, tissue healing, just healing. On a scale of 1-10 they fall in the 2-4 range & pass immediately…however, she said pains that HURT, make you go WTF??!!$$%%^^ , that on a scale of 1-10 are greater than a 6 are serious, stop what you are doing. Hope that helps.

Hi everyone,
I’m currently 9 weeks after surgery for a calcaneus rupture. My doctor is fairly conservative regarding PT, but my therapist is trying to move me beyond his recommendation which caused some pain and distress for me right before (and during) my Xmas visit with my family out of town. I backed off of the exercises during my visit and plan to start back today. But my question is this…What if any pain should I be feeling at this stage and under what conditions? I often feel a shooting burn or zing at the site that my tendon was reattached to the heel bone. Is this a normal sensation caused by healing or reason for concern?
Thanks