4 Weeks Post-Surgery

This is my first post on AchillesBlog.  Here is my story and my timeline so far:

8/23/14 - I am a 43 year old female.  Was playing soccer, got the ball, was about to make a move and felt a sharp pain in my left calf.  Went down and immediately turned around to see who had kicked me from behind.  Of course, no one was there.  I hoped that it was just a strained calf but had a sinking feeling that it was my Achilles.  Had my partner do the Thompson test on me when I got home, and my sinking feeling was confirmed.  Went to the ER and was formally diagnosed with a ruptured Achilles.  Was put in a splint, given crutches and told to call an orthopedic surgeon on Monday (injury happened on a Saturday).  Spent a lot of time on the internet trying to figure out how bad the recovery would be, and quickly realized that I am totally screwed.

8/25/14 - Saw my doctor (same one who operated on my torn meniscus in my left knee 10 years ago) and he scheduled me for surgery the next day.  His view was that surgery gives you a better prognosis for being able to do the same kinds of sports you did before the injury and recommended this approach vs. a non-surgical approach for me (although the chances of me playing soccer again once I am recovered are slim - think I might stick to biking and swimming after this ordeal).

8/26/14 - Had outpatient surgery.  Surgery was at 5:15 p.m. and I was home by 8:00 p.m.  Took a couple of percocets over the next couple of days but by the 2nd day the pain was manageable and painkillers were no longer necessary.  We rented a hospital bed so I could sleep on the main floor and not worry about having to tackle the stairs every day to go up to the bedroom.  Was great being able to keep my leg elevated so easily with the hospital bed and electronic bed adjusters.  I also iced my knee a lot in the hope that it would cool the blood that was circulating in my leg.  Not sure it really worked, but ice on the splint/cast didn’t seem to cool my leg down at all so icing my knee was the next best thing.  I also wiggled my toes a lot to try to keep things moving.  I basically stayed in bed as much as possible for the next couple of weeks.  Went into work a couple of times (I have an office job) but was largely able to work from home with a laptop and doing conference calls.

9/11/14 - 16 days after my surgery I had my first follow-up appointment with the doctor.  My staples were removed (a little painful but not too bad) and I got a cast put on.  Doctor said everything looked to be healing fine and to come back in 2 weeks when they would cut the cast off to check the wound, and then likely recast for another 2 weeks.  My doctor said that he has used both the accelerated and conservative recovery protocols, and prefers for his patients to say in a cast for 6 weeks post-surgery before moving to a walking boot.  Ugh.  So, I’m going to be NWB for 6 weeks post surgery, and then will move to PWB once I get my boot.

9/25/16 - It has been 4 weeks since my surgery.  Had my second follow-up appointment with the doctor.  My cast was cut off so he could check the wound and make sure it is healing okay.  Everything looked fine.  My leg was put in a new cast, and as they were casting my leg the doctor told me to point my toes up as much as I could to try to bring my foot closer to 90 degrees.  My calf muscle is so weak I had a hard time holding my foot steady - it was shaking like crazy as I tried to point my toes up.  So, 2 more weeks of this before I get my walking boot.  I am still trying to keep my leg elevated and am working from home as much as possible and trying not to overdo it.  I have noticed that the swelling is getting much better.  Before, if I put my foot down for more than 5-10 minutes, I could feel my toes swell and it felt very uncomfortable.  Now, I can put my foot down for up to an hour and it feels fine.  I have noticed, however, that on the days when I go into the office, I am totally wiped out by the end of the day and my cast feels tight because my leg is so swollen.  So, I will just try to keep it elevated as much as possible for the next 2 weeks and look forward to the next milestone.  Long road ahead, but reading other blogs and seeing what everyone else is going through has been a tremendous help in getting through this so far.

12 Responses to “4 Weeks Post-Surgery”

  1. The world has a lot more evidence comparing fast and slow rehab approaches - post-op and non-op both - than your OS has, and the results are pretty clear. Going slow post-op (like you) is torture with no benefit, and maybe a smidge of harm. (Going slow non-op is medical malpractice based on today’s evidence.)
    Your OS’s approach to scientific evidence is unimpressive. Your willingness to follow his lead is impressive, but arguably ill-advised. All IMO, of course!

  2. AchillesBlog/Cecilia/protocols summarizes 3 studies with World Class results. One of them is ~100% non-op, the other two split (1 randomized split). All three of them skipped about a month of the torture you’re going through, and they probably all got results at least as good as your OS (often with no sensitive wound and no scar).
    It is logical - though still unproven, AFAIK - that long NWB immobilization post-op increases atrophy and lingering strength and size deficits. This site’s Studies and Protocols page has links to several studies on early weight-bearing for post-op patients. AIR, none show harm, and some show clinical benefits. (All show lifestyle and spiritual benefits, of course!)
    Finally, my blog has a link to a great BMJ article on alternatives to Evidence-Based Medicine. Your OS may prefer Eminence-Based Medicine! :-)

  3. While I do agree with Norm I can say that in the long term you should get back to normal and will be able to play soccer if you want. Most of us on the fast track were walking after 4 or 5 weeks and in 2 shoes by 8. Some are quicker and others a bit longer but that is an average. This is really only the short game. The difference between non-op and op outcomes is better with the more aggressive protocols for non-op. The long game is about a year for all of us anyway but you should be back to some normal routines much sooner. A study I have read indicates the more aggressive protocol for surgery patients tends to get them back to normal routines quicker and improves their quality of life in the short term but after 2 years everyone is pretty much the same. If you are happy with your doc and treatment then stick with it otherwise get well prepared with information and have a say. I would suggest your doc may have had issues with non compliant patients and prefers to cast in order to stop them doing stupid things and re-rupturing. It isn’t fair for docs to lump all their patients into the same routine because a few do the wrong thing but they probably have a lot of work to do and I know they hate it when we undo all their work. Yous by a long way is not the worst form of torture inflicted by doctors I have read about here. I recall one poor guy whos doctor wanted him cast from foot to hip for 12 weeks.

  4. Welcome to the club- I am sorry you have joined up but this site is a great source of information and support. Norm and Stuart have both given you great advice and I think the good news is that your slow protocol will not impact you long term. You sure do have a long time NWB and that will be tough once you move to a boot and then 2 shoes. If you can’t, or don’t feel it appropriate, to challenge your recovery protocol then think ahead and set up PT now so that you have an appointment as soon as you leg is cast free! All the best.

  5. Thanks very much for the comments. I hear you on the more aggressive protocol - after reading about early weight-bearing while waiting for surgery I was hoping that was the route my doctor was going to recommend. If I had pushed, he probably would have gone that route as he said he has used both protocols with success. He just said that he personally has seen slightly better outcomes with his own patients that are immobilized and NWB for 6 weeks in terms of re-ruptures and better wound healing (and as Stuart points out, that could be due to non-compliant patients doing stuff they shouldn’t be doing while in the walking boot). He generally does between 3-7 achilles repairs a month and has a large experience pool that he is drawing from, so I felt comfortable following this approach (even though the NWB is getting old quickly). He also stressed that I would have more calf muscle atrophy under the conservative protocol and so he is starting me on PT as soon as I move to the walking boot and recommends 3 sessions of PT per week for 6 to 8 weeks. So, we’ll see how things go. I’m definitely looking at the long game here, and will post my progress. Thanks for the support.

  6. Good luck, and stay in touch.

  7. I completely ruptured my Achilles exactly 1 week before you did, on 8/16/2014, during a tennis match. I’m a little past week 5 (post surgery) and feel pretty darn good. My ortho’s script called for the PT to follow protocol, which puts me at “weight-bearing as tolerated”. Just yesterday, I started walking around with the boot on (2 wedges,) and have no pain at all.

    There seems to be so many great perspectives on the rehab/recovery process. And some may vary. My sister-in-law is a PT. After assessing me, she recommended that I take 3 PT sessions per week for 8 weeks…then trim it down to 2 PT sessions for the remaining 4 weeks. Yet, when I went to my actual PT, he recommended 2, and then build up as the Achilles is able to tolerate more rigorous exercises. - Personally, and in part, I’m just trying to listen to what my body is telling me.

    I’m right there with you, in terms of timing. Keep strong, and know you’ll come out of it better than where you were before!

  8. Fuzzygreenball (love your username!), thanks for the comment. It’s good to hear that someone who injured their achilles at around the same time as me is walking around with the boot with no pain. I am still in a cast, but move into a boot in 5 days (not that I’m counting). I’m hoping that I can move to PWB and then to FWB relatively quickly once in the boot, though am determined not to push it because a re-rupture at this point would be devastating.

    I heard the same thing regarding PT. My doctor prescribed 3 sessions of PT a week for 6-8 weeks, but when I went to book my PT appointments (first one is the day after I get into the boot), they recommended that I should start with 2 sessions per week and then build from there as I develop more strength.

    Good luck in your recovery!

  9. Sorry about your injury, soccergirl, but welcome to the ATR club and the AchillesBlog community.

    Your comment about “playing soccer again once I am recovered are slim - think I might stick to biking and swimming after this ordeal” will totally depend on your own recovery and rehab, of course, but many of us on this site — with the right OS, the right PT, a bit of luck and a LOT of patience — are back on the field, court, or course doing what we love.

    My post-op path was pretty old school, but, in my case, also highly effective:
    - 6 weeks hard cast (change at week 2)
    - 2 weeks on crutches in two shoes
    - 3 days/week PT for 2 months, then 2 days/week for 1 month
    - back to full activity based on my own symptoms at 5 months (went skiing to celebrate).
    - since then, have run three 5k-5mi obstacle course races, 40 mi bike rides, two 5ks, and am playing softball and football again.

    Patience, perseverance, persistence, and passion: you can do it!!!

  10. Thanks coast2coast. You’re right - patience, perseverance, persistence and passion are all necessary at this point!

    I am thinking positively and believe that when I am fully recovered I will be able to play soccer again from a physical standpoint. It’s more of a mental block - I wonder whether I’ll ever engage in an activity that involves explosive movement without thinking in the back of my mind that I could rupture the other Achilles. Did you have this concern when you started playing football and softball again?

  11. Soccergirl, I had my ATR during a tennis match–the sport I love–7 months ago. During the early stages of my recovery, I seriously wondered if I’d ever go back to sports for fear of another ATR. This injury presents as significant a mental challenge as a physical one. However, as my recovery progressed and my confidence in my leg grew, those anxieties lessened. At 5 months post-op I stepped back on the tennis court for the first time–I was both excited and apprehensive. I was a little tentative that first time out, but I’ve played many times since and now would say I don’t hold back at all. Fear of a re-rupture or a new ATR, while not gone completely, are way, way back in my mind now. I get too much pleasure from sports to give them up voluntarily. It may be hard to see now, but if you stay focused on your PT, I’m positive your confidence will grow along with your physical abilities. Happy healing! -David

  12. hello all,

    today I am 4 weeks post surgery and i am already partial weight bearing with one crutch. I started PT last week and it is going fine.
    I stayed 2 weeks in a splint then directly to the boot with 2 wedges. Yesterday they removed one wedge as my range of motion is good. Im getting very close to Neutral. the doctor said i should have 1 more month in the boot. it really depends on your doctor.

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