May 07 2010

tania

Hello all you injured ones…

Posted at 7:02 pm under Uncategorized

I am new to this blog, let me introduce myself. My name is Tania and I am from Houston Tx. Last week I ruptured my Achilles Tendon while I was in kickboxing class, I was on a weight loss mission trying to look my best for my BIG 30th B-day in Puerto Rico (this June) and this injury was a huge set back for me, not working out like normal has depressed me some. I am currently on the “Famous” Boot awaiting an MRI and Doppler Ultrasound to see the extensive damage. I have been online researching this injury ever since, and that is how I came across this blog. I’m glad I did I hope to learn a lot from people with my same dilema. :-/ Its so hard adjusting to life with this boot and the thought of surgery terrifies me… Any advise or suggestions are appreciated…

5 responses so far

5 Responses to “Hello all you injured ones…”

  1. normofthenorthon 07 May 2010 at 9:43 pm 1

    Welcome to “the injured ones”, Tania!

    There’s obviously a lot to be sad or depressed about, but you’ll probably also start pretty soon, making steady — and often surprising — progress back towards “normal”.

    You can check out a bunch of blogs here for many different individual stories, with lots of them sharing many common features. (Most of us were VERY physically active, so the frustration of becoming a “couch potato” is a common theme!)

    I am on my second ATRupture — 8 yrs apart, right then left, both while playing competitive volleyball — and I’m currently the local advocate of the NON-surgical protocol. More specifically, I’ve been following a fairly rapid non-surgical protocol that was tested (and compared to standard open surgery) in a few recent scientific studies, most recently one just completed at the Univ. of W. Ontario in Canada. (The first time, I had surgery, based on everybody’s recommendations in 2001. It worked fine for me, too.)

    It’s not easy for a patient in the US to get an Ortho surgeon NOT to cut and stitch (I’m in Toronto, where it’s easier) but at least a couple of bloggers here have done just that — mikek753 and gunner, for sure.

    One of my blog posts (plus replies) analyzes the results of the latest studies I’ve been able to find online, mostly comparing surgery and non-surgery. The latest 4 — from 2007 and later — all used a careful scientific approach, randomly assigning ATR patients to the two “streams”, then putting them all on a pretty quick rehab protocol (which I’ve posted), quite a bit quicker than the average of the bloggers here.

    Statistically, everybody did pretty well, and the non-surgical patients did every bit as well (in strength, ROM=Range Of Motion, and re-rupture rate) as the patients whose ATs were repaired surgically. Of course, some of the surgical patients had complications, like infections, incisions that wouldn’t heal right, and the occasional Deep Vein Thrombosis.

    There are a few experimental surgeries being tried — most excitingly by two surgeons in Japan (see my link) — that might well produce better results than any non-surgical protocol ever will. But given the choice between the standard surgical repair and following the non-surgical protocol used in (say) the UWO study, I’d tell ‘em to put down the scalpel!

    And if your Doc wants to keep you NWB (non-weight-bearing, on crutches) for longer than 2-4 weeks, you’ll be going slower than the patients in these studies (who did very well), with more lifestyle disruption, more frustration, and more risk of busting your head by crashing on crutches! (The fact that your Doc put you in a BOOT and not a CAST is a very hopeful sign, BTW!)

    There have also been some studies about MRI and Ultrasound to guide treatment decisions. As I recall them, most find that they add little or no benefit to the decisions you’re facing — and they sometimes add confusion, and delay. (I think I’ve also seen a “consensus document” from a big association of Ortho Surgeons that came to about the same conclusion. I don’t remember if I linked that document in my blog or not.)

    If you can’t support your weight on the ball of your injured foot, if “your life flashes past your eyes” when you put that foot onto a stairway going up (so instead you rotate your foot sideways so the heel is on the step), if the Thompson test indicates that you’ve got an ATR (foot doesn’t “jump” when your calf is squeezed) — and of course if there’s a visible “notch” or “gap” at the back of your poor leg — then you and your Docs probably know all they need to know, and you’ve come to the right place.

    Good luck with your decision and your recovery, and keep us all posted!

    Are you clomping around on the boot now, or NWB on crutches? If it’s the latter, and you’re in a gently toe-down position (plantar-flexed or “in equinus”, e.g. on ~2 cm of firm heel lift), then you’ve already begun the non-surgical “cure” that some of us are following!

  2. mikek753on 07 May 2010 at 9:59 pm 2

    hi Tania,

    Elevate injured leg as more as you can.
    Read other posts and you will learn a lot about ATR and what and when to do.
    Ask questions, but treat answers as opinions.
    We are here mostly post ATR patients then doctors, while some have medical degree too (not me).

  3. normofthenorthon 07 May 2010 at 10:42 pm 3

    Not me, either. http://achillesblog.com/garethcope/2010/03/17/surgery-vs-non-surgery/ is another interesting discussion of the choices facing you now.

    Gareth had a good outcome from a very conservative (slow) non-surgical protocol followed by pretty fanatic exercise program.

  4. taniaon 08 May 2010 at 1:57 pm 4

    Thank you normofthenorth & mikek753 for the good info and advice. :o)
    From what I understood when I went to the Dr. He is hopeful to treat my leg the NON-SURGICAL way. I have my MRI/Ultrasound scheduled for Next Wed. 05/12 hopefully that goes well.
    As of right now I am on the BOOT and Crutches. At first I was so AGAINST the crutches but after having difficulty walking on the boot I gave them a shot and can get around better with them.
    At night sometimes I flex my foot, testing myself and my leg seems OK, and as soon as i start thinking “its not so bad” I get spasms and the pain KICKS in! :o( ..
    I am trying to keep positive and I have read some posting on here about working out, I have started doing that 30 minutes of the day, I use 3lbs weights and do situps, I have also changed my diet hoping to maintain weight.
    As for keeping my leg elevated … that is so hard for me, after a while I feel discomfort in my leg and it starts Numbing up, is that normal? At work i keep it elevated on a stool and after a while that is painful.
    YESTERDAY was a rough day for me, I felt discomfort all day and yesterday I started getting spasms in my Knee and upper leg, continuing by numbness.. it’s worried me a lot, has anybody experienced this as well?

  5. normofthenorthon 08 May 2010 at 2:48 pm 5

    Tania, the first two weeks of the non-surgical protocol that’s been tested and produces good results, have you NON-weight-bearing. Basically in the boot, toe down (2cm of heel lift), 24/7, just like a cast. Then AFTER 2 weeks, you can gradually introduce what they call “protected [=~ partial] weight bearing”, aka PWB, still on crutches.

    I forget if it’s 4 wks or 6 wks when you get to “WB As Tolerated”, but it’s all on my blog, at http://achillesblog.com/normofthenorth . Let me know if you need the specific link to it.

    Nobody’s proven that you can produce good results non-surgically by playing around with some weight-bearing in the first few weeks. You may discover a great new healing program, but you may also mess yourself up. Me, I wouldn’t experiment!

    If you’ve torn your AT (according to those tests I mentioned above), then I’m afraid it’s time to stop dreaming that you haven’t! The good news is that there are two basic approaches to getting back to full strength — and with MORE confidence in that ankle than you should have had a few weeks ago! The bad news is that you’ve got to stick with one of those approaches for a while, and it will be almost 2 months before you’re back in shoes, and a few more months before you start forgetting that all this happened.

    Elevation is very tricky, especially for some people. Surgery makes it even trickier for many people, because there’s a sensitive incision near the back of your leg, where you’d want to rest it when you elevate.

    Me, I’ve been pretty comfy just sticking my leg up on a footstool (sometimes with a pillow) or on a table. The rest of my body (spine, bum) get uncomfortable or even cramped, but my leg mostly enjoys it. (Occasionally it feels numb or cramped, but only rarely.)

    Others here have discomfort in their leg when they elevate “the easy way”. Other options including lying on your stomach and bending your knee to elevate, or lying on your back with your leg propped up on the wall. As long as your ankle is locked into the proper angle, and you’re not WB, you can be as inventive and creative as you like.

    A few people here have gotten relief from swelling-inflammation with compression (like Ace Bandages/wraps), but not while you’re still in the boot 24/7. And applying compressors while you’re out of the boot is scary.

    Many people have gotten relief from ice, again usually while you’re OUT of the boot. I NEVER got out of my boot for the first 2 weeks, and for a week or two afterwards it was just at Physiotherapy, or to swab down my foot with rubbing alcohol or to give it a careful sponge bath.

    The initial “trick” to the non-surgical protocol is to let your body grow new connective tissue to replace the broken “link” in your AT, and also to let Mother Nature somehow make the healed tendon the same LENGTH as it used to be. (This part is bewildering magic to me, but the studies and my experience both say it WORKS if you stay with the program!!)

    If you get the ends laced together surgically, you may have a bit more leeway to take off the boot and play with your foot in the early weeks — doug53 put himself on a pretty aggressive rehab protocol, mostly unbeknownst to his surgeon, and he recovered quickly and well, as described on his blog here.

    Me, I strongly prefer the non-surgical approach (having done it both ways now), but I think the early stages of that approach put you in a very vulnerable and delicate stage, like helping a seed sprout. You don’t want to uproot it to check how it’s growing!!

    BTW. if your Doc has been reading the studies, and has a copy of the protocols they’ve used, and plans to use it on you, then you are in the lucky half-of-a-percent! If not, you may want to be your own “patient advocate” or educator, introducing him or her to the info. (Between the boot and leaning toward a non-surgical approach, it’s possible you really lucked out.)

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