Filed Under (Uncategorized) by starry on 29-04-2011

So my ATR story reads much like everyone else’s, happened while playing basketball on a sunday night, 17th of april, about 15 minutes into the game. I remember catching a pass, and probably twisted a bit and went to accelerate (details a little hazy it happened so suddenly), then thought that someone had kicked me in the back of the left heel! I fell over and clutched at my ankle and like everyone else, looked around me to see who had kicked me - I knew i was in trouble when I realised there was noone around, and everyone was looking at me with worried expressions. After the pain decreased a bit I hobbled off the court hopping on my good leg.

After dorsiflexing my leg and feeling a gap where my achilles was meant to be and comparing it to my good leg, I realised straight away what I had done. My partner gave me a ride to the hospital, where they took some xrays of my ankles, then waited a few hours to be seen by the dr. They performed the thompson test and confirmed it was an achilles rupture, placed me in a backslab and told me to return at 7am the next morning to be seen by an ortho specialist. The specialist discussed my options - surgery vs non surgery, they did inform me that there was little difference between outcomes of the two but maybe a small decrease in reruptures with surgery. Given that I am younger than the usual people that have ATRs and quite active, they recommended surgery and I was happy to proceed. After all, if i was going to be out for weeks then I may as well try and decrease the chance of rerupture! Another backslab was placed back on my leg and I was sent home with surgery scheduled for the wednesday (3 days post rupture).

Surgery all went well, complete rupture which was sutured together.  I arrived in the morning fasted and had to wait a few hours before it was my turn. I had to put one of those backless gowns on, they inserted an IV and gave me a dose of sedation before wheeling me into the theatre. The last thing I remember is moving onto the operating table, then being awake in the recovery room. They gave me fetanyl (an opioid) IV as pain relief for immediately after the operation, then digesic tablets every few hours - I have a few doses of this but felt like they were making me have shortness of breath and feel nauseus so I stopped, with my last dose in the early morning the day after my op. I was sent home the next morning with ibuprofen, panadol (panadiene forte if necessary) and blood thinning injections of heparin (clexane) to prevent DVT. Surprisingly I have felt nearly no pain throughout the whole incident apart from the intial sharp pain when the rupture happened. I didn’t even use any of the ibuprofen or panadol. Apart from the initial rupture, I think the most pain has been from those daily blood thinning injections I’ve had to give myself under the skin in the abdomen - they sting like a bitch! But each one means I’m a day closer to my post op visit and a boot with partial weight bearing!

The first few days were the hardest, for a few reasons:

1. Kept wondering why it happened, whether it was preventable, and why me? From all my reading, ATRs generally happen to people in their 30-50s, especially men. I am a 24 year old female who has been active my whole life and never had any signs of tendonitis, so this all came about very suddenly. The night of the rupture I had not warmed up or stretched much, which would not have helped, but this was no different from my usual routine (but lesson learnt the hard way!). Secondly, I had only started playing competitive basketball again 2 weeks ago - this was my second game in about 1.5 years, so might have placed too much impact on my achilles too suddenly. Although I did play basketball casually with friends prior to this, and played oztag (touch footy/rugby type thing). So I guess I had two risk factors for an ATR, but I thought my body would still be able to handle it since I am young. Eventually after a few days I learnt to accept that sometimes things happen and there was nothing I could do about it but stay positive and stay determined to heal completly from this injury.

2. The thought of rerupture or rupture of my good leg scared the sh*t out of me. I was so scared of having to go through this all again, especially further down the track when I was able to start walking again. Because this is an injury which occurs quite suddenly and without warning, I felt a bit helpless that I could not do much to prevent it from happening but strengthen my leg muscles, warm up well and stretch before games. After some time I accepted that this was a possibility, but that there was not much I could do to avoid it completely, and there was no point worrying about it happening.

3. I was about to go on a 3.5 week holiday to USA and toronto, my first big holiday since I started working 1.5 years ago. This trip was cancelled due to risks of DVT on long haul flights, the need for post op visits and rehab, and the inconvinience of moving around in a foreign country on crutches (hard enough in my home city!). This crushed me as I had been looking forward to this holiday for months, and initially I was more upset about this than the injury itself. Again after a few days I accepted it and am looking forward to making a full recovery so I can go next year instead!

So now I am 9 days post op, I have been elevating my leg above my heart religiously as I do not want any complications with wound healing. This means I have been mostly lying down with my leg propped up on 2 pillows (1 to sleep on, was too uncomfortable sleeping with 2). The first week everytime I got up I would feel the blood rush to my leg and mild throbbing around the achilles area. The past 2 days though this has decreased a lot, and I assume it will continue to improve until my post op check at 14 days.

My surgeon has already sent me my rehab protocol, which I was pleased about as it happened to be the UWO protocol. So fingers crossed I will have a boot on in less than a week and be able to start partial weight bearing - very excited! This means that I can at least get out of the house a bit and drive also (left ATR), and have some sort of social life! Until then I will overdose on tv series, movies and books.

A quick question for you all - anyone that has followed the UWO protocol, how much time in the first couple of days after being fitted into the boot were you able to walk? Did anyone have issues with their tendons being too tight to be placed comfortably into the booth with a 2cm heel raise? Looking forward to getting a better idea of the next step from here, reading everyone’s blogs has been so reassuring!


normofthenorth on 29 April, 2011 at 4:24 pm #

Nice story, Starry, and nice protocol! :-) You’re in Australia? (I’m guessing from the oztag/footy thing.) If you install the ATR Timeline Widget, we’ll all be able to check your “FAQ” info easily.

I followed the UWO protocol myself, but skipped the surgery, so conforming to the boot’s/lift’s ankle angle was no problem (and my techie stuck 3cm of wedges into my boot by mistake instead of 2cm). The protocol specifies 2 weeks of NWB, then 2 weeks of PWB, and “FWB as tolerated” starting at 4 weeks in (4 wks post-op for you). It’s possible that earlier WB is OK or even beneficial, but nobody’s tested that against the UWO protocol, and I don’t think any study has done it much faster than UWO, so you’d be breaking your own path.

There are people here who’ve followed similar protocols post-op (vs. post-NON-op), and maybe one or two will pipe up with advice.

I think you only had ONE risk factor, not two — the return to a high-risk sport after more than a year off is a very common theme in the ATR crowd. But LOTS of us warmed up and stretched before popping the AT, so don’t beat yourself up over that. For every one of YOU who popped it 15 minutes into the game, there’s one or two of US who tore ours near the end of a strenuous evening. (I did BOTH of mine that way, 8 yrs apart!) And the best and newest evidence on pre-sports stretching indicates that it’s neutral or negative for injury prevention, and definitely negative for sports performance. (Our coaches all got it wrong!)

Unfortunately, while there’s every reason to be confident in your torn AT after it heals, there’s no reason to be confident in your other one, if you return to fun, explosive sports like basketball. A number of us here eventually “did” the other side, and there’s a study estimating the risk of doing so — not exactly “likely”, but WAY more likely than tearing the first one. But that’s a concern for another day, 6 or 10 months from now. Nobody here has torn the “good” side while hopping around or crutch-walking, though many of us worried about it.

Your paragraph #2 sounds like your ATR & surgery were a long time ago (as does your “17th of may” in the second line), but your 3rd paragraph from the end makes it clear that you’re 9 days post-op, so your ATR was presumably 17th of April, right?

Glad you found us, and Good Luck and Good Healing and please keep posting.

normofthenorth on 29 April, 2011 at 4:25 pm #

And now I see your ATR Timeline clear as day! Where was it hiding?!?

starry on 29 April, 2011 at 4:39 pm #

hahaha thanks for the help. How much did you walk around while partial weight bearing intially? (I think i didn’t word it very well the first time), like i’m assuming when you start pwb in the boot again you only walk on it for a short time before having to sit and elevate again?
Oops yes 17th of april, i’ll fix that now ;P

starry on 29 April, 2011 at 4:53 pm #

And yes, it is a bit worrying to know that the other AT is at risk of rupturing down the track, and that stretching doesn’t help! Although it is nice to know that noone has ever ruptured their other AT recovering from their current one hehehe. Guess I will have to stick with warming up, and I think bball is off the cards - bad for my knees also, I might just stick with oztag and gym classes.

normofthenorth on 30 April, 2011 at 3:40 am #

Whether or not to return to the high-risk activity that caused the ATR is probably one of the most personal and value-laden decisions you’ll ever make. Me, I gladly accepted the risk, and I’m still pleased with that decision after I actually did tear the other side, so that was the right decision for me.

PWB just means partial WEIGHT (still using crutches), not necessarily part of the day. Of course, you’re usually still battling lots of swelling, so sitting and elevating is still high on the Things to Do list! And SITTING NWB or PWB is way easier than WALKING NWB or PWB! ;-)

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