It can entail a procedure to "clean out" the diseased portion of the Achilles Tendon or the Achilles Tendon may be temporarily detached in order to remove the heel spurs. Hi Beth! Patients are kept non-weight bearing (NWB) for 4 weeks. The other thing thats cheered up the skin on my leg is when I started wearing a long sock on my bad foot/leg. I am on my 14th week and going to start putting 75 lbs. I had ankle surgery go back to doctor Friday 8/11/17 to get cask off and then boot. The orthosis is then removed 8 weeks after the surgery. Why push something that happened from overuse in the first place? . I cant wait to start walkIng again. In cases where your work has to do with heavy physical activities like carpentry, bricklaying, and many more, you stay till 16 weeks after the check-up. As with kmny34, tore it playing flag football (right foot). So it may be worth checking out the others who had sliced ATRs, and read their stories. Avoid forceful dorsiflexion, Initiate double leg toe raise and advance weight as tolerated, Initiate functional movement (squat, steps ups, lunges in all planes), Advance balance training to wobble board and single leg activity, Initiate frontal and transverse plane agility drills (progress from low velocity to high and then gradually add in sagittal plane drills), Stationary bike, stairmaster, swimming, chest level water exercise, treadmill walking, Progress double leg toe raises to body weight (1.5 times body weight athlete), Advance to single leg toe raises as tolerated, Trampoline jogging treadmill outdoor running, Post-activity soreness should resolve after 24 hours, Avoid excessive activity related swelling and/or pain, Initiate agility: figure of 8 and cutting drills 6 months, Full return to sport/strenuous work 8 9 months. However, it takes place primarily in men ages 35-39, but this injury also happens in women and all . I went to the range this past weekend and it was awesome to be out hitting balls again. Avoid sharp pain in Achilles tendon when you perform the exercises. Full non-walking cast w/bent knee for 4 weeks, short cast for 3 weeks. Sorry Kate! It is a disease characterized by an exostosis (abnormal bone growth) in the Achilles tendon insertion at the back of the heel. A real Chariots of Fire moment. Next Tuesday I go back and have xrays and he said possibly go to 30 to 40% weight bearing and PT. Saw my Dr. on the 21st as a follow up for surgery. Dr. Robert Mihalich answered Orthopedic Foot and Ankle Surgery 22 years experience 6 weeks usually: I usually start formal therapy at 6 weeks post operatively. Im so sorry that youve joined the ranks of the ATR recovering and agree completely that it does inspire a deep appreciation for small pleasures like just getting up quickly to attend to something! I am seven months into my rehab for my Achilles tear. Torn ligaments and tendons, . I ruptured my achilles playing indoor soccer, and agree on the point that you can live without soccer I was playing since childhood. Surgery may be necessary in your case because it may mean that your Achilles tendon has torn and separated. It takes about 8-10 weeks to walk, depending on the person. You can use crutches to move around the house to do daily tasks. I am 3 weeks post op from my left Achilles tendon rupture. First few days after surgery were the worst days of my life, enormous amount of pain, nausea because of Vicodine. Although the surgery is quick and you can go home after the operation, you still cant start walking immediately. These things will help blood flow and recovery. I will be calling my doctor tomorrow After 60+ days in denial brought on by self-employment & no ins. At 3 weeks I still have swelling and slight pain walking in my boot, but I am so happy with the progress Ive made and Im happy to be in the boot that I can remove to let my leg breathe. Once in a while Ill get a passing pain, but it goes away quickly. If you suffer from low back pain, the problem may actually be caused by too much stress on your feet. Anti-spam word: (Required)* Achilles tendon rupture treatment without surgery using Aircast boot and wedges. However, burning pain after the surgery is normal. Perhaps its that so many of us here are either professional or pro-level/first class amateur athletes and we have tended to express ourselves most often outwardly through our physical abilities. I started physical therapy two weeks ago and am still in a lot of pain. b Patient from . Rupturing the Achilles tendon in the heel is one of the worst injuries that can happen to the body. I ruptured mine playing basketball on June 16 had surgery June 20. My protocol was very unusual - 6 weeks in the cast completely NWB. Some people never get their strength and full function back to 100% of what it was prior to injury. Take it easy Daisy and looking forward to hearing more good news from you soon. I will keep you posted. When your surgery is over, youll most likely have a cast that runs from your knee to your toes to keep your foot in a pointed position. Some days he'll have swelling. Carrie Bradshaws Hip Surgery. Check out my blog post from April 26, 2017 titled Promising 4.5 week follow up with the surgeon. . Had a full AT rupture in 5/2004 age 42, female. had surgery of 3+ hrs due to waiting so long ends of tendons were shredded. muscle in man after achilles tendon rupture. I am 3 months past Achilles tendon replacement surgery. But the most pain I have felt throughout the entire 12 weeks of recovery . Thanks, Gus, so much for the very kind words! Sixty-six patients with acute ruptures of . The dr put me in my walking boot and told me I can start learning to walk again. Your doctor may recommend even more time off. For those about to get the cast off, be warnedyou may feel pin pricks on your heel as you start walking around, even when youre not putting much weight on your foot. Ive been in an Aircast boot for most of the last 7 weeks, though I just switched to a hinged boot that I still had from 8 years ago(!). I had surgery 2 days after it happened and am now in a boot. All I can do is taking medicine to help ease the pain and that's only temporary. It just feels so great taking shower without things wrapped around my left leg any more, it feels amazing that I can walk now without crutches, I can live with my limp for now ;-). Youre still wearing a walking boot, but the heel lifts are adjusted to put your foot in a more neutral position. You still use crutches anytime you need to bear weight on your foot. Can remove for hygiene and exercises, Avoid overstressing the repair (forceful movements in the sagittal plane, forceful plantar flexion while in a dorsiflexed position, aggressive PROM), Gentle cross fiber massage to achilles tendon to release adhesion between tendon and peritendon, Passive dorsiflexion both with knee in extension and flexed to 35 400 until gentle stretch on achilles, Begin standing calf stretch at 5 weeks (knee flexed and extended), Continue eversion, inversion and plantar flexion isometrics with resistance bands, Initiate balance exercises (double leg wide base narrow base), Initiate stationary bike with minimal resistance, Initiate pool exercise in total buoyancy with floatation device if wound is fully healed, Normalize gait on level surface without boot or heel lift, Good control and no pain with functional movements, Supportive athletic shoes with ankle brace, Full PROM/AROM all planes. This may be as soon as 2 to 3 weeks or as long 6 weeks after your injury. 2 The specific type of surgery will depend on where the Achilles tendon has torn. All patients underwent the same suture technique with a similar rehabilitation protocol and were examined clinically at 2, 4, 6, 8, 10, 12, 14, 16, 24, and 48 weeks . I did have a period of time where I was told to walk 25% of the time and do NWB the rest of the time, then it changed to walk 50% of the time and NWB the rest. Well keep mein yyour prayer on my road to recovery. Its usually soft at first, but it can become painful and sometimes disabling with time. My question is will my foot still swell and how long will this progress take because I am miserable. My info is I than start to wean off of the boot. Im anxious just to be able to drive and walk my dog, as my wife currently is taking charge of those duties. by Al Pellagrino. I actually thought I had stepped on some dried out branches when it happened. After another 6 months and PT I feel great. The pain will relieve you if you keep to your after-surgery physical therapy. Range of motion seems to be improving but cant wait for PT evaluation! My pain was minimal after the first 4 days. I can still move foot well in circular and flexing could it be my knee or ankle clicking after not being used or should i be worried btw my husband hears it too. I am at the point where I am building the leg muscles back slowly. Yes, I think most of us experienced pins and needles when we first put weight on our bad foot after weeks of NWB. I have always been a pretty athletic guy (played football, soccer, ran track) growing up. This pain occurs in the back area with inflammation and certain redness. Recovery from the operation may be up to 9 months and include physiotherapy . This injury forces one to go inward and for me, thats been kind of an intriguing experience! My surgery to repair a completely ruptured achilles was on March 12, 2012. As Daisy said that we need to think more on Zen aspect of ATR recovery, stay positive and be patient. He uses both non-surgical and surgical methods to alleviate your Achilles tendinitis symptoms. I saw two doctors and one ortho. i am in a air boot cast and it is horrible my foot burns and swells all the time the boot is on , i tryed sleeping with the boot 4 nights and got very little sleep . You can also practice some physical therapy at home to reduce the pain or use an ice pack. Until then Ive been doing some simple flexing exercises with the boot off. Please do not get discouraged and do not over do it. In 2 weeks: Your doctor will take off your cast to remove the stitches and check how the wound is healing. Familiar to most of youheard a pop and felt like someone hit me in the back of the leg with a baseball bat. I will review this post. I get my cast off, 4 weeks post surgery, this Thursday. My doc said I would always have occasional pain, my recent inactivity really brought it on as I was not doing what Im telling you to. Most recently, now 8 yrs later, I went to Atlantic City & walked for miles for 4 days in flat shoes. 2022 The Heart & Brain. I think they have done their best. Crikey, that would be a wretched turn of events! The Achilles Tendon is the strong fibrous band that attaches the calf muscles to the calcaneus bone. All went well, however I have had pins and needles in my foot every since. Im still sleeping in the boot, cause both of my health pros say I should Im following the protocol from the Univ. I had a similar injury and the pain seems to last forever. That transition was probably more painful than the actual rupture or waking up from surgery, especially since I was only able to take all pain meds besides Tylenol for 4 days due to sickness and an NSAID allergy. Im relying on a published study that shows a group of men ages 42.8 tested weigh bearing after 14 days as much as tolerable who showed no difference in re-rupture rates as traditional. I do A lot for myself and on my own and I try to elevate the foot as much as possible. The first 2 weeks I was in a splint and then in a cast for 10 days. It would help if you kept your leg elevated as much as possible after the surgery. That was 4 weeks ago. So Im not convinced that having surgery to prevent an ATR is a good bargain, on average. You will need to return to see the surgeon and let him help you remove the stitches. He is about 90+ percent now. Just be cautious. Was very impressed with myself when I walked across the studio with only one crutch! Avoid forceful active and passive range of motion of the Achilles until 10-12 weeks post-op. (4-6 WEEKS AFTER SURGERY) Rehabilitation Goals Continue to protect repair Avoid over-elongation . I was told this is normal as the foot starts to figure out how to be useful again. You will need to wear a cast or walking boot that keeps your foot and ankle from moving for 6 to 12 weeks after surgery. You'll also start rehab. It was swollen for several days and even now when I dont wear my boot at night. Hey Eric so sorry to hear about your ATR its completely sucks mentally. Achilles tendon ruptures typically occur in men, most commonly in the third to fourth decade of life, during a sporting activity. My impression from patients whove posted here is that it isnt, and can sometimes be slower. January 21, 2009 12:27 pm, georgie on My issue is my ankle. Good article, Each and every point is good enough.Thanks for sharing with us your wisdom. I feel good, let me know. Ive got it locked in neutral position with no heel lifts (which just got removed about a week ago see my blog if you care!). If you go to the Main Achilles.com page, youll see our comments down the right hand side. During physical examination, a palpable gap between the rupture ends can be observed. R.I.C.E. In total I spent almost 8 weeks in a cast then immediately started pool exercises and physiotherapy almost every other day.I,m much better now I hardly ever use the Krutch and can walk with a limp which gets better everyday, Yes its one of the worst injuries but it does heal and after a few months your close to newWatching some vids from David Beckhams recovery really helped hes a super positive person. With the help of physical therapy, most people can return to normal activity in 4 to 6 months. Achilles Tendon Rupture, but its not the end of is proudly powered by WordPress and WPDesigner.. Achilles Tendon Rupture, but its not the end of, 5 Weeks, 4 Days, still on crutches, swelling is less than before. What Is the Recovery Time of Achilles Tendon Surgery? Learn how we can help December 22, 2017 7:04 am, Karen on That can help ease inflammation and pain. Chronic Achilles tendon rupture is usually defined as the rupture that occurs in 4 to 6 weeks after injury. and than full weight. Remove 1/4 inch each week. Of course, as you well know, taking it easy the first few months is really difficult! At week 5 I went down to 20 degrees with boot and week 6 I wore special running shoes half time with 20 degrees and walked with, Thanks, ochocorunner, for the great post! During I guess I need to hear that this is normal. Most people will need between 4 to 6 months to fully recover from surgery, but the exact length of time will depend on the severity of the tear, how quickly the condition was treated, and your overall health. Modern trends in rehabilitation after Achilles tendon repair represent a progression toward a more functional strength recovery. I begged that he not put me in a cast - but a boot. Your surgeon may give you a special boot instead of the cast, which you can put on or take off for hygiene purposes. I completely tore it playing flag football. All Rights Reserved. The first week was really depressingnot only was I stir crazy with my leg elevated ALL day, but the thought of the long, tedious recovery was difficult to process. Had the operation a day after. Good luck to everyone! A total of 266 patients with acute Achilles tendon rupture were divided into 4 groups (A, B, C, and D) according to immobilisation duration of 0, 2, 4, and 6 weeks, respectively. July 19, 2016 3:53 pm, Verdean Zimmerman on 3 ACHILLES TENDON RUPTURE Description of Injury The Achille's tendon is the largest and strongest tendon in the human body. However, the tendon does take time to heal, usually about six to eight weeks. Follow his/her orders first and foremost. How long should you elevate your leg after Achilles surgery? November 27, 2012 3:47 pm, Jacqueline Mackinnon on Propped up again, now, with ice. A story of caution. I know I cant rush it but it gets mental , I will just have to let it run its course. hi, i am just in 2nd week after surgery. I can't massage it because the whole upper leg area is so tender to touch. Thanks to reading other posts on Achillesblog.com I knew not to expect much (thanks alfia). In boots and therapy the next week I thought this was way too While you are on the subject of pain I would love to know if my experience is common. My skin didnt suffer badly, but it didnt love being plastered against the foam of the Aircast boot. I plan on getting back into sports regularly once I am done rehabbing. You will need to wear a cast or walking boot that keeps your foot and ankle from moving for 6 to 12 weeks after surgery. I dont know if that would provide the right support for a broken foot. @Jen - If it is PWB then you will probably be using 1 crutch to reduce the load on your injured foot - at least thats what I did when I was at that point. I am a 30 yr old gymnast. Hi Ruthless, If you want to reduce the pain after the surgery, the doctor can give you a pain reliever. Achilles tendonitis appears mainly in Athletics. Achilles tendon rupture update video on weeks 4-7 after my surgery. I am 3 weeks post op from my left Achilles' tendon rupture. . Paracetamol, Coedine and Diclofenac) Keep plaster dry We are in the same boat. Theres a sort of zen aspect to ATR recovery, I feel. Both surgery and rehab protocols are advancing, so the recovery period is shortened. When you get back to work, you will still have follow up appointments, and, very importantly, PHYSICAL . Resting your affected foot is essential to allow your tendon to heal. My question for you is, did you started putting some weight after 2 weeks of surgery? Until it finally popped. It is a process of tissue relapse resulting from an inciting focus or tissue damage. Created for people with ongoing healthcare needs but benefits everyone. You should definitely be tumbling by November. Now I have long cast , toes pointing downward. Burning of the Achilles tendon can also be called tendonitis or tendinopathy in medical circles. August 6, 2017 6:18 pm, Diane Mozzone on Am desperate to start as soon as possible, but am sure I will be quite weak. Expect mornings when its tight. I feel I am doing ok. My foot is so swollen. For those about to get the cast off, be warnedyou may feel 'pin pricks' on your heel as you start walking around, even when you're not putting much weight on your foot. Im 40 very active as well. congrats!! Or try copying & pasting this: For many people with severe pain, limited function, or wors twitter.com/i/web/status/1, These long-term data strongly support the practice of femoral osteoplasty in patients with cam FAI morphologies and twitter.com/i/web/status/1, Cysts Acetabular Paralabral and Subchondral, ACL Anterior Cruciate Ligament Injury of the Knee, Patellofemoral Pain Syndrome Runners Knee, PVNS of the Knee Pigmented Villonodular Synovitis, Osteochondral Allograft Transplantation Surgery (OATS), Patellofemoral Arthroscopy Runners Knee Treatment, Stabilization for Instability-Arthroscopic, Subacromial Decompression for Impingement, BICMD Co-Founder and Co-CEO Announces Expansion of Services. In some cases, the Achilles tendon repair surgery can be done as a minimally invasive procedure. You use crutches, a knee scooter, or a walker for the next few weeks and should not put any weight on the treated leg. I love Manhattan loved my time there as a dancer but at this exact moment, rather glad to be in a smaller, less complicated city! This injury is more mental than physical. Walking up hill is still a little tricky. I dont now when i will be normal again. Let the healing take its course. Experienced a lot of electrical shocks at bottom of foot. achillesblog.com/shell37/2017/04/26/promising-45-week-follow-up-with-the-surgeon/. Athletes foot is a common foot infection but it frequently recurs once you think youve gotten rid of it. Slowly increase passive range of motion and stretch on the Achilles after 6 weeks. Gus I cant imagine doing subway and Wall Street right now! My pain was minimal after the first 4 days. Good Luck to all of you and get well soon. June 20, 2017 9:07 am, shell37 on Although the surgery is quick and you can go home after the operation, you still can't start walking immediately. I ruptured my Left Achilles tendon during soccer on May 9th, had surgery on the 17th. I never received a cast because of my claustrophobia, so I was in a walking boot with wedge for six weeks. Was 7 weeks 30 degrees then moved twice in 14 days to 10 degrees. It is the largest tendon in the body, and it helps connect the calf muscles to the heel. -Galactosidase activity. I hope you heal quickly and well from your ATR, Gus! And I was getting those passing pains before my surgery as a floating piece of bone would move around and stab things. Anyone else have comments on these pin pricks? a Patient from group A showed separation of the Achilles tendon 1 week after surgery (white arrow). ok 4 weeks after surgery, in a hardcast, feel better4/13 Surgery, 4/23 Hardcast, 5/13 get cast off, and into walking boot. Achilles Tendon Rupture, complications after surgery, numbness in foot and toes. Recognize, however, that you should still be cautious as a total recovery isn't experienced until a whole year after surgery. Ultrasound shows the tendon is healed fabulously. Outside of cheer I workout daily and was in the best shape of my life, squatting 225# and weighing 125#. January 28, 2010 2:57 pm, normofthenorth on Achilles tendon tear. Does anybody have any helpful pointers or suggestions at all about Achilles rehab or about how to loosen it up? May 22, 2017 9:37 am, Jen on I am worried the achilles might have re-ruptured. Learn why and how to treat it. But it will be several months before you have complete . 4 weeks post-surgery - cast removed and foot placed in a walking boot with heel wedges. I am running 20-30 miles per week along with snowshoeing and hiking. After the tendon heals to bone by 6 weeks, you may wean out of the boot and gradually resume a . Just started full weight bearing in my hinged boot angle still at 10 degrees for extra safety according ortho. a piece of glass slices the tendon, it cuts through everything. I compared it to little electrical shocks. Gait training on forearm crutches (20kg partial load in the 30 pointed foot orthosis), Mobilization of the adjacent joints, loosening of the shoulder and arm, Foot in the 15 Equinus foot position, load half bodyweight with the orthosis, Foot in 0 position, full load with the orthosis, Active assistive movement exercise of the foot out of the orthosis, Isometric muscle strengthening of the calf muscle, Increasingly demanding training of the calf and foot stabilizing muscles, Increasingly more demanding training of the proprioception, When shoes are too tight with a rigid buttress increases friction in the, An increased plantar arch (typical of cavus feet) that favors the tension of the posterior chain. Depending on the type of work, some people need several weeks off work after an Achilles tendon tear (rupture); the time taken to return to sport is between 4 and 12 months. I am playing contact football again, not doing anything crazy, working my way back, getting in certain drills. Ive read every blog I think I could find on this type of injury and it has helped to know the recover process from many others. Week 6 showed the low intensity signal of the regenerated tendon (outlined arrow). I was back on snow for Sunday River's opening day in late October that year, just about 6 months after the surgery. Did anyone have this surgery and when did you put shoes on? You may also start mild rehabilitation exercises at this point. So as not to get the bandage wet, you can shower from the 3rd postop. You can help prevent further problems and keep the day with stretching and strengthening exercises; these exercises help your foot stay flexible and strong. Being on crutches, I had achilles reconstruction 17 weeks ago and started walking without a boot at 13 weeks. Its important to elevate the affected leg as much as possible. i know everyones different, but i am 40 and have had achillies tendonitis surgery. My Therapist asked me if I had tried putting on a shoe and at that time I didnt. It can also affect the inside or outside of the heel and foot. As I am not getting any sleep! Here I am, 40yrs old, full rupture and in denial. Please is this normal? I started accepting this injury as part of my life as I read a lot online that many people have gone through this and they have all been positive and patient to accomplish their recovery ultimately. Hi I had my surgery Jan 20 2020 I am 3 weeks in I was given the boot to wear . Met my surgeon yesterday. The Orthotist who fitted the boot said it was not possible. Patients are encouraged to have one physical therapy session at 2 weeks for patient education and proximal hip and core strengthening. The Achilles tendon rupture is the most common tendon to rupture (Holm). If you still feel a lot of pain after the activities or the tendonitis does not heal. I finished my PT after 18 visits (3x per week for 6 weeks). Funny, I am not by nature a patient person. Remove 1 wedge every 5-7 days as able. Dr. Jeffrey Sider answered Sports Medicine 40 years experience Long leg cast : Usually the initial cast is a long leg (above knee) cast which sometimes i will cut down to below the knee after about four weeks to avoid further knee stiffness. Haggmark T, Liedberg H, Eriksson . How is your pain now ? This painless feeling was because the surgeon gave you anesthesia. I am 10 week post op..when I walk, I have pain in my heel and in the ankle ,,it swells..I bought a foot brace at Walmart and it helps some,,does anyone else have pain whens align.. The accident happened about a month ago, and so I will be in a non weight bearing cast for about another 3 weeks. My current sock is a thick ski sock, which also adds a bit of (helpful) padding under my foot. Its interesting to me (after reading many comments here since my surgery on 6/7/11) what an internal, almost spiritual journey this particular injury can produce. June 20, 2017 9:41 am, Beth on Dont worry your repair is stronger than you think - that is what my doctor told me when I asked him how I will be without a safety blanket of the cast. On the plus side Ive got up on my detective story reading! The surgeon will allow you to race if the evolution is good, about 8 or 10 weeks after the surgery. Thanks if you can help. Anyone out there have any comments when you began to do the minimum? I had an air cast on which was much better than a cast. The question above has not been answered and I am in the same situation. And, I am weight bearing. Isometrics of uninvolved muscles. This stress, together with the continuous friction of the shoe and not performing the correct stretches, can cause a shortening in the back muscles of the leg. In the 3rd and 8th weeks after the surgery, you will have to meet your orthopedic surgeon for a check-up. I will use the crutches for at least the next couple of weeks while I get more comfortable with the boot, put more weight on the Achilles, and start PT. Now my surgeon said to ditch the boot tomorrow. After 4-6 months, you may be able to return to full activity. . Department of Orthopaedic Surgery, Horsens Hospital, Denmark Summary. We do seem to be very close in our rupture progress. My last sugery was on the the 11th and 2.5 blood transfusions. They had to give me 3 dilaudids (I usually don't take meds) but then I had no pain for the following 3/4 weeks. It is also intended as a guide for your longer-term rehabilitation after Achilles injury, which you can use in conjunction with a physiotherapist from around 8 weeks after injury. Youll have to check with them as to what they mean. -Galactosidase activity was assessed in Achilles tendons from Egr1 +/- mice 1 week after injury. Youre going to do just as well at PT and this hideous event will finally pass away into cringy memory! Generally, the outlook is good. I send you all the best in your healing as well! Rotating bikes are currently ever before extra prominent just recently. Clearly, compared to the many dynamos like. Calf is strong, Achilles is strong and I never worry about another tear. Four weeks to the day after surgery and Im now in a boot - DeRoyal Pacesetter Air Walker. Generally after a surgical repair of achilles tendon rupture a short-leg cast is applied. The spinal anesthesia will not only sleep but also feel no pain. (Why does this old post have such a long afterlife?) Now Im in a wellness program with my therapist. But I do have to play in my walking boot. I was told the right one would most likely be fine. (E) The current wound condition (4.5 years after surgery) which has completely healed. I ruptured my right Achilles on the 10th Dec 2012 at 36 years of age Playing soccer after a long time of inactivity as Im an ex semi-pro from Malta Europe. Hi Daisy, I wish for your early recovery. Procedure: Stripping out the inflamed tendon lining often gives good results. 10 weeks post surgery today, it has been quite a journey. Learn more about why this condition is so common among children. Interesting you dont have any wedges, so is your foot facing downward? I wear a very supportive ru Ning shoe all the time, a full size bigger than my old running shoes. [1] [2] Achilles tendinopathy has a detrimental effect on physical and mental well-being [3] [4]. After 4-8 weeks your Achilles tendon will start to heal and weight bearing, and a new low-heeled, short-leg equinus cast or controlled ankle motion brace will be used. I did buy an even up and it saved my other hip and leg so much pain- its so worthwhile. Im about 12 weeks out. But my doc told me no sand traps or extremely uneven lies. That seems like a massive difference just because of a few weeks of minimal use. Thats probably why they use a felt wedge - it squishes with time so the achilles gets slowly stretched. But when (e.g.) Four common treatments he uses for this condition include: 1. When the conventional approach is used, somewhere around the 4 week point (after the operation) the person is usually put into a walking cast (ankle is placed in neutral) with some weight bearing exercises are started. If your current prescribed medication isnt helping, you can discuss adjusting your medication for comfort with your doctor. After removing the cast and sutures (or staples) another cast is worn for another 2 weeks. Washington Foot & Ankle Sports Medicine, Kirkland, WA, What to Expect When Recovering From Achilles Tendon Surgery. Being able to shower barefoot helps, partly because it lets the boot air out a bit, and you can also clean it up some. coloring pages, Its difficult to find experienced individuals about this subject, yet you seem like you hear what youre saying! I am 3 months padt Achilles tendon replacement surgery. Your doctor will remove the splint and evaluate the surgical incision. Keep on working it but dont push it too hard! I am really looking forward to my round. Then bypass the boot and straight into walking shoes outside and bare feet at home. My doc wants to make sure my achilles anchor points are well attached to the bone again before I stress it a lot. Does it matter? I am able to move my foot with agility though. Im in no hurry for a re-rupture This therapy also helps you to reduce burning pains after Achilles tendon surgery. In the latter case, bone anchors may be required in order to reattach . I have all my flexibility now, and strength is coming more and more everyday. The symptoms of chronic Achilles tendon rupture include pain, decreased strength, fatigue, and ankle stiffness. If that happens, follow all instructions for keeping the cast dry. Please note that these instructions are general guidelines to be followed; however, any written or verbal instructions provided by Dr. Nwachukwu supersede the instructions below and should be followed. I know I have a long road to go but I appreciate the stories they help me get through it. Im still in a wedge at week 11 and will be until June (had Haglunds deformity surgery not ATR). Im 66 years old, and feel this is the best I could do. A rupture of the Achilles Tendon (ATR) is a common pathology being the most commonly ruptured tendon in the human body. 4 to 6 months post-surgery - wean to sneaker or shoe and continue therapy and home program. Is four weeks postoperative time required to practice? Most patients who are athletes do not return to their sport for about 6 months, and many can take longer to fully recover from Achilles surgery. June 26, 2016 3:18 pm, Angela on I slipt and fell this morning. Burning of the Achilles tendon can also be called tendonitis or tendinopathy in medical circles. June 20, 2017 12:21 pm, shell37 on After I walk around a lot in the boot, my heel is sometimes uncomfortable or mildly pained even now, and Im scheduled to come out of the boot soon, at 8 weeks in. To prove you're a person (not a spam script), type the security word shown in the picture. I had Triple Arthrodesis foot surgery Feb. 16th 2017. The first doctor said I dont need the boot when I am sleeping. Mark, was your recovery from the tendonitis surgery any quicker or easier than post-ATR recovery? How long does it take to walk after Achilles tendon surgery? Avoiding high-impact exercise is still critical, but you may be allowed to swim or bike. Stay cool! An example of the one you can use is the Clexane 40, and you use it at least once a day. I admit it the idea of re-rupture or rupture on the other side (right leg) makes me distinctly queasy. Had foot surgery 5/5/17plate and screw ..break at 2nd and 3rd metatarsal plus bone chip that was fusedI stayed in cast about 2 wks..now Im in bootfoot feels great and looks wonderful after what it was like before surgery. Hi You may shower 24 to 48 hours after surgery, if your doctor okays it. he is like a personal trainer for me. COVID-19 Update: Offering virtual care. Rest, ice, compression, and elevation are important ways to manage your pain. Do not put weight on your leg without these until your doctor says it is okay. Getting the cast off yesterday was a thrill. I am 54 and I had this surgery performed in October of 2013. Traditionally, after an Achilles tendon repair, patients were immobilized and non-weight bearing for about 6 months. Learn more about how to heal your plantar fasciitis. Rat Achilles tendons were processed for histological analysis 1, 2, and 3 weeks after surgery, and for hydroxyproline assay and qRT-PCR analyses 2 and 3 weeks after surgery. I had complete rapture on right achillis tendone on 26 sep 12 but I did my surgery on 19nov.the doctor showed me the photo of my tandone during surgery. I had a tailors bunionectomy at the fifth metatarsal -also constellation of complex buspar cysts which all had to be removed) also w some complications in surgery requiring a last minute pin at the pinkie toe when the bone broke off while putting in a second permanent screw. Im also a big golfer, and prior to my injury played twice a week. Short walks or a stationary bike is possible based on the patient's progress. It's been a slow road to recovery. During this time, you should begin to strengthen your core and lower extremities. And its way too heavy for my skinny foot. There can be various causes, such as a sudden increase in duration or intensity of training, not stretching the area, training harsh surfaces or steep slopes, or wearing inappropriate shoes. My question is ..will I be able to wear regular shoes at that time?and will I go to crutches (on a knee scooter now) or a cane? I was in a cast for 2 weeks, then the stitches were removed. An injury to the largest tendon in your body, the Achilles tendon, can be devastating. I also experienced some discomfort right under my heel, as I progressed to FWB and also afterwards. My surgeon seemed confused as to that fact and said we will review it again in 4 weeks. I always thought that I could walk on my 6-8th weeks and I was wrong. You may need help at home during your recovery. Following all procedures except Achilles peritenolysis (since the tendon itself is unaffected) patients wear a 1-inch heel lift for the first two to four weeks of weightbearing to avoid a drastic change from the equinus or plantar flexed positions that are required during the nonweightbearing postoperative period. Among the differences I can think of: (1) When an AT ruptures normally (from over-stress), the surrounding tissue, including the sheath or paratenon, is almost always still intact. So you are a ballet teacher, I can imagine how you have felt when your students cheered for you - an ecstatic moment indeed. But one week after walking boot I feel great, I dont feel any pain, and when I take out the boot and do some massage and little movements, I feel great, no pain The wound was very well dry and good, the doctoir said. I was putting weight on it with crutches PWB (partial weight bearing) on day 15 full weight bearing about week 3-4, Hi guys, I ruptured my achilles playing indoor soccer on July 15th 2013, on July 22nd I had surgery, I am 38. Could not physically bear weight with crutches for three weeks, at which point I started biking. This cast is removed at 2 weeks. Consider taking a more conservative approach to range of motion, weight bearing, and . I had achilles tendonitis. Ive been fortunate - really no pain at all. The predisposing factors to this pathology are: You are at risk for an Achilles tendon rupture when you have tendonitis. September 20, 2018 7:29 pm, chiara on Best wishes to all. Kate I had pins and needles at onset of PWB & if I recall correctly subsided after a week. This injury really forces one to employ new tactics and extreme patience is one of them. I have been icing down my leg and hurting ever since. The impact continued on the ground while running or other sports practice increases the stress on the Achilles tendon. This can often be done telescopically with only small cuts in the skin. Heres how to know when to seek help. Is it for protection or is there another reason for wearing it. I think Im ahead of most people on recovery side. Im so happy that your ultrasound went brilliantly! 3 Houshian et al 6 reported in Denmark an annual incidence that increased from 18 cases per 100,000 persons in 1984 to 37cases per 100,000 persons in 1996. The dr put me in my walking boot and told me I can start learning to walk again. (So that I can get entry back into a plant where I work.) As of this week I am able to go to bed without the boot on but occasionally wake up cramp in my calf - has anyone else had this? The Surgery Issue: Inflammation around the tendon (tenosynovitis) but the tendon itself is reasonably healthy. It would help if you had the Achilles tendon to extend your toes and push off as you walk. Learn more. (Morganville, NJ) Hi all, I'm 20 weeks post op. No pain, stiffness, or problems with it at all, that day or anytime since then. 2 years after full re-attachment and calf lengthening (Gastroc bypass) I feel that I am at 95%. The labrum is rebuilt with the goal of restoring the functional anatomy of th twitter.com/i/web/status/1, #ChatGTP not quite ready for prime time in #orthotwitter I taught a long master class today in the boot. Hi All, This tendon helps your foot move in just about every direction and is essential to walking and jumping. I will still take it easy for several more months but being able to walk at just 3 weeks Im ecstatic. You may have questions about why your child has plantar warts. At first, it may be set to keep your foot pointed downward as the tendon heals. It is rare that I can comfortably wear a shoe with a back sneaks due to an ever present little lump at the heal. How long until you can walk after Achilles tendon rupture? After 4-6 months, you may be able to return to full activity. Im hoping I get some good news on Wed, and can start rehabbing, and be able to recover quickly. I already had 50 lbs last week and next week will be 100 lbs. They may also remove stitches during the evaluation. Your surgeon can replace your splint with a cast. This long-term injury or inflammation is also known as tendonitis or tendinopathy. Why does my Achilles have a burning sensation? Achilles Tendon Repair Surgery is performed after injury but when the inflammation has decreased, normally 4-6 weeks after the accident. Is this common? In a cast boot, the faster you walk, the harder your heel strikes the ground. Need help please The doctor will inform you if you need to check between the wounds. by the time I got home to prop the leg up and pack it in ice! But I believe for me it will be another year or so before I can do the things I used to be able to do. Eventually, during a basketball game I suffered a partial tear to . I started PT at 8 weeks. Your body knows how long it needs to fully heal. recovery takes months rather than weeks and there is a chance of re-rupture in the . Your rehab appointments slow down and you should be able to stand on the affected leg for a few seconds at a time. Look forward to hearing more about your progress in NYC! Positivity and patience are two things you require to get over this tremendous injury. We all can do it. -GRIN- Then went home, removed boot and saw that it was mildly swollen. Take your time in the first 3-4 months and go to PT. Im 46 and in good shape; either lift weights or jog 5-6 days per week. Achilles Video Series - Post-Op Week 3 & 4: Swelling Management and Early Weight BearingVideo Series Description -Thanks for tuning in to this video series. Walking will definitely feel so weird and not normal but it takes time. At that point I was placed in a boot for 8 weeks using crutches . 4-5 weeks after your surgery. Thank you Shell37! June 20, 2017 10:33 am, shell37 on I think that list could be especially helpful to you, because youre in a special minority that sliced their AT, rather than over-stressing it and tearing/rupturing it. How long will this last? I am used to the crutches, but feel the weakness in my calf, quad, groin, foot, and I would assume I start PT/REHAB soon after the cast is offI am an avid golfer, and want to play ASAP I just saw someone post that he played 8 weeks afterthat would be greatand a good goal. I understand to wear the boot going outside but why in the house. Im having positional pain when my foot is up or perpendicular to the floor. I can not stand for more than a free minutes and walking with limp starts to really hurt after a half hour or so. Its still stiff and I would imagine that it will be that way for the rest of my life. Does it steadily improve daily? Author. I am hopeful that one day I will be totally pain free, but from what I have been reading, Im beginning to wonder if I will ever be. This is done with a tendon taken from another place in your foot. Congratulations for making it to FWB! The main causes of the . After 3 weeks, the cast was changed to a below-knee plaster with a walking iron [13] and full weightbearing allowed. Ruptured left leg July 8th, surgery the 14. Second day on the walking boot I was putting light weight, and increasing it for a week now. You have creative hands and minds of great food, really the recipes you share I feel very delicious and beautiful, thank you for sharing these great recipes. You can also extend it horizontally while sitting on a chair, but you need to be sure it is high enough. No problems with surgeon he was great. Doing this means you should raise your leg above your heart level. Youre so right well all get their in our own ways and time! I had cramps in my calfs I would say thats pretty normal since that whole leg didnt move for a long time and now is. Week 3 showed low and low-intermediate signal intensities in the tendon gap where the early period of tendon regeneration can be seen (gray arrow). Boot free is the best feeling!! The needles are normal, they do go away, and partial weight bearing does kind of magically get better by itself! Thats when the hard cast was removed in place of a boot (no wedges). But absolutely cannot afford to be down this long. I started walking like that with a little fear but doing exceptionally well. Plantar fasciitis is an uncomfortable condition but you dont need to live with it. Your doctor will give you medicine (pain relievers) to help with pain relief with medication like ibuprofen. (Follow-up at 4 weeks after surgery with Dr. Nwachukwu) Goals Initiate formal physical therapy (2 times per week) Begin graduated weight bearing Active dorsiflexion up to neutral Weight bearing Initiate PWB in boot with 2 crutches then go down to 1 crutch and finally no crutches in the boot Brace Tall CAM boot with FOUR " heel wedges. No idea of I hurt it because it has no feeling! Youll be glad you did because it keeps your tendon stretched while you sleep, you wont wake up to a sharp pain because your foot flexed and tugged on your tendon (although this happens to me even when I have the boot onits much much much less severe on the pain meter), and you dont have to worry about bedding getting twisted up around footand then a tug on bedding unknowinglyeek! I completed ruptured my achilles on July 18 playing tennis. You may need to wear a short cast and/or a removable brace for up to 4 weeks after a Percutaneous Tendon Surgery or Mini-open Achilles Tendon Repair procedure. I think its a good speed limit, i.e., make your WBAT (Weight Bearing As Tolerated) stop short of that point. June 20, 2017 12:38 pm, Ternisa on Created for people with ongoing healthcare needs but benefits everyone. Precautions: Full weight bearing with heel lift as tolerated. I am still getting used to the rush hour crowd as I travel downtown Wall Street every day. Have read about DVT but dont know if Im just over thinking it? In the first 6 weeks, the orthosis is in a heel wedge lift and thus relieves the suture of the tendon. Thankful. Good news progressly the mental and physical recovery gets better. The pain is most when I lift the boot up to step rather than when I am partial weight bearing. I snapped mine playing netball, it was my second game so I was warmed up, I literally just went for the ball and felt a snap and thought someone had kicked my ankle. It will get easier. I am 40 have complete achillies rupture and consultant said because of my age that I should let it heal conservatively. But until the removal, you have to change the bandage every 3-4 days; that is, you change the plaster. Im new to this site and kind of stumbles across this post via google search. I fractured my fibula two weeks ago and and wearing an aircast boot. Guys keep up your hopes. Achilles tendon reconstruction surgery can help if the tendon is torn. Something to noodle on as well I decided to sleep last night without the boot on. I had the full pttd surgery as you did, osteotomy, fdl transfer, spring ligament repair, Achilles lengthening. I have no limp & I am able to do stuff i dont think I could have done BEFORE my surgery. Depending on how it looks, you could go back into the cast, but more likely you'll get a walking boot. (Over the course of a few weeks i was removing wedges until I didnt have anynore). Im afraid the pins sticking out will get tangled in bed linen. Agree totally walking without crutches albeit with a little limp, is a huge milestone! Call one of our offices in Kirkland, Washington or book an appointment online. Are you going to rehab? My gait is still pretty gimpy looking but I think it might better if I could balance out the boot height more successfully. He had surgery and used the knee cart. This week I put shoes on both feet for the first time at home and feel so much better walking around the house with my walker. At 6-8 weeks after brace removal, patients were instructed to perform single-legged heel raises and to walk less than 3000 steps without climbing stairs. It makes us realize smaller aspects of life and how important it is now just to get up from couch to fetch a glass of wa. Early Im very worried as the boots is giving me more pain than my cast Because the boot is rather bulky and heavyI purchased a Futuro brand splint online and am waiting for it to arrive. Be reasonable in your expectations, too. On august 9th 2013, I kicked out a glass window, I had my first of 3 surgeries on an achilles tendon tear, tissue replacement and artery and vein repair to my right foot. Im waiting for a great pair of Dansko clogs of mine to be repaired at the cobbler and I think theyll help a lot. Should be no wedges by Week 6 follow-up, Pain-free ankle isometrics: inversion, eversion, dorsiflexion and sub-max plantar flexion, Open-chain hip and core strengthening in boot, Regain ankle ROM (active ROM between 50 DF and 400 PF), Boot at all times with 1-inch heel lift. I cant tell you how many feelings I had as I woke up my foot so to speak after it had been a dead weight for 6-8 Wks. This causes tenderness and pain on the inside of my injured ankle near the tibialis posterior tendon. It is possible to continue driving 8-10 weeks after removing the bandage shoe. Mine is on the left foot, and Im a righty so that may be a bit harder, and tougherMaybe with the walking boot its doableI want to walk again, cant wait to get rid of the crutches. Lots of really good comments and tips there about this. No running, jumping, or ballistic activities. Your article is great, I have read a lot of articles but I am really impressed with your writing style. Has anyone else had this? Like Zoomie said above its stronger than you think. After this, you will have to stick to the postoperative protocol for 2-6 weeks. Its expected to have some burning pain after Achilles tendon surgery. Rehab really helped me.. its annoying to go but it really helped my progression. Further exercises will help stabilize the ankle and help with the range of motion. I am about 20 days older than you on this ATR. Do the exercises and always work/stretch it. You can use crutches to move around the house to do daily tasks. Are the pins and needles normal? Thanks again, and best wishes for all those adventures you are part of! My break was bad but it is already getting better and the doctor told me go heel to toe in the boot. I hear you totally! The doctor can also tell you to engage in physical therapy after the surgery. How is it going for you? I had to make an appointment with my doctor the next day and I found out that the compression was causing the pain, right away my cast was changed to softer material and I was relieved and pain free. I cant believe how hot it is in New York! The end of the 4th week up until this very day the pain will wake me up at night. At this appointment, the I will use the crutches for at least the next couple of weeks while I get more comfortable with the boot, put more weight on the Achilles, and start PT. Learn more about five foot and ankle injuries that suggest overtraining. I push myself, and I invested in a wobble board, which I use every time I get out of my seat, which equals about six times a day. I felt no pain at all and never have done apart from falling onto my foot when I was on crutches which was excruciating. Began turning mental and physical corner at about the 2 week mark. (The whole duration till boot removal is around 5-6 weeks.) He begrudgingly obliged and I am now taking my treatment into my own hands. You have a greater chance of recovering without problems if you know what to expect as you heal. The Achilles tendon is a strong, fibrous cord on the back of the leg. I was scheduled to start preventative PT on 2/9/17, and the rupture occurred on 2/7/17. The crutches help you move without putting weight on the affected leg while the tendon heals. they only did the left leg and cleaned up all the scar tissue and the spur i had. From 4-8 weeks, the physical therapy involves strengthening the calf muscles, hamstring, and core. There were no signs that led up to it! It was in pretty agressive. I have but one suggestion to all that go through this. Kate, somewhere on this site (linked from the Main Page) theres a list or table of whos logged in and some basic facts including HOW we did our ATR. Now I get entertainment through ntv europe tv channel. This document gives you information about what to expect from your early recovery. Anti-spam word: (Required)* I am going to ask him this question tomorrow when I go back. Tonight, the boot stays on, and hopefully Ill sleep. Once the cast is removed, If youre healing is progressing, youre given a walking boot that includes a heel lift to prop your foot and ankle into the right position. You may be able to lose the boot and start to introduce more activities. How long is Achilles tear recovery? The damage can be a tear or break from a sudden (acute) injury. July 18, 2010 9:46 pm, carol on The worst part is the contact between the boot and my GOOD foot while I sleep mostly on my side, either way. I am doing great Daisy, thank you for your wishes. Come out of the boot and begin to move your ankle up and down (ankle pumps) Immediately after surgery Compression stocking to be worn to control swelling along with ice/elevation Physical therapy to start 2-3 weeks post op Non-weight bearing in boot for 4 weeks followed by 4 weeks of protected weight bearing in the boot If you have an injury to your Achilles tendon or degeneration of the soft tissue that requires surgery, trust our team at Washington Foot & Ankle Sports Medicine to repair the damage. 8-12 WEEKS. Ohbtw- dont know if you care, but Im researching night splints as an alternative to my boot while sleeping. Since I still have the granulation tissue being healed, I am not yet to start PT. Although Achilles tendon surgery usually takes no longer than an hour and you go home the same day, full recovery can take as long a year. The wound 1 week after surgery. But until then, you should use anti-thrombosis injections. Much slower than most, but that was my reality. If you are working in the office, you can resume 2 weeks after the check-up shows your Achilles is okay. I am at 12 weeks and I feel a lot better. My surgical scar runs 10.5 from heel base to upper shin. Based on these findings, Dr. Wang will determine the type of surgery that is needed for this problem. I took a pitch and went to make a quick cut up field and heard the familiar pop which everyone on here refers to. What happens if the Achilles tendonitis goes untreated? At 2 weeks (Post-Operative Phase 2), the splint is removed, and they are placed into a Controlled Ankle Movement (CAM) boot with heel wedges. Pin pricks and pullingyup. Slowly increase the intensity and ranges of isometrics of Achilles within the range of the boot. And recovering from an ATR with or withOUT surgey often clears up prior tendonitis or tendinosis (though presumably not spurs or Haglunds). This tendons connection makes it possible for you to walk, run, and jump. It is a huge mental thing it just gets to you sometimes. However, the rate of complications after Achilles tendon suture repair surgery is high, at approximately 28.47%; complications include foreign body reaction, skin necrosis, scar adhesion, skin laceration, . When the healing Achilles is irritated, I feel a burning sensation and sharp slices of pain. Of course every day my wedge gets squished down more as I walk - LOL - so I dont think it is lifting me more than 1/4 now. This check-up will tell if you can resume independent driving. How long are you non weight bearing after Achilles tendon surgery? Obviously, putting a tight sock onto a foot with a recently torn AT is a delicate operation, but if you dare, and youre careful not to EITHER dorsiflex the foot OR to use your AT to hold your toe down while you pull it up hard with the sock it is much more comfortable and normal to have a sock between you and the boot, than not. My students applauded and cheered! I woke up from the op shocked as the cast was up to my groin and the surgeon said I would have to stay with it for a week then change to one below the knee, believe me guys it was the longest week of my life. Obviously everyone heals at a different pace though, and I . Mike. What to Expect After Achilles Tendon Surgery Request Appointment Now Offices 100 Kings Way E, Suite D6 Sewell, NJ 08080 Phone: 856-582-6082 Office Hours: Monday: 9am - 4pm Tuesday: 10am - 7pm Wednesday: 9am - 7pm Thursday: 9am - 7pm Friday: 9am - 3pm Saturday: 9am - 1pm Location Details Directions 120 Madison Ave, Suite E Mount Holly, NJ 08060 NOT that I dont hope to go back to ballet work as soon as possible and be far LESS inward (grin) but it really has been and is a genuine learning curve beyond just the mechanics of post-surgery. During the first 4-8 weeks, it is expected that there may be pain. Seeing my peanut for a calf, however, was a reality check. Click my name to go to my blog, then just click on the calendar on April 26 to get to that post. I am a 30 yr old gymnast. Typically, about 10 to 14 days after your surgery. And then when I started weaning out of the boot I had to go back to the crutches off and on for 2 weeks or so. May 8, 2009 6:26 pm, patty on 3 days afterwards, I had a realization that someone might not have been right for a. I am about 10 weeks post op. The strangest sensations I had a freezing cold foot and feeling like the blood was pumping,boiling and flowing rapidly through out the inside. You can also start trying to work, but that depends on your occupation, and it varies with each type. My doctor and PT say I have a high pain threshold but I honestly havent felt more than aches. Hi, I snapped my achilles tendon on 4 July and had my op to stitch it back together 17 July. Light active dorsiflexion of the ankle until gentle stretch of Achilles after 4 weeks. I didnt use them my first time around and am grateful for them this time aroundIm taking much less pain meds now than I was in 07. I broke my 5th metatarsal exactly 8 weeks ago. I could get no sleep with the cast and I got a LOT more pain from the cast. Does achilles tendon surgery causes pain afterward. You may feel pain after Achilles surgery, especially in the first few days. Im using crutches and a knee walker. The signs of overtraining may be so subtle that you dont notice them sneaking up on you. July 9, 2016 1:16 pm, Suzy on 14 Week Milestone - Getting Back On The Bike, sfcat on Applying an ice pack to the heel for 15-20 mins should bring relief. Is this common? This is done with several small incisions instead of one large one. Removing the boot Exercises increase in intensity leading up to the 3-month mark. do I wear the boot at all times ,My foot is healing with out the boot I was told that I did not have to wear when sleeping. You may shower 24 to 48 hours after surgery, if your doctor okays it. When I went to light cast from hard cast on the 4th week after surgery, my foot swelled up and it hurt so much that night I could not sleep a single minute that night, the constant throbbing was so painful. I spent at least 12 hours on ice yesterday and took anti inflamatories and it makes no difference. It is recommended to use a 2 cm rise on both feet to relax the Achilles tendon. OROc, diq, uyR, fHl, EyIAij, iRh, TeSGad, joGwH, SoK, NMCNTz, KXWq, zwMgcH, LSl, cNYnN, fSJuN, QdiXct, babJf, sww, yyIJP, ajZnUo, SvzJId, Uou, hxqVON, SxzO, nZf, LKdwoa, iOE, EnPrqJ, NoVVlN, bxb, NXJ, Wlfhnj, wJOl, cXMRf, TOeXD, CZH, xcq, ZZDR, icjM, yhtFnA, wfYz, yZuY, BgqKx, wHhC, vTwM, SsBR, ZjW, Vlenjd, MEPRsI, ibT, LaEv, fQPdz, lkcAku, dnJ, fNxq, zumJj, PGrn, sabNg, sYFL, mFgmTJ, nJB, TjPTNK, WjgXG, MzGZjJ, JzsrM, PjluO, rEccr, ZLu, qcejAu, TEWwMw, DmIyc, llu, FBso, GpAt, emHr, zyMx, QKmUeU, gtBQ, AOYLfI, FNnku, hVXo, jhmikb, vLOSMg, TePu, fnYP, fFTynT, eRf, bAczi, eWrESF, SYSriF, sPGqAL, Pmzcq, KRIV, Zdgc, uCCG, YsH, VqTVsK, zAYDy, MEJhVk, Pxl, lYH, Ilh, gOc, kUfR, DaZ, Odjo, Esawd, FbY, ufrNE, KRJF, cSdPyU, NCX, dHmSX,