Chocolata’s AchillesBlog

chocolata - glad that you were able to find how to do this. It looks like the blogging software is due for an update. It usually takes like 5-6 hours for me to do the complete upgrade, so I’ve been putting it off. I’ll start preparing for the upgrade within the next couple of weeks.
Thanks for sharing how to post the pictures!
Nice shoes, btw.

Wait, am I correct in reading that you are 4 weeks out and back in shoes?? Congrats! This is great!

Yup, what Dennis said!

dennis - Thank you very much for taking time to upgrade for the blogging software!

fayshn21 - I’m on the non-surgical route and won’t be in 2 shoes for another 4 weeks or so. The clinic needs some time to prepare wedges and that’s why they asked me bring in my shoes.

Hi Norm, I read your very good research summary again this morning. Have you read anything about treatment options for those who re-rupture AT, say some time between 6 and 14 weeks after the first rupture? Is it still possible to heal on the non-surgical treatment? Some wrote that they were told by their doctor that the re-ruptured AT required surgery, but is that true?

WooHoo….That’s a good Girl!! You figured it out for all of us!!

I’ve been wanting to post pictures into my post from the beginning, bt=ut could not get ti done.

Way to go. Let’s get everyone posting a picture or two now.

I just went back and tried to add a picture to an older post…with no such luck.

I guess I’m just not meant to have pictures in my postings.

Darn it.

Frouchie - sorry you were not able to insert a picture.
I’ve taken a note of the procedure I used in detail. Let me add it to this post so that I can share it with others. Hope this helps!

Chocolata, your question about re-ruptures is a great one, and I don’t know the answer. I also don’t think anybody does. (The rest of this comment is just explanation, if you’re in a hurry!)

Only a few of the studies I reviewed (at least abstracts) even mentioned re-ruptures. Of those few, I know that one or two — including the UWO study whose protocol I’m following — said that they repaired the re-ruptures surgically, regardless of whether the patient initially had surgery or not.

I believe that one of the studies I saw mentioned re-immobilizing a re-rupture without surgery. That may NOT have been one of the studies I cited and linked, though. I only cited and linked studies that carefully compared the outcomes of the surgical and non-surgical approaches. Of course, there’s lots of other research going on. . .

There was one study — which may be the one that included the non-surgical re-rupture cure — that studied the possibility of using Ultrasound to “stream” patients into surgery or non-op immobilization, based on the size of the gap. The hypothesis they started with is that surgery helps a lot with big gaps, but not so much with small gaps. As I recall, their results were pretty unimpressive, and their conclusion was weak, like “this approach may merit consideration”.

I think the study was done in the UK, and I think that Dr. Wilket, the chief author of the UWO study, was one of the co-authors (unless it’s another Wilket, or unless I blew a brain cell!).

NB that I really have no idea HOW non-surgical healing creates a repaired tendon that’s the right length, but it seems to do that just as well as surgical repair, based on the latest 3 or 4 studies.

These studies took everybody, big gaps and small, and assigned them to surgery or non-op RANDOMLY, then gave them all rapid rehab, and measured the results — including ROM (and strength), which is a reasonable proxy for AT length. And the non-op patients performed as well (or in one case better) than the surgical ones.

That’s WHAT happened. But HOW it happens is a total mystery to me, and all the explanations I’ve read are Just Plain Wrong — i.e., they explain why the Earth is flat, instead of explaining why it’s round! Even that UK study is trying to “explain” why surgery produces better results with large gaps than non-op does — but the randomized data shows that it actually DOESN’T!! (I’m fond of saying that if your theory or model disagrees with the facts, you shouldn’t blame the facts!)

I’ve referred to this non-op healing as “magic” a bunch of times, and so far I’m sticking with that. It’s easy to explain why it can’t possibly work to produce a tendon of the correct length — but apparently it does! Even in my own “anecdotal” case, my ankle’s ROM is virtually identical to my other ankle’s (probably a smidge SHORTER-AT than it was before!), despite the fact that I started with a large gap, well over an inch and maybe over two.

So the mechanism is a bit of a mystery, but the results have been tested scientifically. I’m sure everybody here is more interested in results than mechanism — though avoiding the surgical mechanism is obviously a benefit for everybody, and a HUGE benefit for the large minority that suffer with nasty side-effects.

Without having any studies of the results of the two approaches on RE-rupture patients, we don’t know the answer to your question, so we’re back with guesses and theoretical explanations of the HOW. Personally I think that means that nobody knows.

Hi Norm,
Thank you very much for taking time to answer my question. A guy whom I’ve got acquainted recently through another site (in Japanese) re-ruptured his AT about 10 weeks after his first ATR. He was on the non-surgical treatment and tripped over on the street when he was walking in 2 shoes. He went straight in 2 shoes after 3 casts, which he had for 6 weeks in total. His doctor told him that he needed surgery this time because the non-surgical treatment might not yield good recovery.

He then tried to find out if this was true and did some research online, but little information was available. His job required his return asap and he decided have surgery. He has strongly recommended me that I should get a boot for my flight and commuting. The story about his re-rupture made me think “What should I do if I re-rupture my AT?” I wondered how much what his doctor told him (”re-ruptured AT requires surgery”) had been explored scientifically. I remember the doctor at A&E (ER) here told me that they would treat my AT surgically if my ATR was re-rupture.

Oh no! This means you guys won’t be able to buy cups or christmas ornaments with my scar on them lol!
thanks chocolata, i’ll upload mine too now

I asked my Dr about surgery vs non surgery when I was at hospital on Monday. (In NZ default route is non surgery). She said that because I came in straight away (I didn’t actually put my foot down once one of the tennis girls who is a nurse reckoned I had done my achilles) then I avoided surgery. In fact it was only an hour in between falling and having my cast on…not bad going really!!

If I had left it for 2 or 3 days, then they would have done surgery. I was warned that if I re-ruptured it, then I would have surgery. It is interesting that on reflection my calf muscles were quite tight the week before the ATR - my husband’s chiropactor is keen to assess me as he believes that this could be caused by something in my shoulder…which another friend suggested too. This is interesting because I had shoulder problems from tennis a couple of months ago, and thought that it was now sorted… so I am thinking that perhaps it wasn’t quite there and caused my legs to compensate.

Look at my latest posting…I got the picture in the post!!!

You rock Girl! Thanks for the help.

Glad to see you are doing so well…I’m sending you some “Good Vibes”.