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. [http://www.ejves.com/article/S1078-5884(08)00339-0/abstract].

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.

10 Responses to “Re-rupture at 15 weeks”

  1. Sorry to hear of your troubles. I am a fellow chicken farmer with a small laying flock. I am still ‘letting’ my helpers do the cows and chickens and will think of you when I want to get with it too soon.

    I too wondered abt the angle on the boot, but left mine at 30 degrees . . . hope it works out OK.

    Do I understand you are now ~7 weeks post re-rupture?

  2. Aw man, sorry to hear that you’ve re-ruptured. I would imagine it’s probably the thing most of us fear once we’re back in 2 shoes (or maybe that’s just me!) and it’s a timely reminder to me personally as I’m coming up to 12 weeks post ATR and keep thinking it’s the ‘magical’ number for the chances of re-rupture to drop - it’s not. I’m really not sure if having the op brings the benefits that the increased risks warrant but we may never know. Hope you are well on the way to full fitness.

  3. God that is so awful. I ruptured about the same time as your original one. You sound like your doing well both with the physical recovery and the mental battle. Keep up the good work and I hope that your recovery is speedy.

  4. I’ve been gardening and feel like I’m on a rocky boat sometimes on uneven ground. It is really hard to remain steady with a weak ankle. I’m at 14 weeks and you have made me think twice about some of those chances I’ve been taking. I remember a post from someone that said they would shoot their self if they reruptured…I can’t imagine going through all of that again. My heart goes out to you. Keep us posted!

  5. so sorry to hear that. I remember thinking at about 13 or 14 weeks that that was the real danger time - becuase you suddenly feel invincible. But good on you being so mentally together - I sure would not be. Take it easy on yourself huh!

  6. All the best with one more undeserved challenge! Keep one eye on the UWO protocol, which I think is a good guide to a good non-op cure. One version’s at bit.ly/UWOProtocol , the other (essentially identical, I think) is linked from the fulltext of the study that D posted here (at achillesblog.com/files/2008/03/jbjsi01401v1.pdf ).

    The best cure for a primary ATR is controversial enough, but we’ll probably never get solid evidence on the best cure for a re-rupture. One of our pals here is doing well (last he posted) with a re-rupture, using the UWO protocol.

    I think you’ve been going slower than UWO (like 4 wks NWB rather than 2), and my reading of the literature is that doing so is probably negative, at least for re-rupture risk — as well as being a bigger bloody nuisance.

    Good luck. You deserve some!

  7. So sorry to hear about your re-rupture. We’re all here for you!

  8. snapdragon, I felt I had to post to you since our injuries have similar paths. I believe it is me Norm refered to about not knowing which way to go on the secound rupture. I retore mine at 13 or 14 wk’s, 2 days after the OS said I was well on my way to recovery. When it popped the second time I went and got the US, saw the 2 cm gap, and back to the doc. He wasn’t big on cutting thru the same area 3 mo since old surgery because of infection, scar tissue etc. so we agreed on non op route. I didn’t have the VACO cast then, just a fixed boot. Doc said 8 wks in that see how it would go. As we all know from this site the more informed you are the better you can manage you own health, or health care even.

    I took the matter into my own hands, I got the V cast, 4 1\2 inch lifts and followed the UWO plan. I was lucky to some extent because I didn’t go NWB ever, just PWB. I did the boot, lifts and gradual progression neuteral and wt bearing. about 8 wks to 2 shoes.

    I can say now I just passed the 1 yr mark to original tear and surgery and am of today 9.5 mo post tear 2 which was is healing non op. It is not = to good side yet but is about 80+%. I can do most things, cycle, ski jog but have yet to do the one think that I was doing at time of injury which was Volleyball. It will come soon but not without some initial fear, albeit unwarrented I would guess.

    My biggest unknown is the wire sutures they used on the original surgery. I will always wonder where they fibrosed to and will they be a help to structure or hinderence to the future. Doc and medical side say they add support but as we see here what we think is the logical best choice isn’t always as good as mother nature.

    Becareful while healing, but I believe you will be fine in do time.

  9. I did not set up my own blog on this excellent site when I blew out my Achilles on May 8 playing soccer at age 54.

    Just tonight, after one beer too many at week 9 post surgery, three days out of my boot, I missed a step on my friend’s deck and felt sharp pain. My guess is I did not re-rupture fully, but I’m going to be popping some Vicodin for only the second time after surgery week.

    One big mistake I made was not getting clear advice about activity level from a PT (not doc) much earlier.

    Second mistake was that fourth beer.

  10. Oh boy! That is frustrating. Don’t panic. The marathon just got a little longer. More muscle wasting, longer rehab. That’s all!

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