ATR Rehab Protocols, Publications, Studies

Here’s a compilation of ATR rehab protocols guidelines.


Standard Immobilization vs. Early Mobilization Postoperative Treatment


Achilles Tendinopathy/Rupture


Related to surgery


Other relevant literature


Surgery vs. Non operative treatment (conservative treatment)


Causes of ATR


Complications:

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

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

  2. 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. 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. 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. 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. 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. 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. 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. These were terrific! Thank you for sharing!

  10. Dennis,

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

    :)

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

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

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

    Don

  17. 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. 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. Ray, what happened when you re-ruptured?

  20. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 (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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Why is it that spammers always have really poor grammar.

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

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

  53. 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. Me gusta el mensaje, el intercambio agradable. mantenerse en contacto.

  55. 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. very nice resource site

  57. I don’t like to be bad - definitely not least while as skilled offering alcohol delivery yet the flow and opinion is not what I wanted, the headline was a little off-kilter to be honest - just what exactly do others think? Then again I may possibly be completely erroneous. It is just my personal first views with regards to your own posting.

  58. I hate to be negative - definitely not least seeing that as qualified delivering alcohol delivery but the story opinion isn’t what was like, the first para was a tiny bit off-topic if you ask me - what do people think? And then yet again I could be fully incorrect. It is just my own first feelings with regards to your post.

  59. I dislike to be detrimental - not least because as expert supplying alcohol delivery yet the flow and angle is not what was was looking for, the last line was a bit confusing in my humble opinion - what exactly do readers have to say? And then again I can be absolutely drastically wrong. It is just my personal quickly thought through ideas with regards to your current posting.

  60. I don’t like to be unfavorable - not least as as expert supplying alcohol delivery but the flow and angle not exactly what was expected, the last line was a little hard to understand to be honest - what do others have to say? And then again I could be absolutely erroneous. It is just my first feelings in relation to your posting.

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

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

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

  81. 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. 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. 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. 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. 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. 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!

  87. Hello. magnificent job. I did not anticipate this. This is a impressive story. Thanks!

  88. 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. 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. 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. 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. 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. 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?

  95. I’d incessantly want to be update on new articles on this internet site , saved to favorites ! .

  96. 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.

  97. Excellent post. I was checking constantly this blog and I am impressed! Extremely helpful info specially the last part :) I care for such info much. I was seeking this particular information for a long time. Thank you and best of luck.

  98. I’m 33 years old and ruptured my Achilles on March 31, open surgery to repair on April 5th. Never got put in a cast because my wound healed slowy. Was fitted with an aircast walking boot at 5 weeks with wedges. Started physical therapy at 6 weeks with AROM, leg strengthening and theraband work. At 7 weeks I was allowed to put 20 lbs of pressure on my affected foot and I’m now 9 weeks today have only 1 small heel wedth left but my surgeon is only allowing 30 lbs of weight on my affected foot. Any advice to convince her to allow more weight, I’d like to be full weight bearing as soon as possible. It’s worth noting that my doctor is the team orthopaedist for one of the D-1 universities in the city as well as the cities ballet and the clinic I’m going to is the orthopaedic clinic for two of the professional sports teams in the city. I thought she knew was very good but after reading many of the blogs I’m now worried this is taking too long
    .

  99. Sounds too slow to me. Look above for “UWO Study” and print it out and share it with her. They used their fast protocol with their surgical patients as well as their non-op ones, and got excellent results, which they published in detail. Then you can ask her if her results are any better, or if she’s just going on instinct, or the logical-sounding (but apparently false) assumption that slower is safer… (If that fails, you can roll up the print-out and smack her with it! ;-) )

  100. Thanks, will give it a try at my next appointment on Tuesday.

  101. So I ruptured my achillies 5/12/12.. had surgery 5/16/12.. out of my cast 6/6/12 and into a walking boot.. Should I be walking without crutches? My doctor told me to ween myself off the crutches, but I’m struggling mightily. Anybody have suggestions?

  102. I want to start exercising does anyone have a good workout program?

  103. ozie33,
    I had surgery two weeks before you and am just now trying PWB at 5 1/2 weeks. I did FWB one day - but it was too much too soon. I had a pretty severe AT blowout, and my foot is not flat in the boot yet - still at 5 degrees - making it difficult to walk normally. So don’t sweat it if it’s still too hard. Just try a resting it on the floor, doing some PWB while doing floor exercises, etc. I like the Boston protocol - check out the rehab page through links on the left - there are all kinds of timelines, ideas for exercises, etc. - but get all cleared through your doc first. Ankle circles have been really helpful for loosening up my ankle.

  104. I can do FWB with my boot on, but it’s just hard to walk

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  106. Hi to You All,
    Had a full ATR 29/6 doing a litlle gentle gardening (!), after suffering from very painful Tendonopathy for 8 months: little help from my GP, apart from sending me for u/sound scan/cortisone injections, which worked temporarily and raised the eyebrows of my orthopod (NHS) just now..
    In between time, I consulted a podiatrist, who rubbed it a bit (!), got me some shoe lifts, charged me lot’s and suggested Plasma Rich Plasma therapy to enable healing, the latter, AFTER I had the ACR.
    Day of ATR, I attended A&E at Hull Royal Infirmary, where they confirmed self diagnosis, X rayed to check no bone breakage and put me in plaster prior to ‘Fracture Clinic’, the next day (Saturday).
    Consultant confirmed diagnosis and declared none surgical, conservative treatment: booked me for an US Scan. Put in full Equinus pot. Ten days later, had scan;
    confirmed ATR and scope of injury which they sent to my consultant. ‘Fracture Clinic ‘ (12th July), where consultant declared that they only do Plaster casts, no boots, no quick rehab/weight bearing etc.

    THEN I started investigating via this great blog and another hospital (Goole).
    After 3 weeks in full Equinus, new Ortrhopod (a specialist Knee and Ankle/Achilles man) took my cast off, after already saying that he was happy for me to have enhanced rehab and use a boot (if I purchased it myself !) THEN my cast came off and found, what he described as a very large gap; probably too big to heal without surgery. I could have another scan to confirm
    what the ends looked like tomorrow (24/7) and another appointment to see him on 30th, when from the sound of things he would arrange surgery.
    I have spent the last three weeks researching on this site and beyond, particularly Norm of the North’s hugely detailed work: I need help and advice, quickly on various things.
    Whether I have surgery or not, which of the various boots would anyone out there recommend:; I think I have narrowed it down to 1) Vacoped system 2) Aircast XP 3) Donjoy MC Walker ? All seem about the same price and instantly available. As my two NHS hospitals will not supply them, could I getNHS discount (mean Yorkshireman that I am !).
    Views on attitude to take with my NHS surgeon, who seems 100% that a large gap will probably not heal and surgery is the only way forward. I don’t want surgery, bacause of the possible complications and most of the advice from our Canadian/US and European studies pointing towards conservative treatment: I am 66 years of age, quite fit and mobile; just looking to able to walk up a few hills and cycle
    in a similar way, nothing explosive.

    HELP !!!!!!!

  107. Hi Roger,

    Firstly, welcome to ‘the club’ the one we’d all like to avoid, but are glad it’s here for fellow ATR sufferers :)

    I am no expert but I assume that if the tendons are not touching then they can’t fuse together naturally, my uneducated guess is that surgery is required to make them touch and allow the body to repair itself.

    I’d also assume that you would be in a cast for the first few weeks?

    Boots:

    The vacocast achilles boot here is the rolls royce, they do one specifically for achilles rehab, follow the link from the advert on this site’s main page.

    I found an online shop called completecareshop.co.uk they offer the other two popular alternatives at reasonable prices:

    Aircast walker boot with achilles wedge, there’s a variety of sizes there, but you will require the one that sits just below the knee, not sure the shorter one does not offer the support we need.

    Also earch for R.O.M. Walker, they do one for £60 ish in various sizes - I’v enot had the others, but I am using this one and I like it. It has an adjustable ‘range of motion’ hinge which you can use to allow the foot to flex but also offers protection as you recover.

    I’d get some advice from your specialist as to which would suit your recovery best, but I remain a bit shocked the hospital won’t supply it.

  108. An interesting link, with more on the web on the same subject:

    http://www.scienceforums.net/topic/34412-how-does-a-ruptured-achilles-tendon-heal-without-surgery/

    Most PT’s and some doctors are happy to explain further.

  109. This explains much better though:

    http://www.ehow.com/way_6038963_collagen-healing-achilles-tendon.html

  110. Hi Roger, just to say there is no discount (there is vat discount for some items if registered disabled). I went down the tendinopathy route so I’ve worn the t shirt so to speak (this includes the achilles blog t shirt!). Sorry you are going down this route but welcome to the club.

  111. Hi Andrew, thank you for your comments: the gap thing seems to be a controversial subject ! Having little to do for the last few weeks (!), I have been all through our great blog. The Godfather (normofthenorth) July 26/2010 ‘As far as evidence goes, neither initial measured AT gap size, nor ATR location is corellated with the success of the non-surgical approach’. same date, ‘Basically it sounds logical that big gaps need surgical repair and do worse with non surgical treatment. Logical, but apparently JUST NOT TRUE ! After my re-scan on Friday shows the gap(?)and my OS
    recommends surgery, what do I do ?????
    My VACOped arrives tomorrow, which my OS could not supply, but is happy for me to have; says he will fit it, reading the instructions ! Had three good conversations with the VACo people yesterday; extremely helpful and agreed that some NHS hospitals supply their orthosis; some don’t (including mine) they are working on it.The initial price was £250 inc vat and delivery, but they did ease up on that a bit.
    They only supply direct now, not via wholesalers.
    Should I dig my heels in (!!) with the OS on no operation, or what ?????

  112. If it were me Roger, I don’t think I’d go against the advice of proper qualified people, I’d have to say they have reasons for making that specific recommendation (you could insist on understanding why of course), because surgey in the UK is not the popular choice for the NHS so I’d suspect that your rupture is a nasty one?

    There’s not massive amounts of risks involved with with the surgery (mostly normal surgical stuff) and some OS’s seem to be more comfortable using a more modern rehab protocol with surgical repairs, which may well work for you in getting you on your feet a bit quicker.

  113. Roger - I really feel for you! Fortunately, the consultant I had at hospital didn’t give me a choice. Friends advised surgery prior to my appointment but due to the gap (1.8cm in my case) and the fact that I am a ‘Type 1′ diabetic, non-operational was favoured. I am finding the whole process quite scary!!! I am currently at 3.5 weeks and went into a boot (provided by the NHS) unexpectedly at 3 weeks. The consultant actually stated to me that it was a more expensive option but (again with the potential complications of ‘Type 1′ diabetes) he wanted me to access my foot daily to ensure there were no problems. I experienced extreme coldness and numbness in the toes, as well as a ‘horse-shoe’ of pain on the sole of my heel, which had led to 5 casts in the first 3 weeks!!! I had beeen told I was going to be in plaster for 12 weeks, but maybe in my case, with the number of casts, the boot was cheaper!!! Initially, I felt I had been advised non-op for financial reasons but on listening to the evidence and reading up I am now totally happy with what I am receiving. I know I repeatedly asked which would give the most successful result for MY injury and I would definately ask that question. It seems VERY unreasonable that they should expect you to buy your boot if that is something you need. The main nurse doing plaster-casts told me that there are 9 consultants he works for, who treat ATRs, and they all have different treatment regimes…..but they are all successful. Kind regards, Molly

  114. Hi again Andrew,
    Got my Vaco boot today: they sent the wrong size: new one tomorrow ! I managed to hire an electric mobility scooter at a bargain £25 per week, so at least I can get to the pub without asking favours. Still worried about my scan on Friday and OS on Monday. I still have an appointment with another OS the next day, so unless they want to operate on Monday (doubt it !) I’ll get a second opinion; both NHS. As with other bloggers, I constantly worry about stability on my crutches; haven’t fallen, but at 6′3″ and 15 stone, I’m not exactly sylph like !!! Will the Vacoped help with stability,
    assume that it will be nwb for a few weeks, or ?? Would really be very interested in Norm of the North’s views on conservative treratment with a big gap, after 3 weeks ???
    Regards
    Roger

  115. Just found another rehab protocol that looks good. Not sure if it’s been mentioned yet :-)
    http://www.yourfeet.com.au/gi_archilles.php

  116. Thanks for all of the info! I tore my achilles about a month ago, but went with the non-surigical route because of a blood clot I had. Just got my cast off and got the walking boot.

  117. I had surgery last Wednesday, I am in a cast and suppose to get my cast off next Friday. My doctor said he would put me in an air cast(boot) and still nwb for 2 weeks. I have scooter and seems better than crutches. I think week 4 I can start to do pwb in the boot. BTW he said I can remove the boot to shower and sleep starting when I get the boot. Should I push for partial weight bearing sooner. I have no pain. I was off the pain killers after 2 days. I am 57 and in fairly good shape.

  118. The UWO protocol has you PWB with crutches at two weeks. Some I have seen in the UK have you WBAT at two weeks and losing the crutches. I was in my boot this time (after re rupture) at two weeks and FWB without at four weeks. Do listen to pain though, I think that’s your call…if it were me I would not be NWB for 4 weeks…apart from not reminding that tendon that it’s a tendon, it’s a pain in the a*** to be on crutches when you can be FWB at two to four weeks. Your call of course.

  119. I feel sick to my stomach after reading the research on early movement and weight bearing, I am 5 weeks post op from full tear with minimally invasive surgery. NWB and haven’t had any ROM since I have been in hard cast. All the research shows early movement and WB is helful to healing, how do I approach my doctor with this? He is a young guy who should be up on the latest research that is why I chose him but didnt really know about any of the alternative methods of healing to bring it up to him.

  120. hey beardedmurray - dont get too down. it seems there are numerous recovery protocols on a broad spectrum and different OS tend to stick to one area of the spectrum. doesn’t mean it won’t work or you won’t heal. also, there could be good reason your OS chose a hard cast for an extended period of immobilization.
    i am 8 week’s post-op, the first 6 in a hard cast and NWB except toe touch. then when that came off, i went to no boot, no brace, just crutches. on this site, i felt out of place and different compared to others, but i’m healing and doing just fine. when i questioned my OS, he did explain that my full rupture was at the spot where the calf muscle and the tendon meet, hence 2 different types of tissues needed to heal and he wanted to be more conservative. if the tear was lower, he would have considered a different recovery approach. i dont know if the studies cited and referenced on this site get into that level of detail - where the tear is located.
    also, check out Coast2Coast’s blog. He was also 6 weeks hard cast, then nothing. and at week 10, he is where most of us would envy to be by week 10. hang in there.

  121. Murray, the good news is that surgical ATR patients don’t seem to show much end-point variation with variations in rehab speed (unlike non-op patients), so you should be mostly suffering inconvenience for no benefit, but not doing harm (unlike non-op patients). At least that’s my recollection of my reading of the various post-op early-WB studies you can find on this site’s Protocols and Studies page.

    Also good news is that even the scariest studies that show ~15% or higher rerupture rates (e.g., non-op with slow “conservative casting” — an approach their “experts” follow to make them SAFER!!) also have around 80-85% SUCCESS rates, without reruptures. And as SitS suggests, clinical results from different approaches do tend to converge over the long haul.

    SitS, I’m only aware of ONE study — and a small one — that tried to answer your question, and test your surgeon’s “logical” assumptions. Some of the UWO study’s author’s probed the data from that study, and tested it to see if the NON-op patients did better if they started with smaller gaps (measured with UltraSound), or if the location of the gap — “low, middle, or high” — affected their clinical outcome. In both cases, they found NO significant relationship, in complete contradiction to the “logical” assumptions. But they only had good pre-treatement UltraSounds from 25 patients, so it was a pretty small (though random) sample. (I haven’t seen the raw data, AFAIR.)

    It is widely believed — and very likely true — that stitches into the end of the calf muscle ends/heads are more likely to pull out than stitches into the torn ends of an AT that tore closer to the middle. That’s why patients with high ATRs are disproportionately likely to get non-op treatment (either fast/good or slow/bad). But it does NOT follow that using slower rehab with patients who have had high-ATR surgery improves their outcomes. It’s basically the same logical assumption that used to dictate Best Practice for non-op treatment, and we now know beyond a shadow of a doubt that it was absolutely wrong, 180 degrees off-target, in that case. That doesn’t prove that it’s wrong in your case, of course — but it doesn’t prove that it’s right, either!

  122. Hey norm quick question. I post on this site but I rarely hear anything back if ever at all. Am I posting to the wrong area or something?

  123. Blood flow stimulators increase oxygen and nutrient transfer to damaged soft tissue including tendons. You can speed up your recovery as well as prevent aggravations with them. I sprained my ankle many times in the past and discovered this technology, I’m finally recovering, before I couldn’t drive for more than 20 minutes without getting pain, and this injury is 6 years old. If only I had this stimulator back when I injured my ankle I may have been able to play college football. I highly recommend it to anyone with a soft tissue injury. I use the one in the link below: http://www.kingbrand.com/Ankle_Injury_Pain.php?REF=52PV25

  124. hi all.
    new here, but glad I found it. I have a full tear of my left Achilles, happened 3 weeks ago during 5 a side. went to my local hospital that evening and they put me in a cast to my knee. attended my main hospital on the Monday. As I was talking to the doctor, before even examining the injury advised me that they only operate on elite athletes. I am 47 and very fit. dr then went on to ask me what I did etc and then said he would speak to the consultant following MRI. Mri confirmed full tear. Then seen by the Dr and the consultant. Consultant informed me that due to the location of the tear it was too near to my calf muscles to stitch, therefore put me in a full leg cast and sent me home with crutches. I also have to inject myself in the stomach every day. Am going again tomorrow and want to ask them to drop the cast to below the knee as I have a horrible feeling that as I have another 2 weeks of injections there are wanting to leave me like this for another 2 weeks. It is doing my head in. I am in the UK, does anyone have any advice for me? It seemed that the doc had written me off for surgery before the mri scan. I am also a little concerned that my cast doesn’t have my foot in the equine position as my toes aren’t facing down as much as they were in the initial cast. thanks all

  125. Hi there, also new here and am so glad I found this site. I have a full rupture of my right Achilles, which happened 2 days ago. I went to the Hospital ED and they had a front plaster cast with my toes pointed down after diagnosed with an ATR after the ED doctor, then an orthopaedic specialist confirmed, both by performing a Thompsons test. I then went back to hospital yesterday for an ultrasound which confirmed a complete rupture. It is fairly high up and they recommended against surgery because of this. So, Im still in the disbelief and frustrated stage, but I am relieved I don’t really have the option of surgery. But I know it will be a long road ahead and I will try as hard as I can to make it work out the best it can. I am a 41 yo guy and have always been active and enjoy running, cycling and more. I just want to be able to do those things again. Two week until I go to the fracture clinic and get a boot on. Cant wait to get this cast off. Good luck to everyone.

  126. cjw1, you should do just fine with a good non-op protocol. I think non-op is the way to go for virtually everybody, BUT it’s very important to follow a good modern (fast!) protocol. Counter-intuitively, spending longer immobilized and/or NWB is LESS safe than going at (at least) the speed of the best modern studies. The 3 best of those are summarized and linked at achillesblog.com/Cecilia/Protocols . Don’t let a misguided or out-of-date expert hold you back slower, “just to be safe”! ;-)

  127. Thanks Norm. I’ve been meaning to send you an email to set up a blog, which I will do! I saw a different orthopaedic surgeon today for a second opinion and to ask questions. I kind of wished I hadn’t now. He wants to operate but has referred me for an MRI first, which I will have tomorrow then see him on Monday to discuss. He thinks the location is not as high as the ultrasound report from the hospital says it is. I am still going to stick to my preference of no surgery, unless I absolutely have to have it, but I will have the MRI and the review. The specialist today took my cast off (has only been 1 week since the injury) and has put me in a boot. Which is nice in some ways but Im a bit worries, because I was scheduled to go back tot he fracture clinic next week (two weeks after injury) to go into a booth then. And the OS today said to get rid of the crutches, not to use them. Now, Im all for a speedy protocol, but I cant help but wonder if this is too quick. I cant help but think he is prepping me for surgery. I will still use the crutches but will partial weight bear at times. Should I be worried?

  128. Cjw1, if you can’t get a Doctor who is up to date and responsive to your desires, I’d say you should be worried, and keep shopping around if possible. (Where are you?)
    My previous post still stands, for me.
    You have to send an email to Dennis (not me) to start a blog. He’s the boss, I’m just an addicted blabbermouth. Details of the email on the Main Page.

  129. [...] Achilles Tendon Injury Recovery Blog » ATR Rehab … – 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 …… [...]

  130. Hello everyone!
    We at iWalkFree have a fantastic injury resource center loaded with information on ATR causes, diagnosis, and treatment. It also covers nutrition and tips for staying positive and active. We wish everyone the best of luck with your recoveries!

  131. Hi everyone! I completely tore my achilles 3 days ago, and am going the non-operative route after seeing a good orthopedic surgeon. I do have a few questions perhaps some of you could give me your thoughts:

    1 - In the first 2 weeks, with the hard cast, is it preferable to start wiggling my toes just yet?
    2- Is a 2cm heel lift generally understood to be the same as 20 degrees?
    3- Being very athletic, but 40 yrs. old, what are my chances of getting back to the 90-95% power within a year?
    4- Is it a big deal that I was at 90 degree angle on my foot for the first 48 hours?

    Lots of questions I know. I really appreciate any responses. Good luck !! Chris

  132. Hi Chris, yes do wiggle your toes in the cast.

    I think watch all of Evan Brown’s videos, they’ll answer your other questions and more :)

    https://youtu.be/Bw6wktBPuPQ

  133. Hi chris i am almost a year since my rupture, i went non operative as well. id love to answer any questions

  134. cplourde (Chris) - 1. Wiggle away.
    2. 2cm heel wedge seems a little less than 20 degrees but much depends on the length of your foot. Mathematically using a 28cm average foot this works out to be about 4 degrees but heel wedges are usually put into boots not casts and your foot may already be pointing down. The important thing with non-op is for the tendon ends to touch and what ever angle that takes is all that is needed. Some gaps are bigger than others. This is really a question for your doctor and you will have to be patient until he gets back. I would have confidence, in the absence of other evidence, that your doctor has set it right.
    3. Given an appropriate and modern protocol, using early weight bearing and movement (plenty here on that) and your tendon ends are touching there is no reason why you should not be able to get back to normal. Do not stress about lack of flexion and do not try to get more too early. It will come back in time. Healing long is the worst thing for strength. Read about that here as well. Your tendon will enjoy the work and respond when that phase starts but no stretching it until it is strong enough.
    4. No big deal. Will not make any difference to the final result.

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