The Second Opinion
So I went to see a private sports injury specialist the other day, to seek confirmation, or ortherwise, that the conservative treatment suggested by the NHS consultant was the most appropriate for me to follow.
He started off by saying that his concern about the NHS was that they tended to offer conservative treatment as a first option for most patients, leaving surgery for those who had re-ruptured. I guess this confirmed some of my fears.
However, we then talked more about my particular injury and when I explained that it was high up the achilles, right where it joins the calf muscle, he was much happier in the NHS verdict. Essentially, he agreed with the original consultant - the prognosis for healing is better in ruptures higher up the leg, the chance of rerupture is considerably lower and it is also a little more difficult to operate in that area. He was happy enough for me to continue following the conservative approach although did say when this cast comes off in a couple of weeks time, if I have any concerns about how it is healing then I should come back to him and he could open the leg up and make sure all is well. At the very least, he said, he would be able to clear out any debris from around the injury.
So all in all, I came away pretty reassured and glad I sought a second opinion. I wanted to make sure I am following the right path to recovery but now that two specialists, one from the NHS and one private, agree on the course of action I am pretty comfortable in what is taking place. Without this second opinion, there would always have been that nagging doubt.
Anyway, it is also time to say say thanks: to those of you reading this blog and leaving comments - believe me I read them all; to those of you writing up your experiences on this site - I have learnt so much; to my friends and family - for your support and to Laura, her mum dad and sister, for the day to day help which is so necessary in the early stages of recovery.
April 24th, 2009 at 2:31 am
Hi Simon
I had similar fears to you regarding treatment but as i said in my blog i was never offered treatment and when i asked the consultant dismissed it but i am happy with my treatment at the moment.
My next appointment is Monday 4th May and believe i am getting an Aircast with heel wedges but i will wait and see and tell all in my blog.
I notice you had your injury two days after me and you are just along the M8, will be interesting to see how our recovery compares.
April 24th, 2009 at 10:43 pm
Holy $%^#!!
That is the same dilemma I have been experiencing for the past 3 weeks Simon…I too was given two choices by the orthopedic surgeon who then went onto explain that either choices were good. Well, I am a healthy 30 year old male who played Div 2 University Football who regularly exercise 3-4 times a week. So after spending many hours on this site, it occurred to me that the surgery might have been the better choice (although I have to say there’s very little information on conventional approach at achillesblog.com).
Tomorrow I am getting the MRI done and I have scheduled an appointment with a renowned physiotherapist. Do you think it’s too early for me to see the physio at this point? I wear my Bledsoe Achilles Boots like 23 hours a day and I have gained some ROM back with no pain during plantar flexion (limited range during dorsiflexion)
In any case, keep me posted and good luck with your progress as well!
PS. Did either doctors tell you when you will be able to walk without any boots/aircast? My doctor said 3 months!
April 27th, 2009 at 6:47 am
Hi Simon,
Good to hear the second opinion has reassured you and interesting to read about your injury being higher up than would be considered “normal”.
Andrew5600, I think you’ll only get the conservative view from the Doctors. I was told 2 weeks cast/NWB, then 6 weeks aircast boot with wedges FWB and then we’ll see.
At 4 weeks post-op I was doing well with the aircast boot and had done away with the crutches, after seeing a private physio I’m just coming up to 6 weeks post-op and I’ve been back in 2-shoes for almost 2 weeks. In combination with the professional advice I’d listen to your body, it will give you some hints about when you’ll be able to walk without the boot/aircast. I know I’m “pushing it” but at the end of the day the Docs seem to want to follow a “standard” path rather than look at the individual case and will always go risk adverse rather than look at being more about risk management.
Please bear in mind I’m no doctor, so your experience and mileage will vary and will be different from mine, but 3 months sounds like a real long time before you are walking without a boot.
Good luck to both of you with your recovery.
April 27th, 2009 at 3:46 pm
Hi Andrew5600
Thanks for stopping by. I agree that there aren’t so many conservative approach stories on here, I guess a factor in the US tendency to operate v the UK tendency to conservative. What I’ve done is look at the list of people on the site via the list on the Group Marathon Tracker (http://achillesblog.com/atrpt.php) and look out the UK based people and click through to their blogs. I’ve found a few conservative treated folks that way and learnt a lot about the NHS to boot…
I don’t know the answer to how long it will be to walking. I know with surgery it tends to be quicker, although my surgeon would still have me NWB for six weeks even if he had operated (against nearly nine weeks for my conservative treatment). I am happy enough at present though will be wanting some firm evidence that the good healing is continuing when I go back to have the foot moved and the next cast added in a week and a half’s time.
April 28th, 2009 at 2:28 am
Hi Andrew5600
I was given the options of surgery/conservative and was told the pros and cons of each. I think it’s not so much the NHS but the hospital/surgeon that examines you and also on the individual being treated (age/health/location of rupture). I ruptured my achilles playing indoor football (I think the surgeon described it as a standard total rupture). One thing I distinctly remember during examination before surgery was the surgeon asking me if I wanted to go back to playing football or not. My response was YES. I’m not sure if my decision to resume competitive sport after recovery had any influence on my treatment option, but I have come across of few blogs on this site that have suggested or have been recommended the surgical option if they want to resume competitive sport fairly quickly. I’ve also noticed that in the UK the Physios will ask you to complete a form, whereby they ask you what type of activities would you like to get back to after therapy. i made sure that I put down the sports that I used to play before injury instead of just putting down walking, as this way they will manage physio therapy treatment accordingly.
With regards to my post-op protocol - I was placed in three different casts (2 weeks each - a total of 6 weeks) totally NWB. After 6 weeks the surgeon basically discharged me to the Physio team and said I can go from NWB to FWB. Initially my surgeon was going to place in two-shoes with heals, but then he changed his mind and gave me the AirCast. It has been about 4 days since I’ve been able to place weight on my foot and I can now walk in the house with my AirCast (albeit just a few minutes at a time) with one crutch. I do experience calf/foot pain/discomfort as the day progresses - ice sorts this out.
I think recovery from this injury is long regardless of whether you go for surgery or conservative treatment. The hardest thing for me was being NWB for 6 weeks. After this period (it’s only been 4 days PWB/FWB for me) I find that progress seems to speed up.