Author’s Introductory Note: I am not a licensed medical professional, I am simply recounting an event that happened to me, research I have done on the subject and how it made me think differently about my own preparations. I hope you find this article interesting and informative, but please also do your own research.
Recently, I experienced my own personal Schumeresque event. I was competing in a sport I have done all my life when I felt something snap in the back of my heel. It happened as I took a hard step and I immediately knew something was wrong. I sat down and felt the back of my heel and knew I had ruptured my Achilles tendon. The event had an athletic trainer who came over to take a look but she quickly agreed with my assessment. She gave me some ice and helped me out of the building to the street while my wife went to pull up the car for the drive to urgent care where the Doctor confirmed my diagnosis.
The urgent care physician sent me home in a walking boot with instructions to call for an appointment with a surgeon the next day (this happened on the weekend). I was able to see the surgeon on Tuesday and he explained that while there are some non-surgical options, since I am very active and in good health, surgery would be the best option with the best chance of full recovery. They scheduled me for surgery on Friday. Until then, I needed to remain in the walking boot (including while sleeping) to protect my leg from further injury.
The surgery was performed on Friday. I met with the surgeon, the anesthetist, and a prep nurse before being taken into surgery. The anesthetist put a mask on my face and told me to start counting- the next thing I knew I was sitting up in bed in the recovery area and a nurse was helping me dress. I was sent home once I was sufficiently awake to move. They had given me a nerve blocker, which made my leg completely numb from the knee down. This was a very odd sensation and was actually the worst part of the whole experience. It took over 24 hours for my lower leg to ‘wake up’. This was really uncomfortable.
My leg was in a cast from just below the knee to mid-foot and this kept my toes pointed downward. (Plantar Flexion is the medical term). This was to reduce the strain on the newly repaired tendon. This cast remained on for two weeks. I was able to shower with difficulty using a special bag to cover the cast and a shower chair to help me balance. Fortunately, my job can be performed from home so I was able to keep working and only went into the office once during the 2 weeks I was in the cast.
During this time, I had a knee scooter to move around the first floor of my house. This is a 4 wheel scooter with a flat bench and handlebars with brakes. You use it by standing on your good foot, and placing the knee of your injured foot on the bench. This allowed me to scooter around the main floor of my house pretty easily. I also had a pair of crutches that I left at the top of the stairs for moving around on our second floor where my bedroom and office are located. I moved up and down the stairs by holding the railings on either side and hopping up or down on my good leg.
The few times that I went out (basically just to go to work and to church) I used the crutches to get to the car and then used the scooter to move around at my destination. After two weeks I became quite good at getting around.
Later, I went back to the Doctor’s office where they removed the cast and helped me back into the walking boot. This time I had to put 2 heel lifts (about ¾” each) into the boot to keep my heel slightly elevated above my toes (Plantar Flexion) to reduce the strain on the tendon. I had to get a strap-on sole for my other shoe (called an “Even Up”) to add an inch to my uninjured leg so that both my feet were at the same level.
I wore the boot for six weeks and then transitioned into shoes with heel lifts which I had to wear for another six weeks.
As soon as I got out of the cast and into the boot, I also started physical therapy (PT). For the first few weeks, this was primarily just flexing my calf inside the boot or taking the boot off and using an elastic band around my toes to do some light toe flexes (pushing down or side to side with my toes against the elastic resistance).
Once out of the boot, the intensity of the exercises increased. One thing that surprised me was just how much strength I had lost in my calf. I couldn’t even lift my heel off the ground up on my toes when standing on my injured foot even though this had been easy, prior to my injury. The first few weeks focused on simple heel raises- rising up to my toes using both feet 10-15 times (while leaning on the counter for support) and repeating for 3-4 sets. I also continued using the elastic band.
After about 10 weeks post-surgery, I moved to more intense exercises including lunges, wall squats, seated calf raises with a 10-pound kettle ball on my knee and balance exercises standing on my weak foot while transferring the kettle ball from one hand to the other. The goal is to activate the calf muscle frequently and rebuild the strength and balance in the lower leg. My strength is improving each week but I still have a way to go to get back to full strength and (hopefully) begin competing again.
What If?
All of this got me thinking about what I would have done if this had happened in a grid-down world. That led me to think about the many types of injuries that are more serious than the minor scrapes and burns that we prepare for but are not really life-threatening like a heart attack, stroke, chainsaw accident, or gunshot wound. There are basic emergencies we can and do prepare for with first aid, and injuries that are really beyond the ability of most preppers. That is, unless they have a surgeon and fully-stocked ER among their preps but what about the stuff in between that? Even with no treatment, I would almost certainly have survived this injury but may have had a permanent limp and been unable to run or do much heavy physical activity (which could end up being fatal in a post-SHTF world).
I remembered the surgeon mentioning nonsurgical options. I also ran into a friend of mine while out in the community wearing my walking boot and he mentioned that he had torn his Achilles tendon and was treated without surgery with good results so I began looking into this option to see just what would be required to deal with this and other similar injuries.
The Achilles tendon is the largest and thickest tendon in the body. (See the illustration at the top of this article, courtesy of Bruce Blaus, via Wikimedia Commons.) It attaches to the back of the heel and runs up the lower leg where it attaches to the calf muscle. When you push off with your toes, you are contracting the calf muscle which pulls on the Achilles. When you pull your toes toward your knee you are stretching your calf muscle and Achilles tendon.
The basic goal of a nonsurgical repair is to keep the foot relaxed in a toes pointed down position to reduce the strain on the tendon and calf muscle. Leaving the foot in this position will often (though not always) allow the two ends of the tendon to grow back together.
As the tendon heals, you can gradually increase activity and mobility. Below is a summary of the phases of Achilles repair. This is specific to an Achilles tendon rupture but similar steps can be taken with severe sprains, fractures and other lower extremity injuries. Timing is approximate and will vary by the patient. Age, weight, health and general fitness will all play a role in the speed and success of the recovery.
Immobilization (weeks 0-2)
It is important that the foot be kept very immobile during this time to allow healing and avoid retearing. This can be accomplished using a solid splint and wrapping material to fully immobilize the foot, ankle and lower leg. The leg should be set with the toes pointed down to reduce the strain on the tendon while it heals. During this time, there can be no weight bearing on the injured leg. Moving around is limited and is done with crutches or a scooter. When resting, elevating and icing the injured limb can help reduce swelling. The splint should be left on for the entire 2 week period.
Limited Mobility, basic walking (weeks 2-6)
After 2-3 weeks in the splint, you can transition to a walking boot with heel lifts. Place lifts (or something flat and solid) under the heel to raise it up an inch to an inch and a half. This takes pressure off the tendon and limits stretching to help it heal. This should be worn 24 hours a day for 6-10 weeks. During this time, there should be very little physical activity with that foot. Weight bearing should be gradually increased but full weight bearing should not occur for 6 weeks or more. Unfortunately, this will dramatically weaken the calf muscle and will require significant time and effort to recover.
During this time, you can begin basic movement with seated heel raises, basic ankle mobility and strength exercises for the upper legs and hips. You need to start slow. Start by just moving the toes around without any weight or resistance. Try pointing them one direction and then another. You could start by shifting them left and right for a set of 10 and then up and down for a set of 10. You can also flex your calf in the boot by pushing down with your toes and pushing up against the back of the boot. Do a few of these each day.
Transition from lifts, increased mobility (weeks 6-10)
During weeks 6-10, remove first one, and then the second heel lift while wearing the boot. Each time you do, you may notice some strain in the tendon as it is stretched a little further. At this point you should be waking comfortably in the boot and should increase the level of exercise to regain your strength. You can start some basic calf raises without the boot. Just sitting in a chair and lifting up on your toes will be difficult at first. You can also use an elastic band looped around your toes and held in your hand to push against some resistance. Be careful not to bend your foot past 90 degrees as this puts too much strain on the tendon. You want to avoid overstretching the tendon for at least 6 months post injury.
Transition to shoes and physical training (week 10-16+)
After 10-12 weeks, you can transition to a comfortable and supportive shoe (a running shoe works well) and should start with 1 heel lift. You will likely find that walking is difficult, and your gait is off as your injured foot doesn’t have the calf strength to finish the step. During this time, you may want to transition slowly to the shoe, using the shoe until you feel fatigued and then moving back to the walking boot, seeking to increase the time in the shoe each day. Let your body guide you. Be particularly careful if walking on uneven ground as this is the period of greatest risk of reinjuring the tendon.
At this point, you will increase your physical therapy. As you get some mobility, you can add resistance with elastic bands or weights. As your strength returns, you can add more intense activity. Riding a stationary bicycle is a good way to engage your calf and get a little cardio as well. Seated calf raises with weight on your knee, standing calf raises on both feet, lunges, and other activities that put weight on your weak leg and will help you to slowly build up strength. Be patient, this is a long process. Prior to my surgery, the surgeon told me it could take from 6 months to a year until I was back to full strength, and that I may not ever be quite where I was before the injury, but I am confident that I will continue to improve.
Final Thoughts
This incident taught me that there are some injuries that, while serious, can be prepared for. A good walking boot can be found for less than $50. Crutches can had new for $40 and can often be found used for much less. I bought a used knee scooter for $25 and have seen them new for around $150. Exercise bands can be found at many sporting goods stores and have many other uses. Other items you may want to have on hand are a wheelchair and a shower chair. This equipment can be used to treat many lower leg injuries beyond an Achilles tear, including broken or sprained feet, ankles, tendon strains etc. – all injuries that will be more common in a post-SHTF world. Though an Achilles tendon rupture would be a serious and possibly life altering injury without modern medical care, a few basic supplies and the knowledge to use them could make the difference between being permanently crippled and making a significant recovery.
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