Tendon thick - is that normal?

I’m at 19 weeks post surgery.  Sometimes, I can walk almost normal.  I have a little limp later in the day if I walk a lot and the first steps in the morning are still quite painful and stiff.  My repaired tendon is really thick compared to the other.  Is that normal?  Will it ever go back to regular size?

21 Responses to “Tendon thick - is that normal?”

  1. armydude618 Says:

    When I ruptured my left 2 years ago and was going through rehab I was urged to massage as much as possible to break down some of that scar tissue. What you think may be a thick tendon is most likely scar tissue underneath. Warm baby oil gel and a moderate deep tissue massage in the area and you will start to see some normalcy within a couple weeks or so.

  2. univofpittbull Says:

    My surgeon told me my AT will be extra thick for a year or so and then it will start to shrink a bit. He also said that it will never get back to its original size. Armydude is right though, massage really helps get the size down as it breaks up some of the scar tissue and softens the tissue. It also increases blood flow down there which aids in healing.

  3. dancingbunny Says:

    Hi there,
    I’m wandering about the same thing. I’m almost 6 months after ATR, and I went with non-surgical way. My left AT did heal much thicker than my good one. My doc said it was a good thing, and eventually it will be back to normal. I still feel pain now and then while moving, wandering if it’s caused by scar tissue breaking up? So it’s a good pain? It sounds like without breaking up those extra scar tissue, how can my thickened AT back to normal size?

    Any advice is appreciated!

    Happy Friday!

  4. ultidad Says:

    I’m 2+ years out and most of my tendon is roughly twice the thickness of my non-injured one. The only part that is closer to non-injured side is the lowest 3/4 inch.

  5. rome24kr Says:

    I had my surgery today 11-18-11, and my surgeon stated that my AT was smaller than the average persons. This came as a real suprise to me, and I am wondering if this will cause my reconstructed or my good AT to rupture in the in the future??? Granted that I complete my rehab and therapy.

  6. Bronny Says:

    Hi there, not been here for ages as I’m almost 18 mths post ATR, non surgical. I had a great recovery and am back to pretty much everything I did prior. I saw my PT last month about something asked and she checked the Achilles too. She has now got me doing strength calf raises as though the calves are similar in size now, one is clearly dominant, u can feel this when u touch it. Anyway the tendon is also fat…she said this will thin down over time as I get my calf back to being equal to the other one. So rather than the sets of 20 calf raises I was doing, she has me doing 1s up 5 s lower for 5 sets of 5 reps. Started with 5kg dumbbell in hand and now up to 20kg.

  7. nick Says:

    Two years ago I fully ruptured my Achilles tendon. Within 3 days I had surgery to repair and was put in a cast for 8 weeks post-surgery (my leg was in an immobile, hard cast).

    After removal of the cast, several of internal stitches that were meant to dissolve, had not, and were visibly poking through my skin. After a few weeks, one of them was naturally discharged and a small, blue, knotted stitch “popped out.” (It literally came out of my skin and I was holding the small stitch in my hand)

    One of the stitches was never discharged. It caused discomfort for several more weeks, but I presume that it eventually “dissolved” as it was designed to do.

    However, at the site of that stitch, I now have a skin to tendon adhesion. It is sometimes painful and causes my skin to “pucker up” during plantar flexion of the calf muscle system.

    I went through post-operative physical therapy, which included techniques to break up adhesions. These included Graston technique, massage, ASTYM, Active Release therapy, and self massage (in addition to general strengthening and flexibility exercises)

    The skin to tendon adhesion causes some pain and discomfort and also restricts my range of motion and flexibility. I believe that it is also inhibiting a full recovery of muscle strength in the calf.

    My question: What other options do I have to break up skin to tendon adhesion in my Achilles? Have any unorthodox techniques worked for anybody? I will try anything at this point.

  8. Wenda Says:

    Hi nick, your pst was about 7 months ago regarding the adhesion of skin to tendon. I have the same problem. Have you had any success on the treatment of this? I am only 7weeks post op, but I honestly think the only option in a case like ours is surgery. It shouldn’t be a huge operation. I will be seeing my PT early next year and will discuss this option with her and let you know. I had complete rupture on left side while jump style dancing. Had percutaneous repair. I live in South Africa. The surgeons here follow a rather concervative rehab protocol. I am doing ROM exercises and massaging on my own account as well as PWB. Hope you are healing well.
    Regards Wenda

  9. normofthenorth Says:

    I hope Nick “hears” and responds, Wenda. Me, I’d be patient for now. 7 weeks is way different than Nick’s 2 years. The techniques that didn’t work for him DO break up many or most post-op adhesions (most of which are NOT caused by errant sutures), and may well work on yours. There’s a limit on aggressive approaches this early in your recovery, too.
    If internal sutures are causing your problem, getting them removed is the answer. The op and the recovery are both quicker and simpler than ATR repair. GerryR’s blog here has his unusually long but successful story, including a total of FOUR surgeries.

  10. Wenda Says:

    Normofthenorth, you are spot on with the patience part. I do tend to be really impatient. Thanks for responding and reminding me! I am now at week 10 and get physio on a weekly basis. It is a really hot summer in South Africa and I decided to go for a swim today. If there is one thing I’d advise anybody to do, then it is to swim and use the water to get a good (and safe) workout. It did absolute wonders for my foot. I’ll try to do it at least 3 times a week. As for the adhesion, it is still very obvious and quite painfull. I am seeing my surgeon tomorrow and will ask him about the options(other than months of trying to treat it conservitavely)…he”ll probably also say, be patient haha! But what the heck! One thing is sure, there is no shortcut to recovery. But there are ways of making it more bareable. The fact that there’s others out there who’ve ‘been there’ is just SO comforting. Thank you for the guidance and understanding. Regards

  11. Wenda Says:

    Thank you normofthenorth for responding. I’m now 10 weeks post op. Seeing my surgeon on Wednesday! I know, I am not patient. The adhesion is still prominent and painfull. They do work on it durin PT, and it is improving slightly. Today I started swimming again and one thing is sure, I’ve had three sessions of PT, but the hour in the pool did more than all three the sessions combined. If possible, I’d advise everybody to opt for the aquatic exersise. And be carefull and patient, this is a injury that takes a lot of time and patience to heal completely…no shortcuts. I think that early ROM exercises are benificial and a positive attitude combined with a healthy lifestyle helps. But patience is the key word. What also carried me through this thus far is the advise and guidance of all the peers and fellow AT warriors :) …thank you!

  12. normofthenorth Says:

    Be patient, but don’t follow a slow protocol! ;-)

    Almost everybody who’s exercised in water during ATR Rehab — swimming and also heel-raises in deep water, walking normally while you still can’t do that on dry land, etc. — loves it. Don’t get your incision upset (or infected) if you’re post-op, but otherwise it’s highly recommended.

    And Wenda, I’d be surprised if surgery WERE an option in cases of nasty adhesions like Nick’s (and maybe possibly yours, too). The problem is adhesions are primarily caused by surgery, and mostly cured non-surgically. Every time our tissues are cut — even a single layer, but especially two or more layers at once — the amazing healing and reconstruction response our bodies throw at the injury (I mean the surgery, not the ATR) causes tissues to grow in ways that are a combination of well-planned and . . . frantic. Some of those tissues grow right into and onto the adjacent layer of tissue, which is what forms an adhesion that keeps those tissues from sliding over each other. Slicing into them again just restarts the (frantic) reconstruction again. . .

  13. Wenda Says:

    On the adhesion again, nine months or so later and the answer to this too is patience! That and deep skin massage. It will eventually break loose. Even if its painfull, try and massage it with as much pressure as you can give and handle. Baby oil or tissue oil or any oil of your choce. Daily or as many times you can! You can even manually try and loosen the skin with your fingers. The physio therapists does this too. Just be carefull not to hurt the skin. Again, everything will eventually get better and better as time passes…patience and work at it! As for the thick tendon, the massage really helps with that too!

  14. Garry Says:

    So I had 6 months off with a series of medical screw ups, from an initial misdiagnosis of a double hernia, leading through various scans to me being cut open and being told “can’t find owt…. must have been a groin strain”
    So 3 months after I’m back running. Doing a steady race and the next day – a serious “Ouch”. I could weight bear, I couldn’t weight move. I googled and realised I’d screwed my Achilles. With my experience, I didn’t go back to the Docs. I strapped it up and after a month or 2, I’ve gradually got back into it. Non impact. Swimming, cycling, yoga, core. Tried the Kinesio tape for a while. It’s gradually loads better. But I’m still not running more than 100yd. I don’t trust it. I’ve got several months invested in recovery. I did it Sept ‘13, it’s now June ‘14. I’m also introducing some careful barefoot walking, thinking this’ll gently stretch it.
    I figure that I’m going to be ‘out’ for 12 months at least (It’s taken a while to come to terms with that) But I want it to be right, not go through another year like this.
    Anyway, thats enough background? My question: One thing I do have is a notably thicker Achilles on the damaged leg. Any home methods for reducing it? I’m currently foam rolling and when ‘our lass’ was pregnant I got a TENS machine which I’ve tried and occasionally seems beneficial.
    Any other tips? Either for reducing the thicker tendon, or otherwise.

  15. normofthenorth Says:

    First off, if you really ruptured your AT (& it sounds like), I hope your “cure” was close to one of the new non-op treatments - e.g. those at /Cecilia/protocols. Just wrapping the thing up and semi-ignoring it usually works badly. (The good bad news is that Belfast’s Dr. Wallace managed to fix most of his “stale” ATRs and ALL of his reruptures non-op, using a simple “trick”, so you won’t have to get another unnecessary surgery, even if this cure fails.)
    The fat AT usually thins gradually over the years, as it’s used. Me, I’d just ignore it, but some therapies might speed it up. Maybe finger and thumb squeezing massage while moving the tendon in the opposite direction? I.e., slide your hand down toward the heel as you point your toes, and up toward the calf as you dorsiflex. (A home exercise from my PT that feels like it’s doing something.)

  16. Mo City Mike Says:

    I incurred a complete achilles rupture 1/08/15…had my surgery 1/19/2015… i am in 3rd week of physical therapy and have recently started weight bearing.. actually walked without boot on today…. the AT of course is still crazy phat compared to the non injured tendon…. my therapist hasnt started the deep massage yet. he plans to start after my 4th week…. did some leg press work today which felt great… i was blessed with very defined calf muscles and th e atrophy had me very depressed…. but now that i am able to flex work the muscles my spirits are lifted…. 1 thing my therapist and surgeon stress is working on it at home… massaging and stretching is essential…. glad i found this tread… wish everyone continued healing and speedy recovery…

  17. Lewis Johnson Says:

    How long does it take for dorsiflexion to fully return. My Achilles has no slack to perform the function. Assume I need another surgery. Equinus deformation is caused by a botched surgery from incompetent doctors. In chronic ruptures the Achilles retracts requiring tendon lengthening. Not sure I have that by the tension place on tendon in the neutral position. Anybody had any similar experiences. My injury occurred on 4/13/15, had surgery on 6/03/15 due to orthopedic surgeons denying me constantly. Thanks

  18. Lee Says:

    Just found this site. It’s nice to hear other people sharing with similar struggles (sad on the struggle we all have…but knowing “im not the only one” is a relief.

    So I had Haglund Deformity. In short… I had a large bone spur on the back of my heel that pushs on your Achilles. Through the years the spur got larger and I just dealt with the discomfort. The Dr’s always said the only option is to surgically remove it which I avoided for 8 years. But last year while running around the bases playing softball (I’m 41) I felt a pop. But it was not my Achilles but actually the bone spur fracturing! So the next day the Dr said I need to have it surgically removed or the bone could float around and really do some damage. The first surgery, almost a year from today, was to detach my Achilles, cut the bone spur out, then reattach the Achilles. This was a success however while recovering my stiches got infected! (Ack!). As a result I had to have a 2nd surgery to clean out the infection. 2 months after that, I still had an open wound. VAC system, antibiotics, etc… my heel still was not healing. An MRI showed my body was rejecting the anchors in my heel so a 3rd surgery was necessary to remove the Achilles anchors. Fortunately it’s been at least 6 months before the anchors were removed so my Achilles attached back to my heel bone and the anchors weren’t necessary anymore. So I am now 3 months post surgery, my heel stitches are healed up and now I’m just now cleared for PT. I can walk, jog (somewhat), etc. however I still experience pain when I walk. I fear a lot of scar tissue must have formed during recovery and I have been concerned of the pain I experience every step. Thank you all for your suggestions on the oil/massage idea to aid in breaking up the scar tissue. I pray this resolves my pain issues as I simply want to be pain free. Thank you for reading my novel and also thank you all for sharing your stories as well. I hope we ALL get back to 100%!!

  19. David Martin Says:

    I had an achilles rupture and a successful operation– no re-rupture. However, I was told that there are permanent stitches in there. Has any one else ever been told this ?? My achilles is still twice as big if not more than the other one, after more than 10 years.

  20. cpo Says:

    David Martin, I am one year post-op and my tendon is probably twice the size of my uninvolved leg. That said, it doesn’t affect functionality in any way so I just ignore it. I was told that I may remodel a bit after a year, but not to worry about it.

    Re stitches, as best as I know I do have permanent stitches. I had “mop ends” at my rupture so first my tendon ends were wrapped in thread before being whip-stitched together in four places.

    I hope that helps!

  21. James78 Says:

    As you gone through a surgery even it is little but have some effects upon your body. It is recommended to engage yourself in some activities to extend the range of muscles. As a medical students, I hired paper writer for my muscle based assignments that was completed perfectly and I am going to present it in the college.

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