TennisNewbie’s AchillesBlog

Newbie, you can post replies to your own blogs, if you like, so more info will appear on one page. (My blog goes to extremes in that direction. . .)

I don’t understand the problem getting you into a boot. I’ve never seen (or heard of) an orthopedic ankle boot that DOESN’T restrict flexion! The cheaper ones restrict ALL flexion in ALL direction because they’re totally rigid, fixed. The fancier and more expensive (and better, IMO) ones can HINGE to various degrees, but they can all limit that hingeing, especially in the dangerous dorsiflex direction, and they can all be totally fixed, too.

And you’re being immobilized too long for your ankle — not to mention the rest of you and your life!

The removable cast is a good thing. I was in a fiberglass cast for 5 weeks with no weight bearing for 7 weeks only to re-rupture at 10 wks post op due to poor scaring due to lack of movement during healing (so they say). The removable cast will allow some movement and may help the scarring process. After my second surgery I was in a walking boot 12 days post op, and the entire recovery has been great. The re-rupture was heart breaking - you don’t want to do that. I was out of the walking boot for 30 minutes when I heard the light pop and knew immediately that something was very wrong. So, be careful whatever you do. Good luck!
wayne

Gosh, you’re welcome, and then some!!

I’ve spent a lot of time thinking about why it’s so hard to get medical practice to reflect these new studies. The age of the doctor occurred to me as a factor, but EDUCATION vs. TRAINING didn’t. I guess it’s because I’ve never been a doctor! So I guess they were taught a few things about ATRs in Med School, then they went out as interns and got their hands-on training from some (older) Attending Surgeon, who promoted them up the food chain if they kept their poor ATR patients NWB long enough!!

I’ve been blaming the Med Schools for not being quick to adopt the new evidence-based medicine, and the surgeons for not reading the studies and updating their educations. But this training thing adds a dimension — and maybe adds even MORE momentum to this super-tanker many of us are trying to turn!

Doug53 and the other doctors here, am I reconstructing this image in a reasonable way? (It’s about 30% “logic” and almost 70% Grey’s Anatomy, so I wouldn’t be shocked if I got it wrong!)

Very cool. You should go celebrate convincing your doctor to not do the usual stuff. Did you also give her a copy of the rehab protocol? If not, you should get a copy to her ASAP and be prepared to do a sales job at your next appointment. Just tell her you’ll be happy to be the guinea pig for her experiment. LOL

I haven’t pored over the early weight-bearing post-op studies the way I’ve pored over the surgical vs. non-op ones, and some of them definitely show identical results rather than better results with early WB, as you say. But I’m pretty sure that some — including the 2005 meta-study that I cite on my blog — showed superior results from very early WB with the “functional orthotic brace” (aka “hinged boot”!).

Either way, if you can carry stuff around weeks or a month earlier and have “only” identical clinical results, why would anybody do anything else??

8 yrs ago, when I tore my right ATR, I definitely drove around in 2 shoes for the 9 days before surgery. I used my heel for the pedals, esp. the brake. It seemed safe enough.

After the surgery, I was NWB for WAY too long, no driving for me. After I got into a “walking cast” then a (hinged) boot, and became FWB, I think I did resume driving, in our stick-shift car. (Whether that was the smart thing to do or not is another question entirely.)

My Donjoy MC Walker boot was narrower than the AirCast (fixed) boot I got this time. And the AirCast was on my left foot this time,

no, you will NOT drive in a boot - it’s just to wide.
Some tried to drive by left foot, but that’s risk.
Think from long term - if you postpone your driving for 2-4 weeks till you are in shoes, but will not get in any accident as result.
While I was in my boot I changed it to shoe in car and drive - very slowly
than back to boot and walk from my car
I sit in parked car at 1st for an hour pressing pedals that tried drive on safe road and only the next day went on 101 and etc.
I even didn’t try left foot as in extreme situation your brain can be slower than your spine and left foot can’t act as should.
as already mentioned get all details from Doc.
Did you try to email your Doc? there is option to do it at kaiser web site.

Norm -

Your post was as much of a blow to my head as the ATR was to the other end of my body. Since reading it, I have been exploring the blog site more deeply and came across the extensive writing that you have done on the issue.

As you said the decision to operate or not is water under the bridge for me. Frankly, I can’t recall whether the location of my rupture was factored into the cut or not to cut decision. I do recall that there was some mention of increased likelihood of scar tissue and re-rupture without surgery. Regardless, that ship has sailed.

However, I have printed several of the articles regarding rehabilitatino protocals that have been linked to the site and the overall impression that I get is that, in the long run, the results from early weight bearing vs. non-weightbearing seem to be the same, but the quality of life during rehabilitation is greater with EWB. Since I am self-employed and my office is 13 miles away, and I have young kids and summer plans, being able to ditch the crutches asap is important.

So even though my next appointment isn’t until July 10, I am going to try to get an appoin

tennisnewbie,

Get informed and make your own rehab decisions - it’s YOUR foot after all. I chose surgery because I wanted a guarantee that the ends of the tendon found their way together even if the risks were a bit higher. No infection but I did get an adhesion so I did pay a small price. My doc is a well respected surgeon and I am satisfied with “our” procedure but I don’t care for his rehab protocol and he does not care for mine. I am going my own way for rehab and PT and I suggest you do as well since both our docs seems to be stuck with classical protocols.

You might inquire about a splint instead of a full cast. I had 2 post-op splints for 3 weeks with the change at 2 weeks for suture removal. While splints are not usually intended to be removed at home, they can be if your incision gets wet and can be replaced after changing your bandages. They are also very comfortable if fitted properly and are self adjusting for swelling if applied with an elastic “ACE” bandage.

Once in a boot you are free to rehab either on your own or follwing doc’s or PT’s orders. Right NOW you have time to order the exact boot you want

tennisnewbie, there are two issues here that have been addressed with Evidence-Based Medicine studies, and I’m afraid your medical professionals haven’t gotten the memos on either! So it’s unfortunately part of your job to educate them, for the sake of your own healing, and as a favor to the next maybe 100 or so ATR patients that go through their care.

The first issue is water over the bridge. Almost everything they told you about the benefits of surgery has been proven wrong in FOUR recent studies, all randomized prospective trials of good quality. All dealing with TOTAL ATRs (”a complete rupture”), the kind your surgeon thinks surgery produces better outcomes — Just Plain Wrong, check the EVIDENCE!!

(Your ATR may have been higher than average, closer to the calf muscle. Several bloggers here have been REFUSED surgery on that basis, because their surgeons told them that a high tear made then WORSE candidates for surgery and BETTER candidates for non-surgical immobilization! I don’t think there’s any good evidence either way, and the randomized trials did not exclude higher-up ATRs, so they’re part of the general evidence.)

Thank you for all of your input. I am nearly 44 and it is my dominant right leg that suffered the ATR. Surgery was presented as the best option, because it was a complete rupture, and my surgeon wasn’t confident, even with pointing my foot in a cast, that the ends of the tendon would find each other and reattach. Perhaps the fact that the rupture is as near to the calf muscle as my heel had something to do with it.

I am in a temporary cast, and have been told that I will get a fiberglass cast in another ten days after my incision(s) are checked. I ws told that I will be non-weight-bearing for six weeks, hence the no driving. I have assumed that once I get a boot after the fiberglass cast comes off that I’d drive somehow, but not being able to flex my ankle could still be a problem, I suppose.

Apparently, the P.T. is not supposed to begin until after I am in the boot, so it sounds like my surgeon has envisoned an old style of rehabilitation. I will be seeing someone different in ten days, so perhaps the more modern program can be discussed.

Qualitatively, your experience is typical, but quantitatively it’s a bit on the extreme side, certainly compared to my experience with both of my ATRs.

Does it help if you keep your knee bent while you’re on the crutches? Some people here have had relief from the other elements of RICE, including ice and compression. Of course, if you’re in a cast, both of those are tricky or impossible. I spent a lot of time kneeling on my “bad” knee, e.g., when brushing my teeth or washing dishes. Is that position excruciating for you, too?

I know I moaned a lot and stayed in bed a lot 8 years ago when I got the operation (and I peed into a jug beside the bed, too, for several days!). Skipped all that this time when I skipped the operation, excuse the smugness. I’ve still been elevating a lot, and only really phased out completely, more or less, quite recently, near the 6-MONTH mark. (See my blog entitled “Swelling (& elevating) is getting OLD!”)

No other suggestions here. I would have suggested what your nurse suggested, which didn’t help. With luck, it will ease up soon. If not, have them look at your leg. Is it invisible to you, i

Like Gerry, I’m one of the local cheerleaders for avoiding ATR surgery. Unlike Gerry, I actually avoided it THIS time, after having successful and uneventful surgery on my other side, 8 years ago. But that decision is “bygones” in your case now! (But if any of your pals or relatives ruptures an AT, send them to my blog for links to the evidence that the surgery adds no benefit to the boot!)

It’s definitely not fair that the people who are most likely to suffer with this affliction are the ones who are doing the Right Thing from a general health and wellness perspective, staying active and getting a good workout in sports. Not fair at all, but it’s the fact.

After my first ATR, I returned to the brutal sport that tore it — competitive volleyball in my case — knowing that there was a real risk that I’d end up tearing the other one, too. It took 8 years — 7 great seasons after my recovery — but it did happen. Thanks to the lack of surgery, the much faster rehab protocol, and knowing where I’m headed, I’m finding this recovery much more pleasant than the first one.

I’m 6 months in now, and I’ve returned to all my normal ac

ask your doctor via email (I’m with Kaiser in San Jose too) about your recovery protocol.
when stitches will be removed? when cast be changed to a boot and what kind and for how long? when PT will start?
yes, it may be 2 months till you drive a car again, but time flies fast.
enjoy your immobility while you can watch TV, browse inet
as when you’ll back on your feet you’ll need to catch up with many things and that when you say good by to TV and much sleep. May be I’m rude about what I wrote - you will recall it in 4 - 6 months with a smile

Right leg and 6 weeks of no driving?

I didn’t drive for 3 months!
I got a ticket the 3rd week of driving because I didn’t stop on time.

Work something out with your employer and rest!

Sorry to hear you ruptured your tendon. There do seem to be a fair number of tennis players here, as well as other racquet sports players. As you will soon learn here, it’s too bad they rushed you into surgery as if that was the only choice. Did you give you the options or explain everything that can go wrong with a surgical repair? I’m the poster boy here for surgical complications and there is no way that I would ever agree to surgery again if I either re-rupture or rupture the other tendon. Are you in a cast or a boot? I never had a cast until my fourth surgery and then only for a week. Some people get a cast and some get a boot? What is your surgeon’s plan for getting you to full weight bearing? My plan, until it got derailed, was stitches out and partial weight bearing at 2 weeks plus begin physical therapy, full weight bearing at 4 weeks and into 2 shoes as soon after that as I could tolerate it. My surgeon told me there was no evidence that prolonged immobility and non-weight bearing accomplished anything except more muscle atrophy. My current therapist told me that within 24 hours of the ankle being immobilized th