markuk’s AchillesBlog

I had rupture repair Nov 16 2015. I had one surgery for what was a rejection of what was believed to be the graft. I have had a total of 6 surgeries in total and still have sutures and material coming out of inclosed surgical sites. My surgeon is top notch and I’m 30 years only seen this happen one other time. 5 years prior he repaired my other Achilles and I had 0 complications. My body just doesn’t want to keep the foreign sutures in my body. I’m currently in paramedic school and am sucking it up till I get done.

Hello,, I had a complete rupture,, recovery sounds like yours even up to a wound developing and a suture coming out. However, every few weeks I kept getting wounds and sutures! My initial repair was November 17, 10 and eventually had to get a debridement on September 29, 2011. The surgeon just went in to see what was going on inside and turned out there was an infection! Now I’m back on a 6 week non-bearing status due to the debridement surgery and a 2 day stay at the hospital ended up being a 7 day stay with an anti-biotic IV drip and a 4 week IV PIC in my arm for home anti-biotic treatment!
This whole ordeal has been a nightmare! I’m hoping that with this debridement (cleaning) I will be on my way to my recovery!! By the way,, I couln’t do therapy due to the wounds!!!

If your body wants rid of something and it can’t break it down, out through the skin is one of its defense mechanisms. Amazing thing the body, really is.

It is a bit of an opening up of the wound but is only superficial and the surgeon checked it out on my visit so happy that it is not infected. It is just where the stitches have disolved and the movement of walking and flexing the foot has not allowed the surface to fully heal right at the bottom of the incision nearest to the heal.

I was paranoid about it being infected and prior to seeing the dr was a bit unsure as to how I would know it was infected (it was swollen and sore but then I would expect that having ruptured my achilles).

In the end dr said (and good for anyone else like me paranoid but a bit in the dark) main signs are:
- pain when not under pressure (ie if there is throbbing pain in the wound when at rest)
- yellow discharge/pus
- smell
- swelling and tenderness (especially if area affected growing)

Is it a blister or has the wound opened up?? Those are 2 different things. I would say blister is no big deal at all but if the wound has opened up you need make sure it has not gotten infected!

Great post. As for me, I am not planning on rushing my recovery. I was told I would be in a plaster cast for 3 weeks and move to a boot for approx 8 - 10 weeks after. Reading most of the blogs, I’ve found that people who re-injure themselves do so because they rushed their recovery and did not allow the tendon to naturally heal. Most professional sports athletes who have this injury, recover quickly but they have the best physical therapists, sports doctors, athletic directors and medicines money can buy to help them recover quickly. That is why they are injured and return within a few games or by the next season. As an average working person, I am not making 4 million to run up and down a basketball court, so my body takes a little longer to heal and I am in no rush to make it go faster than what has been determined by my doctor. Best of luck to everyone during their recovery.
Mr Knox 30

Hi Mark

I would put myself in the category of a “fast healer”. I was FWB after 2 weeks and have started doing some “walking” round the house at 6 weeks.

What I wouldn’t do though is move to 2 shoes. Personally there are 101 things you can do to speed them things up. Calf tensing, pushing against your hang with the top of your foot, pushing against the floor, range of movement exercises etc. All these can be done with far less risk than walking normally and risking re-rupture.

I only take that line as one of the things I’ve done in the last couple of weeks is note the number of times I would have stopped/pushed back off my bad leg because I forgot something or someone walked in the way etc. I can say it comes to at least 5 times a day every single day and what worries me is every single one of them events is a possible re-rupture accident waiting to happen.

I think we all want to move fast but just reading Doug53’s blog again, although he moved fast at the start, after 5/6 months he didn’t seem that much further than anyone else and it wasn’t until 9 months he dunked a basketball.
Personally I would rather be safer

Tara
My treatment is private and I still had to pay for the boot (insurance didn’t cover it). I bought it back when inruptured the other Achilles so I am really getting my money’s worth (every cloud). However, I agree 100% with your surgeon that they should be on the NHS. The difference getting in the boot makes to the quality of life during recovery is immeasurable (not to mention the posibility that early weight bearing could be beneficial to healing). Cost to a hospital of these boots is insignificant in the grand scheme of things (probably the same as the cost of the painkillers given to me when discharged that I never needed).

Stuart - re ‘quick healers’ - I would direct you to a documentary I once saw - x men origins - Wolverine. But in all seriousness I agree that there are a whole bunch of factors to quicker recovery. Putting yourself (and a doctor allowing) into a position where the healing is best served (in particular I think the first two weeks for me was important with complete immobility, leg raised,etc and not everyone is able to do that practically).

Me and anyone who is early walking need to bear in mind wh

Great article stuart, since this injury i never knew tendons in such depth my sport science degree only touched on tendons which is shame with the importance of there role especially within sport. im 30yrs old (just lol) and always done sport my whole life so think this aids the heeling process in any injury ive had. yeah i do work sensible and do know my body limits ie. one day i was fine and heeling and walking well the next id wake up and just know in my head i had to rest my leg all day so did and just did paper work and calls oh and watched lots of DVDS with my daughter hehe Rango funny lol
also to this day ive made my own rule up at 5pm every night i took the boot off and rested my foot from that point and made sure it never touched the floor till morning.
from reading articles i believe the equal balance of rest and mobility is the key to the heeling so enough rest for tendon to heel and enough mobility so muscle wastage is limited.
speak soon Tara x

Need to be careful with the train of thought that some people are quick healers. This is not as true to say as ’some will take longer than others to heal.’ Factors that affect healing include age, blood flow to the injured area and things we do during our recovery. There are lots more but we don’t have to get into them. Doctors know how long it takes for the tendons tto heal. The healing process has been very well researched and apart from a divine intervention it will take about 12 weeks. Below are a couple of articles worth reading. Collagen III is not very strong and that is mostly what you have at the moment. As your rehab continues Collagen I replaces it. This type is aligned, thin and much stronger. I would not suggest anyone at 6 weeks try a heel raise. I think you doctor is using the most recent research and is confident that you will work sensibly within the limits of your body.

http://orthopedictherapist.com/2010/01/tendon-healing-and-rehabilitation/
http://en.wikipedia.org/wiki/Tendon

hiya Mark
your completely right as they say “dont run before you can walk” we need to keep steady, i too have been wearing the boot outside for that exact reason in case i slip etc,,, plus i live down a cobble road so not a good idea lol. i wear walking boots to drive in as it protects the AT area which is good ,think i might live in them for next 6months long time till im in heels again lol.
ive been told from the surgeon takes 3 months for the tendon its self to completely heel inside so a long time, he even said your better off breaking your leg. my daughter broke her leg 4 weeks before i did my ATR so ive watched how quick shes heeled from broken bones , i think its amazing how bones fuse back together and tendons, our bodies really are a complex structure.

did you get your boot on the NHS? or have to buy it? i had to buy mine, surgeon said it was a sore spot with him hes been fighting years to get them in the hospital on the NHS but i can see why they refuse money and there not re useable to another person.

Tara

Thanks Stuart and Normofthenorth. It was interesting to read Doug53’s blog although I think I would have lacked the balls to take that all on without the Dr’s full backing. Good that it worked out for him. I don’t think I have had any particularly more strengthening suture and certainly no graft but the Dr knows from last time that I heal quite quick I suppose.

Taraw
Good to also see someone else is healing quickly. I am about a week behind you and am walking with one crutch around the house and will move to ditching the crutch. However, when out of the house I am going to keep the boot until at least my 6 week check up. I do not think we are likely to re-rupture from walking without the boot but as Stuart points out the most likely rupture would be from a slip or sudden pressure and I do not want to risk that and it is much harder to control against that out and about. I again agree with Stuart that we early improvers have to be careful for a longer period. Whislt we may think we have been walking for 5 weeks and therefore safer, we would still be at 10 weeks post op and others would still be in casts so we need to bear

hiya Mark
i too think im heeling too fast i was 5 week post op yesterday (NHS) and im walking in shoes and driving too already, i was 1 week plaster caster then 1 week fibre cast which was set 15degree not far off neutral position but i was told i had strong flexers in my foot becasue when i did the ATR i still had slight movement and confused the doctors as when i went in for surgery i had a inch gap between the ends, at 2 week mark i was put into CAM boot day 16 i was FWB and ditched the crutches. how does your foot feel? i still get swelling on a evening if ive been on it all day, i can walk fine with a slight limp one thing i cant do it raise on my tip toes the muscles are so weak in that foot, can you do that? i think the heeling process completely depends on you and your body after all where all completely different and heel at different rates plus i think you know your own body and limits, well done with the heeling mark
speak soon Tara x

LARS has mostly been performed on ligaments such as the ACL or shoulder ligaments but is now being used in a variety of other areas including the achilles tendon. The results in elite athletes have been mixed because of the enormous stress they put on the artificial tendon/ligament before it has properly healed. It gets them back on the field early and I guess its a money thing. Early trials had some issues with the synthetic tissue rejection and some deep wound infection but they seem to have rectified those problems. There would still be an increased surgery risk I would think. The Japenese study seems to have been a variation of this using a new type of suture material. Maybe I will give it a go for the other one. Wait a while (a very long while I hope) and I will let you all know if it works out.

+1 to Stuart’s post. You could check doug53’s blog for an example of a post-op patient who went very fast (and came out fine).
In my own early-ish page on Studies. . ., near the bottom, I comment on a small Japanese report of ~36 ATR patients who got an ultra-strong surgery and were back to high-risk sports in record time.
I wasn’t aware of LARS, though several patients here have had various grafts, most recently a few with their own big-toe-flexor tendon. (I think that was the surgery that David Beckham got.)
Most of the RCT studies I’ve seen comparing grafts to normal non-graft open repairs haven’t found much (or any) benefit from the grafts.

5 weeks does seem a bit quick but not necessarily out of the question. Most research suggests you are still laying collagen type III down until 6 weeks. This type of collagen is not very organised or strong. I am sure there would not be many that would question their doctor if told they can speed things up but certainly do when told the opposite. There are a number of different suture methods used for this surgery as well as different suture material. If your doctor is progressive, he may be up to date with this new technology and as a result is confident you can take this next step in your rehab. My doctor (who was not my surgeon) told me that I would have been the perfect candidate for LARS which adds an artificial tendon that takes the load until the body heals around it. I would have been walking in 2 shoes without crutches in 2 weeks. I was done through the public hospital system which costs nothing but could have had this done privately with my insurance and a co-payment. I wish I had been told this before surgery. As you know from past experience, the re-rupture danger period starts to slide after 12 weeks with the

I consider (or considered after this injury) myself to be pretty fit, playing sports 3/4 times a week. I’ve never done a traditional warm up with stretches as to me, you would need to cater that stretching to the specific activity you’re doing. Instead I have always spent the first 5 minutes easing myself into that activity as the only thing guarenteed to use all the bits that I need to use is that activity itself!

I did read somewhere recently, but can not for the life of me find it again, that a good a warm up as any is to do a 5 minute quick walk as this will warm up sufficiently all the major parts you need.

Personally I’ll stick to my way of warming up.
I don’t believe my achilles went due to some pre-disposed weakness. For me I believe it was down to pushing my body way past its physical limits when exhausted.

The stats on ATR patients rupturing the other side — one study linked from this site says ~200 TIMES the normal risk, with only 4 yrs of follow-up, IIRC!! — suggest that many of us have a pre-existing condition that makes ATR unusually likely.

The dominant theory used to be that there’s a blood-flow “watershed” zone a few inches above the heel — and presumably more extreme in us higher-risk folks — where the blood stagnates, so the tendon is slowly starved and deteriorates. I think I’ve seen a recent study or two that calls that theory into question, but SOMETHING seems to make a “tear here” line on our ATs.

“By design”, every tendon in our bodies is significantly stronger than the muscle that pulls on it — or we’d be tearing tendons every day or two. But members of this club have legs that somehow broke that rule, at least on one side.

I’m a big fan of “living our lives”, including returning to the activities we love, even if they present a risk of an other-side ATR. (And I say that after I LOST the bet myself!) Mind you, there are very few decisions that are as properly personal and “there’s no wrong answer” as that

Hi Polly,
In truth, I wouldn’t like to guide anyone one way or the other given that professionals seem to be in dispute but personally think warming up which includes gentle stretching must help. I think it is the intense stretching (to the point when you feel a resistance) that puts the body under stress. But that said, what does Mr Two Rupture here know?

At the end if the day, these ruptures happen and I think I either was very unlucky or I had a pre-existing problem. I do not believe anyone should give up what they enjoy because of a what if. I could have kept myself fitter but people in a much worse state of fitness than me will pick up a racket or kick a football for the first time in years and not get injured. All we can do is follow general good advice (maintain a good level of fitness, keep weight down, build up to any intense sport, warm up properly, etc) and live our lives. I hadn’t played tennis in years so I will not miss it if I don’t play again but I like to ski so it will not stop me doing that.

Hi Markuk, so sorry to hear about your left rupture. it is my biggest, worstest fear. You made the comment but left it open to interpretation…Just confirming that you believe that pre-sport stretching is important? I tend to agree with you. I am hesitant to even think about returning to tennis at the same level i was playing before because I am nervous about rupturing my other (right) tendon. Well, you are well informed about what is in store for you in the next few weeks, no doubt, you are wiser since you’ve been through this before. Best of luck to you!

Found a more recent blog on NY TImes:
http://well.blogs.nytimes.com/2010/09/01/phys-ed-does-stretching-before-running-prevent-injuries

Seems to be contrasting opinions still but I never used to stretch pre-sport (warm up but not stretch) and stretching was for post exercise.

I think a big factor for me was being generally in worse condition than I was 3-4 years ago and suddenly playing tennis. Whilst I have got moderately “gym fit” since 1st rupture, level of fitness was much less and hadn’t really been playing the higher impact sports.

Greetings from a fellow “both sides now” ATR guy — though it took me 8 years after the first to tear the second.

If you read the latest studies on pre-sports stretching, I think you’ll find that it is consistently detrimental to strength and performance, and probably also negative for avoiding injuries! Having non-sports stretching-exercise sessions may be beneficial, but stretching as part of a pre-sports warmup seems to be a Bad Idea, based on the evidence I’ve seen.

There’s a good NYTimes article (online) from 3-4 yrs ago that summarizes the evidence up to that point. I think the evidence that pre-sports stretching hurts strength and performance, may have come more recently.