Debridement and PRP Report – Achilles Tendon

Here is a post-surgery report in my first follow-up visit. 10 days post operatively I had my follow-up appointment.

Pain vs. Discomfort

The first 2 days went by quite well with minimal discomfort thanks to the nerve block. It wasn’t until the end of the third day post-op that I had to take a dose of pain medication (Percocet). On two more occasions during the 10-day period I had to take some. It wasn’t so much trying to be a hero or a great aversion to medications. (I do believe that modern medicine exists for a reason and I won’t suffer if I don’t have to.) But, on a scale of 0-10 (0= no pain; 10= excruciating) the discomfort ranged from a high of 7-8 when I had my foot down for long periods of time to a low of 2 when my foot was put up and rested for 15 minutes or so. The swelling and pressure from dependent edema was tough. I got the message fast… keep it up!

More on the Procedure

I arrived at the outpatient surgical center a bit before the 0600 report time (my brother Jim at hand for the ride home). I was off to surgery at 0730. After an IV was put in and I was rolled into the operating room; I rolled onto my stomach on the gurney. The next thing I remember I woke up around 0900.

Oh ya, here is what happened in my hour and half of mental awareness diversion. After an initial incision (8 inches approximately in the lower third of my lower leg) they then opened the tendon sheath to reveal the tendon itself.

After initial inspection, the doc was convinced that a tendon relocation was not indicated and in fact only the debridement and PRP was needed (woohooo!!!!).

For those who aren’t aware debridement is a method of causing repair to tissue and in a way cleaning it up. The do this through microthermal debridement. They make small electric burns in rows up and down the tendon. The burns are spaced a little over a centimeter apart. All sides of the tendon are treated. The device allows for about a centimeter or so deep burn. I’m not sure but I would estimate at least 30-40 burn marks were performed on mine.

Once completed he then sewed up the sheath and skin. It was only 9 stitches. However, they then used Durabond a sterile, liquid, skin adhesive that holds wound edges together eliminating the need for sutures – usually. In my case it was in addition to sutures. Why? It was so that when they injected the plasma nothing would leak out.

They then injected the plasma.

PRP – Plasma Rich Protein is what is called “autologous” or that it originates from yourself not from someone else. It is injected into areas to stimulate your body’s natural healing processes.

PRP is not a single procedure nor is it standardized. They take your own blood and spin it down to reveal the plasma. However, depending on the procedure they are doing depends on how the spin it down. They can do a light spin and get a liquid for larger areas to bathe. The can perform a bit longer spin to get a jelly like substance (or “snot like” as my doc says) for more localized treatments. And finally they can spin it to get “bands” of material. This is used for something like taking it and wrapping a repaired ruptured tendon.

I was given the first option since they wanted to bathe my entire tendon and all the debridement locations. That is why they used the Durabond so as not to let all the plasma to leak out between the sutures. Interesting eh?

Oh and in case you are wondering since this procedure is so new and standards aren’t set it is seldom covered by any insurance. Despite having the rest of the procedure done the PRP portion will be billed – out of pocket expense.

The Follow-Up Appointment

Now, I did do one thing not advised by the doctor during those 10 days. I did remove the wraps and bandages. They began to stink. My nursing instincts took over… smelly bandages is not good. So I changed them 4 times that week.

When I arrived and was in the exam room and before the doc arrived; I quickly removed my boot and wrappings so he wouldn’t know I changed them. I succeeded.

The stitches were removed without incident. I was given a very good report. Healing is progressing normally.

14 days post-op

14 days post-op

Next

Total boot time is about 6 weeks. The key is to restrict flexion of the ankle and extension of the calf-tendon. We have to allow the tendon to heal. Stretching it would break up the healing taking place.  In the past they advocated as much as 3 months in the boot. The reason for the dramatic decrease in time is to decrease atrophy in the calf and still attain most of the strength gain in tendon has already been accomplished.

There you have it a first person account of debridement and PRP. If you have any questions I will be happy to respond.

Late Post Script: I never was billed for the PRP since it was included in the surgery. All other PRP stand-alone procedures are not covered by insurance as reported to me by others. 

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About Dean Hebert

I’m a mental game coach, author and speaker. I work with individual athletes, parents, coaches, and teams on sports performance enhancement. Beyond my academic post-graduate work in sports psychology - the psychology behind athlete performance – I am a certified Mental Games Coaching Professional (MGCP) and certified hypnotherapist. I’ve authored several books and hundreds of articles. “Coach, I didn’t run because…” (2008) is a seriously light-hearted look at making excuses not to workout and how to overcome them. “Focus for Fitness” (2009) and “Screw the Goals Give me the Donut” (2010) are two of my eBooks on mental game approaches for the everyday athlete. I wrote these because I believe that everyone can benefit from the powerful mental techniques that the world’s best athletes use. I have been cited in Runners World, Best Health magazine (CN), SWEAT Magazine, and the Washington Examiner amongst many other publications. I have been a featured mental games coach in Runner’s World and for the internationally acclaimed trail running resource - trailrunningclub.com. I also regularly appear on sports and fitness talk shows such as LTKFitness, Runnersroundtable and for more than three years I have co-hosted a weekly video series with Coach Joe English for Running-Advice.com. I specialize in mental toughness training. My clients include tennis, synchronized swimming, golf, race-kart, soccer, motocross, volleyball, MMA, cycling (road, off-road, time-trialist), running, duathlon and triathlon, basketball, football and baseball athletes. I have coached world-class athletes and athletes internationally. I have a passion for working with youth athletes and helping them apply mental game skills and techniques to all areas of life. Most importantly, my aim is to have people enjoy sports and life to their fullest through peak performances.
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27 Responses to Debridement and PRP Report – Achilles Tendon

  1. John M says:

    Best of luck with the recovery. Since reading this, I’ve decided to do some research on how to avoid achilles tendon problems…

    • Dean Hebert says:

      Luckily, I have learned a lot about avoiding these problems. And if you do the right things early on in training and in your running life in general you will minimize Achilles issues. I unfortunately learned these things far too late and surgery in my younger years on them has in the long run (pun intended) caused issues with scarring, etc. Ah yes, if I only knew then what I know now.
      In any event, I’m coming back!

      • Kerry Yaz says:

        Hi Dean,

        Your blog has been hugely appreciated by me. I am a self employed fitness instructor, and am currently 11 days into recovery after achilles tendon surgery. I have been suffering with chronic achilles tendinitus for 4 months, using an Osteo managment plan. Due to the location of my fibrous damage, I was not anticipating a full rupture, which I had, whilst teaching a class! I am trying to stay positive, but equally, am incredibly frustrated at my situation. I will check your updates regularly, I’m sure they’ll be a continual inspiration to me!

      • Dean Hebert says:

        Thank you for dropping by… I’m recovering well and have started “real” running. It’s now been 4 full months. It’s slow.. but I’m going to be back. Your frustration is very understandable. But, this is the time for mental toughness training. Focus on NOT getting out of shape (which I did not do well). Do core, do upper body do anything but don’t let you conditioning wane. Focus on what you control… that is your path to recovery. This is also a great time to do things we tend not to do consistently… like planning, goal setting, etc. These can serve as a motivation to get you through the tough days.. which there will be some. You’ll be back. Please stay in touch with your progress. Drop me a line anytime.

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  4. brendan says:

    thanks for your report I am 4 days post op and was wondering once you had your 10 day check up were you then alloed to walk in your moon boot

    • Dean Hebert says:

      Yes I was walking with just the boot after that check up. I’m now 1 week away from my final check up and hope the boot goes away. I have virtually no discomfort whatsoever. But still there is swelling.

  5. Cass says:

    Wow. I am mid-recovery from a first (and hopefully last) achilles injury. Found your earlier article on rehabilitation useful. Best of luck with the healing process, I’ll look forward to catching up on it.

  6. Adam says:

    Hi Dean. I haven’t checked out your site in awhile, so I’m late to comment. I’m sorry that you had to go this route, but certainly hope you get excellent results. Didn’t Matt Tegenkamp get PRP treatment? It seemed to work out well for him! Anyway, best of luck!

  7. Albert says:

    Dean,

    My achilles surgery involved sawing off the haglund’s deformity, removing the partilly torn achilles at the insertional site, and putting an anchor in for achilles suppport. I’m four months postop and I have developed a massive unbearable pain in the back of my heel that I feel with every step, similar to what I felt preop but worse. Also, my calcaneous and achilles is still swollen. In your experience and in talking to others, does the pain the back of the heel sound normal. I am not even close to being able to run, so I’m not sure if my progress is normal. I have been doing PT for 2 months now, I maintained upper body strength, am swimming and cycling without pain, it’s only weight-bearing that I have the pain. thank you

    • Dean Hebert says:

      Albert,
      You certainly had some serious stuff done. Even so, your pain at this point should not in any way be as bad or worse than pre-op!!!! Get in to see your doc and find out what is going on. Some discomfort when reintroducing weight bearing exercise is normal… and some minor ups and downs are expected in the process. Always ice after any workouts even if it doesn’t give you pain. This would not appear to be normal rehab discomfort after this much post-op time.

  8. Deidre says:

    I had a debridement done October 4. The day after surgery was the most pain I’d ever felt in my life and took medication (vicodine) as prescribed. Went to my follow up, stitches were removed and I was off crutches within a week and in the boot. This past Friday was hit with awful pain… almost as bad as the day after surgery. Haven’t been working out since before October 4. I was an eliptical gal… no more running for warming up… plus lifting weights. I want to get back to it but the achilles still feels painful to the touch, some days worse than others. I’m leery about stretching it or getting back on the eliptical. Have a final follow-up November 10 if pain is not completely gone. Any thoughts?

    • Dean Hebert says:

      Deidre,
      If the Achilles is painful to the touch you aren’t ready to workout on it. Stretching is a no-no. When ready you should be doing eccentric dynamic stretches – heel LOWERING on step for instance. The last thing you want is to go back and mess up the work that was done on you. If you start back too early… that is exactly what you will be doing. Be patient… I know.. the hardest thing to do. Once the pain is gone at least to the touch… then you can engage in PT and gradually get back at it. Stay in touch. Hang in there.

  9. Gill says:

    Hi Dean

    I am two days post debridment found your this really helpful. The plan in to remove the stitches next Thursday (8 days post op) and get me into a boot. I have had the boot before now, but found that my foot moved in it. Have you any tips for this?

    • Dean Hebert says:

      The walking boots now have velcro straps and come in a couple sizes so if you are fitted right, you should be able to crank it pretty tight and really limit movement. I have added some soft padding between the boot and my skin both for comfort and fit. Good luck.. you are on the road to recovery. You’ll be back out before you know it! Just don’t rush it.

  10. Gill says:

    Thank you for your advice – can’t wait to get back to any form of exercise and running. Your blog was really helpful!

  11. Ed c says:

    Hi hope all is well with the tendon , I’m thinking of having the surgery .my tendon is Bowed due to a bike pedal puncture . Partial tear, which turned to tendinitis now tendonosis . My question is how long we’re you in the boot ? How long til you were able to fully weight bear ?
    How long til you were “normal” again:)
    Thank you.

    • Dean Hebert says:

      Ed,
      First, since I doubt that I was “normal” in the first place I doubt that I have returned to “normal”.

      I was in a boot for 6 weeks.
      I could walk with FWB immediately but limped due to atrophy of calf muscles.
      After 4 PT visits (long and very thorough) along with my own work at home – about 3rd week out of boot; I ran on the alter-G treadmill @ about 60% of my bodyweight.
      Ran for first time (jog 400 meters @ 10:00 mile pace) about 12 weeks post-op.
      Last year I had a lot of things going on so didn’t pursue getting in shape very aggressively. But, once I decided to run; within 3 months of steady running last Fall 12 months post-op; I was up to 11 miles @ 7:30 pace and could do a 5K in about 19:30. (Slow for me but ok.)

  12. DB says:

    Dean, i am facing exactly what you went thru your site is incredibly helpful. 54 yr old lifelong runner here with gradual degeneration over 6 months no tear visible on mri but been in boot 12 days to try and let it heal. iontophoresis has helped some and my nodule or bump has greatly reduced, have orthotics and 2 surgeons a main and 2nd opinion dont want to operate (saying they cant reconstruct as well what the body can manage to do on its own and they have seen such cases resolve in the past etc.). can do 2 legged heal raises and a one legged one slowly up about 2-3 inches with the bad tendon slight bilateral pain in the OTHER tendon which has improved with orthotics.. its maddening tho as i do have some pain in the bad tendon walking a while even in the boot but no pain to the touch at the mid point. my mri was in december am having a second one next week will keep you posted. if i do need surgery it most certainly will be debridement and or fhl transfer. Was yours a gradual degeneration and r you back to good running now? may i ask your age you look to be about my age more a less a bit! best to you..

    • Dean Hebert says:

      Denis,
      I’m 56. Had my first achilles surgery (bilateral) when I was 27, second one (left) at 44 and the last one when I was 54.
      All were due to chronic tendonosis and scarring no tears.
      I am back running. It took longer to recover than anticipated. And I get twinges sometimes. I can run ok – last week 10 miles @ 72 minutes; 5k in 19+. But I regard myself as out of shape and coming back. I run 20-35 miles per week. 1 quality run per week. Still overall weak – can’t really do hills well. But I’m running and that is all that counts.
      Stay in touch… you’ll be back!!!

  13. Lucas says:

    Hi Dean,
    My case might be different or even strange to you, but I’m suffering from bilateral achilles tendinosis as a result of taking the antibiotic Levaquin. I’ll first start this message by urging you to never take an antibiotic classified as a quinolone.
    Anyways, this drug has left me messed up pretty bad. Just several months ago I was an athlete and parkour fan. I had a pretty impressive long jump as well. But now, my bilateral insertional achilles tendinosis prevents me from even walking comfortably. I’ve been in physical therapy for a few weeks now to no avail. I’m considering looking into surgery for either one or both tendons. I’m only 25 and in college – I love sports and being active. I was previously a very agile and physical skilled guy, I want to get back to that. Is it stupid to think I could be the person I used to be at this point?
    Thanks.

    • Dean Hebert says:

      Lucas,
      I am so sorry to hear this…
      The first question is whether the drug did permanent damage or is it merely temporary and reversible.
      I am not familiar with this drug nor the side effects.

      As for returning to action… I’m an optimist and I figure there is always a way.

      1. Be diligent with all PT exercises. You will not be able to get by with a day here or a day there. You will need the same intensity you have in competing to pushing yourself in rehab.
      2. A few weeks is not sufficient. 2 months minimum is my opinion…. stay focused and don’t get discouraged.
      3. Invasive (surgery) procedures should always be the last measure – you will never be exactly the same afterwards. Not necessarily worse… but just know things feel different and some adjustments will need to be made when you return to activity.
      4. I am not convinced you are a good candidate for surgery. If you only have insertional tendinosis and it isn’t being caused by a bone spur (like I had for instance) then what will you gain from surgery?
      5. PRP may however be your best course of action – sans surgery. It is invasive but has a pretty strong positive history (albeit short) with tendinitis type issues.

      @ 25… you will heal far faster than I have. So, think this through and in the mean time be diligent in rehab. Good luck… drop a note on how things go. We all learn from each other. Thank you for dropping by.

  14. M says:

    Hi Dean

    How many weeks were you off work? I have the procedure booked for the 8th of May.

    Thanks
    M

    • Dean Hebert says:

      If by procedure you mean surgery – expect to be on crutches for a couple weeks maybe less; then walking boots; You should not have to miss work but for a couple days max in my opinion. But you could milk it for more. 🙂
      If you are only having the PRP then you might have a boot for a couple weeks but you should be able to get to work the next day.
      Just know that everyone is different… from healing to pain tolerance.
      Good luck!

  15. joconno1 says:

    Hello Dean,
    Had debridement surgery 3 weeks ago. Doctor had me start PT at this post surgical 3 week date. I am unable to return to work, as I am unable to drive with my right foot. The therapist is working with me to get movement in my ankle so that I can at least drive to work. I am still on crutches with toe touch weight bearing with the boot on. I am a nurse, but will be assigned a sit down position for at least 8 months, per the MD. I am a very healthy, active 60 year old. Has anyone ever mentioned driving to you? If so, any good advice? I am concerned if I should have to slam on my breaks (yikes) or even be in an accident. Also, how long does one usually wear a cam boot? The book actually hurts the achilles area when I toe touch. I am thinking it is because it is stretching it minimally?? Are there any other sites you would recommend for me to glean more information on the post-debridement surgery?
    Thank you for your time. Anxiously awaiting your feed back,
    Jeanne

    • Dean Hebert says:

      Jean,
      First, I wore the boot 24/7 for 10 days. Then only when walking for the next 4 weeks (had it off in evenings and around the house – I never used crutches). Then PT started. I was light jogging/fast walking on an alter-G treadmill in 6 weeks. Yes, indeed the stretching is probably causing it to hurt when you toe touch. Stop. Don’t do stretching at this point – as far as I’ve seen – is not a thing to do.

      As for driving – use the left foot for both pedals. It’s awkward but it’ll work. Been there done that. I took the boot off to drive – was not painful at all.

      I wish I knew of a resource that had more information on Achilles and surgeries and recoveries. It was for that lack that I stared detailing my own journey and experiences and inviting others to comment.

      Recovery from my latest of Achilles surgeries (2010 – age 55) took longer than the others, I can tell you that. But even then I was 80% in 3 months (and running on the roads at that time) and 100% basically in about 5-6 months.

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