meskigirl’s AchillesBlog

Comment by SittingintheStands

January 17, 2014 @ 12:15 am

hi meskigirl. Well, that all seems a bit unfair if you ask me. For a doc to ask you to walk after 8 weeks of cast immobilization, and without physical therapy. I was in a cast for 6 weeks and know how stiff and uncomfortable trying to bear weight is. At 7.5 weeks, I am still on crutches and taking it a day at a time. So for you, without being able to ease into it, I would think pushing too hard could result in injury, re-rupture is possible. I would suggest 1. Take it easy, listen to your body and do not try to push through pain, 2. See a physical therapist to help get you back on your feet. They will help with ROM and scar tissue.
Good luck and keep us updated!

Comment by normofthenorth

January 17, 2014 @ 2:03 am

I’m with SitS. “Pushing through the pain” can get ATR patients into trouble, and Docs/OSs don’t have a clue about an individual’s pain threshold or eagerness to push through it. The good news is that repeated but brief and gentle exercise and slow or asymmetrical-stride walking should show pretty quick results without risking reinjury.

If you’re comfortable PWB with 1 crutch, you could walk that way (me, I HATED using 1 crutch!) with a shorter stride when you’re walking past your sad foot. Or you could use 2 crutches for a day or two and walk as normally as possible with only as much weight on “that” foot as seems comfy.

If your discomfort is primarily from sensitivity on the bottom of your foot (often mostly the heel), you could try squishy gel footbeds or even squishy gel shoes like Crocs.

Once you ditch the crutches you may be tempted to hobble with a “peg-leg” and/or your toes splayed out to the side. DON’T! Instead, just shorten that one stride until you gradually get comfy with a longer stride. In a relatively few days, you should find yourself walking ALMOST perfectly normally, with everything except that “push-off” at the end of “that” stride. That usually takes longer.

If you can line up a PT on your own, most of us found it helpful, all the most successful randomized trials used PT, and getting frequent hands-on treatment and advice during ATR Rehab (which you’re obviously not going to get from your OS!) is comforting. There’s a page here somewhere — on achillesblog.com/gerryr and probably also linked from the Main Page — with tips on how to choose a PT.

Good luck!

Comment by Leon

January 18, 2014 @ 9:45 am

hi,
I got my cast removed after 4 weeks of post OP.and wear boot for 2 days ,ditch crutches and wear 2 shoes in the week 5 and walk 200 meters,than 2000 meters a day.I went back to work in the week 8 after post OP.
It is swelling and I have to put ice(or snow) after work.Follow your feeling ,but becareful not fall down and re ruptur anagin.

Comment by meskigirl

January 18, 2014 @ 9:54 am

Thanks all for the comments. The thing that is concerning me the most right now is that I can not bend the knee of my recovering ankle at all while while attempting to walk. The tendon in the ankle is just too tight and it won’t allow me to bend so I think this is what Norm was referring to as “peg leg”? I am walking heel to toe and trying to stretch it but am not noticing much improvement at all. I am doing gentle stretching excercises and massaging the scar area. Granted it has only been 4 days since cast removal so maybe this is all normal. I live in a small town in Maine so my options for PT are very limited but might be worth a try- I have been surfing the net for info about stretching and what to watch out for.

Comment by Leon

January 18, 2014 @ 12:44 pm

For stretching - I am doing every day . Sit with your legs extended and your knees straight.
Loop a towel around the leg to be stretched. Position the towel so that it goes around your foot just under the toes.
Hold each end of the towel in each hand, with your hands positioned above your knees.
Pull back with the towel so that your foot stretches toward you.
Hold the position for at least 15 to 30 seconds.
Repeat 2 to 4 times a session, up to 5 sessions a day.

you can see your improvement every 2 days .

Comment by normofthenorth

January 18, 2014 @ 7:29 pm

I am generally a dove (wimp?) when it comes to post-ATR stretching, just because more of us complain about healing too long than healing too short. But some surgeons and some ops do leave the AT too short, and that causes problems too. (See my recent blog page with a title like “Maybe healing short is scary after all”.)

With any exercises and stretches, it makes sense to be INCREMENTAL. If you did 8 reps a day or two ago and it didn’t cause pain, try 11-ish today, but not 20 or 30. If you stretch with a towel, try it gently the first day and wait to see if your leg complains. A number of us had serious setbacks (in my case, a painful MONTH!) by jumping into something “new and different”, even though it didn’t hurt at all at the time. And at 8 weeks post-op, you’re just entering the highest-risk period for rerupturing, too, so don’t go nuts and Watch Your Step.

After my first ATR — the one that was repaired surgically — when I noticed that my DF ROM was more limited on that ankle than the other (i.e., short AT), I asked my OS, and he told me he made it shorter than original on purpose, to make sure it didn’t heal long. (Years later, it started causing me knee problems — details on my page.)

Comment by meskigirl

January 18, 2014 @ 7:41 pm

I really appreciate the two of you for responding. All great advice and I really like that stretch with the towel and will start trying that along with some other stretches I found on-line. Frankly, I am not too keen on my OS right now for letting me walk away without giving me more info and not too keen on myself for not forcing the issue and asking more questions and being more of a pain in the ****! I am going to go slow and not try to do too much too soon. I will ditch the crutches when I am ready and not on some schedule given to me by the OS - who did not even test my ROM before letting me leave the office. Norm, I will take a look at your page. I was fearing that he left it “short” but am wondering why that would happen since I did not have a rupture - I had chronic tendonosis with over 75% deterioration. So the tendon was somewhat in tact when the surgery happened. Anyhow, it is done and I am focused and committed to make the most of it and to get back to my active life. Thanks for the support!

Comment by sittinginthestands

January 19, 2014 @ 10:26 pm

norm - a few times you have referenced a period of higher re-rupture possibility. what is this window of time and do you have a sense what causes it? too much PT? too much stretching? pushing through pain? or letting guard down when people feel like progress and healing have taken their place? higher rate for op vs non-op?
as impatient as i am in wanting to get on with more aggressive PT, i sure dont want to re-rupture so any info would be great!

Comment by normofthenorth

January 20, 2014 @ 1:22 am

@sittinginthestands, I think the main reasons why so many ruptures happen in roughly the 8-12 weeks post-whatever (op or non-op) period are probably (a) getting out of a cast or boot, which protected against many injuries, and (b) your last one, over-confidence or “letting guard down when people feel like progress and healing have taken their place”. When we first get into 2 shoes, we’re very vulnerable, but things also improve steadily and pretty quickly, so we start feeling much better, and it’s easy to let down your guard. That’s not just about talking on the phone while walking down stairs, or missing curbs or steps, or slipping on banana peels, but also losing our balance (our balance usually sucks after the leg immobilization) while doing things we don’t think about, like putting on pants or socks, or taking them off, or washing or drying our feet, etc., etc., etc.

Watch Your Step is a useful mantra, right up there with Keep it Incremental. OTOH, the best results do NOT come from slow rehab, so you want to keep moving and keep progressing, while avoiding doing too much too soon — and avoiding tripping or falling.

Over-aggressive PT — usually being over-aggressive after a PT tells you to –does cause some re-ruptures, and some other re-injuries later on, too.

Re: op vs. non-op rerupture rates, there seem to be three important groups: (1) Post-op (surgical) patients, (2) Non-op patients who follow a good proven aggressive modern rehab protocol like bit.ly/UWOProtocol or the one from Exeter, and (3) Non-op patients who follow a slow, old-fashioned, “conservative” protocol. There are some variations within the groups, but in general, the 1s and the 2s have very low and very similar rerupture rates, virtually as low as possible (i.e., limited to those who slip and fall or are otherwise “non-compliant”. Those numbers range from 0% to around 4% or 5% in the various studies. The non-op patients sometimes show a rerupture rate around 1% higher than the post-ops, and the difference is usually statistically insignificant, i.e., well within the bounds of random variation.
The 3s — non-op patients who get old-fashioned slow “conservative casting” — consistently show much higher re-rupture rates than the other two groups, often 15% or even worse.
Note that even that bad group has 80% or more patients who do NOT rerupture, but I think there’s still no excuse for any doctors or hospitals to practice that rehab, when the #2 rehab is quicker and easier and so much more successful. It’s just old habits and logical-sounding falsehoods that perpetuate that bad practice — it SEEMS AS IF going slower and spending more time in a cast or a boot and “giving the tendon time to heal” would be safer, but the evidence says it’s actually way riskier.

@MeskiGirl, if your lack of ROM persists despite stretching and walking and “tincture of time”, you may want to think of a surgical repair. Many youngsters get one version of that surgery — in fact, my late Father-in-Law had it done on both his legs and had a long and fit and active life afterwards.
The old standard approach was (and is) basically to use a scalpel to cause an ATR, then let it heal “non-op”, but without putting the foot into a dorsiflexed “equinus” position when immobilized. So it heals longer than it was.
A newer approach is to surgically lengthen the tendon, leaving it stitched together but longer — e.g., with a “Y-V” cut-and-splice. Kkirk and a few other folks here had that kind of surgery, often to repair neglected ATRs that left shortened AT ends. The recovery is pretty similar to normal ATR rehab — no picnic, but do-able, and usually pretty successful.

Comment by Grammy

January 22, 2014 @ 12:30 am

Hi! I am 8.5 weeks post-op and have been in a boot for the past three- removing one lift each week. I have found that each time it takes about five days to get used to the lower elevation and then the pain eases up - wish the swelling would too, good luck with the walking - hope you will find a PT for help with the walking.

Comment by normofthenorth

January 22, 2014 @ 6:23 am

Fight that swelling, Grammy! Elevate and ice, and try a compression sock!

Comment by Ron

January 23, 2014 @ 12:37 am

Hi Meskigirl,

Sounds as if you DO need PT. You have to not only stretch your PF\DF, but also build those pertinent muscles that allow for gait, walking etc. The ankles, tendons and every muscle from toe to hip need to have some type of PT (coupled with walking).

Work on your ROM work and build strength up by walking, using resistance bands - push down (work the push-off muscle), stand on one leg (the bad leg), do heel raises on your good leg, etc. It will take you a year to build that muscle strength back up without real PT, and just walking.

You can also do sitting heel raises with both legs and doing SIT-DOWN\STAND UP Squats (until you can do real squats). This will build your knee, hip and other muscles, and don’t forget about hip flexors.

Some Ortho’s are not that bright. They fix things and do not rebuild things. LOL

Lastly, compression socks help with swelling big time and I never did RICE concept. I just used compression socks all day and have never had much swelling at all. However, the RICE concept works. Rest, Ice, Compression and Elevation.

Good luck and keep us posted.
Ron

Comment by meskigirl

January 26, 2014 @ 9:27 pm

Ron, Forgot to reply to this and to thank you. YES! Doing most of this and it is working. The only thing that I have not done is get compression socks as the swelling seemed pretty minimal at first. However, the past few days it has been really swollen so I am ordering some now. Thanks for the advice!

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