soccergirl’s AchillesBlog

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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.

Jennifer, most of us experienced sensitivity under-foot, especially under the heel. Very rarely, it can progress to a heel spur (fasciitis) and linger, but it usually fades harmlessly, though sometimes quite slowly.
Weeks later, I still found barefoot walking scary, because stepping on even the tiniest piece of nothing felt like walking on a bed of nails!
Not abusing it helps, as do: (1) squishy soft gel under-foot (a footbed in the boot, then Crocs or similar in 2 shoes), and (2) gentle massage, like rolling your bare foot over a ball while seated. Some people prefer a frozen water bottle (small plastic) to a ball.
If your hips aren’t level — i.e., if you haven’t found a way to build up your “good” foot so it’s as far off the floor as your booted foot — you’ve got to fix that. Walking uneven can damage your hips and knees and spine etc., and can also teach you compensating ways of walking that are surprisingly hard to “lose” later.

Are you having heal pain? I have been upgraded to FWB in boot transitioning into shoes. I have discomfort in my heal and bottom of foot. I’m also feeling soreness in my hip flexor from weeks on NWB.

I find just walking around the house to be mentally draining (it may have something to do with wondering whether my two kids or our dog will come running by at any minute causing a slip

Congratulations on moving on to 2 shoes! Every day does get easier/better so just keep that in mind and be mindful of where you step! Good luck to you.

Thanks for the replies. Stuart, you are absolutely right. I find just walking around the house to be mentally draining (it may have something to do with wondering whether my two kids or our 140 pound dog will come running by at any minute causing a slip!). I am definitely walking slowly and cautiously!

Ctcbusted, yes, I really like my PT and have had a great experience with them so far (12 sessions to date). I am using ProAction Physical Therapy. They are in the Bethesda/Rockville area (so may be inconvenient if not in the area).

Yeah!! Your recovery protocol seems to be the closest to mine. So, it is very encouraging to see your progress.

BTW - I live in Washington DC as well and would love to know if you recommend your PT (and who it is).

You are going to be amazed at how aware you are of your surroundings when you step out of the house and into the world. Its like the old saying watch your step but so much more intense. Some people actually get quite tired mentally until they get used to it.

Good stuff. If you used my trick for walking downstairs in the boot, you can keep using it in 2 shoes, until you build up more strength and ROM.

Walking in shoes again is wonderful. Each day gets easier and faster- thank goodness for that as I started at a nervously slow snail pace!

I live in DC and am a Redskins fan. I have been following DeAngelo Hall since our injuries we around the same time. This is indeed a warning to all of us to be very careful on crutches/rollers/Iwalks to make sure we avoid falls.

Op or non op you still have to do the right thing. He probably should not have been making pizza. Or should that be probably he should have been wearing protection. Still doesn’t sound right. I doubt the big league stars are ever going to believe in anything but surgery to fix every injury. It is conditioned into them and it is a money thing for which they probably have no control over. To suggest otherwise would lablel you a witch doctor. How can the body possibly heal itself?? Needless to say the imortals and invincibles are suffering the same as us and deserve the best treatment available plus our simpathy. It does say regardless of the manner of treatment, re-rupture can occur. Yes, don’t be careless or stupid for they are the most common causes or re-rupture apart from the odd accidental slip or trip.

That Wallace study is summarized and linked at Achillesblog.com/Cecilia/Protocols .

One of the most amazing things about the huge new Wallace study from Belfast is the <3% non-op rerupture rate he got from his ~1000 ATRs. But the MOST amazing thing is that he successfully treated ALL of those reruptures non-op!!
Of course, it will be even more amazing if any of us lives long enough for the world’s (or the U.S.’s) professional athletes to follow that evidence!

Your recovery sounds similar to mine. I have a cast and NWB for 6 weeks after the surgery. I am glad to see that you are making out well with this sort of a schedule. I have 3 more weeks in the cast.

I think that’s the first time I’ve had a comment “awaiting moderation” with NO URLs and NO smileys! The
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error seems to come and go (mysteriously, to me), and may have caused this problem.

Sounds great!
When it’s time to wean off the boot (maybe now, or soon), a hinged boot seems a very helpful transition tool. I’ve no experience with the Vaco, but I’ve used a hinged boot in both of my ATR rehabs, and an AirCast in one of them.
If the Vaco without the front is similar to the AC without the front, you would be very vulnerable if you got up and started walking.

[WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

Congratulations on having your cast removed! For me, that was when things started to look up! The cast was just so restrictive and sometimes became very uncomfortable when my foot started to swell! Very happy for you that you are done with the cast!

It is a bit of a disadvantage to be locked up for 6 weeks but things will start moving. Active ROM exercises can start after 3 weeks if in the boot from the beginning. You will catch up pretty quick and the deep massage should get things free. The progession to FWB will also be easier than you think and a little less daunting than when you will be ready to lose the boot. Each transition has the associated fear factor but you get over it quick enough once you start. ROM will be a thing you will have to deal with for a while. There may be times where you have some huge gains and other times when you are getting nowhere. Just be careful not to try and get it all back too soon. It will come.

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

Getting into a boot is a wonderful thing, so much more comfortable and means the PT can get started. The ROM will improve very quickly, I felt like my brain and foot had to remember how to connect again. I am also in a Vacocast and have found taking the front piece off at night makes it way more comfy. Good luck moving to FWB and being crutch free!

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?

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!!!

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!

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!

Good luck, and stay in touch.

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 p

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.

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 wron

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!

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!