Five months on from Re-rupture at 15 weeks

Thank you for all your helpful messages and support. It hs been an interesting time. As I had a VacoCast boot and a knee trolley already the only time I took off work was the first morning after re-rupture. I could not drive but coped with everything else. It was exhausting. Around week 10 I started driving again. Physio rehab two hours a week. So much muscle wasting and no time off work is making recovery slow. At least by continuing to work I have been able to keep my job. Most of work is in gym with bike, treadmill, stepper, trampoline, balance board and weight dorsiflex machine. Just been allowed to do a sort jog - felt odd.

My advice is that we are all different and make progress as our bodies and circumstances allow so don’t worry

Re-rupture at 15 weeks

On Saturday afternoon walking across grass having fed chickens slight stumble and too big a step forward. Plop like old rubber band snapping and a familiar pain in calf. Knew straight away damage done. Got my wife to get VacoPed Achilles boot. Immobilised it at 30 plantar flexion and elevated on big bean cushion. Luckily I had bought the boot and my knee walker so avoided archaic full length hip to toe plaster and armpit crutches that local NHS A+E provides. I did not even go to A+E – telephoned and managed to get review appointment in trauma clinic for the Monday morning instead. Orthopaedic surgeon confirmed the obvious gap about an inch above the surgical repair. 

I had pushed for surgical repair the first time back in Oct 2010 but this time I wanted conservative treatment. No way do I want to add to the pain and swelling. Boot only goes to 30 and he says 35 to 40 but that’s okay because I bought a pile of heel raises and stuff on line from Algeos before. Put in 3 x 12mm raise with a bit of orthopaedic felt on top for comfort. DUCK TAPE very useful for this – not just for treating warts. Gradually brought that down to 12mm raise by review at week 3. Strict elevation on 2 foot square bean bag, my night time companion, with boot on for first four weeks. Apply support stockings as soon as stable enough to risk it to reduce the swelling. I think they provide 18 to 26 mm Hg pressure but definition of Class I seems to vary. Sometimes when very swollen I use two layers which works a lot better. [].

Strictly non-weight bearing for first four weeks but because I have the knee walker I am back to work that same Monday afternoon after seeing surgeon for first time. I cannot drive and do out office work but I can do procedures requiring use of both hands at work - saved me cancelling appointments. I could not have worked if more swelling or pain and at times I was close to going home. It keeps my partners happier. Last time I was off for 8 weeks as I upset my shoulder using crutches and found that  I could not write or type in addition to requirement to elevate foot above heart for first four weeks. Maybe I only have a bad partial tear this time.

At 3 week review orthopaedic surgeon surprised that I have some ankle movement on Thompson calf squeeze test. We agree to continue conservative management but he is not very familiar with the Vacocast Achilles boot. Maybe when I have more time I will write a guide to how I think it should be used: fixed at times to apply gentle stretch, fixed range when using it to balance then partial weight bear then walk, removed at others to allow mobilisation. Similar story with compression stockings: applying heavy compression all the time can be uncomfortable but benefits of removing oedema in terms of range of movement self evident.

Could I have avoided the re-rupture? Maybe if I had had higher heel raise or still been wearing the boot.

Six weeks post op - I like VacoPed Achilles - 24th November 2010

I cannot comment on the other removable boots but I can say I love this boot. The boot itself allows a wide range of adjustments: fixed, range of movement, gentle fixed night time plantar flexion stretch (my idea rather than any protocol I have seen) and the choice of two soles - Achilles rocker to make walking easier. So much better than a cast…

Why the NHS does not provide this because all the the trips to plaster room must cost a similar amount in materials and technician time let alone patient comfort and recovery?

It is so nice to be able to wash, massage and simply see the injury site. With the boot off I can do all sorts of mobilisation stuff. With the boot on I can do some gentle exercises including those needing a range of movement. Best of all I was up and standing better within a few hours having struggled to do similar thing on the cast only hours earlier.

If you are interested take a look at the videos: However I have to say that the ones of the people swimming, breakdancing and sky diving with a VacoPed Acchilles are too extreme for me:

I have been so fed up with my ATR and this boot has brightened my outlook.

Had steroid injections to try to settle down my right shoulder that has been causing grief since I used crutches at the beginning.

Five weeks days post op - Fed up with casts. I want a removable boot.

Totally fed up with casts. An early one squeezed too narrow - caused me a lot of pain. Now I know what Morton’s neuroma feels like.  Latest uncomfortable, wrong angle and I cannot bear much weight as it still has to be in front of me.  I know from this website and others that there are better choices out there.

I contacted german manufacturer for UK distributor. I contacted their UK sales representative to confirm item I needed. Following his advice I ordered the “new” version VacoPed Achilles boot from Orthofix. The item is not on their website!

Went back to orthopaedic surgeon early at  5 weeks and 2 days and “persuaded” him to let me use the boot. Instantly it is more comfortable. No squeezing my forefoot. So so cross that I did not do this before…

Fourth week after surgery - collapsing shower stool

End of week four plaster changed and despite instructions by orthopaedic surgeon to get to zero degrees, plaster sets at 5 degrees…  I have a shoe and with “Heath Robinson” heel raise - six layers orthopaedic felt I can use my bad leg to balance when shaving.

I forgot to mention I wear walking boot on good leg with heel raise to balance out difference on leg length and because I am having pain in that Achilles tendon. And because it is more comfortable with my insoles for excess pronation casuing ankle pain and plantar fasciiitis.

I must ask my orthopaedic surgeon whether if I buy a VacoPed or Vacocast rather than the DonJoy or similar boot that my local NHS provides he will supervise my use of it… I mentioned it once but understandably he seemed very keen to stick to his normal way of doing things. Will try again when a bit further along. I guess they think that they know more than us patients, eh? The cost of the boot is £120 + vat & postage.

Third week after surgery - I get a new friend called K9 (knee trolley)

ATR on right. I suspect minor partial rupture on left and sever right shoulder pain. I cannot use crutches. My life is not great but I have seen worse.  I was getting desperate so turned to internet and great sites like this. There appear to be two sources of knee walkers in UK. I have not tried this one:  The chap was very helpful when I emailed him. It looks bigger and heavier and useful outdoors. The other one is . This is the one I got. Suits me fine and very helpful round the house and on the odd occassion that I have been to hospital.

Both times at the hospital I have been approached by about six people to tell me how they wished they had been told about these alternatives to using crutches and similar comments. You can buy or rent both of these. What I don’t understand is why if the NHS can tell you how to buy a plastic cover for your cast for a shower, why they cannot tell you about leg caddy or knee trolley. Sadly the physios did not know much about them. At least my orthopaedic surgeon and plaster room technician at least knew they existed even if they did not know where to get them.

Second week after surgery - other Achilles tendon hurts…

So I was crawling everywhere and had also made it to bathroom but there are a few steps so I decided to do the one foot shuffle recommended by someone else. Disaster strikes. I get a sharp pain in my good Achilles tendon. I had had problems and seen physio with pain from my AChilles a few weeks earlier. I now think I had a very minor tear then and the shuffling just broke up the bit of healing that had occured.  Used old bandages and a temporary splint thing to hold foot in toes down for comfort and pain eased after few days. Still plays up if stand on that leg alone or do twisting and stuff.

At the end of the week I get my plaster changed on schedule, to pumpkin orange because Halloween is coming. Interestingly the cast is a bit more flexible than the first one. That helps with some of cast discomfort but not the hypersensitivity and burning pain I get at times in my big toe. The orthopaedic rreassures me that it will improve with time. Most things do so I expect this will to but it does hurt at times!

First week after surgery - shoulder problems

I knew it would be bad and it was. Mobility problems. Bowl and flannel to wash in bedroom. Obtained a urine bottle to reduce trips to toilet.

Struggled with crutches until finally right shoulder got very painful. I had to give up and start crawling everywhere. I suppose I should mention that I had an operation on my right shoulder nine months previously. Major supraspinatus tear repaired and a decompression. It had been affecting my serve in tennis. It was also preventing me sleeping properly and affecting my use of a PC - something about posture and using keyboard.

Surgery - Achilles Tendon Repair

Overnight rather than daycase but that may have been timing of the surgery. General anaesthetic with nerve block.  Three small incisions. Evidence suggests this reduces complication rate. Nerve block seemed to work okay. Much less pain than after shoulder surgery. Back slab overnight. Next day full plaster.

Below knee plaster. Elbow crutches. Physio checked I could manage stairs. Home

Snap went the tendon - 10th October 2010

Playing badminton. Fourth game. Felt as if someone hit back of my leg with a racket. Heard and felt the snap. Realised something very wrong.  NHS. A+E. Hip to toe back slab plaster. Armpit crutches.  That length of plaster is a nightmare. That weight of old type plaster is miserable. Armpit crutches are simple but not great.

Consultant next day offered surgery or conservative.  Main difference is re-rupture rate and complications of surgery. You could argue that I am of an age when I may opt to become less active, but I have no risk factors for complications. I opted for surgery. British Orthopaedic Foot and Ankle Association quote 15 and 5% re-rupture rates. From my reading I think the figures are lower - maybe someone needs to update their patient information since at that level surgery would be a no-brainer for most.