lawwill’s AchillesBlog

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Knee scooters are not a good option nowadays.

Yeah, I’m up for the knee scooters too despite the fact that you could look quite strange riding this apparatus

I dream about two shoes again. I’ll need a new pair, as one shoe is wearing down fast. Good luck!

Stay cautious Lawwill. This is the most sensitive time– reintegration. You’re totally right! Keep that boot around for when you’re unsure and good luck on your trip

Once the ruptured AT heals, with or without surgery, it seems to be at least as strong as it was before. I’ve never heard of anybody who re-ruptured an AT that had fully healed (like say 6-12 months post-whatever or more), and we ALL ruptured one that had NOT torn and healed. Moreover, the science is clear that we’re all at elevated risk of rupturing the OTHER one (as I and several others here have done), again suggesting that the healed AT is stronger, not weaker, than before.

It USED to be clear that non-op (formerly called “conservative”) AT treatment carried higher rerupture risks and brought a less complete recovery. Newer studies (>2007), using faster rehab protocols than used to seem prudent, have produced non-op clinical results that are either identical to post-op results, or a bit better or a bit worse, depending on how you lean back and squint when you read them. One of the best, from Canada’s U. of Western Ontario (”UWO”) is available on this website in full text. Even in one of the larger studies of its kind (~150 patients), their non-op results were all statistically indistinguishable from their post-op results,

Hi lawwill & jjniss
Thank you so much for your comments and advice.You have been most helpful and I am sure your comments are also of benefit to others.
I will continue post my progress so that it may help those particularly with new Achilles Tendon Ruptures.
Take care

Addressing Harry H’s comment and jjniss’s response -Its horses for courses. I chose to go non-op, was immobilised in a cast for 5 weeks, but then put in a boot which I did take off at night and to shower. Gradually weaned myself onto walking and can now walk pretty well normally in 2 shoes after 12 weeks. Very slight trace of a limp. Still pretty cautious though and do use the boot if I have to walk longer distances outside. Turning point for me was about a week ago when I did walk quite a long way outside without the boot. Found it tough going towards the end, but no soreness in the tendon and was certainly limping noticeably. But since then the limp has virtually disappeared altogether when walking around the house. it does strike me that once past the initial healing stage then perhaps the more one uses the tendon the better the healing process progresses. Have hospital appt. this week when I’m pretty sure I’ll be told I can officially go to 2 shoes, even though mostly doing that already. Not sure on the comment that healing non-op you end up with a weaker mend than operative. Any additional comment or data on this app

Hi all
Many thanks for your advice, it is greatly appreciated.
I will continue reading this very helpful blog and also keep posting my progress so that it may help others with a new achilles rupture.

First some immediate advice. Yes, do not take off your boot for any reason! It’s there to immobilize your injured leg in an optimal healing position, essential during the first weeks of healing, especially for a non-operative recovery.

It sounds like you are receiving bad, uninformed or at best inattentive care. Follow your instincts and actively manage your treatment and recovery. Recovery for ATR is complicated, much more so than a broken bone.

This blog is a fantastic resource, folks with our injury tend to be active, curious and involved. And importantly share a lot of information based on personal experience and hours of research.

There are a few people you should particularly read including for exhaustive data on non-invasive recovery protocols, for aggressive recovery strategies and, for thoughtful insight. You can read my posts too, mostly I complain a lot that my leg hurts.

Your initial experience sounds exactly like mine. For my initial diagnosis I was with the ortho for 15 minutes, given a boot and told walking was OK (although not to take the boot off) and then to come back in a month. I suppose becaus

Hi
Nobody explained to me how the two tendon ends re-attach non-op so I checked it myself on the internet.
The foot is held in the boot or cast with the toes pointing downwards so that the two tendon ends “meet”.
I understand that the healing process is similar process to a broken bone and the tendons, grow and mend on their own as the fibres regenerate, albeit never as strong as before. What I am not sure about at this stage is how they will re-attach and also be “correctly aligned” as they would be with an operation!
An operation was briefly mentioned to me but I was then directed to the room where my boot was fitted and I was sent on my way non-op and no real oportunity to request one. No real guidance either of how to cope!!!
Disapponted at the hurried treatment and my next appointment is in another 10 days. I intend rsearching this injury and asking the consultant (or his assistant who I saw initially) some relevant questions at that time.
I was told by the nurse who fitted the boot that I could remove it for sleep and shower!! Surely this can only be harmful, especially in bed. My boot is staying firmly fastened until my

Hi I am new to the blog and just now setting mine up. I had to comment on the boot. I LOVE my Vaco cast! The boot Kaiser insurance gave me is the “ole standard black velcro put the heel wedges in boot” you and everyone gets. I thought the same thing about it. My ATR is the left and with the “bad boot” my knees were knee knocked while my left foot swept outward 30 degrees. Trying to start PWB with this boot was not right! With the Vaco is more comfortable with the liner forming to my foot and the way the boot buckles down it does not put squeeze my foot to death and nor do I have strap marks on the ankle and top of foot. The sole of the Vaco gives a natural heel to toe rocker and easy to walk! Today I walked 2 miles and have only been FWB since 12/19. Instread of putting in heel pads in my right shoe (like needed 6-8 of them) to even me out I wear a comfy platfom wedge heel. Wow you opted for a non-op? How does the achilles reattach itself????

Hi
New achilles complete rupture, non-op.
Any 1st hand experience of the healing process will be welcome here.
New Years Eve and I decide to play badminton and SNAP went my left achilles!
Now just 1 week later, wearing boot with 4 wedges, sat here, leg raised, extremely frustrated and naturallty quite worried.
Are these boots sided? When I look down everthing seems to be facing left by about 30 degrees. surely they have not fitted me with the wrong boot have they?
I know better than to rush things but at the moment I regularly curl my toes downwads, stretch them upwards, raise my leg up and down to try keep my thigh strong, does this help or hinder?
Getting around the house OK on crutches. Wobbling on them half asleep to the bathroom during the night is very risky, so I now go to bed at about 1.00am to try prevent having to do this.
I sleep in the boot and dare not remove it at all for fear of harming whatever may be mending at this early stage.
Having a bath is difficult!
Feeling very frustrated at loosing my independence and now being almost totally relant on my good wife and kids is alien to me .
Makes me once ag

I too was non surgical and am very happy with the results. I believe you need to listen to your body. I was out of my boot around the house a ling time before I did that out and about. Use the boot for protection but when at home go for it. I think physio is really important not only to build strength but also stretching and flexibility. The exercise that really brought it home to me bizarely was when the physio made me stand on my good leg with my eyes close in a door way and I had to hold on to prevent me falling over!!! Its not just your leg thats affected. Good luck with your healing but try and get some physio. LL

I was 8 weeks NWB and in a boot till 10 weeks where I went to FWB a week later. I’m now at 14 weeks, 2 shoes and walking better every day. During my recovery I’ve found the advice on this site is really good, there is a lot of it though which can be frustrating. Here’s what I’ve learned and works for me.

1. Don’t be overly concerned about being immobilized longer than many others on this blog. An extra 4 weeks in a boot won’t seem like much a year from now. However, you have been immobilized for a long time as was I. We both have lots of scar tissue and a stiff repaired tendon. It will take us longer to achieve the flexibility we want versus a protocol with a shorter period of immobilization.

On the other hand if you feel the doc is not up to date on current recovery protocols then let him (or her) know and share the info from this site. My surgeon who is experienced with ATR learned stuff from here. Guys like Norm, Stuart and Ryan have taken the time to gather a lot of info and share it.

2. Walk without limping no matter how slowly. If you need to go faster use a crutch on the opposite side but don’t give into limping. S

11 weeks immobilized would be a LOT. The very successful UWO study specified “wean off boot” at 8 weeks into treatment (w/ or w/out surgery) — see bit.ly/UWOProtocol . Are there risks? Sure, and they don’t disappear if you stay in a boot for months, either! So definitely Watch Your Step, and try to avoid slips and falls and other injurious errors.

When you’re limping bootless, concentrate on having your “bad-side” toes facing straight ahead — or at least as straight-ahead as normal. If your gait is shorter when you step over that foot, or if you “dip” at the end of the stride, then fine, and “welcome to the club”, and “this too shall pass (eventually)”. But avoid the temptation to find new and creative ways to walk, like with your “bas-die” toes pointed out. They can cause other problems, and be hard to “lose” later.

An exercise bike is a great way to stay in shape while recovering. By shifting “that” foot forward on the pedal, you can apply as little force to the calf-and-AT as you like — kind of like standing in the water while you do heel raises!

Many of us (including you and me) had very little or no pain, apart from

For what its worth I never wear my boot unless I leave the house. Otherwise I have my foot elevated as much as possible.

I was taken out of a cast after the 1st week…..seems odd but Ive had minimal to no pain. Ive also put zero pressure on the foot & it hasnt seen the ground in 4 weeks. For Post-op week 2 I cant complain.

I can say that the boot did re-aggravate a bunion before surgery so im not looking forward to walking in it, which is why I only wear when necessary.

I can only address the hamstring issue. My hamstrings have been really tight.

Heres a case study 144 cases. 72 operative. 72 non operative.

2 re-ruptures in the operative. 3 in the non operative.

I make that 2.78% re-rupture rate for operative, and 4.17% for non operative.

Along way short of the 20% you are talking about.

Also. Look at complications in the operative group compared to the non op group. Some would say you and your doc took the sensible option.

http://www.ncbi.nlm.nih.gov/pubmed/21037028

Good luck with your healing. Get some decent physio sorted for when you are out of the boot, and I am sure you will be fine.

The UWO Study disproves that. Norm will no doubt be along shortly to add more info but look for and read that to start with

Thanks Stuart
Your father’s experience seems remarkable in relation to some of the experiences here.. I really haven’t had any pain at all in my achilles from PWB or FWB and little sign of any serious swelling either. I plan to take both crutches on holiday as find I can actually move faster over long distances with them, but do move around the house without most of the time.

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What you are doing so far seems quite good and sensible. Many protocols will say weight bearing as tolerated. If you are FWB at times and it doesn’t hurt then you can do some more. FWB basically is without crutches. The wedge in the other shoe is a good idea to balance things up. How much you walk is going to be up to you and be guided by pain. You will get some swelling regardless so you should make sure you can get ice on your trip. I would still take a crutch but how much you need it will depend on pain. Remember that not much can happen to the tendon while you are wearing a properly fitted boot. Massaging the tendon and calf will help as well. My father (81) was FWB non op from day one because he couldn’t support his weight on crutches and there seems to be no ill affect. He went into shoes at 7 weeks.

Thanks - gives me a little more confidence. Just find my stride is much shorter without crutches so its slow going. Have just put a one-inch heel lift in my other shoe which is definitely helpful when walking without crutches

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Hi, a chair is a means to an end, it might make everything quicker and slicker at the airport and means you can carry some stuff (such as your crutches) on your lap. Ask if they have a self - propelled one. If you are worried about going longer distances (I mean if you are like me and you want to see as much as possible!) you can hire one from the Red Cross. Enjoy the holiday.

For those short trips in the middle of the night, while sleeping without the boot… I just used the crutches and went to and from the bed “NWB” (but no boot). There was a risk of tripping over something of course, which I tried to mitigate by having a lighted (nightlight) pathway between the bed and my, ahem, destination. I kept the crutches by the bed, well after I was FWB (in the boot) for this purpose. I finally put them away, after I was comfortably established in two shoes.

I would have to agree with Bcurr. You are at 6 weeks and in a walking boot. You are already PWB. I read long ago of someone having a fall with the scooter/ no boot when it hit something on the floor and re-rupturing. I cannot see any reason why over the next week you can’t increase the weight and ditch the crutches entirely. Remember the boot is designed to protect the tendon. It cannot flex so you cannot put the tendon under tension. If you try, then start with one crutch on the opposite side and go slow, walking as normal as you are able. When you feel ready to ditch the crutch, start walking near furniture so you can take hold if you need. I believe you will be surprised how well you do and how quickly you can move ahead. It will make your holiday so much more enjoyable. The decision is yours. Good luck with it.

If it were me I would rather walk on my heel than use a knee scooter unprotected. Walking with weight on just your heel on your bad leg (think of your leg out to the side at an angleand leg almost straight when walking) puts the same amount of pressure on the achilles as your boot ie. hardly anything at all.

With regards the airport, it may be small but they will still have an ambulift if you don’t want to do the stairs. Even though its only 12 days away, I imagine your boot confidence is growing daily so you may not be that bothered by then anyway.

With regards walking, I’d be surprised at 8 weeks if you were still using them. Its your choice, but you can do no harm without the crutches so if you start without them now by the time you go you should be racing along … so to speak

Thanks again, I certainly appreciate the information.

Taking it out of the boot and moving it back and forth is probably a good thing. I used to prop my foot up on a pillow, and try to draw out the alphabet with my toes (moving it in all directions) while watching TV. But, until told otherwise, don’t force the motion by pulling or pushing on it - say with a rope or towel. Moving it on it’s own is called “active” mobility. Tugging/pushing on it with something external (to stretch) it is called passive. In the early stages, active is good- if your doc wants you to do PWB, you’re certainly ready for some active range-of-motion work. Passive work will probably start with PT, and you need to be very careful with it; for lots of reasons.

Thank you so much ryanb, that is the best info in regards to PWB. I will start right away. With the information you have provided will give me the confidence to do it, wow I feel so much better. I have been so frustrated with this injury and with that frustration it has led me to be so nervous about re-rupturing.
I have been taking my foot out of the boot and moving it back and forth, should I not be doing that?
Should I just stick to PWB in my boot?

Becky-
It is important to start the PWB process. So, here’s a few tips to get started:

1) Start sitting in a char (one that you can put your legs under). Try resting your foot (in the boot), flat on the ground. Put it out in front of you a bit, and rest on the heel. Tuck it under you a bit, and rest on the toes. Get comfortable letting the weight of your leg - or if needed, just part of the weight - resting on the ground.

2) Next, start out on the crutches as you have been. You’ll be going: crutches, (good) leg, crutches, (good) leg,… Now when your crutches go down- simultaneously touch your boot to the ground. You can try “flat”, or try tapping your toes. You’re not bearing weight on it yet- your just touching it to the ground. No harder than when you were sitting in the chair. All your weight is still supported by the crutches.

3) Next up, is rolling your foot. So- just like before, you’ll touch your foot to the ground, taking all your weight on the crutches. But, now, touch your foot slightly in front of the crutches, on the heel of the boot. Leave it on the ground as you come over

I am in a boot 4.5 weeks post-op. I am suppose to PWB but really don’t know what that means,so I don’t do it. My surgeon assures me everything is great but I am too nervous. I sleep with the boot on as directed by my surgeon and I do it because I would be ticked off if I damaged it while sleeping!
I’m also seeking any advice on what to do. All I think about is what if…and I know that is no way to live but it is how I feel. I was a very active person beforethis injury and Now I just don’t even see myself walking again.
I guess I’m confused too…

It ishould not hurt you at this point of your healing to walk in the boot without crutches. You can do what is call weight bearing as tolerated. If it hurts then don’t do it. Your tendon is protected while you have the boot on. Regarding sleeping with or without it. It is not advisable if you are a rough sleeper. Your foot could get caught in the sheet as you turn and push it into dorsiflexion or you could get out of bed quickly in the night and stumble. You are tempted to go to the toilet at night without it and could trip. To be honest, I just couldn’t sleep well with it on so around week 3 I took it off and finally had a good nights sleep. It stayed beside the bed and I never left the bed without putting it on. I had a few spasms at night and they gave me some concern but there was no damage done. I am not advising you follow my lead but at 5 weeks there is less chance of something bad happening while you sleep. Some people are in 2 shoes by then and my elderly father took his boot off completely the other week after only 6 weeks non-op. As always, the choice and risk is yours.

Many thanks - thats pretty much exactly the way I feel. Tendon isn’t seemingly giving any adverse reaction to either partial of full WB. Some nervousness re taking boot off at night - but not while in bed. its only seems scary if I wake up and need to go to the bathroom. Still have hired knee scooter so use that to prevent putting any weight at all on bare foot, but I’ll prob send that back end of next week. I assume one could go barefoot to the bathroom being utra cautious but haven’t tried that yet - way too nervous!

seems like many are at least PWB at 4 weeks… I was NWB until week 6, then FWB… started this gradually (walking w/assistance of crutches, but was walking w/o the crutches by the 3rd day of FWB… best advice i can say is to take it slowly/gradually to get a feel for how your leg/body reponds to the gradual increases in weight. i took my boot off for sleeping, though got my boot at week 6 so healing was further along. haven’t had any problems w/this, though feels wierd and very vulnerable the first night or 2.

Hi Norm
Your blog is one of the highlights. Thanks. Checked out the recommended protocol but note it seems primarily to apply to recovery from surgery. How much would it differ for non-surgical?

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Thanks for best wishes. Knee scooter saviour for me too. but now trying PWB, but still using scooter for anything that requires anything more than a very short walk as am not yet confident with PWB (after one day *grin*), although it seems OK with one crutch - no pain at all, but then haven’t yet had any pain with any aspect of the injury or rehab. (poss advantage of non-surgical). But terrified of re-rupturing and then having to face surgery so will remain cautious I think.

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Thanks - interestingly the Knee scooter I have hired is exactly the same one as recommended on goodbyecrutches.com - but from someone who has a UK franchise for them. I’d thoroughly recommend anyone in the UK looking to hire something like this to use them (they hire out wheelchairs too). The scooter was delivered the very next day. Chris who runs the site http://www.wheelchairs-r-us.co.uk is in a wheelchair himself so is very sympathetic and helpful.

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ANYTHING with WHEELS is potentially helpful while you’re NWB & even PWB! Chairs, carts, dollies, scooters, etc.
I’ve been away from here, and haven’t checked on your rehab plans. Skipping surgery often works very well (and I recommend it to most patients), but the best results seem to be most likely with relatively fast protocols — a boot instead of multiple casts, with some unweighted exercises starting as early as 2 weeks in, and FWB as early as 4. My fave plan is at bit.ly/UWOProtocol (a link).
In the old days, when “conservative” treatment meant going much slower than that protocol, they had ~15% re-rupture rates instead of the the ~2-5% in most modern studies with modern (faster) protocols. Slow isn’t safer, and maybe especially on the non-op road.
Good Luck and Good Healing!

I went to goodbyecrutches.com. And they are a phenomenal company. They delivered directly to my. Work place and they cost $100 per month but after the first month you can pay by day. I highly recommend this company - their customer service & follow up is amazing!!!!