Archive for June, 2011

Jun 18 2011

2 week specialist visit - am I healing?

Published by mtbrider under Uncategorized

Well I have just had my 2 week specialist visit at the local hospital.

Things went ok but I got the impression that the doc had seen this injury far too many times before, he was with me for about 1-2 minutes max. Basically my cast got taken off and then he came in and had a wee feel and poke. He asked where the most pain came from as he did this, and this was my lower calf. He then said “OK we will put you in another cast, foot still pointing down for 4 weeks then will put you in another one for 2 with the foot slightly flatter then see from there.

This was where I asked him about the chances/benefits of being placed in a moon boot instead of a cast. His answer was almost a telling off/lecture based on a greater risk of re-rupture if you take the moon boot option. I gave him my best ‘I would like a moon boot, I have done research about it… please’ face but he did not seem to read it at all. He left the cubicle. Two minutes later he came back and told me that I will be in a cast with a bowler iron (steel brace with small walking pad below the foot) for 4 weeks then I can go into a moon boot. Obviously my ‘I would like a moon boot, I have done research about it… please’ face had a much greater impact than previously thought. Then he took off.

So here I am resting up with another cast which I was told, by the nurses later, means that it is healing - big yay. They also told me I can weight bear on the cast ‘foot pad’ when I like. I am planning on taking it very easy this week (Week 3), then will try to weight bear more when standing upright and stationary for the following 3 weeks of this cast. Want to take it slowly at this point.

My pain is about 1-2/10 during the day, mainly around my whole ankle and a bit on the lower calf. Some nights while sleeping I wake up with the pain about 5/10 but that feels more like a discomfort from the cast being restrictive. I am not taking any pain medication or anything, I like to know what me body is telling me and feels like as much as possible.

Good news on the work front too, I am heading back on Monday, 2 weeks and 2 days after the rupture. I am lucky I am a primary school teacher so will be ok. The kids will be pretty excited about being allowed to get the photocopying, printing, reading books etc so that is all good. I feel a return to work will help speed up the whole process too as my mind will be busy with other things. I will be taking it easy, no worries there. Also it will be easier on my wonderful wife who has been busy looking after me all day as well as our two wee kids.

Thanks to those people relying to my posts. Nice to know of the support out there from strangers, and kinda nice to know my writing does not send people to sleep. Completely anyway.

11 responses so far

Jun 15 2011

10 days post rupture, my current thinking

Published by mtbrider under Uncategorized

Well, it is just over 1 week post rupture. I have my orthopedic specialist appointment tomorrow and I am pretty excited (and hopeful) about going along and being told my achilles is beginning to heal well by itself. The last 10 days have been pretty boring, I have pretty much kept my foot elevated as much as possible, including having some pillows under it when sleeping. The achilles pain has been pretty small, maybe a 2/10, however the cast feels a bit tight  around the middle of my foot. My family has been awesome. my wife has done EVERYTHING around the house and my two kids (4 and 2) are doing their bit too. It makes being in this situation much easier with the support of a great family.

The things I have found interesting are:

1. Going to the toilet at night. Usually at night I make my way down the hallway in a sleepy stagger, however with the injury I need to stand outside our bedroom door for 2-3 mins to wake up before making the trip safely.

2. Not being able to carry stuff. I have never had crutches before and never realised that you can not really carry anything. It is obvious when you think about it but by having a crutch in each hand you can not carry anything else. Can’t take my dirty plate to the bench, can’t carry my water bottle to the sink to fill it up, can’t carry my clean clothes to the shower….

3. How funny Cheers is. The writers were clever people to be able to write such a funny programme shot entirely in a bar. Luckily this programme is on tv for an hour each morning and an hour each afternoon. Unluckily the two morning shows are repeats from the evening before. It is probably the one time in life alzheimers would be a real bonus.

4. How you take your mobility for granted. When you walk and move so easily in everyday life you never think about how fortunate you are to be able to do so. It is in times such as this you think about how something as simple as walking is actually pretty damn cool, and a privilege.

5. I am thinking of this injury as a challenge to beat, not a hinderance. It is by encountering instances such as an ATR that you can test yourself and find out more about the person that you are. You can be a sad and down person who looks at the next 12 months as being a right bitch and a nuisance, or you can see it as a challenge, a time to find out more about the type of person you are. It is also a time to show your family and friends more about the person you are too.

So basically I am not that annoyed at my injury. From what I have read any sportsperson can get an ATR. From the weekend tennis player, to the most supported, well-trained and fit sportspeople (e.g All Black, Dan Carter). The alternative? Sell all your sportsgear and  become a much less active person who spends most of their time on the couch? Yeah, you could, just don’t get off that couch to get another chocolate biscuit, you could get an ATR doing that too.

3 responses so far

Jun 10 2011

Bruce Twaddle’s recovery plan (copied off Bronny’s blog)

Published by mtbrider under Uncategorized

Hi i copied this from Bronny’s blog - hope you do not mind Bronny. It outlines the manner in which Bruce Twaddle approaches an ATR. This is pretty much whay I think I would like to go through:

Hi all

Awhile back I said I’d emailed Bruce Twaddle who was one of the authors of the NZ study that Norm has referenced which looked at operative and non-operative recovery and showed similar results for the two.  Anyway, he responded with his protocol which he was happy for me to post here (”Knowledge is Power”). The same protocol was applied to both operative and non-operative. I don’t have the full results but you can see the summary on Norm’s blog I think.

In addition to the protocol I asked him about heel raises in particular (as I went to heel raises for the 8-12 week stage) and he commented that while he isn’t a big user of heel raises, he recognises that some people feel more comfortable with them for awhile (i.e didn’t seem to think there was a problem with that).  I don’t want to get into a conversation about surgical /non surgical here, but he also commented that he doesn’t  see any place for surgery in the primary treatment of ATR even in elite athletes - he will operate if people want it, but would apply the same rehab.

So here it is:

1. For the first 2 weeks after injury the patient should be immobilised in a hanging equinus pop (not forced equinus) and be mobilising non-weight bearing.

2. After 2 weeks up until 4 weeks from injury the patient can be placed in a removal orthosis set at 20deg of equinus. The patient is allowed to remove their foot from the boot for 5 minutes of every hour and move their ankle with dorsiflexion and plantar flexion, being careful not to come beyond a right angle, as the greatest risk is having a tendon that heals long. This should be repeated 5 minutes of every hour where possible.

3. At 4 weeks from Injury the moon boot is brought to 10deg of equinus and the range of motion exercises continue, being careful again not to bring the ankle beyound a right angle position. The patient can be touch weight bearing through the toe of the boot , up to 20kgs of pressure, from 4-6 weeks.

4. At 6 weeks from injury the patient can bring the orthosis to O deg and begin weight bearing as tolerated, weaning himself/herself off the crutches by 8 weeks from injury. They need to continue on with the range of motion exercises of their ankle and can remove the orthosis at night.

5. At 8 weeks from injury they can come out of the boot and start toe raising exercises, increasing the weight bearing on the affected leg. When they can single leg toe raise and support their own weight they can start a stretching and strenthening programme and increase their activity level according to their symptoms. This should allow them a quick and full a functional recovery as possible.

2 responses so far

Jun 08 2011

A NZ’er joining the club

Published by mtbrider under Uncategorized

Hi all,

Looks like you have another achilles tear member. I am 34 and live in New Zealand. I tore my achilles last Saturday (5 June 2011) playing football and am currently spending my days lying on the couch with my right leg elevated above my heart 24 hrs a day. I got my below the knee cast put on the following morning after my tear.

As I am couchridden I have been on the net and have been researching this injury and treatment. My local hospital has a plan of recovery is (if all goes to plan) of 2 weeks in cast where toe points down, 4 weeks in a cast with walking attachment, 2 weeks in a cast with foot in more normal position, then cast off after these 8 weeks and into heel raises on my shoe. It seems different hospitals in NZ have different approaches depending on the preference of the specialists. Some use moonboots, some stick with casts. They all start of with conservative treatment from what I understand.

Now I have been researching and reading about my injury (not much else to do as I am stuck on the couch) and came across that study where after the 2 weeks patients were put into a boot with partial movement. This is basically to get the tendon moving early on in the recovery process to increase bloodflow and promote better healing. It also basically implied that having you foot stuck in a cast with no movement for 8 weeks is not the best option.

Many of you will be aware of the study but if not I have attached these for you to read (if you are interested):

http://achillesblog.com/files/2008/03/jbjsi01401v1.pdf (the study)

http://www.eorthopod.com/content/new-study-challenges-surgery-for-achilles-tendon-ruptures (comment)

http://www.cfas-uk.com/pdf/vacoped-rehab.pdf (a suggested programme)

Now I’m not a doctor but I like what this programme suggests, it makes sense to me.

Now basically I think I want to see if the specialist at the hospital would be interested to allow me to follow this programme. I do not want to come across as some know-it-all who has spent too much time on the internet, he is the specialist after all. In your opinions do you like the approach this takes/would a request like this be ok to ask my specialist? What are your opinions of cast for 8 weeks vs 2 week cast then boot?

Cheers for all your help

a broken mtbrider

4 responses so far