4 oct 2013- 2nd Op 1st follow up appointment
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
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Good luck! I’m wondering: second rupture on same side? If so, how long since first and what caused it?
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!
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
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, 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!!
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.
Hi SM, sorry to read about the re-repture. Keep up the good spirits and looking forward to reading more about your progress!
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
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
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.
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.
Under what circumstance is 15-20% rerupture rates common?
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.
Appreciate any input on when it was safe to drive for right footed injuries? Thanks.
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.
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!
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Is six months from surgery generally a reasonable expectation to drive?
Gary, once my boot hit neutral after 8 weeks I started driving.