97 Responses to “ATR Rehab Protocols, Publications, Studies”

1. brendan, on March 8th, 2008 at 6:52 pm Said:

   Anyone know what ADL or AROM stand for in the workers comp post op guidelines document?

2. Ross, on March 8th, 2008 at 8:09 pm Said:

   Brendan..
   ADL= Activities of Daily Living
   AROM= Active range of motion

   just had surgery on my AT…I am chiropractor so I have dealt with the acronyms..let me know if you need anything else

   Ross

3. Stephanie, on March 16th, 2008 at 9:18 pm Said:

   one more thing before I go….I think I have saved so much money because I can only pick up things that I really need… No more shopping til I drop….LOL :O)

4. dennis, on March 16th, 2008 at 9:58 pm Said:

   Stephanie,

   I think I’ll have to add that one to: Bright Side of ATR

   Welcome to the ATR team. I wish you speedy recovery. How is the walking going for you?

5. Jim, on March 20th, 2008 at 9:14 pm Said:

   Dr. Ross, do you have chapter 6 from the article “About Tendons and Ligaments”? I would love to see that since it talks about the most effective rehab exercises.

   Thanks

   Jim

6. Doc ross, on March 24th, 2008 at 11:00 am Said:

   Dennis..

   Not sure if I sent this to you…but a good web of water rehab for ATR..
   http://www.hydroworx.com/rehab-and-performance-applications/sub-section.aspx?sectionId=1&subsectionId=5

   Doc Ross

7. dennis, on March 27th, 2008 at 1:00 pm Said:

   Good news!

   It’s taken a few weeks for me to get hold of this paper:
   Early Weightbearing and Ankle Mobilization after Open Repair of Acute Midsubstance Tears of the Achilles Tendon

   I was able to get it through a personal contact.. here it is:
   http://achillesblog.com/atr-rehab-protocols/

   It may be on this site temporaily as it’s an article you have to pay to access..

8. dennis, on March 27th, 2008 at 1:03 pm Said:

   If there are other articles that you wanted to read, but you could read only the abstract (requiring a fee or a subscription), please let me know, and I’ll see if I can also get those too.

   If there are issues with legality of this, then I’ll have to take it down at some point, and I may have to do my best to summarize the findings instead.

9. zurichfan, on May 30th, 2008 at 3:30 am Said:

   These were terrific! Thank you for sharing!

10. John Kelly, on May 30th, 2008 at 9:01 am Said:

    Dennis,

    As Doc Ross said donation time, keep up the good work !

    

11. Gonzalez, on July 10th, 2008 at 1:07 pm Said:

    Hi, I just had my op to repair my ATR 3 weeks ago I will be seeing my dic in a couple of days to remove the staples and replace the cast. Please advise what am I expecting to come when I see my doc for my first follow up? Thank you

12. catnboot, on September 4th, 2008 at 5:21 pm Said:

    Does anyone know if this injury, even after 1 or 2 years in recovery, means that the tendon is not as hardy as a tendon that has not had the injury?

13. lauran, on October 24th, 2008 at 11:53 pm Said:

    This is a very nice and interesting article which tells about ATR rehab.
    ———————-
    lauran
    Alcohol Rehab

14. Daniel, on January 6th, 2009 at 1:07 pm Said:

    hi, it’s been about 8 weeks after my surgery and my foot can move upto angle 80-90 degrees to my leg. my first rehab is tommorrow and I am getting a bit nervous about the “re-rupture”. Is it possible to be re-ruptured during rehab sessions?

15. delaneybill, on March 31st, 2009 at 7:54 pm Said:

    Anyone who is really interested in the article tendon_info.pdf that Dennis has posted here can find the book for sale at this URL
    http://www.redwingbooks.com/products/books/TenLigHea.cfm

16. Don, on April 26th, 2009 at 11:22 am Said:

    For people with chronic achilles tendinosis this new procedure may be of interest.

    http://www.sciencedaily.com/releases/2009/04/090423132910.htm

    Don

17. José, on May 24th, 2009 at 5:59 pm Said:

    Hi: My name his José and I ruptured my achilles tendon about 8 months ago. I went under percutaneal surgery, inmovilization for a month, and then rehab for about 10 sessions. After that I started riding my bike and i kept doing rehabilitation at home. Im prety ok now, it dosen´t hurt and the length is normal, however I have an abormal hipertrofy. I had ecotomography made and acording to the radiologist, it looks awfull. My question is. Is there any treatment for this at this stage?

18. ray, on July 16th, 2009 at 4:37 pm Said:

    Ruptured in January and reraptured 12 weeks ago
    I have now been walking without aids over 2 weeks
    Physio in the morning still very worried of another rerupture. I have had no surgery

19. trisportgirl, on July 16th, 2009 at 9:54 pm Said:

    Ray, what happened when you re-ruptured?

20. annieh, on July 17th, 2009 at 4:49 am Said:

    Ray,

    It might help us all to know how it happened (as trisportgirl has asked) and why no surgery? All sounds very strange,

    Annie

21. sam66, on September 7th, 2009 at 5:22 am Said:

    In case anyone is interested in reading any other journal articles relating to ATRs, most of them can be accessed for free on the PubMed website via:
    http://www.ncbi.nlm.nih.gov/pubmed/
    or http://www.pubmedcentral.nih.gov/
    Just put the search terms you want in the search box and click.

22. jim, on September 30th, 2009 at 4:29 am Said:

    Well I ruptured mine on 7-24-09 at work, 2 months now. Not using a boot anymore. Paramedic/firefighter age 53, getting along pretty well I think. can’t really find clear rehab guildlines. how long does it takes to get back to running and climbing and the whole ball of wax?

23. Kathy, on October 1st, 2009 at 12:29 pm Said:

    rupurted mine 2 years ago ,no sugery cause no insurance ,so now my left lag muscles are still so weak what do i do?

24. Doc Ross, on October 2nd, 2009 at 4:05 am Said:

    Kathy
    Sorry to hear about the muscles. 2 years post op means that everything has healed as best as it will. In order to truly reach maximum medical improvement with this injury it is my opinion that surgery is the best option. Hopefully things have changed with respect to insurance. Make an appt with a orthopedist or podiatrist for recommendations.
    Good luck and I hope it works out.
    Doc Ross

25. James, on October 30th, 2009 at 8:46 am Said:

    I came across your page at http://achillesblog.com/atr-rehab-protocols/. I wanted to suggest adding a link to http://www.BioMedSearch.com. This is a free site that aggregates biomedical literature, similar to NIH’s PubMed (and in fact contains all of PubMed’s documents, plus more), but more comprehensive.

    While it already has more documents than PubMed, shortly several million additional full-text documents will be added that are not available anywhere else on the web, making BioMedSearch clearly the most comprehensive place to search biomedical literature.

26. Big Horn Bret, on November 12th, 2009 at 7:32 pm Said:

    Are you aware of any nutritional studies that indicate foods, vitamins or supplements that can assist with recovery and/or maintaining healthy connective tissue? I tore my gastroc last spring and my Achilles last week…wonder if I have an age (45 yrs old), genetic, training, or other issue. Awesome website that has been helpful to become knowledgeable so I can ask the right question of the doctor and physical therapist.

27. bosuntom, on November 24th, 2009 at 10:20 am Said:

    Cannot afford surgery as my insurance has recently lapsed. Is there any possible self-tratment for ruptured AT that might allow me to resume hillwalking and an active life. I am 66 and until this injury (3 weeks ago) I was always very active (walking/cycling/climbing rigging)
    I find it hard to accept I’m destined to be couch-potato.
    PLEASE help with any practical advice

28. linda atterton, on December 5th, 2009 at 10:45 am Said:

    What’s the difference between expected discomfort following advised trial of walking in boot without support and actual damage or god forbid re-rupture, how did people know?
    Thanks

29. Speedy Steve, on December 14th, 2009 at 9:22 pm Said:

    It’s nice to see and use this site. Spent a couple years with achilles problems that were probably small tears. Then had a bad “partial” tear on May 5, 2009. Never really recovered and limped around for 6 months and couldn’t regain strength. Then had a complete rupture November 20 and surgery November 24. I hear it can be a long hard recovery so I have been searching for info on rehab. You all know the normal questions like should I be moving more or resting…etc. The info here is very helpful. Thanks

30. Scary Larry, on December 16th, 2009 at 3:02 am Said:

    Scary Larry (54) from BC Canada says:
    I had ATR Surgery Aug.09/09 following a waterskiing mishap. I have been grateful for the information found in the ATR blogs as the surgeons do not offer an abundance of info. I had no idea how serious this injury was until I read up on it while waiting for surgery. Here is a record of my progress to date:
    Cast - 3 weeks (was not told to move toes as much as possible -which would have helped with swelling)
    Walking Boot - 4 weeks with physio / hydro pool / band exercises / light weight bearing / ditch crutches
    Stationary cycle and eliptical trainer were very helpful
    Riding Mountain bike -@ 9 weeks -gentle terrain -pushing with heel (not recommended-but I couldn’t help it). Walking with pronounced limp - short distance
    10-12 weeks - walking with less pronouced limp
    - Biking - moderate terrain / Walking at a brisk pace on the treadmill (bare feet) is a big help in returning to a normal walking gait (as I found I have to overcome the “habit” of limping). Now walking with slight limp
    16 weeks - the Big Test - Downhill Skiing Begins -spent several evenings walking around with ski boots on to ensure there were no new pressure points.
    Skiied moderate terrain - taking great care not to fall. Properly fitted ski boots offered great support and did not aggrivate the AT.
    17 weeks - skiing as prior to ATR . (just notice turns to injury side are weaker - careful not to push it)
    18 weeks - gaining strength - but no clalf raises yet.
    Note: I found that a tensor wrap helps with support and greatly reduces swelling.
    Hopefully some will find this info both helpful and encouraging.

31. normofthenorth, on June 3rd, 2010 at 12:50 pm Said:

    I’ve just started slogging through the various linked reports and web-pages that Dennis has linked above, and I find it a “mixed” group. Naturally, many of them were current in early 2008 when D tore his AT, which was a time when the consensus was still that surgery produces better results than non-surgical immobilization. (Heck, that’s why I had my first ATR repaired surgically, in late 2001! But not my second one, in late 2009.)

    If anybody wants to see a copy of a fairly fast rehab protocol that’s been proven to produce good results in a large number of patients, both WITH and WITHOUT surgery (and you SHOULD!!), I’ve posted one at http://achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/ . It was faxed to my sports-med surgeon by the staff at U. of W. Ontario that did the latest randomized study of “op” vs. “non-op”. The discussion of that protocol and that study and others is on my blog, on the page that D has linked above (with “Thanks Norm”).

    For those pondering or facing ATR surgery, D’s first link above on that subject. entitled “Surgery or Casting, a meta analysis. Debate continues” is a very interesting article, but I don’t think it’s really about “Debate continues”! (Except maybe in the US, which is so biased in favor of ATR surgery that anything that shows that it’s not useful is considered a “debate”!)

    Here’s the “bottom line” of that article:
    “In Conclusion

    [b]Based on a critical analysis of the best available evidence, active, healthy adults with acute Achilles rupture should undergo conservative treatment with functional bracing and early weightbearing.”[/b]

    (1) That sounds much more like “Debate Over” than “Debate Continues”, doesn’t it?
    (2) “functional bracing” means a HINGED BOOT. That’s my fave “appliance”, too, after two ATRs!
    (3) “Early weightbearing” in this article means starting immediately, post-op or post-non-op. The article cites two studies that show benefits from that “instant” FWB, which I haven’t read yet. That is MUCH quicker than in the UWO protocol that I followed, which (a) included 2 weeks of NWB and 2 weeks of PWB, (b) used a FIXED boot not a HINGED one, and used it for EIGHT weeks, so ankle flexion was only in PT and home exercise until then.

    Below that link, we find “WebMD’s nice overview on ATR surgery and whether it’s right for you.” I find this much less “nice” than Dennis does, because it repeats a number of pro-surgery myths that have been disproven by the best and newest studies — higher AT strength from surgery, better performance in sports from surgery, etc., etc. It seems like a typical US-based pro-surgery “summary”, whose bottom line hasn’t changed since the last 4 studies showed that it’s based on old myths. Misleading vulnerable people who’ve just had a crushing injury and are facing an important decision is NOT “nice”, in my books!

    BTW, I am this site’s biggest fan, recommender, and participant, so please don’t take these comments as putting down “our” Dennis! He’s put together the best site on the Internet on this subject, working harder and better at this “sideline” than many of work at our jobs! And he’s still “spilling blood” over it, almost 2.5 years after his own ATR! God Bless, and Please Don’t Stop!

    Unfortunately, the job of maintaining a full and balanced and up-to-date Annotated Bibliography of ATR Rehab Protocols, Publications, and Studies is a monster job, which I think no FIVE of us have the energy to do. . . Heck, huge “professional” sites like WebMD SHOULD be doing a good job of it, and they’re blowing it badly, IMHO!

32. normofthenorth, on June 25th, 2010 at 2:43 am Said:

    I’ve started a little “crusade” to get a bunch of other websites — including WebMD — to stop repeating the old myths. Details on my blog, in the comments to the “surgery vs. non-operative” page. Others I’ve contacted recently include Mayo Clinic and U. of Michigan. No substantive responses back yet, but it’s only been a day or three.

    The Wikipedia article now generally speaks the up-to-date truth, but that’s because I edited it myself! I fear that some pro-surgery person will reverse my edits, but they’ve stayed put for a couple of days so far.

    So it’s possible that the link to WebMD can stay put, and WebMD will start presenting “the whole truth”. . .

33. Chris, on June 25th, 2010 at 5:19 am Said:

    Had op 7 weeks ago!! Had been in 3 casts 2 weeks in each! Now in boot for the last week, Have had some rubbing on scar which had made leg painfull, have been walking around house without boot slight pulling on scar but not painfull! Able to walk with limp with limited heel to toe movement! Is it best to wear boot all the time, Am I doing damage? Have boot for another 3 weeks!

34. jski, on June 25th, 2010 at 1:16 pm Said:

    Chris-
    My suggestion would be to use crutches with the boot while easing into a heel-toe gait and do not start walking without the boot until you can walk normally in the boot without crutches. Take the boot off for PT and be VERY careful if moving around without it. Keep the boot on most of the time and avoid setbacks.

35. normofthenorth, on June 25th, 2010 at 3:07 pm Said:

    Chris, lots of patients here walked around the house bootless before being told to do so. Most did OK, some not so much. At 7 weeks, if you keep your “bad” foot in front of the other one, and if your foot doesn’t complain from the weight, and if you avoid “false steps” (be careful, no distractions, watch where you’re going, etc.!), then you’re likely to be OK. Many new protocols call for weaning off the boot starting at 8 weeks, sometimes sooner,

    Why are you limping in the boot? If it gives you full support, so you can roll over the boot’s toe with your shin (and the top of the boot) taking all the strain off your ankle, you should be able to boot-walk pretty straight, and fast.

    If the bottom of your foot is rebelling against the pressure of FWB, that’s not uncommon. Solutions include delaying the FWB and/or padding your foot with soft footbeds and the like.

36. mikek753, on June 27th, 2010 at 2:57 am Said:

    Chris,

    at first make sure you can balance on one leg in the boot
    and you should NOT have any pain doing it
    than only stay on one foot hanging for something and than balance on one foot.
    I would NOT recommend barefoot right away, use 1+ cm inserts in shoes to reduce pressure on tendon.
    All those are logical steps and your foot just might not be ready for this after so much immobility!!!

    Ask your PT and do it first under supervision!!!
    Think about risk management.

37. Chris, on June 28th, 2010 at 7:13 pm Said:

    Thanks for the advise! Ended back in hospital as scar was infected!! (not a blood blister as I thought) Scar had been rubbing on stich in tendon It has been cleaned and I am back on antibiotic’s for a week. It is alot better wearing the boot no pain at all now! Thanks for your advise I will try and not rush my recovery! Have been told it is best not to drive for 6 months do you think this is a little over the top! Have read that you can resume driving a manual after 12 weeks! And my wife’s driving scare’s the hell out of me!!

38. GerryR, on June 28th, 2010 at 8:08 pm Said:

    Chris,
    I have to have a lot of experience with infections caused by the internal non-absorbing sutures that are used for ATR repairs. I’ve had four surgeries as a result of the internal sutures, the last one being on May 20 to remove them entirely because they had created an abscess which no amount of antibiotics could fix. For the first time since about early August I do not have a large lump on at the site of the original incision. I’m back in PT full speed now and may actually be able to resume running in another week or so. I hate to sound pessimistic but you may well be headed for the same thing I ultimately had to do. There is ample evidence available that the braided internal sutures they use can and do cause infections and abscesses. I had to shop around for a surgeon who would listen and ordered an MRI which showed the abscess.

39. charmcity, on July 6th, 2010 at 5:24 pm Said:

    I am six weeks out from surgery on a total ATR, in a hinged boot, and walking carefully at home on bare feet. I went swimming and pool walking this past weekend for the first time. The tendon is tight, but I feel like I am making good progress with walking and stretching exercises. Does anyone have an opinion as to whether physical therapy is necessary? If I had unlimited time and money, I would not hesitate to do it, but if I am making progress on my own, is it worth it?

40. gunner, on July 6th, 2010 at 5:28 pm Said:

    I’ve had great success using a PT. Been about 8 times (now 18 weeks post ATR) and received continuous adjustments to my exercise regimen as the tendon and leg permitted, including different drills to do in a pool. I’d recommend you try it if you can find a good PT, tell him/her your situation and work out a schedule you can afford. Also, take Norms (normofthenorth blog) protocol and get a specific set of exercises for each 2-4 week progression.
    Glad to hear you’re in the pool. Feels great, doesn’t it?

41. jski, on July 6th, 2010 at 11:30 pm Said:

    charmcity,

    Formal PT is great if you need instruction and motivation, otherwise it might not make sense if you are on a budget and doing well without. If you are unsure of yourself definitely try a few sessions. If you are walking, swimming, exercising, and stretching for the purposes of rehab then you are already in physical therapy and you are the therapist.

    I have a medical professor, an ER doc, and a PT in my family. Do I ask for their advice? Sometimes, but not for my ATR rehab.

    Take care.

42. espaa, on July 14th, 2010 at 3:08 pm Said:

    HOLA ! just found this site, looking for help after a total Achilles tendon rupture while jumping of joy while watching my team, Spain, win the World Cup….seriously…just jumping when they scored during quarter finals, and POP it went..sooo weird, but I knew exactly what had happened.
    Had surgery already, on a cast now for 10 days and then we´ll see.
    Looking for the best way and fastest to recover from this.
    I´m not an athlete, but I was before, I am a busy mom of 2 young kids and will settle to be able to ski again.
    Thank God Spain won the Cup in the end…..my cast decorated with Spanish flags.
    Thanks
    Ana

43. normofthenorth, on July 14th, 2010 at 5:29 pm Said:

    No problem being able to ski again, maybe even at the very beginning of the season. (I spent a week at Whistler starting at 17 weeks, no problem — at least to my AT!)

    One good modern REASONABLY fast recovery protocol that produced very good results (with and without surgery) in a careful study is at bit.ly/UWOProtocol . For one of the FASTEST ways to recover post-op, you should check achillesblog.com/doug53 . Nobody’s done a study to check the re-rupture rate going at that speed, but Doug healed fine — 100% success, 0 statistical significance!

    BTW, how are you so clever that you “knew exactly what had happened”, when so many of us didn’t have a clue?

44. GerryR, on August 15th, 2010 at 11:59 pm Said:

    Why is it that spammers always have really poor grammar.

45. KristinWA, on August 22nd, 2010 at 6:51 pm Said:

    To Espaa,
    I also popped my achilles during the World Cup. The event was when Landon Donavon scored after the 90th minute. Overall, I was rooting for Spain to win!! Yeah!

    I am in an aircast, with partial weight bearing. I see my OP on Wednesday and am really looking forward to some PT. I have not read too many rehab protocols but I think mine must be somewhat conservative. I wonder why so many people rerupture or have their other side rupture. I think my foot and ankle were feeling funny for a good while before the break. I noticed the link questioning the fluoroquinolone connection had disappeared. quite a few years ago I had a reaction to Cipro and wonder if there could be a connection to the breakdown of my tendons.

    Could someone point me to a discussion on this board that explores this possibility? Thanks. THis is a great resource.

46. Espaa, on September 14th, 2010 at 8:46 am Said:

    HOLA ! I´m back on my foot after 8 weeks, very happy walking with no crutches and being able to fend for my self !
    In rehab 3 times a week and doing stretching exercises at home.
    My scar is very hard ant stiff,even though I massage it everyday with vitamin E oil ,and a have a very annoying tingly sensation on the skin of my ankle…..Anybody has has that ??? It´s driving me insane !
    @normofthenorth, I knew what had happened because I have been a serious gymnast,ballet dancer and skier…so one gets to know your body ,muscles and pains.
    @Kristin, I´m happy to hear I was not the only one jumping (and falling) with the World Cup….when people ask what happened and I tell them, they don´t believe it !
    Adios for now…

47. normofthenorth, on September 14th, 2010 at 3:46 pm Said:

    Espaa, I’m all too familiar with my body ,muscles and pains — but I still thought one of my volleyball teammates had kicked me HARD in the back of the ankle when I tore my first one (8+ yrs ago)! Then I drove home and iced it, assuming it was a sprain, until my sweetie convinced me that it sounded serious and I should go to the Sports-Medicine clinic the next day.

    KristinWA, have you tried the little Search AchillesBlog gizmo at the top right, for fluoroquinolone or Cipro? It’s definitely been the subject of some discussions here. The other two scary risks you mention — “so many people rerupture or have their other side rupture” — are two separate issues (though with very similar results!)

    Re-rupture is a serious risk while your ruptured AT is healing — with or without surgery — and is vanishingly unlikely afterwards, except for people with very serious healing deficits.

    Rupturing the OTHER Achilles is not very rare, especially for those of us who threw ourselves back into the “explosive” sport that tore the first one. There’s a study linked above that followed ATR patients for a few years. They found a 1-2% risk of rupturing the other side, which was around 200 TIMES the “normal background” risk of an ATR. MANY of us here ruptured the other side much later than that study ran, so the total risk is significantly higher than that. (Mine was 8 yrs later, and I think there are two bloggers here now who tore their second AT 11 years after the first.)

    The cause of the elevated other-side risk is presumably a combo of genetic pre-disposition (like stagnation between two sources of blood circulation, that leaves a malnourished “weak link”) and risky behavior (like playing competitive volleyball with a bunch of 30-somethings, in my case!). Plus Cipro and other factors. It’s a sad fact, but a fact, to be dealt with. But with the newest studies showing great results from (a) NON-operative treatment and (b) fast, aggressive, CONVENIENT rehab protocols, most people can recover from their second ATR with much less pain, risk, scarring, expense, and nuisance dislocation than they experienced the first time around.

    I’m a big fan of resuming the high-risk “explosive” sport, but it’s probably the most personal, value-laden, and even emotional decision we all have to make. There’s only one “right” answer, and it’s the one that’s right for you. (I’m not that generous when it comes to slow rehab protocols, and maybe even ATR surgery!

48. normofthenorth, on September 14th, 2010 at 3:49 pm Said:

    KristinWA, there’s a link above to “Levaquin linked to Achilles Tendon Rupture (Thanks Doc Ross!)”. Is Levaquin the same as Quinolone? If not, the “Quin” suggests that the drugs and the issues may be very similar.

49. Espaa, on September 15th, 2010 at 5:35 pm Said:

    Hi normofthenorth , I also thought somebody had kicked my ankle since we were all celebrating Spain’s goal…but I also heard a “POP” inside my calf, loud and clear…I wasn’t in much pain, but the realization of what had happened made me faint right there and then !
    Do you know anything about the tingly sensation (like if skin had burned)? I talked to the surgeon today and he said it could be the recovering ankle nerves that are inflamed ….gave me some anti-inflammatory meds to see if that helps.
    Apart from that I´m doing great walking on my own, although the thought of going to the supermarket or similar makes me cringe !

50. normofthenorth, on September 15th, 2010 at 11:24 pm Said:

    Espaa, start a blog — this really ISN’T about “Rehab Protocols, Publications, Studies”, and it’s inflating a page that lots of people consult!
    I heard the “pop” both times, although I’m not sure any of my teammates did, either time.
    I think many of us have had various weird skin symptoms, either from surgery, or from long times in a cast or a boot, or just too long without washing normally. I don’t think I had burn-like tingles, but others may have.
    Going shopping anywhere — not just to the supermarket — always wiped me and my leg out worse than anything else! I thought being able to lean on a shopping cart would make it easy, but NOOOOO!

51. Oc, on December 10th, 2010 at 10:26 am Said:

    Very nice blog, I like to visit this blog often to have such article which help me a lot.

52. dennis, on February 4th, 2011 at 2:05 am Said:

    I’ve added an additional study to this page under the topic:
    Surgery vs. Non operative treatment (conservative treatment)

53. rj, on March 1st, 2011 at 12:17 pm Said:

    An excellent primer on tendon ruptures and post-surgical rehab. More significant is the wealth of highly informative support for new patients.

    -rj
    http://people.virginia.edu/~rj8b/Research.html

54. Dana Point Refrigerator Repair, on March 7th, 2011 at 9:25 pm Said:

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55. jos, on March 21st, 2011 at 3:29 pm Said:

    Had surgery to repair torn achilles 7 months ago. But seems infected due to the stitches used. Infection has refused to clear and causing abscess. Help

56. zion, on April 13th, 2011 at 7:48 pm Said:

    very nice resource site

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    I can’t stand to be damaging - certainly not least as as specialist delivering alcohol delivery but the story opinion not exactly what I expected, the first para was a bit confusing imho - what exactly do you guys have to say? Then again I might be totally wrong. It is just my personal quickly thought through views concerning your current post.

62. BA WP7App, on May 31st, 2011 at 11:14 pm Said:

    I dislike to be bad - certainly not least since as specialist giving alcohol delivery yet the story view is not exactly what I like, the intro was a little garbled in my opinion - just what exactly do people think? Then yet again I could possibly be totally drastically wrong. It is just my first thoughts concerning your current article.

63. BA Windows Phone App, on May 31st, 2011 at 11:16 pm Said:

    I dislike to be bad - certainly not least since as professional giving alcohol delivery so the flow and opinion isn’t what I was looking for, the first para was a touch garbled to be honest - exactly what do you guys think? Then again I could possibly be absolutely wrong. It is just my personal first feelings about your posting.

64. BA Windows Phone App, on June 1st, 2011 at 8:17 am Said:

    I loathe to be unfavorable - certainly not least when as specialist offering alcohol delivery but the flow and angle is not exactly what was like, the headline was a touch hard to understand if you ask me - what exactly do readers think? Then yet again I could possibly be entirely wrong. It is just my own quickly thought through feelings about your current post.

65. BA WP7App, on June 1st, 2011 at 8:29 am Said:

    I don’t like to be unfavorable - definitely not least since as professional delivering alcohol delivery so the flow and angle is not what I expected, the headline was a little bit misleading imo - just what do people think? Then yet again I could be 100 % completely wrong. It is just my own intitial ideas with regards to your own article.

66. BA WP7App, on June 1st, 2011 at 8:35 am Said:

    I don’t like to be unfavorable - not least seeing that as expert delivering alcohol delivery but the story angle not exactly what was wanted, the headline was a bit hard to understand to be honest - what do others think? And then again I can be fully completely wrong. It is just my first views regarding your posting.

67. BA Windows App, on June 1st, 2011 at 8:49 am Said:

    I loathe to be bad - not least because as expert supplying alcohol delivery but the type of story angle not exactly what was like, the intro was a tiny bit misleading in my humble opinion - what exactly do others reckon? And then yet again I may be entirely erroneous. It is just my personal first views in relation to your current posting.

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69. daisydarlington, on August 26th, 2011 at 4:00 pm Said:

    Hi Everybody!

    I hope you all are healing quickly and well! Still ploughing forward here. I have disposed of the crutches and have been slowly rehabbing myself since my insurance issues have seriously delayed the start of professional physical therapy. I will add that I’m highly irritated with Anthem Blue Cross and that they will be receiving a tersely worded letter very soon.

    Am down to one wedge in the boot and hope to loose that at the beginning of September. I see the orthopedic surgeon on Sept. 26th and think I should probably get the all clear to make the big switch to shoes.

    I’ve decided to take Stuart’s sage advice and pay for an evaluation from a PT next week so I can assess where I’m at with my own rehab and get some sound advice about the two-shoes transition.

    That’s about all the ATR news from me! I wish everybody excellent healing and to those of you on the East Coast of the US (such as Gus in Manhattan), all good thoughts out to you this week-end!

70. daisydarlington, on August 26th, 2011 at 4:29 pm Said:

    Oddly enough, just as I finished and posted my last message — I got a call that my rehab has just been approved by the insurance people! Hurray! On we go!

71. ali, on August 26th, 2011 at 4:40 pm Said:

    Hi Daisy, great to hear your progress. Glad you finally got the go ahead for physio, great news.

72. Stuart, on August 26th, 2011 at 5:14 pm Said:

    Daisy, I was going to send a search party out for you. Good to hear this news. Now we just have to find Dancing Bunny. It could be a sign she is doing well and is too busy to check in I am off again next week on another trip. Camping out each night and doing some of the things I used to do like hiking (short ones) and riding. It is still cold down this way and the campfire will be great to sit around. My strength and movement improves every day but I still have to take time out to rest, ice and elevate after a day on my feet.

    Ali - what is happening with climbing. Are you going out to watch and take photos? My partner has been doing plenty of forearm exercises in readiness for her next climb and we have been hitting the trails on the bikes. No single track yet for me though but plenty of hills.

73. ali, on August 26th, 2011 at 6:15 pm Said:

    Stuart, camping sounds brilliant. Not quite there with photography but getting there (except ++ photos of feet/ankles/scar/casts ) . I have to get near the crags, some are a little hilly (we call outdoor climbing areas crags here). The longing never goes away which is good.
    Im finding the push off a problem due to pain and stiffness. I’ve got some work to do. Due to update as the op was 12 weeks tomorrow. Have a fab time camping, hope you get good weather for cycling!

74. Stuart, on August 26th, 2011 at 7:21 pm Said:

    Ali - it is after all only 12 weeks. The strength will come. I think Norm suggested doing some heel raises in the pool. In any case a slow and steady (consistant and logical) approach within your limits is what you have been doing and it is paying off. Don’t let it get you too down at the moment. Look forward to the next update. We have crags here too.

75. Daisy Darlington, on August 27th, 2011 at 12:38 am Said:

    Stuart — your trip sounds brilliant! I hope you have a tremendously good time! I do love sitting around a campfire and have to admit that a wee dram of single malt adds to the experience!

    I hear you on the ice and elevation — doing that right now after an afternoon of teaching advanced level ballet. I don’t do much but at least I can move around the students now and make placement adjustments!

    Hope Dancing Bunny is doing well and that you are right about her being too busy with her ATR improvement to check in! I miss her cheerful presence!

76. Daisy Darlington, on August 27th, 2011 at 12:45 am Said:

    Thank you, Ali, for the kind words! I was pretty chuffed to get the go ahead on rehab. Maybe they heard I was planning that tersely worded letter! (grin)

77. Stuart, on August 27th, 2011 at 4:19 am Said:

    Will be taking a scotch for that purpose. One wee dram is never enough. You hunker down with that storm coming.

78. Stuart, on August 27th, 2011 at 4:20 am Said:

    Daisy - Will be taking a scotch just for that purpose. One wee dram is never enough though. You hunker down with that storm coming.

79. Daisy Darlington, on August 27th, 2011 at 11:17 am Said:

    Stuart — you are the best of us! One wee dram is never enough indeed!

    Fortunately, I am currently on the West Coast of the US so I’ll miss Hurricane Irene. Less happily, my father is dying in a New Hampshire hospital directly in the path of the storm. We’re a theatrical family so he’d appreciate the King Lear overtones of going out with such a bang. Very frustrating for me because I can’t fly into the area this week-end!

    It is, as they say, always something.

80. Stuart, on August 27th, 2011 at 3:55 pm Said:

    Daisy - Sorry to hear about your father but happy to hear you are out of harms way.

81. dancingbunny, on September 1st, 2011 at 1:58 pm Said:

    Hi Daisy and Stuart,
    Just came back from a long trip, visiting family on the east coast (almost a month) and just catching up on the blog today… Thank you for thinking of me, miss you guys too! Daisy, so sorry to hear about your father!

    I tossed my crutches around early August in the middle of the trip, so happy to move around without asking for help! Right now, I’m already 4 months and half after injury, still walking with limp.

    I went to see my PT yesterday for the second time, he gave me some massage and tubing to exercise my foot back home, then I was put on the treadmill, was doing fine for the first 9 minutes, then while working on pushing off, a sudden pain ( cramp, maybe?) happened on my injured leg above my injury spot. Is it normal? Or is it a symbol that I pushed too much?

    How long does it take to walk without a limp?

    Take care, everyone!

82. Daisy Darlington, on September 1st, 2011 at 5:45 pm Said:

    Thank you, Dancing Bunny, for the very kind words! GREAT news about dumping the crutches! You were mighty missed here! I’m struggling with the same issues, my friend! Every little pain or cramp worries me that I’m about to or have re-ruptured! (grin) I’ve become a real nervous nellie.

    Example: today the tendon repair looks just a little bulgy to me! Yikes! But pondering it, I realize my entire foot is no longer truly swollen and so that the repair spot just looks a little bigger by comparison. But it doesn’t stop me from chewing my nails a bit!

    I think we’re doing fine though. Listening to our bodies the way ballet dancers do (when they’re being smart and not pushing for theatrical effect!) should see us through!

    Glad you’re back, Dancing Bunny!

83. Stuart, on September 3rd, 2011 at 4:25 pm Said:

    Bunny - Can’t tell you exactly when that limp will go. I am about the same time as you and can walk without a limp until I get tired or have done too much. It could be as your strength and flexion improves the limp will slowly go away. I have also had a few pains like you discribed but they feel like they are more in the muscle tissue than tendon. I worried as well that I had done something but nothing bad has come of it. Great to hear from you and a month away must have been good too.

84. Eddie, on September 4th, 2011 at 8:31 pm Said:

    Just want to say “thank you” for all the information and opions posted on this blog; they’ve been VERY helpful.

    My Summary:
    * Ruptured my Achilles July 15 playing tennis; no pain, just thought maybe I’d done something weird to my ankle
    * I’m very athletic, but due to my age (53), my Ortho recommended non-surgical/”conservative” therapy.
    * (A few days later, 71-year-old Alex Trebek had an ATR and received surgery, leaving no doubt what the Jeopardy question for the answer “The proper therapy for ATR” would be.)
    * In a fiberglass cast for 3 weeks
    * After reading into on this board, I pushed my Ortho toward “early mobilization” (thanks norm!), so instead of putting me in another cast as planned, I was put in a Cam Walker boot, NWB, at the beginning of week 4, with 2 cm heel lifts, occasionally taking the boot off to clean my leg, but sleeping in the boot
    * At 5 1/2 weeks, began PT with stretching, range of motion, and massage, still NWB; also allowed to take off my Cam Walker at night — yahoo!!!
    * First heel lift removed in week 5
    * Final heel lift removed at end of week 6
    * Beginning with week 7 the Ortho allowed me to Weight Bear as Tolerated, judging for myself how quickly to wean myself off the crutches
    * I’m now beginning week 8 and I’m allowed to drive (without the boot, of course), but will continue wearing the boot in public and at work

    I don’t wear the boot at home, but after reading re-rupture stories on this site (both non-surgical and surgical), I’ll be very careful how I handle stairs and exercise. I’ve been doing “dorsiflexion” stretching of my Achilles tendon a couple of times daily at home since 5 1/2 weeks. There’s some general stiffness/soreness/occasional swelling around my Achilles tendon, but my Ortho says that will go away in time.

    So far, so good. Thanks again for all the great info.

85. Eddie, on September 4th, 2011 at 8:43 pm Said:

    P.S. Typo alert: My PT began at 4 1/2 weeks, not 5 1/2. My first heel lift was removed at the end of week 5.

86. lb, on September 30th, 2011 at 6:46 am Said:

    Hi,

    I had an ATR on Sept 2 and surgery to reattach the same day. Going on week 5 here. The first 12 days were in a plaster cast/splint and now I have a fiberglass cast toes pointed down. I still have swelling when I put my foot down but what’s new this week and bothering me most is calf muscle cramps and pain. Has anyone else experienced this? I figure the electrical impulse type pains in the tendon are normal healing pains but this muscle pain is different. It’s almost like a charlie horse and feels like someone’s squeezing the hell out of the muscle. Also concerned about the swelling - when will it end so I can sit in some other position than leg elevated?

    Thanks and wishing everyone a full recovery!

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88. Abdallah, on November 30th, 2011 at 5:41 pm Said:

    I am about to undress the splint in coming two weaks. I have been using the crutches since 4 weeks. I read some of comments above and I feel perplex about the physio-therapy as I am intending to do it on my own. I am just feeling nervous in case my walk will be unbalanced after this long lasting disability…

89. tonytrumpet, on December 1st, 2011 at 2:40 pm Said:

    BRILLIANT resource, thanks so much for providing it! So hello, I’m Tony and I’m a recovering squashaholic. Popped my other achilles yesterday (did the right leg in 2002) so I will at least be balanced. Has surgical repair on first injury, was going to have same again until I read Norm’s impassioned pleas. So I have decided to forego surgery, and instead get a VACOped with aggressive physio. (Does anyone know where I can find an aggressive physio, btw?) Big thanks to Norm, you have me convinced. So now I start from the bottom of the hill on my journey to normal walking again. Any good hints to minimise muscle atrophy?
    Good luck everyone!

90. meganmichele, on December 5th, 2011 at 10:46 pm Said:

    Is there any information about how to deal with the normal complications/pains after surgery.

    I had surgery 4 weeks ago and at my Dr follow up he said I was fine to go without crutches or the boot (I’m 22 and I’d been walking in the boot for a week and a half already)

    I’m having pain (and had pain even with the boot on) in my heel making it difficult to get around and I havent read anywhere else yet of someone having this which I find odd. Is it just a suck it up and deal with it kind of pain or is there something I can do, like a stretch or shoe insert?

91. Abdallah, on December 21st, 2011 at 10:13 am Said:

    I removed the cast last week. I lived six weeks with cast. Since a week, I dont feel the additional weight of the cast but the first time I tried to put my foot on ground, I felt my foot weaker. This is normal since my foot was paralyzed in cast for more than 40 days. At the moment, I feel more confident and I am trying to live a normal life without thinking of the past. I feel better and getting my walk balanced with time. I joined the therapist for 2 days and he taught me what to do. With 20-30 minutes of daily exercises, I am sure you will gain back in 15 days.

92. RB, on January 22nd, 2012 at 12:17 am Said:

    Just had atr but did not go thru surgery. I was in cast above the knee for 6wks then another immobilization for two more weeks. Now i’m trying to walk on it with the help of my walker but i’m finding it hard to bend my leg. And i can’t stand straight with my two feet yet. Is this normal? Any help would be great.

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94. JimD, on February 28th, 2012 at 5:09 pm Said:

    I’m 53, a jogger and injured myself playing basketball, so I consider myself physically fit. I had surgery to repair my AT approx. 6 weeks ago. I’m now in a walking cast for two more weeks (8 weeks total). Will I be able to walk without crutches when my cast comes off?

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96. normofthenorth, on February 29th, 2012 at 3:36 am Said:

    JimD, it’d be a bit easier if you’d been doing exercises and PT in a boot, instead of being in a cast, but it is what it is. Are you FWB now, or still using crutches with the walking cast?

    Most people make the transition to shoes around 8 weeks; a few earlier, too many later. The transition is almost always a minor step backwards as well as forwards: your walking speed slows way down, your gait shortens and/or gets asymmetrical, you feel much more vulnerable (because you ARE!), and you may experience more pain in the bottom of “that” foot than before. My fave protocol suggests returning to crutches when ditching the boot, if necessary (though that isn’t my fave PART of that protocol!).

    With a boot, many of us kept it handy and strapped it back on for scary outings, like bicycling, or going to places like train stations or subways, etc.

    There’s also a gradual change of ankle angle, from “equinus” toward “neutral”, which is easy to accommodate in a single boot, but usually requires a series of casts. So even if you keep your last cast (to use as a boot-like brace), you may not be able to get the ankle angle you want at that stage of your recovery.

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