23JAN16- R+33 weeks, non-op, early weight bearing protocol

I have not posted in quite some time, largely because my injury no longer plays a central role in daily life (acknowledging that feels even better than I thought it would).  The insights found in these blogs and the support from the community were vital to my progress (especially in the early days) and I am truly thankful for it.  I am also grateful that all of that patience and effort paid off and that I now find myself “nearly normal” again.  I still avoid tennis and other activities that would require an explosive push off, but I am active again in all of the other activities I enjoy (biking, swimming, running, hiking)… and it is so satisfying.

As with other phases of my recovery, the past couple months have involved a dose of judgement and moderation.  I was thrilled when I regained the strength to run again (typically 1.5-2 miles)… but discovered that a normal stride would result in some post-run AT soreness for a day or two. It seemed that I was flirting with possibly damaging tissues that I wanted to be as strong as possible over the long haul, so I prescribed a break from the impact of running (since a poorly executed stint of barefoot running seems to have contributed to my AT rupture, I may be a bit paranoid).  I decided at around R+26 weeks to stop running for awhile to allow things to heal further.

My next run was at R+32 weeks.  I found myself in a scenic town and decided to jog to a historic area… it turned into a 5.5 mile round trip, and everything felt fine afterward.  I did opt for a higher than normal cadence and minimized push off (e.g. more of a shuffle than my normal running stride), but that hardly seemed like a big sacrifice.  It is so satisfying to be able to get back out and enjoy an activity that has been a big part of my life since my teens (a long time ago).  I went out for a 2-mile run yesterday at just over 9 min/mile pace, and was very pleased at how the AT felt during and afterward.   I will continue with the high-cadence, minimal push-off stride for now, and slowly transition toward a normal running stride over time.

Progress in other activities:

Walking-essentially normal looking, but I do have to focus at times to pull that off because my right (injured side) calf is not yet as strong as my left.  The bottom of my heel was sensitive for a long time after my transition to two-shoes.  While that sensitivity is much less than it once was, if I stand in one place for too long I do feel it.

Swimming-In flip turns, I used to push off mostly with my un-injured leg.  Now I use both legs equally and never give it a second thought.

Cycling-The AT is probably ready for anything at this stage, but I do not accelerate as aggressively as I once did.  This is probably more of a psychological limitation than a physical one.  I’m not racing anyone, so don’t feel rushed to push it just yet.

My biggest remaining hurdle is to regain strength in my right calf.  Although I have functional strength back, that calf still is only capable of a comparatively wimpy single-leg heel raise and is still visibly smaller than the left.  It has been too easy to lose discipline and not exercise it as I should, and my focus over the coming months is to bring it as close to its original strength level as possible.

Lessons learned worth sharing:

-Be diligent with your PT.  Progress won’t happen without your deliberate effort.  At every phase, you should actively seek out the activities that will escort you to the next level of progress.  E.g., in the first few weeks those small movements when out of the boot keep things from seizing up, so that you will have less stiffness to combat when real exercises begin.  Every week or two, you will probably be ready to introduce new exercises and activities.

-Listen to your body.  Every Doc and therapist has to guess a little about where your body is and what you can do.  The line between harmless discomfort you should work with and pain that means “stop!” is one that is not obvious in the early days, but that you need to figure out.  Doing exercises with some discomfort is just part of the program, but ignoring pain can cause real trouble.

Best of luck to everyone on our own path to recovery.

  1. BobFV Says:

    Hi Evan - congrats on your progress. I am about the same as you in terms of time - my surgery was 5/20/15. I can do anything, like you, and sometimes forget about the injury. I have intentionally decided not to try running until at least the 9 month mark, which comes up in a few more weeks. I have no doubt that I could run, but am instead focused on strengthening because like you, I can only do the wimpiest calf raise on the bad side. For my daily aerobics I have taken to 40-60 minute fast walking on the treadmill, including using a gradient up to 10 percent - it gives a good workout similar to a run without the impact of running. Keep up the good work and best of luck to you in your continued recovery.

  2. Manny Says:

    Thank you, ejbvmi and Bob for your comments and thoughts. I am still in my second month, in the boot, and am learning to live with the necessary aches and pains of healing and recovery, while alert to the warning pain.
    I’m non-surgical and am working hard with my PT team to get the best possible recovery, since I love walking, dancing, and going places.

  3. beanie Says:

    Hi Evan, congrats, it sounds like you’re nearly 100% now! Thanks for keeping such and excellent blog and for all the YouTube videos you made. They really helped me and I keep pointing other ATRs to them as well. Very much appreciated. All the best for the remainder of your recovery, I’m sure you’re hardly going to remember you had an ATR by the time a year has passed.

  4. ejbvmi Says:

    Thanks, Bob. The incline treadmill walk sounds like a great idea. How is your dorsiflexion limit? I find that tightness in the the top/front side of my ankle is the limiting factor, not the AT, and that I still can’t reach the same angle that my good foot can.

    Good luck, Manny and beanie! Thanks for the feedback, and be patient. It is far easier said than done during those early weeks, but it pays off in the end.

  5. Lin Says:

    Hi Evan,

    Thank you so much for posting the videos and the blog. Your videos help me decide to go for a nonsurgical treatment. My Achilles tendon was ruptured about a month ago while I was playing badminton. Please continue to blog about your recovery progress. I hope you can play tennis again someday soon.


  6. Allan Park Says:

    Hi Evan,

    I just wanted to tell you how awesome your YouTube vids and blogs are. 1 week ago today I had a complete rupture of my Achilles’ tendon while I was playing squash. I too am going the non-surgical route.. A recommendation given to me by two surgeons. I’ve been feeling pretty helpless as I have been in a cast for the last 6 days, but today I changed to the boot! I see the progress you made by week 4, and that gives me lots of hope! I am starting off with a 6cm lift… Is that about the same as you? I get to drop to 4cm in another 1-2 weeks! Thanks again for the video that was so relatable! Everything you talk about is what I am going through. Congratulations on your recovery! I feel like I will never take waking for granted again..
    Allan- Canada

  7. Justin Says:

    Hi Evan - thanks for your blog. Very informational and inspiring. Congrats on your recovery. I was just curious - did you feel any tendon soreness/tenderness around the time you came out of the boot and started walking, and if so did it persist, and when did it subside? Appreciate any feedback you have. Thanks!

  8. ejbvmi Says:

    Sorry for not replying sooner, Lin. I am glad that the injury is no longer a focal point of my life, but still should check in more often. How is your recovery going? Hopefully you are in two shoes and progressing well. One big lesson learned worth sharing: protect your heel. A sore heel was my one residual pain, but memory foam insoles have helped a lot. If I had used them from early on in my return to two shoes, my heel might have been less painful over the ensuing months. Good luck!

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  9. ejbvmi Says:

    Thanks, Allan, and sorry for not replying sooner. I think your heel wedge was a bit larger than mine was in the beginning, but that seems to be writhin art area of managing the recovery. The big thing is walking on it as early as practical, and it sounds like you did that. How is the recovery coming along now? Be sure to cushion your heel well. I highly recommend memory foam shoes (mine are Sketchers) and insoles. They have helped me overcome my sore heel, which was my last residual aggravation from the injury. Good luck!

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  10. ejbvmi Says:

    Sorry for taking so long to reply, Justin. Yes, I had significant tightness, and it was a regular balancing act between (being active and making good progress) versus (pushing too far, getting sore and being concerned about hurting the tendon). Sometimes I would take a few days off from exercises if I had pushed too far. How is your recovery coming along?

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  11. Justin Says:

    Evan - thanks for your note. Understood and thanks for your insight. I’m about 18.5 weeks out from my rupture, non-surgical early weight-bearing approach. I was a bit delayed in my recovery and didn’t get my boot off nor start PT until the end of week 11, but since then I’ve caught up exponentially. My PT is pretty impressed at how my recovery has gone given no surgery and said I’m at least at the same level or better than where I’d be had I gotten surgery. The first day out of the boot my tendon was extremely weak but since then has gotten a lot stronger. The first month or so of PT and out of the boot was met with a ton of soreness and stiffness but I’d say the last 3 weeks has been extremely positive - limited soreness in the tendon and truly feeling muscles getting worked. Walking is near-normal. I’m extremely far away from doing a single-leg calf raise on the bad leg but I can hold the bad leg up for a few seconds after going up on both and releasing the good. I won’t be cleared for any running until the calf strength comes back so I’m curious how strong your calves were when you first started jogging. Thanks again for your blog and appreciate any feedback.

  12. ejbvmi Says:

    Thanks, Justin. My “run” was more of a shuffle for a few months, and whenever I tried pushing off with the calf the AT would be a bit warm or sore… precipitating a break from running for a few days or more to recover. The calf strength recovery has been gradual but steady. I got out of PT routine due to work travel and complacency, but at month 10 hit an inflection point where my running mechanics returned to normal and pushing the pace no longer caused any post-run discomfort. My single-leg calf raise is still not the same as the other leg, but the calf strength and circumference are steadily increasing. With better attention to strength conditioning, you can probably have your calf closer to matching the opposite leg by your anniversary. Just listen to your AT and set the throttle accordingly. One steady recovery is far better than starting over with a re-rupture. Good luck with your recovery, brother!

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  13. Justin Says:

    Evan - appreciate the words of encouragement. At this point I’m able to do a very weak single leg raise and the eccentrics are strong than even a week/2 weeks ago. It’s incredible how the body is able to recover naturally. Have you been able to do more explosive type movements / sprinting? I’m curious how your power level compares to pre-rupture. Thanks again for all of your insight.

  14. Suleiman Akhalwaya Says:

    Names Sulaiman from South Africa. Am a 39yr old male.Was playing soccer today 17/07/2016 and heard a pop, was stretched off and strapped my leg as I suspected Achilles tear.
    ER is closed for non lethal injuries so I have to wait till tomorrow to visit a physio and then an ortho specialist.
    Currently doing RICE treatment. I’m not sure what’s going on… Need advice as I don’t want to do surgery. Family has a history of Achilles tears with both younger brothers having had operations done. Advice me…..

  15. ejbvmi Says:

    As an introduction to the topic, I would recommend reading the article at the first link, and the summary that “Norm of the North” compiled at the second link:



    The short answers are:

    1\ Have you performed a “Thompson test”? If you squeeze your calf muscle with your foot hanging, your toes should move away from you. If your “good” foot does this and the injured one does not, that is probably a sign that you have a rupture. The ER doc will do this as part of his assessment.

    2\ I am NOT a doctor, but my own experience and lots of studies show that early weight bearing protocols result in much better outcomes than being in a cast for a long time. I was in a boot from day 3, partial weight bearing at 2 weeks, walking without crutches at 4 weeks and walking without in regular shoes at 8 weeks. I am over a year post-injury, and pretty much back to normal except for needing to strengthen my calf a bit.

    3\ Some patients need surgery. I was one of the large majority who do not. Surgery was offered as an option, but since the studies show that it would not improve my outcome but would increase risk of infection, nerve damage, etc… I decided to go without surgery. Some doctors are adamant about surgery. If the doctor you see will not explain why surgery is needed in your case, then I would suggest finding a doctor that is willing to have an informed discussion about it with you.

    Please let me know if you would like a copy of the recovery protocol I followed. Good luck with your recovery!

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  16. justin Says:

    just an update and potential message of encouragement - i am roughly 8.5 months removed from my achilles tear with a non-surgical recovery. at this point i’d say i am 80-85% of the way recovered, with 100% being my status prior to injury. i’m able to run/jump with ease but the main difference is strength, explosiveness, and general soreness after long or hard work-outs. long days of walking will also cause some soreness/stiffness the next day. my single leg calf raise is probably somewhere between 50-75% of my healthy leg with the main difference being strength and stamina. i would say i’d expect to be around 90-95% recovered by the 12 month mark.

    the key to the non-surgical approach is patience and time: you probably won’t see much of a response to the thompson test until 2.5-3 months out from injury, but don’t let that deter you from taking a pro-active approach to recovery. muscle preservation and controlled, time-laddered weight-bearing in the walking boot is key. your achilles will heal naturally but the hardest work will be keeping patience during the healing process and finding a very good physical therapist once you are out of the boot.

    good luck!

  17. jone Says:

    Hi Evan,

    I would guess that you are not following comments from this blog anymore but I thought I would give it a try anyway. First of all, thank you for your videos, they encouraged me to take the non-op route after seeing how well things had gone with you.

    It seems to be incredibly hard to find any information about random pains that occur during recovery from this injury, I’m currently 6 weeks in and FWB. I can feel a response from my calf muscle which is great but at times during walking or even just tensing the muscle I get shooting pains like electric shocks, it’s the same if I try to point my toes down, there is a pain up the back to the point where I think, ‘I better get back on the crutches’! I did a lot of walking in Corwall this past week which has a lot of hills and uneven pathways ;( I’m wondering if I’ve set myself back a few weeks or this is just part of the process.

    My protocol was 7-10 days cast then boot, work to full weight bearing over those two weeks then FWB as tolerated after the 3 week mark, I rested when it started to get sore. I didn’t have a scan, just Thompson test to confirm.

    If anybody has any experience with this please let me know as getting an appointment with the hospital is next to impossible before the next appointment in 2 weeks. It’s slightly freaking me out because I’ll be down to 0 wedges at that point and don’t want to damage it further

    Thanks to anyone who can share a similar experience.


  18. ejbvmi Says:

    Sorry that I did not see this comment sooner, Jon. I hope that you are doing well. I can certainly recall a number of seemingly random pains, in my foot and along the AT during recovery. I interpreted some of those as warning shots across the bow regarding something that I had done, but some of them may have been just part of recovery. If the pains were concerning, I would put a wedge back in for a few days, put the boot back on for extended walking (after I had transitioned to “two shoes”), or simply rest a bit. The pain in my foot, in particular my heel, continued for several months. Memory foam insoles really helped, and I would recommend using those as soon as you jump into shoes again. If the pain is significant and continues, it may be best to talk to your Doc to rule out a re-injury. Best of luck with your recovery.

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  19. Pas Borsa Says:

    Hi Evan,
    A very informative recovery journey. Thanks for sharing. At what stage in your healing were you able to drive your car?
    Can you share your time line and any thoughts/tips on how to approach getting behind the wheel and on the pedal after the boot comes off.
    Would appreciate if you could offer advise and your particular experience.

  20. cserpent Says:

    I had bone spur removal so achilles was cut/reattached. You can check out my blog for my full timeline. First surgery was on my right foot so I couldn’t drive until my doc tested to make sure I could push the pedal - that was at the 6th week mark. This was also when I started walking in the boot. To drive I took the boot off, put on my shoes with lifts in them and drove. To get out I had to reverse the procedure since I was still in my boot 100% of the time. As I transitioned into shoes everything got a lot easier - LOL! For my left foot surgery in August I’ll be driving at 3 weeks. The first 3 weeks I’m spending with the foot elevated 90% of the time so hubby drives me to doctor appts while I recline in the back with my foot elevated.

  21. Pas Borsa Says:

    Hi cserpent (sorry didn’t name),

    I injured (ruptured) the Achilles (right foot) on June 19, 2018. It is encouraging to hear that you were able to drive at week 6 of your recovery albeit removal of boot and then putting it back on after driving. How did the Doc test to ensure that you could push the pedal with enough pressure?

    I have chosen the conservative non-operation route so perhaps it might take a bit longer. My goal is to drive by the 1st week in September(in about 12 weeks),..earlier would be better!

    At what point did you transition to 2 shoes?

    I will check your for the full timeline.

    Thank very much

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