And the results are IN!


Written on May 6, 2010 – 7:28 pm | by normofthenorth

As I posted last night,

Tomorrow my PT puts me on the computerized machine that’s going to compare my healing ankle-and-AT’s performance to the other side. My ROM is pretty close to 100%, but I expect the various strength benchmarks to be maybe in the 45%-65% range. We’ll see.

Well, I’ve now got a spiffy 1-page summary printout with full-color graphs and a chart with a bunch of numbers showing my quantitative results at 21 weeks, just under 5 months “post-NON-op”.

I thought there would be more different measurements, including inversion and eversion. All they measured was strength and ROM in plantar- and dorsi-flexion. Not static strength, but dynamic strength, at just one rate of flexion — 60 degrees per second.

As I already knew, my ROM is virtually identical on both sides — in fact, a hair better on the “involved” (aka “bad” or “healing” or “left”) side, at 60.3 vs. 58.4 degrees!

My dorsiflexion torque and power and work are ALSO a bit better on the “involved” (aka “bad” or “healing”) side, by margins ranging from 0.8% (peak torque) to 5.8% (total work), with “max rep total work” and “avg. power” falling in-between.

I am “left-footed”, so maybe that’s why that foot is stronger at dorsiflexing? That’s also a move that I work hard all Summer, while “hiking” out the side of a small sailboat — and the first race is tomorrow night!!

On the colored bar charts, they included 3 bars: my “involved” foot, my “uninvolved” foot, and a bar marked “goal”. The PT/operator said that was NCAA athletes. Interestingly, while my “good” foot is 12.7% below the “goal” in PLANTARflexion (in “PK TORQ / BODY WEIGHT %”), I’m more than 7% BEYOND the “goal” in DORSIflexion! (Maybe they weren’t collegiate dinghy racers!)

In the “real bottom line” of plantarflexion strength — a pretty pure test of the strength of my healing/healed AT and my atrophied-and-recovering calf muscle — the “deficit” ranges from 29% (peak torque) up to 37% (”avg. power”), with “max rep total work” and “total work” falling in-between at 32.1% and 32.8% deficits.

So my recovering ankle-AT-calf is 63%-71% as strong/powerful as my “good” one, depending on the measurement. That’s a bit higher than I was guessing, which I think is good, right? The PT who did the measurement, and my Ortho surgeon — remember I did NOT have surgery on my AT this time! — both thought I was doing well considering the time.

Actually, I experienced a bit of a strength breakthrough this morning, before I went for the test — I SORT OF did my first 1-leg heel raise, SORT OF. At this point, I can support my entire weight (which is about 5-10 pounds higher than it SHOULD be!) on the ball of my foot, AS LONG AS MY KNEE IS BENT. Specifically, I can “roll” forward on that foot, with all my weight on it, until my heel is up in the air, with my knee bent, and hold it.

It’s definitely not a normal, full-strength, stand-tall heel raise, but it’s one more little landmark on this “marathon” we’re on, and it does indicate that this long (and sometimes frustrating) “plateau” does actually have a slope, and it is going in the right direction. It’s nothing like the rapid-fire early progress of “losing” heel lifts, getting to PWB & FWB, and getting into 2 shoes, but it’s there, and it’s cheery!

On a functional note, I’ve really been enjoying bicycling and even short bursts of running, and my bod is in much better shape than it was just recently — e.g., when I was skiing in Whistler on April 11-17!

Onward and upward. Good healing, all!

  1. 97 Responses to “And the results are IN!”

  2. By normofthenorth on May 6, 2010 | Reply

    BTW, if there are any Physics purists in the crowd (I’m a “half-baked Physicist” myself), I’ve discovered a bit of inelegance or error in one of the measures they presented — and prominently, too.

    Specifically, that “PK TORQ / BODY WEIGHT %” is a little bit flaky, since it pretends to be a meaningful dimensionless ratio, but it’s really torque (in FOOT-pounds) divided by weight (in pounds).

    It’s a pretty pedantic point, but that flakiness means that (e.g.) when the chart says my left foot is at 29.7% of something and my right foot is at 41.9% of that same something, the “something” has no physical reality to it. And in the rest of the world, where the Imperial “foot” isn’t even used, those torque-to-weight flaky ratios would be totally different numbers.

    Contrast that with a meaningful ratio, like peak force (pushing away-down with the ball of my foot) divided by my body weight — in POUNDS/POUNDS — and the answer is the same everywhere in the world, even if it’s measured in KILOGRAMS/KILOGRAMS or whatever. And if I can push down with 93.9% of my total weight, that’s a perfectly meaningful ratio, which has a clear physical reality, independent of the units used to calculate it.

    Similarly, the % ratios between my left-side results and my right-side results (or either side compared to the “goal”) are perfectly meaningful (and dimensionless) ratios.

    (Here ends the pedantic nit-picking rant! I’ll try to control myself better in the future.)

  3. By ultidad on May 6, 2010 | Reply

    ah, but maybe now you can go to bars and brag that your Peak Torque/Body Weight Percent is 10 inches!

  4. By normofthenorth on May 7, 2010 | Reply

    No, but my Official Pedantry-and-Nitpicking Index is!

  5. By mikek753 on May 7, 2010 | Reply

    did you just try 1 heel raise at 22 weeks for the 1st time?
    Or I missed something?
    If that wasn’t 1st time then when the 1st time?

    I started at 9 weeks 2 foot heel raise against a wall - 10 times a set, 2 sets a day.
    then dorsiflex against a wall while good foot forward and bend 90 degree - stay for 60 sec. not actually much pressure at healing tendon, but for 60 sec it starts feeling pain.
    trying to be careful not to push much.

  6. By normofthenorth on May 7, 2010 | Reply

    Mike, I’m not sure what it means to “try” a 1-leg heel raise when you’re not strong enough to DO one. But I clearly couldn’t do one until that ALMOST experience yesterday morning.

    I’ve been going up on two legs and down on (mostly) one for many weeks now, and walking down stairs starting on my toes (and trying to lower my weight SLOWLY), etc., etc. I do the “2 up 1 down” on a stair, and also at the bathroom sink or in a doorway, while leaning way forward.

    All those exercises are similar to a 1-leg heel raise, but not as hard. I’m at exactly 21 weeks “post-boot” this morning (or last night), and yesterday I sort of barely maybe kind of did a 1-leg heel raise.

    One of the guys here (Peteco?) has a whole blog page about “that darned 1-leg heel raise” or some such.

    [Edit: It was really placervillemadman, and it's at http://achillesblog.com/placervillemadman/2010/03/10/this-damn-single-leg-calf-raise/ -Norm]

    And very few of us have been able to do a good one before 18 weeks, either post-op or post-boot. I could do a few good ones at 16-17 weeks post-op 8 years ago, but I shouldn’t have tried, and then I couldn’t do even ONE (or walk right) for another month (to 21 weeks) because of pain at the back of my heel.

    The period between roughly where you are and where I am is what Doug53 named a “frustrating plateau”. He went through it faster than most, but it can take a long time. It’s like driving East from the Canadian Rockies. Mountains, mountains, foothills, foothills, and then it’s flat prairies for a LONG time, without many landmarks.

    Doug and my PT are convinced that the time can be shortened WAY down by “religiously” exercising like a weightlifter, with exercises that isolate the gastroc and the soleus (straight knee and bent knee). I’m sure there’s an effect, but I think the leg also needs some time to heal up, regardless of the intensity and frequency of exercise. The frustrated folks who responded to that blog page seemed to agree with me. (And I proved 8 yrs ago that it’s not very hard to overdo and LOSE time.)

    I’ve never liked LONG stretches, especially when the muscles and tendons (etc.) are cold, i.e., not yet warmed up. I avoided them, and my ROM is fine. You DEFINITELY don’t want to overdo dorsiflexion stretches, whatever you do.

  7. By mikek753 on May 7, 2010 | Reply

    Norm, thank you very much for all details you wrote.
    It’s very valuable to me and I hope to others as well.

    I’m hitting a wall right now, while I can push harder, but I started feeling pain in rapture area so I stopping at pushing more for now.

    I’d like to do more exercises, but afraid to do it for a while.
    I do what my PT asked me to do and “little” more.

    When pain in rapture tendon area may go away?
    May be this is just nerves are reattaching that brings new feelings / sensitivity?
    As before I didn’t get such specific pain.
    It isn’t that I can’t tolerate this pain, but I afraid to NOT to listen to my body at this stage.

    I’ve been trained - “no pain - no gain”. May be after 12-16 weeks I can start using this method again.

  8. By normofthenorth on May 7, 2010 | Reply

    Yes, Mike, I’d back right off and take it easy-easy until everything felt good again — or at least the same weird “good” you were used to a few days ago!

    As I’ve indicated a bunch of times, the one time I went too far — 8 yrs ago, with 1-leg heel lifts — the new pain stuck around for a month. Yours might go away in a few hours or a day, but I’d wait for it. Listen to your body!

    This isn’t just a case of ordinary weakness, it’s also recovery from a serious injury (obviously).

  9. By sullypa on May 8, 2010 | Reply

    Hi Mike and Norm

    Good to listen to your body. It usually knows better than anyone what it’s capable of doing.
    Recovery means removing the weak and disorganized collagen III that the body puts in the injury zone to make the initial repair into parallel strands of strong collagen I. That means putting some stress on the tendon, and calf muscles to line up the collagen III. Too little stress, little transfer of collagen III to I. There will be some discomfort from that stress, as it breaks up the collagen III scar tissue maze.
    Too much stress, though, leaves tears that take a long time to heal. So the right balance is critical.
    Norm, something you can try is to dangle the heel off a stair, block of wood, etc. At 15 weeks I’ve reached the 1/2 foot point. (1/2 foot (ball of recovery foot) on, 1/2 foot (heel of recovery foot) off, carrying full weight on the recovery foot). No way I can push off 1 leg raises yet.

  10. By normofthenorth on May 8, 2010 | Reply

    Thanks, Sully. I’ve been able to carry all my weight on the ball of my foot “passively” — even dorsiflexed — for a surprisingly long while now.

    E.g., I dismount from my bicycle normally, “scootering” along with all my weight on my left (recovering) foot. The first few times, I was VERY careful to have my foot slid forward on the pedal. After a while I got sloppy and did it “like a normal person”. It made me nervous, but it worked and felt fine, and that was at close to your stage (maybe 15 weeks).

    I also climb stairs like a normal person.

    And when I step onto the bottom step of a stairway to do some calf exercises, it used to be VITAL that I start with my “good” foot first. Now, not so much.

    Things change — Thank God, for the better!!

    About 2 months ago, I posted a blog entry about a painful “faux pas” I made, where I tried slightly crouching down while walking fast. I thought it might eliminate the “dip-limp” at the end of my stride, and instead, it put me into an unsustainable overloaded dorsiflexed position! Now, for some reason, I find it EASIER to walk slightly crouched down than standing tall! I think it’s related to the fact that I can hold my heel up in the air with my knee bent, but not with it straight.

    At first, I thought the difference was that the knee-bent flexion is done more on the soleus, and the knee-straight flexion is mostly gastroc. But that’s not it, because I think my gastroc is stronger than my soleus. (When I do sitting heel raises with a weight on my knee, it’s still a remarkably light weight.)

    So the real answer is that I’m pretty strong when my ankle is at around 90 degrees (or even less), but I get weaker fast as I plantar-flex. And when I roll my knee forward, I can lift my heel off the floor without actually plantar-flexing, I just have to hold my ankle at 90 degrees — and THAT I can DO!

    At placervillemadman’s page on “that damned 1-leg heel raise”, several people said they can lift their heel a little bit off the floor, but nowhere near as much as the “good” heel. Sounds like the same progression I’m starting.

    BTW, when I did those tests on Thursday, my leg was locked in the machine with my knee bent a bit — maybe almost 45 degrees of bend. But I had to push and pull the “pedal” to both ROM limits, around 60 degrees. I also saw (on the monitor) a graph that superimposed my strengths, both legs, over the 60 degrees (horizontal axis). The graphs seemed to gradually converge toward the plantarflex extreme — i.e., they did NOT show a growing deficit with increasing plantarflexion, which is what I think it feels like.

    (If that last section doesn’t make sense to you, maybe ignore it!)

  11. By normofthenorth on May 11, 2010 | Reply

    One more little landmark today, along the way to forgetting about the AT: Bicycling to a meeting in the city, I stopped for a light, planning to lean onto my right (”good”) foot, on the right curb. I lost my balance instead, and tipped way over onto my left (”bad”) foot. It only occurred to me later how scary that would have been a month or two ago! It was a total non-incident to “land” on that foot!

    Mind you, I don’t think I landed up on the ball of my foot or anything. (Be REASONABLE!) But still, it’s just one more indication that where general function and stability are concerned (as opposed to calf strength!), my injured ankle has pretty much recovered 100%.

    BTW, because Friday was wet and cold and dark and stormy, with a scary forecast of thunderstorms, I wimped out and skipped the first sailboat race. Only two boats made it out from my club (the farthest from the race grounds), and they barely made it home by the time the lightning and thunder and big wind and rain blew in.

    So I still haven’t exposed my “new” AT to sailboat racing (or sailing), though I expect to do that this Friday night.

    I also bicycled up that mean long hill today, for the third time post-ATR, and it was by far the easiest yet. AT not an issue, except that I’m going out of my way to “use lots of ankle” when I bike. It’s my fave form of calf exercise — and it gets me where I’m going, too!

  12. By normofthenorth on May 15, 2010 | Reply

    Tonight was the first Friday Night [Albacore 15-foot sailboat] Race that I attended, having wimped out on a dark and stormy night last week.

    Tonight was bright and partly sunny, but it was HAIRY out there! Lots of boats tipped over, one or two were abandoned(!), and there was one nasty collision. Fortunately, in my first sail of the season (and the first post-ATR), my crew and I stayed right-side-up and even had a half-decent finish, way ahead of my club-mates anyway.

    And while hanging out the side of the boat for dear life, I got to use my powerful DORSIflexion that’s now been officially measured, on a fancy machine, at above the NCAA-athletes’ average! (My plantarflexion, “not so much” on EITHER leg!)

    So now that I’m comfy bicycling AND sailing, I should be set for a “normal” and fun summer — YAY!! (I suspect I’ll hold off on the beach volleyball, but we’ll see.)

  13. By notsorad on May 15, 2010 | Reply

    Way to go, sounds like fun AND you kept the “shiny side down”!

  14. By normofthenorth on May 16, 2010 | Reply

    Yup. Just saw the results, too, and we were 12th, which was near the optimistic end of my guesses. It might even be a “keeper” at the end of the season, when we get trophies based on our best 5 races in that series. 2 races down, 16 to go!

    BTW, I’ve just figured out why it’s so much easier to do a perfect “push-off” at the end of a perfect (long, fast) stride, than it is to do a straight-knee 1-leg heel raise. (Doug53 had a back-and-forth about this a couple of months ago.) There are three factors that make the difference, I figure. It’s all on a comment on Mike’s blog, at http://achillesblog.com/mikek753/?p=73&cpage=1#comment-107 .

    I’m also starting to figure out another puzzle about heel raises that actually had me worried:

    When I was doing various calf-strength exercises, it was obvious that the END of a 1-leg heel raise, going into extreme plantarflexion, is MUCH more difficult than the beginning. Straight-knee, bent-knee, standing, sitting, recumbent on a gym machine, whatever, it’s relatively easy to go from dorsiflexed through neutral and a little farther, and then it seems to get hard or impossible.

    For a while, I was afraid that the difficulty was proof that my AT was healing long. I could plantarflex a long way without any weight, but the Posterior Tibial Tendon can do that. (That’s why plantarflexion doesn’t disprove a total ATR.) So this was a cause of some worry.

    In the many discussions on AchillesBlog about “that elusive 1-leg heel raise” (like a whole page about it started by maybe placervillemadman?), lots of people say they can get their heel a LITTLE way off the floor, but nowhere as high as their other heel.

    If you think about what the calf-and-AT actually DO, and how they do it, I think it all makes sense. It’s partly about muscles (I think they’re usually stronger somewhat stretched and weaker when near their compression limit), but mostly about geometry and trigonometry!

    Our AT flexes our ankle by pulling up on the back of the heelbone. The foot pivots around the ankle, not far away. And the force to lift our weight is applied at the ball of the foot, pretty darned far away. I think this is called a “first-class” lever, same general type as sticking a long board on a rock and pushing down to lift another rock on the opposite end. Or using the claw end of a hammer to pull a nail.

    But in those two cases, we give ourselves the “mechanical advantage” in strength, at the expense of distance. The hammer handle moves a foot, the nail moves an inch, but it gets pulled out with 12 times the force we apply. In the case of the foot lever, we’re pushing (OK, pulling!) on the SHORT end of the lever, and the action is at the LONG end.

    So we’ve got to apply maybe 12 times the FORCE we need, but we get lots of DISTANCE. So our calf muscle and AT have to pull maybe 6-8 times HARDER than our body weight to lift us up at all — but we have a chance of outrunning that tiger, so it’s an evolutionary winner.

    The problem with a HIGH heel raise is that the angles keep getting worse and worse as the foot plantarflexes and lifts us higher. The heel attachment point rotates up and forward, until it’s almost OVER the ankle “fulcrum”. If it actually got there, all the way, pulling harder wouldn’t cause any foot rotation at all — it would be just like pushing down on a bike pedal that’s at the bottom already, “nowhere to go”.

    And as you approach that point, the geometry-mechanics keep making the leverage worse for power — though better for speed. So while an inability to complete a good heel raise MIGHT indicate a problem with AT length (= too long), it PROBABLY just reflects the simple fact that the “top end” of a heel raise takes MUCH MORE STRENGTH than the beginning!

    As I indicated in a final complicated paragraph to a comment above, the computer display on my clinic’s Biodex machine confirmed that both of my ankles seemed to be losing strength toward the end of their plantarflexion at about the same rate, which basically confirms the proposition that it’s NORMAL to become a wimp toward the very top of the heel raise!

  15. By normofthenorth on May 22, 2010 | Reply

    That first race result has since improved to 11th, through the complexities of our local score-keeping. (Don’t Ask!) Not too shabby!

    Raced again last night, in my second Friday Night Race. I beat all my club-mates (though just barely), but we were all very “deep in the fleet”, so the results shouldn’t count for prizes by the end of the season. The wind was shifting so hugely before the start, I thought they might not even be able to run a race — WIERD!!

    Other than that, things are progressing normally and slowly. I can now consistently lift my heel off the floor with a bent knee, but only kind-of, sort-of, maybe with a straight knee. I’ve got a pretty good “spring” in my step at the end of my stride. Bicycling is great, sailing no problem, walking over rough terrain and huge pine cones, etc., isn’t much (or any?) worse on the “involved” ankle than the “uninvolved” one.

    I have developed a big bruise on the front of my “involved” ankle, which is sore and throbs a bit when that foot first goes down under me. Nice pretty yellow patch with some purple in the middle! I assume I smacked it on the sailboat or a bike pedal or something, though I don’t remember doing it. (At my age, they say “Memory is the first thing to go. . . and then. . . there’s loss of memory!” :-) )

    And I’ve got a little soft “lump” on the medial side of my shin, like a “venal lake”, i.e., a distended blood vessel. I have had “varicosity” for many years now, so I assume it’s some of that, or it’s from the boat’s hiking straps — in any case, nothing to do with my AT. Both of these puzzles are on the involved/healing leg, though, just to keep me thinking. . .

    Good luck and good healing, all!

  16. By smish3 on May 24, 2010 | Reply

    Norm: I have been following your no-op posts with interest. After having 3 Achilles surgeries, 2 on the right and 1 on the left, I am left with what could have been. I had 2 different doctors. A general ortho did my rupture surgery (first surgery) on my right. When I went to the ortho foot and ankle specialist, he told me that he probably would not have done surgery for the rupture and he thinks the non-surgical approach would have prevented part of the second surgery on my right. He said that in his experience, the Achilles heals a little bit longer when a rupture is healed without surgery. Have you read anything about this? Making both Achilles longer is one of the reasons for my second and third surgeries. Multiple other procedures were performed as well but I am sure they are a much easier thing to recover from by themselves. Anyway, if I ever rupture again, if there are no crazy complications, I would have no problem going the non-op route. I don’t think the healing is faster with surgery but that is just my opinion. By the way, my specialist said he would have gone non-op and I was in my late 30’s and he knew that I earned my living through athletics.

  17. By mikek753 on May 24, 2010 | Reply

    to avoid my healing tendon be longer I stopped doing stretching above 20 degree - just to keep my ROM at 15 degree as my PT wants.
    There was one report of longer healed tendon, but it was surgical case.

    If there is a way to measure tendon length I’d like to know it.

  18. By gunner on May 24, 2010 | Reply

    Hi guys: At about 11 weeks I bumped into my ortho in two shoes for the first time. He said, “I bet you have no trouble with dorsiflexion stretches because the tendon grows back longer at first.” He was right. He also said the tendon grows in stages and the stronger it gets the more it draws up and contracts. He did not give me any reason to believe a longer tendon was a problem at this stage. Are you hearing something different?

  19. By normofthenorth on May 25, 2010 | Reply

    The more you can dorsiflex (toes UP) and the less you can plantarflex (toes DOWN), the LONGer your AT is. And vice versa: A shorter tendon can’t dorsiflex as far but can plantarflex farther. (The geometry is a lot like basic levers and ropes.)

    My first-AT ortho surgeon said he was aiming on the short side of my original length, and that’s what I got (and it’s worked fine). My second ATR has healed without surgery so my ROM is basically identical to the other (surgically repaired) leg, so it must be a smidge shorter than it was at first, too.

    Some people end up with too-long ATs after healing, both with and without surgery — there are examples of both on this website. Like Mike, I went easy on the dorsiflexion stretches once I felt I was in the ballpark of where I wanted to be, and it seemed to work out fine.

    Smish, I think that means that my experience, like the evidence from the 4 latest studies I found and cite (comparing “op” with “non-op”), do NOT confirm your foot specialist’s view. That view seems sensible and logical — I’ve referred to the right-length non-op healing of ATRs as “magic”, because I can’t really explain it, but that magic seems to happen virtually all the time, and just as often as after surgery. So the sensible and logical view is wrong, and the facts are right.

    Gunner, I don’t think I’ve lost any dorsiflexion ROM along the way, at least not that I’ve noticed. Relatively early on, my flexion in both directions seemed about the same as my other ankle, and it still was a couple of weeks ago when I had the Biodex measurements done, and it still is. My bicycling — which I now make especially “ankle-intensive”, as part of my continuing therapy — also seems pretty symmetrical, except for the fact that my “involved” calf is still weaker than the other one.

  20. By smish3 on May 26, 2010 | Reply

    Norm: I also have not found anything that says non-op for Achilles rupture heals longer. In hindsight, I wonder if that was just my doc’s way of “dissing” the doc that did my previous surgery because he matched my Achilles length to the Achilles in the leg that hadn’t ruptured yet, when that was clearly and obviously too short. (But didn’t bother to check) Anyway, it’s over with and I need to move on. I am doing really great now and that is all that matters.
    On a previous note, I do love wearing the Fivefingers but I don’t know that they work for everybody. I don’t know all of the claims the manufacterers have made. I just know that when I wear them, I am pain free with a whole lot of movement, going a whole lot of distance. Again, I have VERY narrow feet with VERY high arches. Happy healing!

  21. By mikek753 on May 26, 2010 | Reply

    Norman,
    Somehow I don’t agree with your math about tendon length :-(
    I can be mistaken as I don’t have med education of any kind.
    My logic based on that tendon has fixed length, but it’s connected to not fixed length muscle (Soleus, Calf).
    http://en.wikipedia.org/wiki/Achilles_tendon

    point is - foot ROM is based on more or less fixed length of AT + relaxed Soleus/Calf in one way and fixed length of AT + contracted Soleus/Calf in another way. So this contraction length is personal and may be even different between legs for the same person.

    I don’t have plantar flexing the same as on normal foot, but that is due another issue
    in my Talus area and that is due to long immobility of 1st 2-4 weeks post ATR.
    I’m working on this issue by just sitting on my knees / Calfs pressing / plantar flexing foot by weight of my body for 2-5 min a time.

  22. By normofthenorth on May 26, 2010 | Reply

    No med education here, either, Mike. So it’s all about geometry and common sense I guess. I certainly agree with your basic description of a fixed-length tendon and a variable-length (extending and contracting) calf muscle.

    I suppose it’s always possible that some people have calf muscles on their two legs that behave very differently from each other. It’s also conceivable that the length of extension or contraction changes significantly during the ATR or the surgery or the rehab (surgical or not). If any of that happens, it certainly makes the issue more complicated.

    By “the issue”, I mean the simple “all else equal” relationship between the AT length — which is DEFINITELY affected by the ATR and the surgery and the rehab (surgical or not) — and ankle ROM.

    So you’re right, I’ve been assuming that the ATR patient started with two very similar legs, and that those other things also don’t change much between the ATR (or the minute before!) and the end of rehab.

    If those assumptions are wrong, though, I’m afraid we have a really complicated “head-scratcher” here! Here’s one indication that the assumptions are reasonable: When somebody suffers from limited ankle ROM, in either direction (esp. after an ATR heals), they can usually get cured by surgery to lengthen or shorten their AT. That’s directly addressing the relationship between AT-length and ROM, and ignoring all the other variables — and it usually works fine. That’s not a scientific proof, but I think it’s a practical indication.

    One other thought: There’s a pretty big range of “good” ROM measurements. As I’ve often said, I lost a fair amount of dorsiflexion from the surgery to repair my first ATR, and I haven’t lost a single point in a single volleyball game as a result — or a millimeter of vertical jumping height, or agility in floor defense, or anything else. The key is in the functional tests, how does it WORK? And ankles usually work quite well with ROM that’s somewhere CLOSE to average-normal. . .

  23. By mikek753 on May 26, 2010 | Reply

    no, I didn’t want to over complicate AT length measurement.
    Just trying to understand how it can be done without cutting skin?
    Your method is one way, while I think it’s tight to Calf.
    And in my case my Calf isn’t up to speed / strength yet.

  24. By normofthenorth on May 26, 2010 | Reply

    I don’t think my slowly-increasing calf strength is having any affect on my ROM — i.e., I don’t think it’s affecting the calf muscle’s two length-limits (full extension and full retraction).

    Mike, if your dorsiflexion is way short of your pre-ATR levels, and it MIGHT be because of a too-short healing AT, it may be a good time to start doing all the stretches your PT (and mine) recommended! Don’t go nuts, but it does sound as if you’re at higher risk of healing too SHORT than too LONG. . .

  25. By normofthenorth on Jun 5, 2010 | Reply

    I’ve been commenting around this site like crazy, but not much here on my own blog! It’s mostly because there isn’t much to report, good or bad. Life is good, lots of sailing and sailboat racing, some kite flying, lots of bicycling — oh, yes, and even some WORK thrown in there!

    My general fitness level has improved (despite a gimpy Aortic heart valve) so I am running and bicycling through yellow lights without much huffing and puffing.

    On the other hand, my calf strength isn’t doing much that I can notice. Still no “real” 1-leg heel raise, and I’m only 5 days short of 6 months! (You could call it 7 days if you wanted to eliminate the “ripoff” of having February in there!) I can lift my heel off the ground at the end of a walking pace (when I’m “slanted”), and by rolling my bent knee forward, but not straight-kneed with pure calf strength.

    I don’t think there’s a problem, and it’s not a big deal or a problem for my lifestyle, since it doesn’t affect my sailing or bicycling or walking or anything else that I generally do in the Summer. It would just be “nicer” if I had more of that calf strength back by now.

    My sweetie and I both bought amazingly inexpensive aluminum-framed hybrid bicycles today from. . . Toys ‘R’ Us(!). Made in China, natch. Nice looking frames and accessories, very fancy high-profile alloy rims, C700 x 28″ tires, nice Shimano indexed grip shifters and super-powerful brakes. Quick-release seats that we’ve got to convert for city use. I haven’t ridden mine yet (outside the store) — not til I install a rear carrier and mudflaps, a rear-view mirror and a coffee-cup holder on it! (That’s a vertical water-bottle holder, mounted on the seat tube, BTW!) And a rear light-bracket.

    It should save me a couple of minutes bicycling to the boat that takes me to the sailing club — assuming my front wheel doesn’t dive into a gap in the pavement! And if it means that my sweetie will start bicycling in town again. . .

  26. By mikek753 on Jun 5, 2010 | Reply

    link or picture of this bike? Please ;-)

  27. By normofthenorth on Jun 5, 2010 | Reply

    I can’t find the Avigo bike anywhere on the Web, or anything close on the Toys ‘R’ Us website. But the bike that’s shown at http://www.canadiantire.ca/AST/browse/5/SportsRec/BikesAccessories/BikesHybrid/PRDOVR~0711376P/CCM%252BExcelsior%252B700C%252BHybrid%252BBike%25252C%252BMen%252527s.jsp?locale=en looks like about the same bike.

    I can’t be sure about the wheels — the picture I linked looks like “ordinary” alloy wheels, while the ones we got are fancier and newer-fangled, “high-profile”, with the part of the rim where the spokes emerge extending towards the center hub in a “V” profile.

    The rest looks just like mine, except that my top tube may be more horizontal, making the “down tube” taller.

    I set it up the way I like it today, and rode it around the nearby park almost a dozen times. Very easy to pedal, though it seems WAY less stable than the 26″-wheel fat-tired steel-framed (even cheaper) mountain bike I’ve been riding. Tomorrow I get to ride it down to the Lake (Ontario) to get to the ferry boat that takes me to my sailing club (torontosailing.com) so I can get to a sailboat race. That will be a better test.

    BTW, we only paid Cdn $139.99 for each of our bikes, on sale for $40 off. One of my wife’s bike’s rims has a little ridge at the (TIG-welded?) seam, that should have been ground down smoother. Otherwise, they seem very nicely manufactured and assembled. (I usually find at least brakes and gearshifts are out of adjustment when I buy a cheap bike from a mass-market retailer. This time, “not so much”!)

  28. By normofthenorth on Jun 9, 2010 | Reply

    6 months tomorrow (if you call February a “real” month) and I’m still slowly creeping closer to a “real” 1-leg heel raise. I can easily raise my heel way up by rolling my leg forward, and I can pop way up on the ball of my foot at the end of a stride, just before my “good” foot hits the floor or ground.

    When it comes to standing on the one foot and just lifting that heel up, well, just in the past couple of days, I can actually get that heel off the ground! But not far, and not for long.

    On the “eccentric” side, when I go up on both toes then shift all my weight to the “bad” side, I can lower myself down super-ultra slow, but maybe not stop and “hang” up there. (OK, I haven’t actually been testing this very often!)

    The good news — in addition to the fact that I’m doing everything “in life” that I want to do this month — is that this eentsy-weentsy heel lift is new, it’s progress. It’s not a real honest-to-goodness heel lift, but I’m getting there. And it seems obvious to me (based on my ROM and strength, etc.) that my AT is the right length and healing or even healed. And the calf strength is still a little wimpy, but it’s coming.

    I think I was a little farther along by this time, last time (8 yrs ago). But all I know for sure is that I could do a bunch of them without groaning by around 10 months (when the indoor court volleyball season started again) — after a summer of bicycling and sailing.

    Well, I’m already into the summer of bicycling and sailing. . .

  29. By mikek753 on Jun 10, 2010 | Reply

    are you allowed to jump on 2? on 1 leg?
    my 1 heel raise about 3 cm behind normal leg.

    Yes, my PT said I have to raise on 2 and than use 1 to go down to increase injured leg raise.

  30. By normofthenorth on Jun 10, 2010 | Reply

    I don’t remember anybody saying that I could, or could not, jump, either way. I’ve occasionally been enjoying shifting my weight from one leg to the other, knees bent, the way I do when preparing to receive a serve (in volleyball, tennis, badminton, squash, whatever).

    It feels like useful exercise, and it also reminds me of the fun feeling of playing some of my fave sports. But I haven’t been jumping.

    Today when I experimented with a 1-leg heel raise, with my knee straight, I could only “bounce” the heel off the floor, very briefly.

  31. By normofthenorth on Jun 12, 2010 | Reply

    Thursday, on my official 6-month-aversary (if you call February a month!), I had another “tiny breakthrough” on the way to a real 1-leg heel raise. When I went up on the balls of both feet, then shifted all my weight to “that” foot, I could hold it! I think that’s the first time I could manage that.

    So now I’ve got TWO ways to hold “that” heel up in the air while my other foot’s also up in the air: by rolling my knee forward, and by starting up in the air on two feet.

    It probably sounds like I’m terribly frustrated by the long wait for a 1-leg heel raise, but I’m actually having a blast bicycling (quite aggressively and fast now, too) and sailing. I’m checking on the heel raise mostly because I don’t want to be “bringing up the rear” in the AchillesBlog group!

    As some of you know, I’m NOT going to grunt and groan to try to do a 1-leg heel raise, or to do as many as I can once I can. Been there, done that (with my first ATR 8 yrs ago), and paid the price (a lost month of rehab, in pain). This is way better, honest!

  32. By normofthenorth on Jun 15, 2010 | Reply

    I had a couple of nice long bike rides this evening, back up that mean hill that runs across Toronto a few miles north of downtown. Between my recovering “shape” and my new lightweight bicycle, the hill was MUCH easier this time than the other two times I’ve climbed it on a bike, post-ATR (YAY!!). I left about 40 minutes to bike to a meeting, and I was uncharacteristically early! Maybe huffing and puffing a little, but only because everybody else had arrived by car or subway!

    Mike753’s brand-new video of barefoot walking and heel raises etc. (at 15 weeks) demonstrates that he’s been recovering his calf strength quite a bit faster than I have — in fact, he’s overtaken my 11-week head start! I think Gunner (my other “protege” here — i.e., the other blogger here who skipped the surgery after reading my blogs, study links, and protocol) is also up to or ahead of my calf-strength level — despite starting months later.

    I certainly wouldn’t mind being able to do a bunch of 1-leg heel raises now (or even one solid one!), but as I’ve said, I’m doing all the activities I want to do in June (sailing and bicycling — and walking without a limp!), I’m recovering steadily, if slowly now, and it will come when it will come.

    On the whole, this non-op rehab has been so easy compared to my surgical one on the other AT, 8 yrs earlier, and with so much less pain and disruption to my lifestyle, that it really has been “almost nice”. Add in the fact that I skipped the risk of complications and infections and saved the medical system maybe $10,000 or so, and it does seem like a no-brainer.

    Durng a break in my meeting tonight (which had ZERO to do with ATRs or medicine, etc.), I was chatting about ATRs with one of the other participants. He suddenly “kicked himself”, because a friend of his tore his AT 2 weeks ago and got rushed into the surgery! I think that was around here, so even all the ortho surgeons in Ontario haven’t gotten around to reading the study from Univ. of Western . . . ONTARIO!!

  33. By normofthenorth on Jun 16, 2010 | Reply

    It just occurred to me today that I’ve been sticking my leg up while eating breakfast, but that I was no longer sure WHY I was doing it! Today I left my leg down, and it felt fine. I’ve still got a soft footstool (and a pillow) beside the laptop I’m at now, so my leg is up. But I have a feeling I could finally go back to normal, or very close, without complaints from my recovering leg.

    Mind you, I’ve ALWAYS been uncomfortable after long periods of STANDING, probably partly because of what’s now turned into Varicose Veins. But walking and cycling and probably sitting, too, probably aren’t the Bad Things they were 6 weeks ago, when I started the thread “Swelling (& elevating) is getting OLD!”

  34. By gunner on Jun 17, 2010 | Reply

    Hi Norm: Don’t despair about you single leg heel lifts. I’m stalled a bit on that one too. Getting about an inch or two but that’s it, even though I seem to be making good progress in the pool. I think we both realize by now that if we have good ROM and functionability, there’s really not much too miss. Were we aspiring triathletes that would be different!

  35. By normofthenorth on Jun 27, 2010 | Reply

    Today, the bad news is that my leg is KILLING me! The good news is that BOTH legs are killing me, and my mostly-healed ATR is fine!

    Because of the G20 Summit in Toronto this weekend, lots of people have moved out of the city for the week or especially this weekend, including many members of my Sailing Club — http://www.torontosailing.com . And it seems that more of our Crew members have left town than us Skippers, so we had a surplus of Skippers in the random draw for team matchups for the Friday Night Race, and I was “overflow”. My efforts to beat the bushes to find crew failed, so I raced a Laser (little 1-person sailboat) instead of my usual Albacore.

    I was fine when the wind was strong, but when it died, I found myself kneeling in the boat, either on the fiberglass boat itself, or on top of the miles of rope sitting in the bottom of the boat. My knees are visibly bruised, my thighs are RUINED, and I didn’t even win the race!! :-( As Pravda is said to have reported after the Soviets lost a car race to the Americans, “We came in second, and the other competitor finished second-last.”

    Anyhoo, I’m in pain, but it’s another sign that things are pretty much back to normal, except for the 1-leg heel raise. It’s taking baby steps forwards, but the speed of progress reminds me of the end of last night’s race, after the wind died!

    Good healing, all! I’m having fun making trouble for the web-sites that promote ATR surgery, but I’m keeping that discussion on the page about “A more complete review of the options — surgical vs. non-operative”, where they belong. I’ve at least got the Wikipedia article on ATR reflecting the 4 randomized prospective trials, for almost a week now!

  36. By smish3 on Jun 27, 2010 | Reply

    Norm,
    I ran into someone recently who had ATR’d right around the time of Beckham. She went non-surgical and is still in a boot except for sleep. She was kind of upset thinking that she should have gone for surgery. I tried to reassure her that non-surgical is getting more popular for a reason (I also tried to scare her showing her my incisions! ha) but I ended up giving her your information and how to find you. Hopefully she contacts you and can put her mind at ease.

  37. By normofthenorth on Jun 27, 2010 | Reply

    Thanks, Smish. She should blog here. The good news is that a non-surgical protocol can produce great results, as good as surgery. The bad news is that she’s been in maybe casts and now a boot for around 3 months or more, which is probably way too long — that’s NOT the protocol that produced the great results.

    The results from the “old school” “conservative” protocol weren’t very good, and that sounds like what she’s getting. Part of the reason for the bad old results was probably non-random selection bias in the patients (”jocks” got surgery and “crocks” got slapped in casts forever), and part of it was the ill effects of the overly “conservative” protocol — imposed out of fear of re-ruptures, but ironically INcreasing the number of re-ruptures!

    I think it’s too hard for anybody (me, for sure) to tease out the relative effects of those two biases in the old studies, and I keep leaning one way then the other.

    Anyway, maybe the two of us can get her and her Docs to get her moving and into PT while her leg still remembers how to move.

    I don’t suppose she was lucky enough to get a HINGED boot?

  38. By smish3 on Jun 27, 2010 | Reply

    Norm,
    I am not sure what a hinged boot looks like. She has the same insurance I do and was treated at the same clinic but she got a different doctor. I am sure she got the same boot I had (actually I have about 7 of them!). They were always referred to as cam-walkers. The only way to adjust the angle is to put an insert inside. My second two surgeries I woke up with about a 1 inch pad under my toes(not heel)leaving me in a dorsiflexed position. I also had to take my foot out of the boot starting 24 hours after surgery and rotate my ankle (bloody bandages and all). I was FWB at about 3 weeks. No boot at 5/6 and doing single leg toe raises at 9/10 weeks.
    I was a little concerned about how long she had been left in the boot. She hadn’t even been cleared for physical therapy yet. She said she had to wait until the 4 month mark for that. Yikes!

  39. By normofthenorth on Jun 28, 2010 | Reply

    Smish, the hinged boots look a lot like many non-hinged boots — most often like the kind with fabric tops and two steel struts running up the side. But instead of the struts being fixed to the sole of the boot, they’re attached with an adjustable pivot on each side.

    By changing the position of two pins in those pivots (usually) you can limit the range of motion in the two directions. And by cranking down on a set-screw, you can make the boot absolutely “fixed”.

    Gunner’s fancy new VacoCast (VacoPed in Europe) uses a different system than the older hinged boots I’m more familiar with.

    Smish, don’t you have a blog here? I can’t find it now.

  40. By smish3 on Jun 28, 2010 | Reply

    Norm, I never set up my own page. I have always just posted on other blogs but I have been around a while. I am 16 months post-op on my last surgery. I had 3 total. I also did a partial rupture on my right about 11 years ago. I was casted for about 3 months and sent on my merry way until I fully ruptured it July 4, 2006. The tendonosis I had in both legs during that whole time was brutal. I did not find this blog until right before I had my second surgery in 2008 so I started posting then. I am now feeling pretty good but I feel like I got grounded. Oh well! At least I can take care of my family pain free.

    The hinged boot sounds pretty neat. I am sure the gal I told you about did not get one of those.
    -Smish

  41. By normofthenorth on Jun 28, 2010 | Reply

    Smish, it sounds like a complicated and interesting enough story to be worth telling in some detail, on your own blog!

  42. By firstdayofsummer on Jul 9, 2010 | Reply

    Hi Norm,
    I just wanted to say thank you for all the information you put out there! I had my ATR (right leg, fully ruptured) on Jun21 and been trying to find a doctor which supports non-surgical treatment with early weight-bearing for about 2 weeks. Things seem to finally look up (I ordered my vacocast and it will be fitted next thursday). Thanks again, oh and I was trying to start my own ATR blog but couldn’t find how to go about it.
    - Johanna

  43. By edhdave on Jul 10, 2010 | Reply

    Norm, I’ve been reading your blog for better than a month now. I ruptured my left achilles on Jun 1 and am on the non-operative path to recovery. Like you this is my second go round with an ATR as I ruptured my right achilles in ‘97 and had open surgery. I was told that young athletic folks should have surgery and that is the route I choose back then. As I approach my 6th week since my recent injury I’m feeling confident about my choice to bypass surgery. My doc initially put me in a waterproof/fiberglass cast (my injury happened 2 days prior to a Hawaii trip) for 2.5 weeks and then I moved to a VacoPed boot. I was able to ditch the crutches and go FWB at ~4 weeks. I’m following the same protocol you are on, I have a great doc who has been open to all my inputs, including ordering the VacoPed boot (which he’d previously never seen). For all those reading this blog the VacoPed Pro boot is outstanding, very comfortable, easy to adjust, waterproof and it has gotten me back to a somewhat normal life quickly. I’m looking forward to two shoes and building calf strength soon.

    Anyway, I just wanted to thank you for all the great information contained in your blog!! It has been very helpful.

    -Dave

  44. By normofthenorth on Jul 11, 2010 | Reply

    Johanna and Dave, you’ve both made my day! Thanks for the thanks! The VacoCast = VacoPed seems like a fine boot, according to all the reports that have been posted here, led by gunner’s.

    Johanna = firstdayofsummer, what have you been doing (AT-wise) since June 21? Crutches? Cast? Limping on 2 shoes? I hope it isn’t very different from the first few weeks of the UWO protocol at bit.ly/UWOProtocol .

    If you click on the link at the very top of the page that says “Create your own Blog”, don’t good things happen? As I recall, you’ve got to sign in, with an e-mail address first.

    (Try clicking to “About AchillesBlog.com” at the top left of the main page, then click where it says “You can create your own here.”)

    Then Dennis e-mails you the URL of your new blog. When you go there (for example http://www.achillesblog.com/firstdayofsummer) you should see a “Hello World” blog with extra links at the top like “Dashboard” and “Write”, which will give you the chance to change the content to something more personal and meaningful.

  45. By firstdayofsummer on Jul 11, 2010 | Reply

    Norm, I have had a splint cast and crutches since day 5 (somehow assumed i twisted my ankle at first and only went to ER 5 days later).

    The doctor I am seeing now is very experienced (head of orthopedics at the local hospital) however when i went to see him on July2 he told me he only supports the conservative immobilization (8 weeks in cast at least).I had printed out all the studies to proof to him that the results are the same with early weight bearing versus surgery and begged him to take me on as his ‘guinea pig’ but he wouldn’t go for it.

    When I had my next appointment with him on July7 I was ready to schedule surgery since i felt like time was running out and I had seen so many doctors and all gave me the same two options. So when he examined me the second time he shook his head and started smiling. He said he’s never seen anything like it but my tendon has grown back remarkably fast and that my foot suddenly reacted to the Thompson test and that he feels surgery is not necessary any longer (yeah).

    I am aware that i have to tell him about the UWO protocol ecc but I completely trust him and am therefore willing to do it. It will be a long way to recovery but at this point i am happy that I finally know where I stand and what to do next.

    Thank you for the blog information. It did not work for me last time but I will try again.

  46. By normofthenorth on Jul 11, 2010 | Reply

    Johanna, I love your story! (And I hope you get to elaborate on it in your own blog, too.)

    I’m also glad to hear that you’ve been immobilized and NWB since soon after your ATR, because that seems to be an important early part of the non-surgical “cure”. (Your 5-day delay isn’t very unusual, and is probably well within the range of delay of the participants in the scientific studies.)

    In addition to your increasing chances of getting state-of-the-art treatment for your own ATR, it sounds like you’ve got a solid chance at improving the treatment for many future ATR patients at that hospital, and maybe in the whole region! (Where are you, BTW?)

    I’ve been working like a beaver at the non-surgical thing, and the UWO protocol thing too, for 6 or 7 months, and I can count on 1 or 2 hands the ATR patients who have actually changed their therapy in response. If you can get the head of orthopedics at your local hospital to internalize the new evidence, and change general ATR practice accordingly, your direct influence could swamp mine, with way less time and effort spent!

    So good luck, and don’t give up easily!

  47. By edhdave on Jul 11, 2010 | Reply

    Norm, question for you…at what point did your healing AT begin passing/responding to the Thompson test? I’m approaching 6 weeks and definitely feel tendon regrowth, however there is only a little movement as compared to my non injured side. My ROM is very good and weigh bearing is not an issue. Just curious what your experience was like.

    Glad to make your day :)

  48. By normofthenorth on Jul 12, 2010 | Reply

    Dave, I never tested it! Mikek753 asked me the same question early into his non-surgical rehab protocol, and I told him the same thing, and also shared the old joke about the farmer who kept uprooting the carrots to check that they were growing well!

    I recall my Physiotherapist eventually squeezing my calf, but I don’t remember when. As Mike likes to say, there’s no prize for being the fastest in this race! Almost all of us come out pretty close to 100% somewhere between 6 and 12-ish months, though the individual graphs seem to dip and weave substantially on the way there.

    I’d just keep following the road-map, being careful to avoid re-injury, and having faith in the statistics!

  49. By normofthenorth on Jul 12, 2010 | Reply

    For those who’ve missed it, savvy525 (a volleyball-playing Med School student from Chicago) and I are having a discussion on his blog that suddenly turned in the “flame” direction! (He just addressed me as “Norm of the Arctic Circle”! :-) )

    It’s a level of discourse that’s very common on the Internet, though quite unusual here, among us ankle-fixator types!

    I’ve responded, but I noticed that my reply is “awaiting moderation”. I was signed in, and I didn’t include any URLs (except one of my bit.ly/ links — would that do it?), so I don’t really know what’s going on. It is bloody long, but that’s me, and I didn’t have time to write a short one! :-)

    If it doesn’t appear on his page soon, I’ve saved the text, and I’ll just post it here.

    I hope he’s not playing blog-moderator “power games”, though he did seem MOST put-out with me in his last posting.

  50. By normofthenorth on Jul 12, 2010 | Reply

    Oh what the heck, here’s the text of the reply I tried to post on Savvy525’s site. When it appears there, I’ll delete it here:

    Savi, I’m alway sorry to infuriate a fellow volleyball player — I’d rather resolve this on the v-ball court! ;-)

    Gerry is right that in most of your rant, you’ve got the wrong guy! My surgery on my first ATR turned out great! My rehab was way too slow because my surgeon thought slow was “conservative” (= safe), and it isn’t according to the careful studies. I was as close to “the patient from Hell” as I dared to be, but my options were pretty limited after each time he slapped me into another cast! Eventually I got into a hinged walking boot — the first of his patients who ever did, and he’d been doing orthopedic surgery including ATRs for several decades! But it was a sideline, because most of his surgeries were knee and hip replacements.

    Still, my recovery was essentially 100% at 10 or 11 months when I returned to competitive volleyball, immediately giving 100% to every ball and soon playing as well as before the injury. My ROM was a smidge more limited on the dorsi side, and my surgeon said he did that on purpose. It worked fine, and still does, no complaints, much less a “horrible experience” or anything else that you have tried to pin on me as the cause of my confusion.

    This time, I’m a smidge behind my 2001-02 schedule on calf strength — though every other landmark has been much quicker — at 7 months in, so I’m just hoping I’ll be as strong at 10 or 11 months. I’m just barely lifting my heel off the floor with a straight knee, while I was doing multiple “good” 1-leg heel raises by “now” the last time. The randomized trials tell me the difference isn’t likely from surgery vs. non-surgery, and my scientific training was good enough (I’m an MIT grad, BTW) that I know my two ATs are just “anecdotes” to a scientist.

    When I tore the other tendon last December, one of my first phone calls was to that same surgeon from 2001-2, to see if he was available to fix this one. Nice guy, and I got an excellent result. And I assumed that surgery was still “the only way to go” for an athlete, as I’d been told by EVERYBODY the first time. (He had left town and wasn’t available, or I might have gone under the knife again.)

    I was still expecting — and wanting — surgery, when I got referred to one of the most prestigious sports-medicine surgeons in the city of Toronto, who “turned my life upside down” by exposing me to the new evidence, and how it had changed his own surgical practice. (He STOPPED doing ATR surgery, because the evidence and the researchers convinced him that it adds no benefit!)

    I’m sorry if any or all of this falls, as you say, on deaf ears. As you probably know from many stories told here, that’s a very bad kind of ears for a medical doctor to have, so I hope you can get treatment for them! ;-)

    Incidentally, Doug53 and I have exchanged notes, and links, on the difference between Evidence-Based Medicine and “Eminence-Based Medicine” and several other commonly practiced versions of EBM. There’s a very funny article on the subject, and Doug has posted a link to a graphic scan of it, and I tracked down a text version of it online and posted it (both here somewhere!).

    We humans often use a lot of mental energy reinforcing or justifying the decisions we’ve already made (for whatever reasons), and we may both be guilty of that. I’m asking a lot of you, so soon after your own surgery, to look at the evidence without getting into playing that mental game. Maybe it’s too much to separate the two issues.

    I also agree with jski that scientific studies have to be read carefully, and that a remarkably high percentage of published studies will eventually be proven false. (I’m even skeptical of much of the IPCC’s “consensus” on AGW, jski, though I’d rather leave that out of this discussion!)

    But there’s a difference between saying “show me” about the studies, their protocols, and their raw data (as I’ve tried to do), and turning “deaf ears” to any scientific evidence that contradicts your local surgeons, or that makes you wonder if you just got sliced and stitched without a solid reason.

    For every surgeon like my second one, who has checked the evidence, corresponded with the study authors, and changed his practice fundamentally in response, there are probably 50 or 100 in North America alone who have not done any of those things.

    I don’t think that’s because of a “conspiracy”, I think it’s for the reasons outlined in jski’s last reply — and perhaps also the ones you’ve highlighted (inadvertently) in your own, like deaf ears, and a deference to authority over evidence. (The fact that many surgeons, and hospitals, would lose income without doing ATR surgery is also a factor, for reasons that are obvious to people who understand how humans make decisions. My guy has a 7-month waiting list WITHOUT ATR surgery, so it didn’t cost him a penny.)

    BTW, you’ve also got the wrong guy when you accuse me of citing Wikipedia as a scientific source. The paragraph in the Wikipedia article that I cited was inserted in the article by ME!! The authority isn’t Wikipedia, or me, it’s the studies that the 4 endnote-references link to! I just referred to it because it’s got all 4 links right in a row, and you don’t have to slog through all the analysis in bit.ly/achillesstudies to find them!

    If you really believe that we should all bite our tongues here unless we’re “board certified orthopedic surgeons”, then I really don’t think you’ve picked up the essence of this terrific web-site and why it’s so valuable and important.

  51. By jski on Jul 12, 2010 | Reply

    Norm,
    Who, exactly, do you think is most guilty of ranting on this site, at least in the last couple of months? Word count could be a good metric.

  52. By normofthenorth on Jul 12, 2010 | Reply

    Jski, I’ve occasionally referred to my own more argumentative and longer-winded posts as “rants”. I’m sure I’m leading the word-count metric, compulsive poster that I’ve been. I may also have offended or displeased a record number, and I know I’ve also been leading the “Thank You” count. :-)

    I’m pretty sure I’ve never used the word “rant” to describe anybody ELSE’s post until Savi joined us. Maybe I should have used the word “flame” instead, since he’s clearly used a temperature of discourse that has been (blissfully) absent here, despite our sometimes strong disagreements on issues of great importance — at least to US!

    I HOPE I haven’t responded to Savi in kind — at least I didn’t make fun of his name, as he did with mine! ;-)

  53. By normofthenorth on Jul 12, 2010 | Reply

    BTW, the link to the hilarious article about alternatives to Evidence-Based Medicine is http://www.bmj.com/cgi/content/full/319/7225/1618 . There are also a lot of follow-up submissions on the BMJ site, mostly at http://www.bmj.com/cgi/content/full/321/7255/239 .

    H/T to Doug53 for the original tip-off to this modern classic!

  54. By scott on Jul 14, 2010 | Reply

    Norm, I just wanted to let you know I am the one rerupture that hasn’t yet been surgically repaired. It will be 6 weeks on sat since retear occured. Saw Doc yesterday, he feels it is 60% closed down on the 2 cm gap. I got the vacocast boot and was following UWO protocal. Doc was fine with that plan. I feel stronger, but the great unknown is scary. Like your farmer joke, I’d be US’ing (ultra sounding) the tendon every day looking for healing, but I have to trust time right now.

    I’ve read about folks asking about Thompson test, I get a slight deflection now at 6 weeks, but only when I’m kneeling on the bench. If I cross my leg and try it isn’t there yet.

    I tried to set up my own blog, but wasn’t successful, Any tips?
    Thx, Scott

  55. By normofthenorth on Jul 14, 2010 | Reply

    Scott, about starting your blog, look above for my July 11th comment to Johanna aka firstdayofsummer about how to do it. If that doesn’t work, post back here and we’ll try to figure it out, or get help.

    I’ve been telling everybody not to worry about monitoring their healing AT, Scott, but I think I might make a little exception in your case. In the “standard” case, the evidence shows that virtually everybody heals fine. In the re-rupture case, there is no good evidence about the non-surgical cure, so it’s natural and “correct” to wonder. (In most or all of the studies that proved the advantages of the non-surgical cure, the rare re-rupture cases got surgery!)

    The good news in your case is that the Thompson test is generating SOME motion. That indicates you’ve got at least some continuous AT connecting your calf to your foot. But if I were you, I WOULD be wanting somebody to look at it with US or MRI to see how it’s going/growing, because your case is NOT the one that they tested in the careful studies. Maybe it’s all the same, and maybe it isn’t; we just don’t know.

    BTW, I’ve heard that it’s very difficult for most people to give themselves a good Thompson test. Physios do it, and you should be seeing one by 6 weeks (if not for the whole past month).

  56. By smish3 on Jul 15, 2010 | Reply

    Hi Norm: I noticed on another of your posts that you are thinking about trying out a pair of the Fivefingers. I can’t wait to hear what you think after you’ve tried them. The Classics are the only kind that I am not comfortable in. They have a tie right at the back of the heel that hits me in the wrong spot. Other than that, I absolutely love the KSO’s. I wear them with socks because I always have cold feet. (teehee) I strongly suggest that you try them on before you buy them. Let your feet warm up in them a little before you make your decision and if you bring them home, have someone there to try and help you contain yourself. You will want to take off down your street on a dead sprint. :) All kidding aside, I have had so much trouble finding shoes that I could feel back to normal in. I actually had given up that I would feel normal again. (heyyyy, maybe I am not normal but I just think I am.) These shoes are my favorite shoes on the planet. I have the KSO’s, Bikilas, and KSO Treks on the way. My whole family has them. Hubby is the only one that had trouble with soreness when he first started wearing them. It is good to ease into them slowly.
    -Smish

  57. By normofthenorth on Jul 15, 2010 | Reply

    I’ve gotten only as far as trying on a pair of too-big KSOs in a store for 5 minutes. The stock (esp. in pop. sizes) comes in slowly and flies out the door quickly. I could order direct, or drop into the two stores more often, but then I might miss a new post here! ;-)

  58. By firstdayofsummer on Jul 22, 2010 | Reply

    Hello Norm,
    sorry for the delay…no idea where the time went.

    My doctor is in Norwalk, CT and I saw him again last thursday to have my vacoped fitted. This time the doc must have had a bad day because he basically only helped me into the boot but wanted to hear nothing about early weight bearing or PT.

    So I decided to take matters into my own hands as much as i can at least. I have been doing knee, leg and hip exercises as suggested on the german vacoped website, as well as doing upper body exercises. As of monday (which marked my 4 week ATR) I started with WBAT which feels good.

    My boot is set to 20%, no ROM and I did wear it 24 hours the first couple of days. Over the weekend I decided to let my leg ‘breath’ a bit and took off the shell of the boot…..wow what a strange feeling at first. My leg started twitching (as if it has little spasm). Scarring at first but then I thought this might just be due to the fact that it had been in a cast or boot for 4 weeks. So I started taking the boot off every night to take a foot bath and both my foot and I are way more comfortable with this new sense of freedom now.
    - just to clarify, I only take the boot off when lying or sitting down in the evening. I do wear it to sleep each night however -

    The one thing I would love to do however is some cardio workout (my treadmill is obviously out of the question). Do they let you do the stationary bike with the boot at 4 weeks in the protocol you followed? And if so, should I buy a regular stationary bike or one with a bucket seat (with your legs pushing forward versus down) ?

    And one more question if you don’t mind. Since my body more and more often tells me I should start walking without the crutches (don’t worry, I won’t do it until about week 6 :) but my ‘good leg’ is way shorter and I’m already developing a limp while walking with the crutches, would you recommend I get a heel lift and if so, which one should I look for?

    Thank you so much Norm for always sharing your wealth of information with everybody, it has helped me and I am sure many others immensely!

    - Johanna

  59. By normofthenorth on Jul 23, 2010 | Reply

    Sorry to hear about your Doc’s deaf ears, Johanna. There’s a lot of that going around, among humans in general, and maybe surgeons in particular.

    WBAT, starting at 4 weeks in the UWO protocol, generally means you can walk without crutches (or 1 crutch, or a cane) as soon as it feels comfy enough and secure enough. No shame in going back and forth for different situations, either. (A crutch or a cane is often a useful “flag” to help defend a radius around you, in high-traffic areas like subway stations — even if you don’t actually need it for support!)

    I started WBAT at 4 weeks, just like the protocol, and I think it took me less than a week to realize I’d forgotten where I’d put the cane (which I switched to after I put the crutches away). My blog remembers exactly how many days, but I think it was before week 5. YMMV.

    If you feel comfortable pushing against a bike pedal now, then you should be fine on a stationary bike. In a fixed boot, it shouldn’t even matter much where your foot sits on the pedal. (When the boot hinges, and when you’re in shoes, it will matter a LOT.)

    Mikek753 tried a recumbent bike and had some trouble keeping his foot up on the pedal, as I recall. (It’s on his blog.) I didn’t actually use a stationary bike, but I started bicycling around (despite some snow on the ground) in my boot (first fixed, then hinged) as soon as I felt confident that I could “catch” the weight of a sudden stop. (My left foot was the booted one.)

    If you can get into a Physiotherapist’s care, they usually have stationary bikes (and other exercise equipment) handy, so you wouldn’t have to buy anything, unless you wanted to. Or you could rent. There are also brackets to turn a bike into a stationary bike, though I’ve never used one and I don’t know how secure they are. (No bike accidents, please!)

    Does your word “scarring” mean “scary”? Looks like that in context. A lot of us had some tingles and spasms while healing. Big violent calf-muscle spasms can be scary for a healing AT (and may call for muscle relaxing pills, etc.), but small stuff seems common and pretty harmless.

    Yes, as you start walking on the booted foot, you MUST even out the height of your two feet! There’s no perfect way, but you have to find a way or you’ll risk getting into serious trouble with knees, hips, back, whatever — or just making it harder to re-learn how to walk RIGHT later, when you’re in 2 shoes and getting stronger.

    Maybe start by just finding the highest-soled shoes you own, then adding footbeds — from the store, peeled out of your athletic shoes, or cut some out of felt or hard foam or cardboard or leather or whatever, and see if that’s high enough to match the boot.

    I had one shoe (like a low-cut Merrell boot) that was high enough that a few footbeds crammed into it made it pretty close. For around the house, I had a “cast shoe” (a big clunky Velcro-and-nylon thing to put over a fiberglass cast) left over from my first ATR, post-op, cast #3. (And they’re $5 items in med-supply houses, too.) I slipped a little sandal into it, tightened it up, and it became my indoor “slipper”, exactly the same height as the boot.

    Others have either hired shoemakers, or been shoemakers, or done other creative things with shoes. But SOMEHOW, you need to get yourself a suitable “elevator shoe” so you can walk straight.

    It sounds sensible to match the boot’s ankle angle, too — like with heel lifts and not just full-length footbeds — but I never did that, and THAT imbalance never bothered me. Heck, there’s nothing wrong with your OTHER calf and AT, so as long as the balls of your feet are at the same height, you can always lift the other heel while you walk. . .

    Good luck and good healing. And start a blog if you can, partly to keep your story and your Q&As mostly in one place. (And add the widget at http://achillesblog.com/dennis/2008/03/08/achilles-timeline-widget/ , too!)

  60. By firstdayofsummer on Jul 23, 2010 | Reply

    Wonderful advise once again Norm, thank you so much!

    I tried walking around the house a bit today but until I find a way to lift the left (good) leg it’s not going to work without crutches.

    My foot suddenly felt very swollen which scared me (as in scary ;) but after doing some research here I realized this is very normal. So I took off my boot, elevated and iced the foot (one doctor I went to 3 weeks ago told me not to ice it anymore…clearly wrong advise as it felt great). I then started wiggling my toes. To my surprise this did not work as well as it did 10 days ago which might have something to do with the fact that my splint cast was very loose compared to my vacoped now and that I therefore moved my toes much more often throughout the day then. It took a good 20 minutes until I could move all of my toes comfortably. Lesson learned today: do your daily exercises, including wiggling toes.

    While I was ‘playing with and admiring’ my swollen and bruised foot I couldn’t help but notice that the dent on my tendon is still quite visible (I wanna say 1 1/2 inches). Is this normal?

    I tried various times to start my own blog but I keep getting the response ‘you are already signed in’. Will try and contact Dennis about it.

    Oh and I found this non-surgical study on the german vacoped site this morning (the study is in english). Not sure whether you have seen it yet:
    http://vacoped.com/vacoped/de/doc/studieVachEfort.pdf

  61. By normofthenorth on Aug 2, 2010 | Reply

    Probably time to start a new blog page here, but there really isn’t much new or different. The biggest news this week is that my “good” leg has become my “bad” one! While stepping into the boat (15′ Albacore sailboat) from the dock on Friday evening, late, with several other crews and the towboat-operators waiting, I smacked my other shin-calf area HARD, on the edge of the boat I think.

    I was distracted enough by racing to the race, then racing IN the race, that I didn’t really focus on it, or the pain, ’til we were towing home. By then, it looked a bit as if I’d grown another knee! I’ve had worse lumps after bumping that area — same leg actually, on an Albacore, while sailing in the World Championships 7 yrs ago! — but it was still pretty dramatic.

    I have been feeling unusually klutz-like in the boat this year, and maybe being post-ATR is a risk factor for that (and maybe it was a factor in 2003, too). Or maybe I’m just a klutz!

    Anyway, the leg swelled up a lot — though with my under-developed calves, I’m afraid it looked better instead of worse! — and it’s still achy and very sore to the touch at the impact site, which has a hard sore lump. Maybe ~5″ below the knee, and an inch or so inside (medial to) the shin bone. Not much padding there, at least on me. Hardly any black-and-blue bruising yet, though I expect it’ll come.

    I’ve commented on it before, but there’s a weird kind of “joy” in worrying about a pain, especially in the leg, that has nothing to do with this ATR! On the other hand, I’ll be happy when my right leg’s back to normal!

    BTW, I’ve received 2 e-mails from the (chief?) author of the study that Johanna linked above, and he sent a copy of the study. I’ll probably paste the text and discuss it, on my “studies” page, where it belongs. Basically, he thinks surgery is better, based on (e.g.) a rolling rough average re-rupture rate based on all the studies done over the past 20 years, rather than focusing on the 4 latest ones (as I do) that were all randomized and all used modern rapid rehab protocols — and the same protocol for surgical and non-surgical patients, too, unlike many of the earlier studies.

    He points to Beckham’s surgery to prove that he’s not alone. Of course, we here all already knew that he’s not alone, far from it! That’s the problem, eh? But Johanna and her surgeon are taking care of Norwalk, CT, and my surgeon’s helping with Toronto, ON. . . :-)

  62. By firstdayofsummer on Aug 2, 2010 | Reply

    You are kidding about the author of the study, right? Which part of ‘The present treatment resulted in good to excellent functional results in most cases’ did he not like?

    FYI, there is german Achillesblog as well and I was delighted to see that conservative treatment appears to be the choice of treatment by many hospitals and surgeons…..even for young people and athletes!

    Sorry to hear about your ‘klutziness’ yesterday but glad it did not effect the tendon ;)

  63. By gerryr on Aug 2, 2010 | Reply

    Albacore World Championships!!!!!! Now that is really cool. Sailboat racing is a kick. I did a little of that when we lived in Minneapolis, crewed for a another guy at the yacht club with a 28′ foot O’Day. It was a lot of fun.

  64. By normofthenorth on Aug 3, 2010 | Reply

    I’ve traveled to two World Championships (We’re actually supposed to call them the Albacore INTERNATIONALS), 1 in Rehoboth Bay Delaware in 1999, then in Kingston Ontario in 2003. We “overperformed” in 1999 and finished 12th — suprrising many people, but probably none as much as the two of us!

    The 2003 Worlds were going almost as well for a while. We were sitting in 18th position 4 races from the end, then had a series of minor disasters in the last 4 races (me falling out of the boat between races and the boat dumping, then dumping in strong winds and “clocking” my crew right over the eye with the centerboard while I was under the upside-down boat, then skipping the last two races after she started getting a lump and a headache!) that kept us from finishing ANY of them, and dropped us to 35th. Out of about 60 boats, both times.

    Heck of a sport. The Worlds are coming to town (Toronto) in 2011. The way I’m racing this season so far, I may skip them! Fun sport, though, and “deliciously complicated”, too.

  65. By normofthenorth on Sep 14, 2010 | Reply

    I just posted this in response to Savvy’s blog about athletes who’ve had ATRs (where it belongs). But it’s awaiting moderation because of the URL, so I’ll mirror it here, too:

    I just tripped over a video of Misty-May Treanor — including the ACTUAL RUPTURE(!) at http://www.youtube.com/watch?v=yqNGFoakTDA&feature=player_embedded .

    It looks like she was doing “the move” that tore close to 50% of our ATs (and both of mine) — pushing off from a foot that’s well behind you, hard eccentric loading of the calf and AT.

    And she apparently got surgery and a cast, straight “old school”.

    [And I found out about it from a notice at http://www.squidoo.com/achilles-tendon/ .]

  66. By normofthenorth on Sep 14, 2010 | Reply

    And here’s a “mirror” of a post of mine from Foozed’s blog page:

    +1 to everything you said, Nate. But I’m surprised how many people report experiences like yours — fast aggressive rehab, with lots of PT and exercise and STILL have significant deficits after a pretty long time.

    I’ve been much more lackadaisical than you and Foozed about exercising (as I was 8 yrs ago when I had my first ATR on the other side), but I’m still surprised that my calf strength is still wimpy after NINE months. I can only do a couple of really short 1-leg heel raises, maybe just under an inch. That is better than a month ago, but at this rate. . .

    8 yrs ago the whole recovery was different. I was immobilized “forever” in a series of casts before I even got into a walking (hinged) boot, then I stayed in that “forever”. Then one day, while I was still hanging out in the boot, I noticed that I could walk normally, even barefoot. That same day, I was capable of doing 3 or 4 good-height heel raises, too — though I should NOT have been talked into DOING them (by my PT). I then suffered real pain behind the heel, which didn’t go away for a whole month!

    But after that setback, at around 5 months, my calf was presumably strong enough to do at least ONE good high 1-leg heel raise, which is more than I can do now at 9 months. And I’ve had a MUCH shorter immobilization, with quick rehab and PT starting at TWO WEEKS after I started.

    I did skip the surgery this time. But we’re talking about calf strength here, not how my AT has healed. My ROM is perfect, so every indication is that my healed AT length is perfect. I feel great, almost 100% normal. Other than the calf-strength deficit, the only lingering effect is a slight tenderness under my heel. No problem in shoes or barefoot on normal surfaces. But when I wear the little bumpy “massage sandals” that I used to live in constantly while at home, my left heel still gets a little unhappy.

    Back to the calf strength: Doesn’t it HAVE to be true that a shorter immobilization and quicker mobility and PT and exercise and WB means less calf-muscle atrophy and a quicker return to full strength? There are certainly examples of bloggers here — doug53 pops to mind — who’ve followed that program with great results. But there are a remarkable number of counter-examples, too, including the three of us. Maybe the FOUR of us, including my first ATR.

    There is one more variable in my case, that I haven’t mentioned: I did go from a 56-year-old to a 64-year-old between my two ATRs. But I was still playing competitive volleyball with a bunch of 30-somethings. AFAICS, I had lost nothing in speed or vertical. In fact, I’d switched from competitive 6-on-6 court ball to competitive 4-on-4 court ball, and I’d also taken up some serious beach volleyball, including some (brutal!) 2-on-2 beach. Not your typical 64-y-o (now 65), but maybe that age thing is still holding me back this time.

    Puzzled!!

  67. By ripraproar on Feb 23, 2013 | Reply

    Hi
    Normofthenorth, been following your comments for 2 days.bought myself an iPad I’m not it savvy so struggling finding pages but have got a real thirst for knowledge, nor in looking at the lazy way out soil cut to the chase, had ATR Sunday, went to A&E I’m uk based, they put me in cast Sunday, saw a consultant tues, he put me in airboot 5 wedges, told me to take one wedge out 2weeks then one wedge a week after, he told me to put weight on straight away which is a bit daunting, norm do you feel this is aggressive, norm I’m wondering if non ops the right way to go and finally are you still on this site, I was also following brady browne Winnipeg but he seems to have diss alerted from you tube
    Many many thanks

  68. By normofthenorth on Feb 23, 2013 | Reply

    Thanks, ripraproar. Putting weight on an ATR in the first week post-non-op is unusual and quick = aggressive. The tapering-off of plantarflexion from 5 wedges to none is “logical sounding” but not evidence-based AFAIK. I.e., I’ve never seen a study that treated a bunch of ATRs that way to see if it actually WORKS better than (say) the UWO study’s way — 2 1-cm wedges for the first 6 weeks (NWB, PWB, & FWB, 2 wks each) then none. My bias is to follow the evidence, i.e. mimic the study that produced the best results so far. I think that’s UWO, and I’ve posted their protocol at bit.ly/UWOProtocol . They waited 2 weeks before adding any weight, then moved to FWB As Tolerated 2 weeks later, ; weeks in. And careful exercises and PT started at 2 weeks.

    It’s always possible that your Doc’s 5-wedge system wld work better on average, or maybe especially for you — there’s no way to prove otherwise, but there, no evidence that it’s true, so I wouldn’t bet on it myself. The only study I’ve ever seen that tried to estimate the perfect angle of PF to bring the torn ends of an average ATR together but not overlapped (”approximated”) — which we all ASSUME is optimal for the first stage of healing — was done on cadaver legs and came up with 2-3 cm of heel wedge, IIRC. You might find it online, or J may have posted a link here somewhere. 5 wedges sounds like a lot, assuming they’re 1cm thick at the fat end (and firm, if your putting weight on them).

    One factor is that so far, the most aggressive rehabs (UWO 2010 and the 2007 NZ study) have produced the best clinical results AFAICS. There’s got to be a limit to that correlation, but it’s not unreasonable to guess that we haven’t hit the sweet spot on the graph/curve yet — i.e. that going a bit faster than those studies might work as well or better.

    Good luck and good healing!

  69. By ripraproar on Feb 23, 2013 | Reply

    Hi Norm, Thank You for your speedy reply, I apologise for my slow reply and my grammar, I only stumbled across your reply by accident and the grammar is a spell check thing, I said I wasn’t IT savvy, but think ill get that sorted quicker than the ATR, don’t think my doc was being revolutionary, he was printing of the net whilst speaking to me, for sure I’m not going to wait six weeks before I see him again and I may go for a second opinion.
    Norm, don’t wish to embarrass you but I think your an absolute star for taking time out to help and advice the anxious , so a great big thanks.
    One last question are you back to 100 percent yet and do you still favour non op route,

  70. By normofthenorth on Feb 23, 2013 | Reply

    Thanks for the thanks, ripraproar, it makes my day! :-)

    Yes, I still favour non-op treatment for ATRs, PROVIDED that (1) the treatment starts promptly and (2) a modern protocol (like bit.ly/UWOProtocol ) is used. If either of those conditions is violated, I get nervous about the non-op cure and start recommending surgery. It’s possible that non-op treatment can improve significantly, but so can surgery, so the jury’s got to be still out about the very best future approach. But for now, starting ASAP on the UWO non-op protocol (or the 2007 NZ one) seems to give about the best odds of an excellent result, while minimizing the chances of a terrible result.

    My own case is interesting (”It’s complicated”), and I’ve documented it to death on my various blog pages. I’m functionally back to 100% after two ATRs, op on the right side and non-op 8 years later on the left. By “functionally back to 100%” I mean I’m back to all my fave activities (including competitive volleyball 1-2x/wk with a bunch of young jocks) with absolutely no concern about my ATs or my calf strength, etc.

    But in different ways, neither of my legs has recovered perfectly, with a short AT-and-calf on the post-op side a a long one (esp. the connection to the Gastroc muscle) on the post-non-op side. The long one keeps me from doing good strong 1-leg heel raises (which I USED to care about!), and the short one has my podiatrist very concerned about the future of that ankle holding me up, and it may also be responsible for my “trick” right knee, which goes badly out of alignment every time I sit down for an hour.

    Most people on this site probably believe (as I used to) that never regaining the ability to do good strong 1-leg heel raises would be a serious lifestyle problem, but for me — and to my great surprise — it’s been a zero. OTOH, my right knee may end my long volleyball “career” in the next year or two. And if my right-knee misalignment problem really is the result of my surgeon’s decision to repair my AT on the short side ~11 years ago (just my theory now), then that imperfect surgery has done me way more harm than my imperfect non-op cure on the other side. And the non-op cure was much faster and easier and more pleasant, and left no scar and no attachments.

    But I’m just one (mouthy) data point (or maybe 2), and it makes more sense to look at the randomized trials involving 100+ patients when choosing a treatment.

  71. By ripraproar on Feb 24, 2013 | Reply

    Hi Norm
    Thanks once again, I’ll make the appointment and let you know the outcome
    Have a great day

  72. By pavlik99 on Mar 4, 2013 | Reply

    Hey norm, thanks for posting all this useful info and for all the fellow ATRs. I had a question regarding weight barring. I fully ruptured my Achilles’s on 2/06 playing soccer and went to see doc next morning. was put in a cast with foot pointing down for 3 weeks and had the cast taken of 2/28. My doc put me in a OSSUR boot with 3 wedges and told me to no weight bearing, and to come see him in 3 weeks to have one of the wedges taken out.

    The same day that i got the boot put on. I did partial weight bearing, by putting about 50% of my weight on the foot, and had no pain at all. next day i was able to put full weight on my foot and still had no pain. Roughly after being in a boot for 2-3 days i am able to walk in it with out a slight bit of pain, just not sure if I should be doing this.
    Any thoughts?

  73. By normofthenorth on Mar 5, 2013 | Reply

    I’d compare your progress to bit.ly/UWOProtocol , which is my standard benchmark because (a) it’s fast and pleasant and (b) it got excellent results, both with and without surgery, in 150 carefully followed ATR patients. Check it out.

    They went from NWB to PWB at 2 weeks in, then GRADUALLY progressed to “FWB as tolerated” at 4 weeks in. You’ve gone to PWB at 2 weeks in, then jumped straight ahead to FWB the next day.

    I don’t think ANYBODY can be sure if you should be doing this! The fact that you’re pain-free is good news, but it doesn’t guarantee that your eventual results will be as good as the UWO patients were, following that protocol. Your way’s never been tested, AFAIK, so nobody can prove it isn’t much worse — or even better — than UWO’s. You’re navigating uncharted waters.

    My own preference is to stay with the evidence and avoid uncharted waters. But you are directing your own rehab now, and my opinion is just an opinion, making my own personal tradeoff between convenience and evidence, not yours. So me, I’d back off and follow UWO’s schedule. But if you decide to continue, then at least be very sure to take the next steps very slowly and incrementally and back off at the first hint of pain.

  74. By pavlik99 on Mar 5, 2013 | Reply

    Norm, thanks for the quick reply. I understand that I am in uncharted waters here with this. It just that everywhere I read seems to say the sooner mobilization provides for better end results.
    UWO Protocol does not mention anything regarding sleeping with the boot off. Any idea when this occurs on average?
    Also could you describe these, not sure what it entails

    1. active plantar and dorsi flexion to neutral
    2. inversion /eversion below neutral

  75. By normofthenorth on Mar 5, 2013 | Reply

    pavlik99, you’re right that all the studies so far (at least the ones I’ve seen) have shown that faster rehab produces better results, with and without surgery (and especially without). But there’s GOT to be a limit to that relationship, where going another 1% faster has no benefit, or goes “off the cliff” and produces very significantly worse results. We just don’t know where that limit is, or what “shape” it has.

    We NOW know that Columbus and the others were NOT in danger of sailing off the edge of the Earth, but we don’t know that about ATR rehab, and “the faster the better” can’t go on forever. (We DO know that people who just “go to 2 shoes” and walk around on their ATRs do very badly. So that’s clearly “off the cliff”, too aggressive a “rehab”.)

    If you search this site for “sleep” and “boot” you’ll find the “club’s” experience, and what our various health professionals told us. Most people are most concerned about being injured by bed-covers or a boistrous partner. I’m most concerned about (a) getting up in the night (e.g. to go to the bathroom) and injuring your leg or something else, and (b) having your ankle/AT tighten up = plantar-flex (toes down) during the night, so getting back into the boot is a stretch.

    I especially worry about stretches that coincide with WB, like this one. That’s why I advise people who are removing a heel wedge to do it at bedtime, and sleep in the boot that night, to get the leg used to the new ankle BEFORE loading it up with weight.

    Personally, I’d probably wait ’til ~4 weeks in before trying to sleep boot-less. Or ’til you’re really comfy walking barefoot if you get up during the night (or in a rush).

    “Active” flexion means wiggling your foot down (plantar) and up (dorsi) using only your own internal muscles: no floor contact, no towel, no hands, no Therabands. Using anything EXternal is called “passive”. (Not the most obvious terminology for most normal people.)

    “Neutral” is a normal stand-up-on-your-two-feet ankle angle, 90 degrees between your shin and the sole of your foot. In both of these instructions, your foot does NOT dorsiflex above neutral, to avoid stretching the AT or “scaring” it early on. No ankle angles at 89 or 85 or 80 degrees, never more acute than 90=neutral.

    “Inversion” and “Eversion” mean wiggling your foot (pointing your toes) “in” (toward your other foot) and “out” (away). And of course, you still keep your up-down ankle angle “below neutral”.

    That last point can be confusing to some people, because “below neutral” is not really a limit on inversion /eversion, but a limit on motion in a different direction. Logically you might expect something like “inversion /eversion within 90 degrees of motion” or something similar that limits the exercise under discussion. But no. And there’s an overall “lesson” there, too: Even when you’re focusing on wiggling your foot in and out, left and right, if you go too far in the “up” direction — a direction you’re NOT focusing on — you’ll hurt yourself!

    This may seem stupidly obvious, but it’s important: Ignoring something, or being distracted, will NOT protect your body!! If you get comfy and confident enough to walk down stairs while carrying stuff and talking on the phone or texting at 6 or 10 weeks in, YOU will feel “safe as houses”, but your still-healing AT will be very vulnerable to reinjury. It’s in our normal nature NOT to think about walking, and to get into all kinds of weird and (usually) wonderful positions and “moves”. But NOT NOW! Now, you’ve got to Watch Your Step. If posting “Watch Your Step!” posters on the wall will help, do it! Most reinjuries, including reruptures, look like stupid distractions in hindsight, but didn’t seem like any big deal until the injury.

    ‘Nuff said. [/rant]

  76. By pavlik99 on Mar 5, 2013 | Reply

    I was supper active prior to injury, gym 5 times a week, running and soccer several times a week. This whole sitting on my bum and not doing anything is driving me nuts.

    WOW! What you say and what all the studies and recent information shows is not what my doctor told me at all. After 3 weeks in a hard cast with NWB and then he said to be in the boot for 3 weeks at NWB, take it off only to shower. I did not have an MRI/X-Ray done at my initial visit nor at my 3 week visit when i had the cast removed and boot slapped on. However I am able to walk with the boot easily if i turn my foot out to the side. Not a single bit of pain… Really concerned about the no pain as I pretty much went from NWB to FWB in a matter of days, just because my body was not stopping me. Could it bit that it is not healing? (MY MAIN CONCERN AND WORSE NIGHTMARE) When i take the boot off, I can feel the separation with my fingers in my Achilles. both ends seem to be right next to each-other almost touching, however it does not feel like it is consistent or enacts.

    Any supplements work in your experience or assist in recovery? I have read on one of your posts you started taking MSM, that should help with joints, and possibly ligament tissue regeneration.
    I have been taking about 500mg of Vitamin C, Cissus, MSM, Glucosamine, Fish Oil, Multi-Vitamin and about 25g of Whey Protein.

  77. By normofthenorth on Mar 5, 2013 | Reply

    It is a cruel irony that this ATR injury mostly happens to people who are unusually active, and to those of us who get our kicks, our identity, and our sanity from being active — and then we can’t be active for a while. It’s cruel, but it’s real, and dealing with it is the only choice.

    I would go back to the UWO schedule, no FWB ’til 4 weeks in — maybe a few days later, because you spent 3 weeks NWB instead of their 2. And I would NEVER EVER walk with your toes pointed out, once you’ve started treatment! When you are (now?) PWB, still (or again) on crutches, you should be imitating a perfectly normal walking stride, just with reduced weight on your injured-and-booted foot.

    Then when you begin FWB, you should continue walking as normally as possible: toes pointed straight ahead, strides normal length and the SAME length. As you roll forward on your boot, your weight will be transferred through your boot, from the ball of your foot to the front of your shin.

    If you want to start FWB now instead of a week or so from now, enter those uncharted waters with my best wishes, but please don’t teach yourself how to walk like a crippled person. Those tricks can be damaging and also hard to un-learn later.

    Everybody worries about non-healing, especially non-op patients, but that is almost unheard-of. Have faith, stay with a proven program, hang in, stay sane!

    I didn’t focus much on supplements, but several others here did, including ryanb IIRC. Search for it.

  78. By normofthenorth on Mar 5, 2013 | Reply

    BTW, I’ve just noticed that the only recent ATR folks here who’ve mentioned exactly when they tore their ATs, mentioned that it happened LATE in the game, the session, the evening. That’s when my two ATRs happened, too, and may other people’s here over the last few years. If anybody’s still “kicking themselves” for not having warmed up enough before starting the sport/activity that caused your ATR, I’d say Forget It!

  79. By ryanb on Mar 5, 2013 | Reply

    Hey, that’s my cue:
    achillesblog.com/ryanb/2011/09/26/tendon-nutrition/

    I’d also advise caution accelerating a non-op protocol beyond the tested standards. At least with an op, you know things start out connected, and (though, not always) if you tear apart the sutures, you probably know it. With non-op, you’ve got to first allow things to reconnect on their own, and my concern would be that getting active and weight bearing TOO soon, might inhibit that magical process. We just don’t know enough about it to be sure.

  80. By normofthenorth on Mar 5, 2013 | Reply

    pavlik99, I just found some more evidence of how and when going TOO fast can cause harm in a non-op cure: One study that used immediate full weightbearing —
    Metz R, Verleisdonk EJ, van der Heijden GJ, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing: a randomized, controlled trial. Am J Sports Med 2008;36(9):1688-1694 — reportedly got really AWFUL results from their non-op patients:

    “Researchers reported a complication rate of 21% for surgical treatment, versus 36% for nonoperative therapy. The mean time to return to work was 59 days after surgery, versus 108 days after nonsurgical treatment.” [Quote from “BATTLES OF ACHILLES: The operative vs nonoperative treatment debate”, May 2011 Lower Extremities Review, http://lowerextremityreview.com/cover_story/battles-of-achilles-the-operative-vs-nonoperative-treatment-debate

    (I lost a whole week of work after my ATR#1 surgery, but I didn’t lose a day when my ATR#2 was treated non-op. Mind you, I don’t dig trenches or haul stuff around for a living. . .)

    I haven’t consulted the 2008 article or even the abstract yet, but the description seems to indicate that immediate full weightbearing is “over the cliff”.

  81. By ryanb on Mar 5, 2013 | Reply

    Very interesting stuff Norm. Studies like UWO show that, when using a similar protocol, surgical and non surgical treatments can often yield similar results. However, those studies have to be done at a pace the non surgical patients can tolerate.

    What I think you’ve found here confirms something I’ve suspected for a while. Surgical patients *can* go a little faster (the non-op folks fell of the proverbial cliff here). Surgical guys didn’t do great at this pace (%21 complication); but they did a lot better than the non-ops (%36). My guess would be that most of the non op complications were pretty severe… where as some significant percentage of those op complications would be the usual infections, adhesions, suture problems, etc. So, I’m speculating the difference might be more extreme than these numbers suggest (what’s a minor non-op complication?)

    My next question would be: is there any advantage to going at the faster (fastest) pace that surgery allows (fastest you can go without seriously increasing the risk of complication)? My gut instinct says that the faster you get weight bearing, mobile, using the calf… the better you’re likely to do in the long haul phase 2 of recovery. Less atrophy to overcome. Less degradation of proreceptors. Etc. Gut instincts are often wrong though.

    Alternatively, one might ask: If you’re going to throttle yourself to a non-op pace, then why get the surgery? :-)

    Good to see more data and info; keep up the good detective work.

  82. By normofthenorth on Mar 5, 2013 | Reply

    Ryan, it’s certainly possible (maybe even both logical and likely) that the OPTIMAL post-op rehab is faster than the optimal non-op rehab — AND that going that fast would produce optimal results, which non-op can’t match. In fact, I recall sharing these musings on this website with doug53, maybe 2 years ago! But that study’s immediate weight-bearing schedule is too fast for both kinds of patients, so it doesn’t really answer the question. (But if you want to read more of that study, be my guest; I probably won’t.)

    There’s also a link on my “studies” page to a small Japanese study of a then-new surgical technique that permitted a super-fast rehab that seemed to produce incredibly good results. (IIRC, the average age for returning to the high-risk sports was around 16 weeks post-op!) Probably also not 100% optimal, but very possibly better than optimal non-op. (I think doug53 and I discussed that study, too, as well as his own very fast post-op rehab.)

    Unfortunately, the same stodgy bunch of “It’s already good enough” surgeons (mostly in the US) that I complained about in my very recent comment to my “The case for skipping surgery” page, are continuing to use suboptimal approaches, including post-op rehab schedules that are WAY slower than optimal. And probably also suboptimally not trying out that new Japanese technique.

    The average post-op patient here is still being “throttled” at a much slower pace than UWO’s fine-for-non-op pace — so it’s definitely not non-op that holding them back. And unfortunately, the average non-op patient here is going even slower, which is clearly harmful. I’m sure there are some old studies where both kinds of patients went at a similar or identical way-too-slow pace, and I’m sure the post-op patients did much better — or maybe I should say I’m sure the non-op patients did much worse. If you look through the studies linked on this site’s “studies and protocols” page that test fast rehab for post-op patients, I think you’ll find (IIRC) that most of them do NOT show significantly superior results with faster rehab, more like comparable results. That’s enough to justify going faster (since it’s way “nicer”), but I don’t think it gives much evidentiary support to your logical “gut instinct”.

  83. By pavlik99 on Mar 6, 2013 | Reply

    Thanks for the update guys and thanks for the reference article norm. I agree, going FWB right away is probably not a great idea. I went 3 weeks in a hard cast with no NWB to a boot and FWB in 3.5 weeks. I was able to take my foot out of the air cast and move it around a bit to neutral position and then to planter.

    Unforanatly this might not make a difference in my recovery as I think i might be back to square one. It snowed here today and as i was getting in to the office, the building has marble floors at the entrance, my crutches were wet and slid to the sides right from under me. I ended up landing on the toes of my injured foot. I was wearing a boot, but the instinct was to stabilize and I might have reruptured. I felt a slight “pop” similar to the one originally felt, but on a smaller scale and pain. I have not had any pain at all for about 2 weeks up till now. The pain was pretty bad at exactly the point of original injury, though it gradually subsided over 6 hours from the fall. It has now been 8 hours since the fall the pain is gone, unless I move my foot, which before did not bother me at all. I took my foot out of the boot and i can still bring it to neutral position, but not any further as I feel a stretch and slight pain in the achilles, which is how it was before the fall, so hopefully it is not as bad as I think it might be.

    That fall was pretty horrible especially the after-effects of it. Before getting up I had so much emotion flowing though me, did not know weather to cry, curse, hate myself for not being more cautious, or just scream out in agony.

    Today is week 4, exactly one month from original injury. Due to snow, doctor’s office is closed today, I am going to go in first thing in the morning tomorrow and hope for good news. Really hope i did not just blow a month of recovery away.

    Will keep you guys posted, and thanks for the support!

  84. By normofthenorth on Mar 7, 2013 | Reply

    We all hope that, pavlik99! Wet crutch tips on a smooth floor, or crutches on a wet smooth floor, are the WORST!! My worst fall after my 2nd ATR came that way, and was scary. Most of us have had slips and falls that made us worry that we’d reruptured. Most often we did not, but some of us actually did. The Thompson test is the quickest way to get a “second opinion”, though it’s almost impossible to do on yourself. But if you’ve got somebody nearby, just lie face down on a bed or table, boot off, with your foot hanging free, and have the other person squeeze your calves — first on the UNinjured side, then the injured side.

    If your injured-side ankle extends when your calf is squeezed, then at least some of the AT is still connected. Many patients and doctors also like to try to “see what’s going on” with UltraSound or MRI. I’ve had, and seen, so many weird and flaky results with both of those, that I’ve lost faith in them, at least until the technology or the training improves.

    I think we’ve had reports here of ATR patients who “failed” the Thompson test (ankle doesn’t extend) several weeks after their treatment, but they were OK. But for sure, if you “pass”, it’s not a total rupture. If it is, most surgeons suggest an operation, though we’ve had a few people here in the past few years who went non-op after a re-rupture. I can only clearly remember one, and he was doing fine last time he checked in here. (I’m guessing he would have let us know if it had failed.)

    Having a doctor palpate (feel) your AT area is also a good plan — though again, most 4-week-old non-op ATRs still have a palpable “notch”. . . But definitely see your Doctor for a professional opinion, and good luck. And DO Watch Your Step!!

  85. By pavlik99 on Mar 7, 2013 | Reply

    I had my fiance do the Thompson test last night and the foot did not move at all, that had me even more scared.

    Just got back from the doc, he felt the tendon and tried moving my foot a bit and says the tendon is still intact, though I probably re-injured it (not re-ruptured) and just aggravated it.

    The foot is back to being in pain and nicely swollen. The plan was for me to remove one of the wedges in the boot a week from today, but now he thinks I should keep it there for 3 more weeks till I remove the first one, so I guess pushing my recovery back by two weeks.

    Not as bad as I thought, but not all that great either. I guess this is a good reminder to be supper careful.

  86. By normofthenorth on Mar 7, 2013 | Reply

    For sure, be super careful! Your situation is unfortunately uncertain, and the ideal course from here also seems uncertain. I’m the main “cheerleader” here for skipping surgery, but one of the nicest things about ATR surgery is that it reduces the uncertainty, so it’s psychologically easier than non-op rehab, regardless of the studies and the results. You get to deal with a doctor who’s held your exposed tendon in his hands, and repaired it. So when he gives you an opinion on (say) whether or not you damaged it again (right or wrong), you believe him and you feel better.

    MRIs and UltraSounds have a similar effect (though I fear they’re wrong almost as often as they’re right).

    In general, doing the logical thing in a non-op ATR treatment — going extra slow in order to “make sure” or “be conservative” or “avoid problems” (”heck, we don’t want to have to do this twice!”) — turns out to be stupid and wrong, according to the evidence. Based on that, delaying your rehab by 3 weeks might be a Bad Thing.

    On the other hand, it’s possible that (a) you have seriously reinjured (or reruptured) your AT, and/or (b) your renewed inflammation (pain and swelling) from your fall, WHATEVER the clinical details, have restarted the frantic-healing process that usually only occurs in the first few weeks after an ATR. In either case, you might have the best results by “starting over”, NWB in plantarflex-”equinus”, and starting a good non-op treatment from now.

    I sure don’t know, and I’d be surprised if your Doc knows, even after getting an MD and after examining your leg.

    But FWIW, bit.ly/UWOProtocol used 2cm of firm rubber heel wedges, and left them in for 6 weeks (and got great results). NWB lasted 2 weeks, PWB another 2, then FWB “as tolerated”. And “wean off boot” at 8 weeks. It might be reasonable to compromise, to go somewhere between “UWO starting now) and what your Doc has prescribed.

    Another psychological edge to the post-op crowd: Most post-op ATR patients, even those with pretty crummy results, are comforted by the fact that they got the most aggressive treatment. We’ve had a bunch of folks here with wounds that didn’t heal “forever”, or sutures that didn’t dissolve and caused grief or re-ops. . . and I can only think of one (gerryr) who clearly and publicly wished he’d gone non-op. Getting surgery seems like DOing something, and going non-op often doesn’t.

    By contrast, non-op patients — especially those who don’t love their results — are prone to kicking themselves for not doing enough. You hear phrases like “leaving it alone” or “leaving it to heal by itself” or even “not repairing it”. Even if non-op results were clearly and significantly BETTER than surgical results, we humans would be at risk for those kinds of thoughts.

    Again, don’t get me wrong: I think the scientific and clinical evidence points toward non-op cure for the majority of ATR patients. But despite the extra pain, scarring, and risks, surgery is much easier on the psyche for most patients.

  87. By pavlik99 on Mar 7, 2013 | Reply

    My doc pointed out that bright side of re-injury that it kick starts the healing process that occurs during the first few weeks and accelerates the healing. I will listen to my body and see how things go. As stated I am 1 month from injury and was doing pretty well. Had no pain in boot, no swelling, could FWB and do basic neutral to plant extensions. Now pain at slightest movement and even when setting my foot down on the ground, swollen probably worse than the first time around,. I have 3 wedges in my boot, and doc wants me to pull first one out in 3 weeks (originally the first one was suppose to come out next week) So I will see and if pain goes away, might pull that first wedge a bit sooner, hoping for 2 weeks from today. Till then keeping the boot on all day, except for showering and occasional rest on the bed, for about 15 min to let it catch some air, once a day.

    As far as op and non-op goes. I live in the states and seems like there is a big push for operative repair here. I ruptured mine on Feb 6 at an evening soccer game. Came home and did some research and it was pretty obvious that it was Achilles that was ruptured from self-diagnoses and just googling it. I than started looking at treatments and it seemed like everywhere in the word non-op was the way to go, except for US of A. With some knowledge under my belt I went to the first Ortho doc, a sports med foot specialist. I have been to his office in the past for a dislocated shoulder (snowboarding incident and only other injury ever sustained). He checked me out, confirmed that it was the Achilles and said we need to get you in to surgery by next week. He did not even mention or give me the option of going non-surgical. When I asked him if there is any way of doing it without surgery, he told me that if I plant to ever be active again, surgery is the only way to go. At the point I decided that he was not the right doc for me. Went to another Ortho doc right after him and this one gave me both options, advised of benefits and draw backs of each. Informed me of the recent study done in Canada that shows good results in non-op procedures, and I went with him.
    I was outraged with the first doctor not even presenting me the option of doing it non-surgically, hopefully I won’t regret not taking his choice of treatment later in life =)
    Here in US operating rooms are chilling idle, and need to be put to use to pa the hospitals, docs make thousands of dollars on these procedures that last not even an hour, as opposed to slapping a cast on or providing a boot. So it is mostly in their own benefit to advise the patient to do surgery. I am sure there are other drivers for it, but that’s probably the main one.

  88. By normofthenorth on Mar 8, 2013 | Reply

    Nice that your Doc and I saw the same bright side, Pavlik! I hope it’s the dominant effect of your slip — but don’t do it again!!

    I’m outraged at your first specialist too. I’m sure financial self-interest drives some of the bias, but I suspect a lot of it is just “confirmation bias”. Mark Twain or somebody else said “If your only tool is a hammer, all your problems look like nails.” My daddy used to say “Go to a carpenter, he’ll say to make it out of wood.” Neither of these smart guys accused the carpenters of being greedy or crooked or evil. Maybe they were, but it’s not necessary to assume it, because we all are vulnerable to that same kind of bias. We choose professions partly because we think they are useful, and then we “see” evidence that they’re useful, and we “don’t see” contrary evidence. Just normal humans.

    The rest of the world, outside the US, is less pro-surgery, but way far from “everywhere in the word non-op was the way to go, except for US of A.” More like “they’re all over the block, even at the same hospital”! And a few places are sometimes as outrageously anti-surgery as your first specialist was pro. The evidence is currently complicated and nuanced and pretty balanced, so all the bullies on both sides have it wrong, IMHO.

    Good luck! Start a blog of your own, and keep us posted.

  89. By pavlik99 on Mar 26, 2013 | Reply

    Norm,I have a few questions for you, if you don’t mind sharing some wisdom =D. Tomorrow I will be 7 weeks post injury/treatment, I no longer have any wedges in the boot. I started sleeping with out the boot 2 days ago. I can move my foot to neutral and plant flex. Yesterday I took a few steps around the couch at home with out the boot as well.

    I can still feel where the injury occurred the tendon is much thinner then else where, is this normal?
    The tendon on both sides of the tear is still swollen and feels inflammatory.
    I am also having some minor pain at the bottom of the calf muscle… all this part of normal healing process?

    Also have you heard anything about this product?
    http://www.amazon.com/Tendon-Rescue-Gel-3-50-Ounces/dp/B0016AZT5E/ref=sr_1_1?ie=UTF8&qid=1364308835&sr=8-1&keywords=Tendon+Rescue

  90. By normofthenorth on Mar 26, 2013 | Reply

    It still sounds pretty uncertain, pavlick, but I’ll share some guesses FWIW:
    A palpable “divot” at the ATR site is common in non-op patients early on, I think.
    The effects around the tear could (also) be normal and transient or a sign of problems.
    A pain at the bottom of the calf muscle (well above your ATR, right?) is probably unrelated and probably not serious IMHO. Your calf has been through a very strange time.
    No clue on the link, sorry.

  91. By ripraproar on Mar 26, 2013 | Reply

    Hi Norm,
    May I ask you a question, I’m getting a few tendon pains recently hot legs too, I’m over 5 weeks now and not back to doc for another 3to4 weeks, with the niggles I’m getting curiosity is getting to me , the question is do you think it would be ok to do my own Thomson test now I.e get my partner to do the calf squeeze? Or should I sit and be patient.? I’ve had a few slips so would like to know if I’ve done the damage. I value your opinion

  92. By normofthenorth on Mar 26, 2013 | Reply

    I’d vote for patience unless there’s an abnormally good reason to fear that things are off-track. Where’s your rehab, up to PWB in the boot? I’ve never heard of anybody rerupturing from a Thomson Test, but the whole purpose is to pull on the tendon, and I don’t think you should be pulling on it yet. Once bit.ly/UWOProtocol calls for passive df stretching with a towel or a Theraband, the test should be very safe. ‘Til then, I’d just laugh at the joke about the farmer who kept uprooting his carrots to make sure they were growing OK.

  93. By ripraproar on Mar 27, 2013 | Reply

    Ginormous got my blog confirmation, filled it in but no send button so I’m just going to check its gone.i I was told to go fwb from day one, that was the only source of info I had until I found this great site. I will take your advice thanks one e again

  94. By ripraproar on Mar 27, 2013 | Reply

    Ginormous. Is hi norm , sorry it a spell check thing

  95. By normofthenorth on Mar 27, 2013 | Reply

    I love the Ginormous!! :-) Was that the iOs spell-checker, or Android, or what?

    I think the button is maybe called Publish? There IS a way, obviously. Also, I THINK (hope) I’ve activated the “AJAX Editing” option that lets you change your own posts here for 15 minutes — but then we would have missed Ginormous!

  96. By hillie on Mar 27, 2013 | Reply

    Fwiw, Ginormous, 1940s (originally military slang): blend of giant and enormous. (oh, really) According to one of the Oxford English dictionaries at least. Sounds too new though…

    On the same web page (apologies for diverting completely from AT issues but we need to sometimes don’t we) is the terrific word ‘cockalorum’.

  97. By ripraproar on Mar 27, 2013 | Reply

    Hi , yes it’s iOS
    Your right hillie on 2 accounts ginormous is giant and enormous , still say it in this part of England, and we do need a break from ATR , I’m addicted, sometimes the stories have me down and some sky high, it’s a real roller coaster. Anyways ive been in contact with docI’m going to see consultant tues, see how I’m progressing. Will update you all. Have a ginormous good day

  98. By normofthenorth on Jan 22, 2016 | Reply

    And MORE results are in, whether or not they’re meaningful: This past Fall, after spending an almost volleyball-free year because of a shoulder that was injured in a nasty bicycle spill, I returned for 3 marathon sessions (~2 hours each) of competitive indoor beach ball with a bunch of “kids” (much) more than 20 years my junior.* I played OK and had a blast, but after — and even DURING — most of the sessions, I noticed a discomfort in my left calf, which lingered a LONG time after the third session.
    Consulting with Dr. Google convinced me it was a tear in my calf muscle. I’m not sure there’s a connection, but that’s the same leg that got the non-op ATR cure, and where the Gastroc-AT has healed on the long side, with that calf muscle a bit visibly higher/tighter than my other one (where the AT was surgically repaired short).

    After skipping volleyball for over a month, I think it’s finally faded, maybe completely. I probably won’t test it again in volleyball until I get back from an upcoming Whistler ski week. If skiing doesn’t bother it (and I don’t think it will), I’ll presumably get it to run and jump in the deep sand a few times before Spring.

    Otherwise, my 70-year-old bod is behaving OK. One day at a time!

    ____
    *In my third session this season, I THOUGHT I’d finally bumped into the first volleyball player I’d ever seen in my competitive group (playing 4-on-4 or 3’s or 2’s) within 20 years of my age! But I asked him how old he was, and he turned out to be 24 years my junior, so my remarkable record is still intact.

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