#TornAchilles- Injury/Surgery/1st Followup

First I would like to Thank the team at Achillesblog for helping me get this up and running.

#Tornachilles is the hashtag I use whenever I post a picture of my foot on twitter.  I decided to post pictures of where I take my foot during this journey.  So far its to my Kids B-ball games and work but I hope to increase those pics as my mobility increases.  My handle is @mwz524

I had my injury on 04/21/2013 and surgery on 04/26/2013.  The MRI and x-rays (because of what looked like a bump on my heel they took and X-ray) showed a complete tear and that it was a bad one.  The X-ray showed prior trauma and some calicfaction in the area of the tear indicating prior trauma that never healed correctly.

THE SURGERY:

Due to the severity of the tear my Dr. suggested that we also do an FHL tendon transfer.   The surgery went well and afterwards she said it was worse than he thought and had to remove about 1-1.5 inches of torn tendon so the FHL transfer was a good idea.

POST-OP:

I think my post-op was similar to a lot of peoples where there is no pain due to the nerve block but you BETTER make sure to start your pain meds IMMEIDALY because when the block wears off you will not feel great.  I found this out because while I decided to start my meds immediately upon arriving home, the next day I thought I was feeling ok so i slowed down my meds and THAT wa a BAD idea.  It took me 8 hours to get comfortable again.  There wasnt pain it was just that I couldnt get into a comfortable position.

1ST FOLLOW UP:

BY the 2 week mark I was ancy to get the splint off and see my stiches.  I was a bit scared because I heard that this area is the hardest to heal due to the lack of space between the skin and tendon.  Turns out my Dr. said it looked great, no pus or oozing and the sutures were removed.  I was then told that due to the severity of the tear I would be in a cast for 4 weeks .

The Dr. had me put in a cast with a heel wedge and told me I could walk on it if I wanted to or use my crutches whatever I felt.  He also told me to do as many toe exercised as possible.  stretch the toes massage them, etc.

So here I am at 2 weeks Post-op with a cast for 4 more weeks.

9 Responses to “#TornAchilles- Injury/Surgery/1st Followup”

  1. Interesting combo of aggressive-modern (early WB) and Not So Much (cast, not boot).

    I’ve seen a couple of studies randomizing early WB, but I don’t think I’ve ever seen one randomizing the things you’re not getting — early mobility (foot wiggling) and early (very gentle) PT. My impression from all the studies I’ve seen is that post-op legs tend to end up about the same place in 10-12 months, almost regardless of the rehab protocol. (This is very much in contrast to non-op patients, who suffer worse clinical outcomes if they go slow — or crazy fast — but do great if they go at the right modern-fast-aggressive rate.)

  2. I didn’t think of it that way. My foot is casted in a 25degree downward angle with a heel lift to make the bottom flat so weight bearing doesn’t activate the calf or achilles which is probably why he said I could put weight on it now without worrying about engaging the achilles.

    Gives me more freedom but let’s the achilles confuse to heal uninterrupted.

  3. Michael, it isn’t clear that you’re representing the views of your client (your AT) properly! ;-)
    Standard modern successful rehab — like bit.ly/UWOProtocol — includes NWB for 2 weeks then PWB for 2 weeks, and FWB from 4 weeks on. You’re going roughly that fast, and maybe even faster (depending on when you get to FWB).
    That progression is mostly independent of — and not altered by variations in — the progression from a toe-down ankle angle toward the “neutral” or 90-degree ankle angle. In fact, RyanB and I had an exchange a while back, on his blog, where he even graphed two very different “paths” from NWB in “equinus” to FWB in “neutral” — one of which changes angle quickly but waits longer for FWB, the other of which gets to FWB quickly but waits longer to get to neutral.
    Whether or not you’re “worried about” going to FWB ASAP while immobilized in equinus, the evidence suggests that going to FWB significantly faster than the modern well-documented protocols (like UWO) does harm, even with a fully immobilized ankle in equinus.
    On one of my blog pages (”The case for skipping surgery”?), Ryan posted a link to a recent study that pushed some post-op and non-op ATR patients through rehab at record speed. Both kinds of patients did badly, with unacceptable rerupture rates, though the non-op patients did worse. That’s the only study I’ve seen that tried to go significantly faster than UWO 2010 and Twaddle 2007 etc., and they’ve clearly blazed a path that should NOT be followed.
    Anyway, my point was that your progression NWB-PWB-FWB seems close to optimal, while the rest of your rehab progression is on the slow and old-fashioned side, delaying mobility and PT — and also delaying ankle-angle changes, compared to Ryan’s schedule, though yours will be as fast as UWO if you go straight to neutral at 6 weeks in.

  4. Tomorrow is 8 weeks from my FHL transfer surgery. I can wiggle my toes somewhat, but the center of my foot just below the ball of my foot and along the arch is still swollen and very painful. Met PT said NO HEAT. I’m still using cold therapy but am so very weary of enduring the pain. Wish I could go to sleep and wake up in 6 months and my foot be completely healed. I have pretty good ROM in the ankle joint so the transfer seems to be successful, but don’t know what to do to eliminate the swelling and pain.

  5. Debuff
    Spooky I also had pain same area and made same comments about going to sleep for 6 months, once I Sussed it was nerve pain it helped and it’s steadily going, with strength excercise

  6. I know I have nerve issues with the perneal incision on the outside edge because I have burning and numbness up the outside edge of my calf. But I believe it’s due to swelling that is compressing the sural and perneal nerves. What exercise did you do to strength the arch? I’m doing isometric strength building exercises pressing down on a pillow and pushing up from below. Anything else?

  7. Hi Debuff
    It’s the last 2 weeks I’ve improved but I’m 2o weeks, the seated and standing weighted calf raises and leg press, I still have some burning but I feel much better

  8. Ok - I have started weighted leg lifts at PT. I’ll start doing more leg lifts in the boot at home.

  9. Hi Debuff,
    Think incremental and have rest days, I still have few issues, had a really good week last week biit sore now on base of heel, did a bit of walking today so maybe thats why , however I am putting faith in the strengthening will get things moving.
    RRR

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