19 November 2013 - no cast!!

Posted on November 19th, 2013 by spacemonkey

Hello all!

After 8 weeks in a plaster cast following the second operation I finally got the cast removed yesterday, hopefully for good!  Unlike the first time round the cast had been very irritating this time so it felt amazing to be able to scratch my leg, Although it was a bit flaky.  I am now back in 2 shoes with a half inch heel raise in the left.  The muscle wastage is pretty bad so a decent amount of PT ahead for me.  I had an ultrasound scan this morning and this confirmed the tendon is in one piece, however he was unable to get it to move so not able to see if it is just being held on by the sutures or if it is actually healing this time.  So the Ultra sound was a waste of time, except maybe for the Doctor who will invoice an eye watering amount for 10 minutes work :-)  On the plus side I move on to PT and I am wearing 2 shoes!!!

It is definitely winter here… the streets are white with frost! and the thermometer says ‘Zero’  ….  the sun is shining though!  Hope you are all well where ever you are!

4 Comments »

Monday 21st of October

Posted on November 2nd, 2013 by spacemonkey

Got my cast changed for a second time since the second repair.  It is strange having it replaced by the surgeon and not the plaster technician, and to be honest the casts are not quite as good.  The plan this time is to bring my foot back to neutral in a non weight bearing cast, and then back in the boot.  The surgeon had just returned from holiday in Bermuda and was a bit vague, I am back on Monday for another cast (neutral position) so I will hopefully get more time….. Counting the days, cannot get used to being in a cast.  However now winter is coming and the days are shorter it is a bit easier not to think of all the things I could have been doing.

hope everyone is getting on well and getting back to your various sports & exercise…

take care

sm

2 Comments »

4 oct 2013- 2nd Op 1st follow up appointment

Posted on October 5th, 2013 by spacemonkey

11 days following surgery I went in to get the cast replaced and stitches removed.  They were stitches this time, tied with a surgeons knit.  Being an angler I appreciate a good knot…

All was well, a very nice and helpful nurse removed the stitches, they don’t come out as easily as staples, but at least the back of your leg does not look like train track.

I was surprised to have the surgeon replace the cast himself, glad it’s the insurance company paying for his time :-)

Given this is a second rupture I will be kept in plaster for almost 8 weeks, getting the cast changed from full to mid to neural  equinus settings, this should result in the foot getting back to neutral without being worked or weight bearing.  I will then get a ultra sound scan before the pt gets his hands on it.

Still no closer to getting back on my bike, however I have a bit of freedom now I  have an automatic car…. Currently sitting in Starbucks watching the golf, waiting for the children to finish swimming lessons, and I can go back to work on Tuesday.  All good for morale!!

all take care, I hope you all have a great weekend!

SM

18 Comments »

The second repair

Posted on September 24th, 2013 by spacemonkey

Firstly, my thanks to all of you for you kind wishes and support, it has been a great help as I have got through the recent difficult days.

I went in to a different hospital around 1.30 on Monday and was being operated on by a different surgeon by 3:30.  I had a little bit of time to control / manage my anxiety about hospitals and in particular general anaesthetic.   The only blip was when I did not get released on the same day.

The operation took around an hour, 30 minutes longer than scheduled, however I am lead to believe it went well, fingers crossed.

I am am home now staring at the equinus cast again.  It’s more painful this time, maybe because I am avoiding tramodol…. Anyway taking it easy for the next few days….

I hope you are all getting on well!!

16 Comments »

Wedge 4…

Posted on September 12th, 2013 by spacemonkey

Yesterday started off well with a lunchtime visit to the physio and everything looking good.  More exercises to strengthen the ankle and foot…  the 4th wedge taken out and advised to remove the final wedge on Sunday, and talk of getting back in to shoes on the following Friday.  The physio did a Thompson test and advised at least it was fixed.  All good stuff but I am sure you know there is a ‘however’ coming.  I got home from work around 6pm, so I had been getting around in the boot for about 5 hours with wedge 4 removed with no issues or concerns to report, then as I walked down my hall I felt a sickening thump on the back of my leg, very low down near the ankle.  I thought my daughter had tripped and fallen on my leg, but no.  My ankle started to swell but I felt no pain.  I sat down and decided to leave the boot on and go to A&E.  Including travelling time and waiting time it was around 3 hours before I was examined by a doctor.  He advised he was not getting much response from the Thompson test, but apart from the skin being a little warm and more tender around the injury still felt no pain.   the doctor asked me to put weight on it, I put the boot back on and stood on my left leg, again it was not sore but it did feel stiffer than it had earlier.  The A&E Doctor spoke to ‘Orthopaedics’ they did not come to examine me, just advised them to put me back in an equinus cast and I have to go back this afternoon to get an ultrasound.  My fingers are well and truly crossed that the Achilles is still in tact.  My operation involved the Plantaris tendon being weaved around the Achilles, I don’t know if this can rupture, without pain?  I guess I am just clutching at straws and will have to wait until later for the answers…..

21 Comments »

Hasta la vista wedge number 3

Posted on September 4th, 2013 by spacemonkey

Another one bites the dust, half way to a ‘neutral’ position on my left foot… All progress is goooooood!!!
Back to the gym later to abuse the leg curl machine. I don’t think you need to be sadistic to be a physiotherapist, but I am sure it helps :-) …
Everyone have a great day!!

1 Comment »

Physio - Wednesday the 28th of August

Posted on August 28th, 2013 by spacemonkey

Uneventful trip to the Physio today, all appears to be going well and my ankle has mobilised well.  ”It is about maintenance at the moment” so no need for me to go back for a further two weeks.  I have been given a number of core body & leg strengthening exercises to do and I have been given the responsibility of removing a further boot wedge next Wednesday.  A task I will take very seriously!

It seems to be a bit of a waiting game at the moment, as I rest my tendon is feverishly fixing itself…

Have been without Crutches for almost a week, for Monty Python fans out there I am applying to the Ministry of funny Walks!!

Off to the gym for some weights!!

5 Comments »

Descriptions for ‘The Boot’

Posted on August 26th, 2013 by spacemonkey

Since having the equinus plaster replaced with a ‘ÖSSUR rebound Airwalker’ I have been given a variety of run of the mill descriptions…

  • “Stormtrooper….”
  • “Is robocop missing a foot?”
  • “You look like a partially assimilated borg” - too geeky for me..
  • “I can’t walk next to you with out getting seasick”
  • I know Skiing is expensive but you really need two boots”

Please comment if anyone has any other descriptions, unlike the ones above preferably humorous…. :-)

2 Comments »

Physio - Wednesday the 21st of August

Posted on August 26th, 2013 by spacemonkey

A week of wearing the boot doing some exercises, and being partially weight bearing had made me feel better.  It had taken a bit of a toll, in that I had experiences some lower back pain on the opposite side from the boot.   This was eased by sitting on a cushion on the right hand side only or putting a thick book under my right foot to even me up when sitting.  A few stretches around the side an IT band resolved the problem.

The second Physio session was about checking the mobility in the foot, a bit of manipulation to get it moving and the removal of the first boot wedge!!! a date to mark in the diary.  The Surgeon had advised no to work the tendon or attempt any dorsiflexion at this stage so it is mostly about ‘maintenance’.

Estimated another 6 to 7 weeks before I would be able to drive a manual car again.  Fortunately I had managed to get my father to drop me off, hang around for an hour and take me back to work - very kind of him, but 3 weeks or so after returning to work the logistics of planning all my trips was getting trickier..

Since getting the first wedge removed from my boot I have had a bit of pain / tenderness on the inside of my ankle, right on the bone of the joint.  It is a bit uncomfortable, but not enough to make me scramble for the Tramadol yet ….

I think I have caught up with the detail of my ATR experience so far… I will make every effort to make further updates a bit more ‘Real Time’  ….  Physio again tomorrow….

No Comments »

Physio - Wednesday the 14th of August

Posted on August 26th, 2013 by spacemonkey

Having previously experienced a 5 week wait for an NHS physio appointment and being in the fortunate position of having medical insurance I decided to use it to fund a private physio.  The difference was immediate, I called around 2pm on a Tuesday and got an appointment for 12:15 on the Wednesday.  It makes me think about the NHS “Free Care at the point of Need” - I needed physio now..

The initial appointment was a check of me walking in the boot with crutches, check of the scar and an exercise routine to strengthen the upper leg.  No work could be done on the lower leg until the Physio spoke to the consultant.  I was very pleased with the physio and it was good to be getting back to some form of exercise.  A small step but PROGRESS……..

No Comments »

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  • ATR Timeline

    • Name: spacemonkey
      Location: Edinburgh
      Injured during: 5 a side football
      Which Leg: L
      Status: PWB

      513 wks  3 days Post-ATR
      507 wks  2 days
         Since start of treatment

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  • Recent Comments

  • Carol Loar | November 26th, 2013 | 1:19 AM

    Congrats on the two shoes! No heel lift in your good shoe? Does this mean you’re lopsided? That’s a good way to cause back and hip problems, so be careful!

  • Ron | November 20th, 2013 | 12:37 AM

    Good luck Space monkey,

    Hang in there and I hope that AT moves soon.

    2 shoes is great! Be careful with the weather - I’m in Chicago, and the freeze is coming (still can’t believe we had that many tornadoes this past weekend - unprecedented).

    Keep us posted.
    Ron

  • normofthenorth | November 19th, 2013 | 7:00 PM

    unable to get the AT to move confuses me some. Can’t you extend your ankle? Doesn’t your wasted calf muscle show signs of motion when you do? Can’t happen without the AT moving.
    I didn’t use heel wedges in shoes (though I did spend time in a hinged boot, pre-shoes), but I would THINK that you’d walk straighter with wedges in BOTH shoes instead of just the one. Comments from shoe-wedge people?

  • thelifechangingpop | November 19th, 2013 | 1:05 PM

    Hi Space monkey
    I’ve just read your story, crikey you haven’t had it easy. Hope that tendon has healed, must have been hugely frustrating to not have got an absolute diagnosis of healing from the ultrasound. I guess you’ll have to find some more patience and wait for your PT to give you the go ahead to start hinging your ankle. I assume that you are using crutches to get around. Be careful of the frost!
    Hope all is positive from here onwards. Keep us posted.
    Jen

  • Bigbamboo | November 8th, 2013 | 12:08 AM

    Gary, once my boot hit neutral after 8 weeks I started driving.

  • Bigbamboo | November 8th, 2013 | 12:04 AM

    Two shoes stage has arrived.

    Therapy is also a rude awakening…….walking is tough but I am trying.

    Two shoes feels good thoug

  • kellygirl | November 4th, 2013 | 8:24 PM

    Sounds like you are doing well–all things considered. At least you sort of know the drill–lol! The days are getting shorter and it’s colder so I don’t even want to go outside most days. Wishing you a speedy recovery :)

  • Ron | November 3rd, 2013 | 1:48 AM

    Awesome!

    Neutral is a good thing. LOL about the winter comment b/c I tore my Achilles in early August, so that was a boomer. :-)

    Good luck, and keep us posted.
    Ron

  • Gary | October 16th, 2013 | 8:12 PM

    Is six months from surgery generally a reasonable expectation to drive?

  • normofthenorth | October 15th, 2013 | 8:26 PM

    What Stuart said. People here did all kinds of different things with driving post-ATR on the right leg. Some governments and some insurers restrict driving in a boot, some don’t. Doctors’ advice seems all over the block, too. Some patients here learned to drive left-footed. When I went into 2 shoes (after doing some driving in a boot), I learned to hit the brake pedal with my heel, so I could stomp on it as hard as I wanted without putting any strain on my calf and AT.

    For longer trips, many of us found that just keeping a recovering right foot on the gas pedal at the same angle for an extended period was a pain (maybe literally). Even being a passenger on a long trip was a challenge for me after my two ATRs, with and without surgery. I’d sit normally for a while, then put my injured foot up on the dash, etc., just trying to keep it semi-happy. (As a passenger, of course! :-) )

  • Stuart | October 15th, 2013 | 8:18 PM

    Gary - It is best to get a clearance from you doctor before you drive. This will cover your insurance and other action should something go wrong. Modern cars do not need a great deal of pressure on the pedal to stop but in an emergency you tend to overdo the pressure and that could cause a re-rupture. It is impossible to control what others do on the road but you can take precautions such as leave a greater than normal gap between you and the car in front (3+ seconds) and drive a little slower.

  • Gary | October 15th, 2013 | 7:34 PM

    Appreciate any input on when it was safe to drive for right footed injuries? Thanks.

  • normofthenorth | October 15th, 2013 | 5:19 PM

    Gary, all the old studies of “conservative casting” — traditional slow non-op ATR treatment, mostly for geezers and sick people — produced thos high rerupture rates. A good 2005 meta-study of all the older good studies found an average around 12%, IIRC. I reported it and linked it on my “Studies” page.

    Since 2007, smart people have figured out how much better they can do with much faster non-op rehab. No comparison! The results, going fast, are good enough that some elite athletes are starting — though just starting — to skip surgery and go fast, pain-free, low complications, scar-free.

  • Gary Riley | October 15th, 2013 | 2:42 AM

    Under what circumstance is 15-20% rerupture rates common?

  • normofthenorth | October 14th, 2013 | 6:17 PM

    Best practice for 1 crutch is clearly opposite the injury. For a cane, I think it can go either way, and I think I went on the injured side. Mind you I hated them both, and ditched them ASAP.

  • normofthenorth | October 14th, 2013 | 6:13 PM

    Reruptures are a sad fact of life post-ATR, but the risks can be minimized down to near-zero levels. Post-op rates are usually 8wks, NWB >2wks — cf. bit.ly/UWOProtocol ), rerupture rates of 15-20% are common. NB that the Worst Care still avoids rerupture in 80-85% of ATRs (which is probably why it’s not extinct yet) — good news and bad.

    SM’s experience is quite rare IMExperience. There’s probably a cause, but we may never know it completely. Matching the amount of surgical shortening (if any) to the immobilization angle is clearly more art than science, but the data suggests that most legs adapt within a pretty wide range. SM’s didn’t.

  • Ron | October 14th, 2013 | 7:33 AM

    Hi Spacemonkey,

    I understand. I was thinking about the wedge being moved and all the walking afterwards that may have caused it.

    Thanks the the answer, and good luck.
    Ron

  • superjewgrl | October 14th, 2013 | 1:07 AM

    Hey SpaceMonkey….. Sounds like you have a great attitude. I have thought of you often. I am 11 weeks post op, and if my re-rupture happened now or last week, I could not have handled it like you have.

    You and I both re-ruptured while in a boot. Although yours wasn’t because of the boot, like mine was. I did get a vacocast the second time around and thought it was the best investment i’ve made.

    My second time around, I was in a cast for 6 weeks then in the boot for 5 weeks, and although initially I was bummed about it, I think it was the best. In fact, I went to two shoes a few days ago.

    Keep us posted on your progress. I’m happy your doing well. Take Care. xx

  • josee | October 13th, 2013 | 5:00 AM

    Hi SM, sorry to read about the re-repture. Keep up the good spirits and looking forward to reading more about your progress!

  • steve01 | October 9th, 2013 | 10:00 PM

    Spacemonkey: This is the type of story that keeps me up at night. I’m approaching my four-week post surgery mark in a few days and hope to start PT next week. Sufficed to say, I am terrified of a re-rupture. A friend of mine re-ruptured when he pushed too hard in physical therapy and that is a concern of mine.

  • spacemonkey | October 6th, 2013 | 10:53 PM

    Ron, the issue was with the lack of healing of the tendon. After 10 weeks it was only being held together by the sutures. I was at the PT at midday to get the 4th wedge taken out of the boot, then at 6pm the sutures came apart.. The 4 th wedge was the final straw for the sutures,…. In other words it was just waiting to happen. If the tendon heals as it should the boot provides great protection…
    Best wishes for your recovery!!

  • Ron | October 6th, 2013 | 9:30 PM

    Wow, I was told by my Ortho that it was not possible to re-rupture while in a boot - guess he was wrong. You were just walking, too. That is scary. I am just over 4 weeks Post Op and will be a bit more careful going forward. Thanks for the post and heads up.

    Good luck with this go around and I hope you heal quickly with no further set backs.

    Have a great day.
    Ron

  • Ron | October 6th, 2013 | 9:27 PM

    Hi SM,

    So sorry to hear about you re-rupture. What were you doing when it happened? I wish you a quick recovery.

    Have a great day.
    Ron

  • spacemonkey | October 6th, 2013 | 8:39 PM

    Steve01
    Second rupture was on the same leg, 10 weeks post surgery. The explanation I was given was….. The tendon was possibly repaired under too much tension first time round preventing it from healing as expected. What is too much tension is down to the opinion of the surgeon at the time. The second surgeon repaired it using a ‘turn down’ technique, (http://www.uwhealth.org/files/uwhealth/docs/sportsmed/SM-27399_AchillesTendonProtocol.pdf ) leaving the tendon under less strain.
    Th re-rupture happened as I was walking down my hall! wearing the ‘boot’, the sutures gave way…. As the tendon had not healed it was only a matter of time.
    I sincerely hope this does not happen to anyone else!
    Thanks for the question and good luck with your recovery!

  • steve01 | October 6th, 2013 | 5:48 PM

    Good luck! I’m wondering: second rupture on same side? If so, how long since first and what caused it?

  • Bigbamboo | September 28th, 2013 | 12:37 PM

    Has anyone ever used ‘King Brand’ BFST ( Blood Flow Stimulation Therapy ) wraps or braces ? I have done some research on them and the response seems very positive. Seems like the product reduces the healing time. I was considering the purchase of one but would like a first hand testimonial if possible……..we all know that those products can fake ‘Reviews’ on their websites.
    LOL……just looked at the ‘Anti- Spam’ word I had to type ‘quicker’……..

  • Bigbamboo | September 27th, 2013 | 12:14 PM

    Hey SM, I am wearing a ‘Cam Walker’ boot not an air cast. It has a compass on either side that adjust the degree setting. It fits well and really holds the leg at the precise angle. Have no problem getting on an aircraft with it. What is an headache is security .
    I hate those elbow crutches. I had a set in Fl but tossed them. They locked onto my elbow once when I lost my balance and almost caused me to break my leg. With my normal crutches I could just let go and break my fall by doing a judo roll or with my hands but those elbow crutches are attached and not so easy to release.

  • spacemonkey | September 27th, 2013 | 8:11 AM

    Best of luck BB, I hope you can enjoy the sunshine? It is 6 degrees and damp here in Scotland, but we are still smiling! I am looking for a new coat, that will fit in my elbow crutches :-) do you have to check with the airline before flying to Florida in an aircast? They would not allow me to fly to Orkney ( about 1 hr 20 m ) in my equinus cast. Would be good to hear how you get on.
    Take care, my best wishes for a continued Great recovery!!

  • Bigbamboo | September 27th, 2013 | 12:35 AM

    Wow, thanks for the response guys. SM you are in my prayers buddy, hope ou have a full recovery this time.
    Thanks normo will def check it out.

    BTW…..boot goes to neutral today……..PWB…….VERY Partial……heeding SM situation.

    I live in the Caribbean……Trinidad…..have to head up to Fl in two weeks to check in with my surgeon. Guess he will give me my PT rehab routine to instruct my therapist in Trinidad.

  • normofthenorth | September 26th, 2013 | 7:33 PM

    BB, it’s at bit.ly/UWOProtocol . Copy and paste that into your browser, and there it will be.

  • spacemonkey | September 26th, 2013 | 6:17 PM

    BB I was advised that re-ruptures beyond 12 weeks are very rare, but it often takes up to a year for the tendon to fully recover to allow you to return to sport. It can take this long to regain your confidence too.
    My tendon did not heal properly, at 10 weeks post op it was only being held together by the sutures. It was a late presentation therefore probably under too much strain on the initial repair…. all of this is speculation of course. What I am trying to say is at 8 weeks your tendon should be pretty strong and benefit from controlled mobilisation.
    My second repair used a ‘turn-down’ technique to bridge the gap between the ’stumps’ of tendon to make sure there is a join between healthy tendon and not the frayed ends. I still expect to make a full recovery, but have been advised it may be 18 months before I can consider the tendon fully healed and return to sport.
    I was weight bearing in the boot after 6 weeks and the additional mobility was great. With regards to a workout schedule I would ask your PT for one. A lot of the work at 8 weeks will still be around how you safely build up all the other muscles that wi

    [...]
  • Bigbamboo | September 26th, 2013 | 12:16 PM

    Where do I get that Rehab workout schedule ?

  • Bigbamboo | September 26th, 2013 | 12:09 PM

    Thanks for the encouragement and for showing me the silver lining. I am ready for that marathon. My injury occurred while playing competitive B- ball……I came out of retirement to play in a tournament. During the 4 th game it happened when I was making a simple, non forceful dribble to my left.

    I have no intention of playing again but I do miss my gym workouts and my 3 days/ week of urunning.

  • normofthenorth | September 26th, 2013 | 4:11 AM

    BB, I’m not sure I’ve ever seen anybody track that “completely fused” point after an ATR, with or without surgery. Rather, there are a bunch of steps going from (usually) being a total bed-ridden invalid (especially for the surgical patients), then crutch-bound NWB, then PWB, the FWB, then in 2 shoes, gradually walking more normally and regaining strength and flexibility, then running, then jumping and playing high-ATR-risk sports (again).

    For most of us, there’s also a long slow progression from having occasional brief moments when we forget about our ATR, to having longer and longer periods when we don’t think about it.

    Click on bit.ly/UWOProtocol for one good rehab schedule. One of the themes of this site is that recovery is a year-long marathon, and that’s a reasonable average. But there are lots of heart-warming milestones much earlier than that. E.g., I went for a week-long downhill ski trip at Whistler in Week 17, non-op, and others have matched or bettered that. I was back at competitive court volleyball (the activity that ruptured BOTH of my ATs, 8 years apart) after about 10 months, and several people here have beat

    [...]
  • Bigbamboo | September 26th, 2013 | 2:35 AM

    Anyone knows how long it takes for the AT to completely fuse after surgery? No graft was used.
    My Dr. said 12-16 wks……..can anyone confirm ?

  • Bigbamboo | September 26th, 2013 | 2:26 AM

    Tomorrow I go to neutral, 8 weeks post op for RAT surgery…..I am so nervous after hearing SM story. Dr wants me to start weight bearing with the help of crutches for two weeks then start PT.

  • Bigbamboo | September 26th, 2013 | 2:23 AM

    Tomorrow I go to neutral…….Doc says weight bearing with crutches should begin……I am so nervous after hearing what SM went through.

  • kellygirl | September 25th, 2013 | 7:04 AM

    Hey Space Monkey! Glad to hear the update. Sorry that you are in a cast again. Best wishes for a speedy recovery!

  • loumar747 | September 25th, 2013 | 6:23 AM

    Thinking of you spacemonkey and trying to send healing vibes!

  • upstate2519 | September 24th, 2013 | 10:38 PM

    Hang in there spacemonkey; glad to hear the second surgery seems to have gone well. Here’s hoping the second recovery is a real recovery!

  • scamp | September 22nd, 2013 | 9:52 AM

    I’m sending you every best wish I have.

  • upstate2519 | September 19th, 2013 | 10:05 PM

    Best of luck on Monday, spacemonkey. I’ll be thinking about you.

  • Nicky | September 19th, 2013 | 9:33 PM

    Good luck on Monday. I can’t imagine how depressing it must be. But time will pass and hopefully it will just be a distant bad nightmare.

  • superjewgrl | September 19th, 2013 | 8:55 PM

    Good luck on Monday. You will do great.

    Please reach out if you need a cheerleader!!!!

  • spacemonkey | September 19th, 2013 | 8:24 PM

    Thanks superjewgrl, your wishes and sentiments are very much appreciated… as is everyone’s support… I have been spending a couple of days considering my options (and generally feeling sorry for myself). However time to move on and I have booked myself in for surgery on Monday. Different Surgeon, Different Hospital and hopefully a Successful outcome…..