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Achilles Tendon Rupture

Scott Gregor · · Unknown Hometown · Joined Feb 2017 · Points: 0
Samantha Kaney wrote:   It is hard to hear that you are never truly 100% again, but I guess that is to be expected with the nature of the injury related to climbing.

I'm not ready to believe this yet. Some people on letsrun.com say their repaired achilles is now stronger than the other one after all of the PT.

Wesley Neill · · Sequoia National Park, CA · Joined Nov 2016 · Points: 578
Scott Gregor wrote:

I'm not ready to believe this yet. Some people on letsrun.com say their repaired achilles is now stronger than the other one after all of the PT.

Agreed. I am going into this fully expecting to be as good or better than I was before the injury. I think the only way for that to be possible is with good attitude and a willingness to push myself during rehab. I do everything the PT tells me PLUS A LOT. The doc says walk no more than 20 minutes at a time, then I do 30. The PT says "do these exercises", then I do them twice as long as he recommends. 

However, I also listen to my body. If things dont feel right, I cut it out immediately. I'm 34, so not that old and can get away with pushing a little. But, I'm also not that young and wont recover as quickly as a 20 year old. It's all a balance, but neither my PT nor my surgeon realize that. They treat 20 year olds the same way they treat 60 year olds. I've had to take my treatment into my own hands. 
Samantha Kaney · · Phoenix, AZ · Joined Feb 2018 · Points: 0
Wesley Neill wrote: However, I also listen to my body. If things dont feel right, I cut it out immediately. 

This is kind of what I've heard. Push it, but listen to your body, keep the pain below a 3, and do a little a lot. I have an awesome PT lined up who works with mostly athletes that has had a really good success with achilles ruptures post surgery, so hopefully I don't get treated like a 60 year old. Re-rupture is my biggest fear. 

Experience with getting back into climbing shoes?? I have seen only a couple comments on here about not being able to get into a climbing shoe for a very long time. I'm predominately a boulderer, so I have pretty aggressive tight shoes. I'm guessing I won't be able to get into them on my bad ankle for awhile, if ever?  
Scott Gregor · · Unknown Hometown · Joined Feb 2017 · Points: 0
Samantha Kaney wrote:

This is kind of what I've heard. Push it, but listen to your body, keep the pain below a 3, and do a little a lot. I have an awesome PT lined up who works with mostly athletes that has had a really good success with achilles ruptures post surgery, so hopefully I don't get treated like a 60 year old. Re-rupture is my biggest fear. 

Experience with getting back into climbing shoes?? I have seen only a couple comments on here about not being able to get into a climbing shoe for a very long time. I'm predominately a boulderer, so I have pretty aggressive tight shoes. I'm guessing I won't be able to get into them on my bad ankle for awhile, if ever?  

i was allowed to climb (statically weight my bad foot, not push off it to make a dynamic move) about 3 months post surgery. My skawmas were too tight to wear at first so I wore my comfy TC pros. after a couple of weeks in the TC pros, im back to wearing my tighter, aggressive shoes.

Dan Daugherty · · Virginia Beach, VA · Joined Aug 2018 · Points: 5
Wesley Neill wrote:

Agreed. I am going into this fully expecting to be as good or better than I was before the injury. I think the only way for that to be possible is with good attitude and a willingness to push myself during rehab. I do everything the PT tells me PLUS A LOT. The doc says walk no more than 20 minutes at a time, then I do 30. The PT says "do these exercises", then I do them twice as long as he recommends. 

However, I also listen to my body. If things dont feel right, I cut it out immediately. I'm 34, so not that old and can get away with pushing a little. But, I'm also not that young and wont recover as quickly as a 20 year old. It's all a balance, but neither my PT nor my surgeon realize that. They treat 20 year olds the same way they treat 60 year olds. I've had to take my treatment into my own hands. 

If your PT is treating 20 year olds the same as 60 year olds, you need to look for a new PT. My mom worked as a PT in the elementary school system and had a side hustle in a clinic working with adults. Her plans with the kids were vastly different from the plans for adults and within those adults, if you had different fitness levels coming in, your plan was adjusted accordingly. I've had the same experience when I've needed PT myself with other PT's.

Dan Daugherty · · Virginia Beach, VA · Joined Aug 2018 · Points: 5
Scott Gregor wrote:

I'm not ready to believe this yet. Some people on letsrun.com say their repaired achilles is now stronger than the other one after all of the PT.

Do they have any actual evidence to support this? I have a friend doing a thesis right now on repairing Achilles ruptures in such a way to make this a possibility because testing shows that the Achilles, at the point of repair, is weaker than a non repaired one.
The folks claiming a stronger repair are likely relating the stronger muscles around the Achilles due to focused strengthening (PT) of those systems around the Achilles that isn't done on the other, non injured, side.

Scott Gregor · · Unknown Hometown · Joined Feb 2017 · Points: 0
Dan Daugherty wrote:

Do they have any actual evidence to support this? I have a friend doing a thesis right now on repairing Achilles ruptures in such a way to make this a possibility because testing shows that the Achilles, at the point of repair, is weaker than a non repaired one.
The folks claiming a stronger repair are likely relating the stronger muscles around the Achilles due to focused strengthening (PT) of those systems around the Achilles that isn't done on the other, non injured, side.

I haven't seen any actual scientific data, just simply people saying how they feel. Your reasoning of strengthening the surrounding areas makes sense.

Samantha Kaney · · Phoenix, AZ · Joined Feb 2018 · Points: 0
Dan Daugherty wrote:

I have a friend doing a thesis right now on repairing Achilles ruptures in such a way to make this a possibility because testing shows that the Achilles, at the point of repair, is weaker than a non repaired one.

So the thesis is saying that there is evidence that non-surgical intervention in an achilles rupture is better than a surgical repair? That would be really interesting to find out. All the research that I have done, and talking with my surgeon, says that the outcomes of the surgical or non-surgical options are the same long term for an achilles rupture, but that for the younger and/or active population, surgical repair is almost always recommended. I'd be very interested in reading your friend's thesis when it is completed.
Wesley Neill · · Sequoia National Park, CA · Joined Nov 2016 · Points: 578

Samantha, I dont know about shoes. Seems like most people experience over tight shoes on the off foot. I expect the same.

 I'm climbing in my surgical boot still. Last night I lead 11a and 11b in the gym (probably 10a, 10b realistically) with it, but in two weeks or so I intend to start top roping with two climbing shoes. In a month I have a JTree trip lined up to try some easy trad. I'll let you know how real shoes go.

Dan Daugherty · · Virginia Beach, VA · Joined Aug 2018 · Points: 5
Samantha Kaney wrote: So the thesis is saying that there is evidence that non-surgical intervention in an achilles rupture is better than a surgical repair? That would be really interesting to find out. All the research that I have done, and talking with my surgeon, says that the outcomes of the surgical or non-surgical options are the same long term for an achilles rupture, but that for the younger and/or active population, surgical repair is almost always recommended. I'd be very interested in reading your friend's thesis when it is completed.

No, the thesis is about finding a way to repair the Achilles rupture (think STEM cells or the like) so that the repair is at least as strong or stronger than an uninjured tendon. 

Wesley Neill · · Sequoia National Park, CA · Joined Nov 2016 · Points: 578
Dan Daugherty wrote:

No, the thesis is about finding a way to repair the Achilles rupture (think STEM cells or the like) so that the repair is at least as strong or stronger than an uninjured tendon. 

I just read a study on this topic. The bit about stem cell therapy, among other non-traditional treatments is way down at the bottom, but before the summary section :

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178860/#!po=25.0000

Sadly, science does not agree with me that I can be better than ever after surgery. Studies across the board show that very few patients recover fully, even after several years. 
Ero Sennin · · Pyles Peak, CA · Joined Jul 2018 · Points: 185
Scott Gregor wrote: 

I'm not ready to believe this yet. Some people on letsrun.com say their repaired achilles is now stronger than the other one after all of the PT.


I think this has more to do with a the runner/climber/whatever being afraid of more injuries, and more cognizant of training properly.  The person is diligently and correctly strengthening muscles, and doing stretches that they might have not done previously.  I have not seen any scientific paper or study that says a person's tendon is stronger after an injury, always weaker.  Look at any of the pro athletes who've had torn ATs and the history behind their subsequent performance. They have much better resources than we do.  I'm not saying you can't still climb hard, or run fast.  You might be better than before, but that has to do with better training, technique, and conditioning, not that your tendon is stronger.  I have a friend with three shoulder, and two knee surgeries and he's still doing 12s, but he's OCD about his training, and he trains properly.

Samantha Kaney wrote:
Experience with getting back into climbing shoes?? I have seen only a couple comments on here about not being able to get into a climbing shoe for a very long time. I'm predominately a boulderer, so I have pretty aggressive tight shoes. I'm guessing I won't be able to get into them on my bad ankle for awhile, if ever?  

I'm about 8 months post-op and still have trouble fitting into TC Pros.  When I try on my old size, it's too tight and uncomfortable.  If I move up, there's too much slop on the good foot.  I'm wearing a cheap Five Ten model that doesn't have an aggressive heel.  Quality isn't the best but I can wear them all day without issues.  I wouldn't be too concerned though, as I seem to be the outlier here.  Everyone else seems to be able to fit into their old climbing shoes within 3-6 months.  I've had two therapists say they've never seen any other patient in decades who's AT has scarred and thickened as much as mine.  It's not necessarily a bad thing as I don't feel any abnormal pain from regular activity, it just makes fitting shoes a PITA.  They were concerned with tendinosis, but now think it's just the way my body reacts.  

Samantha Kaney wrote:
So the thesis is saying that there is evidence that non-surgical intervention in an achilles rupture is better than a surgical repair? That would be really interesting to find out. All the research that I have done, and talking with my surgeon, says that the outcomes of the surgical or non-surgical options are the same long term for an achilles rupture, but that for the younger and/or active population, surgical repair is almost always recommended. I'd be very interested in reading your friend's thesis when it is completed. 
 
I spoke with three doctors about this.  All say that surgery is superior if the patient is active.  The total healing time may be the same for both methods, but I was told that allowing the ends of the tendon to reattach naturally will never result in the original/desired tension.  A person will feel no difference walking, think that 60 year old office worker who doesn't live an active lifestyle.  I was told the trick is to sew the ends back at the correct tension, not too much, not too little.  Without the proper tension, you won't have the power for that push off for running, jumping, etc.  But, that's just what I was told and I have no medical background whatsoever.
Samantha Kaney · · Phoenix, AZ · Joined Feb 2018 · Points: 0
Scott Gregor wrote:
7/24: size of heel wedge reduced, but still non-zero. i'm hating this boot. its painful to walk in and i have a burning sensation on the bottom of my foot. the pain makes it hard to sleep at night. i bought a 2nd liner since i work out in my boot a lot.

Scott, I transitioned to a boot (with ~1" lift) from my cast a couple days ago, and I'm having this same pain on the bottom of my foot and around the back of the lowest part of my heel bone. I'm not really weight bearing yet (working on it), but it seems to be worse when I am laying down or have my leg elevated. Did you experience this too? The pain also makes it hard to sleep at night. I seems like it may be the pressure from the boot, as when I relieve the straps completely or take my foot out of the boot for a couple seconds, the burning sensation goes away. Did the extra liner help with this for you?


Scott Gregor · · Unknown Hometown · Joined Feb 2017 · Points: 0
Samantha Kaney wrote:

Scott, I transitioned to a boot (with ~1" lift) from my cast a couple days ago, and I'm having this same pain on the bottom of my foot and around the back of the lowest part of my heel bone. I'm not really weight bearing yet (working on it), but it seems to be worse when I am laying down or have my leg elevated. Did you experience this too? The pain also makes it hard to sleep at night. I seems like it may be the pressure from the boot, as when I relieve the straps completely or take my foot out of the boot for a couple seconds, the burning sensation goes away. Did the extra liner help with this for you?


i didnt have the pain at the back of the of the lowest part of the heel bone. the burning sensation on the bottom of my foot got better every time the lift height was reduced. the extra liner helped me since i would get sweaty in it and wear it for days before washing it, maybe some sort of bacteria/fungus building up in there. aircast liners are only $17 on amazon, worth a shot. taking off the boot did help me too. i didn't sleep in the boot at night. teylenol helped a little at fisrt, ibuprofen helped more (checked with my doc if it was ok to take NSAIDS yet). 

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