Too Fast?

Had my 4 week check up with my surgeon and on walking into the consultation room (ie in the boot without crutches) he commented - “so you’ve decided your recovery will be very fast?”. I did point out he said that I could move to full weight bearing but couldn’t work out whether he was being critical or not.

Anyway, he seemed very pleased with the healing and the strength in the foot and said that I can move to two shoes around the house assisted by crutches and in 4-5 days without the crutches. I said “so you’ve decided my recovery will be very fast?” but he didn’t seem to get the joke.

That would be two shoes and full weight bearing less than 5 weeks post surgery. I am more than happy to get back to normal asap but that does sound a bit fast (I had full rupture and surgery) but has anyone else done this and did they have any problems?

I had a previous rupture which has healed very well and used the same surgeon (I remember that being fast too) so I am happy to go along with what he says. I am going to obviously be very careful and still use the boot when out. I would like to pass on words of wisdom to anyone wanting the healing to be quicker but I have not done anything specific and assume I just have a progressive surgeon.

11 Responses to “Too Fast?”

  1. 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 most dangerous period once you are in 2 shoes. Most of the re-ruptures occur with a miss-step, slip, fall or doing and exercise that puts too much stress on the tendon too early. I guess you will have to manage that a few weeks more than most. I don’t need to urge you to be careful. I have followed your posts and can tell you already have a level head. The time we spend in the boot or cast is very short compared to the rest of the recovery. All in all I am still happy with how things are going. My strength and muscle is coming back but it is the range of motion that is limiting.

  2. +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.

  3. 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.

  4. 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

  5. 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 that in mind.

    I haven’t got much to report on effects yet as just hobbling around the house. I am not getting swelling or pain but most of the day I am still in the boot. My foot feels fine but there is very limited strength in the calf. I have not tried but pretty sure I could not raise on my toes.

    I agree 100% that different people heal at different rates but I do think it is strange how different Drs’ approaches are so varied given they do not know in advance how a persons body is going to heal. At week 2 when the cast was taken off, nothing was particularly checked out before the Dr said I could have the boot and start to weight bear (beyond checking the position of my foot permitted by my flexibility and putting a bit of pressure on the foot). Maybe they look at the surgery wound and if that has healed very well then they know internally the achilles will be healing. I should really ask my Dr but when he says I can walk, I don’t like to question him in case he changes his mind.

  6. 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

  7. 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

  8. 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

  9. 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 what you say. Walking is all well and good (it is very good) but the fact the doctor is saying you can do this is because they trust that you will be sensible. The tendon is not healed but you can walk without straining it. Anything beyond that would be a risk.

  10. 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 than sorry in the short term, knowing long term my “quicker healing abilities” will be put to better use.

    Anyways, good luck with however you proceed and I hope for the best for you!

  11. 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

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