My ATR experience

Hi all! Glad to have found this blog. It’s really nice to hear about people’s success stories and best practices (so to speak) regarding rehab as I am sure I will need them later on. Anyway, I decided to write about my experience as the approach my doc is using seems to be quite different (I.e. more agressive) than what most people post here.

I ruptured my achilles on March 1, 2015 on a freak indoor wall climbing accident. On March 2, my sports doc recommended I get surgery and from what I’ve read it seemed like the best choice. Got my surgery on march 4 and the next day my doc fitted me into an aircast boot.

However, unlike most ATR repairs, my doc surprisingly had me go on FWB on the cast boot 1 day post op. I never thought this was strange until I read up more on ATR repairs. It seems like most people go FWB only after four weeks post op (at the earliest). This worried me quite a bit but after talking to my doc and seeing the extensive research and experience he has had on ATRs, it did put my mind at ease.

So I am now at approximately 3 weeks post op, dressing for the stitches have been removed and wound is absolutely dry. Started to do isometric exercises for my foot every other day. I still have to wear the cast boot for tge next 3 weeks though, but as noted above I can go on FWB as long as I am in the boot. However, I would like to keep myself as active as possible during this time so maybe you guys have any suggestions as to programs you use to work your upper body (and your good leg) with the boot on. Also, I am trying to think (outside of walking) what other cardio exercise I can do to get my heart rate higher without harming my rehab.

Thanks for reading and good luck to all of us!

12 Responses to “My ATR experience”

  1. You are one lucky guy. I am at 6 weeks and yet to even start PWB. I have an appointment this Wednesday and if my OS doesn’t prescribe PWB, I am going to see another OS ASAP. I ordered a Weider Ultimate body workout machines and have maintained most of my muscularity. Its a good machine for home workouts until I am able to get back into the gym. Good luck and a speedy recovery.

    Isaac

  2. I’m glad you found the blog! Yes, nice to have someone on what may be in the future of protocols…day 1 FWB.

    I’ve read several studies about early weight bearing…I’m also familiar with EBM, and so far I’ve not seen a study that would support this protocol.

    (EBM definition: Evidence-based medicine (EBM) is a form of medicine that aims to optimize decision-making by emphasizing the use of evidence from well designed and conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations.)

    Though promising the studies I read regarding early weight bearing were of the weaker type…in other words they did not meet the criteria for yielding strong recommendations in protocols. However, I’m sure I am not privy to the latest research and it sounds like your doc. is…I’m assuming there is research out there now that does meet the criteria for yielding strong recommendations in protocols.

    Perhaps you could ask for the “extensive” research he cited, I’m quite sure I’m limited in my ability to access all the newest stuff, that would be exciting if we could have more information about it!

  3. Ohhh also…can you tell us how FWB was at day 1…and how is it now at 3 weeks?

    I was FWB week 3 (cast 3 weeks, boot at week 3 and FWB within a day or two) so pretty early….I’m 19 weeks now.

    Also, you said: “, I would like to keep myself as active as possible during this time so maybe you guys have any suggestions as to programs you use to work your upper body (and your good leg) with the boot on. Also, I am trying to think (outside of walking) what other cardio exercise I can do to get my heart rate higher without harming my rehab.”

    Are you doing PT? If not when will you start? They are invaluable for knowing what is best to do when.

    There are lots of YouTubes on upper body work while sitting or without using the lower body. At 3 weeks you can do the indoor bike with your boot. I started the indoor bike without my boot at 6 weeks in sandals….Also for the best cardio I danced with my boot on at 3 weeks and it was a great cardio workout.

    You can use the search box top right on the main page to type in key words for things you want to look up like “cardio exercises”.

  4. Thanks all for the comments.

    Actually, what made my mind at ease when was able to talk to some of his old patients while waiting at his clinic. He particularly had an ATR patient who tore his on the same day kobe bryant tore his. He was running on a treadmill by his 3rd month and when I asked him, we went through the same process (1 day post op FWB). So when I asked my doc he said he’s been doing ATRs this way for a little over 7 years now.

    I am doing PT but what the PT did was to teach me the isometric exercises and asked me to do it every other day. I do have another schedule with the PT on the 28th, so I will have to see what he will teach me next.

    thanks for the cardio tip. I will look that up.

  5. Donna, after 3 weeks being FWB on the boot, I have gotten quite used to moving around with it. The heel soreness still happens though if I walk or stand on my feet too long. Compared to day 1 though, of course the pain from the stitches are gone. Plus it was really disorienting at first, but the longer I was in the boot, the “better” I got walking in them. I think the biggest difference for me in terms of walking in them was when my doc allowed me to wear cocompression socks instead of the elastic bandages. They were less abrasive and really helped with the circulation in my leg.

  6. Thanks for the answer to my questions!

    Yes, once used to the boot you can go really fast…once in two shoes you slow down again…In those early weeks (7-12) I sometimes wore the boot even though I was in two shoes when I didn’t have much time because walking in two shoes was (and still is to some extent) slow.

    They based the newest early weight bearing protocols on studies done on tendon healing. If I understand correctly if the tendon is not under stress or tension the body will lay down fat or weaker collagen in repair, but if under stress (tension) the body will lay down stronger collagen. What is unclear is when it needs that kind of stress and how much, how often that needs to happen…day 1…day 28? Who knows…I’m glad your Doc has had good results and I most certainly wish that for you!

    I’m excited for you and wish you all the best. Keep us posted!

  7. Donna, yes my doc mentioned that. Apparently, he believes that tension should be there once tendon is surgically seen together. This he believes speeds up the healing process.

    That is quite interesting what you mentioned about being in two shoes again. See my boot cast is due to come off on the 15th of april. Thing is I have a wedding to go to on the 18th (I am part of the entourage) and I need to take a trip on the 30th. You think it would be prudent to hold off?

  8. I know some people just ditch the boot and never wear it again but for me it was a transition. It can come early or later…it seems to happen on this site from the data collected on average by week 9. I’ve seen two shoes as early as week 5 and as late as week 12…for me it was around 6 weeks that I first started indoors and between week 7 and 8 that I took it off at PT and by the end of week 8 went outside in two shoes. I was in and out of the boot as needed until around week 13/14. Never wore it in the house after week 8 but still did outside - some of that was because of weather (ice/snow).

    (As needed meant any ‘risky’ situations like a busy store or if it was icy/snowy. As needed meant when I was in pain/swollen and needed to “rest” the tendon or even just needed to be on my feet for a long period of time and knew it would get sore. As needed meant when I needed to walk fast like to run a bunch of errands, going in and out of places.)

    So I’d say use the boot as long as you need to. You can go in and out…it doesn’t have to be one or the other.

  9. Hi Timothysy, How are you? Hope all well…:) Are you on FWB all the time now ? Or you still using chruches? I wanna be a little more aggressive with my WB in week 3 but im not so sure yet..got my Walker boot after 2weeks post op, Im 17days post op and pretty happy when doing eversion and inversion..

  10. @glenskieus as with what most people here have said, each OS is different and may use diff protocols. But my OS has never allowed me to use crutches or a cane since day 1. His belief is that the more I use a crutch, it makes me trust my repaired achilles less which would lengthen the rehab process. So after 5 weeks I have gotten quite used to walking in my boot.

    There are also a lot of studies put there that early WB is good for achilles repair and lessens elongation. Ultimately, I think being aggressive depends on you. I always use pain as my barometer. If ever I feel pain, I stop and rest or avoid doing whatever activity it is that causes pain. Talking to your OS is of course always a big help.

    Best of luck!

  11. Hi,
    I had non surgical repair. 3 weeks in non weight bearing cast now in second week of boot 75% weight bearing. I feel PT is useless. I do it at home but am really worried the tendon is really tight…also, hard to sleep with the boot. Anyone use anything else at night besides boot?

  12. Hi Betty at 5 weeks what PT are you doing at home? and how do you know PT is useless? The tendon can be tight, mine felt like I had a really tight sock on around my ankle, at 5 weeks I’ d avoid stretching it, however, over time I believe a good/gentle stretching program can gain you back flexibility, thus alleviating the tightness. I never slept in the boot. I got my boot at 3 weeks. Protocols regarding Boot sleeping varies widely doctor to doctor. I used an ace bandage to sleep in. There are a variety of braces you can get that would be more comfortable to sleep in than the boot….you can google search to find them.

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