Case 25: Non-operative treatment

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seven months post injury (non operative) - not so great results

September 30th, 2009 · 6 Comments

It’s been a while since I posted a blog here. But I feel this information needs to be shared.

Some of you may recall that upon my ATR injury back in February, I was treated non-operatively and was put in this study that injected blood plasma into the injury region. Well … 7 months has gone by and I am still in a less than promising situation. I still have pain (!) while I walk. I still limp noticeably and have difficulty going down the stairs.

I changed physiotherapist last week. He started measuring me up and discovered that my injured tendon has healed long! It’s a rather simple test: I would sit with extended legs in front of me; I would then try to point my tows towards me as much as possible. In normal cases the feet are parallel. In my case, there is a 30 degree angle difference!

The cause? Very likely has to do with the mistake happened at the emerg. The resident had given me a wrong cast and gave me no heel lift. My first appointment was 18 days post injury. So the flat cast/boot could have been the reason.

Now the surgeon wants me to continue more intensive physio. In 2 months he’s going to reevaluate the situation. He may decide to go in and “fix” things, as he said. The whole process will begin from scratch. I am NOT pleased with this.

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6 responses so far ↓

  • 1 annieh // Oct 1, 2009 at 6:34 am

    mazmouza, I think I know exactly where you are coming from and I do remember you.

    I am in a similar situation, organising an MRI scan today, my surgeon says everything is OK but my physio says it isn’t. Went to see physio last night and he brought in another man more experienced in achilles problems. They are at a loss as to the problem, I have absolutely no power or muscle in my leg and it is getting worse. Surgeon thinks it is a spinal problem, I don’t. Have you read TomToms recent posts he has just gone through a second surgery and on his advice I went back to see my surgeon.

    The test you did, are you actually sitting flat on the floor or sitting up with legs straight out in front of you, tried your test this way and my bad foot was easier to point towards me, not a huge difference but different, will mention this test to my physio when I next see him.

    I hope you get better news


  • 2 jeeepin // Oct 1, 2009 at 9:33 am

    I also had the PRP injection which was done on 5/15/09 after a misdiagnosed injury that happened 12/15/08. I am the first patient that my doctor has tried this on so I am also an experiment. My achilles was still hanging on by a thread but everything around it was badly deteriorated due to the first doctor continuously telling me that it was only my calf muscle that I injured. My choice was either a reconstructive surgery or try the PRP. I tried the PRP and mine has healed quite a bit which was visible on an MRI I recently had. It hasn’t completely healed so last week I had a second injection, which hurt at the time and each day has started feeling better. Since it was extremely sore, I was limping pretty good but each day it is getting less. Based on much it healed with the first shot, I am optimistic that the second will finish up the process. Before I had the second injection, I had a very minor limp if I tried to walk fast and it would get sore at the end of the day if I had been on it all day.

    I had been going to physical therapy to build up my calf muscle that was terribly atrophied. The more I built it up the better I walked. Since I still had the small tare, I did reach a point that I could not make the calf muscle any stronger because the tendon would start hurting if I tried heavier weights.

    This is the worst injury I have ever had and unfortunately no matter how you go about fixing it there is no fast way to get over it.

    Hopefully yours gets better soon. I know how frustrating it is. I just want to be completely healed and move on.

    Good luck.

  • 3 tomtom // Oct 1, 2009 at 9:34 am

    mazmouza - As Annie mentioned, I know your situation all to well. My achilles healed “long” as well after the initial rupture and repair surgery. I’m currently 9 weeks post-op from a second surgery to shorten the tendon. I’m not sure whether the tendon elongated post-op or if something wasn’t set right during the surgery. My current feeling is that it happened as I was rehabing. Feel free to peruse through my blog and ask any questions. Hopefully you won’t need a surgical fix, but I may be able to share some of my experiences if you do.

    Annie - Anxious to hear how the MRI goes. To test your dorsiflexion I would try sitting on the floor with your legs stretched out in front of you. Just pull your toes towards your face. As an alternative, you can try lying on your back and bring your legs up straight up, perpendicular to your back, with the bottoms of your feet pointing to the sky. This is easier to do up against a wall. Then, just relax you legs as much as possible and compare how far your toes drop on both feet. Don’t know if I’ve explained that well, but it is essentially a yoga pose called “legs up the wall.” The toes on my injured foot dropped noticeably further than on the uninjured side.

  • 4 2ndtimer // Oct 1, 2009 at 10:37 am

    I am closeby in Oakville, and ruptured my tendon originally on Feb 22.
    I was treated non surgically, too. In emergency they put me into a splint at 90 degrees - which is the wrong thing to do: the technician of the ortho surgeon 2 days later was shaking his head when he saw that. But after that I had the cast with pointed toe for 4 weeks. I got out of the boot at 11 weeks only and had physio 3 times a week, but my tendon was painful, swollen, and I was limping. I re-ruptured after 18 weeks.
    So it seems you were put straight into a boot at 90 degrees (or they call it 0 degrees) angle?! And no-one noticed? I am surprised your tendon managed to reconnect at all.
    You can flex your toe towards you 30 degrees more than the healthy one?? Does not sound good to me!
    It is not very funny when they experiment on us like that….
    Also you seem to have had a mishap at the barber shop… I wonder if you might have actually re-ruptured it. When I re-ruptured it the emerg doctor thought I did not, only the ultrasound confirmed it a day later that it was ruptured.
    I had surgery after, and my leg feels very different. I am just starting to walk again, but I have no pain in the tendon. Neither when I do heel raises. I do not feel confident yet that all is well, but am optimistic.
    So what did the new physio therapist think?
    Keep us posted.

  • 5 normofthenorth // Jan 20, 2010 at 4:27 pm

    You “guys” are all cautionary tales for me! I’m going through the UWO non-surgical protocol, here in Toronto, almost 6 weeks into it.
    I also had PRP injections (3 of ‘em). A brand-new peer-reviewed study shows it’s no more effective on Achilles tendinopathy (not ATRs) than salt water! My physio thinks it could still be effective for ATRs, but that study has to be cautionary, at least.
    So far my rehab seems to be going well, though the one thing I can’t really test yet is my AT!!
    My first torn one ended up a bit short post-op. The test I used was like the old-fashioned AT stretch: Stand at a wall and move your foot back, away from the wall, flat on the floor, ’til it won’t flex any more. You can do it with both feet at once, which will give you an instant comparison.
    My surgically-repaired one wouldn’t flex as far as my other one when I tested them 1-to-7-ish years ago. It didn’t affect anything except that test, and my surgeon said “Good, I try to make it a bit on the short side, because that’s better than too long.”
    Mazmouza, if you’re still there, I’m sure we’d all like an update. I hope you’ve had some joy.

  • 6 mazmouza // Jan 23, 2010 at 10:12 am

    Thanks for writing…. I’m now in my 12th month. I am NOT happy with the results. My tendon healed long, actually. For that reason I have great difficulty lifting on the injured leg. The tendon is sore, stiff and painful every single morning. I can’t go down the stairs without holding onto rails, still! I can walk (with a slight limp), job (with a noticable limp) and do other phyical activities, however. The only bothersome issue is the morning pain and the inability to lift myself.

    In retrospect, I wish I hadn’t gone through the non-operative path. My surgeons at Fowler are useless! Everytime I tell them about my challenges they say: “oh well, statistically some of them treatments fail”. I must say though that the main issue could be traced back to the emergency room when the idiot gave me the wrong cast (a short one) and didn’t put a heel lift in there. It took me 3 weeks to see the surgeons. So I am guessing that initial mistake is the main reason why I am suffering now.

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

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