The Waiting Game

Two weeks after my Achilles tendon rupture, I’m waiting for my recovery to begin. Here’s basically what happened so far:

  • 02/12: Injury and trip to ER, where I was diagnosed with ATR and surgery was recommended
  • 02/17: Follow-up appointment with orthopedic surgeon, who diagnosed it as ATR and recommended surgery
  • 02/19: Radiology appointment for ultrasound, to see the extent of damage
  • 02/24: Follow-up appointment with orthopedic surgeon to review ultrasound and (once again) confirm surgery
  • 03/06: Scheduled surgery (this was apparently the earliest available time slot)

So my scheduled surgery will be more than three weeks after the initial injury. Everything I have read and heard suggests it is better to do the surgery soon after the injury, but I can’t find any details about why, exactly. Is the surgical repair more difficult? Does waiting make the recovery process less successful? I’m concerned, but not sure why.

The delay also makes it seem like my recovery has not yet begun. The ER doctor put me in a boot, which I have been wearing since. He said it was fine to put weight on it, and after the first few painful days, I am full weight bearing without discomfort. At this point, though, I am not actually healing. I am just living my life with a torn Achilles until surgery day finally arrives.

9 Responses to “The Waiting Game”

  1. Hi Achillias

    At 15 days, being in a boot is where the best protocols would have you, with the foot angled down to around 30º, and beginning to weight bear. I don’t know if you have the foot down but assume you have, as it is the normal position for a newly diagnosed atr, for up to 4 weeks.

    From what you’ve written, you may be well on the way to healing in a sound non-operative way. What makes you think that you are not healing? Don’t expect a Thompson test to show success just yet.

    Also, what country are you in? There appear to be significant periods between each of the events described above.

  2. I shared your concerns about any delays in getting surgery so asked my surgeon about it. He told me that it makes no difference at all and not to be worried about it although there was only a week between my rupture and the surgery.

    Have you asked the reasons why surgery is being recommended as at 3 weeks your tendon should be starting to repair itself? Maybe there is a large gap between the broken ends of the tendon?

    Opinion is very divided on whether or not have surgery so it’s probably best you have a discussion about your options with the surgeon as you would expect him to have a reason for recommending surgery.

  3. Thanks for your replies. The surgeons recommended surgery because I am in my 30s and like to stay physically active. Their understanding was that the non-operative option is fine for returning to daily activities, but the surgical repair is stronger for athletic activities.

    hillie, you are right that I am technically healing at this point. But because we already decided on a surgical repair, it feels as if the recovery process won’t actually begin until after the surgery. I assume that the post-op recovery will be the same, regardless of any healing that takes place before? If so, it seems like three wasted weeks.

    I’m in the United States, where the healthcare system is fairly slow, in general, and I have become very frustrated with the delays between each appointment and the overall wait to get the surgery.

  4. Sorry about having to deal with the delay, but as bailey indicated, I don’t believe there is any issue other than a delay to the recovery process. (from what I’ve read). I think the real advantage of getting in early is so you can start recovering sooner. I feel for you though, as I had a week wait until surgery and just the anticipation was brutal. You’ll get there though and be recovering before you know it. Best of luck!

  5. Aloha,

    I was misdiagnosed initially so it delayed my surgery by about two weeks. Just got mine done this past Saturday. Everything seems fine so far. The first two days were brutal but that part is behind me now.

    Good Luck!

  6. The Time thing goes like this…if you have a rupture and are not diagnosed for a long period of time you will find yourself in a situation in which you have to have surgery to repair it, thus loosing your chance to choose to go non-operation, and you will have most likely done more damage using the foot in all that time, so the repair may be more involved.

    I’ll echo those hear who’ve said most get you into surgery, if that is what you choose, asap to start the recovery sooner and because it is a painful situation for some although not everyone.

    Since you were diagnosed asap and you are in a boot you are fine waiting until surgery.

    Once you were put in a boot in the ER, if as Hillie said it was set properly at 30 degrees plantar flexion and you did not weight bear for the first two weeks, you were already in a non-op protocol and are healing.

    As Hillie said: “From what you’ve written, you may be well on the way to healing in a sound non-operative way.”

    I hope along with all the other responses here, that your worry is alleviated.

  7. Regarding surgery being stronger for sporting people you really should ask why. Surgery holds the tendon together with sutures until the body fills the gaps with collagen. The first lot of collagen is laid down between 3 weeks and 6 weeks. It is weak and disorganised but your tendon is joined together. Once you start working the leg again the good collagen forms. It is aligned with the force (not Luke’s) and it is strong, much stronger than sutures. This happens whether you have a surgical repair or not so there is no sense to what these doctors have said. The important thing about the non op process is that you can get the ends of the tendon to approximate so the body can fill the gap and your tendon will not heal long. Old information using lengthy casting and non-op has been shown to have a higher re-rupture rate than a surgical repair but that is mostly in the first 12 weeks after which the re-rupture risk declines. I wish I had all this information before I had surgery but instead I was given outdated information by someone who had only read the textbook. There are many examples of active sporty people here who have gone non-op. Hillie is one. Normofthenorth is another. The trick with it is to use a more modern protocol. The expert doctors have agreed that is does not work for all and those few patients usually end up in surgery a few weeks on. This is usually because the ends could not get close enough and there was a gap in the tendon so don’t worry about having surgery 3 weeks on if the need arises. In the meantime research all your options, make your own informed decision and then be at ease with it.

  8. Hey Achillias- looks like some good advice has come your way from the blog community. For what its worth I am also active in lots of sports and don’t feel that the non-op recovery offers a less than equal recovery- at the 6 month mark my tendon is strong and scar free. If you do end up waiting for surgery then you will be fine, the recovery period will just be longer.
    Good luck!

  9. my doctor waited 1 1/2 mo. to operate. this is so madening. Im 65. This sounds like hell just because I given Cipro antibiotic. This drug caused my rupture.

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