Out of the Boot!

Last Friday I met with my Ortho, I am 8 weeks post injury, and have been in a boot for 2 weeks. I haven’t started any official PT but I’ve been doing ROM exercises. The Ortho said I was about 90% healed up and beyond any rupture unless something traumatic occurs and I should start to wean myself off the boot.  I asked if I can wear a brace instead of the boot (athletic ankle brace - Mc David brand), he said yes.  So I’m out of the boot and using the brace, my ankle is really responding with increase ROM and strength, I’m scheduled for my first PT on Wednesday.  The Ortho said I needn’t come back unless I have a problem, just follow PT instructions and I should be  running by July, 3 months after the injury.  I’m amazed that the prognosis is so good.  This site is so enlightening, because of this site I found an ortho that was progressive and is currently writing a paper on non-surgical intervention of the Achilles tendon rupture.  Some of the modalities that I’ve been using are ROM, compression socks, contrast hydrotherapy, ultrasound, massage, and heat always followed by cold.

Conservative Rehab By Accident

I ruptured my Achilles Tendon while I was working out, I was in a kettle bell / boot camp class that I’ve been taking for 6 months.  We were during 30 seconds of an exercise and then switching to a different exercise.  The station that I injured myself was a sprint with the instructor adding resistance by holding onto a harness that I was wearing.  This was the 3rd time around and it was the 2nd to the last exercise, I hit a wet spot and my left foot went into hyper dorsiflexion  and I felt and heard a pop and I knew actually what it was.  This was on Friday.

I went to the ER and after 2 hours they told me I had ruptured the Achilles Tendon (no surprise), but I needed that referral to see a orthopedic doctor the next week (Tuesday).  They did the MRI and confirmed the rupture and then I got to see the ortho  that day.  He talked to me about conservative rehab but I’m a Nurse with 20 years of Orthopedic Surgery and every surgeon that I had worked with recommended that I do the surgery for a better and quicker rehab, and being as active as I am, I insisted on surgery.  I play volleyball 3-4 times a week, doubles on the beach and indoors, still play in tournaments and the nationals and open events,  mtn bike, canyoneer, hike, you get the drift, I just wanted things to be just like they were before.  Surgery was scheduled for 10 days after the surgery. (I left out all the phone calls I had to make trying to get an OK to go to the ER, and to see a ortho doctor within a short time frame.)

The day of surgery I was laying in the pre-op area, I had talked to the anesthesiologist, the nurse, then the surgeon walks in and tells me the surgery had been pumped due to an emergency head trauma.  He told me that we could reschedule in 2 weeks but he started talking about being conservative again.  I wasn’t buying it!!!  He said that by the time I had the surgery it would be 3 1/2 weeks after the rupture and it would have been 50-60% healed and he would have to go in and tear apart the healing, reconnect the tendon and then the rehab clock would start all over and that I would come out of the cast on the exact same day and start the exact same rehab process, but I would have had to deal with the surgery pain and discomfort.  He sited several studies.

I told him I wanted to see these studies and I would have to come to his office anyways since I had cut off the cast the night before surgery (it was driving me crazy).  I went to his office about 1/2 hour later and he spent about 30 minutes talking to me about surgery vs. non-surgery (since he had nothing to do).  He was very informative and showed me the studies and gave me copies of them.  I was still apprehensive about going the conservative route since I’ve been doing these surgeries for years and had never been exposed to the alternative.

So I’ve been in my current cast (it’s a posterior splint with a complete cast around the calf and ball of the foot (4" at each location so it’s open from mid calves to mid foot with a posterior splint), for 4 weeks with two weeks to go (13 days and a wakeup) but who’s counting?

It seems that there’s not any standard rehab protocol, just whatever the surgeon is trained to do.

I’ve been putting weight on the leg, the surgeon said I could if I tolerated the pain, to get used to walking in a boot without spending too many days on crutches.   I’m not walking on it, since my toes are locked in a downward position.  I’ve been using a "IWalk 2.0 instead of crutches and I find it so much easier to get around.

Reading about other ATR’s and the rehab has helped me get over some of my angsts about non-surgery.