ATR Timeline

  • Name: szaitz
    Location: New York City
    Injured during: Touch Football
    Which Leg: L
    Status: 2-Shoes

    424 wks  6 days Post-ATR
    424 wks  1 day
       Since start of treatment

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Too Fast, Too soon?

January 6th, 2014 by szaitz and

Hey Guys,

My achilles history has been: Surgery Dec 3, cast for 10 Days until Dec 13 and told to wear boot. Started PT on Dec 13 and have gone there every Mon, Wed, Fri since, probably about 10 sessions in total. He massages the scar tissue, does ultra-sound and today told me to bring my left shoe, which had been on holiday for the past 6 weeks.

So I walked up and down the hall in his office and it felt pretty good, no boot, no cane, no crutches. I can’t bend the foot past 90 degrees, so it wasn’t great form as a walking step, but a great step to recovery. He says that I don’t really even need the boot, but just to be safe, wear it outside until my OS appointment a week from today. It still feels like there is a barrier reef around the back of my foot that prevents a lot of dorsiflexion, so I’m far from normal, but we’re both very happy with the progress.

I’ve read a lot of your blogs, and I would say that the numbers I have reported above seem to way too accelerated and I fear I’m doing stuff too soon. But I don’t have swelling or pain the next day when he asks me to something. I’ll see tomorrow if this was too ambitious.

For whoever missed it, Michael Crabtree who had ATR surgery in May, had a really great game yesterday for the 49ers. He was cutting, jumping and running hard in freezing cold conditions. He clearly has conquered this thing physically AND mentally.

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19 Responses to “Too Fast, Too soon?”

  1. Janis Says:

    That’s great! Did you have a rupture or some other sort of surgery? My surgery was 11/20/13 and I’m still only supposed to be partial wb in the boot (and two crutches).
    I cannot wait to start pt.

  2. dwolf Says:

    Wow that is a speedy recovery.. but hey if it isn’t hurting, and you make sure to be careful and not push it, then keep doing what you’re doing. The reason why it took me so long to walk without the boot/ crutches was because I had zero flexibility after the surgery.

    Hearing about athletes who are still able to compete always gives me hope :) thank you, and good luck!

  3. coast2coast Says:

    Sounds speedy, but hey if it works it works!

    Crabtree had an awesome game Sunday night. As a lifelong Niners fan and fellow ATR’er, I cringed every time he looked upfield after a catch, but was stoked to see him be able to perform at such a high level (for both reasons!). Guessing you’re a Niners fan as well?

    I’m curious about what the staff did to get his strength back. I’m only 5 days into FWB/2-Shoes, but strength is by far the biggest issue I foresee with getting back in the game.

    Keep up the hard work!

    c2c

  4. kimc Says:

    For comparison, I was 2 weeks in a hard splint, 3.5 weeks in a boot (most of that time FWB), then into 2 shoes as 5.5 weeks. Was doing ROM, alphabet in the air, ankle circles, inversion and eversion with a band from 2 weeks forward. At the time I moved into the boot - 2 weeks - I had fairly good dorsiflexion. With the home exercises, dorsiflexion was really good by the time I moved to 2 shoes. I used the boot for part of the day at least 3-4 days when I moved to the shoes, so as not to overdue. My PT started at 5.5 weeks and was just “homework” - things for me to do on my own.

    At nearly 11 weeks, I can tell you that it’s fairly easy to overdo - and you don’t find out about it until the next day or the day after that. The progress was fairly rapid when I moved into two shoes because the foot and ankle really wake up and begin to strengthen. The progress then slowed way down and there are set-backs from doing even a little too much.

    I am more cautious at this point than I was at 6 weeks. Celebrate and enjoy your progress and know that you won’t be slowing the healing down by doing a little less!

  5. masons Says:

    I feel like i’ve moved to slow, but i believe that my dr. knows what he’s doing. 10 days after surgery i got a hard cast and that im supposed to have in for the next four weeks when i’ll get my stitches out. At this time i’ll move to a boot. I move it and stretch it a ton inside my cast. i can simulate calf raises without any real discomfort, and if my cast wasn’t there i feel like i could bring my foot back past 90 degrees. does this sound about right. most people i hear about are already putting weight on theirs. i was a surgery

  6. szaitz Says:

    This small sample of comments I think proves that each patient, as well as surgeon/procedure, makes for different recovery schedules.

    One thing I should also mention is the shortness of my incision. The surgeon was able to cut it small and ‘reach up’ with a blue plastic device to find the upper torn section of the tendon. My therapist said it was the shortest achilles scar he had ever seen. For all those people who are about to have the surgery, ask the doctor about this thing. I wish I could remember the name of it.

    My whole foot was a different color than the the other one when I woke up today, but after 10 minutes, it normalized and I have no pain. The exercise I was instructed to do for the next few days is to put my bad foot on a 12 inch high platform and move my knee forward as far as I can without pain. The ‘cuff’ of tissue, around the back of the foot, from ankle to ankle, doesn’t allow too much range of motion at this point.

    KimC - you say that you started PT at 5.5 weeks, but only for ‘homework’ exercises. Do they not do the ultrasound/massage therapy that my PT says is very important?

    Coast - I’m a Jet fan - but I root for Crabtree to do well.

  7. normofthenorth Says:

    SZ I’ve seen that surgical tool on the Web. It’s been written up, and may have advantages in addition to the small scar — like more consistent (& better?) repaired AT length. I still “push” non-op for the vast majority myself, based on latest evidence like UWO, so I’ve paid more attention to that than surgery. The one surgery I’ve praised on my blog was done by two OSs in Japan. They got great results, with immediate FWB (maybe no boot even?) and shockingly fast return to sport. If a teammate of mine wanted surgery ai’d send them to those guys! Details on my “studies” blog, IIRC.
    But for most of us — already in rehab — all this is “bygones” and “what if”. The key is to do our best starting from here…

  8. normofthenorth Says:

    SZ, when we first walk boot-less, there are usually two related problems that keep us from walking normally: (1) we lack ROM, i.e. our ankle simply will not bend (df) far without hurting or just stopping; and (2) we lack strength (calf and AT), so if we COULD step normally past our injured foot, doing so would overload our injured leg and it feels like we’d collapse or rerupture, etc.

    The solution for both is the same, and often comes naturally: shorten “that” half of your stride, when you swing your uninjured foot forward. Do NOT turn your injured-foot toes out to the side (the way you probably did right after ATR, pre-treatment)! And there’s no good reason to shorten the OTHER half of your stride, swinging your injured foot forward, IMO. The key is to keep your stride as normal as possible apart from the shortening.

    AFA going too fast, I’d agree with the folks above: if it feels fine the next day, it’s not too much too soon. But do Watch Your Step, because you’re at LEAST as vulnerable as you feel! And “think incremental” whenever you add new challenges.

  9. kimc Says:

    No ultrasound for me. My PT, doc, and ART guy all said it’s pointless. So….just another example of health professionals having different opinions about what to do, huh? As for the massage, the chiropractor that I go to for ART (Active Release Technique) handles the soft tissue stuff. So, he got the lumps out of my incision and the places where the collagen was uneven, dealt with some adhesions. I’ve been seeing him 2x a week since 5.5 weeks. So, it’s not really “massage’ but it’s keeping everything long, pliable, and adhesion-free.

  10. anne Says:

    I personally would let your doctor tell you when your ready to ditch the boot. I’ve seen a lot of people have successful recoveries moving to 2 shoes at 6 weeks.

    Had I not re-ruptured, I would’ve moved to 2 shoes in 6 weeks. Sigh. Anyway, my doctor didn’t prescribe PT, he didn’t think I needed it. His only advice was to stop when it hurt. I do go to PT once every 2 weeks because that massage they do has helped substantially and I get new exercises for the AlterG. I use the AlterG 4x a week and I use the bosu for balance exercises.

    I had issues with my dorsiflexion and limping coming out of the boot. Walking backwards on an incline completely eradicated that problem within 2 weeks.

    I am very impressed with Michael Crabtree. All the articles I read refer to his injury as a tear and not a rupture and I’m not sure if that’s intentional or not.

    I’ve learned at my old age of 44, success comes to those who think they can. So if Michael and Kobe can do it, so can you.

  11. Tord Steiro Says:

    I agree with Norms conclusion above, but I would like to highlight one thing: Watch out for ankle injury, ankle pains, and ankle swelling. When you land with full weight on your heel - because, with no active AT, neither your AT, your calf, nor your plantar fascii can assist in cushioning the impact of the stride - you are at risk of compression damage and inflammation in your ankle.

    I got compression damage at the same time as my ATR, which developed into an inflammation due to excessive walking in the early days, and then excess early running. Because running didn’t lead to any pains or unpleasantness in my AT, I jacked up mileage too soon. Now, this thing won’t heal properly, and the inflammation is till there, 7,5 months post-op. This has forced me to suspend running altogether, and any other activity that forces my to either land on my heel (like jogging/running/walking downhill) and any activity that includes rotation in my ankle (.

    This sucks badly, to say the least. But hey - my AT feels great!

  12. JB3 Says:

    I also had the small horizontal incision (rather than vertical)with the gnarly looking tool used to repair the tendon. Part of the tool keeps the cut open and then 2 small arms go up and get the tendon then they stitch both sides together.

    My scar is less than 2 inches wide and was basically healed 3 weeks after surgery.

  13. Patty Says:

    I had surgery Dec 19, 13 and two weeks after they took out my SEVEN stiches and put me in a hard cast. Two weeks later I go back and the incision is open and NOT healing?!? I got my cast off, but NWB until I see the dr tomorrow. It doesn’t look good. Does this seem like too few stiches to anyone else?? My husband had 17-20 stiches for about an inche long surgery he had on his back and has a “beautiful” scar. I can already say scar is going to look bad !!!! ; (

  14. coach24 Says:

    I ruptured my Achilles tendon on January 20, 2014 playing basketball with my daughters’. My doctor gave me the two options to treat my Achilles injury, and I have been back & forth trying to figure out which is best. I have researched both and I’m leaning more toward the non-surgery. However, I’m just a little bit hesitant because my OS said that being immobilized with toes pointing downward is old school, and that aggressive rehab is the best treatment for non-surgery ATR.

    I have read a ton of NSATR success stories and they all say the same thing that, being immobilized is the most crucial aspect to a successful recovery. Basically, I just want know have any of you heard of this approach, or should I seek a second opinion? I have to make a decision soon to give myself a fighting chance for a successful recovery.

  15. kellygirl Says:

    @coach: there are a bunch of us with NSATRs. Check out Ron’s blog. He has the pros and cons of surgical vs. non surgical and the related protocols. Lots of great information there. Good luck!

  16. hillie Says:

    Coach, take a look at achillesblog.com /suddsy/2013/06/24/end-of-wk-2-wow-progress/. Posts from a number of us there but do read up on the latest Exeter and UWO info.

    Having ‘toes down’ does not mean non-aggressive. Non-surgical rehabs can be very good, ok or bad. I was fortunate and had an aggressive rehab (even though toes down 30º first 2 weeks). Some have had full cast for many weeks then below knee then a boot…

    I hope this helps. Got to go now, work to do!

  17. hillie Says:

    Coach, in the url I quoted make sure to delete the space between .com and /suddsy.

  18. normofthenorth Says:

    Coach24, +1 to the comments above. But if your OS is determined to start your non-op treatment with WB and in neutral=90-degrees, he is apparently planning to be too aggressive. Compare his plans with bit.ly/UWOProtocol and the Exeter protocol linked above. And there’s also a discussion on one of my pages — The Case for Skipping ATR Surgery, IIRC — about a published study that went too fast and got bad results. If that’s what your OS likes, I’d run away.
    Most bad treatment is too slow, and good treatment is relatively aggressive, as your OS suggests — but that doesn’t mean The Faster The Better with no limit!

    Especially non-op, results deteriorate sharply when you stray from the optimal path, in either direction. The best protocols produce excellent results, comparable to surgery, but the tolerance for variations in timing is much lower than post-op, according to the evidence.
    Exeter seems to have done well with only one week NWB rather than UWO’s two, but I wouldn’t skip that week. And they both immobilized in equinus for a while, though Exeter included ROM-boot-hinging relatively early, as I recall. I think their non-op results were roughly equivalent, so you may as well choose the faster one.

  19. hillie Says:

    You’re correct Norm. Beneifitting from the Exeter protocol I was in a light cast, in 30º equinus, for 2 weeks, then in boot fixed at 30º for 2 weeks but able to start weight bearing after week 2, and weaning off my elbow crutches.

    After week 4 the boots was adjusted to allow the hinged ROM 30º - 15º PF. Gentle exercise after week 2. No boot in bed after week 4.

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