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Welcome, Mike! Now you just have to delete what’s here and tell us your story!
Hi everyone, the below post is approximately 5 weeks ago and will start my story. I will post more leading up to where I am today.
Just ruptured my achilles on 1-24-10 playing basketball, ruptured occured about 1.5 hours into game and felt great up to the point it happened. Knew right away it was something serious but my pain was up a little higher than the normal achilles tear, almost near my calf. I still suspected achilles but hoped for calf tear. First doc recommended conservative approach for ruptured achilles and I was placed in boot day after injury. I have a degree in health and kinesiology so I started researching for countless hours and realized I should get a second opinion due to my age (34) and active lifestyle (phys ed teacher, soccer, racquetball and bball daily. Most of the data for the past few years says surgery is necessary for younger athletes. However, I also was very confused on proper treatment since the two most recent studies I found have shown NO difference in the recovery, strength or re-rupture rate of conservative or surgery approach. However, the studies did not tell me the mean age of the individuals or type of tear regarding place and partial/complete or lifestyle. These are very important variables. It appears that many docs are just starting to try having patients go directly to a walking boot for six weeks and then rehab. They also encourage full weight bearing in walking cast from day one for six weeks due to these studies. It is the consensus that this allows for more blood flow to reach tendon and encourage healing and reduce scar tissue(non conservative) as well as not endanger the patient to infection from surgery. From what I read doctors are just turning the corner on this new method and are “butting heads” on proper procedure. The data is too new and has been contested. Nevertheless, I went for a second opinion later this week from a well respected doc. My tear is also high on my ankle near the soleus. Anyone have any data on this type of achilles tear? Can not find ANY. Most people tear the achilles down near the heal. The first doctor insisted that my tear was more favorable for healing because of its location with the non conservative approach even with my age and lifestyle. The second doc disagrees and says it makes no difference where the tear occurs however acknowledges that my tear is abnormally high. He also stated that he could not even find the step/ridge that usually accompanies the tear but I have failed the Thompson test at every attempt.(I am sure it is torn). He said he normally does not order MRI’s but in this case he did. I got the MRI yesterday and will return Tuesday to decide my route of healing. He said the we will most likely have the surgery but wants to know exactly what he is dealing with from the MRI results. I was glad he ordered the MRI because that was my intention as I entered his office. I had two well recognized PT’s (one nationally) insist that I get one of these before the surgery. Most docs go on the Thompson test alone and schedule the “explatory” surgery. There advice is to always ask for MRI because it will tell them specifically where the rupture is and just as important what type of space is between the torn tendon. If the tendons are resting against each other torn, then non conservative approach in the walking boot may be the best method even for me. However, this apparently is usually not the case and there is usually a 2-3 cm space that requires surgery. I have tried to read the films they gave me for the MRI and find my tear at home but keep getting crossed up from photo to photo. I am pretty certain I have found the tear(from learning what to look for from other achilles tear MRI’s online) and I appears to have 1 cm gap between the tendons midway between the soleus and heal. However, I am not certain. I will find out Tuesday. To recap. Always get a second opinion, ask for MRI, and consider the data available on conservative or surgical approach. I will listen and trust what the doctor decides on Tuesday but myself as well as the doctor are leaning toward surgery Wednesday morning. This is due to the data that is available for the success of surgery <5% rerupture rate and other variables that may allow me to return to full sports/work without losing a step. Most people if rehab correctly can get the leg back to 98% of original strength with surgery and GOOD rehab program. 98% will not even be noticeable. The verdict is still out on the conservative approach but with more research it may be the new method for treating most in the future. I do not think I am ready to be the trial case. I know I went in circles with the above post but was just typing off the top of my head. Hope it helps and I will be posting during my recovery process.
Below was part of a discussion I had with someone when deciding my route of recovery
Yeah it is clear that there is no clear cut method for repairing the achilles tear. It seems from the countless replies on this site most doctors are being extremely cautious about rehab. The doctors here in the US seem to agree and encourage the surgery and then casting for two weeks non weight bearing.Then 4-6 weeks of rehab in walking cast weight bearing immediately! In between that time wedges are removed about every ten days until you are at 90 degrees. Once again they encourage weight bearing two weeks after surgery once you are fitted with the walking cast with arches plantarflexed. Rehab takes place after cast is removed(two weeks after surgery) and walking begins without boot at the six week mark in most cases with a ortho shoe with high heel arch. Does this sound consistent with others? because from what I have read this seems extremely agressive. It does however go along with the new studies that I have read concerning rehab of this injury. It is almost like they are in a crossover on how to treat this injury and are pushing for more agressive especially in younger athletes. To recap, the two surgeons here want surgery-two weeks casting no weight- 4 to 6 weeks walking cast(weight bearing immediately)- ortho shoe. Rehab begins immediately after initial cast is removed. Any comments.
I guess it kind of make sense because if you do not have the surgery they want you in the walking cast with arches immediately after injury with full weightbearing. That is where I am now, but I am awaiting surgery this week. The only thing holding me up is my MRI results(get them tomorrow morning), my tear is a bit odd and have two areas of extreme pain, down near my heal(no apparent tear) and way up in my gastroc. It is sore inbetween but not anything like those two areas. Also, my anterior of my shin is blue and bruised all the way up to my knee as well as most of my foot. I’ve got to let the docs do their work but I feel like I have torn my achilles and my gastroc and possibly my plantaris muscle.
below was something i wrote after I decided to go surgical route
Well I am a week and a half post op. Things went smoothly so far, doc says surgery went well. Worst part was when the leg block wore off. That hurt like a $%&& about 8 hrs after surgery. Otherwise I was off the pain meds the next day and dont feel like I have any swelling and haven’t felt any pain as of yet in the area however I am still in cast keeping it elevated but moving around pretty well on crutches. The doc says I get the cast off this Friday and back to the boot I wore before operation. I also believe he said full weight bearing or as much as I can put on the leg without pain immediately only two weeks after the surgery??? but I can not take the boot off at all except to bath. I did not have my surgery until two weeks after my rupture and the interesting thing is when I took it off the morning of surgery I could walk pretty well. I actually walked into the surgery room on my own and they even said wow you are doing pretty well considering the mri showed a complete rupture. If you remember an earlier post I got four opinions on surgery by different orthos in which three recommended surgery due to my lifestyle. The other felt the outcome could be the same without surgery even though my lifestyle career requires it. Two weeks in that boot really seemed to be working but the surgery set me back to day one which was hard to accept. I began second guessing my decision at first but had to trust the docs decision. My rupture gap was 1cm(relatively small) but one of the top orthos(my wife’s dad is a doctor and was able to contact him) explained that it would heal non surgically but over the next months the 1cm gap would become a 4cm gap of “stretched” scar tissue leaving the tendon longer and somewhat weaker. They do always leave an outlet though(anyone else notice that) and said it still could heal good enough non surgically but recommended the surgery. Nevertheless, been scanning the board and can’t really find anyone else who is was full weightbearing two weeks after surgery in boot. I believe he is following the same protocol as the other orthos who state the new studies show weightbearing asap after surgery is beneficial to healing barring their is no wound infection or other problems. I guess it make sense since when they had me following the non surgical route they wanted me full weighbearing immediately keeping boot on all the time. I think the only difference in the new approach of surgery is they need to get the stitching out and watch wound healing for the first two weeks before the put the boot back on with surgery. I’ll give some updates as I go along, wish me luck.
I wrote this after I got my cast off at about eleven days.
Got cast off today and stitches out, everything looked good with no signs of infection. Back in boot for 4 weeks full weightbearing w 3 heal wedges. Walked out of the office with no pain(in boot), remove a wedge next week and then another two weeks later. Last wedge at four week mark. then next visit occurs. Felt good to be mobile without crutches. Must keep boot on at all times except to bath but it is better than that cast! Back to work monday, only lost four days sick time due to the historic snowstorms we just had here in the eastern US. He said he would likely keep me in the boot for a total of six weeks, but I was a little disappointed he did not want any rehab until next visit(six weeks post surgery) He thought the full weightbearing was the best physio until that point and keep some strength in that leg and limit atrophy. I’ll check in if anyone has any questions but otherwise this is where I stand for next four weeks.
Below was a conservation with someone who had a aggressive approach to post surgery
Wow, I thought my doc was aggressive. Unless you meant a few weeks instead of days when you transitioned into a “croc” (I imagine that is a type of shoe). I imagine whatever you are wearing has heal wedges but it doesn’t sound like it. I am not trying to play doc but I have spent extensive time reviewing the MANY different ways of rehabbing this injury but never heard of someone transitioning that fast. I am three weeks post surgery and went into a boot full weightbearing at the eleven day mark with three heal wedges. I get to remove one wedge Friday and it is a pain because one foot is like walking in a high heal. I will be in the boot for a total of six weeks and then i may be able to go into ortho shoe with one wedge pending review. My PT starts at week four of the boot. I am 34 and also play tournament racquetball as well as soccer and basketball. Mine snapped about 1.5 hours into a game of basketball but doing a sharp cut. Sounds like yours may have been “hanging by a thread” and had a lot of microtears to rupture in that fashion because usually it happens with an quick movement or great stress. you can even youtube people who were videoing when it snapped. I love racquetball but man it is hard on your body especially the legs but you already know that. I actually went and got four different opinions in a week period and even considered going the conservative approach to healing as one ortho was confident it would heal the same due to MRI results(full rupture but only 1cm gap). Other three recommended surgery. I wrote on the achilles forum in the surgery forum if your interested. The docs all have different protocol but mine did not want me doing anything but full weightbearing in the boot for the first four weeks after the cast was removed. Did yours have you walking in a shoe by week 3? Concerning the boot, my doc felt that this would help get blood circulation to the tendon for healing and prevent muscle atrophy in the leg and studies are showing this is a good approach. He stressed that anything else I do could stretch the tendon out and effect the main reason for getting the surgery which is adjust the tendon back to its proper length and ensure proper recovery strength/reaction time. I think if you post this on the achilles blog forum you’ll get some good feedback also. I honestly feel that I could take this boot off and start walking now with an ortho shoe but no better after reading countless posts and my docs rec. I am no doc but I would be careful and maybe talk to a PT about what they recommend because some of the things you would like to do sound way down the road. I know three PT’s and they recommend just wiggling your toes, non weightbearing slight plant and dorsiflection as well as the full weightbearing in a boot til week four to six after surgery just as my doc suggested. I have been told that the tendon is very prone to rerupture until about week eight post surgery so be careful. You probably have already but spent some time reading posts and blogs from the forums and you’ll get some good info. I think many will write back to you interested considering your aggressive approach. Hope all goes well.
This is where I am on March 1 2010 as part of a conversation with another blogger.
Hi, I am feeling pretty good also and seem to be healing pretty fast also. My scar is fully healed at three weeks and looks like a 4 inch paper cut with very little swelling if any. Compared to some of the pictures I have seen on the blogs it looks very good so far. I am walking in the boot very well and since I have removed two of the wedges I walk fairly normal(as much as possible). I would like to start PT now since several people posted they started very early but doc says he wants to wait til my next appointment. I am very tempted at times to “safely walk” without it because I feel like I can but I won’t. Since it is not sore my wife and I have been massaging the area quite vigorously twice a day(read that helps with breaking up scar tissue” and soaking it in hot water morning in night followed by ice for blood flow. Not sure if that is helping or not but I feel like I could take this thing off right now and start walking. I tried some non weight bearing ROM and everything moved well and I notice the calf tensing slightly again. I think being in the boot has really helped any atrophy since both calves look the same. The docs seems to have all types of different protocals on these injuries, some people are in the cast for eight weeks at different angles and that seems way out to date. My goal is to be walking normally at the eight week mark in shoes, one leg foot raise at three month mark, and hopefully return to light sports by the four month mark. Right now I am on my feet eight hours a day teaching PE, I think all this weightbearing is helping healing but my foot and heal get pretty tired from this boot. I want shoes! Good luck and hope all goes well.
Hey Mike, it sounds like your doc is a lot like mine. I got stitches out at day 10 and went to the boot directly, FWB allowed. Took me 2 days to trust my foot enough, so day 12 was FWB for me. Sadly, however, it seems my doc wants me in the boot longer than yours now. I just hit week 6 with the boot still on and 2 wedges, though I walk around my house every day in bare feet (and was just outside with my kids in bare feet trying to get something out of a tree). I don’t even see my doc again for 2 more weeks…I’d say your guy is doing a good job. If we lived in the same place I’d give him a call. I know I am ready for life without the boot.
I am 3.5 weeks post surgery and tried Thompson test today out of curiousity. It was “negative” which is a good thing. My surgery foot moved toward the ceiling as it should. ROM was not as good as my good leg but it was good to see. I think surgically most people should have a negative test but I was wondering when you get a negative test with non surgery healing and whether this means anything for my recovery,PT process etc. other than telling me its attached
7 weeks I was into two shoes, took about a week to start walking “normal and had to retrain myself how to walk without boot. Started PT 3x a week and have made good progress. Among many other things I do double heal raises very well and do three sets of 12. Lots of stretching, Then I do a double heal raise, and while up on the balls of my feet lift my good leg off the ground and slowly lower my bad foot back to the ground from the raised positon. This was a little scary at first but my confidence has grown tremendously. I also do sets of balancing on one foot(bad one) on trampoline for 1 minute sequences and finish with 15 minutes of stim for calf. PT has me slated for first one legged heal raises at ten weeks and are preparing me well. I am doing my PT at the Univ. of De. My doc asked me to do be part of study with a prof from UDE and will be doing strength testing for some time. They want me doing the exercise everyday inbetween my sessions. I’ll see if I can post some pictures.
Hi Mike
I ATR’d left foot 1/22/2010, operation 1/24. At 11 weeks in 2 shoes without inserts and no limp unless I’m really tired. Just started toe rise progression at 10 weeks, but only doing 2 legged heel lifts now, Doing left foot balancing, wobble board. Plantar flex against springs. Doc is conservative so I self-elected to go 2 shoes at 7 weeks also, but doc knows what I’m doing. He plans to release me for sports in mid-May. I play light tennis and softball now - have trained myself not to push off or stop on the recovering ankle.
I do a lot of massage/heating to reduce scar tissue. What do you mean by “15 min stim?” Do you use ultrasound? If so, what frequency, etc.?
In surgery the usual Kessler suture was done on me. Did you have any of the advanced sutures, grafts, or blood treatments?
Hi Mike,
If you did a controlled descent of your entire body weight with your injured leg’s calf at eight weeks or so, your rehab is going very well. When you say they want you exercising every day, between PT sessions, that is the way to go. Some folks get a little lazy once they are walking relatively well, and their strength comes back slowly as a result.
Keep it going,
Doug
Hi, i will try to answer your questions. First about the stim. Basically they hook two electrode pads to my calfs and every thirty seconds it causes a strong contraction of my gastroc and soleus with some pulses set in between also. It feels like a really bad leg cramp and is for strengthening the area. Doug is correct about the one footed descend. I started out my PT doing the two legged raises pretty well and last monday they moved me onto the descends. At first I said ” are you sure and said I am only eight weeks” but they said I was ready. After a few sets my confidence grew and I feel pretty comfortable doing them. I also am now part of a study through a prof who is here for the next year from Europe where they are going to test for strength and do ultrasounds of the tendon in the coming months. I find out more later but I know there are 50 rupture patients surgical and non surgical and she came to my PT session last week for some preliminary analysis.Obviously, she is very well informed on the whole achilles “controversy”. I was very surprised to be doing the one legged heal descends at eight weeks but both her and my PT felt controlled descends were safe and quick bursts is where you have to be careful. She also said that my recovery and healing was going well and said one out of ten people could do what I was doing at this point. She also mentioned that the boot must of helped keep my gastroc somewhat strong and that is was contracting with definition. My tendon feels very good but I do have some very minor annoying pain at the heal area from that boot. I know the boot did more good but it left my heal feeling bruised up to this point after being in it for a lengthy time and being on my feet so much at work during this recovery. We also recognized quickly that my ankle strength was poor but that is coming back very quickly. So that is my glitch in my recovery so far. I am glad to hear that you will be released to light sports in mid may. My goal is to be able to play in a soccer league in June and I realize it may be wishful thinking. The prof said that 6 months is the target to return to sports but said some take up to year others are back in four months. She did stress that regardless, the tendon is not fully healed to about the one year mark even though it is fully functional and able to withstand sports so that is something I have seriously consider.
Hi Mike,
So if you and I are in the fastest one out of ten in recovery, the question, in my mind, is the role of early mobilization and calf strength work in that recovery. My strong belief is that too many doctors are way too conservative in their rehab plans, leading to extensive muscle atrophy, which then greatly lengthens the rehab process. I suspect many more than one out of ten could come back this quickly with proper guidance.
Maybe someday,
Doug
I agree totally from my experience. obviously there are a lot of factors and individual plans sometimes need to be made but I believe that eventually early weightbearing will be a key component considering my calves are almost equal size and at the start of PT they said I had lost only about 1cm. My gastroc feels strong but the soleus which was really immobilized tightly in that boot is the weaker portion. I also believe age has had a strong impact on my recovery and we usually bounce back a little faster.
just to follow up on a question from sullypa. I had the usual surgery with no other treatments. They do not use ultrasound in PT on me assuming you mean for scar tissue. I asked why not and if I remember correctly they did not recommend it. can’t remember why. I will be having the other type of ultrasounds done as part of the study I am in to examine the healing of the tendon etc.
Dear Mike
Sounds like you are getting “Russian” or electrical muscle stimulation. I’d like to know the details, if that is possible.
I agree that early WB is key. When I did in my other foot 10 years ago 8 weeks NWB took off many pounds of leg muscle, and required a very long time to recover.
This time, I went PWB 2 days post-op after I slipped while NWB. I decided it was safer putting the cast into a Bledsoe Boot, and using only 1 crutch. Was at the beach walking my dog 6 days postop when my surgeon found me there walking his dog. Other than telling me he wishes me to be safe he allows me to do whatever I want. I’m 65 and teach - have to stand a lot also.
Because I went PWB early, lost little mass, but what was left jiggled all over. Lost most of its tone from lack of use in cast and boot. Coming back quickly now that I’m doing the toe rise progression.
I go to PT, but most of the rehab is from walking the beach. I try 1-2 miles a day at beach & 4-5 miles total each day - use a pedometer. PT told me ROM was normal when I started PT at week 7,
I agree that full tendon strength won’t be until 1 yr out, and then only with lots of work, so limiting impact until then is key. I’m unlikely to get kicked playing tennis or softball, but wear extra protection - high top sneakers plus a Futuro brace (with hard side inserts) for protection. I’m planning to go back to cleats when I get full sports release in May at 3.5 months postop. .
I’m not sure how you would protect yours against kicks if playing soccer, Perhaps you can modify a shin guard to protect your Achilles tendon.
My understanding is that ultrasound stimulates blood flow to the tendon, thereby helping healing by bringing nutrients and taking away waste from the collegen III scar tissue.