Feb 27 2015
Just had surgery- hope that was the right decision
Hello thanks for letting me share my story and also look forward to learning from others that are further along in the process.
On 2/19- I was playing a fun game of one on one basketball- forgetting that my college basketball career was over 30 years ago and heard that horrible pop. Actually went up for a jump shot- saw a white light as my achilles ruptured- feeling like someone else had come into the gym and threw a ball at me and took me down. I knew right away that I ruptured my achilles. Since I was at LA Fitness in Florida when it happened an ambulance was called.
In ER - X-ray and MRI done- confirming a total rupture. When being discharged they told me I would definitely need surgery.
Saw an ortho surgeon same day - and actually he did not recommend surgery and explained to me the non surgical approach using boot, wedges, and physical therapy. I was pretty happy to hear that I would not need surgery, though I really was not educated in this injury and what the options were. Basically the doctor said I would have the same outcome without all of the risks of surgery.
I did all of the regular internet searches when I got home and then also found this blog/ site which was very helpful.
Of course I needed a second opinion and ortho surgeon # 2 recommended surgery- since I am 51, very active including golf, yoga, moderate cardio, etc. He felt that would give me the best outcome since I was very healthy and would be a good candidate for surgery.
Now I was really confused and continued to research and ask people what I should do. (Doctors, friends, others with same injury, etc)
I did go for third opinion with one last ortho surgeon and he came down on the side of surgery.
The deciding factor for me to go with surgical approach is that this last doctor didn’t understand how a non surgical approach with boot, wedges, pt, etc. would work if my knee was not going to be immobilized as well. He said if he went non surgical he would have to put me in a full leg cast.
So I had surgery yesterday and am in some type of half leg cast. After I had surgery he told me I made the right decision as my tendon was pretty far apart.
I am now one day after surgery. Left with antibiotics, pain meds, and also visiting nurse for the next two days. She needs to give me strong anti inflammatory shot twice a day for next two days. The pain med was getting me a little nauseous so she also gave me an anti nausea suppository which helped quite a bit. So right now I am doing pretty good - leg elevated and on ice and no real pain, just mild discomfort.
I will see surgeon in one week to check surgical site. He seems somewhat conservative and wants me in cast for 8 weeks- though I have seen a lot of folks on this blog and research suggesting getting moving sooner vs later. I would like to discuss this approach with my doctor when I see him next week - so if anyone has a proven protocol or a study for more aggressive therapy that I could share with my doctor- please let me know.
16 Responses to “Just had surgery- hope that was the right decision”
Hi Linda
Did all of the doctors who you sought advice from suggest that you would be in a cast for 8 weeks?
As for protocols and research you could look at what I’ve just posted on Isaac’s blog. One study, at Exeter in UK, compared op and non-op patients and found virtually no difference in sustainability and speed of recovery. May be worth checking what the protocol there is now, as the period that I quoted on was 3 years ago and may have been amended.
What country are you in?
Hi Linda…you said: “so if anyone has a proven protocol or a study for more aggressive therapy that I could share with my doctor- please let me know.”
There is lots of information here regarding faster therapy protocols based on proven science no matter if you go op or non-op. If you search using the box in the top right you’ll find blogs with links to research and protocols. Dennis has also posted stuff on the main site.
What I’d like to point out is that you’ve had the surgery and it is what it is, in other words you can’t undo it…therefore, I’d encourage you to avoid the road of self doubt/regret and keep on keeping on…you’ve got this! How do I know? We all recover no matter what and studies also show that at the end of one year we are all basically at the same place. YAY US!
You’ll find blogs here with many flavors…I’d encourage you to look forward, trust your gut, what’s good for one isn’t good for another. Give yourself a break, be your own best friend…and though we all travel slightly different roads pertaining to op vs non op, fast vs slow protocols we can still relate and support each other.
I hope you find a safe haven here…Big smile for you.
It may take some convincing to get your doctor to change but the important thing is if you cannot change his mind in the long term you will be as good as those who were on a more aggressive protocol. This applies to surgical patients only. The main advantage seemed to be quality of life in the early stages. Fortunately for me I suffer from cast claustrophobia and had it removed after a week. There is a link to a study on my page regarding early weight bearing and movement under the further reading tab.
You made the right choice. I’m convinced that surgery is the best way to go on these things and lead to a more rapid and better outcome. This opinion is basically my doctor’s and I agree of course. Get out of the cast at 2 weeks if you can and full weight bearing in a boot as soon as possible. My doctor had me do that and I was back in two shoes before my 6 week appointment. Results vary, but I’m a very active 45 year old and it worked for me. I’ve read, and my doc told me, full weight bearing as soon as you can is instrumental in recovery time. Good luck!
ckotro
Although it has been proven in recent years that, for most patients, surgery is little or no better than a non-op schedule, it is worth adding that for that to be the case, it is vital that, as you describe, weight bearing and early mild exercise in a boot starts as soon as possible, ideally after week 2. 2 shoes before week 6 appointment is earlier than most but cases do vary.
A fast, progressive modern protocol tends to be the same timeline whether starting with surgery or going without. And whichever way you go, the risk of re-rupture is most significant before around week 12. Even then, most cases have been when the patient did something that his or her AT was not strong enough for, maybe a slip, maybe too big a jump too soon, too fast a takeoff when starting a run. Not faults with the techniques used.
Whichever protocol has been prescribed, it is key that you have confidence in the medics. By 4 - 5 months most of us seem to be at a similar stage in any case, so point in regrets.
Linda, your blog not intentionally hijacked! Good luck with your recovery, the time will fly.
Thanks everyone for your responses. I am in the United States. I am day 3 post surgery and doing very well- at least as far as pain goes. I would say that the doctor did an amazing job managing my pain with very limited pain meds needed. I had a visiting nurse that gave me injections of strong anti inflammatory drugs twice a day for the last today’s. A am now justt on an antibiotic for 5 days and Celebrex for next two weeks. I am trying to keep foot elevated and iced and when not elevated can tell I am having a little swelling in my ankle as my cast seems to get tighter. I see the surgeon again on Thursday and will try to explore with him why he wants 8 weeks in a cast and if we can explore other options based on the input of all you nice folks who took the time to respond to me. I am getting a few pins and needles in my heel if I place my foot down, but that sounds somewhat typical based on some of the other blogs on here. Thanks again everyone for your responses and encouragement.
I had surgery 3 weeks and two days ago. I was put in a half cast for two weeks, stitches came out,then full cast for two more. I go this Friday for the boot. Scheduled to have boot for 4 weeks with PT starting my first week in the boot.
Most discomfort was in the first ten days. It was Very painful putting my leg down for any length of time. That slowly disappeared after the 10th day. I can feel it getting better each day. Hang in there for those just coming off surgery.
Hi Linda
From what I learnt over the past 2 years or so, it seems that many os do not trust their patients to follow their protocols, In many cases the os would be correct. Whereas strong sustainable repair starts off with therabands and minor flexing, then moves on quite quickly, even this means no running until past 12+ weeks.
There are those ATR sufferers who cannot bear to wait that long while rushing through the most risky phase. Many are lucky, many are not with some re-rupturing - jumping onto boats, taking 2 stairs at at a time, and so on, at well under 10 weeks.
It appears that a good os or especially a knowledgeable physio will explain all the risks, treat you like an adult, and get you in a boot with weight bearing by end of week 2, hopefully even going to bed without boot at week 4. Crutches weaned off around now too.
They will give you a written protocol, and advise on adjusting the boot ever 2 weeks - to the point where your leg is supported from 30º plantar flexion (down pointing) through 10º dorsi flexion (up). Then, within a week or two, into 2 shoes with the boot handy for riskier ground. for a while.
Your mission, should you choose to accept it, is to persuade your os that you want to follow an aggressive protocol, and exchange the cast for an adjustable boot (preferably with ROM) and that you will follow some sensible rules. If he’s not allowed this previously, what a good trial this will be for him and for you. Read Exeter protocol for a good, well proven guide. Your os could talk to the guys there too - their names are quoted in the online paper.
H
One week post surgery- I had my first post op appt. with the surgeon. He removed the soft cast and examined the incision and stitches. He said everything looked good. They then placed me in a plaster cast ( red- to match my manicure and pedicure)with my toes pointed down on an angle. They told me to continue to keep my foot elevated and iced as much as possible. I will continue to take a daily Celebrex for another 10 days or so. I have another appt. next week,where they will cut a window in my cast and remove the stitches. Cast is a little tight but overall doing and feeling pretty well. Still using the knee scooter. No driving.
Sounds good Linda….nice of them to match your cast too
I got a lazy on my scooter and fell off at week 4, it’s easy to take it for granted after you’ve used it daily for a month. Please, learn from my error make sure your knee is ALWAYS planted firmly on the seat even if going a short distance 
Isnt the knee scooter the best thing ever? I wouldn’t be able to get around at all without it!
Hi Linda
Hope you’re not too disappointed to be still wearing the plaster, and knowing that that is going to be there for some time yet. Have they moved the foot angle this time? Even with re-casting, os’s often do this every 2 weeks or so.
gdubz - I enjoyed my little knee scooter after week 2 and was almost disappointed not to need it after around week 4 because the weight bearing had gone so well. Still I was able to use it as a mobile foot rest when watching tv with my leg up. Must sell it now, it’s been hanging around here too long.
I’m imagining your red cast and matching red toes nails and smiling! Thanks for the chuckle!
Donna- glad I could brighten your day.
Hillie: Yes when they removed the soft cast they seemed to move the foot angle down. Next week they only cut a window in the cast and remove the stitches. No changes in foot angle or cast next week. I am then scheduled to fly back home to NJ on the 13th ( I got hurt during a two month stay in FL to get out of the NJ winter) as long as the incision site still looks good. I then need to change doctors to continue my follow up care in NJ. My surgeon down here was very good and experienced ( mid 50s) but I will be transitioning to a newer /younger ortho surgeon in Nj. I am hoping her rehab protocol may be a little less conservative than the doctor down here- so we will see.
One other thing I notice is that towards end of day -surgical site and sutures seemed to get irritated. I have been taking OTC Tylenol about 1000mg which seems to help. I also have prescription sleep med which at least is giving me a pretty good night sleep - so for those having trouble sleeping- perhaps your doctor can prescribe. I think proper rest and nutrition is important to our recovery.
Does anyone have recommendations on nutrition? I read that pineapple is good for tendon healing, so I have been eating. Also what type of core exercises can be done while only 10 days post op without disturbing the achilles.
Hey Linda…recently Laetitia posted a list of food that is pretty complete. Also, if you put the word “nutrition” into the search box top right of the main page you’ll get blogs about that or that discuss it.
You can do a google search for “seated core workouts”…you’ll get videos as well as descriptive workouts you can do without engaging the lower body. I was pretty happy to find everything I could do without using the calf, even now on days when it’s tired or overworked I can find lots to do with other body parts to move around because exercise feels so good!
Happy Eating and Working out!
Hi Linda!
you can have a look at my story, although we are not in same age bracket, my surgeon is also a conservative one who put me in a cast for 8 weeks.
My story is here:
http://achillesblog.com/nico76/
I am something like 19 weeks since surgery now and happy as ever. Except the size of the calf, everything is close to back to normal, can do everything I want. I was proposed first the conservative approach, but then the surgeon pointed out that for people with high level of activities / sports guy, surgery is the way to go (obviously he is biased). For your info, my surgeon is world expert in the field of achilles rupture - has operated a number of high profile sport pros. He is very conservative as well.
have a look here:
http://www.swissfootcenter.ch/pd-dr-mathieu-assal
Now that surgery is done, keep in mind that everything lies in your hands: careful, step by step and follow guidance. Do not rush for anything, take it slow.
Good luck!
Nicolas