Scott’s AchillesBlog

I went for the PRP myself (3 shots @$400) — though that was just before the RCT results came out. To be fair, my OS told me that there was no good evidence that it helped, but that it “seemed logical”. Maybe especially with AT stuff, I’ve come to believe that there’s a huge gap between Evidence-Based Medicine and Logic-Based Medicine…

The donor collagen has grown back and filled in the areas of my missing cartilage already, it was mostly filled in after two week by xray. Pretty amazing stuff.

I have no idea if the centrifuged blood helped or not, I would have said go for it despite trials. I have seen studies where centrifuged blood has helped paralysis patients.

I hope your donor collagen works better than the centrifuged blood — aka PRP — has worked in randomized trials. At least on ATRs, it did no better than saline solution. Much more expensive, though.

Hi Andrew, I’m going to write a new follow-up post. The donor cologen has worked amazingly well. Feel free to PM me direct if you want.

Thank you Andrew! Yes, way too used to the drill of it all. I’ll definitely keep things updated so you can have a guess as to what to expect.

The last two months have been trying to get in to amazing shape so the recovery is easier.

That procedure you described is something I am considering for my knee, I have a slither of meniscus (cartlidge) left and apparently they can sew that to some ‘grown’ or ‘donor’ cologen to rebuild the cartlidge… that’s one reason why I will be reading your future updates with interest/

I guess you are used to the ‘drill’ of this type of thing now and being that little bitmore mentally prepared/experienced will, I hope make this a less difficult recovery and I wish you well for the operation and recovery

every little bit of infmroation and exercises being shown here can help. The key is to use these tips and exercises in moderation as is the case with everything in the world. When coming back from achilles injury, don’t do these exercises 7 days a week but rather 3 days a week. Walk and move around standing up-right walk with your feet pointed straight ahead. If you’re overweight or obese then lose weight. If you lift weights and you have a big .I injured my left achilles pretty bad

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Thanks Ryan!

Sheena, sorry to hear you reruptured, I can’t imagine the thoughts that must be going through your head, I feel for you. I don’t know your history, when did you initially do it? You went the non-op route it looks like?

To answer your question, I had a previous ankle surgery before my Achilles and had a different boot, I hated it. The Vacocast is expensive, but well worth it. I wouldn’t think an AirCast would give the type of heel support needed for an Achilles recovery?

Hey Scott,
can I ask you a question? I have re ruptured and I guess I will be having surgery next week. I had an Aircast for my non op rehab but I am toying with a Vaco this time ( I will have to buy it myself as my UK hospital doesn’t use them). Did you have a different boot before your Vaco or did you have only the Vaco but had heard that they were better? They are quite expensive so I don’t wait to waste money if my Aircast (which I really liked) is OK.

Awesome ride, and awesome pictures Scott. So great to see another “old timer” here getting through this successfully!

Yep, I had the drill and debridement.

My ostochondrial lesion/defect doesn’t hurt that bad on its own. It’s the tendon running past it that hurts the most. I notice that tendon feels better when I use my muscles to do what the ATF should.

Let me know how yours comes out.

Speed thanks so very much for your reply it’s actually very helpful going into my appt with my ankle surgeon Tuesday. It’s really interesting the loose ATF could be a big part of your problem my MRI also indicates mine is strained from prior ankle sprains. Makes me wonder as u indicate if that is what can weaken the whole structure down there. Was your 2009 Debridement a drill curettage and Debridement of the talar dome lesion? And how is your pain now from the lesion? mine is intermittant but does hurt badly at times after walking few blocks and coming out of a boot for 6 weeks recently it was incredibly painful at first. Mine is on the medial side as I think yours is. It sounds like you r considering the modified bostrum now rather than further talus joint work. if he offers Debridement I will question it as the bone edema you and I have might contribute to a poor result as drilling (if you had that or was it just Debridement?) into swollen bone may not provoke the desired response. This is such a helpful site I really appreciate your taking the time to note all this. Their r some docs using juvenile cartilage literally donated

My storyline goes…

2008 - Crashed skiing, pulled foot halfway out of my boot, tore some cartilage and chipped a piece of bone 9mm x 13mm off. I didn’t know it was that bad, thought it was another sprain (I’ve had lots). I put my boot back on and continued skiing.

Saw doc a few times over the next few months, thought it was a bad sprain, kind of forgot about it.

2009 - Referred to specialist, MRI shows cartilage tear and osteochondral lesion. Does debridement, but doesn’t seem to work.

2010 - Old doc moves out of state, see awesome new doc. He mentions the debridement couldn’t work because my ATF ligament is too loose and it’s allowing the bone of my lower leg to put pressure on the area of my talus where the osteochondrial lesion is. Recommends physical therapy to strengthen surrounding muscles to possibly bypass surgery.

2011 - Finally had enough and talk to doc about best time for surgery. Decide on after the summer as it just hurts, but isn’t limiting me any besides some fast direction changes.

Aug 2011 - Tear my Achilles, doc says it was 100% due to extra tension put on it by my loose ATF.

At this po

Speed may I ask how is the pain from the osteochondral lesion or has it improved lessened or healed? I face surgery soon f or paratenonitis which has thickened my Achilles and caused some possible tendonosis although the MRI per my foot ortho says there in none just the paratenon inflamed. Also I have a mild osteochondral lesion of the medial talar dome just as u have or had! You r the only post I have found with this how did u have it addressed if at all? Mine is from ankle sprains over the years from running and tennis although I have no fracture or lose bodies in the talar dome. I would be so interested in how you dealt with this and appreciate any response. My guess my doc whom I visit tues with proceed with a Debridement of the paratenon and wait and see on the talar dome which does cause some pain. Thanks so much!

great

What would really be inspiring is seeing a pic of what happened when you turned right side up and landed.

Great pic! Yeah the mental game is really tough at times, the 1st time it really caught me out after thinking all was getting better, I was 5 months post injury, walking ok, then I went to change an alarm on the ceiling I had to stand on a table to do it, a table I have stood on many times before. I stepped onto from a chair with my good leg and went to put my bad leg on it, would my brain let me do it, no! took me a full minute to convince my brain that it would be fine! now almost 7 months on I am back bouldering (low level rock climbing over mats without a rope) and I feel I have finally started to really feel “normal” again

Great Picture. Thanks for giving hope.

Thanks for the post, speed. I haven’t overcome the mental barrier yet but it’s still early. Glad you’re doing well.
-GK

Awesome pic! Love hearing the success stories!

Walking in 2 shoes wasn’t easy at first.. been doing it for so long now that I forget how tough it was, the limp is gone… but I was pretty slow, pretty cautious… I didn’t do much PT at all, mostly because I’ve had ankle problems before and knew what to do… but also since I was never in a cast or anything really, I had tons of range of motion from the get go… my problem now is that my gastrocnemius is still SOOO small..

glad to hear your’re in 2 shoes, i can’t wait till i hit that that mark. how much different is it walking in 2 shoes than it’s walking in a boot and a shoe? did you do any type of PT for your foot and ankle to get ROM back before you started the PT for your achilles? are you walking w/a limp or smoothly? congrats and keep up the great work!

I didn’t wear high tops, I think in my case my tendon was too fat for them to even be comfortable. I just walked around barefoot for a couple weeks and then did both low athletic shoes. I’d say do what’s comfortable, but be careful.

Hello World. I come off my boot tomorrow. I am nervous. I have been walking around without my boot because of the pressure that the boot puts on the back of my heel. My range of motion is GREAT, until I have to go down the stairs. I get nervous like it could pop again, but I am sure that is mental.
I fell several times on my crutches and had to go back to surgeon to see if I re-tore my tendon because of the immediate pain and swelling but I think I stretch it out enough with falling that I may not have to do much PT. I know that sounds awful. Well it was. So it’s week 13, boot comes off and I am wondering should I wear high top shoes for ankle support or will I be alright in my regular low top shoes.
Any advice?

Hey guys, I totally agree… I was going to edit my post to say my doc told me throughout this to be my own best clinical advisor. Even though the 1 leg heel raises can be done, and the clutch can be pushed in, it doesn’t necessarily feel like something I “should” be doing… I’m in no rush and am happy to keep doing the double heel raises and driving an automatic for a few more weeks.

I’ve always had the “problem” when playing sports of muscle strength being gained quickly, but then tendon problems from them not keeping up, I need to remember that and take it slow.

I think the limp is a product of tightening up, if I ride the bike or warm my leg up, then the limp is nearly gone. But don’t do that and there’s definitely tightness that causes a limp, and it seems to get tight really easy… Any suggestions on keeping it loosened up?

I concur with Norm. What I would say is, don’t get hung up on certain exercises.

Norm is a great example … crappy one leg heel raises, but can jump and spike in volleyball. I can do a few good one leg heel raises, but no chance I’m spiking a volleyball just yet.

Remember, slow and steady wins the race, though its not a race even if some people seem to act like it is.
First thing you should be doing in my opinion is working on your walk. If you’re limping you need to get that sorted. A bit of dedication and you’ll have it sorted in no time. Once you do that, build up your exercises week by week and do them little and often and before you know it you’ll be back to some sense of normality before you know it!

Ya, 2 shoes is a bitter-sweet victory, because almost all of us slow way down when it starts. Losing the crutches is almost 100% pure joy; losing the boot is much more mixed.

Me, I’d vote FOR paranoia re 1-leg heel raises at this stage in your recovery. Splitting your weight equally between both feet sounds aggressive enough to me. The risk from delaying is that you’ll lose a week or two; the risk from rushing is that you’ll lose a month (as I did!), or heal long… You do the math!

I’m all for high speed for WB, early exercise, PT, etc., but dorsiflexion and heavy-duty strength work should be approached very gradually and with caution, IMHO, because it’s too easy to heal long.

Speed i think a lot of your decision ways on what you want to be able to do in the future. If you want to get back into a active lifestyle where the weak ankle may bother or limit you, then go for the surger and get it fixed. On the other hand, if you think you’re going to back off on the activity and hit the recliner, then skip it.

As to schedule, I would hold off until you regain some of your calf strength before getting the next surgery. It’s already wasted away a good amount, no need to completely destroy it. Strengthening surrounding muscles of tendons and ligaments before surgery (when possible) has been shown to give better results and decrease recovery time. Take a few weeks to pump that calf up a bit so you don’t have to start from scratch after the ankle surgery. From my limited knowledge of ankle surgeries, you should be able to get back to FWB after an ankle surgery fairly quickly which will save your calf from too much additional atrophy anyway.

Those are all very good points… especially the part about relying more on the injured AT during recovery… but also the point about rehabing only to do it all again…. the allergy still scares me, I should schedule figuring that out quickly then…

One last thought: maybe it’s just me… but it would be very hard for me to stay motivated for PT/rehab, when I knew I’d just be doing it all over again before too long. I can hear myself thinking: “What’s the point?…”

I think I’d do a lot better when I knew, no matter how hard it was, that the worst was behind me.

I’d just think about the rehab schedules, and make sure they don’t compromise each other. Seems like you’re at about the right spot…

wk 10 (now): schedule surgery
wk 11: get surgery
wk 11-12: NWB (you said 2 weeks)
wk 13: PWB - no boot, guessing 1 week
wk 14: FWB - back to 2 shoes
wk 15: starting rehab.
(I bet that’s an aggressive schedule, given your still angry AT injury)

At wk 15, (conservative estimate, which is what I’d be using in this situation) your AT should be fully healed and ready to endure the rehab from the 2nd procedure.

With my AT injury/rehab, I feel that the other muscles/tendons/ligaments in my ankle are getting worked extra hard, sometimes compensating for the weakened AT. With this 2nd procedure, my guess is (ask your doc) you may find yourself doing the opposite: relying more than usual on the injured AT. I’d therefore want to be careful/conservative at first.

The good news is, once you get through this, you should be able to proceed with rehab in earnest, without compromise from the damaged ankle. No looking back at that point. But, as you’ve already figured out, it’

It is the same doctor… I talked about doing the ligament surgery at the same time and he said it wasn’t good for the body to introduce more stress in a time of extreme trauma like an Achilles tear. He also doesn’t like any of his patients to be under anesthesia for more than around 2 hours as he said the risks increase at that point. My impression is that he’s a great doctor and the physical therapy place I go to say all of his patients do very well in rehab.

The goal back then was to avoid surgery, but it never really worked that good… I had tearing pain, although not overwhelming, constantly. I could tense the muscles on the loose ligament side and relieve the pain, but it was very unstable in sports.

After trying to build up the muscles, which worked fairly well as I could almost walk normal even after tearing the Achilles, and still having pain, it was decided to do surgery to tighten them up. I had sort of planned to do that this fall until this happened.

My wife agrees with you, she thinks if I wait and let my leg get strong again that I won’t have the surgery and then I’ll end up rupturing the posterior tibi

Water under the bridge… but I’m curious: is your Achilles doctor the same guy you were working with before? Did you guys talk about doing it all at once (10 weeks ago)?

It seems like you were making good progress with the ankle, prior to the Achilles injury. Was the goal back then to avoid surgery? Or, just to delay it? Has this Achilles injury changed your mind? Do you now believe surgery is necessary, or are you just worried that the Achilles injury has set you so far back that a non-surgical ankle rehab isn’t viable anymore?

If it was me (that’s what asked), I think I’d try to step back and ask: what would I do if I hadn’t ruptured my Achilles? Will I still be able to execute that plan (with a delay of course)? If so, that’s the path I’d try to get back on.

If the conclusion is: yes, I will now need surgery- then I’d probably try to do it soon. Insurance is a (small) factor. Mostly, I’d rather go through 1 more difficult rehab than 2 easier ones… I hate being immobile. Plus, time spent recovering from that 2nd surgery, would be “safe” (tendon healing) time where I’m not at risk of re-rupt

Wow, I totally felt like that guy in video #7. I turned around and asked who kicked me. Now I know who. It was my achilles. lol

One thing that seems a common theme is that the injury occurs right at the point of an explosive acceleration and many times coupled with some change in direction of the foot.

My gosh, those are rough! Thanks for posting….

I don’t know if you all have seen these videos, but what I took away was how benign most of the movements were. The ruptures happen during motions that most of us have done hundreds of times. Scary.

I have to admit, being almost 2 weeks post surgery, I too wonder that about the Biggest Loser when watching. I also wonder how seniors that lived so long and walking in stores have fine tendons and I’m crutching around. Don’t get me wrong, I’m not wishing this on anyone, it’s just another thing that makes me special I guess! It’s funny that you mentioned that…it’s like how can these very obese people run a marathon and all I did was push of to just start out running in a basketball game!!

Yeah, I guess what I was meaning was that the “classic case” for an Achilles tear is late 30s-early 40s with a recent big increase in physical activity. The Biggest Loser candidates fit that perfectly and they’re overweight, so it just surprises me that there are never problems with the Achilles with them.

I’m not a big girl and I tore mine stepping off a ladder.
And then again jumping.

I’d say it’s complicated and many factors.

I think there’s a good amount of people on the site who were walking around the house barefoot by week 9. Some of us were even earlier than that. It’s all about how you feel and what you know about yourself. If you know you’re a bit clumsy, you may want to wait a bit longer before walking around more so you don’t step on a shoes and re-rupture. If you were really active and athletic before the surgery then you may feel it’s not as much of a risk for you to walk around.

I’d also take a look at the tracker: http://achillesblog.com/atrpt.php and find some comparable people to your age and rupture activity to see when they went to 2-shoes. It’s pretty safe to assume that they were walking barefoot before that date.

Cheers

That’s a great analogy…. I like your analogy about the 100 hr pilots as well, that seems to be right where I’m at…

At this point- I would consider the boot to be sort of like a motorcycle helmet. It doesn’t do much for you when your riding, but it can do a whole lot for you if you’re crashing. Riding (nominally) without it isn’t harmful; but it’s risky. If you crash, the penalty can be very severe.

Unlike a helmet, the boot has some down-sides too. You’re already feeling how much weaker all the other support muscles are, and how unstable your ankle is getting. The longer you keep them from working, the worse this will get. At some point, you will decide that these downsides are starting to out-weigh the benefit. I made that decision early- recognizing that I was (and still am) accepting more risk by doing so.

You will need to decide when you feel OK walking. Most people want to get their docs/PT’s approval first. I’ll just urge you to be VERY careful when starting to do so. You’re riding without your helmet.

I know, I’ve thought of it… I also need to head back to allergist to really confirm it so I can answer definitively, although they were pretty clear last time after doing their investigation. It was kind of irresponsible on the part of the anesthesiologist…

Cool, that’s good to know… I wonder when it will go away…