Injury Photos

1) April 29, 2010 – Morning after the rupture.  Home from the ER in a splint, ankle swollen, achilles tendon ruptured

April 28, 2010 - Home from the ER in a splint

2) April 30, 2010 – At the Hospital for Special Surgery, reassured by pro jerseys (patients)

3) April 30th, 2010 – Wearing the futuristic moon boot up until the day of surgery, after surgery its back into a splint for 2 weeks

Non Weight Bearing Orthopedic Boot

4) May 3, 2010 – Day of Surgery, what I look like coming out of anesthesia

Waking up after surgery

5) Week 1 (post-surgery) – The nerve block from the knee down wears off, 3 days of extreme pain ensue, followed by intense pain for another 2 days.  I’m told to take one blood thinner injection in the stomach every night to help prevent blood clots.

Blood thinner injections

6) Week 1  – I take a combination of percaset and vicodin to ease the pain the entire week.  Percaset is the only thing that helped.

Some relief from post-op pain

7) Week 3A – The post-operative splint comes off at the beginning of Week 3, and I see my leg for the first time in two weeks.  You can see how the muscle has atrophied since surgery.

Week 3B – The blue markings are lines that were drawn by the surgeon perpendicular to the incision. Some swelling is present around the ankle, typical for 2 weeks post-surgery.  I’m told to start taking aspirin in place of the injections to help prevent blood clots and stimulate blood flow to the achilles tendon area.

Week 3C – At home before formal PT begins – Ankle Pump, Inversion/Ever, Circumduction

Repeat 20 times per set, 4-5 session per day

Repeat 20 times per set, 1 set per session, 4-5 sessision per day

Circle foot clock and countclockwise 10 times, 4-5 times per day

7 Responses to Injury Photos

  1. Andrew, you seem even keener than average to return to high-level and high-risk sports (though most of us are keen!), and your decision to opt for surgery seems to have been motivated by that desire, and by the belief that surgery is more likely to get you there more surely and more quickly than non-surgical immobilization.

    First: I present links and discussion on my blog of the 4 modern (2007-2010) randomized studies that seem to disprove that belief, at least when all patients — post-op and non-op — were subjected to exactly the same rehabilitation protocol. The patients that skipped the surgery did, statistically, just as well (in strength, Range of Motion, and re-rupture rate) as the ones that had the surgery! (Apart from surgical complications, there was only ONE measurement in ALL FOUR studies that was statistically different between the two groups — and in that one measurement the non-surgical patients had MORE strength!!)

    Secondly: Your own rehab seems to be going much more slowly than the protocols in these modern studies — even for those of us who skipped the surgery and just got slapped into a boot! 4 weeks in a splint, not seeing your foot? I was getting PT just after 2 weeks, though admittedly it was very gentle PT.

    Have your Docs given you a written protocol that lays out a clear road-map of where you’ll be at 6 weeks, and 8, 10, 12, etc.? Many of us who DON’T get written protocols (like me 8-ish years ago when I tore my first AT and had it operated on — because back in 2001 “everybody knew” that what you were told about surgery was true!!) have felt like Yo-Yos, not knowing what we’d have done to us in the brief and infrequent sessions we had with our surgeons. A written protocol is a bit like a contract between you and your Doc, that indicates what you can expect. (I’ve posted the one I got and followed this time, on my blog. It’s the one that was used in the most recent study, done on about 150 randomized patients, at Univ. of Western Ontario. I’ll give you the link if you have trouble finding it.)

    If you’ve gotten one, please share so we can see if there’s a plan for you to “catch up” to these faster protocols that have been shown to produce excellent results, or not. If you haven’t, I recommend asking for one, both for the physical benefits and the psychological and “empowerment” benefits.

    Good luck, and good healing!

    • @ Norm – I think my original timeline may have been misleading. My surgery was May 3, 2010 and I was immediately placed in a splint for two weeks. Thus, my PT didn’t begin until May 19th, 16 days post-surgery, and at the beginning of what I am calling “Week 4″, or the number of weeks from the day of the injury, not the day of the surgery (I am going to edit the timeline so that it reflects time from the day of surgery). I do have a protocol from my doctor and physical therapist that I will be posting soon. I will also be posting videos with exercises that have been working – in just two weeks of PT my range of motion is getting much better. Today was a major breakthrough as I began PWB at 30% in the boot. Feels awesome to get weight back on that side. My therapist says I am right on track!

      Week 1 – April 28 (Day of Injury) – May 3 (Day of Surgery)
      Week 2 – May 5 – May 11
      Week 3 – May 12 – May 18
      Week 4- May 19 – May 25
      Week 5 – May 26 – June 1
      Week 6 – June 1 – June 7

  2. That sounds MUCH better! In addition to counting from surgery (or from immobilization, for those of us who skipped the surgery), it’s customary to round DOWN but not up — i.e., anything that happens in the 3rd week post-op is something that was triggered by your reaching the “two weeks” milestone, so we usually call it a 2-week event, not a 3-week event. With both of those translations, the beginning of your protocol sounds closer to the protocols that were tested in the studies and produced great results.
    But still just close, not really the same:
    You’re past 4 weeks now and just starting PWB — which I agree is a great step physically and psychologically/emotionally. (FWB is even bigger, because you get to carry stuff around like a normal person!) The UWO protocol I followed got me to PWB starting at TWO weeks, and to “WBAT” (WB “As Tolerated”) at 4 weeks, which for you was this past Monday, May 31.

    In my case (without surgery), it took a few days to go from crutches to a cane, and then to forgetting where I’d left the cane, i.e., FWB. It doesn’t sound like you’re going to catch up with me there, even with sutures holding the ends of your tendon together.

    I look forward to seeing your protocol, and you should be able to find mine (from the UWO study) at http://www.achillesblog.com/normofthenorth .

    Several people at achillesblog, post-op, have been much more aggressive than that protocol, some of them with excellent results. (“doug53″ comes to mind.) A few others had bad results, but these don’t come with labels that identify their cause, so it’s all just anecdotes. But the protocol I followed had more than anecdotal evidence, because it produced excellent results in both 70-odd post-op ATR patients AND another 70-odd NON-op ATR patients. I don’t think there’s any science to show that going any slower has any clinical benefits, and it definitely has non-clinical DISbenefits, including physical ones like the risk of falling down on crutches.

  3. Rick says:

    nice boot :) , im on my second week Post Op will wear my boot tom, my doc placed me on half cast after Op then will wear boot although im not sure if NWB or PWB after tom , im surprised at how my doctor is making this so fast i read from other blogs that they had their ankle pos Op in a cast for around 1 month or more , damn my doc said my tendons were liek spaghetti they way it ruptured :P

  4. Dan Harrison says:

    Did Dr. Elliott perform your surgery? I have the same rehab protocol, same boot, and one of your pictures looks like his office. I also had my surgery at HSS. I ruptured 90% on 9/20, surgery on 10/1, reruptured 9/22 (fell in the middle of the night without the boot on – I’m an idiot for that), had surgery again on 10/26, and started PT 11/15. How is it this many months out for you? Do you walk with a limp? Any tips or suggestions? Thanks! – Dan

    • Hi Dan – sorry took so long for me to respond. You won’t believe this but I was complaining about my achilles in October when I last went to see Dr. Elliott and tells me the story of a kid (obviously didn’t mention a name) who reruptured. I couldn’t believe what I was hearing. Much respect for having going through the surgery again and sticking with the protocol. I’m now 10 months out and feeling great. I’m close to running at full speed, my work-outs are longer and my wind is better. I’m confident by month 12 I will be back to my usual workout (1 hour, mix of running, bike and lifting).

  5. Dan Harrison says:

    Yup, that was me. I also developed what he called “spitting sutures” in December. Basically my body rejected the stitches in my tendon and started pushing them out through the scar. It was…gross. He pulled me out of PT for a month & put me on a major antibiotic for 10 days. Actually, I’ve had a great attitude about the whole thing because it pretty much couldn’t have been worse. Rupture, surgery, rupture, surgery, in PT, infection, out of PT etc. SHIT STORM! But I tend to roll with things so I guess it depends on your perspective. Anyways, I just had my 6 month visit with Elliott and I am A ok! Started jogging and moving with no limp or pain. He thinks I’ll be 100% by October. I’m a happy camper now that I can walk/run. Glad you are doing well too!

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