UK ATR

I have done this page for everyone from the UK who has suffered a  ATR. I have read lots of blogs on this site and also across the internet about different peoples experiences and recovery from the dreaded ATR. The volume of information and advice is unbelievable and i have gained so much confidence from just reading these. I have noticed that a lot of achilles bloggers seem to be from the USA with only a few appearing from the UK. As most people know the health system is vastly difference in the US and also in most case more advanced that out NHS health system here in the UK. The information i have picked up from reading our USA bloggers is excellent and helps me to ask more in depth questions when i see my consultant.

What I would like to do with this page is to hear just from UK patients suffering with a ATR. To find out what sort of help and treatment they are being offered in in the UK by their local NHS board. Also if there are UK patients who are being treated privately as well so we can compare the ways things are done here in the UK.

I would like to take this opportunity to ask people from the UK drop a reply on here and also tell me about their recovery from a ATR.

366 Responses to “UK ATR”

  1. Morning Daz,

    Just found your link. Will do a little summary for you when I get home tonight.

    Think when I ‘joined’ way back in April there were only a couple of us. I did pose the question on my site “GB ATR’s”? but didn’t get a response.

    It will be very interesting reading when you gather the information together. I am in Manchester.

    Annie

  2. Ooooppppssss!!!!

    Just noticed your a Villa fan look at my site Manchester City!! The richest football club in all the world…. Not the best yet, but we live in hope.

    We also have something else in common, I posted a while ago about Curtis Davies (at least he is playing again) and of course our Valeri Bojinov, both achilles victims.

    http://achillesblog.com/annieh/

    Annie

  3. Daz,
    Where are uyou based? I’m just south of Brum.

  4. Hi Daz, here is my ATR history upto 14 weeks

    Hertfordshire, NHS treatment - Conservative / Non-Operative

    41 year old weekend warrior. Ruptured right AT landing after a celebratory jump playing cricket. Knew what I had done, having had 3 weeks of bad tendonitis in left ankle.

    Straight to A&E, confirmed by doc who talked through two treatment routes. She made an initial enquiry about surgery that night, but nothing doing. Put me in a half cast (old style plaster of paris with a 4 inch channel cut out of the front)) and made an appointment to see the fracture clinic in 6 days time. Stopped taking painkillers wihin two days.

    Surgeon saw me and again explained two routes, saying he would recommend surgery. I opted for conservative route, fearing post surgical complications and going back to “the start” after 2 weeks. Left on crutches with a lightweight plaster below the knee.

    Back two weeks later for re-positioning and new plaster, but specialist felt that I needed two more weeks in position I was. Very little pain as such, but a lot of discomfort from circulation, all alleviated on raising leg.

    New plaster for 3 weeks at nearly 90 degrees. Blood pooling not getting any better.

    One week of Airboot on crutches, one week with one crutches and one week full weight bearing. Start free Physio with the hospital, Theraband stretch and slow rotations

    Week 11 - given gel heel inserts and told to walk, physio includes calf stretches

    Week 14 - walking with obvious limp, some discomfort from swelling around ankle joint, only occasional twinge in tendon… which is very thick. Physio includes walking the line heel to toe and heel drop stretches and drops and held toe rises on a step

  5. Thanks for your posts, the information you have all given will help us all to see the difference between our local NHS services.

    I am from the West Midlands, not far from Kidderminster.

    I come under Dudley NHS

  6. Daz,

    I had my ATR on 20.02.08 and had the non-surgical approach to recovery, out of cast on 01.05.08 and resumed cycling by 29.05.08.
    Currently clear from PT and looking forward to returning to playing football very soon.
    My local NHS trust is Lothians and the service has been 2nd to none.

    Cheers
    Johnk
    :o)

  7. Thanks for taking the time to respond John. You recovery timescale seems good. I too look forward to the day i cam kicka ball again but its going to be a long way off for me yet.

    Tell me, do Scottish NHS and English NHS come under the same umbrella?

  8. Dazf,

    The funding is slightly different in that the Scottish government spend the money that is allocated as they see fit and do not have to go to Westminster for permission. The structure is essentially the same.
    I think I have been well treated by NHS service throughout this injury and the recovery is down in part to listening to my body and the advise on this community/ATR nation of ours.

  9. Daz,
    Treated in Warwick Hospital fracture clinic.
    ATR on Thursday 24th July, went to A&E on the friday. Temporary cast until the monday. Non-surgical (no other option offered). 2 weeks in first cast, 4 weeks in 2nd (almost neutral).
    At cast removal was given 2 inserts and told to walk as much as possible. No physio or exercises shown and next appointment is on 20th Oct (6 weeks post cast).

    I decided to get private physio and boy am I glad I did. Have lots of exercises and am almost walking without a limp.

  10. Daz

    My potted history of ATR:

    Intended to go to the local tennis courts to have a gentle knock about with the boys (two teenagers) and wife. We met a friend and his son on the courts, who challenged us to a match..

    After an hour of competitive tennis, I rushed for the last ball, then I heard a pop in my left leg… fell to the ground…. thought it was my shoes… then realised I could not put weight on the foot… my friend go home and put it in ice…. I disagreed with him realising that I needed a doctor.

    I went straight to A&E at Mayday, Croydon (London)… saw a very attractive lady front line who did the thompson test on it and said I will not be driving for sometime….. she contacted the A&E surgeon in on call…. he wanted me to have a x-ray… to see if there are any broken bones as well……. I waited for sometime before I eventually saw him…. he also did the thompson test… showed my wife (i was on my front and coud not quite see)… that I had a 2.5 inch gap at least to my tendon.

    The surgeon (who luckily was an othopeadic surgeon)told me I had the choice of surgery or non-surgery…….. and gave me the odds of rerupture were better for surgery… but also advise us of the issues of surgery and infections. In the back of my mind I was concerned about surgery as Mayday has a very incident of MRSA (and we knew of someone died about 3 years ago from a routine foot operation due infections)…… So I opted for the conservative route… and thought that I copuld always have surgery if the conservative goes wrong.

    I also was going on holiday to Cyprus in 4 days time, and surgery seemed a bad idea for a hot climate.

    The surgeon then put a reverse back slab cast of me, with a open web to the back.

    I went to work the following day. I am a self employed architect, and my wife works with me… so i could not just stop.

    I had to ensure that I had the filght plan sorted as well for the Thursday… the airplanes would only allow you to fly with a cut cast (to allow for quick removal if swelling occurs), and a doctors note stating you are fit to fly.

    I had message left on the answerphone on the Monday from the surgeon who saw me on the Sunday to attend the fracture clinic on the Tuesday.

    I therefore rearranged all my appointments… and went to the clinic.

    I saw a very nice young Egyptian surgeon… who again advised of the two options of surgery and conservative. He then got my cast removed… and inspected the tendon area in the cast room….. he said that the tubes around the tendon were still in place… and that I had good sensitivity around the foot… so a conservative route would be okay……. I then got a new lightweight below the knee cast, with a cut to the front… then banaged to hold to the cast.

    Went on holiday for 10 days. Getting my GPs fit to fly letter is another story.

    When I came back from the holiday I went to cast room, to ensure that the cut to the front was repaired.

    I went back to the fracture clinic 3 weeks after ATR and saw the senior surgeon… who stated that he wanted me to go into an above the knee cast for two weeks. I said that I still need to work… and cannot afford further restrictions he did not care but could not force me do as he says… he basically stated he would had done surgery and would have not done conservative route… he made me feel rely bad…

    After 5 weeks I again returned to the fractice clinic and saw the Egyptian surgeon again… got be to change my cast and have my foot reangled by 10 degrees (all i could manage)…… he asked me to start to allow the toes to rest on the ground.

    After 7 weeks I returned to the clinic and my foot was repositioned to approx 85 degrees…. I saw the Egytian surgeon….. he seem pleased with this…. and said he wants to put me out of my misery…. and have the cast off in a weeks time…. he also stated that it was a full rupture at the time.

    After 8 weeks cast is off… and I saw the senior surgeon again….. he touched the tendon… then said come back in 2 months…. and book into physio therapy… he said I need to start puting weight onto the leg carefully.

    Day two from the cast being removed… I met the physio…. who checked the tendon….. was expecting to see an MRI…. however felt that it was okay… he did some figure pulling on the tendon… showed me four types of excercises to do……. three times a day…. he also wanted to see if I could walk…(very painful… and almost impossible)….

    I am now due to see him again next week…. he was happy with that… as we had expressed concern about the different approaches that the surgeons had within the same department.

    I hope the above gives some idea of the NHS approach….. however from reading other peoples blogs… it does seem matter alot as to which authority you come under… as yet the NHS seem to be performing well for me… albiet waiting times are strange (but only once)…… I was impressed that the A&E surgeon took time to contact me in orderv for me to come in… I assume to ensure I was put in something more than a temporary A&E cast for my holiday…… I was impressed with the positive attitude that the Eqytian surgeon had…. I was not so impressed (almost upset) about the old fashioned attitudes that senior surgeon had.

    Regards….. Bernard

  11. Isn’t it strange about the different approaches. My Surgeon said immediately 9/10 weeks in full cast. No alternative, he said he had found that over the years he thought 9 weeks plus got the best results. Apparently I had a 4.5 inch gap in the tendon because I had continued to walk on it for over 2 weeks before the operation. At least you are getting the physio.

    Annie

  12. I didn’t have a full rupture, just a dent where the tendon had split, but oh no….no physio for me!

    I pity the fool with no physiotherapy! (yes it’s a Mr T impression).

    My consultant didn’t give me an option, just said that he could either go surgical or non-surgical……..and this occasion he was going to go non-surgical (Although I don’t know what I would’ve chosen had he asked me for my choice).

    I go in on 20th for my 6 week post-cast removal for hopefully my final checkup.

    Jon

  13. Hi All,

    I rupured my left achilles playing football on the Sunday 5th and was operated on the following day. So been at home now for 1 week with my cast on!

    I’m Non Weight Baring so spending my days on the sofa watching Skysports News & surfing the Net!

    I’m back to Outpatients next monday to have my stitches removed and anew cast put on.

    I have to say that i’ve been disapointed with the level of info given by the NHS. They released me without giving me any idea of what to expect in my two weeks at home.

    Pain wise it’s been ok, i’ve noticed this week that my leg has visibly shrunk in my cast, presumeably due to the swelling subsiding! This does mean though that i can feel my leg moving around in my cast!

    Is this a good thing?

    Anyway it’s been great to read other peoples experience and advice.

    Cheers
    Jimbo

  14. Jimbo

    My leg shrunk during the two weeks post op. I also felt mine moving slightly as well, to the point where it had started to rub me on the top of my toe.

    I also was disappointed with the info given t come after leaving the hospital so your not on your own here. It gets no better after you go back for your check up.

  15. Hi,
    I am from UK and had NHS treatment. Very happy with my treatment and full details on my page: -
    http://achillesblog.com/jacksprat/atr-resume/

    I was saddened to hear some NHS patients being short sold (e.g. being told the NHS doesnt use a medical boot!).

  16. dazf,

    Nice slide show. I’ve got one picture taken by ‘Andrew’ in the plaster room at Wexham Park Hospital, when I was in for stitches inspection - I’ll try an post it on my blog http://achillesblog.com/johnw/ which I should also update with a bit of back story.
    cheers, John

  17. Hi Dazf,

    I’ve managed to get my blog uptodate and now back home after having my stitches out and New Cast on ( No Boot Tho!!!).

    I was given more advice and information this time so feeling slightly happy about my NHS experience :)

    Check out my blog

    http://achillesblog.com/jimbo/

    Cheers
    Jimbo

  18. hiya folks, how great to find other uk patients. im at six weeks after surgery- had a hiccup dancing to mama mia ! full weight bearing & started physio today- will be checking out everyones progress along this scary journey. XX

  19. anyone see air ambulance documentry about the chappy who came off bike, paralysed from neck down, kind of helped me get things into prospective http://achillesblog.com/abbavick/

  20. ATR on 21/08/08….Walsall West Mids HNS…….saw doc. after 20 mins in A&E..then a registrar 20 mins later.
    X ray within 30 mins and back to registrar in A&E. Diagnosed ATR using Thompsons Test and inability to stand on tip-toe. Elected non-operative treatment (amd am 62 y/o and type 2 diabetic)

    5 weeks in lower leg cast in equinuus position,
    3 weeks at 60 deg….
    3 weeks at 90 deg. then heel lifts in shoe (2 for 4 weeks then 1 for 4 weeks)…now at 13 weeks, cast off, heel lifts in. waliking on elbow cructhes more for balance than weight bearing. Swelling lessening around ankle after 2 weeks out of cast but top of foot from back back of toes to ankle stilled swelled….anyone know how long swelling is likely to last ?.

    All in all couldn’t fault the Walsall NHS.,….all appointments in time and care and attention 100%……..

  21. Hi all. Ruptured achilles playing squash on 18/9/08 - 5 days before my new son was born! GP, minor injuries unit and A&E all failed to diagnose rupture! Private physio some 6 weeks later identified rupture that was then confirmed by ultrasound. Surgery on 29/11/08 using flexor hallucis longus tendon. In walking boot now but wound breakdown and infection delaying recovery. Readmitted for intravenus antibitoics and copius oral antibitoics with many unpleasent side-effects! In short it has been hell pre and post surgery!

  22. Hi all.

    Firstly I would just like to say a big Thank you to Daz for this UK site. It has been very encouraging as the nhs have given me no information so far.

    A little about myself………….

    I ruptured my achilles on the 1/2/09 playing tennis. Went straight to casualty, had a cast put on and was told i had to see the consultant the next day.

    When i saw the consultant, he confirmed it was a total atr and that i sould have the op due to my age (30) and job (firefighter). He wanted to get me in straight away but the beds manager said no way, and that i would have to wait.

    The consultant gave me the beds manager name and number and told me to ring her everyday to ask if she had a bed.

    I went home and proceded to call her twice a day until she finally got fed up with me calling and i had the op on 6/2. (To be fair - as soon as a bed came available she rang and said get here asap before you loose it).

    PLEASE NOTE - The best bit of advice i have had concerning the NHS is - complaining gets you everywhere!!

    Before surgery I asked a lot of questions about the surgen. Bradford Royal Infirmary is a teaching hospital - so you can have a top surgen or a student being watched by a top surgen. I wanted the top surgen to operate on me and through a bit of complaining and ‘banter’ i was assured that it wouldn’t be a student.

    The op went well and before i was discharged i asked to speak to the surgen. I was told that he was busy and that he would send up one of his little helpers. I said i wasn’t interested in speaking to anyone who wasn’t in theatre and didn’t see my injury. Again after some more complaining and ‘banter’ they agreed to send up his registar who was in the theatre and i grilled him with as many questions as possible.

    I still came away knowing very little and was told to come back in 2 weeks.

    I am now 1 week post op and thanks to this site i will be ready with my questions.

    I hope this post helps concerning the nhs. I have many friends who work for the organisation and know how disorganised the beast is. You really have to keep on top of things. Yesterday i rang the surgens secretary just to make sure i had my 2 week appointment booked. She said i am down for 19/2 and will send confirmation through the post.

    P.S What stage where others at 12 weeks. I am due to fly to Oz on the 1st May

    Cheers
    Robby

  23. It’s so great to find some people from the UK!
    I ruptured my achilles four and a half weeks ago while exercising at home. Both me and my husband heard the popping sound and then my foot went floppy and we were off to the local nhs walk in centre across the road.
    The guys at the walk in centre were great and did Thompson test and then put me in a wheelchair across to a&e. Very quick in a&e (Tues morning, so not very busy) another Thompson test and then another for the benefit of a student doctor but they asked my permission first. Doctor said it’s a complete rupture and a temporary cast applied immediately with toes pointing downwards. At fracture clinic next day, put in a thigh length lightweight cast in equinus position for 4 weeks and non weight bearing. Went back last week and they removed cast and replaced it with an air cast boot with 5 wedges in the foot to keep the toes pointing down. I have to remove a wedge per week fro 5 weeks to bring the foot back to neutral position. It still feels very weak and is a bit swollen, but at least it can come off for a bath and if I’m just sitting for a while. I was told to sleep in it for a couple of weeks until I felt I could cope with it being unsupported overnight. The consultant also ordered an ultrasound scan to check on the progress. I really can’t fault my treatment so far… I’m in Derby and am being seen at Derby Royal Infirmary… every question I’ve asked has been answered and I’ve even rung them when I wasn’t sure of something and they said that was fine. Since the boot I’ve started to feel small twinges in my tendon, which I’m taking as a sign of life, that’s progress I guess… It’s really helpful to read about others experience, thanks for taking the trouble to write guys…

  24. Saw my G.P 9.00 am in Northenden manchester he told me to go to A&E AT Wythenshawe Hospital, arrived at 10 .20, saw the triage nurse who confirmed my doctors thoughts on a ruptured achilles. Went to fill in my details at reception and was sent through to the fracture clinic where I saw two more doctors who confirmed the rupture and advised conservative treatment. I was then sent through to the treatment room where a cast was fitted, and left the hospital at 11.50. All the staff were very helpful, pleasant and efficient and a credit to the N.H.S. Ken

  25. Hi Ken,

    From an ex-Wythenshawe girl (Woodhouse Park) actually but went to school near Northenden (used to be called St. Columbas) think its gone now.

    Glad your experience of NHS was OK, mine was the opposite. I’m 1 year on now, it is a long road to recovery but patience is the key, check out my blog (beware if you are United)

    AnnieH’sAchillesblog.com weblog

    So glad you found this website, I was one of the very early ‘victims’ but the help and advice you will get will be fantastic so keep checking it out.

    Good luck
    Annie

  26. Hi Annie, been back to the hospital today ,same good service, but I have been told I must wear the boot for another 20 weeks, after four weeks I hate these boots but as you say patience is the key. Thanks for your reply Ken

  27. Wow Ken, 20 weeks is a very very long time. I was in a cast for 10 weeks which I thought was an awfully long time, but 20 weeks in a boot, phew…

    Will you be able to have some physio during that time, I would presume you will need some muscle strengthening.

    Good luck, and follow all instructions from medics, they speak from experience even if we think they dont.

    Have you thought about setting up your own blog, I had never done anything like it before, but it certainly passes the time and takes your mind of things. Are you able to go to work? I went back after just over a week and although at times I was very tired it really helped, and you get lots of sympathy!

    Annie

  28. Hi Annie, I went back to work after two weeks in a non weight bearing cast, and I have to be on my feet 9 hrs a day sitting down when I get a chance.
    As you say you do get very tired,but the bills have to be paid so its not an option being off work.
    One way i’ve made my life easier was to build up a shoe to match the height of the Aircast boot so I can walk on an even keel,as I’m a shoe repairer this was easy and if anybody felt like trying this their local shoe repeirer should oblige.
    I have thought about a blog ,but at the minute working a 6 day wk with the boot on I’m shattered all the time.
    Again Annie thanks for your input Ken.
    p.s I used to work in the heel bar in the co.op at civic centre from 1968 till 1976 so you might even of had your shoes repaired by me.

  29. That is hard work Ken, no rest for the wicked!!

    We moved from Wythenshawe to Prestwich in 1965 after I finished school.

    My Dad used to be a ‘cobbler’ on Princess Road way back in the 1950’s. He used to have some old heavy lasts at home and repaired shoes from home as well for the neighbours. Small world, but I do remember Civic being built it was a very exciting time as when we moved to Wythenshaw in the early 50’s there were no shops as all, so Civic was amazing.

    How will you cope with the hot weather, even after 1 year my ankle swelled up today just because it was a hot day. You really must rest and elevate as much as possible.

    Annie

  30. Hi

    Sad to say I am now a member of the UK ATR club, following an injury playing football in Glasgow on Sunday 5 April.

    Being treated via non-surgical route, although am a little concerned that this might not be right for me, as a lot of web advice suggests surgery for young and active folks - well I am active if no longer young!

    Anyone consider it worth me trying to get a second opinion? I am a BUPA member through work, but am currently being treated by Glasgow and Clyde NHS.

  31. Hi Simon

    If you want the opp, get a 2nd opinion. I have had a battle with my local nhs but through complaining (lots) and having a little knowledge from this site, they have given me everything I asked for.
    e.g
    I rang and rang until a bed came up so i wouldn’t get lost in the system

    I wanted an experience doctor to treat me (not a student)

    I wanted and got a boot. (After the op they said I would be in a cast for 6 weeks as boots are to expensive)

    I asked for a removable cast to sleep in.

    I have asked for physio but they won’t provide this. Luckily work are providing this.

    I am now 9 weeks post op and am able to walk a couple of hours in 2 shoes.

    Complaining gets you everywhere in the nhs.

    Any other queires, feel free to email
    robpuzo@googlemail.com

  32. Hi Annie, another coincidence, the cobblers I first learned shoe repairs in was Coombes on Princess road in moss side back in 1965, moss side was a safe place to live back then. What you say about the warm weather has crossed my mind because my ankle keeps swelling now, but such is life. Ken

  33. Thanks Robby

    I’m not certain I want the op, just want to be certain that I am doing the right thing for me, for the long-term.

    I think I will organise the second opinion, it certainly can’t do any harm.

    Do you know if, assuming no re-rupture occurs, the end result in say a year is a tendon that is equally strong, regardless of whether the conservative or surgical route was followed?

    Thanks again for your help.

  34. Sorry Simon

    I do not know the answer to that question. I am sure that you will find the answer on the main site - http://achillesblog.com/

    The right thing for you is vital so do the research.

    I was strongley advised by the doctor to have the op because of my age (30) and job (Fire fighter).
    I am also due to fly to Oz soon and that had a big influence as I was told that the op would result in a quicker recovery.

    In the 3 days I had to wait for the op I did a lot of research and was 100% certain that I wanted it and I am glad I did as I am walking in 2 shoes at 9 week.

    Hope this helps

  35. Have the op if you want to play football again. I had it and I am 40 now but would still like to play 5 aside with friends, I am 6 months post ATR now and have been let loose on jogging now. I can jog up to 12 minutes and am building on this every week. It has been slow but there is light at the end of the tunnel.

  36. Thanks dazf

    I have a second opinion booked with the surgeon who treats players at Rangers FC.

    I shall see what he says and then make a decision on op or not!

    You can track my progress on http://achillesblog.com/thedukester/

    Glad you are progressing well. I know it will be a long time, but I am determined to come back strong.

  37. Hi,

    I ruptured my achilles on the 28th of March, basically went pop while out and I knew exactly what it was. Went to A&E the next day where I was diagnosed put in a bandage and given crutches.

    Went to see my GP for a referral on Monday and had an appointment with an ortho surgeon on Tuesday. He basically gave me the option of surgery or conservative, went through the pros and cons of each and left it to me. I pressed him on what he thought best but he was entirely neutral which I found quite strange.

    Anyway given the risks of surgery and my hatred of hospitals I went the conservative route. I have been in the cast for 2 weeks now and it feels like a lifetime.

    I also asked my surgeon about going back to work and again he was very lasse faire, said it was up to me. I have a full on (albeit office) job, so I went back the next day (Wed) and by Friday my ankle was very painfull. I worked from home a couple of days the next week and have now taken time off.

    What timeframe have others gone back to work (particularly those who have taken the non operative route)? I am really concerned that I am pushing it and will make things worse in the end.

  38. [...] Achilles Tendon Hell » UK ATR UK people blogging experiences (tags: achilles conservative) [...]

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  39. Hi,
    Saw your post. I ruptured my achilles on February 16th, 2009. I tore it high-where it attaches to the calf muscle and was talked out of surgery because of the difficulty in stitching together what the surgeon called “spaghetti like” pieces of tendon. I was put in a cast, non weight bearing with my toe pointed for 4 weeks. That was removed, my foot straightened out as far as it would go and put in another cast for 4 weeks, with gradual weight bearing until I was walking with it.

    I just had the 2nd cast off and I am healing on schedule. Very tight in the calf right now, walking is difficult due to the muscle lost in the ankle/calf, but am managing. I was back to work 2 weeks after the date of the injury with major inconvenience due to the crutches. I was ok though, for the most part and only really had pain that made it unable to work for one day. It’s a long road, but there’s little we can do but follow dr’s orders and be careful!!! Definitely a horrible injury, and the non surgical route seems to take longer.

    You can email me back if you wish at gregjdelahunty@hotmail.com
    I am not a member of this site, just came across it.

  40. Hi Luke1..

    Just to say I completely understand where you are coming from re surgeon’s vague response to questions..

    I Ruptured my right AT playing 5-aside 4-04-09. 11.45am when just about to go in goal for a breather!!Straight to A&E where Thompson test confirmed. consultant advised surgery but i opted for conservative. no advice was given re going back to work..nobody mentioned having a certain period of time off or rest or anything re weight bearing??

    I had 2 days off and went (only through boredom)back on crippling crutches (office job). i have no pain, just discomfort if i rest foot up due to pins and needles. i read on another blog that those opting for non surgical should weight bear as soon as possible, and should push for a ‘breg boot’ immediately… ?

    (I can actually stand un aided and put pressure on injured foot.. is this advisable or downright insane??)

    Anyone else heard this? Apparently it’s a study from Ireland?

    I go to get 1st cast off on the 1st May

  41. Hi Everyone,

    In my opinion if the orthopaedic surgeon gives you the option of surgery or conservative but does not recommend one over the other - the best thing to do is ask him/her what procedure he/she would have done in a similar situation. That may make your decision slightly clearer.
    Hope you are all healing well. I have my appointment with orthopod tomorrow (six weeks post-op) hopefully I will have cast off and a walking boot so that I can progress to PWB.

    Take care.

  42. Hi Vern,

    I would be a bit cautious about placing weight on foot so soon (i.e. 18/19 days post ATR) especially with conservative treatment. The tendon takes a long time to heal (more so than most bones) because it has poor blood supply. There are several scientific papers from all over the world that talk about early weight bearing after ATR - however, the bulk of these papers do so with the surgical treatment and for those that have been given walking boots (air cast, bledsoe boot, vaco boot) farily early on after surgery.
    In general, immobilisation periods tend to be longer for conservative route compared to surgical. I would recommend that you wait until your appointment with orthopod before you place substantial weight on foot. I think it’s important to remember that this is not a sprint but a marathon and patience at this stage may pay dividends towards the end. Having said this, every individual has different recovery abilities. My advice is purely based on my eperience and from what i’ve read on the web. I am no orthopaedic surgeon nor medic.

    Hope your recovery goes well. The best thing to do before your next appointment with consultant is to make a list of all questions you would like to ask as at times when in hospital these questions can easily slip your mind.

    Take care.

  43. Hi Vern,

    I went back to work similar period to you (ie right away). Pre accident I had booked a week of leave (to go surfing of all things), but took it anyway just to rest and get used to the cast and crutches. I think it really helped, both in letting my body get some uninterrupted healing time but also just to adjust to my new lifestyle (which mainly involves sitting about!).

    Returned to work full time after leave and like you have been putting some weight on it when showering, cooking etc (I cant see how you can avoid this unless you do not leave your bed and have a tribe of slaves pandering to your needs).

    I am getting my first cast off in a week’s time, hope the surgeon is happy with progress.

    Anyway Vern, how did you go with getting the cast off? I am really interested as you seem to be in a similar position to me.

    Cheers

  44. Hi all

    Sad to say this is my second ATR. Left achilles ruptured when I was playing squash at 17yo and had op to repair it. Now aged 36 and right achilles now done same thing- I’m a teacher and was playing dodgeball with my class. The only up side was that we beat the kids! This experience very different though, as this time it is a partial tear rather than a rupture and so the docs have gone down the non surgical route.

    8 weeks down recovery road (it happened on Friday 13th (!) March 2009) and I’m about to go back to the hospital tomorrow to see what happens next. Don’t know if reading blogs and all stories online have helped. Very worried about the chances of a re-rupture if they haven’t got it right and will have to make sure I ask the right questions tomorrow. Wondering if I should have pushed for the op again but hindsight and all that.

    Doesn’t seem to be much about reference recovery time after non-surgery approach so any advice from others who have gone through it or are going through it would be greatly appreciated.

    I have my fingers crossed for positive outcome tomorrow- may even be looking forward to the dreaded boot instead of another cast! At least this time I can expect physio through the hospital as when I did this 19 years ago I had to pay for it myself.

    Will let you know how it goes.

  45. Hi all,

    I ruptured my left Achilles Tendon on February 14th while dancing at my other halves 40th birthday party. As it was only a partial tear, I also have gone down the “non-surgical” route.

    I have found sites like this a great help. Due to the fact there aren’t many blogs from people who didn’t have surgery, I am writing a fairly in-depth dairy of the events which I will post a link to. Until then if anyone has any questions please email me at leepantling@dsl.pipex.com if you have any specific questions about my recovery.

    Cheers

    Lee.

  46. Hi everyone

    Well had the first cast off after 6 weeks today and am now in aircast (walking boot). Doc was a bit concerned that it may not have healled that well. So iam back in 2 wks to have another look.

    Anyway gingerly having a crack at the weightbearing in the cast, very weird after 6 wks….

  47. Hi all fellow ATR sufferers,

    Had my ATR on 23rd March playing 5 a side. Heard a massive ‘pop’ and was looking around for the person who kicked me!!!!. Was put in plaster for 2 days before going to fracture clinic then diagnosed with a full ATR….nice…was then told would be in plaster for up to 8 weeks - conservative approach. Asked to see a ankle and foot specialist re. surgery and he again suggested the non-surgical route. I had looked on web sites for research but found the surgical approach more favourable in USA. I opted for the non-surgical approach (I do not want an infection - been there before in a uk hospital) but asked the specialist surgeon about the aircast boot. I was given this after 4weeks and i must admit it is great.

    Hardly use the crutches (only for long distances)….freedom…get the boot if you can!!! Don’t be scared of asking.

    I am now 7 weeks post rupture and initiallly i had 5 wedges in the boot another one comes out on Monday which will only leave me with one left. I have another appt with the specailist on the 26th May when hopefully I will be allowed physio.

    Does anyone out there know how long it is before you can drive (non automatic) the dr’s tell me anything from 16-18 weeks post rupture? I need my freedom!!!!

  48. Hi Paul, I too had my ATR on April 5th while playing basketball. I opted to take the conservative approach when the orthopedic surgeon gave me choices. From day 1 I was fitted with a bledsoe boot with 2 wedges on my left foot (thank god I drive automatic) and was walking around FWB. At around week 5, I started to feel as if my tendon was actually connected and with the advice from my PT, my left foot looked almost normal, thanks to the compression stocking and mild PT exercises he prescribed me. I am from Canada and I believe Doctors here do not readily recommend surgical route, unlike in USA.

    16-18 weeks seems rather long. My doctor said I should be able to walk in 12 weeks unaided and be able to jog in 20 weeks. I am a very fit 30 year old male working in law enforcement field and I too am anxious to put this injury behind me.

    I have an appointment with my orthopedic surgeon tomorrow and hopefully he will allow me to begin an aggressive PT program.

    What kind of boot are you fitted with? And alot of people keep referring to 2 shoes, what is a 2 shoes? (its not Bledsoe or VACO is it?) Can someone explain what 2 shoes is?

  49. Hi Andrew,

    I am in an Aircast boot, which looks something like a strorm troopers leg!!!! You have to inflate it to protect the ankle, leg etc. I also initiially had 5 widgets (heel raises) which I take out once per week to lower the elevation of my foot.

    The good thing here is that you can FWB and move around the house, but the downside is that i have to have it for 5 weeks. So that will be 4 weeks in plaster and 5 weeks in the aircast - a total of 9 weeks before any physio.

    After reading alot of comments from this site patience is the key and this is something I am learning. I am on 1 widget as of Monday and I am looking forward to the physio but with the view that if I push too hard and re-rupture I will be back to square one.

    I really hope I can walk within 12 weeks, you do tend to get jealous of people walking around, but i do have more respect now for anybody on crutches !!!!!

  50. Treatment via NHS Scotland Forth Valley.
    I ruptured my Achilles Tendon on my right foot on the 13th of April 2009, playing football with my kids. I felt this dreadful pain on my foot and thought someone had kicked me. Went to the Stirling Royal later that day to get it checked and found that there was nobody qualified to state exactly what I had done, so I was put in cast and told to return to the Orthopaedic Clinic a few days later. At the clinic it was confirmed that I had completely ruptured the tendon and I was informed of the two ways of recovery. The register who say me appeared keen for me not to have the surgery and informed me that it would be a 12 week recovery in plaster cast, with my foot being moved every 4 weeks. I am someone who needs to be active at all times and hates sitting around, I’ve always been physically fit and even though I’m over 40, I need to either be playing sports or carrying out household chores, I hate sitting watching television or doing nothing much. I explained my situation to the register, but he didn’t appear concerned and so I had a new light weight plaster cast put on (blue) and was told my next appointment would be in four weeks. I struggled with the armpit crutches and felt dreadful pain on my left side, due to using it so much, so I asked my GP to contact the Orthopaedic Consultant to arrange for me to meet them, which she did. I met the Consultant after 2 weeks in plaster cast and I explained my situation. The Consultant was excellent and listened to me, he informed me that he felt the surgery could be problematic and that as I had gone through 2 weeks of the conservative treatment, that I would be better to stay the course. He explained that I would probably only be in plaster for 9 weeks and that I could have a plater cast fitted with a small heel to allow for a minimum weigh bare. I was also given elbow crutches. I spent the next 3 weeks in the new plaster cast and then I returned to the Orthopaedic Clinic. My nurse at the clinic discussed with me the next option and I was allowed the air cast boot for 2 weeks, followed by no support and back on my own shoe. I was offered no physio at the hospital and noticed that my foot was swollen and sore, so I asked my own GP to arrange physio for me. My physio appointment was made for Monday 29th June at 10.15am. I had returned to work 4 weeks after ATR as I don’t get paid for being off work. On Sunday 28th June at 12.20pm, whilst showing my son how to swing a driver at golf, my right foot Achilles Tendon popped again, this time higher up and I knew what has occurred. I went back to A&E at the Stirling Royal were I met a senior register who stated I had torn the Achilles Tendon and that he would recommend surgery. I went back to the hospital the next morning after fasting since 10pm the previous night, to wait for a bed to have the surgery. I was told I would have an ultra scan first. At 1.20pm, the staff nurse at the ward I was in, informed me that the ultra scan department didn’t have any information on me and that I couldn’t have the operation that day. I had fasted for nothing. I eventually had an ultra scan which the person who carried it out, couldn’t confirm anything about and then I was taken to the fracture clinic to get a plaster fitted! I informed the fracture nurses that I wanted the operation and therefore didn’t need a plaster cast, but was told my Consultant (who I hadn’t met nor had he seen my ultra scan results) had told them I was to get a plaster cast fitted and come back in 4 weeks. I refused this and was told I would need to wait for the Consultant. After a length of time, I met with the most arrogant person I have ever met, and lets just say we didn’t get on. I stuck to me decision and informed him I wanted the operation, to which he stated to me that it was not his fault my Achilles Tendon had re-ruptured. I explained that I hadn’t blamed him or the hospital, but felt had I received the physio I should have got earlier, then perhaps I would not have had problems and would not have been on the golf range, 3 weeks after getting back on to my shoes. He explained that “it is no skin of his nose if I have the operation or not” and that if that is what I want, then he would perform it. I was operated on two days later and kept in overnight, where I felt very dehydrated. The nurses in all the wards I was in were brilliant and very caring, but the Consultants left a lot to be desired. I have an old fashioned plaster cast on the foot and have had it for 2 weeks now, I visit the Orthopaedic Clinic tomorrow to get the plaster cast removed and stitches taken out. I will probably have a new plaster cast (light weight) fitted for another 2 weeks and then hopefully be back on the air cast book for a further 2 weeks. I have already spoken to my local physio & will have physio soon. I have no intention of doing anything sporty with my foot this year and hopefully within the next year I will be back to normal.

  51. Scarborough NHS Trust, ATR 8th August 09 on Scarborough North Beach.

    Hi All, we were having a BBQ for Scarborough Ladies football team (I cooked the burgers while they played footy on the beach), I played volleyball then rounders, plenty of excercise then twang I thought I’d hit myself on the back of the ankle with the rounders bat!

    I limped around for 6 days prior to presenting myself to my GP. By then I had swelling all round the ankle and foot and bruising either side of the ankle running along the bottom of the foot to the toes.

    By this time I had read lots of the ‘google doc’ stuff on the net and was convinced of either ATR or calf strain…Thompson test can be used for both.

    Anyway my GP was more concerned with the swelling and thought I’d sprained my ankle even though I told her I had no pain except when I plantarflexed the foot…I gave her all the handy hints but she never picked up on them and she told me to come back Monday if all was still the same (I had a feeling it would be after 6 days already!)

    Rang Monday for a doc appointment…4pm, I decided to present myself to A&E.

    Scarborough hospital A&E was great, Thompson test, ATR diagnosed, ‘you’ll be in for an op tomorrow’. Went home with a half pot on the back of my ankle, never ate after 8pm just in case.

    Tuesday 18th, got pot off, saw consultant, he did Thompson test and decided I should have ultrasound prior to him operating on Thurs or Friday. Lots of emergencies that day so Ultrasound sent me home and asked me to return 4.30pm.

    Re-presented myself, got scan full rupture 5cm above heel. They told me to go home and I would get a call re the next stage. I asked if they needed to re-pot as I wasn’t in for a couple of days…..the consultant was busy carving folks, it was late in the day so nobody could be found who would make a decision. They took me back to A&E to find a ‘potter’.

    The lady at A&E said they would have to re-admit me (2-4 hours waiting) and suggested I go home and drop back the next morning & ask for her and she would take me straight to the ‘potter’.

    On presenting myself Wed morning the lady on reception insisted on processing me in the usual way…half an hour later I saw the triage nurse and repeated my instructions from the previous evening. She found the relevent nurse and I was taken to the fracture clinic waiting area where she told me there was a change of plan and that I would be seen soon.

    Half an hour later I was in with a different consultant (Scottish) to last time, not sure if he’d seen my ultrasound, but he described that two courses were available…op or conservative and pros and cons of each. He also mentioned that 1-5% reoccurence with op and 5-10% reoccurence with conservative, and asked me if I played squash or did lots of excercise, I told him a bit of badminton and cycling and gym (I’m not a fitness fan but try to keep up with a bit of a regime). He told me that I’d answered the question and that I should be potted, 3×4 weeks of foot at different angles.

    Went home with pot on foot equinus but niggling doubt about the complete rupture and that I hadn’t reinforced the fact that I was walking around for 8 days prior to treatment to consultant number 2.

    Next day got on blower to consultant secretary to tell her my worries, she told me that it was the consultant’s last day (!) and that she would add it to my notes that she was typing up and that I would hear from them in due course.

    In the mean time I kept my leg up all but one day, I stuffed a piece of cushioning material to stop the top of my big toe rubbing on the pot as it was driving me mental, all else was well.

    I received a letter stating come to see us on 3rd Sep, then the next day I got one stating change of plan, come to see us Tues 25th Aug at 9.43am.

    On presenting myself I was called into the potting shed, my old pot (fibreglass) cut off and foot put into light semi-equinus as I could feel it pulling and a bit of pain…then re-pot. I mentioned to the chappy that I had only had my previous pot on 6 days, he said he’d noticed that in my notes and when another(different) consultant dropped into the room they discussed and the consultant highlighted that it was a bit early and that with the light equinus re-pot I would not be called for a change for 4 weeks.

    Currently I feel it has been a bit of a ball ache because of the disjointed approach, but feel that the attention has been good, and I’m fairly certain that the tendon is heeling otherwise the potter would have been able to push my foot back to the natural position that I had staggered around on for 8 days…and the pain told me that the foot was certainly not going to go anywhere near that position!

    Sorry it’s long but this is my tale so far :)

  52. Hi again, just to add:

    I do have BUPA (private medical insurance, for USA folks that may read this) with work but haven’t bothered with it yet….might do if I need extra physio but am more than happy with the current situation. I can’t imagine what they would have done better except the timing on the ultrasound I suppose….plus I have had the attention of three consultants not one, so I feel that I’ve had a team approach to my treatment. I definitely feel that the potting chap who was on loan from Stoke Mandeville hospital was attentive to my concerns, so a thanks to him.

  53. So some good & some bad points for the NHS here. I was misdiagnosed at A&E (Mayday University Hospital, Croydon) and my GP wouldn’t even look at my ankle but referrred me to a private consultant as soon as I mentioned my husband’s work health insurance. I have since read that NHS are more likely to go the conservative route unless you are quite athletic, but there are many success stories for both routes on this site. Best wishes for a good recovery.

  54. That was quite a story but hopefully you feel as if you are on the mend. Like Sam I was misdiagnosed by NHS Walk in Centre, I was told it was an achilles rupture but to just go home and ice the ankle for 2 weeks then put hot wheat bags on it for a further 2 weeks. Eventually after three weeks I went private, I have PPP cover, I saw a foot and ankle consultant and was operated on the next day. He did tell me that because I had walked about for 3 weeks it was at the limit for getting a good repair. As it happens, 16 months later, I am due to see my surgeon again next week to consider having the operation again.

    Good luck with your progress, I have to say without this site and help advice from others it would have been a long and lonely road.

    Annie

  55. Annie:

    Why the 2nd surgery?

    I too was misdiagnosed (calf tear) and walked around for 7 weeks (!) before surgery. I simply was not getting any better and finally went back in to see the doc, where the ATR was confirmed with an MRI.

    My doc is hopeful for a complete recovery even with the delay, but seeing your comment “He did tell me that because I had walked about for 3 weeks it was at the limit for getting a good repair” did cause my heart to sink a bit. Oh well, it’s not cancer, right?

    @ 3.5 weeks post-op, I am hobbling around in the boot a lot more than I am supposed to, but am feeling stronger and better every day. Hopefully I go to PWB next week.

  56. This is a great resource, thanks for the comments and help.

    One thing that has confused me is that I walked around for 6 days yet the ultrasound highlights a full rupture…..I was under the impression that the foot would be all floppy and uncontrollable with a full rupture. I was convinced up to this point that mine would be partial….not that I suppose it makes a difference.

    BTW I’m a 42 year old ‘weekend warrior’, or at least I was :)

  57. Tom C

    Getting too many Tom’s on here now, I along with TomTom have had similar problems in that the tendon has knitted back together but it is ‘too long’ so I have no muscle power or strength in the leg and after all this time I cannot go up on my toes. I went to see Freddie Flintoffs physio a few weeks ago and he said I had no option but to have further surgery, so I will see what my consultant says next week. TomTom had his second surgery a few weeks ago.

    Also, you are only a baby compared to me, I was 60 yesterday so healing is not as good as for you young ones.

    Check out TomToms page or my page

    http://achillesblog.com/annieh/

    Get your own blog going, it helps to put down your thoughts on your own page so that you can go back and see how well you have done.

    Annie

  58. Tom C, sending this again, it seems to have got itself locked in the system.

    …..

    Getting too many Tom’s on here now, I along with TomTom have had similar problems in that the tendon has knitted back together but it is ‘too long’ so I have no muscle power or strength in the leg and after all this time I cannot go up on my toes. I went to see Freddie Flintoffs physio a few weeks ago and he said I had no option but to have further surgery, so I will see what my consultant says next week. TomTom had his second surgery a few weeks ago.

    Also, you are only a baby compared to me, I was 60 yesterday so healing is not as good as for you young ones.

    Check out TomToms page or my page

    http://achillesblog.com/annieh/

    Get your own blog going, it helps to put down your thoughts on your own page so that you can go back and see how well you have done.

    Annie

  59. Hi TomC, Having trouble posting at the minute, I may end up with 3 answers to your questions.

    Annie

  60. Hi TomC, Not sure what is going wrong, but my posts to you don’t seem to be getting through. This is my third attempt, so hope it does not clog up Dennis’s system.

    Getting too many Toms on here, I may have to have a second op because the tendon has healed ‘too long’. I went to see Freddie Flintoffs physio at Lancs. CC a few weeks ago and he said I have no option but to have op again to shorten the tendon. TomTom on the blog has just had a second op for the same reason. Check his blog he explains the whole process in great detail. I see my consultant next week to see what to do next.

    Age is on your side, you are still only a nipper, I was 60 yesterday so healing process is not quite as good, check out my blog

    http://achillesblog.com/annieh/

    that gives a little insight into my problems, very unlikely to happen to you, just a blip in my recovery.

    Get yourself a blog, it is amazing how much help, assurance, advice and fun you can have and it keeps the brain going as well trying to work out how to set up a blog.

    Annie

  61. hi all ,great blog its answered loads of questions.

    ATR last monday night playing football i new straight away what i had done (after finding nobody had kicked me lol)
    went to local walk in centre next day , quick diagnosis then put in a cast .
    told to be changed in 3 weeks time then have another one put on then the same again but then onto a walking cast!
    not given any advice on rest,work,pain relief
    still a few questions ..

    what if any pain killers do you take
    whats the best way to shower/bath leg out or cover it
    crutches- under arm or fore arm ones

    Rgds mark

  62. Hey Mark,
    Hope my experience with above questions help, I had th ATR surgically repaired, so some of this may not apply.

    a) Were given the option for an operation ? Being active you may want to examine the options for repair…I’m sure you can find more on it here (on this site) and my surgeon said 2 weeks post injury was still a good prognosis for repair outcomes.

    Seems very strange if you weren’t given ultrasound/MRI to check if an non surgical repair would work, but I am far from being an expert.

    b) Pain killers - The outpatients Nurse said to take Ibprofen PLUS Codeine or take an Ibprofen with a paracetamol…the first option known in Australia ad Neurofen Plus but I also note that pre admission to surgery It was advised not to have ibuprofen up to 5 days pre op.

    other than swelling pain for 2 days post op, and the evening of the injury I had very little pain, and at most 1-2 over the counter pain killers were more than ample, but I am sure there are multiple experiences here.

    c) Showering - My wife bought me a cast cover called a Seal Tight… a latex bag that has a rubber ring on the top to keep water out..was $50AUD and obviously re-usable, but I think a good pack of garbage bags and a roll of electrical tape ight also do the job for a lot less.

    d) crutches, the physio I saw post op didn’t really give an option, straight for the forearm ones. Their good from the point of view you can grab something and not drop them, though they do get in the way for my when I try and help around the kitchen..

    e) work - I was back at work after 2 weeks, but that’s with a low activity desk job, and I cold drive with the injury being my left foot and my card automatic, though I probably pushed it a little to far.

  63. cheers jphicks i appreciate your help,
    first cast off on tuesday (15/9/09) fingers crossed

  64. Thought I’d give you my experience of NHS in Northern Ireland.

    ATR at Glastonbury Festival on 28th June 2009 whilst dancing to Madness!

    Split cast applied at Yeovil hospital so I could get home to Belfast.

    Day 4: half cast applied in Belfast with foot in equine toes pointed position.
    Week 3: cast removed and tendon checked by specialist. Confirmed complete rupture healing well. Told that no surgery was required and that he could achieve similar results using conservative method. New lighter cast applied, foot again in equine position.
    Week 4: cast removed. Aircast boot fitted. Light exercises start whilst sitting. Weight bearing with crutches.
    Week 5: no crutches needed now. Full weight bearing in boot. Bathing possible. No standing without boot.
    Week 7: started private sports massage and reflexology to get blood circulating better.
    Week 8: boot removed. Full weight bearing in two shoes. No further support or shoe inserts. Further exercise advice from physio. Started swimming and exercise bike. Leg swells easily but not too painful. Lots of walking but with limp.
    Week 11: still limping but more movement. Swimming working well. Massage reduces swelling. And that’s me so far!

    I am very pleased with NHS support. My specialist sees dozens of ATRs every week so seems very experienced. He always does 4 weeks plaster, 4 weeks boot and it seems to be effective without surgery.

  65. Hi all,

    I ruptured my Achilles tendon playing squash ten days ago - October 14th. Knew straight away what I’d done, or feared that’s what I’d done, anyway. I’d been playing every week with a friend for around 2-3 months, fitness fine, reasonably competitive. I’m 34. Just coming to the end of the game, went for a routine return, heard a loud bang! (or sounded loud to me), felt like someone had smashed my calf with a racquet, or a cricket bat. Went down and actually turned to look at the spectator gallery because I thought someone might have thrown something at me from there.

    Told my mate I thought I’d ruptured my Achilles. Where it used to be was just a bit fleshy. Nothing there. Felt pain, but not too bad - overriding emotion was panic; 99% sure what I’d done and I’ve got a decent knowledge of sports injuries and knew what an ATR meant. My mate helped me off court and drove me home; he was telling me it could be a torn calf muscle and to ice it. I hoped to hell it was but knew it wasn’t.

    Got home. Wife came downstairs to find me in tears of panic and she called my stepfather to take me to A&E - Peterborough is the nearest hospital to me with those facilities. About 20-25 mins drive away.

    It was 9pm by the time I got there. Seen by a nurse at 10pm, who gave me some painkillers (co-codamol) to take the edge off. Another hour and I was seen by a doctor. He did some quick tests (standing on tip toes - yeah, right! No chance with my injured AT, the right one). Told me I’d had a complete rupture. Sent for a colleague for him to have a look.

    A second guy arrived. He was better, seemed more knowledgeable. Did some other tests, similar. Diagnosed the same. Sorted an X-ray to check for further damage and we spoke about my options, surgery or conservative.

    X-ray fine. Was then put in plaster, toes to above the knee, equinus position. Very heavy, could barely move. Given more painkillers and driven home. To be fair to NHS, they moved pretty fast once I was diagnosed.

    Next day - as suggested by the doc - I read up on surgery v conservative. Day after, an appointment at the fracture clinic to see the specialist. Didn’t want the surgery but said if he recommended it, I’d go for it. He said people often ask him what he would do. ‘Go on then,’ I said. ‘I wouldn’t have the operation,’ he said.

    That did it for me. That was just over a week ago. After the specialist saw me, the plaster room cut the first cast off, replaced it with a synthetic one just under the knee. Much better. At least I can put my own underwear and jeans on now. On crutches, doing as little as I can but getting in to work (I’m in publishing and it’s pretty much desk work so not too bad and my desk/Mac etc has been moved from my office to a space downstairs to combat the stairs) by getting lifts in.

    That’s me so far. Reading blogs on here kind of help - a bit - and I think I’ll start one. I must admit, mentally I’m struggling. Today’s a bad day for me, no real reason. Worried about all sorts of stuff (mainly whether I should have gone for the op) and finding I’m reliving the ‘moment’ quite a lot. The full realisation of this injury is sinking in, and some days it’s difficult to absorb. I know it’s early days though.

    Cheers for reading.

  66. Kevin,

    I busted my left AT back in January also playing squash. It’s such a physically demanding game. I attribute my injury to insufficient warm-up, poor squash shoes, and repeated pounding on my left leg. This is a major injury, no doubt about that.

    In retrospect, I would not have opted for surgery. So I think you should calm your mind regarding that worry. The reason I say this is that you’ve avoided a long deep scar, additional internal scar tissue, and the surgeon’s potential mistakes (I have alot to gripe about this). Obviously one downside of no surgery is the strength. It does feel strong but it takes away some flexibility. Without the sutures, I believe you would eventually gain more flexibility perhaps closer to pre-injury.

    I’m able to return to the squash court but I am not going full-boat. Amazingly I play better now than pre-injury. I suppose the time-off has given me time to think about how to improve my game. I know my tendon is even now still healing, and as others have pointed out that it could take over 1-2 years to settle.

    For now you definitely want to elevate your leg as much as possible to avoid excessive swelling.

  67. Hi Daz here’s mine, Squash right ATR drop shot to the wall went for it loud bang down like a sack of spuds. Knew immediately what had happened not a lot of pain though, partner iced it elevated it was in A&E in Shrewsbury within the hour. Waited 1.5 hrs seen by triage nurse who sent me to see a Staff Nurse she examined me and got me to try the standing on the toes routine which went as expected. Down to X Ray back and into Plaster after X ray checked. Appointment next day at fracture clinic. Saw a great consultant (Badminton player) who offered me invasive or non invasive option. He then examined the damage and I asked him what he would go for. He said he would go Op route and gave me the full benefits plus risks. Had a hernia op a while ago and seemed to heal quickly with no complications so after a bit of thought opted for Op. Said he could do it the next day (yes it is the NHS) as day surgery. Came in on the Thursday having done it on the Tuesday night 5.30. Got bumped off the Thursday list but Operated on Friday 4.30. Escaped from hospital Sunday lunch in cast and starting the long road to recovery. Can’t complain about the treatment so far, fingers crossed.

  68. Hello,

    What a great site & resource this is.

    I ruptured my achilles (left leg) playing squash 18th Jan, 4th game 3 points from winning the match, no pop, but stabbing pain to the back of the ankle. I knew something serious had gone.

    Carted off to casualty (Airedale general, N Yorks) they had
    a look & did a few tests and said I had a bad calf strain.

    Went to work the next day on the bus, walking was difficult
    but plodded on. Friday could hardly stand on my left leg.
    I managed to get a doctors appointment for friday am,
    doctor had a look, leg/ankle very inflammed. Told her the story, she just gave me a course of anti-inflammitary pills.

    I had to ask about some physio, she gave me a contact no
    to book an appointment.

    I thought something was not quite right so booked in with a sports physio, 29th Jan. Took him 2 minutes to work out
    I had ruptured my achilles, he said get yourself off to casualty.

    So I have been wandering about, going to work & having to
    walk a bit on a ruptured AT. - (Gutted)
    Will this have caused further damage or just put my recovery back by 2 weeks?

    Airedale managed to get it right this time, put in plaster up to my thigh + I have to inject myself to stop possible clots.
    Appointment with othorpedics on Tuesday 2nd Feb.
    Decided to leave pot on for another 2 weeks, full length cast, no joke like dragging another person along with me.

    I assume/hope they will change for a below the knee cast
    in 2 weeks + scan to make-sure its healing ok.

    Will update after next appointment, but not impressed with
    with the service so far.

    Thanks for reading this, hopefully you’ve not nodded off.

    Sydw

  69. Not exactly UK or NHS, but Canada is sort of “mid-Atlantic” right? You can check out my normofthenorth block here for details. I got surgery on my right AT 8 years ago, healed slowly but well. Tore the left one Dec. 8 and had trouble finding a surgeon in Toronto who still does ATR surgery!
    The fancy sports-med surgeon I did find told me he stopped doing ATR surgery months before, because of a fancy randomized trial report from U. W. Ontario that showed that conservative non-invasive approach produced results every bit as good — provided both groups got relatively rapid mobilization, rehab, physio, etc.
    So far I’m very impressed with the non-surgical protocol I’m on, after 8 weeks, and the way my leg is healing. If anything, I’m ahead of my schedule from post-op 8 years ago — though it was slower than today’s state of the art (or even 2001’s!).
    Protocol says “wean off boot” starting now, and I’m sticking with a hinged boot that I saved from 8 years ago. The boot’s set up so it can’t dorsiflex past neutral (so far), but it can plantarflex way down.
    Links and more on my blog.
    Good luck everybody!
    P.S. Sydw, make sure they give you a below the knee cast soon! Immobilizing your knee is a major nuisance, and has absolutely no benefit for an ATR! Just a mistake. No reason to lose all the tone in your thigh muscles and knee ligaments.

  70. Hi. I’m so glad to have found this blog because I’m having ATR treatment (conservative) in the UK! I had the ATR 2 weeks ago while dancing and was taken to A&E (New Royal Infirmary in Edinburgh) right away. Here is what has happened so far.

    DAY 1: Put a below knee half cast (with a ballerina toe) which didn’t cover the back of my leg/foot including the injured AT. Asked a doctor about a surgery option, but he said that it could involve other problems (e.g infection) and didn’t offer me the option. He instructed me to take ibuprofen or paracetamol where necessary and to make an appointment with their orthopedist in 1 weeks time.

    DAY 2: The cast edge pressed my nerve in the root of my big toe and gave me massive pain at night.

    DAY 3: Called the hospital to request re-plastering and was told to come and see an orthopedist in the afternoon. A plasterer there told me that their A&E didn’t have professional plasters and that he was going to put a proper below knee cast (glassfiber one covering around leg/foot with a a ballerina toe). After the initial cast was removed, much of the pain disappeared. I went home with an appointment in 4 weeks time. The plasterer told me to bring a shoe for the injured foot on my next appointment so that he could put several layers of heal to the shoe.

    DAY 4 - 14: Haven’t had any major pain in my AT but have suffered from muscle ache in my arms for a week since DAY1 when I started using crutches.

    The doctors provided me with little information about the treatment regime and they gave me different numbers regarding the healing time. The first doctor at A&E said that it’d take 12 weeks and the second one at the Orthopedic Outpatients 10 weeks.

    Later, I read a few medical journal articles and a book titled ‘ATR Treatment Guidelines for Orthopedists’ (all in Japanese) along with blogs and web pages to get information about ATR treatment options and rehabilitation. So I’m now prepared to ask questions about my treatment at my next appointment. However, English is not my mother tongue and blogs like this one written in English is really helpful to learn English terms! Moreover, I wanted to know how ATR is usually treated at NHS hospitals in the UK and this blog has given me good ideas about it.

    I’ve got a job in Japan and am flying there at the beginning of April (in WEEK 8 from my ATR). Airlines would only allow me to fly with a cut cast or a walking boot (to allow for quick removal if swelling occurs). So at my next appointment I should ask a doctor about what kind of protection I will be wearing. After reading lots of comments here, I want to have a walking boot but don’t know if the hospital offers me one. If they don’t give me one, I may want to visit a private hospital where a walking boot is an option. In Japan I have to set up my new flat and need to use my both hands. Also, I have to commute by train (for about 1 hour with one change) and by walk (30 minutes in total for healthy legs!), and using a walking boot seems more reliable than a cast with a heal.

    Well, I should write down questions (in English!) to prepare myself for my next doctors appointment! I’d appreciate any comments and advice from ATRs. Thanks a lot!

  71. Hi All,

    I ruptured my Achillies 4 weeks ago today playing Badminton at Center Parcs on holiday.
    I didn’t feel much pain just a loud pop and a what felt like a kick in the back of the ankle.
    Anyways, I got rushed to the nearest A&E (Bury st. Edmonds) where they took a look and told me it was completely ruptured (squeeze test). I spoke to the consultant who said there were two options, surgery and conservative. He told me the pros and cons of both options. I decided to go the conservative route as I’m not an athelete and dont like hospitals at the best of times!
    They plastered me up there and then with a ‘back slab’ and my toes pointing downwards and told me to go to my local hospital when I got home from holiday the following week.

    I tried to make an appointment at the local hospital on my return only to be told to go to my GP, which I did then he referred me to the hospital without even looking at me!

    2 weeks after the injury I got an appointment, they took my cast off and sent me for an ultrasound. The doctor said my Achillies was not ruptured completely but still very swollen and he couldn’t tell if it had been fully ruptured and had healed slightly in the last 2 weeks or if it was never fully ruptured at all!

    They put a new cast on and told me to come back in another 2 weeks for another ultrasound which is due next week.

    I’m getting around ok on crutches no major pain just annoyed with the lack of mobility (I’m usually very mobile - hyperactive my wife would say!)

    Waiting for a final diagnosis and whether they are going to need to cut me open or not (hope not!).

    Any advice on what to expect next / what questions to ask / demands to make at my appointment next week at the hospital???

    Thanks in advance,

    Andy.

  72. Andy, your experience sounds totally typical for a (total) AT rupture, and your treatment so far sounds perfect, for the modern “every bit as good as surgery” non-surgical cure. Just make sure you get into a boot ASAP instead a bunch of casts, and try to get partially weight-bearing (PWB) ASAP, and start doing some gentle out-of-boot exercises (all below neutral position) as soon as you get a boot.

    If you can get some (gentle) Physio sessions, that’s also a boon, and it’s not too soon to start, according to the most modern and most successful protocols. Adding surgery to that approach, according to the latest FOUR careful studies (all linked from my blog page) does not improve the outcomes.

    And if they convince themselves that it was a partial tear, that certainly shouldn’t help them convince you to take surgery!

    Fight for a boot! Lots of ATR patients have gotten them in the UK, from the NHS. If they won’t buy you one, buy one yourself! Boots are better than casts, for you and for your leg!

  73. Hi all

    I completely ruptured my right Achilles playing football (soccer) on Saturday 3 April. I live on the island of Uist in the Western Isles and visited my local A&E (Uist and Barra hospital). They arranged for surgery the next day at the Western Isles hospital on the neighbouring island of Lewis (which involved a 1 ½ hr ferry journey and about 3 to 4 hrs driving to get to).
    ——————————————————————————-
    My experience to date:

    3 April
    Rupture Achilles. Visit A&E and they arrange for surgery.

    4 April Easter Sunday
    Travel to Lewis. Open surgery of Achilles performed. Surgeon advised Achilles ruptured and part of the Achilles had to be reattached to heel. Leg in a plaster of Paris cast with the foot was in an equinous position

    22 April
    Attend local ortho clininc. Cast broken off, stitches taken out, new hard cast applied, foot still in equinous position. Surgeon advised incision healing well. Next appointment on 20 May to apply new cast. He said that I would probably be in a series of casts for up to 12 weeks. No chance to query this.

    1 May
    Slip on crutches on a wet floor and fall on my injured foot.

    6 May
    I saw the consultant for a very brief check up (he visits my island every two weeks) and he was confident that I hadn’t done any significant damage to my achilles. Asked about getting a boot but surgeon thought that casts would be better.
    ——————————————————————————-
    I was a little concerned about having my operation done in Lewis. The surgeons tend to do a little bit of everything (broken bones, knee replacements, etc) and I do not think they would see many Achilles tendon ruptures. I also have family in Glasgow so it would be easier for me to go to than to Lewis and via plane travel time is similar. However, the A&E doctor advised me that it was a straightforward operation and that it was best if it was done quickly. The surgeon in Stornoway could see me the next day (which happened to be Easter Sunday).

    I am also concerned by what the surgeon said to me after my operation. He advised that I probably shouldn’t play football again. I asked him whether running would be OK but he said he wasn’t sure. My sister is a physio in Glasgow and she told me that he was probably just being conservative and that I could make a full recovery. I’m 30 and can’t imagine not being active and plan on being very thorough when I get to physio. I’d love to hear from anyone else who was told something similar but who managed to make a full recovery. I’ve had a lot of encouragement from various blogs here and still hope to be able to be as active as I was previously.

  74. Sorry if I sounded a bit negative above. The surgeon I had at the Western Isles Hospital was very experienced and the nurses at the hosiptal couldn’t be more helpful or pleasant. I do think the surgeon was just being on the careful side and I am looking forward to starting on physiotherapy and making a good recovery.

    Good luck to everyone.

    Donald

  75. donaldinhio

    My experience has been that UK doctors tend very much on the conservative side. I ruptured my left achilles on 21st Jan 2010 playing squash. This was treated conservatively - in a cast for 7 weeks then into boot / physio. Then, 14th April, tripped and re-ruptured. Surgery this time, and now in first of three casts (roughly 6 weeks / 2 weeks / 2 weeks). This to be followed by boot / physio.

    It seems typically that UK doctors are conservative, and also that protocols differ significantly between doctors. I am 48, and extremely active (squash, running, cycling). I think the squash days are over, (my choice really) but doctors / physios advise running should be fine, BUT it’s a long journey - maybe as much as a year before running is anything like it was pre-injury.

    I like to think my re-rupture wasn’t down to me pushing too hard, although it came a day after my first session back on the stationery cycle and days after my first long distance trips in the boot for business meetings. However, this time round I will be taking a more conservative approach myself!

    Best of luck

    daviduk

  76. DavidUK, you almost beat the odds. Re-ruptures are pretty rare after 12 weeks, and I think you were a day short. Bummer. It’s possible that your extremely long period of total immobilization with NWB extended your period of vulnerability. It certainly does more harm than good (with or without surgery), according to all the new studies — not to mention being a bother in every OTHER way! I’ve linked a few of those studies on my blog.

    Donald, it’s interesting that ATR patients in the UK are still being rushed into surgery. And being casted for 12 weeks, which is far to the primitive side of the merely backwards!

    Your main risk from returning to high-risk sports like football/soccer after your leg recovers (maybe 6-12 months, depending) is that you’ll tear your OTHER AT. It’s still relatively unlikely — maybe 1-2% of the single-tear population does it — but that puts us at ~200 TIMES the “background” risk!

    My story’s on my blogs, but after tearing my right side 8 yrs ago and getting surgery, I returned to competitive volleyball at my earlier performance level (if not higher, despite being an OLD guy!). Then last December, I did tear the other one. This time I was talked OUT of the surgery by a fancy surgeon who had read the latest studies. I’ve had a much quicker and easier time of it than the first time, partly by skipping the surgery and partly (mostly) by following the modern rapid-rehab protocol that the latest study used. They got excellent results, and so far (touch wood!) I am, too.

  77. David, it sounds like you were very unlucky with your re-rupture. How long had you been out of the boot when it happened? Your rehab timeframe is similar to mine and my next appointment on 20 May (6 ½ weeks). My cast is being changed and my foot is being moved from equinous position. Fingers crossed that I will be PWB.

    Norm, it’s great to hear that you made a full recovery from your first ATR. As I live in a very rural place it probably doesn’t help with getting the most cutting edge treatment for Achilles ruptures. I tried dropping hints to my surgeon about following Beckham’s rehab but he just laughed. I’ll have to get him to look up this blog to get him to change his old fashioned ways.

    Good luck with all our recoveries!

  78. Donald,

    I follow almost the same as Norman protocol.
    You may check for my progress reports.
    It took me some “salt” that my doctor and PT were agreed to this newer protocol - thanks to Norman for all info and links and even the protocol. I’m not in any sport related center - just village (Santa Teresa) hospital.
    Your doctor doing it by the book and might not take / tolerate any risk of newer protocols.

    I’m not sure we ever will know what kind of surgery Beckham had and what protocol he’s followed. This is private info and might not be released at all.

  79. My review of the rehab protocols and the studies that used them, is at achillesblog.com/normofthenorth/2010/03/08/a-more-complete-review-of-the-options-surgical-vs-non-operative/ . (It’s linked on the home page, too.) Most of the studies I link were set up to compare surgery to non-surgery, using a good, standard, modern rehab protocol for both kinds of patients.

    So one fringe benefit of the studies is that they tested and reported the results of following those protocols, which are way quicker than Donald’s and David’s. And the results were excellent, so try to steer your Doctors to those studies!

    There have been some other studies that compared quicker and slower protocols, most after surgery, and they’ve generally found that quicker is often better, and I don’t think I’ve seen one that showed it worse than equivalent. So being SLOW is just being SLOW — it’s NOT really being CONSERVATIVE, because it’s no safer, and it doesn’t produce better results or fewer re-ruptures!

    achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/ contains the exact version of the protocol from the Univ. of W. Ontario study that I’ve been following. Mike753 and gunner have since adopted it as well.

    (Ask your Doc if HIS schedule has ever been tested and proved effective in a randomized study!! I bet not.)

  80. Hi Mike

    I think you’re right in saying that my doctor is following a standard proven procedure which is no bad thing. You’re also correct about Beckham’s treatment and I can see why the doctor laughed at me!

  81. Donald,

    Print out those studies and protocol that Norman has at his page and give it to your doctor.
    One thing when random patient tries to “lecture” his doctor and another proven facts.
    May be your doctor will get attention and will check it online or even make some calls about those protocols. And then may be you’ll get faster recovery protocol ;-)

  82. Donald, don’t confuse “the way it’s always done around here” with “proven”. “Proven” means it’s been subjected to a scientific test, like a randomized trial study. Most doctors don’t have time to read those, much less do them!

    Doug53 and I have posted a link to a very funny article about “EBM”. It should stand for “Evidence-Based Medicine” but it often stands for other things, like “Eminence-Based Medicine”, where the opinion of the most senior professional is treated as truth, regardless of how baseless it is in science!

    But I’m pretty sure your Doc has never “lost” an ATR patient, because we all survive!

  83. 3 1/2 months post op I took a chance and went skiing. It went well so I’ve been 4 days in a row now and am going again tomorrow. Talk about killer P.T. The mountain, the sun and good friends. I thought the season was over, now I’m just stoked!

  84. You’ve been going at great speed, Obsessivec! You beat my time to the ski mountain by half a month — and one of the bloggers here used the word “superman” on my blog when I went skiing! (Are they still skiing in Colorado in mid-May?)

    If any of you folks wants to read some delightfully written funny reports about a fellow ATR patient’s progress, I commend you to obsessivec’s blog!

  85. For Donald and anyone who has trouble with doctors not wanting to be aggressive: I had the exact same experience in Georgia. Doc wanted to operate and leave the cast on for at least 6-8 weeks. Thanks to this site, and especially Norm, I went in prepared with research and options and basically took charge of the process. I had no operation, got the cast off after 3 weeks (lost one week on that one!), ordered the VacoCast, brought in the therapy regimen Norm provided and away we went. This experience has taught me that a)most docs are not doing enough ATR repairs to stay up on the latest; b)security and surgery fees drive them to the most conservative option and c) some will be open to change if approached with data and boldness.
    We all must take responsibility for our own care. Thankfully we live in the internet era where we can learn from others experiences (mostly the “best teachers”) and those who, in the words of Norm’s wife, aren’t afraid to “practice medicine” (dispense wisdom).

  86. HI,
    I am a 43 year old male who has recently suffered a re-rupture - and at this point I am totally gutted.

    Rupture 1 was in January - I had been back training with my old fooball team for about 3 months, cause I was just so bored at night during the long Scottish winter. - I was asked if i wanted to play in a friendly they had arranged and i said “yes why not?”.

    About 30 mins into the game I ruptured the left achilles and done the typical responses - firstly looking around to see if someone had kicked me or thrown something.
    I quickly realiased that this was not the case and found myself in the local A&E in Paisley. I was checked over and put in a cast by the A&E and told to attend the fracture clinic in the morning.

    I was driven to the fracture clinic by my wife and we basically went through the same process that we done the previous night where they checked the achilles and came to the same conclusion - full rupture.

    I was then given the options of a cast or surgery and I choose the cast as the doc didn’t seem to keen on me going for the surgery and his manner when discussing it put me right of it.

    So I was placed in a full aquinus for 6 weeks, then the foot was raised in a different cast for 2 weeks and then the foot was raised again to 90 degrees for a final 2 weeks in plaster.

    When the final cast came off I was asked to walk to the nearest table (about 6 feet away) and back again. When I managed that the doc said “right thats you good to go”.

    Well, I felt great and almost ran out of that hospital.(though i still had a heavy limp)
    I booked a last minute holiday in Cyprus in May - a week after the cast came off and got some sun on the leg and some swimming done. I felt great and though the ankle was still very stiff and I couldn’t jog or anywhere near it, I felt like my life was returning to normal.

    I started playing golf again (tentatively) about 4 weeks after the cast came off and felt I was well on the way to a full recovery.

    Then disaster - 5 weeks after the cast came off the first time, I was playing golf. I was 1 over through 3 and was playing my second shot at the 4th when BANG - during the follow though the achilles ruptured again - AND I DONE EXACTLY THE SAME THING AND LOOKED AROUND TO SEE IF I HAD BEEN HIT WITH SOMETHING!!. I quickly realise I had of course re- ruptured the achilles.

    So back to the frature clinic. This time a different doc who recommended surgery. But again he really stressed the negative side of the surgury (deep infection was mentioned) and after reading some journals on-line, i decided to turn down the surgury and go for the cast again.

    The doc said “OK, but this time its 6 weeks, then 3 weeks, then 3 weeks”.

    So here we are - I am 4 weeks into the re-rupture first cast - bored, depressed, angry - you name it.

  87. Dave, it sounds like you stepped through a time warp!

    A couple of points:
    1) Your first rehab protocol was WAY slow by today’s standards, and may have contributed to your re-rupture. Going slower now is very likely going in the wrong direction.
    2) While there is very solid evidence of excellent results from non-surgical treatment of initial ATRuptures, the evidence on treating RE-ruptures is naturally scant to nil. E.g., in the latest and biggest study comparing surgery to non-op, done at U. of W. Ontario here in Canada (and linked from my blog page on studies), they had only 3 re-ruptures out of ~150 patients (1 post-op, 2 post-non-op), and they treated all three of them SURGICALLY.

    Ultimately, that study showed (like its 3 immediate predecessors) that surgery brings risks and NO statistically significant benefits, but the authors thought it “made sense” to treat the RE-ruptures surgically. I don’t know if they’re right or wrong, and I don’t think they do, either. (Maybe if they were doing it again now, they’d treat the reruptures NON-surgically — but maybe not.)

    The good news and the bad about re-ruptures is that they’re relatively rare. That’s good because they’re terrible, but it’s bad because it makes it impossible to get good evidence about what works well in fixing them.

    Personally, I don’t see why a good modern non-operative protocol like the one I followed (from UWO, posted on my blog) shouldn’t work just as well for a RE-rupture, but (1) that’s just one well-read patient’s opinion, with no solid evidence either way, (2) lots of experts seem to assume that surgery is indicated for re-ruptures, and (3) those modern protocols are NOTHING like 6 + 2 + 2 weeks of non-weight-bearing in a series of casts (not to mention 6+3+3!!), followed by “Goodbye”!

    If you go to achilesblog.com/normofthenorth and jump down to the “studies” blog, there’s lots of info and links on the latest studies. But if you look at the comments to that blog page, you’ll find the link to my/UWO’s actual protocol, which is a reasonable place to start. It produced excellent results in the ~75 non-surgical patients in the UWO study.

    Just to give you the flavour of how different it is from yours:
    NO casts, you spend the whole time in a boot. (They used a fixed boot, but a hinged one is better, even if you “fix” it for the first month or so.)
    TWO weeks of non-weight bearing, on 3cm heel lifts (=~”equinus”);
    NEXT TWO WEEKS starting gentle Physical Therapy, and Partial or Protected Weight Bearing (PWB), still on crutches;
    NEXT TWO WEEKS (wks 4-6) FULL WB “as tolerated”, still in the boot on the heel lifts — discarding the crutches;
    At 6 weeks in, discard the heel lifts. (I prefer a more gradual withdrawal myself, one wedge at a time.)
    At 8 weeks, “wean off boot”. (I prefer a hinged boot that starts hinging sooner, and I might continue a bit longer, at least as protection in scary circumstances.)
    The PT and exercises continue throughout and gradually become more aggressive.

    So at 8 weeks, when you’re supposed to be in your second cast of three, this protocol has you back in normal shoes and on a first-name basis with your Physical Therapist.

    Many docs “feel” that slower is safer — they call it “conservative” as if it saves or conserves something. But the scientific studies generally show exactly the opposite is true, that long immobilization produces WORSE results, including higher re-rupture rates, compared to rehabs at least as quick as the one I followed.

    Keeping heel lifts for a longish while makes some sense; keeping non-weight-bearing and total immobility for a longish while makes no sense at all. And doing it in casts instead of a removable boot is just torture, IMHO.

    BTW, I’ve torn both sides now, 8 yrs apart, and had the first one operated on. This time I just got “the boot” following this much quicker protocol. And so far it’s been a delight, though I’m “ready” to be able to do a 1-leg heel raise now (at almost 6 months) but I’m still just short.

    Good luck, and good healing!

  88. Well Dave you’ve just ruined one of my standard lines when describing this injury: “this is an athletic injury. it doesn’t happen to people walking or playing golf, unless they fall”. Of course, yours was a reinjury so maybe I’m still OK!

    Everything Norm said makes sense, as it always does. He got me on the right path early and it has paid off with a near perfect recovery at 15 weeks.

    best of luck

  89. from 10 - 12 weeks of total immobility straight to shoes?
    this is kind of harsh to me.

  90. Thanks for the responses thus far - especially normof thenorth.
    I am amazed at the difference in the approaches to treating this type of injury - it would appear that the Argyll and Clyde Acute Hospitals NHS trust in Scotland has a rather dracononian way of dealing with achilles injuries.
    The second doc who treated me was the consultant - so if he thinks re-ruptures are 6,3,3 weeks non surgery, I would doubt his junior doctors are going to disagree with him.
    I have the first cast off in 2 weeks, I am going to go armed to the teeth with some of this info and see what their reply is - it cant be any worse than another 6 weeks in a cast.
    Also, things like physio, heel raises and boots haven’t even been MENTIONED by any of the docs - first or second rupture - its been cast or surgery - and even with the surgery they were still talking about me being in a cast for a further 10 weeks following surgery.
    I dont know, maybe I just tried too much after the first rupture, with me playing golf at 5 weeks cast free - but if you are not told any different, what do you do? just sit and hope it all gets better?

    Another snippet my local GP mentioned - he said second injuries of this kind tend to heal QUICKER due the body having the repair mechanism already in place.
    If thats the case, then why am I in a cast for longer?

    There is a lot of conflicting info - even from the docs. You would think something as straight forward as an achilles rupture would have a standard protocol developed by now.
    Has anyone been in this situation and approached the docs re a different type of protocol than the one they have been initially recommended? what was there response?

  91. Dave: Look at my blog and you’ll see a similar story which, thanks to help from Norm (primarily) and others has turned out much better than yours. In short I went to the hospital less than 24hours after the ATR and talked the doc (a good friend of mine) into a non surgical repair and, two weeks later, into transition to the VacoCast 6 weeks earlier than his first recommendation. Then, presented with the recovery “road map” from the UWO study, he and the PT went along gladly. Great results so far, at 15 weeks. Keep us posted and best wishes.

  92. Norm: No response to you from my previous query on writing a publishable article on what we’ve learned. Seems like more fuel for the fire from Dave and others recently. What do you think?

  93. Dave: check out my own blog - similar experiences in terms of very conservative approach in the UK, including re-rupture.

    One lesson seems to be that UK medics are conservative, but open to influence (if you don’t mind the ‘told you so’ when issues arise!)

    daviduk

  94. Gunner, I’m happy to defer to you if you’ve got the energy to write a newspaper article about what we’ve learned. I really don’t expect to get around to it. And I certainly agree that it’s worth doing.

    Dave, I think most of us at AchillesBlog have been amazed by how differently ATR patients are treated by different doctors, hospitals, and regional systems — and often extremely differently than patients a mile or two down the road, too!

    There are two HUGE decisions an ATR patient faces: (1) Should I get surgery or not? and (2) What rehab protocol should I follow, including cast vs. boot, etc.?

    At least the first key decision is often presented as a decision for the patient to make (though usually surrounded by misinformation and myths instead of up-to-date scientific evidence).

    The second key decision. . . well, don’t get me started! Most ATR patients aren’t even told that there IS a range of protocols, or that some have been tested in large controlled studies and most haven’t. Heck, most ATR patients aren’t even told what rehab protocol they’re going to be following — only “trust me” and “I’ll see you in X weeks”! The typical patient assumes that they’re being guided by somebody who knows the facts and is following a well-worn path that’s been tested to work best. Unfortunately, that’s almost never true.

    How can a patient make a good informed-consent decision when nobody tells the patient that there IS even a decision to MAKE?!? I think it’s near the top of the front page here that Dennis writes that the purpose of this website is to help patients take charge of their care and become participants and make informed decisions, or words to that effect. And I think that’s spot-on and vital — and revolutionary, compared to what most ATR patients are “kicked by” while they’re “down”!

  95. Hi all,

    having ruptured my left AT 4 weeks ago, reading all your comments has been really helpful and also confusing as there are so many differences in treatment. my experience so far as follows

    11th May 2010 - playing football no one around me went to push off to run and heard loud bang and collapsed to floor in a lot of pain, not able to WB. went straight to A & E who confirmed my ATR with the squeeze test, i couldn’t see it but my wife said it was a quite visible gap just from looking! given options of surgery vs conservative, consultant advised conservative due to being able to treat straight away, any further delays would mean surgery only real option. I was put into a plaster with toes pointing down. and to expect to come back in 2/3 weeks time to change plaster.

    1st June 2010 - apt at hospital where doctor said to put into boot but with heel inserts (he didn’t look at the leg out of plaster? is this normal?) went to plaster room who were concerned that it was too early for boot and checked with doc and i am now back in plaster with toes pointing down, whilst plaster was off the plaster room guy gently pushed my toes back and i could feel the tension on my achilles, was told this was a good sign? i have another apt on 15th June to have plaster changed and position of foot moved.

    The pain i experience comes and goes and mainly painful in the evening, when getting about on crutches my toes still go red/purple and this is removed by elevating the leg.

    would welcome anyones thoughts on my experience so far and perhaps what to expect next?

    Wishing everyone a speedy recovery.

    Steve (beets168)

  96. Beets: Good to have you with us. Here’s what I would do if I were you: read Normofthenorth’s blog and follow the leads to the UWO studies and rehab protocol, engage Norm, myself and others who have taken the “conservative” path (an inappropriate adjective since the surgical route is much more conservative in the risk avoidance/ old medicine sense) with your questions, take the rehab protocol to your doctor and get his agreement to follow it or find another doctor; get out of the cast, into the boot and on your way to a quicker recovery and a more workable life.

    Fortunately for me, I discovered this site and the path I’m suggesting to you within hours of my ATR and have followed it religiously for the past 15 weeks. Results have been very good, compared to those who’ve had surgery and those who have not.

    Hope this is helpful and good luck.

  97. Norm, looks like the Toronto Argo player who had an ATR has decided to have surgery on Friday. Looks like OS surgeon could not convince him otherwise.

  98. Thanks for the head’s-up, ifixteeth, I’d missed that news.

    I wonder if Dr. Zarnett will be doing the surgery (after losing the argument)! Who’s the player, and where’s he from?

    Whenever the first elite athlete with an ATR, anywhere in the world, decides to skip the surgery, I think it will be front-page news (at least to us here!). And maybe by the time it happens, the leading elite folks will have figured out how to do surgery the new Japanese way (linked from my blog), with no boot or cast(!) and ultra-fast recovery times.

    Despite my strong advocacy for the non-surgical route given the evidence about today’s realities, I am not confident that any non-surgical approach can match those Japanese recovery times. (Who says I’m biased or religious on this subject?!?)

  99. OK, Google has answers: running back/slotback Steven Turner, Canadian kid, Toronto-area (Brampton, ON) native, played undergrad at Bishop’s U. The Toronto Sun says “He goes under the knife on Friday and then will be in a cast for two weeks and a walking cast for a month after that.”

    I’m guessing that means he’s not directly under Dr. Zarnett’s care, or at least he’d be in a boot, and getting PT from (at most) 2 weeks in. (Why should he go more slowly than I did?)

    It’d be fun to be a fly on the wall during the discussions that happened.

    When I first met with Dr. Zarnett, he told me that he preferred operating on ATRs (before he stopped doing the surgery) after they had “aged” for around 2 weeks. That’s quite different from the conventional wisdom, that prefers them young and fresh. Dr. Z said that he found the more compact, proto-healing ends of the torn tendon easier to stitch together than the often-highly-frayed ends of a fresh tear.

    Turner tore his AT on Monday, so it will still be quite “fresh” on Friday. Maybe Dr. Z is out of town at a conference. . . (I’m not scheduled to see him ’til September, and we’re not Facebook friends or anything. . .)

  100. Full rupture on 4th April, Easter Sunday, while playing badminton. Went for conservative treatment. Consultant said very few advantages to surgery.

    Usual procedure plaster for 8 weeks with foot gradually moved up to neutral postion.

    Following removal of pot I was due to go on holiday the next day. Noticed foot very swollen and purple. Thought nothing more of it as told there may be swelling.

    Next day while in Fueterventura foot still purple and swollen. Decided to get it checked out at local hospital as words like thrombosis are being banded around.

    Diagnosed with DVT spent 4 days out of 7 day holiday in Spanish hospital.

    Back in UK GP dicounts DVT as foot is cold (DVT affected area is usually warm.

    Back to UK hospital various tests. Ultrasound, MRI, and heart Echo test. All come back fine.

    No DVT, and no obvious reason for poor circulation.

    Started physio. They tried thompson test, could not get positive response. Although they are certain tendon is reattached.

    Started exercising and stretching the tendon and calf muscle by looping a towel around the foot and gently pulling the foot back past the neutral poition and then trying to push down on the towel with the foot. All while keeping the leg strainght at the knee.

    Getting the knee straight was challenge enough in itself.

    3 weeks ater pot removal.

    Foot still going purple and swollen when not elevated. (colour seems to return to normal as soon as foot is raised)

    Have another physio appt tomorrow (22nd June) and appt on Thursday 24th with the vascular team.

    Just wondering if anyone else has suffered similar dicolouration and swelling problems?

  101. DVT is much less common after non-surgical immobilization than after surgery, but it does occur.

    “Plaster for 8 weeks” may be the “usual procedure” where you live, but it’s being supplanted (esp. by boots) in many jurisdictions. Were you Non Weight Bearing (NWB) for the whole 8 weeks? Were the plasters above the knee, as some have reported? Otherwise, I can’t figure out why “Getting the knee straight was challenge enough in itself.”

    As far as needing to elevate to avoid swelling and discoloration, even long after moving to “two shoes”, I’m afraid that part is pretty common. I’m at 6 months (non-op), and I’m just NOW getting out of the habit of sticking my leg up on top of something. Last night, at dinner, I put an unshod foot up on my own chair — first foot elevation of the day — and I was shocked to see that I’d unconsciously lifted up the OTHER foot! First time that’s happened since my ATR!!

    Less than two months ago, I started a blog page entitled “Swelling (& elevating) is getting OLD!” so I’m glad to be finally rid of it, more or less.

    Not getting a “normal” Thomson test is certainly odd, no explanation here.

    Good luck! Start a blog and keep us posted on your progress.

  102. Well,
    thats the first 6 weeks over with - went to the fracture clinic yesterday to get the first plaster removed.
    My appointment was specifically for a Thursday as that was the consultants day - and he wanted to see me - but he never turned up.

    Nobody checked the tendon, just went straight to re-plaster in partial aquinus (I had to tell the nurses it was partial as they were going to put in back in full aquinus again).

    Asked about the boot and was told “we dont do boots on the NHS”, Asked about other protocols and was told “this is what we do here”.

    However when pressed on this the nurse said that some docs at this hospital do 2 weeks, 2 weeks , 2 weeks all in plaster (as opposed to my 6 weeks, 3 weeks , 3 weeks. So it appears to be a fairly ad hoc affair when dealing with this injury.

    So anyway, I didn’t get anywhere and I am in this plaster for 3 weeks before it is removed and replaced for another 3 weeks.

    Everyone at the hospital is very nice but I get the impression they dont really give a monkeys about this type of injury…

  103. Dave, the case for orthotic boots (and especially “functional orthotics” which means HINGED boots) producing better outcomes than a series of casts is very strong, and your Docs should know it.

    NHS is actually wasting precious funds by going a more expensive route, especially when you include the cost of cleaning up the mistakes, like the re-ruptures (including yours, unfortunately). A good boot costs maybe 100 pounds, and 10-15 minutes to fit. (And it can even be washed out and re-used!) I bet your casts cost more.

    Ordinarily, I’d say that you’re far enough along that it wouldn’t be worth your buying your own boot. But your protocol is slow enough, and a hinged boot is good enough long-term rehab — very safe but very functional and much more “realistic” for your leg than a cast or fixed boot — that it might still be worthwhile. If you can afford it and find one to buy. Gunner’s VacoPed/VacoCast is available online.

    Somebody here referred to an ATR as the tonsillitis of the leg — every Surgeon learned how to treat it (surtically and non-) in Med School, and nobody specializes in it. Your “they dont really give a monkeys” about it is another way of saying the same thing.

    BTW, it’s Equinus, because it’s the way horses hold their lower legs. (The hoof is actually the ball of the foot, not the heel, which is a little bump higher up on the horse’s leg.)

  104. My aquinus typo’s must be sea horse related then… :-)

  105. Dave, it hurts my well-healed AT just to THINK about holding my ankle the way a seahorse holds its tail, early in the process! :-)

  106. Hi there
    Had a complete rupture nearly 3 weeks ago and just had my cast off today & and aircast boot fitted with3 inserts back on 4th Aug to have boot taken away. I have 3 questions for you experienced people!:
    1) Today the consultant did not even look at my injury or ask any questions. Just looked at dates and instructed the nurse to fit me with a boot. Should he have looked at it/asked me questions?
    2) it is *killing* me today! I was told I could weight bear but it is so sore I cant really so am i doing damage by weight-bearing? Is it too early?
    3) Once I get the boot off - can I drive and will going on a villa-type holiday be ok or will I have loads of physio appointments?

    Oh - and one more!! I have taken the boot off this evening and sat with it up as was so sore. Is this ok as long as I don’t weight-bear or wiggle it?

    Thanks for any help - it all seems so bleak! I have a full time job and 2 kids under the age of 5 and husband is now away for 2 weeks!! Help!!

  107. Well, thats the 2nd cast off and 3rd one on - 9 weeks gone - 3 to go!!

    of course they were going to put me mid equinus again until I told them i had already done that for 3 weeks…

    It was a real struggle for the nurse to get my foot to the flat position….he was really pushing the foot up and saying “i can’t get get it near to 90 degrees ” and I could really feel it in my achilles - I was really worried it was going to go again right there and then.

    Fortunatly after a bit he managed to get the foot “there or there abouts” the 90 degrees - but it was a worrying time.

    I feel as if i am on the final stretch now ..taking it “slowly and carefully” as the consultant put it. 5th Aug is cast free day - so i can’t wait. It certainly is slow though and what a difference in comparison to Sarah’s treatment.

    I asked about driving - the insurance company said “if the doc says its ok then its ok” - “no chance” was the docs answer…certainly not in a manual transmission.

    Anyway..nearlly there!!

  108. Sarah
    You dont mention if you had surgery or conservative treatment.
    1. My consultant has barley looked at the achilles in the 6 visits I have made. When the foot was in plaster he just instructed the plaster room guys how he wanted it setting.

    2. Listen to your body. If its killing, get the foot elevated and rest it. At 3 weeks mine was very uncomfortable, but I was in plaster. Put it down to the healing process.

    3. Once you have the boot off you should be ok to drive. But dont kid yourself. If you dont have the strength in the ankle to do an emergency stop then I would think twice. You will have physio appts. Maybe 2 per week. However dont let these get in the way of holiday. The physio will give you plenty of excersises to do at home and on hols so your progress will not be set back. If you have a pool on hols this is ideal for hydropherapy. Ask your physio for some hydropherapy exercises.

    Re boot off cannot realy comment as never had a boot. But always tried to wiggle toes while in plaster.

    Hope this helps and have a good holiday.

  109. Dave
    So you are going to be in plaster for a total of 12 weeks.

    Not suprised they had a struggle getting you to 90 degrees.

    I was 3 , 2, and 2. When they put the last cast on at 90, they had a hell of a struggle getting to 90. Hurt like hell, and like you was very concerned they were going to snap it.

    Have been out of plaster now for 7 weeks. Having physio. Walking is improving but with a heavy limp, but pretty much crutch free.

    Dave, am I right in saying this is a re rupture for you? Did you have any physio after the first rupture?

  110. Dave

    I am not suprised the nurse struggle to put your foot in the neutral position, 12 weeks in total sounds a very long time. I am going through the non-surgical route of 4,2,2 and had the same problem when my foot was put to the neutral position. I had alot of pain on the day and really uncomfortable for the next few days. The pain ease off eventually. I assume that is the foot trying to adjust to the new position. Its now been over a week since the cast got changed and its been alot more comfortable and less swelling. I will be cast free on 19th of july and according to the doctors I can go straight to 2 shoes. Have you been told to bring shoes with you on 5th aug?

  111. Stephanie, try and get a walking boot after the cast. I didnt and couldnt walk, without crutches, for another 4 weeks.

    Also make sure you get physio straight away. Again I had a 3 week gap between cast coming off and physio starting.

    Once physio starts you will see improvement straight away.

    Another thing is heel lifts in you shoe, make sure you get some.

    Good luck on the 19th or the 5th.

  112. Thanks Jonboy1968

    Physio have been arranged for the following day after the cast comes off on the 19th july. I have prepared myself heel lifts on the day as the NHS doesnt seem to provide any boot or heel lifts.

  113. Hi all, i have just returned from the hospital this afternoon (10 weeks) my plaster history is 3 weeks, 2,2 then 3 weeks.
    i have just had my plaster removed and left the hospital without a boot, told to build up weight bearing using crutches gradually i.e 25% wb then 50% etc etc i have a physio apt booked for thursday, the doc said that as i had no feelings of pain or tenderness on the tendon then this course of action would be fine. walking albeit with the crutches feels strange and my ankle feels very stiff. have another follow up with the doc in 6 weeks where he feels at that point i’ll be walking ok and start to think about driving again(manual).
    i keep reading about heel lifts for shoes what are these and where can i get them?
    i feel very nervous going from plaster to nothing but glad to be making progress.

  114. Hi Folks,
    Really pleased to have discovered this site. Thanks to everyone for posting.

    My story:
    I thought I’d been kicked from behind during an easy going game of football. Didn’t go to A&E as I thought it was just a knock. A week later went to the GP, who missed the (now) obvious signs. Went back a few days later after some researching my symptoms. Due for an operation in a couple of weeks at the Horder Centre.

    So I’ve got the hard bit yet to come. I’ll try and update along the way. Good luck.

  115. Beets168, you’re right to feel nervous (sorry!), because your ankle is probably more vulnerable than it’s been since you were first casted. Watch Your Step! Ten weeks of immobilization and NWB is a LOT (too much, actually), and it’s not surprising that your foot is stiff.

    You’ll have to get used to WB gradually, and restore your ROM, also gradually — and be especially gradual about combining the two! But you should be able to advance at the speed of light, compared to where you’ve been. . .

    Heel lifts are usually hard-rubber (occasionally felt) wedges that go under your foot, or under a footbed (under your foot). Ski shops (that sell and fit ski boots) definitely stock them, as would podiatrists and chiropodists and probably some shoe-repair shops. The good ones I’ve used are often bright blue (at least here in Toronto). Anything that’s soft enough to compress under your weight is not what you want — if indeed you do want heel lifts in your shoes. Some Docs recommend them, others not. If your ankle has been in the neutral position in your last cast, the heel lifts might be optional, though they will make it easier to walk more normally (without going far past neutral).

    Andreus, I’m surprised you weren’t rushed right into surgery! Many surgeons insist on getting “fresh” ATRs to operate on. Yours is maybe 1.5 weeks old already and your operation isn’t for “a couple of weeks”, which is very unusual. Is your ankle immobilized now, at a toe-down angle? Are you on crutches, staying off that leg completely? If not, every little “oops” you do has a chance to retract the top of your AT farther up your leg, and scrunch up your calf muscles into a tighter ball, too. All of that makes the surgeon’s job harder.

    At least online, it looks as if the Horder Centre sees a lot more arthritic and old and overweight people (e.g. for knee and hip replacements) than athletes (e.g. for ATR repair). When I tore my first AT in late 2001, I got surgery in Toronto’s Arthritic and Orthopedic Hospital. I was surrounded by patients getting knee and hip replacements, and my surgeon did many more of those than ATR repairs.

    He did a fine job surgically, and was “ultra-conservative” in the post-op rehab. I got 3 different casts, then a hinged walking boot that I’d been fighting for, for many weeks. (I was his first patient to get “booted”.) He was convinced that going slow was safer and produced better outcomes, though the evidence points the opposite way, in general.

    Surgery is no picnic, but getting a modern fairly aggressive protocol like bit.ly/UWOProtocol , and getting into a boot instead of a bunch of casts, may actually be “the hard bit yet to come”! Start a blog and update us there.

  116. In response to the various questions - yes it was a re-rupture, yes I have been told to bring shoes with me on the 5th aug (so they can fit heel raises) and no - I didn’t get any physio.

    As per my previous posts- after my last cast from my first rupture i was asked to walk to the nearest table and back.(6ft) when I done this the doc said “right thats you good to go”

    No physio, no heel raises, no crutches not even any advice.
    I just jumped in my car and drove home (manual transmission)- which could have ruptured the achilles right there and then according to the new consultant.

    To be honest the more I think about it the more I am thinking of sueing cause basically - apart from 4 weeks - I have been in one cast or another since the middle of January and frankly i am not a happy bunny.

    This blog has been a great help - people to moan at that actually sympathize!!:-)

  117. Hi all

    That was me CAST FREE on 19th july. I went the non surgical route of 4,2,2. I was discharge without being checked by a doctor due to the monday was a scottish holiday, the plaster room people said according to their notes the tendon was re-attached at 6 weeks and I was free to go. Asked about a follow up appointment and was told that is me, there wont be any follow up, physio have been arranged the next day. Just seems like some nhs hospital in Scotland dont give a damn about this kind of injury. I was not able to walk out the hospital without the crutches as my ankle was very stiff and could not put the foot to the floor. Went to Physio the following morning they tried the thompson test, positive result so that was good news. The physio gave me the following exercise to do, stretching the tendon and calf muscle by looping a towel around the foot and gently pulling the foot back past the neutral position. I have manage to put my foot to the floor however still getting alot of stiffness around the ankle and swelling. How many sessions of physio will need to get rid of the stiffness and swelling?

  118. Stephanie

    Also been under NHS treatment for rupture (Jan) and re-rupture (April) - see my blog for the gory details.

    The exercise you describe is one of a range given by my physio - this is the first exercise i was given, moving on to the same but pushing down on the towel, and stretching sideways also. A next step was to swap the towel for a thereband to get some resistance with the stretching. BUT i would stress that all these exercises were based on regular sessions with the physio and her seeing my progress and deciding what i was ready for.

    I am now using the exercise bike for up to 60 mins, steadily increasing resistance. Also using treadmill to walk at medium pace, feeding in a little incline to help the ankle loosen and to build strength.

    Have had two long stints in plaster my ankle is VERY stiff. My tendon is less of an issue than getting the rest of my ankle working again. It’s stiff and painful up both sides and in the front of my shin. I also get swelling, particular if i sit with my ankle in the same position for long periods - eg long car journeys.

    I see the physio once a week, and probably will for at least another month or two - it’s good to get an ‘expert’ opinion on progress. It’s tricky to know whether you are pushing hard enough or too hard.

    To be signed off by your consultant after only 6 weeks is simply bizarre - should be 12 weeks minimum. To be sent home on crutches after 6 weeks, with no ROM boot is even more bizarre (again see my blog for the c. 12 week approach i had, be it either a series of casts or casts then boot).

    daviduk

  119. Steph, your “4,2,2″ put you in 2 shoes at EIGHT weeks, not SIX, right. They just told you that the AT seemed re-attached (probably Thompson test) at six, before your final cast. That’s not necessarily too soon to be “free”, though you’re certainly vulnerable and have to Watch Your Step constantly. (See my notes to beets168, above.)

    I guess your care is now being supervised by your PT, not your Docs, unless you really get into trouble, hope not.

    You should see pretty steady progress on the stiffness and the swelling, though the latter can take a while, especially without frequent enough leg elevation and maybe icing, too.

    Dave, I don’t think there’s any objective evidence to suggest that being casted (or even booted) for 12 weeks is a good idea for anybody. Typical for the old-fashioned “conservative” cure, which produced bad results, especially compared to the newer faster protocols, like bit.ly/UWOProtocol . The re-rupture rate seems to drop from around 15% to around 2-3% for non-surgical treatment of complete ATRs, just from updating the rehab protocol! So you get to live your life better and sooner AND you get a better cure! Why are some places still doing it the old, dumb, way?!?

    I hope you sue, and I hope you win. Incompetent treatment of ATRs has been ignored and tolerated too long in too many places by too many patients, IMHO. If your treatment or Stephanie’s were a car part, it would have been recalled; if it were a drug, it would have a big warning plastered all over the box. You’re suffering from a regulatory loophole, and it’s time it was closed!

  120. Spoke to my GP this morning regarding being discharged without being seen by the doctor on monday 19th after 8 an a half week since ATR. His answer was since I went the non surgical route and my tendon was rettached at 6 weeks and with monday also being a holiday it would be fine to let me go. David I totally agreed its bizzare to be signed off at 6 weeks and without any follow up, I guess that is the NHS for you in Scotland.

    Norm the Doc said my case is now passed on to the PT unless I have any problems or not happy with the progress then I should contact the fracture clinic. I will definitely be watching every step now. Getting my 2nd session Physio tomorrow.

    Happy healing everyone.

  121. Hi my name is Maggie and I am an alcholic ….. oops wrong site. Not really! just feel like getting plastered but not steady on my crutches after a couple of glasses of wine. I ruptured my right tendon playing badminton - classic story - but luckily without pain. Ended up in Milton Keynes A&;E on Friday evening and was told to take my paperwork to my local hospital. Was booked into fracture clinic a week later and I asked to be operated on due to the lower re-rupture rate, consultant wanted a scan first which didn’t happen for another 2 weeks. I eventually had surgery at 4weeks after spending that time in a cast (very frustrating) and back to square one. Consultant assures me delay in surgery will not affect long term success of operation - fingers crossed. Had cast for further 4 weeks and now in ROM boot, walking with crutches and at week 6. Had my first physio today - which seemed to go well and back again next week. I had been doing exercises off the internet, using Bio-oil to massage wound. Anyone else had a delay in surgery and how are you getting on?

  122. My last cast is off tomorrow morning at 9:30 - can’t wait - this has been the longest 6 months of my life. I will keep you posted on what the doc says tomorrow…

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  124. well I have had my cast off now for just over week - which feels great. the achilles doesn’t look as thick as it did the last time and I appear to have a bit more movement. I still have a heavy limp and know there is still away to go yet though. I was given heel raises and told to come back in 4 weeks (I had to make it 6 because of holiday commitments). No mention of physio though at this stage… but on the mend!!

  125. Hello Daz,

    Really wish I’d found this site 13 weeks ago!!

    I ruptured my left achilies tendon on 12-May while I was in the gym with a personal trainer. I wasn’t actually doing any particularly strenuous exercise at the time, I simply stepped back off of a step!!

    I went straight to A&E at QMC in Nottingham & was put in a temporary plaster cast to the knee & an appointment made for the following morning at the Fracture Clinic.

    The Orthapaedic consultant confirmed the ATR & went through the Surgical vs Non-Surgical treatment protocols. When I told him that I didn’t have a clue which one to go with, his words were “If I were you and I sustained that injury, I wouldn’t have the surgery”. I put my trust in the hands of the expert and plumped for the non-surgical protocol.

    I was non-weight bearing in full leg plaster-cast for first 3 weeks (I think it’s called equinas) and then straight in to an Aircast boot (starting with 4 wedges that were removed sequentially) for 9 weeks.

    I came out of the Aircast on August 5th and on August 12th I had my first Physio session at Nottingham City Campus hospital. I’ve been told it’ll be a further 3-6 months of Physio depending on how well I do.

    I’m limping heavily at the moment. The tendon feels quite tight and my lower leg/ankle area is still pretty inflamed so I’ve been told to elevate & ice it up regularly and take Ibuprofen if I feel I need to. I was also shown a method of massaging either side of the healed tendon (to counter scar tissue apparently) called ‘bowstringing’ which I have to do for 5-10 minutes a day.

    I don’t know whether the advice I was given to go with the Non-surgical treatment was the best or most appropriate option for me, that’s why I took the consultant’s advice, but the one thing I can say is that I’ve been hugely impressed with care/treatment I’ve received from the NHS in Nottingham. I can’t fault it really.

    I guess the one big thing I would say is that I totally stuck to the letter of the law with regard to the treatment. I didn’t once take the Aircast boot off myself for 9 weeks (I slept in it every night)….I did everything the Consultant & Occurpational Therapist told me to do! From what I’ve read on other blogs and from what the Consultant told me when he signed me off, that’s pretty unusual so I’m hoping it pays off!!

    I can honestly say it’s been 13 of the toughest weeks of my life so far…..a real test of character!

    Tracey.

  126. Welcome to our world-wide club. Knowing what I know now, I absolutely think you made the right decision. If I had it to do over again, there is no way I would have surgery. I had complications which resulted in having 3 additional surgical procedures beyond the initial one to sew the tendon back together. The only thing I would fault in your treatment is that it was too slow, but you will get back on track and return to whatever you enjoyed doing before the rupture. Good luck with the healing.

  127. Just a message for Dave Dark. If you have not been offered any physio I would be back onto them to find out why. If non is forthcoming then organise your own.

    Without it you wont make the progress you need. Im having hydropherapy and physio once a week. Costing me a fortune in hospital car parking fees.

    But the progress is pretty spectacular. From completely non weight bearing at first appt was walking at third appt.

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  129. Hi there, I did my left Achilles tendon yesterday 05/09/2010 - I am really struggling keeping my leg elevated as instructed by the hospital (Bradford B.R.I.). They said to keep my toes at nose level but its so hard to get it comfy unless I lie it sideways (so it doesn’t push on my calf) but that hurts my knee after a while.

    Does anybody have any advice for this?

    Also I’m goin to New York for my Honeymoon 16 weeks today for New Year’s Eve - am I gunna be ok???

    I already started a blog @ http://myleftachilles.blogspot.com/
    before I found his place unfortunately.

    Cheers to anyone that replies!!

    Lewis

  130. Great post. Thanks. I just tag your article to my facebook page

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

  131. Hi All, thought i’d update with my progress and would welcome any thoughts on how its going?!
    i am now 18 weeks post ATR and 8 weeks out of plaster. i have been seeing the physio once a week with various exercises to do. i am now driving again and walking without the crutches (have been for just over a week now) been through various stages of pain and discomfort, started off ok still lots of swelling but not too much pain. then after about 2 weeks after plaster came off started to get very painful so slowed down with exercises and went back to 2 crutches, after a period of rest felt really good again, noticed that pain/swelling and more pronounced limp come when i’ve overdone it. so learning when to rest and elevate is important. my consultant was very confident i’d be running comfortably and playing whatever sports i choose in about a month, the way i feel it doesn’t feel possible but i’ll see how it goes!! does my story sound normal is it slow progress or quick compared to everyone elses experience. pleased to be finally getting there but at the same time feel there is still a long road ahead.

    Steve.

  132. Hi all,
    just an update- thats me been 6 weeks out of plaster - I have spent the last couple of weeks abroad on holiday and spent a lot of time in the pool doing a lot of swimming and the ankle feels great.
    The limp has dissappeared and although it is slighly stiff in the morning thats only to be expected. the day after I returned from holiday i had a checkup and the doc basically said it looked great and that there was good movement and released me - so no more appointments.
    I enquired about physio and he said that what I had been doing on holiday over the last 2 weeks was 10x better than any physio.
    He said now is the time to start longer walks and when I am confident enough, to start light running.
    He said a return to the golf course should be ok in about 2 to 3 weeks as long as I dont overdo it right away.

    So I am a happy man!

  133. Hello all,

    I ruptured my achilles tendon on the 10th Oct. went straight to A+E and confirmed what I thought and put me in a cast. Knew a doctor from previous ankle injury and he arranged to see me on the 12th Oct again confirmed the rupture, he operated on Saturday the 16th. Now at home, with leg up in a open cast with foot down and in pain mainly from where the operation wound must be. Is this normal? I am on pain killers but have not seen any other people on this site talking about pain from their wounds.

  134. I was in a lot of pain for quite a while-I’ve read some people hardly had any and I wish I would have been one of them

  135. hi, nice to know that i am not allone on the pain front. Thanks for the info.

  136. another couple of questions, appreciate all and any advice. i plan on going to the gym this week to do some upper body work out only, is this ok 5 days after my rupture opartion?

    also why do i have to keep my leg in the air and above my heart at all times? any idea how long I have to do this for?

  137. Heather…slow down! LOL. Its amazing to me how quickly people are ready to jump back into the fray!!! Where’s the fire? I learned very quickly uhm…where do I think I’m going exactly?

    Anyway, how in the world will you get to a gym? I shouldn’t be so cautious but honestly I want to help people be motivated but realistic. I have made a full recovery in 8 months time able to play sports at the highest level..maybe even better than before in some ways. But it was seriously patience, mental toughness, and being honest with the risks involved.

    The leg in the air helps alot but…there will be a point where you should at least move the leg a bit just for circulation purposes. But in my own opinion..take it easy girl…its a long process, it takes time, and the risk of slippin or falling or doing something to mess things up is really not worth it.

    I hated “feeling like a log” but you know what..its what helped me the most. I stayed off it a long time, and little by little got around the house, then outside, then stairs, and so on and so on.

    Again, everyone is different of course, but I think we all agree…you do have to find a way to stay the course and let nature do what she does best. Maybe get some dumbells or some weights so you can do them in the house like i did…

    In time..soon, the day will come when its time to fight the siffness, the limp, and the fear…for now, think 5 days is a bit soon to be bumping around already.

    But i love your desire and determination and trust me, it will prove extremely valuable in the months ahead…very soon hopefully!

  138. hi ya,

    many thanks for the advice, will not be going to the gym tomorrow. Leg up it is then:)

    H

  139. Heather……LOL, alrighty speedy. Im just expressing my own small opinion so anyone can do whatever they wish but glad you are able to relax little longer. I apologize for not answering your other question…for me, again…I stopped leaving the leg up when honestly..it seemed to hurt more up than down! I wanna say this was about a week to maybe 10 days. its just to keep the swelling down during this early time. It started to affect my knee and think that’s when I stopped and tried to leave it level and I slept like a baby! So in a week or so, your leg should be stabilized as far as maximum swelling. Your knee is gonna weaken considerably so soon you need to get out of bed and start trying to hang your leg off your bed or a chair for a while. Not often, but just to keep things moving around you know. Balancing the weight with your knee is toughest part..takes some patience. But for now…think you doing just fine. Just understand, the more you try walking and unncessarily stressing your leg…its not just your Achilles u must worry about, its your knee too. So keep that in mind. You will need to rebuild that later so one thing at a time.

  140. Hi Manupstairs,

    Thanks for the info about how long I need to keep my leg up for, as I am now 5 days post op from what you are saying another 5 days for me. I am keeping my knee fairly active so far, with out putting any weight on it. I live alone so I have had to do a far amount of doing things for myself and I live in a house with three floors so I have no choice but to go up and down the stairs but i do this as little as possible, my bed and my sofa are my new best friends.

    Do you know if there are any supplements that are recommend to aid recovery?

    By the way how did you rupture your achilles tendon?

  141. There are no specific supplements that will help. You may hear of glucosamine and chondroitin but the research has only been done on arthritis and evidence for it’s effectiveness is pretty weak, so I wouldn’t bother. Save your money and just stick to a good balanced diet especially your fruits and veggies.

  142. Heather…No problem with the info. Again, its just my own experience. So if its helpful, or gives you a new perspective..then wonderful. 3 floors! my lord. Thank god you’re careful. But little as possible just for a little while. You are stronger than I was..stairs? I didn’t see my 2nd floor for weeks!

    As for my story. I was a basketball “fool”. LOL. Just reached up for a rebound, came down and felt something funny. I noticed my left leg was not even with my right when I walked. Took me weeks to figure out..it was the little tiny strand of my Achilles, holding my life in the balance! The difference between surgery and not. And foolishly i actually limped home, on a subway, up and down stairs! I am stunned it didn’t finish and tear off! I am extremely extremely lucky. I saw the MRI and that’s when i knew..i had a shot to recover cause they told me I completely destroyed it but had no answer why I could still stand at all. After research and research…I decided, put it in god’s hands and ready to kiss off jumping, sports, and live flat footed forever. But then..it began to heal, i started to be able to put full weight, then started to be able to limp, and the rest is history. Just played 10 games of basketball two weeks ago.

    Its a gift from god, and I do believe there truily is no other normal explanation. I needed surgery, and 98% of my achilles was at the base of my heel in a pile…But man, whatever you wanna call it..I wanted to share with everyone that if I without surgery can make it..I know everyone else can. I know its tough, i went through the same emotions, same doubts, same fears and worries..but..same progress, same limps, aches, pains, stumbles, almost fainting, recalibrating my other leg which started hurting, rebuilding knees, wearing right and wrong shoes…been through it all and I definitely want everyone to know…little by little..we all get through to the other side….its quite a journey to recover…but its wonderful in the end..

  143. Nice website.
    45 yr old male,playing basketball and ruptured it completely on 21 sep 10 and had surgery on 28 sep 10. I had Haglunds Deformity (basically a bone growth) that was irritating my achilles and i was sore every time after playing. Had a podiatrist give me orthotics and that worked better for about 5 years , but it finally caught up to me. Had an Orthopedic surgeon do the surgery(highly recommend vs. Podiatrist) although good and bad can both be found.
    Splint cast for 2 wks,stitches removed and hard cast for 2 more all nwb. Getting boot this Monday at 4wks and begin pwb and therapy for mobilization. Been a police officer for 23yrs and have always been in good shape. 2 weeks in i started upper body workouts with weights (carefully!) Really want to go to the gym and begin cycling(maybe only using my heel while still in the boot). Anyone done that and at what time frame? Im going to ask Dr. on Monday.

    Although i use crutches, this may help others–i rented a small scooter that you bend your knee and rest your injured leg on and then push along on the floor with your good leg-advantage is that you can use your hands to make dinner etc! Patience!! Good luck to all !!

  144. Don, I think most of us waited until we were FWB (Fully Weight Bearing) before doing the bike thing, and then in the boot and on the heel. If the weight isn’t any more than you’re applying while walking, then I wouldn’t expect it to do any harm.
    If you look at the list of all of us and how we “did” our ATRs, you’ll find a number of other Haglund’s people, and their blogs. Or use the Google Search blank at the top right corner of the Main Page.
    There’s also been a lot of discussion here about various alternatives to crutches, including the knee-scooter type you’ve got. Mostpeople love them — though I think one tipped over, so don’t go nuts!. Some of us went to FWB so soon (like at 4 weeks in — in my case, without surgery), that it didn’t seem worth tracking down an alternative to crutches.

    Manupstairs, your experience is fascinating and unique. I don’t think anybody else here (and there are 100s!) recovered from an ATR — even a partial one — without surgery AND without a cast or a boot! And you did it without crutches, too, if I read your story right. Holy Nellie!! Once you got a month or two into your rehab, your experiences sound pretty typical — but until then, NOT typical at all!

    BTW, there are at least four very new studies showing great results from non-surgical rehab after TOTAL ruptures. But they all used a boot, and crutches, too, though fairly briefly with both. Even those studies support the “magical” powers of healing. The most incredible part of their results (IMHO) is that the healed tendon LENGTH — measured by Range of Motion — comes out fine, as good as post-op, without surgery, provided it’s done right, with a fairly quick rehab. I’ve posted reams of info on my blog, including links to the studies and the protocol from my fave study (which I followed this time — my second!).

    From our own personal experience, we each get a little glimpse of the whole picture — even those of us who’ve torn both ATs and have been through it twice! The various randomized trial studies add a lot to the big picture. And the collective wisdom of the crowd gathered here is gold!

  145. Yes it is entirely true what I described. No crutches, no boot except when they gave it to me at the hospital in preparation for surgery and ONLY ONLY cause i was so so so so tired of limping and had to go to my insurance and uptown and downtown..it was so so hard..was just so demoralizing. I think the boot made me feel worse and for some reason, hurt like freakin hell after a while. I just decided, let me sit my ass down until I can limp by myself.

    But doctors told me it was over basically. I went a week after my tear..dec 27th 2009…watched new year’s in my bed cause i could not even get to the bathroom unless i slid onto my wheeled computer chair and literally slide around the house for weeks..and the pain, of even getting the leg out of the level position was the most intense pain ever. WITHOUT surgery! I don’t know how you guys do it.

    But I researched and research and studied my own MRI and just came to the conclusion..i saw something..a tiny piece..and i remember something very critical..i remember being able to feel my left foot step down but like a half second before i felt the ground under my right one..and so it meant..it was dangling..which means it wasn’t torn 100%..which is why i could limp all the way home..and therefore, i knew i was onto something. I think they missed it in the MRI or just cared more about the other 98% laying at the bottom of my heel bone! (yes that was gross and depressing). But that little strand..honestly is what changed things for me.

    Then i had to read and read and read and try to discover..how do non surgical people recover? How can they determine it? And after so much research, i understood that scar tissue is gonna fill in if its under 2 cm tear. And if I stayed immobile completely…its possible the scar tissue would somehow hold the whole thing together as one piece. In about 2 months time..went back to doc and they discovered I had a full achilles again.

    Now the trick?..how strong is it really gonna be? I was able to limp into the doctor’s office by then and so where was the wall gonna be for me? what will be my final limit? This was scary decision to make..if i waited too too long, it would be impossible to do anything..and they didn’t wanna open me up cause they said “it was a waste of time now…its shot already”.

    That motivated me more and I read enough to conclude..I have a 20% risk of rerupture, i may never jump, run fast, or play ball ever again…and honestly i was content with that. But taking some muscle from my big toe and using it as a new achilles…uhm, yea…made me nasueous and just decided, i don’t want that. Too weird and odd to me..either i have an achilles or I don’t..I’m not having a toechilles.

    So left the office..and never returned. They said try PT and see if any improvement…went once, and he was telling me to use a rubber band on my toes…(again, was doing that all in bed and in my house literally all the time the past 2 months…and oh yea…I WAS ALREADY LIMPING!!! So i was done and decide i’m gonna hit the gym and see what i could do on my own.

    My main fear, scare, focus.will i ever be able to stand on one leg and lift my weight off the ground ever again. Its all i focused on..all i cared about, because if i could do this…it meant my achilles was really surely connected to my calf muscle and it was working as one unit and therefore I would simply just have to rebuild my calf muscle so I could lift my own weight. But if I couldn’t?..then i knew i messed up and made a bad decision and the limit would last for the rest of my life…

    Anyway it was not looking good for so so so so long..and then one day, it happened.I just gave it a shot and i “hoped up and down for a split second with my weight”..and then i knew..i was gonna be ok…so kept practicing, lifting, at the sink, brushing my teeth, lifting two feet then trying the one by itself..it was tough seriously..so so so hard..i mean to not be able to even budge off the ground..was so scary to me…frustrating..annoying..depressing.

    But god only knows..somehow..someway, i got that hop, then hop again, and again, and then little less of a hop and more like a limp up..then to a actual raise for 1 second, then 3 seconds, then 6…now i probably am up to about 15 or more before it is still tough to keep 190 lbs on that one achilles…

    Things I need to work on still?…again i want to be able to stand on my toes on that leg at least 80% as well as on the right leg. And rebuilding my calf muscle to the maximum i can get it to..its running around 65% i’d say so i could work on it more and get little more mass so i can get to that 80% heel lift onto my toes finally.

    So non surgical studies are all over the map but I stil think..without the tiny tiny tiny horse hair strand left..I wouldn’t be here today. And i felt with all the stories on here days and days it seems this journey was gonna take..I just thought surgery and PT and all that was such a long long long time…I think its the same now but I was walking in 2 months, and playing intensive basketball at high speed and levels even before i tore it in 7. So i don’t know..its not fair to compare..but I don’t think non surgical is complete bunk…it is possible..maybe sometimes.

    But if this happened to someone else, I would defintiely not recommend what I did and for the reasons I mentioned…I’m not a doctor..I simply research things and like information. So I made calculated decisions based on analyzing myself..but again, would never recommend that to anyone else…I took a risk the minute I knew it was torn..(and i knew it when it happened with the dangling feeling) and didn’t go to doctor hoping to god the pain would go away…when i woke up and could not take my foot out of bed…that was the beginning of a very very very long process of which I will never ever forget…And neither will anyone else..its a tremendous personal triumph for an individual, and bonds many of us together forever.

  146. manupstairs…

    I’ve been reading your posts – long though they are! – with a lot of interest; your recovery path, rate, and mental process seems very similar to mine. I ruptured my AT on October 14, 2009 so I’ve just passed the one-year mark. Like you, I decided against surgery, based on all the pros and cons I read about and, finally, the clincher from my ‘consultant’, who eventually let his professional guard drop and steered me towards asking him a question he felt he could answer.

    Anyway, I do feel there’s a lot of emphasis on bouncing back to be fitter, stronger, faster, better following an AT injury. That’s fine, but I personally urge caution: it’s called a long-term injury for a reason. I made a trade with myself early on – if my body could heal itself, I’d proceed slowly, not rush it. Like I said, I’m at 12 months now and still don’t feel my right AT is where it was pre-injury. If someone asked me to play a game of 5-a-side football tonight – football is ‘my’ game – I’d have to say no. But I’m happy with that.

    At six months, I wasn’t back on court (the squash court), but I was starting to walk with a minimised limp; I was aware of it, my physio could spot it a mile off, but not many others. I started to feel as if I was fitting in again. I started to feel like myself again – you walk down a busy high street the week before Christmas in an aircast boot and crutches combo and you know what it feels like to be stared at!

    Hitting the year has made me think about the injury a lot again. I find I have no trouble recalling the incident itself, absolutely no trouble at all. But what does freak me out, what I always have difficulty in comprehending, is how I recovered. I didn’t have an MRI scan so don’t know if I had a single strand left remaining or what state it was in, other than being diagnosed as a ‘complete’ rupture. My foot was totally floppy.

    And to think… to think that my tendon re-grew itself, around scar tissue, and strengthened and re-generated… I just found, and do still find it, amazing. Really. That’s what makes me emotional when I recall the experience. And for nine weeks, until the day the boot came off and my consultant examined me properly for the first time (he never actually looked at the AT; it was diagnosed by a doctor in A&E and though he saw me two days later, it was to discuss my options and after that, every appointment was with the fracture clinic, who would change my cast and re-position my foot, then fit me into the boot, etc – consultant just left them to follow procedure) I had no idea I was healing.

    I had this dark feeling of dread that he’d examine me, declare that the tendon hadn’t healed, and that surgery was required, after all, and I’d have wasted 2.5 months. But it had. It worked. And that wonder will never leave me. I fixed myself.

  147. Manup,

    You and I are alike, in that we rehabbed our ruptured tendons in unorthodox ways. With me, it was surgery and, out of necessity, a rapid rehab. With you, it was nonsurgical without the usual support of a cast, splint, or boot to keep the ankle in the plantarflexed position.

    Two questions, if I may. First, did you keep you ankle plantarflexed, (only without the usual hardware to force it there), during those first few weeks? Second, are you confident that your tendon has not healed too long?

    I ask these questions because the usual thinking about nonsurgical rehab is that the ankle should be kept plantarflexed in the early healing phase, or the tendon may heal too long.

    Best wishes,

    Doug

  148. Hang on, manupstairs, scrub that in terms of me saying our recovery was similar…..

    I’ve just realised I missed your first post and didn’t know you did non-op without crutches or a boot! What the….?

    That’s amazing.

  149. Doug…I am amazed to meet someone else similar to me. You ask two good questions.

    First I did not have any support at all whatsoever. I simply did not move my foot..I mean when I say did not move it..you don’t understand..I rarely left my bed…when I had to hit the restroom…I could not even bend my leg down really because of the sharp pain which felt like a trillion needles running down from my calf to my heel. I kept the foot straight for most of the first few weeks and slide around on my chair and literally slide from the chair seat to the toilet…(sorry for graphics). I did not move that foot at all. Then as i said, I started trying to put the foot down direction..hurt like hell but little by little, I could finally get the foot towards the floor when I moved around on the chair. It was almost like the pressure or weight was literally too heavy in the beginning or something because after first weeks..I was still on the chair but the pain from “hanging my foot toward the floor” began to subside.

    Then as i said, moving my toes, trying to point up and downward (with ice and elevation the first few weeks), it simply got to the point where I could manage the pain. And finally got my leg toward the floor and could hop around. Once I could hop around, and stand on my other leg at least…(even though that was the good LEG! it was such stress and pain from I guess literally “pressure of gravity” on the bad leg that I couldn’t hop around in the beginning)..I knew I may be ok. Not even lying..I couldn’t get up any stairs, out of my house, nothing. First day I tried to go out of my house was a week later and it was the most painful thing ever in my life. But i knew i had to get to the hospital to see what happened seriously. (call it dumb guy finally not being stubborn and manly)

    Hospital told me it was destroyed, gave me a boot, which sure..helped a bit, but honestly me knees were weakning and my calf was atrophy rapidly so it was just too unstable for me to walk in it. I wanted nothing more than to be be home again in my bed.

    So when i got there..dude i was stubborn and said..no freakin way i’m coming back out until I can at least stand on this thing. It was like having a wooden leg seriously.

    So to answer question one…I had nothing but mental focus on not moving that thing at all. I knew i had a 2cm tear and just hoped and prayed the scar tissue would at least hold…but my mind was considering surgery and I had to make up my mind or I would be screwed…I won’t lie..I truly believed if I kept my foot in place, the little strands if close enough would magically reconnect…(not knowing this was stupid until i finally looked at my MRI…it truly is horse hair! )

    second question…healing too long. This was a concern for sure, but I remember them doing a test to see how off my right foot laying on my stomach and feet up was compared to my left and I truly believe my soleus muscles were already stronger than my achilles. When they pushed down on my toes and asked me to push back, I had good strength actually..which is why they were surprised my achilles was totally destroyed. So I personally think that test told me honestly, there is no way this is over because the rule I thought was..if you tear it completely..you’re on the floor..and not getting up and foot is just hanging. Remember mine..i remember distinctly feeling a weird slipping motion with my left foot when I took a step. ..(that’s why i never ever ever ever ever ever believed it was completely torn. It didn’t roll up back of my leg or anything..) It simply tore jaggedly to the last strand. I was a fool looking back because one misstep and I really could have lost everything on the way home. So I honestly took very very small steps limping home that day and i noticed something was very very very wrong when..walking up stairs was like standing on a pipe or something..like my leg was just a bone with nothing around it. I used my other leg and pulled myself up the stairs because I had nothing on my left leg…But think the swelling honestly is why I could get home..like it somehow supported me enough to get that leg home. Again…i was stupid looking back…I was in denial and praying it was sprained leg or something. Another thing I remember doing is, knowing it might be torn..I stood in one position for almost an hour right after it happened and didn’t move a lot so maybe that helped..I rarely lifted my foot up again the rest of the time on my way home.

    So my length I think I saved by maybe some of those actions earlier in the very beginning. Along with again, knowing in my mind..if i did not use the leg, move it around in the early days…it was possible the 2cm would not lengthen and I figured the scar tissue was gonna keep the pieces close together enough. So that was my thinking.

    They tested out my achilles and found i have a .5 or 5 degree change. It is little longer henceforth I can lift all my 195 lbs up on my toes on that leg but…can’t get the heel up off the ground as high as standing on the other leg and lifting on my right. 2nd thing I lost…calf muscle..and this I think I have reconciled…i will never have my sexy beautiful calf muscle ever again like on my right. I went to the gym and worked on that baby and worked on that baby, but no mas…its about 30% smaller than my right and that’s a function of the length being off a bit and also remember scar tissue is mixed with my new achilles…scar tissue does not stretch. and last loss I have, if I put my feet up, and tilt my foot forward with my right..the calf is already pulling the muscle when i bend it back and forth, but on my left leg, the first second of moving my foot or toes forward, the calf muscle does not move..so that’s where the length is noticeable. The achilles should be always “erect” actually with your foot in neutral. Mine is slightly loose and only when pointing it forward, do you see the full muscle move.

    So those are the three things I have lost due to length. But you know what…I can’t complain. I’ll take it. I could maybe get everything down to about 20% difference maybe but no, never again will the two legs match. But today I can squeeze the spot where my tear was..and I don’t feel a darn thing. Used to be a little ball downthere and its all smoothed out. And actually this achilles is stronger than my right now which is only thing that scares me..(go figure).

    So there you go…doug

    Kevin..sorry bro we not as similar as you thuoght. LOL. One thing if i may will tell you, your only only only mistake is the MRI. You honestly should have gotten that because at least you have a clue you know. So in your situation..are u kidding me..I would have just died and probably would have never ever been walking even now!! LOL. I have no clue whatsoever why they did not do an MRI..That’s insane to me. You still do one just to know how bad, is it high, is it low, etc. I don’t know why they didn’t give you one. I’m not a doc so let me know say anything..I would just say..I think honestly as a friend, you really should get one just for your own sanity and for yourself. It really helps to understand your injury, realize what’s happening, and gives you a bit of relativity to the injury and how you feel. What i haven’t done..is gotten my “final mri”, but promise you I will and gonna hang them up on a wall somewhere in my room. I had an ultrasound but cmon..what the hell is that thing? looked like nothing to me! So i’m gonna get a 2nd MRI just to see how it looks. But honestly, in one year…I don’t know…its my own small opinion, but I am very surprised they got you all booted up and everything without just getting into the exact detail, measurement, size of the tear, etc…

    Anyway for everyone..please know, cmon..do you guys think I’m gonna be playing in a basketball league? or football games every week, or running around nyc? LOL. Don’t even worry..I know I’m not superman and my only issue mentally right now…is finding a way to walk way from the game I love like a cat loves chasing mice. I was extremely careful playing the last few months. But yes, its winter so that will keep my ass indoors. Also the anniversary of my injury is coming up..and you know my ass WILL NOT BE NEAR A COURT in the month of DECEMBER!!!! Gonna be walking straight lines man til that day passes. Gonna enjoy this New Year’s that I missed last year..(semi most depressing day of the whole journey!..I am rarely home in NY on that day so it was tough to watch on TV!!!)

    But please don’t get me wrong, the minute i take a step outside, I think about it, the minute i pass a store, an elevator i used to use just to get on the train, stairs i couldn’t walk quickly down, streets i remember limping and feeling completely embarassed people staring at me, going out at night and remember how long it used to take me just to get to the place my friends were at, walking fast to something, reaching down for something, standing on one leg..(yes i STILL do these excersizes and still wiggle my toes and lift my heel and point my toes downward and upward…..almost unconsciously!!) Its on my mind sometimes when I read the stories you all have..and when I put my hand down there just to “pinch myself”..I realize..the same thing will happen to all of you and maybe someday you’ll share your stories with others just like me.

    Like i said..it may be tough and maybe my story is nothing like yours..but we heading the same direction..and I’m still not 100% my old self…but in some ways, Im actually stronger, mentally, and spirtually and even i think physically as I never worked out and never cared.

  150. Well, MRI or not, I can’t complain at the way it’s worked out - the whole recovery was reasonably pain-free (to a point), though mentally it was tough. I guess my guys obviously knew where the tendon had ruptured (it was pretty obvious) and then I followed a pretty standard non-op procedure and, in a way, their total confidence in that was encouraging enough.

    I’d say, in terms of an unusual protocol, my not getting an MRI is easily superceded by your method! Good luck and keep on going!

  151. Well hey buddy..we’re in it together. I am very happy it worked out too. But don’t think our path separate so quickly. Trust me..i’m mulling retirement from the game soon..and save time so that when I have kids, I can at least stand out there with them and still take a few shots!!! So i’m considering hanging the shoes up til Summer 2010 and even then, just a few pickup games once a week maximum…days of intense sports are pretty much over for me. But damn I love that game!

  152. Oops Summer 2011…but trust me, I’m thinking of hanging it up for good. Its tough, but maybe its time..Its either golf, xbox, or job where I work on saturdays! LOL. Something to keep me away from playing with the fellas. But I have a feeling the only kryptonite that’s ever kept me away from playing ball on the weekends is..the girlfriend life! So maybe its time to go back and return to that life again. I was enjoying my single life break last year but man…maybe simply too dangerous for me without one! LOL

    Glad you’re ok kev..either way, we in the same boat and we all will continue to recover and be amazed at what the body and we ourselves are truly capable of. But please know, in all my posts..the manupstairs..is truly the one I am thankful for..because I could not have done anything without god himself. So faith in him is who really deserves the credit and I shouldn’t forget to mention this. I owe it all to him seriously.

  153. Hi Manupstairs,

    thanks for sharing your amazing story with me/all, you are amazing!!

  154. teresa1, many thanks for the advise on the fruit and veg :)

  155. Someone who can out talk Norm. Amazing.

  156. Thanks, Gerry — that same thought occurred to me, too! :-)

  157. Hi Manup,

    That’s unfortunate that your tendon healed long, as I don’t know if much can be done about it once that happens, other than surgical shortening. If you are happy with your outcome, though, that is what matters.

    Best wishes,

    Doug

  158. Hi , just seeing if I can post - I have tried to register a few times but I dont get a password sent any of the times.

  159. Hi , great that I can post-I would really appreciate some advice-I ruptured my AT on 8 August, given an ultrasound at local hospital (Perth Royal Infirmary ) in Scotland. Ultrasound could only tell that it was over 70% ruptured. No operation was offered, i was simply told that it was going to be put in a plastercast for 8 weeks etc etc

    Plastercast came off at week 9, I had tried a boot at week 4-it was soooo sore (admittedly I had been pegging up and down fields after my horses) hospital put me back into a cast.

    cast off at week 9, told by physio to walk with 2 crutches for support. Now week 11 no hint that I’ll be able to walk-please does anyone have any advice on what i should do. I cant bear much weight on the affected leg and Im feeling pretty bad

    Also feel so very angry that no real discussion given re operation. Now I know the statistics I truly wish I had had the op-I run (or used to) every day, am extremely fit and have four horses to exercise-no riding for at least 3 months Im told

    The physio told me at the hospital that the hospital doesnt operate on cost grounds, basically its a postcode lottery-once I confronted my consultant i was told the tear was high and would hear better without surgery. Ive done a lot of reading and found out this is nonsense. At one point I asked if I would be better off having the surgery now…any advice anyone can offer me would be much appreciated, as Im in a pretty bad place at the moment-yes I do realise its not terminal and it will get better eventually but I just cant believe I am nowhere near walking yet…!

  160. Sorry to hear that sad story, Marathonrunner, and best results to you going forward! I’m a big fan of non-operative treatment, but the way you are treated gives that option a terrible name. :-(

    It IS true (not nonsense) that many surgeons are reluctant to operate on “high” ATRs, near the calf muscle. I’ve never heard/read an explanation, but I’m guessing that the op involves more and deeper cutting, so it’s just harder, and harder to do it without doing harm. That’s just my guess about the REASON, but the reluctance is real, and influenced the treatment of many bloggers here. Some surgeons also recommend non-op immobilization for partial tears, too, so you may have been pushed there by both factors (as well as cost-cutting).

    There’s also a widespread reluctance to operate on old ATRs, though some surgeons do overcome that when there’s a good reason to operate.

    I don’t understand why switching from cast to boot at 4 weeks was painful, but that’s history now, and probably not worth discussing.

    Looking ahead now: Where’s the problem when you try to bear weight? Soreness under the foot, especially the heel, or something else? When you say you were pegging up and down fields after your horses, in the cast, do you mean without the crutches, or with? NWB or PWB or FWB?

    At ~11 weeks post-immobilization, after long casting, now in shoes, your AT is very vulnerable, so you should be very cautious, while GRADUALLY trying to re-educate and re-accustom your leg to the pleasures of standing and walking. If you’re walking on uneven fields where you’re at high risk of twisting or wrenching your leg, you might be better off in a (hinged) boot for a few weeks, while your leg is still recovering and vulnerable.

    Are you using heel wedges in your shoe? Many people get them, and find they ease the transition from immobilization to walking in shoes. And a squishy footbed (or squishy shoes like Crocs) can also help if the problem is pain underfoot.

    If you don’t control inflammation — e.g. with elevation and icing and maybe compression too — it will make everything hard and painful. You may need more help with the horses.

    Share some more details here (or on a blog of your own), and you’ll probably get some targeted experience and advice that will help you recover!

  161. Hi marathonrunner,

    I am very sorry to hear about how you have been treated, it does not seem, well very fair. I myself am just one week post surgery to repair my total rupture and so far I have been treated very well by my consultant. I can not offer you any real advice other than to say keep going, you need to stay positive even though I understand that this must be very hard for you to do. At my stage of post op it is all about keeping my leg up above my heart at times, my doc says for upto three weeks until the swelling and throbing has gone, then i will be able to go out on my crutches and put my leg down, no weight bearing on it but down. From your listing can I not see that you did any resting like this, am I correct? May be this type of total rest would help you?

    Heather

  162. Hi Heather and Norm of the North, Thank you both so much for your replies. I managed fine in the cast and all was well for the nine weeks, even a bit of a giggle at times-its this two weeks after, foot nowhere near flat to the floor, still cant walk that is getting to me. I had a boot at 4 weeks was probably more than PWB due to an incident with one of the horses.
    i do have help with horses and dog just not enough of it!
    In terms of my foot, progress is very slow, Ive a great physio and even he is suggesting me going back to the surgeon as things are just not improving
    He is trying to encourage me to weight bear more, which I am doing but is sore afterwards. main thing is swelling right up the tendon and pain. Is this normal?
    The pain wakes me in the night.
    I mentioned hinged boot to my physio and he said he felt it would be a step backwards and suggested hot and cold buckets of water and to step up the exercises
    Thanks again for your replies and any advice you can offer is greatly appreciated! :-)

  163. Hi Marathonman

    Sorry to hear about your atr and how you have been treated. Think I had similar treatment to you through NHS in Scotland. I ruptured my achillies tendon on may 19th and was casted for 2 months, the cast was changed over 4,2,2. Like yourself I was not really offered the choice of surgery or not. When the cast came off at week 9, I was given Phyiso the following day and had a lot of pain for a few weeks and only after 6 weeks of going to Physio twice a week I started to walk kind of normal. Just make sure you elevate the leg and ice it when it swells. It will eventually get better, its just a very slow process unfortunately. I am almost week 23 now and things are definitly improving slowly. Just stay positive and keep going.
    Happy healing.

  164. Hi Stephanie thank you for your post it is very encouraging to hear that you could actually walk after 6 weeks.
    was your rupture parial or a total rupture and I also wonder which NHS region in scotland are you in?
    I am at a definate very low point as my hubby has headed off to calgary (again! ) for work which he cant of course help but it leaves me so frustrated to the point of tears as i just cant do much (yet!) with children and animals to look after -long since given up on work-i work from home and the motivation left me about 4 weeks ago ;-)
    I am just not sure how much to push the exercises and of course i am absolutely terrified of rupturing it again!

  165. One thing I would like to stress to everyone..I see and notice some of you are so frustrated after 9 weeks and I guess I just want you all to know..it takes time!! I know you may HEAR stories of people doing things, or progressing faster than others and I guess I just want people to understand you must have patience. Its the only way you’re going to get better and through this journey. 9 weeks is absolutely not enough time to see very big progress in heel raises or stepping on the floor or stairs or not have pain. It takes such a long long long time to heal enough where you can even be comfortable walking. I just feel so bad for some people who seem to get down and disappointed and worried they may need to hit the surgeon again or change physio docs. It takes time..there is no way around this. Again, not tooting my own horn, but I recovered in 8 months and had no surgery and had no physio and nobody to help me get around. I was lucky but also a bit stupid too. But I’m telling you, not many people started off and continued on the journey as lonely as I did and I’m telling you guys…It seriously is about practice practice practice and practice. Moving your toes around often, lifting your leg with your toes while sitting down up and down and up and down, trying to walk little baby steps around the house, setting goals of how far or how long u can limp/hop/walk every week, standing on two feet, then one, then two, lifting your heel once maybe at the kitchen sink or standing near a pole or if you happen to be near a railing, walking up steps one at a time maybe every other day or so, sticking with the heel raises with little weight, and sure its not gonna move, and u may not even budge, but practice practice practice and more practice…I’m telling you.its gonna take time. I can’t explain to you more than being a basketball player, city lover, walking for miles every week, dancing in the clubs every weekend, being able to run faster than most of my friends…don’t you think that I was frustrated too? angry sometimes, annoyed, pissed off, dissappointed, nervous or scared i would never walk again, considering being a limper all my life……all these thoughts will cross your mind and have crossed most of our minds. It sucks big big big ass sometimes when you think of not being able to just do simple simple things you used to do for 10, 20, 30 years of your life!!! Its such a crazy injury!! But………………………………

    I’m telling you..whatever stage you are, wherever you are in this process..please please please please don’t compare yourself to others, don’t get down thinking you won’t recover at all, don’t start thinking something terribly wrong with your surgery or non surgery after 2 and 3 months, don’t feel pressure to rush back asap because you’re afraid you will lose ur mind or your security within yourself, don’t give into the pain which causes doubt, don’t think for one minute whatever you are doing..its a waste because other people do it better or it helps them more.

    It takes time…i just can’t explain it any other way. Think about it this way..when u scrape your knee, or hand, or break a nail or cut your hair, or get stitches, or have a burn mark…how long does that take to recover?..an hour?, one day? 3 days? two weeks? a month?……….now imagine…YOU CUT YOUR FREAKIN TENDON FROM YOUR CALF TO YOUR HEEL? I mean i just hope people understand the trauma that has occured to your body down there. Its simply devastating to that region of your body. And the mechanics, the rotation, the system is very complex and its simply hard hard hard hard work for your body and your own mind to wrap its head around this injury and why it can take so so long. In some ways, its better to have broken your foot or hand than to go through this.

    So don’t wanna sound overly hard on anyone..but I want to help people understand..I know its tough, I know it hurts, I know its so darn frustrating, and I know progress some days or even weeks just seem like you going at snail’s pace. But I want you all to know..at least for me, I truly truly truly know how you feel and I didn’t have anyone to help me, support me, docs, physio people, nothing. Mostly by choice but point is..you have a good support here, many of you have docs and physio people to help, family, friends…and I know if i can do it..if i can deal with all those emotions and feelings and frustrations…I just know with this site, and some of the support you all have..the only real threat to your recoveries…is doubt or being impatient.

    I want to lift some spirits here as I have been trying to do since I decided I want to give back to others and help maybe just one person on here if I can. I want people to think about the journey as ups and downs but progress. Because I read these things and I reminsce and I feel man..i wish i had someone to keep me up when I felt like that or them. So I just hope everyone will keep their heads up..ask anyone else who is 10 or 12 months recovered..do you think we feel 100% perfect? Do you think we plan on taking the exact same risk after getting through a journey like this? (ok excluding the 2nd ATR people..:) Its something you never forget, it changes you a bit, and makes you more aware…but trust me,..the journey doesn’t end even if u return to sports or running or whatever..Its a reminder of what you can lose in a matter of seconds, what you can tolerate, how you can deal with ups and downs, and lastly what you can achieve as a individual through work, training, mental toughness, and setting up workin on then surpassing your goals when you put your mind to it!…

    Anyway, as a friend and fellow ATR survivor..I just want people to know…everyday is progress..everyday your body is trying to repair itself, everyday means something to your leg, and every little step or practice or extra second u can surivive pain that u couldn’t day before, every goal you push through, everyday you believe you are getting better…it really really does bring you closer to where you wanna be..Some days..victories are not always visible..sometimes progress can happen in your heart and mind too.

    If you ever have a question or comment you wanna make, please feel free to email me at back2rich@yahoo.com. I will always tell you what i think, and why i believe its possible, surgery or not..to get back to normal. Once you have done it..I’m telling you, you will want to help others do the same..despite their doubts and fears..the same we all have had ourselves. Good luck everyone and I just wanted to emphasize patience, expectations, practice, and staying mentally strong…I still believe in all of you…

  166. Hi Marathon runner,
    Can’t offer advice but you have my support and understanding I’ve also had to cope with husband being away (in China, Thailand and Norway ) and being left alone with two children, ok , they are teenagers and have been really helpful in their own ways. But once they were back at school the homework kicked in and I couldn’t expect them to do so much. I was unbelievably frustrated at my own helplessness, everything was such a bloody effort. It resulted in quite a few rows when my husband came home, I wanted to go out for the first time in a week, he wanted to sleep off the jet lag. I just wanted to scream sometimes.
    I think this is a mental marathon as much as a physical one. All I can say is it will end.
    Keep on at your consultant for answers, it is difficult to work out whether their treatment is evidence based or funding based
    Good luck

  167. Hi Marathon runner

    It was a total rupture from playing badminton. I was given treatment at a hospital in Glasgow. I can totally understand where the tears are coming from. It is very frustrating not being able to do all the normal things. I remember going through the tough times a few months ago when I was not able to look after my 2 year old and feeling really useless everyday. I was very lucky to have my families and friends around to help me. Dont be afraid to ask friends and families for help you can return the favours when you have recovered. At week 11 I was doing alot of stretches with the band 3 - 4 times a day. Do what you are capable of and dont over do. Stay strong and be patient you will get better slowly.
    Good Luck

  168. Hi Marathonrunner,

    After seeing your posting I did send a reply but thinking more and more about what you said lead me to doing some research into items that cna be used at hoem to help with the recovery and I have come across this USA website.http://shop.mendmeshop.com/

    I know that sometime these thing can be all talk as it wher with no results abut this company seams to have been going for a while and they seam to be getting good results with the Frezze, Inferno and ultrsound combo for the achilles. When i get a for more weeks into my recovery I shall be ordering myself the pack. Anyway it is just a though, hope that it helps

    Heather

  169. Just a quick update. 7 months on from total rupture of right achilles. Still limping, but doing more and more walking.

    Message for Marathonrunner. I didnt walk until 12 weeks. But by 14 weeks was almost crutch free. Once you take your first tentative steps the improvment is swift. Think alot of it is confidence. With regard to re rupture your physio wont ask you to do any exercise that is going to risk re rupture. Shortly after my cast was removed I stumbled on my crutches and put full weight through my toes on my bad foot bending the foot and stretching achilles. Thought I would have reruptured but all ok. You will be surprised at the strength of your reattached achilles.

    As manupstairs says this injury is a major deal. In a lot of respects a broken bone is easier to deal with. Patience is the key.

  170. Another update
    - that just over 3 months since my last cast was removed. The limp is gone and I am walking about 5km over a 45 min period on my treadmill daily. I occasionaly break into a run, but my foot gets a bit sore after a while (my foot - not my achilles) - I guess its just not used to the pressure at this stage.
    So progress is being made but its slow.
    Theres no doubt in my mind that there are two things you need to have with this type of injury: patience and more patience.

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  172. 9 months on still struggling to walk without a limp. Still not done a heal lift with bad leg. Had ultrasound scan today. Looks like tendon is a bit of a mess. Guy doing the scan said it was not a happy tendon, although it is attached. Lots of scar tissue. He also found a tear in the calf muscle close to the tendon which isnt helping.

    Still to get any response from thompson test. Apart from all that recovery is going well.

    Seeing consultant on 21st Dec. Got a horrible feeling I will need to go under the knife.

    Would love to hear from anyone else who has not had a good result from conservative treatment.

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  178. Left leg ATR 4 months ago and went to my local NHS hospital, Walsgrave in Coventry.
    Offered option of surgery or non surgical routes and opted for non surgical.
    Leg went into plaster for 1 day which was take off the following day and replaced by a removeable steel leg brace below the knee and 2 wedges inserted in to the trainer.
    Wedge one came out 4 weeks later with wedge 2 after 6 weeks and the brace 2 weeks after.
    Re crutchers - I had 2 crutches for one day only followed by one crutch for 4 weeks.
    Since the start of my ATR I have been walking, although very slowly for the first 8 weeks.
    Been driving for the last 4 weeks, having physio and took my first business trip to Denmark last week although I worked from home for the first 9 weeks..
    Each day there’s an improvement and when you look at the world around you, we have nothing to be depressed about as we will recover!
    Helps also that Walsgrave Hospital are conducting research into ATRs and every 2 weeks for for the first 12 weeks, I went to the hospital for a check up and to take part in this study where they monitor via shoe fitted foot shaped sensors, the changing and improving pressure profile on the injured foot.
    “An investigation into accelerated rehabilitation strategies following an Achilles tendon rupture (Allied Health Professionals Training Fellowship - Rebecca Kearney), with Associate Professor Matthew Costa, Clinical Sciences Research Institute, Dr Juul Achten - Clinical Sciences Research Institute - Prof Sarah E Lamb - Health Sciences Research Institute, Funded by: Arthritis Research Campaign, Project Start Date: 01/09/2009 Project End Date: 31/08/2013″

  179. Tosh, I’m SO happy that a hospital in the UK is getting hip about accelerated ATR rehabs, and especially fast rehabs without surgery — it’s about time!

    I’ve posted (too?) often about the recent studies showing the benefits of both, and none of them is from the UK, and most of the centres in the UK don’t even seem to have read or understood them — ’til now! :-)

  180. Hi
    Only just found this, wish I’d found it months ago!
    Here’s my story.
    Suspected Partial ATR in left leg on 15th March while in Italy (on a snowboarding holiday. I was doing a warm up session, and we were playing tag. I sprinted and pop went my leg)
    I had some history of tendonitis/tendonosis but had seen an NHS physio about it. He signed me off on 22nd February, having seen me 4 times since December, and given me exercises to do. No ‘hands on’ therapy of any sort.
    Was given a full leg bandage to immobilise and compress the leg in Italy and told to elevate, obviously was NWB.
    Returned to the UK on 19th March, saw my GP to get a ‘fit note’ on 21st March, and she advised me to go to A&E. Went to A&E at Queens Medical Centre, Nottingham where one of the physios looked at me. He cut off the bandage, confirmed (and wrote notes) that it was a suspected PATR, and sent me off to the Fracture Clinic. He didn’t put any support or bandage on my leg. Got an appointment at the FC for the next day and went home. This was the most painful day I’ve had with the rupture, without the support and compression of a bandage my leg was giving me quite a lot of pain.
    Attended FC 22nd March. Based on the fact that I had no support/bandage, and the notes from A&E stated ‘suspect PATR’ I don’t think the consultant thought much of my injury. However when he squeezed my calf to complete the Thompson test I think he was surprised at my reaction – I screamed and started to cry. Total surprise to both of us, I’m not the sort of girl that cries about anything! My Mum was watching and told me that my foot/toes didn’t twitch, unlike when he checked my right leg. Upshot was he said ‘it’s definitely a PATR, but we’re going to treat it like a full ATR’. Consultant said I could have surgery or not, and said probably better to not. I wasn’t really given time to make a decision, and didn’t really know the right questions to ask.
    I was put in a toes-pointed cast that day, and told to come back in 2 weeks.
    Returned to FC on 5th April, cast off, I was fitted with an Ossur Rebound Air Walker with 5 wedges. So I commenced with PWB – it’s very hard to do anything like FWB when you’re on 5 wedges! It’s like wearing a 6” heel shoe! With one wedge out every 2 weeks I’m now 10 days away from the boot coming off, and honestly I’m terrified! I’m now FWB, only needing crutches to help me get up steep hills (I live on one!) But my calf muscle is now half the size, and is in fact concave through wastage. I can stand up without the boot on, but I don’t put full weight on it, because obviously I’m not supposed to take it off. So far I haven’t had an ultrasound.
    I think the NHS has provided me with a fair service, but not the best.
    The next stage will obviously be physio again. I would describe myself as active – I take part in Snowboarding, Mountain Biking, Horseriding and Badminton on a weekly basis, I walk a lot and want to be able to do more. I’m very worried about the possibility of a re-rupture. So my question is, What should I ask when I go back to FC on 28th June? I’m willing to throw money at this and get private physio as well if it helps.
    My next snowboarding trip is pencilled in for late February. I’m just hoping I’ll be able to do it!
    Thanks for any comments/advice!
    Caroline

  181. Start a blog of your own, if you have the time and energy!
    Your “I think the NHS has provided me with a fair service, but not the best.” sounds about right. 12 weeks immobilized is ~4 weeks too long, and seems to increase the risk of re-rupture rather than diminishing it. And it obviously increases the bloody nuisance to you and everybody around you, too, so it’s lose-lose.
    So my first suggestion for “What should I ask when I go back to FC on 28th June?” is “Why do you force your ATR patients to follow such an old-fashioned, slow, and difficult protocol when all the evidence shows that faster, more convenient protocols produce better results, especially without surgery??”
    I’d suggest that you try to gradually converge with one of those protocols, like bit.ly/UWOProtocol . Start doing gentle foot-wiggling “exercises” a few times a day, staying below the “neutral” ankle position. You can probably do 2 or 3 weeks-worth of those exercises per week, but don’t just skip ahead.
    “Terrified” may be excessive, but “I’m very worried about the possibility of a re-rupture.” is rational and helpful. You’ll be at the greatest risk in the few weeks after the boot comes off. Many of us followed the UWO’s “wean off boot” — i.e., for a few weeks we padded around the house in Crocs or similar, and wore the boot for outings. Then just for scarier outings, etc. Weaning.
    You’ve been (forced to be) very slow and conservative ’til now, but when you get out of the boot is a GOOD time to be conservative. I like to say “Watch Your Step”.
    Good luck, and good healing!

  182. BTW, I was downhill skiing in Whistler at 17 weeks, no problem, non-op but with that fast protocol. Soft snowboard boots aren’t as protective as hard (ski or SB) boots, and your slow protocol will also add a month, but I’d guess that you’ll be ready when the season starts.

  183. Thanks for your comments normofthenorth.
    Been in today for my ‘boot off’ appointment.
    Took boot off, consultant did Thompson test, seemed pleased with progress. Asked me to walk a few steps, which I did, with a wobble or two!
    His exact words were ‘right, you’re ok to take it off now.’
    That was it. Stunned, I asked about physio. He said no physio due to the re-rupture risk. But that I can phase the removal of the boot. Then he left, saying he’ll make a note that I can have an open appointment.
    No scheduled check ups, no considerations of driving or of sports participation. Nothing. As of now the service from the NHS has gone from ‘fair’ to poor. He was so desperate to leave the consulting room I didn’t get a chance to ask anything else.
    Going to be phoning the clinic tomorrow once I’ve calmed down and demanding to see someone else.
    Blog will be in the making over the next few days.

  184. Hi all

    I suffered a tear to my achilles tendon on May 12th halfway through playing rounders. I heard a loud pop and it felt like an elastic snapping in my ankle. I went to A&E and was put in plaster. I went back 1 1/2 wk later. The consultant I saw gave me limited information and was pushing the non op treatment. As I am a wimp when it comes to op’s and injections I went along with this. He said there was very little difference in recovery time and re-rupture.

    I was in a cast for 3 weeks, then put in a boot with 3 wedges and told to walk on this using crutches and that it was ok to put my weight on the foot in the boot. I was told to take 1 wedge out after 2 weeks and return at 3 weeks.

    At no time was I given a scan.

    At the next appt (6 1/2 wk) I was discharged after a very brief meeting - 2 min. The consultant only felt my leg through the bandage. He referred me to physio.

    2 days later I attended physio. I mentioned that I had developed a really bad sore on the underneath of my foot which was weaping - think I had got friction sores from the boot and wedges. Ended up having to be seen by another consultant. He did a very thorough check up of my leg and foot and said he wasn’t happy with how it was healing. He organised a new plastic splint and no weight bearing. He said he would refer me for a scan. He gave me an appt for 3 days later.

    At my next appt I saw a different consultant that hadn’t even read my notes properly and just said continue with splint and no weight for further 2 weeks then start physio. When I mentioned scan and other diagnosis he then agreed to chase it up. I was asked to go back the following week. I ended up chasing up my own scan and arguing to bring it forward to today as they weren’t going to do it until 15th July 2011.

    Today I had my scan. It wasn’t good news. I still have a tear 2 -3 cm long that isn’t repairing. The guy told me it is highly likely I am going to have to have surgery on it. This will mean I will be right back to square 1. I wish the consultant had advised that this might happen. I am due back on Tuesday and even though I know that I must go for the surgery option now this cannot be booked until after I go on Tuesday.

    So for anyone reading this wondering whether to go for surgery or not - consider your options carefully.

    Has anyone else experienced anything similar? Is anyone else out there currently recovering?

    I played netball and rounders regularly and am really missing it and hope that I will eventually get back to it but am worried about the tip toe bit with netball.

    Tee Gee , Chorley , Lancashire

  185. ryanoseris, on July 18th, 2011 at 7:40 am Said:
    hi all, particular normofthenorth if you can get this
    I had an ATR 5 weeks ago after a fall up the garden steps (totally sober i might add)
    off to A+E where a cast was fitted in the ballerino position for what was to be 4 weeks , however due to a suspension of the fracture clinic at my local NHS hosp had to wait until 5 weeks (due off this week )
    I have read lots of blogs and searched for info , all of which is great and found loads of tips for recovery
    However my situation is this 0 as well as the ATR i also have something called Hoglands Nodes (also known as heel spurs) these in effect mean the achilles tendon has further to travel
    Try as i may i cannot get a straight answer from all involved whether this will have an effect recovery or increase the risk the risk of re rupture
    Any one got same or similar or any info??

  186. hi ryanoseris
    on the home page of achellisblog.com you will see a search function on the upper right corner. search for heel spurs and u will find many bloggers with that condition.

  187. Hi. I’m trying to sort my blog out in next few days. However short overview: 51 year old from Coventry ruptured Achilles in right leg on 22nd June playing 5-a-side football. I never normally play football until that fateful day. I considered myself fit and active. I played hockey for 35 years, mountain bike, play golf, and the last 12 months doing gym circuits 4 days a week. So to rupture jogging playing football seems bizarre! Following rupture I was put in cast and told to come back 5 days later. I was then put unbend air boot and advised non-operative was best. The consultant had been involved in the Canadian studies so I trusted his judgement. Day 20 one wedge taken from the boot. I’m now on day 28 and try not to use my crutches. I can walk freely and am in no pain apart from the boot rubbing on my shin. I’ve been going back to the gym to take part in Body Pump sessions. Consultant advised to weight bear as often as possible to stimulate the healing process. Physio happy with progress and said healing started as some reflex in the foot when she rubbed my calf. Still have no clue as to how long this process is all going to take. Patience not in my dictionary - until now!

  188. wow 28 days walking.that’s fast.. im amazed that different consultants have different approach to how to treat.
    I ruptured mine playing football (should know better far to old now) went to clinic same day to be told i have ruptured i must admit at time i did not know fully how bad this is i thought couple weeks with limp .. when realty kicked in i was given option or sugary or non sugary. i asked which one was best told by consultant that sugary was best it speeds up recovery and less likely of re rupture so agreed to sugary. when i went to surgery because i had done some research on net to see if there is any advantages to having sugary and not seeing that there was i mentioned this to him he still insisted that sugary is better no arguments. Anyway had sugary then leg in plaster after ten days i fell and put all of my wait on bad lag the pain was something i hope i don’t feel again and i thought i had re ruptured. next day i went back to see consultant who agreed to see me . After a quick look he says i have not re ruptured in fact he took the back of cast off and left me with front cast on he told me to put wait on toes has i walk with crutches and start to move ankle and get some movement back. I must admit i was terrified at being exposed . i have to go back and see him in 3 weeks when he said he will remove front cast and give wedges in shoe.
    Its seems strange reading other posts how different consultants deal with this some very slow approach and some very aggressive getting full wait barring very quick. I will say my consultant is very good spends lots of time explaining things and his sugary work was very good ardley any scares at all . I do sometimes worry if im going to fast to soon but my consultant is keen on doing more rather than less. I never in all my life realised what this injury was like and it reassuring hearing different stores of other people . good luck all speedy recovery.

  189. Hi all, Tee Gee here again, I am now 11 weeks in and still at the none weight bearing stage and using crutches whilst awaiting my op on 16th August 2011. I feel like i am in Groundhog Day! I really hope thing go ok this time as we are due to go to Florida on a family holiday and I am really worried about what stage I will be at by then. Can anyone advise where they were up to at 9 wk post surgery? Has anyone flown long haul at this stage?

    I would love to hear back from anyone.

  190. Hi tee gee
    I’m just at 5 weeks after surgery and I’m walking in my own shoes with one .wedge in each shoe . It dose seam to me that different consultants have different approach to how they treat. My consultant is doing a studdy on this Achilles tendon and how it should be treated . He says that surgery is best for long turn results and a very aggressive approach to getting back on feet again .. I must admit I’m a bit worried on how fast he has moved me on ..I was in full cast for two weeks after op then he removed it to half cast this just supported my foot from rising and putting to much strain on tendon it was held on by straps that went around my leg which I could remove . Then 3 weeks on he took that away and gave me to wedges to put in my shoes and told me to walk .. I can tell you now I was scared to death of walking I felt so fragile and thought I could never put any weight on my foot but I did and I took my first steps and it felt great . Iv got one hell of a limp but walking I am !! Foot is a bit sore but not has bad has I expected and do feel I’m getting there. I do think every one is differant and should go at own pace but I do feel what he had me doing two weeks after surgary.( stretching exercises and
    massage th leg and tendent has helped me. Get your self some massage oil and if you can gentley massage bake of tendon it really dose help and rub back of calf this gets the blood circulting which helps the healing prosses. I hope all goes well for you and at nine weeks your walking and be on your way to Florida.my doc says at nine weeks I can run and play some sports again but I think at mo I’m happy with the walking and will give it more time before running or playing sports . Good luck

  191. Hi Kevin

    Thanks for the advice and words of encouragement. I have now had my op which went fine. Had to go to hospital this week and must say they have made a really neat job with my scar and stitches. I am now in my boot with 2 wedges (have to go down to 1 asap) and have been told to walk on it with crutches. I am not due to see consultant now for another 6 weeks. My foot feels very painful when I put it down and I am in agony when I start walking so taking it slowly. Massaging oil in the back of it sounds good. I will have to give this a try.

    You are doing fantastic being in shoes at this early stage you must be really pleased. How well did your shoes fit when you put them on? How did they feel? Did you have much pain? Have you been to physio also? Hope you continue to make a speedy recovery.

    TeeGee

    I

  192. I did my ATR in turkey where they operated about 3 hours of my entering the hospital. I then went to a&e at the QE hospital birmingham on my arrival home. they booked me in to trauma clinic the next day (saturday) where they changed my dressing and booked me in for a scan on the monday for suspected DVT (due to my recent flight home) which was all clear. due to the removal of my partial cast for the scan i was given a temporary cast until the next day when i was due back to trauma clinic for the removal of stitches. i was then given a fibreglass cast and told to return in 3 weeks (tomorrow) it was when leaving the hospital in a wheelchair i saw a young soldier with one arm missing and both feet missing from about half way down his shins, wheeling himself outside for some fresh air. it was then i vowed not to complain about my ’slight’ injury and just get on with the healing process.

  193. Ruptured my Achilles tendon in early February. It took 3 hospital trips, 9 visits to GP and eventually transferring to a whole new doctor before it was properly diagnosed…. 8 months later. I was told it was a sprain, so had been in agony and fully weight bearing the whole time. Now it has healed really badly, and I am 2 months into 6 month intense physio to try and get it better. I may never play rugby again, which is a HUGE part of my life. Physiotherapist has hinted that even though surgery could let me play again, the nhs probably won’t do it, as being able to walk without pain is considered ‘a good result’…. Has anyone here opted for private surgery ? Am just so upset that this may now plague me forever :(

  194. Hi all,

    I ruptured my Achilles’ recently; so painful! The scans apparently showed it was ruptured up near where the tendon joins the muscle so the doctors decided on conservative treatment. It seems to be mainly cast, occasionally changing the position of the foot with a new cast.

    I’ve read that one can see better results by early movement possibly using a boot. Do the NHS provide this as a treatment? So far it has not even been mentioned to me!

    Cheers.

  195. Hi Ese1
    Like you I am a recent (5 weeks) full ATR and on the NHS.
    I was fitted with a boot, non-op. These are possibly better than a cast as they can be removed in order to adjust the position of the foot at 2 weekly intervals (up to 10 weeks).
    Hope this helps, please look at my earlier messages posted on this site, it may help.

  196. Hi Harry,

    Thanks for the info. I’m now 3wks “post rupture”. I have a hospital appointment next monday (4wks) where they are supposed to move the foot slightly. It’s at a different hospital so maybe they will offer a boot, if not I will definitely ask for one now I know it’s available.

    Cheers

  197. Hi Ese1
    Hope you manage a boot. I am now on week 6 and down to 1 heel wedge.
    I have been informed that I can now remove the boot to flex my foot downwards but must not raise it back beyond the position it was in while in the boot. I can also have a bath without the boot as long as I do not inadvetantly flex my foot!
    I do flex my calf while in the boot to keep circulation going to help prevent clotting.
    To be honest I am not going to rush things. I prefer to leave the boot on until I am settled with no wedges before I start weight bearing. The hospital has booked me in for physio from week 10 onwards. They expect me to be walking in normal shoes by week 12.
    Although non-op, my leg swells whenever it is not raised, this soon disappeares when raised again. I have been told this is normal and it can take months for the swelling to go.
    I am a healthy 12.7 stone fit guy in his 50’s desperate to get back to a healthy lifestyle.
    On the downside, the doctor told me that because I have had this ATR it is highly likely that my other side will rupture at sometime as it is a degenerative thing caused my past sporting activities. If it is going to go, it has the ideal opportunity right now because I have covered miles hobbling to the shops etc on my one good leg + crutches!!!
    Hope your own recovery is going well and that you are coping OK. An understanding spouse or partner is essential!
    Take care.

  198. Hey folks, thought Id add to the long list of UK ATR sufferers and throw in my tales of woe with a frank recommendation for the Vacoped Achilles boot.

    I suffered a full ATR whilst playing tennis on 11th January. It was to be the start of my new fitness regime in prep for a dream holiday to Oz in March. Needless to say both the tennis and the fully paid trip to Oz have gone out the window!

    I changed direction quickly on the court and pop the tendon went. Ive never suffered any injury like it but knew immediately what had happened. Within 10 mins of the ATR I was in my local A+E in Bromley. Unfortunately I had a further 3.5 hrs wait before I saw a trainee doctor. She had a look and diagnosed it as a partial rupture, said there was little that could be done and I should go home and rest it. Fortunately for me her diagnosis had to get checked by her mentor who ultra sounded my ankle and confirmed a full ATR. I had a visit to the cast room, left leg (toes to below knee) place in a front slab cast. I was given Ibuprofen and co - codamol and given an appointment for 8 days time at the fracture clinic. That when I became an Internet doctor! For the next 8 days I researched every aspect of the injury, specifically looking at the pros and cons of surgery Vs conservative. I was a bit confused but was weighted towards surgery.

    The big day -
    The consultant immediately said that he has been treating full ATRs conservatively since the 1990’s and uses a special boot rather than casting.. A trip to the casting room and I was fitted out with a rather S+M looking fracture boot. The boot was a Otto Bock Malleo Immobil Airwalker High (try saying that after a few drinks). The boot was fitted with wedges at 30 degrees and had a pump to pump up airbags around my ankle. I was given an appointment for another 2 weeks time and told to elevate the leg with no bearing of weight. At first the boot was comfy and a nice relief to be able to keep my foot clean by removing the boot and washing it. However the boot was clunky and the straps created pressure points.

    The Vacoped -

    I did a bit of research and there was a lot of talk about a boot call the Vacoped with supposedly 25% quicker healing time through its use. I had already bought an £85 pair of ‘Smart crutches’ (worth every penny) to assist me so I thought Id give the Vacoped a go. The price from the Uk supplier was a bit steep at £240 inc vat so I thought Id give ebay a go. To my astonishment I ended up buying one for £40 (one careful owner, 4 weeks use). The Vacoped had eased the pain of having this injury. After showing it to the consultant on my next appointment he was sold. Its just so much more comfortable and versatile than the one they issued me with. Much more hygienic too as it comes with interchangeable terry towelling liners and you can take the sole off in bed at night. This not only lightens the boot but stops you taking any debris into the bed.

    On this visit ( 3 weeks post rupture) the consultant said that the tendon was reconnecting nicely and to drop the angle of my foot to 20 degrees with a view to being 50% weight bearing by the end of the next 2 weeks. The adjustments on the Vacoped are a doddle. You use a plastic key to adjust the angle at the back of the ankle.

    Where Im at today -

    I had my 3rd appointment today (5 weeks post rupture) the tendon is healing nicely and the consultant says I can drop the angle down to 10 degrees this week and then when Im comfortable 0 degrees (natural right angle) the following week. Better still I am now fully weight bearing. Once at 0 degrees I can take the boot of in bed at night. My next appointment is in 3 weeks with a view to starting physio in the next few weeks also.

    So there you go. I was truly apprehensive about going conservative (no political pun intended) but Im kind of glad I did. I never though Id be full weight bearing 5 weeks after the rupture and on track to a speedy recovery. I can honestly say that the Vacoped has been a blessing, along with the Smart crutches. If you can, its worth investing a little in you own recovery. The NHS stuff just isnt up to scratch but at least they were open about that. Ill look forward to giving you the next update in 3 weeks time!!!

  199. I too bought a vacocast but when I was full weightbearting the bean bag system annoyed me and I cut up an old camping mat instead- see my casts and boots page on my kiwiclaire blog.

  200. Hi Shellshocked1977
    I read your recovery comments and am encouraged by your rapid recovery from this nasty injury. I am also non-op full ATR and relying on the boot, albeit the one provided by our inconsistent UK NHS.
    I am uncertain what make the boot is, but it is velco fastening though quite heavy (good for the leg raises with the extra weight)!
    I am now in my 7th week post rupture and down to 1 heel wedge that must remain in position for another 10 days when I can also start the partial weight bearing. The final wedge will be removed at that time.
    You are obviously somewhat younger than me and heal quicker. I am just taking it cautiously as I am in fear of a re-rupture as I cannot face the prospect of going through this again.
    I am keeping very active and always out and about on the crutches. I slipped yesterday and put my bad foot down for support and ended up in a heap on the floor. The pain was bad but my main concern is “was any damage done”? The pain perhaps indicates that I am not sufficiently healed at this stage to start weight bearing.
    I will keep looking for your recovery notes and will compare them to my own recovery calendar. I expect to be walking in my own shoes by week 12. I understand though that recovery sufficient to allow me back on my beloved golf course will take up to 6 months, maybe more.
    You seem to have a first class consultant. I have had 3 visits to the LGI (Leeds) and have now seen 3 different doctors!
    During my visit this week I asked if the tendon had re-attached and she said that they are unable to tell until week 12. How useless is that? I asked about a scan but she informed me that a scan would “only show up as mush” and that little could be seen! She said that if it has not mended then an op will be needed. I nearly blew a gasket and demanded answers why I was not operated on in the first instance. She waffled away about infections and how it is possible to loose a leg if post ops go wrong and that they always try conservative repair first.
    In the meantime I do my own research and I find comments such as yours on this blog most helpful and encouraging.

  201. Harry, you shouldn’t equate slower (non-op) rehab with safer, less risky, or better proven rehab. The weight of evidence suggests that the OPPOSITE is the case. Most older non-op treatments were done with slow “conservative casting” and had much worse re-rupture rates than surgery. More recent studies have used fast protocols like bit.ly/UWOProtocol (mostly with boots instead of casts, PWB and exercise and PT at ~2 weeks, FWB without crutches ~4 weeks, into 2 shoes ~8 weeks), and have shown re-rupture rates virtually identical to surgery, without the scar and most of the potential complications.

    There is no reason to wait until your heel wedges are removed for PWB & FWB to begin; the UWO study got excellent results by NOT waiting.

    I would find the UWO study (it’s on this site, in the studies section, ask if you can’t find it), print it out, and confront your doctors with it. “Confront” — as in, ask them if THEIR non-op results are half as good as the results in that study! And if not, why are they using a slow protocol (that’s a bloody nuisance and a prolonged crutch-walking falling risk for you!) instead of one with superior proven results!?!? In fact, it’s ~100% a hangover from the old days, especially common in some regions (including yours). If it was good enough for your grandfather. . . or for the doctor who trained me when I was an Intern. . .

    In general, the AT does seem to reattach just fine by itself, with or without surgery, although we patients would probably get several MRI or US exams every week if we had the choice. (Ever hear about the farmer who kept digging up his carrots to make sure they were growing OK?) But keeping your ankle immobilized for 12 weeks, and especially staying NWB for nearly that long, is NOT a short-cut to a low-risk best-outcome cure, according to the best evidence.

    BTW, the fact that crutch-slipping and landing on your bad foot hurt, is ABSOLUTELY NO indication that you’re not ready for WB. Your muscles have all gone to mush because of the immobilization and NWB, and falling on a foot is not the same as gradually re-learning how to stand on it and walk on it.

    The time most of us spent FWB in a walking boot was usually the lowest-risk part of our rehab: Before that we were at high risk of crutch-slipping, and after that we were in 2 shoes, dealing with a weak and unstable and still-vulnerable leg, without the protection of the boot!

  202. Hi All,

    So I had my appointment today and the doc put me straight into a boot after a quick feel to check my tendon had actually reattached.

    He said for the plaster room guy to put 4 wedges in and for me to take one out per week. For some reason the plaster room technician put in 5 and the doctor just said “oh well, you’ll have one more week with the boot”.

    So as it stands my protocol has been 4 weeks NWB full equinus. 2 more weeks NWB removing one heel wedge per week then continuing to remove wedges gradually moving towards FWB.

    This seems a little slow to me given what some of you guys have been saying. I’m tempted to slip one of the wedges out early (especially since the doc said initially 4 not 5)

    Another question I have, I was told I could take it off to sleep and it seems from searching the site a few other people started taking it off at about 5 weeks. I’m a tad worried about damaging it when I sleep, I don’t move around too much but do swap from back to side without waking sometimes. Does 4 weeks seem too soon to do this?

    Thanks!

  203. Hi normanofthenorth
    Firstly, so many thanks for your comments and advice, it is truly appreciated. It is incredibly re-assuring when you (and others) are prepared to write to offer such help from your own experiences and research that make this blog so useful.
    I have now viewed the UWO Protocol that you suggested, seen the outcomes for myself and feel much happier knowing that the non-op treatment is essentially as good as the operative method.
    Following your comments I have now started PWB. To my astonishment it appeared so relatively easy. The walking boot is still in position, but I was soon strolling, albeit with crutches, up and down the lounge some 30-40 times. I only stopped for worry of causing damage and not because of any serious pain!
    Yes, I did feel some pain on the underside (ball) of my heel (nowhere near the area of rupture) and also an aching in the calf muscle but I assume this is simply due to lack of use.
    It is difficult to estimate just how much weight I do allow onto the injured leg but to be honest I reckon that by tomorrow (day 3 of PWB) I will be at the FWB stage. I currently feel that I could have tried this sooner!!!
    What does feel strange and presumably needs great care is when I remove the boot and try to flex my ankle/foot. I am still on 1 heel wedge so it would be foolish to try flex it upwards so I am simply working it from between the 4 and 1 wedge positions. The foot and ankle are both much more swollen than I imagined they would be, but hopefully this will disappear during increased mobility.
    I do feel much happier than I have for a long time and offer you my sincere thanks.

  204. Thanks for the thanks, Harry, and congrats on your accomplishments and pleasure! If you could drag one of your doctors (or your PT) along with you, it would probably be much better for you AND for the next few dozen patients who may otherwise be subjected to a too-slow protocol. You are under some doctors’ care, and I’m no doctor, so don’t be tempted to let me replace them.

    OTOH, slow protocols are outdated and counter-productive, so congrats on speeding up some!

    Now, you’ve got to be smart and cautious about it, aka “Watch Your Step!” — especially if you’re going to be your own interpreter of a protocol that your Docs aren’t prescribing for you. My general advice for somebody who finds themselves way behind the schedule in the modern protocols, is to avoid “skipping ahead”, and instead to gradually, progressively close the gap, by starting with what you’re doing now, and going through (say) the UWO protocol at faster speed than they did.

    E.g., if they started exercising at 2 weeks and you’re at 5 weeks and haven’t started yet, start with their week-2 exercises for a few days, then do the week-3 exercises for another few, etc., etc. And similarly with WB and other progressions.

    The UWO protocol restricts all ankle flexion to “below neutral” for the first little while, and also restricts it at first to “active” flexion, meaning using your own leg muscles to wiggle your foot in the air, NOT pulling your foot up with a towel or a Theraband, and CERTAINLY not using the floor. I’ve personally become a dorsiflexion “dove”, since the consequences of stretching too much too soon can be seriously bad, and the consequences of being a wimp seem trivial by comparison.

    Most of us felt pain or discomfort underneath the foot — especially under the heel — when first doing some WB, and often again when going into 2 shoes. If you can add something like a squishy gel insole into your boot, under your foot, you may find it helps a lot. Many of us chose Crocs (real or imitation) as our initial “2 shoes” for similar reasons, because they’re so soft and squishy and sole-friendly. Socks help, too, inside the boot, though getting them on and off takes care and can be scary.

  205. Hi Guys,

    I’ve been in the boot for a couple of days now, on the whole I *much* prefer it to being in the cast. About the heel pain, my heel wedges are already causing me a bit of discomfort and I’ve not even started PWB! Perhaps my boot is on a bit too tight.

    I’ve taken the boot off a few time now just for a short while each time. When the boot is off my leg feels so vulnerable, it’s hard for me to judge what it should feel like at 4 weeks but I feel like I couldn’t move the ankle even if I wanted to. Could those who are ahead of me shed some light on if this is normal for this stage?

    Despite what the technician in the plaster room said, I haven’t trusted myself to sleep with it off which means I haven’t slept amazingly for the last nights (the boot is definitely worse in that respect).

    I did however take the boot off for a shower the other day… I’m sure you all know how nice the first shower feels like, my leg hadn’t seen the light of day in 4 weeks so it felt *great* to give it a wash.

    This morning I took it out of the boot and had a little lay on the bed. Not for long though cause I didn’t want to risk feeling asleep! ;-)

  206. I started sleeping “free” very early; 2 and a half weeks post surgery.

    Starting 5 days after surgery - as soon as I got out of the fixed post surgical cast, into a removable splint - I spent as much time as I could with my foot free; keeping it as active and mobile as possible (but no weight bearing). So, just laying on the bed with it free was never an issue- that’s how I was spending most of my day.

    It took a little while to get comfortable under the covers. I started out by taking my splint off early in the morning. At first, maybe for only 15 minutes, before I’d get up and into the shower (no real danger of “falling asleep”). I remember waking up one night at 4am, and deciding to take my splint off. I fell back asleep for a few hours, and slept better than I had in weeks. I think that was the last time I wore the splint to bed. :-)

  207. Thanks for the info ryanb. I had non-op so I don’t know if I should expect the tendon to feel different than if I were 4 wks post op.

    I had a check up on Monday and the consultant said there was no gap in the tendon so I feel like I should be able to move my foot at least a little. I’m reluctant to try too hard for fear of doing damage.

    To be honest neither the consultant nor the plaster room technician gave me a fantastic amount of detail about how to use the boot, i.e. just for walking/crutching or keep it on bar sleeping. So I’m kind of winging it … and of course searching this v. useful site for relevant info and experience!

  208. Ese, I’d urge you (as I urged Harry) to print out the UWO study from this site, and its fast protocol, and use it to educate yourself AND your local health professionals. In the nicest possible way, ask them if their clinical non-op results are anywhere NEAR as good as those reported in the study — if so, why haven’t they published them, and if not, why should you suffer with their slower protocol? (If that doesn’t work, roll up the printout and swat them with it!)

    Wiggling your foot gently while sitting in a comfy chair or on a bed is definitely a Good Thing at 4 weeks post-whatever. Don’t go above 90 degrees aka “neutral”, and don’t apply any force. (See my suggestions to Harry, above.) One classic exercise is to spell out the alphabet in the air with your big toe. . .

    Sleeping without the boot should be fine, except for a few considerations: (1) A night (or two) in the boot is very helpful when you’ve just removed a heel wedge. Basically, your AT and calf will tend to tighten, and your ankle will tend to plantarflex, when you’re sleeping boot-less. Then you’ll have to stretch them out to get into the boot again. Especially if you’re PWB or FWB at the time, you’ll be stretching them out AND loading them up at the same time, which makes me nervous. So especially if you’re WB, switch out the heel wedge just before bed, and sleep booted.
    (2) If you have to get up during the night, e.g. for a “pit stop”, you’ll likely be safer if you’re still/already booted, rather than crutching around bootless in the dark or fumbiing to strap the boot on in the dark. (Your sleeping partner may prefer the booted option, too!)

  209. > and if not, why should you suffer with their slower protocol?

    If not, why WOULD you suffer with their slower protocol. It’s your leg- do what YOU think is best for it.

  210. I thought I’d add my name to the list of weekend warriors. First off, thanks everyone for a superb resource, just seeing everyone’s comments is a huge help (as I’m sure you all know).

    If a relatively fit 41 year old in the South of England. My ATR happened last Monday (20th Feb) on the Badminton court. I’ve been playing since I was 12 and was half way through a match when I lunged for a shot at the net, heard a distinct pop and hit the floor like a sack of spuds. I knew exactly what I’d done instantly and my only thought was “why isn’t there any pain?” One of my friends drove me home where I was whisked off to Casualty where I sat for a long time… Four hours later I was home in a front cast and with an appointment to see the consutant in a week’s time. I’ve subsequently had an ultrasound that confirmed it is a total rupture which is higher than normal - 8cm above my ankle and I’m back in a different half cast.

    Having read my way through this excelent blog I am now armed with loads of information to meet the consultant this coming Tuesday. One thing is for sure though - I’m pushing for a boot!

    I’ll keep you posted and may start my own blog to chart my progress.

  211. Adam, thanks for your post, it seems your tale is similar to mine and would be interested in hearing how you progress. Like you, I have been playing badders from a young age, am in the South of the UK and popped with little pain. The only difference is they gave you an ultrasound, I just had the thompson test. I recommend starting a blog, it is quite theraputic and has helped me a lot so far, I am 2 days post surgery in a backslad cast for 2 weeks until my follow up.

  212. So, I’ve actually been sleeping without the boot now. It’s much more comfy! Though I’ve had to forbid my girlfriend from migrating onto my side of the bed ;)

    Without the boot my ROM is tiny! Because of this I took one of the 5(!!) heal wedges out earlier than the doctor instructed and will be doing so with the others in an attempt to (slightly) accelerate this procedure.

    I am getting very impatient now but I guess I must be careful that whilst taking things a bit quicker I do not rush and hurt myself again.

    normofthenorth, do you have a link to the actual paper/article where the results are published? I had a look at your bit.ly link but I’m sure the consultant would be wary of anything but a published paper.

  213. Very pleased that I have found this blog, so thought i’d join in. Interesting to read lots of similar almost identical situations to mine.

    I’m 38 and relatively fit. Playing football on my regular Thursday night kickabout/game, when half way through, under no pressure I pushed off to run (not sprint) and there’s literally what sounds like a loud snap and it feels like i’ve been shout by a sniper! What was strange and I have read in some other posts was that there was not much pain. When I felt down to the back of my ankle there was no achilles there! Just soft tissue and then I nearly passed out. Got taken to AandE, waited 4 hours to have it confirmed that ?I had fully snapped my achilles. I was then booked in and went for the operation option which was carried out on Monday. Stayed in until Tuesday afternoon and came home last night. Still no pain. Leg in plaster with foot pointing down. Taking Paracetamol, Diclofenac, and having to inject some stuff once a day to avoid any clots! Got to go back in two weeks to have either a new cast or boot fitted. Look forward to reading more of your posts for tips and what to expect. I have been initially signed off work for four weeks and would be interested to follow others recovery times. Cheers and good luck to all. Mark

  214. I wish I could say I was a new member of the ATR club having ruptured my left on March 5. But I’m not. I ruptured my right July 1999.
    I guess that means I should know what I’m in for. I’m now 3 days post op.
    GA’s have improved in 13 yrs. Surgery at 1430 conscious at 1530. Tea and toast 1630. 1730 walked out (crutches), home by 1800 no ill effects, very little pain to speak of except for a minute after standing up?? 1999 I was 2 days in a hospital bed.
    I’m hoping the recovery protocol is as much improved.
    Did it whilst playing 5AS, no warning, no tackle, not even with the ball. Just pushed off and snap. I’m in plaster, though I do have an angle adjusting boot.
    I’ve got lots planned so I need a fast recovery if possible, no more 5AS though EVER. I’ve had a good run out at 50 this year. I need some less violent sport and fitness from now on. I’ve read quite a few blogs and it seems the emphasis is on early mobility and WB. I think I have to agree though I don’t know what the NHS has in store for me till the 21st………….

  215. Bill G, you’ve got lots of time to reconsider whether or not to return to your fave sport. I “donated” both of my ATs to my fave sport (court volleyball, usually 4AS, 2001 & 2009), and I’m still playing it (at 66yo!). As one of the other “two-timers” here posted a while back, “Unless I grow a third wheel, I should be pretty safe from tearing an AT again!”

    You’ve been at significantly elevated ATR risk since your first one, but it’s virtually unheard-of to rupture an AT that’s recovered from an ATR, with or without surgery. I’m sure it’s happened (probably in another part of the tendon), but I’ve never actually heard of one.

    For now, I’d catch up on the modern studies and the modern fast protocols — like “UWO 2010″, which is available elsewhere on this website. That protocol — also available at bit.ly/UWOProtocol — will have you in a boot, PWB, and in PT, all at TWO WEEKS post-op, and FWB “as tolerated” at 4 weeks. You can read the rest of the details. I don’t think there’s any sensible reason to go slower, but many professionals still haven’t gotten the memos, so it might be up to you to bring them up to speed. Several Brits here have even bought their own boots, usually the Vaco.

  216. Quick question for anyone…

    I am now two and a bit weeks post op and my leg is still in the cast with the foot pointing down. Our hospital sends out their appointments by post and the first attempt got to me on the day of the appointment with about half hour to go! So couldn’t get there and am now awaiting second appointment.

    My question is, all seems fine in terms of the achilles and the Op, just still a nightmare getting around on crutches.

    But I get this really bad pain in my big toe, a bit further back and onto the foot. It is worse as the day goes on and is pretty unbearable in the nighttime. I have been taking the painkillers that I got after the op which help, but it really is an awful pain that is keeping me awake/waking me up. In fact it’s the worse pain since the moment I ruptured the achilles.

    I think it may be the cast touching onto the big toe that is becoming irritated, but not sure.

    Just wondered if anyone else on here has experienced this?

    Cheers for any help.

  217. Hi Mark, sorry you had to join the club. I think I would get this checked out - asap. Not sure whats causing it (biomechanical/pressure or something else).
    As for the crutches - I rented a knee scooter for a while, it was great. (Not sure if you are in the UK - mine was from wheelchairs.r.us.) All the best with it.

  218. Hi Mark, sorry you had to join the club. You don’t want any secondary problems. I would get this checked out - asap.
    As for the crutches - I rented a knee scooter for a while, it was great. (Not sure if you are in the UK - mine was from wheelchairs.r.us.) All the best with it.

  219. Hi I am 49 pretty non active lady full rupture on 24jan2012 sober showing son how to skip!!!!! was taken to A and E by ambulance as fainted with pain and fractured cheek bone!!!!! A and E was a nightmare however knee cast equine position told come back to fracture clinic local Scottish NH S hospitall in a weeks time Returned to be given chat about not going down surgical route as too risky looking back they quite clearly weren’t interested go away come back in 2 weeks and will reset cast.Two weeks later ie 3 weeks ATR went back to be told they were going to try and put me in boot nearly punched nurse when she tried so plaster back on same position told come back week 6 . Gave up went private night and day air cast book with 4 wedges down to 2 after only one week started phsyio week 7 lots of movement in ankle.NHS don’t have time or resources to give you that this slow injury needs not there fault just the way it is

  220. Sad about the Scottish NHS, Louise. As you’ve learned, there’s no contradiction between “boot” and “equinus” — you just have to have some heel wedges!! I don’t know why so many “otherwise intelligent” health professionals think that boots are only appropriate for ATR patients who are in the neutral position. It’s so dumb and counter-productive. . .

  221. Yes,I now realise that to my peril,and agree why can an orthopaedic surgeon not make more thought through decisions? I am sorry but my experience is that NHS don’t have time and resources that this devastating injury needs Don’t want sound like a princess but you feel so down when you realise the extent of ATR that time and TLC from a proffesional makes huge difference .My advice to those stuck with NHS is read this site top to bottom be Knowledgable and ask lots of questions!,,,,

  222. Nice web site. Good data

  223. Hi Norm thanks for the reply - downloaded UWO2010 but Doc is more cautious.
    However surgery +10 days I am out of plaster in boot. No probs no pain- stitches healed nicely. Still swollen though. This boot has pins that set the angle in 7.5° increments. In 3 weeks Docs going to jump me 22.5° in one go.
    Surely its got to be better, say after another week, to jump it gradually in 3 lots of 7.5° over 2 weeks.
    What do you think?

  224. Hi all

    Ruptured my achilles last Sunday 8th April playing football, based in Birmingham UK. Went to A&E straight away, put in a temporary cast and appointment for fracture clinic on Monday morning. After being told I would have to wait 6 weeks for an ultrasound scan (!) after 4 hours of phone calls I had it done on Thursday 12th, and had an operation on Friday 13th (I’m not superstitious!).

    Currently in a plaster cast and will be for 6 weeks, followed by plastic boot for 6 weeks at different incremental angles.

    I’ve started a blog chronicling my experiences here:

    http://adamsachilles.wordpress.com

    The NHS are good but often need chasing to make sure you get the treatment you need. I’m only 26 and wanted to make sure I could do some form of sport again even if it’s not football, as well as walk without a limp, so that’s why I kept pushing for the scan. It turns out it should be scanned within 48-72 hours and the 6-week prediction was a mistake - but not one that would have been rectified without chasing it up myself.

  225. My story so far:
    23/03/12
    I ruptured my Achilles tendon whilst dancing at a celebration for my 53rd birthday. I didn’t realise what I’d done at the time.
    Ironically I had in the last few weeks started on a fitness regime befitting an oldy like myself, consisting of yoga on a Wednesday evening, swimming on Monday and Friday evenings and table tennis on Sunday mornings.
    I was really enjoying myself and feeling fitter.
    24/03/12
    I attended our local poly clinic on Saturday morning and after waiting nearly three hours I was diagnosed very quickly and told I had to go to casualty!
    At casualty I had another long wait (apparently if the doctor at the poly clinic had had the sense to give me a letter with his diagnosis I would have been spared at least part of the wait)
    So, after seeing yet another doctor to confirm what I’d done, I then had to wait to see an orthopaedic surgeon, who told me my treatment options.
    Firstly I could have my lower leg plastered for probably a total of 8 – 9 weeks which would give me a 60 – 70% recovery.
    Secondly surgery, either percutaneous or open.
    The first option only if I was found to be a suitable candidate for a trial being done by the consultant at the hospital involving percutaneous surgery, the second option of open surgery.
    Either option would apparently give me a much better full recovery rate than non operative treatment.
    I wasn’t told what the criteria of suitability entailed.
    Having decided surgery was the best way to go I was put in a light plaster cast to keep the foot immobile until there was a space for me in theatre.
    After a full day of waiting in clinics and hospitals I went home.
    26/03/12
    On the following Monday 26/03/12 I received a call to say they had booked me in for surgery first thing Tuesday morning and to make sure I was nil by mouth from 12 midnight.
    27/03/12
    At the hospital the next morning I was seen by the registrar who informed me that I was going to have percutaneous surgery under a local anesthetic (that caused a wobble)
    The surgery took 20 minutes, and it did hurt despite being assured it wouldn’t but it was bearable.
    I was put in a full weight plaster cast in the equine position and sent home with an appointment for two weeks hence when the plaster would come off and I would be put in a ‘boot’.
    02/04/12
    I stayed off work for the first week returning on the 2nd of April after my desk and computer had been relocated so I could access them via a lift in the office next door!
    I managed 2 full days, took work home for Wednesday and returned to the office on Thursday, Friday being good Friday so I looked forward to a long weekend which I spent sitting bored and bemoaning my fate.
    10/04/12
    Work again on Tuesday the 10th of April returning to hospital in the afternoon to be fitted with my ‘boot’
    Unfortunately after taking the cast off and declaring my ankle looking good I was told there were no boots left so I had to be re-plastered and sent home waiting for a call to go back when they were in.
    The very next day I got the call and was told to be at the hospital first thing on Thursday.
    12/04/12
    I cannot describe the pain when that boot was put on………
    Apparently the trial I am on encompasses full weight bearing at two weeks after surgery,
    My consultant says he has 24 other people on this trial so far and they are all doing really well.
    Weight bearing?? I couldn’t even straighten my leg, it was agony.
    13/04/12
    However after 24 hours the pain had gone and I started to stand on my left foot.
    16/04/12
    Back to work and I am now walking on it no problem, though by the end of the day my leg aches and feels swollen in the boot.
    I am not allowed to take the boot off to sleep or even shower.
    I have 4 wedges in place to keep my foot at a forward angle which I have to take out at intervals of two weeks. I will not see my doctor again until my foot is at a right angle at 6 weeks post surgery.
    The next step this week when I have to take the first two wedges out, I am not looking forward to it!

  226. Hi Alison I’m 49 and went down non surgery route. I was in plaster for 3 weeks when they tried boot ——– it wasn’t happening ! Went back to plaster for 6 weeks in total in same position then boot FWB with 4 wedges all of which were removed over 2 weeks Boot off all together at week 10 now at week 13 (tomorrow) walking with limp all be it improving every day good luck

  227. Hi Everyone, I have been daft enough to rupture both tendons now (13 years apart). I was put in plaster for 8 weeks in 1999; it was hell. Add to that the muscle wastage and loss of function, all be it temporarily, it’s the dark ages. I’m in the ROM boot now and it is a vast improvement. I must of had a great surgeon- not much pain. I am much more advanced in my recovery and have been weight bearing from 4/5 weeks. I can walk, I can take it off and do the mobility exercises, I can bathe. Without hesitation go for the surgery and insist on the boot.

  228. Hi Bill G

    Are you in UK and US, or somewhere else? Seems to be that surgery is preferred in US and ‘conservative’ here in UK, although many exceptions to this in both.

    I went weight bearing after 2 weeks and put in a VacoPed boot, starting at -30, and adjusted every 2 weeks to -30 +10 over 6 weeks. That last adjustment was 7 days ago and today, at week 9, I will be trying shoes with heel pads, albeit indoors only for a week, then outdoors too if all ok.

    So far I don’t mind not having surgery and look forward to picking up the hill and mountain walking after some good physio work. This accelerated ‘conservative’ treatment is getting some good results - time will tell. A pity that across the UK (and probably elsewhere too) that ortho capabilities vary so much.

  229. Hi Plummy, I’m in the UK in the care of the NHS, God bless ‘em. I can’t praise them enough. Surgery was carried out to perfection, I was very lucky.
    I’m wk 9 and things are going really well. I did have a sailing trip planned in June and unless I took an aggressive recovery protocol like the UWO2010 as recommended by Norm (Thanks Norm) I was never going to make it. However if the yacht I was going in was sea worthy I would be going definitely. However boat is not, so cancelled till 2013. Anyway I think the key to an early recovery is access to the achilles and mobility which means no plaster cast. Massage aggressively every morning, don’t be afraid of walking and doing stuff during the day, then ice in the evening. I was getting hip pain so dumped the boot at wk7. DO NOT WEIGHT BEAR ON THE BALL OF YOUR FOOT. I’m wk 9 and have been doing a bit of cycling, walking in trainers about a mile. After the morning massage limp is barely noticeable but comes back after 2 hours. I do ankle alphabet, gentle stretches, band exercises and have full mobility. I don’t have any strength yet, that will come with time and patience and being careful.
    Good Luck Everyone.

  230. Hello Bill G

    I used the Vaco boot without problem, until Week 9 for indoors and Week 10 outside. Now in walking shoes although PT has suggested wearing something softer indoors, or go barefoot with care.

    If you are a car driver, have you started back on the road yet? My ATR leg is right side, might try driving on a quiet road this weekend, with a co-driver on hand.

  231. I blew my right ATR 3 years ago this week. Everything back to normal for quite some time, but I remember that first time out driving again. Beware the panic stop.

  232. I am sorry to say that I too am a member of the ATR club! I am 50 years old and have been on a great keep fit regime this year and tore my Achilles during a personal training session at the gym on 24th April. My trainer had changed one of the exercises and had me doing a step exercise with only half a foot on the step - which I now realise was a recipe for disaster! I heard it pop and was immediately unable to put my foot on the floor, in fact the sensation was that there was no floor! Straight to A & E and was xrayed to show no broken bones, they did the Simmons test and knew straight away that I had torn the Achilles. I spent the first 10 days in a cast with only the front as a full cast to allow for the swelling to go down. I then returned to have that removed and have it replaced with a half leg cast (they did attempt to fit an air boot but the pain was too much!). Returned today and now have the air boot with 4 wedges. I have been told to remove one wedge at a time per week-10 days and then I go back in 2 months. Painful today but I expected that. Up until now I have not had trouble sleeping but fear the worst given the size of the boot! Never had plaster cast fitted before and was not prepared for the frustration in not being able to get around, let alone the sore hands from the crutches, the painful shoulders and the most undignified was I have to heave myself up the stairs on my bum to go to the toilet ! I would urge anyone to get a Limbo cast protector which allows you to bathe in the confidence that your cast will not get wet. Just hope it now fits over my air boot! St George’s Hospital, Tooting have been great however I am going to call on my private medical care for the physio. Have been told not to take the boot off (however, i can unfasten to get air to let, but not bathe) or put any weight on it. I am doing everything by the book as the thought of going back to square one fills me with dread. I have been up And down and was totally unprepared for the low days, never been depressed before but can honestly say there have been some weepy moments. Any further tips are truly welcome at this stage.

  233. Tonigirl,

    Part of what make this injury so tough to deal with is that many of us are very physically active and sometimes that activity is what causes the ATR in the first place. Then your activity shuts down to near zero. About all you can do is to accept the fact that life will be different for a while. This recovery is a journey and you will learn many things about yourself and how you relate to others in the process. Embrace that discovery. Many of us find that this discovery causes this episode to be a somewhat positive experience. You may find this as an opportunity to do some things you have been meaning to do but had no time for. I caught up on a lot of my reading and connected with friends I had been meaning to contact for a long time.

    Keep looking at the long run, trust your physical therapist and you’ll come out of this okay.

  234. Hi Tonigirl

    I used a Limbo cover many years ago and bought a new one for my ATR rehab. I have a VacoPed boot and found that the cover wouldn’t get past the boot’s heel.

    Time to get inventive - I cut off the sealed end of the Limbo, pulled the cover up my bare leg so that cover and rubber seal were above knee, put the boot back on, followed by a bin/garbage bag tucked into top of boot liner, then pulled down the white limbo cover down over the boot. No need for tape.

    You could do it without the plastic bag of course, but the foot will get wet, and you will then need the liner to dry or insert a spare liner.

    Hope this helps.

  235. Hi, I am 2 weeks into my recovery after a heavy fall led to a complete rupture. I have been treated by the nhs but like everyone else faced the decision of surgery vs conservative route. I decided to go private for a second opinion. What was interesting was the nhs reccommendation for non-surgical was made without an mri, which i paid for myself (£300) .What that showed was the two ends of my tendon were close together - less than 1cm at worst and that the break was high, thus near my calf muscle and all its lovely healing blood.

    So the nhs direction seems right for me and i was re-assured by the second opinion, which in all cost around £700.

    Next stage for me is out of the cast and into a boot. Im not sure who is more pleased - me or my wife.

    One final word on the nhs. When i fell I went into shock and was cared for by an nhs consultant who happened to be nearby. He spent 90 minutes with me, made sure an ambulance came and generally was a star. Theres something very right about the culture of the nhs. That bit of care cost me a bottle of whisky in thanks.

  236. Hello Alaric

    I hope that your recovery is going well. Do you know when you will be into the boot? Depending on your hospital, there could be another financial decision coming.

  237. Hi all bust my Achilles tendon last week jumping over a little fence and went my righty foot went down into a hole .it went with a pop and i thought that I’d been shot limped to the hotel next day went to a&e and was given the bad news total rupture was told a cast was the preferred option as an operation had no great advantages for me one week on and I’m going mad with boredom was told six to eight weeks whats the real length of time for recovery I could do with some cheering up

  238. Hi Owen

    Cheering up? Ah yes, all those great daytime tv programmes, old films (if you have Sky, ask for a reduced film subscription for 6 months if you don’t have it already), read more, do some upper body exercises, knit (?), text even more than you do now.

    Which leg is it? Might mean no driving for around 10 weeks if right ATR. Keep asking med staff what you can expect, why, etc. e.g are you having a boot soon?

    I’m coming up to 20 weeks, right complete ATR, also non-operative, back at work for ages, going to gym, doing the garden.

    Might get more response on http://achillesblog.com/atrs-in-uk/ the general UK blog.

    Good luck over the next few months - lots of support here as you’ll have seen.

  239. Daz,

    Just a quick thank you for monitoring the UK web area (if you still do). I have unfortunately just joined the ATR club. Am hoping the website will help me with my state of mind in my recovery.

    Best wishes…

  240. Great Blog

    I completely ruptured my achilles tendon on the 3 May 12 after stepping up on to a kerb. I went to A&E on 4 May 12. Doctor at A&E did a cursory investigation, felt up the back of the leg and said it was a bad sprain and that I had two options – immobilise it or leave it. Obviously I went for immolising it. It was put in a half cast and I was given an appointment for the fracture in two weeks.

    Two weeks later and saw an Ortho Consultant who after investigation, Thompson test and an ultrasound the next day confirmed it as a complete rupture. Told surgery was not an option as the healing process had already started. He said I would be in a cast for 12 weeks and then walking boot for 4 weeks with physiotherapy. Knowing the seriousness of a re-rupture I accepted my fate.

    After a couple of replacement casts, I was seen by another Ortho Consultant and finally had the cast removed after 11 (10 Jul 12) weeks. I was given no airboot nor offered any physiotherapy as Consultant said physio entertains re-rupture. Another appointment has been booked for 3 weeks time to see consultant.. I’m a little concerned and slightly confused about the mixed course of treatments mentioned by two Ortho Consultants – is this another NHS cost saving exercise?? Have written to my GP for his comments.

    In the meantime I will use gentle exercises to gain leg strength. I can walk with a hobble and my heel kills me. Walking on the beach is great as is the cold sea water. I work for the NHS so not in a hurry to get back to work.

  241. Hi all ATR’s

    Wishing everyone a speedyand successful recovery.

  242. Hi Robert02,

    You are a long way down the road of recovery now, you’re certainly not engaged in what I would say is the current protocols - so I assume your injury was more complicated than that (other underlying issues etc).

    http://achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/

    Above is a link to an aggressive recovery program, they’re softer options but yours is the softest I have read so far.

    I am not a doctor or an expert, but generally (speaking for treatment in 2012) and reading other people experiences in the UK non-op healing process, the cast should of been off within weeks 3-6, then put in a boot which (over the next 3-6 weeks) would be adjusted to slowly to stretch the healing tendon and a degree of physio (home exercises in my case) would be advised to get that ankle moving again, then move onto physiotherapy and away you go.

    my suggestions - get some good running trainers that suit your feet, they are more comfortable for getting used to walking in again - tread carefully, use a walking stick if it helps and keep moving :)…. and find the UWO Study and discuss this with your doctors, just in case they are still living in the past.

    Best wishes for continued safe healing.

  243. Hello All,

    I’m 41 and (was) relatively fit until I ruptured my right achilles playing badminton in March (2012) on an evening when I’d done more warming-up than usual!
    My treatment has been on the NHS in York and involved surgery a few days after the injury, then six weeks in an aircast boot, non-weight bearing with three heel wedges, one of which I removed every two weeks.

    Everything went well but ten days after “losing” the boot, having started walking without crutches and cycling (on physio advice), the tendon re-ruptured when I was stepping from the patio back into the house.

    After the re-rupture, I had another op, which included a transfer of my “big-toe tendon” to the achilles.

    I’ve been in a serious of casts for the last eight weeks, with new casts to set my foot at a different angle at weeks 4 and 6. I’ve now been out of the final cast for ten days, have heel wedges in my normal shoes (one of which is very tight due to the swollen foot that’s in it!) but I’m still walking very carefully with crutches as I’m fearful of a third rupture.

    I have hardly any movement at all in my ankle and don’t see a physio for at least another week or so.

    I’ve found it very interesting just how many different ways of handling the ATR have been reported on this great blog, I myself have had two consultant surgeons telling me wildly different prognoses so it’s good to know I’m not alone in that even if it isn’t particularly re-assuring.

    Sorry this has ended up being a much longer post than I’d anticipated but I wondered if anyone had had the same (tendon transfer) op and could give me any advice on rehab etc.

    Thanks,

    Jamie

  244. Hi everyone, I joined ” the club” two weeks ago and am currently being treated in Halifax. I have no complaints, so far they have been fantastic! I did not know much about this injury two weeks ago, but they seem to be following the fairly standard route of recovery judging by everyone elses experiences. I stumbled upon this website by accident and it is a great comfort to know that there are others out there going through the same day to day challenges as me! To have the ability to walk taken away in a split second (I didnt realise dancing “strip the willow” at a scottish wedding could be so dangerous!) is just one of the many frustrations associated with this injury. Last week I bought a limbo after seeing an advert for them in the hospital…..it is the best £13 I have ever spent! To have that little bit of normality and independence back doing something that normally would be so simple ie bathing or showering is priceless and I would recommend them to anybody!!
    I wish everyone a speedy recovery ….. And thank goodness for sky plus and I-books!!

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  249. Well here goes
    I ruptured my AT after a fall from my horse 25th July 2012. I went to the A&E department and after waiting several hours and telling the Dr I felt a pop in my calf was told take pain killers go home you may have a ruptured muscle, this was all diagnosed without moving my sock!
    On the 30th July I attended my local minor injuries by this time my leg and ankle were multi coloured, the nurse did the thompson test and said my AT was ok!!
    on the 23rd August I attended my Dr surgery to see if they could strap my leg so I could ride my horse, saw a locum GP who said he needed to speak to a friend after doing the Thompson test, he called the following day to say I had been referred to Physio 2nd September I phoned physio and as I was literally around the corner from the hospital managed to get an appointment, physiotherapist sent me to minor injuries for an x ray, this was done even though the nurse said there was no point as he was certain I had partially ruptured my AT, the nurse arranged appointment with Otho surgeon who i saw on the 10th September who ordered a scan which we had to chase up and gave me a walking boot (this caused me pain which I hadnt really had until then)
    My scan was done on the 14th September and I was told my AT was completely ruptured with a 4cm gap .
    Back to the surgeon on the 17th September operated on the 21st September told as time between rupture and surgery was so long they had to attach the tendon to a muscle and were not sure how successful the op would be!
    Two weeks after op returned to have dressing changed put back into open front cast and am now entering my 4th week NWB and stuck in my bed!!!

  250. Quite the ordeal Alysbach- good to finally get the proper diagnosis, have the repair, and be back on track to recovery.

    My question is: why are you stuck in bed? NWB just means no weight bearing on your foot; on crutches, knee-scooter, or i-walk-free type of device, you should be mobile and able to be out and about- has the doc put you on bed rest for some reason?

  251. Sorry…just re posting on here as i’m unsure if i’ve posted on the correct site…thanks Ryanb for your answer but wondering if anyone else can offer advice…..

    I’m wondering if someone can help me as i’m experiencing a great deal of confusion with my ATR at the minute.
    Quick summary of events;
    ATR dancing on Sat 7th Oct- Attended hospital after I realised something was seriously wrong on the 8th so approx 40hrs later.
    NHS walk in centre diagnosed ATR and said it would need stitched- sent to A and E @ Blackburn Royal Infirmary.
    ATR Confirmed-but said it was partial - straight into a cast and ultrasound booked.
    5 Days Later - Serious Pain in the calf and lower leg - advised to return to the A & E as suspected foot was in the wrong position- Indeed it was- cast not put in equinus.
    Cast Changed to equinus.
    5 days later - attended fracture appointment where the consultant removed cast, re did the thompson test and sent me to orthotics where I got a vacoped.
    I had read, and to be fair it was mainly american info that surgery produced superior results and had a lower re rupture rate however, both orthopeadic specialists and my orthotics specialist said the Vacoped was just as effective.
    Got the boot, followed all the instructions, after 4 weeks in the boot im allowed to fully weight bear and I take it off 2 x per day to do 10 reps of movement excercises- ALL GOOD….NOW..here’s the bombshell!
    Attend an ultrasound on weds 14th where the ultrasound woman tells me a) i’m about 5 weeks too late for the ultrasound b) My tendon is 20mm apart and will never re heal - sends me to A & E where I wait for hours to see a Junior and then a registrar who tell me to continue on the conventional treatment.
    The next day, I’m back seeing the orthotics specialist - (who has been consistent and re assuring throughout) who tells me he has treated bigger and smaller gaps and he is happy to continue to treat me.
    The problem is….I dont know who to trust now.
    Has anyone had experience of a full rupture with such a gap being treated the conventional way??
    I have requested the Orthopedic Specialist re look at the case for a 2nd opinion…I didnt even need to tell the guys secretary my name!
    I will hear back from them Monday. Im just HOPING that after 6 weeks I get to continue with the same course of treatment or im back to square one.

  252. There’s no way any of us can know but based on my own experience I think it’s good that you’re getting a second opinion.

  253. I made a long post that’s “waiting for moderation”. Same general idea as ryanb’s. Maybe this will get through.

  254. Thanks Lisa and Norm….Ive been reading your posts norm and had the all clear from the specialist today that regardless of the 2cm gap…my non surgical rehab protocol remains the same…its an aggressive method like the one you have posted and favoured. I think I just need to have faith now that things will be fine as the treatment I have been given by the orthotics department seems to be pretty much at the forefront of ATR recovery. For me it seems this injury is as much a mental challenge as a phisical one and I know the real work probably starts when the boot comes off in 3 weeks.
    Thanks

  255. Ran up the stairs last night to suddenly feel like I’d been shot and a pop sound, packed my foot in ice and waited till this morning and feared the worst. Went to Accrington Hospital this morning and a nurse and a physio both looked at my foot and carried out a Thompson test, in their opinion it was a full rupture and I got referred to Blackburn to see the Urgent Care Centre. After a decent wait I was treated by a Dr who didn’t do a Thompson test and said he couldn’t tell until I’d had an X-Ray and Ultrasound. Anyway hours pass and I have an X-Ray and I’m told to wait again for the ultrasound. He then comes back and says I can’t have an ultrasound this side of Friday and they will bandage my leg up and book me an appt with Fracture Clinic in 9 Days time !!!
    Anyway I’m sat there waiting for my Wife to come and collect me after having to go and pick our Daughter up from School and I’m reading this site were everyone seems to have at least got a cast of some sort. I then went to complain, the staff to give them their credit have been superb and have pushed me all over today but the Drs attitude was very poor. Anyway after meeting him again and some Trauma Nurse !!?? She says the bandage was adequate but I said I don’t even know if its full or partial damage at which point the Dr says its partial !! I said well thats funny you didn’t know this morning so how come you do now ? He then says its the same treatment anyway !!

    Just feel fobbed off, though I did get a partial cast before I left which I feel is giving me better protection until my next visit which is the fracture clinic but no sign of an ultrasound scan.

    Sorry about the rant :-)

  256. It fascinates me that we have so many people who love technology, but complain about the products that come out. Or worse, complain that software doesn’t work as expected but then complain when a new version comes out that resolved the issues.

  257. Message for Not happy….Have a read of my post above…im being treated at Blackburn for a full rupture…it was exactly the same treatment for me regarding timescales-10 days in a cast then into a vacoped boot (apart from they set my cast wrong) so I wouldn’t worry too much
    They told me last week that full and partial are treated the same as initially I had been diagnosed with a partial.
    Although ive had some major cock ups….all the specialists have been consistent in the way they treat the injury and if you’re lucky enough to get a boot it is seemingly the most advanced non op treatment for ATR.

  258. Thanks xaviero Hospital rang this morning to bring my appt forward to Monday. I’m just finding it hard to hop because I’ve had a PCL operation on the other knee and its not the strongest. If you get a boot do you not need crutches ?

  259. More good news, ultrasound on Thurs now, glad I grumbled a bit but give them their due people have cracked on and sorted things which I appreciate.

  260. Hi Nothappy…or should I call you not hoppy ;)…sorry that was a bad joke!
    I didn’t hop much really and used my crutches because I didn’t want a fall or slip etc….Living alone, I was practically immobile for 4 weeks. It was Horrible. At least you have a wife and kids to help and bring you cups of tea!! :)
    I am a very independent 38yr old Female, on my feet all day for work, ride my MT bike at the weekends…try and keep fit and healthy and I never sit still!
    All i will say is get used to resting, preferably with the leg elevated because whichever road you go down…op or non op, the VERY least amount of time you’re looking at is 8 weeks in a cast/boot. It depends on the course they take for you…..I could fully weight bear at 4-5 weeks from the initial ATR which was a MASSIVE help as crutches were driving me mental!
    Good news re the ultrasound…It does make me wonder if the stir I caused about my ultrasound has given them a kick up the arse!
    Let me know how you get on at fracture

  261. Will do thanks for the advice, hopefully tomorrow ill find out if it partial or full and what route I’m going down. Didn’t think I was that active but when you can’t do anything it’s so frustrating !!!

  262. Hello All,

    I’ve now become a member of “ATR” clan :-( . Playing 5 a side football 29th November 2012. I played for nearly 20 mins. I was stationary then went for a header, all of a sudden my heel felt like it was numb. I didnt hear any pop or tear. My calf muscle balooned right up. I could still walk so I went and got changed, hobbled back to the office with my heavy GYM bag. Then made my way home, From Canary Wharf S-E London.. I went to see the DOC and she did the simmonds test on me. I could not tip-toe on my left leg. She sent me to hospital and I went the next day. I’m now in a cast, with my feet pointing downwards. Am in a lot of pain and feel very sorry for myself having to use the crutches :-( LOL I must say the hospital staff were excellent. One part I hate is having to inject myself every day with blood thinners!! :-( Luckily I can work from home.

  263. London attractions aren’t just buildings of historical interest however - many visitors are drawn by the vibrant nightlife and wealth of shopping opportunities offered by a host of world famous clubs, shops and markets.

  264. Hi All,

    I’m 29, originally from the UK but now living permanently in Holland.

    I ruptured my achilles 11 days ago and had surgery the day following the injury (for some background, I was playing badminton at the time). I was sent home the same day with a semi solid cast and had this non-weight bearing cast removed yesterday (day 10 post operation).

    Having read a lot about post operative procedures, I was pretty horrified when the process in Holland was to literally take the cast off and give me an ankle support with a 6mm silicone wedge to put in my shoe and told to go home and walk.

    I was expecting some sort of walker boot with some feeling of support with the extended heel wedges so the tendon can be stretched over time back to a normal standing position. The wedge provided was so short I can not physically stand let alone walk.

    My home doctor did a house visit today, took one look at the ankle support and proceeded to cut me out of it because it was so tight I couldn’t get it off without being in intense pain. It also caused swelling to my foot and toes. Pins and needles is also being experienced ever since the operation (is this normal?)…..

    I suppose what I’m looking for is some sort of recognition from you all who have experienced this injury that my gut feeling was right about the ankle support. I have another appointment with the same hospital department, as arranged by my doctor, for this coming Monday. Should I be more insistent about the walker? Is it too soon after surgery? Any advice (help!) would be greatly appreciated!

    I’ve been living abroad now for 6months and trying to work my way around a foreign healthcare system is proving to be a bit of a nightmare so thank god for this blog!

  265. Melissa - I am not sure what the ankle support you spoke of is but since your doctor cut you out I would assume that you have no support for your tendon. Swelling of the feet and toes is not good but I am concerned that you have nothing at all until Monday. It would be in your best interest to get into some kind of boot like Vacocast. There are other boots as well that offer support and can the angle can be adjusted. They are also designed for walking. Early weight bearing is not a problem but most advise you do it as tolerated as long as the tendon is protected. It could be that your surgery was different to what most (all)of us here have experienced. My surgeon told me of a new type of surgery using an artificial tendon that is glued and not stitched. It is mostly used in ligament replacement such as the ACL (knee) but has recently been tested for the Achilles tendon. In these cases, patients are walking in shoes within a couple of weeks.

  266. Hi Xplora

    Thanks for the response - I think I had the same type of surgery as most people on the website. The surgeon explained he would make the incision and use some sort of wire to pull the tendon back down so it could be stitched.

    I have an appointment at the hospital tomorrow so hopefully can get some sort of boot there otherwise it’s going to be a case of sourcing one (again somewhat problematic as I have no idea where to start but I’m sure the hospital can recommend something).

    Since being cut out of the support the swelling has gone down dramatically - have tried doing some soft stretching of the ankle upwards, as the foot was cast with the toes pointing downwards. I can place my foot flat on the floor (with the leg at an angle) but haven’t tried to weight bear as I have no support at this moment.

    The ankle support I was given was the achillotrain - a support made by a German company but it seems this would be more for the last stages post rehabilitation. I also don’t suppose you would know if it’s normal not to have any rehab at all? I’m still pretty shocked that I was sent home with the advise to learn to walk by myself again……

  267. At 2 weeks most protocols would have you coming out of the cast and into a boot - one with a variable, fixable range of movement which can gradually increase over the next 6 weeks or so.

    You would be beginning very light easy movements around the ankle, with informed advice from a physiotherapist or ortho specialist. I know that I was told not to flex upwards at that stage although I did cheat a little because there was a small degree of space in the boot liner which meant that I could flex a safe amount but while protected by the boot - I couldn’t go too far, just a degree or two (it was still plantar flexion, PF) and rerupture as you appear to be risking. With the correct boot, you’ll begin weight bearing and not have crutches or a knee trolley etc for very long.

    Even by the 10 week stage it will still be wise to have the boot around for more difficult terrain. If you’ve had a good rehab to date by then, chances are you’ll manage without the boot again - but that is if you’ve had quality care and a well structured rehab protocol. Don’t underestimate the risk of rerupture - read the posts from the past few months (do a search). By the time you’ve read the many posts, you’ll be demanding that the specialists give you the optimum treatment - starting tomorrow?

    Good luck Melissa.

  268. Hi Hillie,

    Thanks for the response. As feared and expected because I didn’t have any protection on the until Monday, I had a fall when my crutches slipped on Sunday night. The pain was incredible as I put full weight onto the foot twice. After a stint in A&E was advised that I thankfully hadn’t done any further damage.

    Was so annoyed by the whole process and the amount of pain I was in that I took on two doctors at A&E, the registrar eventually conceeded and wrote a prescription for a walking boot. That was ordered yesterday and they say will take 2/3 days to arrive. Being super cautious now with the foot - they gave me a tubigrip to “support the ankle”.

    Pretty exhausted at the moment, the injury was enough without feeling consistently fobbed off because “we don’t do it that way in this country”. I miss the NHS! I was told also that they do sugery so the tendon is strong enough to full weight bear at this stage (cast post op was removed afer 10days on Thurs) so I should just get walking.

    Anyway, as it stands, I hope the boot will be here soon so I can finally stand and there is marginal follow up treatment in the form of the doctor who will review in 3 weeks time once the boot has been fitted.

    Did you also suffer a full rupture and go the surgical route?

  269. Melissa:

    > they do sugery so the tendon is strong enough to full weight bear at this stage

    The surgery stitches the tendon together, holding it in place to facilitate healing. These stitches are nowhere near as strong as the healed tendon. The stitches can easily tear out. Re-ruptures, after surgery do happen: it’s not terribly common, but you are at much much higher risk during this period. If there are no major setbacks, your tendon should take 12-16 weeks to heal. Up until that point, you need to be very cautious and careful with it.

    I pushed a VERY accelerated recovery schedule - lot’s of people might say too fast - but I was not walking in shoes until almost 6 weeks. Until that point, I had the protection of a cast (1 week), splint (1.5 weeks), or boot (3 weeks).

    Commonly on this blog, you’ll find us advocating a modern (faster) schedule. Some doctors like to cast for up to 12 weeks; faster protocols seem to be better in almost every way. I often recommend patients become their own advocate, taking charge of their own recovery. In your case, I’m going to do the same, but for the opposite reason. You need to take charge here so as to not go too fast :-). Learn more about some of the protocols/studies, pick one you like/trust, and follow it… even if your doctors think it might be too slow. For what it’s worth, I essentially tried to follow an accelerated version of this one:

    achillesblog.com/files/2008/03/achilles_tendon_repair_rehab.pdf

  270. Hi Melissa

    Yes, I suffered a full rupture but was fortunate enough to be seen at a top NHS orthopaedic centre. The consultant briefly considered surgery but decided to try the non-op route first - the rehab was identical (sorry I can’t post it here) and I had the benefit of no post-surgery issues, an accelerated protocol, the best boot on the market (yes, on the NHS), great physiotherapy (part NHS, part private sports physio) all resulting in a good strong repair.

    The atr was 10 months ago and I’m now hillwalking (mountains when the weather improves) - I’ve had a swollen AT leg, a very sore ‘good’ leg (caused by an imbalance in height of hip - important to get level, check in the mirror).

    I stopped the crutches at 3-4 weeks, was full weight bearing, increased ROM progressively as I said in previous post, and was in 2 shoes after week 8. As you’ve read elsewhere, you have to be very careful for at least 16 weeks - my protocol told me what I could and couldn’t do e.g. nothing ‘explosive’ until 6 months.

    The boot will be great for you, hopefully it will be one of the newer types.

    How did your injury happen and why surgery for you (in many cases it is essential of course, but sometimes when I read this blog I wonder if it is chosen as the default option)?

  271. Melissa - I am a bit shocked at how poorly you have been treated and concur with Ryan that you should start being your own advocate. Leaving your tendon unprotected and not in position for so long is very dangerous. They could have put a front slab cast on your foot and bandaged it up. I feared you may have a slip but am glad to hear your are OK. Your foot needs to be secured in a plantar flexion position (pointing down) at the moment to take pressure off the healing tendon and you should avoid any dorsi flexion (pointing up). After 3 weeks, your tendon has enough collagen around the injury site to support some gentle movement but it should only be with your own muscles and nothing artificial. Write the ABC’s with your foot. Ryan is usally here for good advice as are many others. I am not here as often anymore. If you go to my page I have some links to further reading. Some are a bit technical but you should understand how tendons heal. Ignorance and complacancy with this injury can lead to a bad result or a re-rupture. It is a long process and very different to other soft tissue and bone recovery. There is also some information about early weight bearing and movement studies and rehab protocols. I hope the boot fitting goes well and start preparing a list of questions for your doctor. I would want to know how their surgery is so different to the rest of the world. It could be more advanced. I also read of a technique used in Japan that had people back in shoes in a couple of weeks but couldn’t find a great deal of depth to the information and not sure how I came by it. Norm (Normofthenorth) may recall it better. Make sure you tell your doctor about the slip and confirm there has been no further damage. Look into setting up your own page going so we can better keep track of your progress.

  272. Hi All

    Thanks so much for the responses. I asked about the surgery when I went and it was definitely the standard surgery with vertical incision and pulling the tendon down for reattachment with nothing artificial being used.

    I read so many blogs on here that I know there is a chance of rerupture, hence being so adamant that the way in which the Dutch system wants to treat the injury is not the way in which I want to progress.

    I have ordered my own aircast boot with the achilles wedges and my aim will be initially to start with partial weight bearing. I saw the type of boot that was ordered and it looks like a bit of a relic so am once again going to take matters into my own hands.

    I’m prepared to take the recovery period much slower than what has been suggested by the medical professionals over here to ensure primarily that I don’t have a rerupture.

    Ryan - thanks very much for the guide, I shall follow that as long as the feeling is ok. It’s actually very similar to a guide I have already and intended to follow.

    Xplora - I went into A&E immediately after the fall and they just glanced at it and continued to talk about how the achillotrain was the best method for dealing with the walking issue. Very frustrating. I know I haven’t reruptured and the pain has gone down considerably now although the ankle seems a bit floppier than it was.

    Hillie - I suffered the injury whilst doing a forward motion on a badminton court. I’ve played competively for years and the tendon was probably worn anyway. No symptoms of anything though, just that dreaded snap. They didn’t really discuss the non-surgical route with me (although from my research I wouldn’t have opted for this method for myself). I was simply told if I want to get back on court quicker then surgery is the way to go, although I was told the outcome would be the same it was just a matter of difference in timing. Had the surgery the day after I was injured.

    Thanks again for your feedback all. It’s difficult when medical professionals are giving advice you know can’t be right (moreover doesn’t physically feel right when you attempt it) and this blog has turned out to be an absolute godsend!

  273. Melissa, well done in taking the initiative and a good deal of control. So many with an ATR have accepted it as a pretty raw deal that they must endure - wrong of course, although injuries vary quite widely.

    Because I’m so active too, and I was 10 days post-injury when I saw my specialist, I almost did have the surgery. As a borderline case however, we agreed on non-op, following an accelerated aggressive protocol on the same timeline as for a surgical case.

    At about 16 weeks (after regular visits to the NHS physios) I went to a sports injuries clinic for the same rehab routines as surgical cases, many of which were runners and rugby players. This guy really tested, over 8 sessions, the quality of my repair and gave me home exercises to continue with. My pastimes include hill and mountain walking (the Alps, Pyrenees, Scottish Highlands) and badminton so I was after something totally (?) reliable.

    Good luck with the boot.

  274. Melissa - I say well done also. Feel along the tendon injury site to check for any gap or dip. The fall may not have caused a re-rupture but it could have pulled the sutures apart a bit. Still worth having it checked by a good doc. This blog is truly fantastic but be guided by your own body when taking advice. We are not doctors but collectively we have a great deal of experience. My name is Stuart. Hope it goes well from now.

  275. Hi 53 year old male right atr on new years day [heard the pop felt the pain] wife took me to a&e where i was told that i had a partial tear,put in a temp cast then waited 6 days to see a consultant he ordered a cast from the knee with toe pointed down and it has been that way since cant put weight on it and told could be in cast for up to 12 weeks this seems far to long from what i have read .My question is has anyone else been in a cast 12 weeks. cheers

  276. Steve e: please fight for a more modern (faster) protocol with better demonstrated results than the old-and-slow path you’re on! I recommend bit.ly/UWOProtocol — the protocol followed in the 2010 study from U. of W. Ontario that’s available in full-text on this site. ATR patients in your dad and granddad’s generation got casted for 12 weeks, and as recently as a 2005 meta-study, they experienced a re-rupture rate in the 15%-20% range. The UWO study’s non-op patients had a 3% re-rupture rate, and also returned to normal life WAY faster.

    It’s not safe to try to “jump” from a slow schedule to a fast one, but I recommend “tapering” or gradually catching up. On the UWO timetable, you would have been out of the boot (not casts) and into 2 shoes ~4 weeks ago. But even going to 2 shoes now when you’re still NWB would be unsafe and leave you prone to a rerupture. If I were you I’d fight for a boot (preferably hinge-able) and some (initially gentle) PT and exercise, while you transition toward normal.

  277. Sorry, steve e, when I said you’d be in 2 shoes ~4 weeks ago I was thinking you’d already been in the casts for 12 weeks, but I see now that’s the plan, not your history (yet). In the UWO schedule, the patients starts moving from the boot to 2 shoes at 8 weeks into treatment, after 4 weeks FWB in the boot. Check it out, and “hit” your doctors with it!

  278. Hi thanks for the fast reply i will have been in a cast 8 weeks this wednesday 27/2/13 i have spoken to the consultants secetary and she told me that the consultant is out of the country and his colleage is on a months paternity leave, i told her this was unsatisfactory she told me to ring her again this week to prompt her to get me seen asap i am also seeing my gp to complain tommorrow and i will use the references you have provided
    Thank you very much

  279. Good luck Steve E - even the protocols used Belfast study (which is the one my NHS followed) was in a boot by week6 - so unless you’re a particularly complicated case I hope you are able to make some progress in the shortest possible time.

  280. Hi as an update, through complaining had my cast removed yesterday 7/3/13 after nine weeks saw a different consultant and went armed with copies of studies recomending early moblization,he agreed that 9 weeks was long enough [previously it was going to be 12 weeks]he examined me when plaster was off wouldnt give me a boot but told me slowly generate some movement he also has made arrangements for me to have physio and another scan this he said was because he wanted to confirm complete healing.He repeatedly told me to go slowly he did seem irritated in a good natured way when i produced the printed studies and told my wife to keep me away from the internet [nhs got to love em] he said my aim should be to slowly free my ankle so my foot is 90 degree to shin this is very difficult, then to weight bear and to consider my leg as a third crutch. Sorry for the long post but what do you think,i wish i knew about this site earlier and complaining does work.

  281. Hi Steve

    From what you have described you appear to have been treated with a great deal of ignorance (I was always one for understatement). 9 weeks in plaster and then only after pressure from yourself - shocking!

    Worldwide it seems to be the same, not just our NHS. From operate in what seems to be 100% of admissions, to slap it in plaster and leave it for 12 weeks, treatments and protocols vary massively - even in the same hospital as Norm described a few days ago.

    I’m not even going to venture into the different rehab protocols as you’ve been supplied with masses of info in the previous posts. At this late stage I would still seek a referral to a true specialist - ask your GP for advice. Then phone them, ask questions. You are are at an absolutely critical stage now and if you’re not very careful, those odds of a re-rupture are going to increase massively, and you really don’t want that do you?

    What part of the country are you in? There are some great ortho centres all over the UK, and do seek advice too from physios direct, many of them appear to be truly well informed and practical. My NHS treatment was first class and I only saw the specialist once, when diagnosed. It was then down to the physiotherapists, with a boot after 2 weeks and into 2 shoes at week 8 or 9. No crutches after week 3 or 4. No need for more scans. Exercises from week 3. After 53 weeks my tendon is healed (touch wood) and strong, and I have returned to strenuous hill walking and looking forward to the mountains.

    Steve, you owe it to yourself to make this better - and you can’t put it off…

  282. Hi Hillie thanks for the advice and the encouragement i live in Birmingham west midlands and have been treated at Solihull hospital the fracture unit.I have used private physio before and intend to again, i am fortunate in that i am being paid and work continues to be supportive .Again thank you all for the encouragement and will keep you informed.

  283. Hi all
    I’m trying to figure out how to start a blog post on achillesblog.com but not doing very well - advice welcomed. I’m in the UK - Bromley, South East London, aged 47 and female.

    I ruptured my achilles 9 days ago, on October 6th, 2014, playing badminton. Initially went home (not much pain) and then to minor injuries unit, where I was X-rayed and nurse practitioner told me she thought AT was ruptured. I then went to bigger A&E (Princess Royal University Hospital, Bromley) where I eventually saw an ortho who put the leg in a cast in equinus position and made an appointment for me for a week later in fracture clinic.

    I went there on Monday armed with stuff from PubMed (I am a medical journalist anyway so wasted no time in looking everything up).
    I saw a surgeon who said he wouldn’t have surgery if it were him, and was put straight into an air boot with 3 wedges. This is much preferable to the plaster but I am a bit concerned as was not given any advice really as to how much weight to put on the foot, whether to still use a crutch/crutches, whether to still primarily rest the leg etc etc - am using my common sense at the moment, putting some weight on it and using 1 crutch on the side of the rupture.
    I am also taking Clexane for DVT - this was started after ortho gave it to me in A&E (probably because I told her I had to use it during a pregnancy). I haven’t needed any pain medication at all.
    I’m trying to get advice from the local NHS physio clinic (who of course won’t talk to me because I haven’t been referred there yet!), but in the meantime will look up recovery protocols online.
    If anyone can let me know which are the best ones, or if there are any AT specialist clinics near me (south east London) that would be great, as will save me having to scroll through lots of posts.
    I have another appointment in a week to see the head honcho orthopedic surgeon in the hospital- I also insisted on having an ultrasound, which hopefully will be done in the next week before I see him!
    Any advice/comments/ gratefully accepted.

  284. Hi Daz,

    45 years old, very fit and active, tennis, cycling and jogging. Played tennis for 2 hours followed by footy kick around and achilles popped as I changed direction.
    Straight to A & E where surgeon advised me to have conservative treatment. He told me the risk of re-rupture post op about 2% and greater risk of complications like infection and for non-op about 4% re-rupture rate. Recovery rate was about the same. It seemed a no brainer to me to go non-op route. Now just a little concerned about the end point quality of the repair from what I have read.
    In a cast for 3 weeks, then boot for 7 weeks. Now into week 14 and concenred about the lack of physio I have been given. So much so that today I rang the hospital and asked to speak to a consultant. (Waiting on a call back) I am under a trainee NHS physio who has told me I can start jogging. I am skeptical about whether I am ready to go jogging as I feel my calves need more development first. On the whole, quite pleased so far just feel i should be doing more physio at this stage.

  285. Phil - you would be right not to start jogging just yet. Not many do and although you are past the 12 week critical phase (where re-rupture is mor likely) the risk slides from there and does not go away completely. Jogging puts a huge amount of stress on the tendon. I was not comfortable jogging until 19 weeks. I tried a few steps around 14 weeks and it hurt. There will be no problem in the long term with your strength. Surgery does not actually make the healing stronger. Your body does the healing and all the surgeon does is stitch it together until the body has done its job. I feel surgery may be necessary for those who cannot align the tendon with the foot pointed down. Sometimes the muscle retracts like a roller blind and may be necessary to open up to pull it down. Other than that the non surgical approach with the more aggressive protocols do just as well. Have a look at CeciIia’s page from some of these. I would also be concerned about the lack of physio and you are doing the right thing to follow it up. I know the NHS is free and sometimes you get a good doc or physio. Other times you get someone who can’t make it in the real world or a trainee. Hospitals in Oz have physio but most people go to the private ones and leave the hospitals to those who cannot afford it or do not have private health insurance. We have plenty of them so wait times are huge anyway.

  286. I ruptured my Achilles tendon on 29th December 2014 playing 5 aside football (soccer). I went to see my doctor the day after who sent me to the local hospital. The consultant confirmed that it was a full rupture. I was offered two options (operation or natural recovery). Due to my age (40) I opted to let it heel naturally. I am now wearing a below the knee cast and have to return to the hospital on 1th January 2015 (just over 2 weeks from the accident). I am really worried about some of the things I have read on the internet and I am worried about a re-rupture in years to come. I just want to be able to walk again.

  287. First thing you need to do is to get away from the feelings of doom and gloom! It is a lousy injury but not life threatening or permanently disabling. And the really good news is that for most of us the latest non-op protocols work at least as well as with surgery but without the additional trauma from the op. Go to the main achillesblog web pages and you’ll find masses of good positive information. Look up achillesblog.com/ suddsy/2013/06/24/end-of-wk-2-wow-progress for some very informative information.

    As for walking, make sure you get a boot, preferably hinged type, and you’ll be walking by week 3, hopefully ditching crutches most of the time by week 4 or 5. Back into 2 shoes by week 8 or 9, some have done it earlier but make sure your recovery is sustainable.

    The hard work is the physiotherapy which you should start in a couple of weeks, low key to start with and progressing fairly quickly over the next 2 - 6 months. Full recovery (for sports at least) can be up to 12 months.

    Much of the next few months is down to you and the quality of your care. Don’t accept second best and don’t believe most of the negative stuff you’ll read elsewhere on the net -most of it is old info or by unfortunate types who’ve taken bad or or outdated advice.

    Achillesblog posters will keep you motivated (won’t you all?) and you’ll be wondering what the fuss was all about.

    Where are you by the way? And start your own sub-blog here - see achillesblog home page.

  288. +1 to what Hillie said! (We’ve missed you, Hillie!)

    Stdennis, you can find 3 of the best non-op protocols at AchillesBlog.com/Cecilia/protocols. Don’t let anybody send you down a slower road non-op, because the results (rerupture risks) get WORSE as you go slower! Not to mention the nuisance of being handicapped longer!

  289. I suffered ATR on 13th January whilst kickboxing. I heard a loud pop and felt a kick to the back of my leg but when I looked up my opponent was nowhere near me. I am the 4th person the gym owner has seen this happen to so I knew pretty early on it was likely to be an ATR.

    I got taken straight to A&E where I was correctly diagnosed, put in cast and given an appointment at a fracture clinic in 2 days time.

    At the fracture clinic the cast was removed and a squeeze (Thompson?) test was carried out which resulted in me passing out. I was then sent for ultrasound where they found a gap of 8 - 10mm was between each end of my now useless tendon.

    The doctor gave me option of opting for either a surgical or conservative approach but when I asked him about the pros and cons of each he started off by telling me that surgery is “pretty brutal” and then failed to give me a well balanced argument for either option. He did throw in the fact that surgery was only really beneficial for people who had a gap of over 20mm between the ruptured ends of the tendon but I haven’t found any information to back this up.

    After being suitably scared by the words “pretty brutal” I opted for conservative treatment, was put into a plaster and sent on my way.

    All in all, I was in the hospital for a little over 5 hours. 4 hours of that time was spent waiting for doctors, ultrasound and cast removal / fitting!

    It wasn’t until I got home that I started to question what I had been told by the doctor and started my own research into ATR and the merits of surgery and conservative treatments. Although there seems to be no real consensus on the best form a treatment I did note that surgical repairs offered a lower re-rupture rate than non-surgical - 4% for surgical and 12% for conservative.

    The ATR has been disastrous for me as I work on an oil rig in the North Sea and won’t be able to return to work of any kind until I am completely healed so the re-rupture rate information led me to contact a foot and ankle specialist at a private hospital and an appointment was made for Tuesday 20th January.

    Prior to the appointment I emailed the specialist with details of my working life, activity levels and that I hoped to return to pre-injury levels of fitness. With this information the specialist made his recommendation and I was booked in for surgery the following day.

    My recovery was planned to be as follows:

    2 weeks post surgery - Remove cast, check wound and re-cast
    3 weeks post surgery - Remove cast. Position foot to half eqiunus position
    6 weeks post surgery - Remove cast, fit Aircast boot and begin physio

    Not much to be said about the surgery. I went to sleep on my front with my leg in a cast and woke up about 1.5 hours later sat up in a bed with a new cast on my leg and feeling suitable confused.

    The specialist stopped by to tell me that the surgery went well and then I was wheeled back to my room where I was given a cup of tea, a sandwich and told that I wasn’t to get up for any reason.

    A “block” had been put in my leg so I had zero pain and had no feeling on the underside of my toes.

    The next morning I was sent home with some paracetamol and ibuprofen for the pain that would be coming once the block wore off.

    Later in the day the block had clearly finished doing it’s thing and my heel became pretty uncomfortable. Strangely it wasn’t the tendon or the operation site that was sore so I put it down to the fact that my heel was swelling and I assumed I must have crushed the heel of the cast a little whilst it was still wet.

    The next morning my heel was still feeling uncomfortable so I contacted my GP and was prescribed codeine.

    The codeine sorted the pain and also helped me remain stationary with my leg elevated as I couldn’t really be bothered to do anything. Result.

    After 4 days of sitting on the sofa I was beginning to make a pretty good imprint of my ass on the cushion but I was now able to get back onto my crutches and try to get on with life again although I did elevate my leg whenever I was sat down (which was still more that I would have liked).

    Getting off the sofa coincided with me stopping the codeine and I went back to paracetamol and ibuprofen for the next 3 days. After this I stopped pain relief all together and have had zero pain. All in all, the surgery wasn’t anywhere close to “brutal”.

    2 weeks after surgery - I had my cast removed and my wound was checked to make sure it was healing ok. No signs of infection so into another cast I went.

    3 weeks after surgery - My cast was removed and the specialist began to try and maneuver my foot back towards a more neutral position.. The feeling was really really strange and is hard to describe. Tight is an understatement!

    Very disappointingly, the specialist only managed to move my foot a little bit before deciding that it should be left another week before trying to go any further. I reckon it’s only moved maybe an inch or so.

    I’m gutted as it feels as though I’ve fallen at the first hurdle. It’s clear the emotional side of things is going to be as tough as the physical side.

  290. Normally I think you’d see a boot at about 2 weeks at 30 degrees plantar flexion then gradually “up” to zero “neutral”

    I would ask about getting into a boot like the Vacocast Pro Achilles so you can start at 30 degrees then gradually work to zero, even that little bit of progress (10 degrees at a time) is psychologically (and physically) beneficial

    Good luck!

  291. Looking on here it does seem as though a total of 6 weeks in a cast is excessive.

    An Aircast boot has been ordered by the hospital so I think I’ll have a discussion about the boot at my next appointment with the specialist.

  292. This page has been very enlightening to say the least! Great to hear everyone’s stories.

    I’m five weeks into ATR, didn’t get an ultrasound or MRI but it was fairly obvious what happened (pop sound, bang against leg and back of ankle went soft) consultant said as gap wasn’t too large non-surgical was fine, but like most people he seemed quite unmoved to guide me either way.

    Just had my second cast put in, they managed to raise the foot a bit after five weeks but not enough so I’m going back in another two weeks.

    Having read this thread, I’m currently looking at Vacopeds on eBay and thinking of printing out the protocol for two weeks’ time. Is that a good idea?

    I’m also wondering if anyone started physio before the cast was off? I’m seeing muscle wastage on my thigh so have been doing simple leg rotations and raises.

  293. Isabelle…In my opinion I encourage anyone to be out of the cast at 2 - 3 weeks and into a boot with PWB as tolerated moving to FWB when ready because that is what research shows is most conducive to good healing results. With that said, yes get into a boot and move into some more aggressive protocols when you get this cast off at 7 weeks.

    Yes you can do leg raises, there are many ways to do them so you can isolate and work the hips, quads, and hamstrings.

    Best of luck to you.

  294. It’s 2 years today since I suffered full ATR playing tennis at the gym. All the usual loud pop, we all heard it, I hit the deck in panic as I knew what had happened but oddly no pain, but also no sign of tendon in heel. Attended A&E and ATR was diagnosed, straight into boot, no offer of surgery or scan. 16 Weeks later and into physio when walking across room at home it went again, I can’t tell you how I swore. Back to A&E no scan and would not offer surgery, proposed I went back into boot, but unclear if full or partial rupture as I had good strength so thought to be partial.

    I was unhappy and had private cover available so saw consultant via BUPA scans identified full ATR and surgery recommended. Had repair on 10 September 13. Again progressing well out of cast and air cast boot in walking boots only outside bare feet carefully inside when at 13 weeks stood from floor and felt it sting, back to scan and consultant, stitch had popped in middle of tendon. As a significant tear but not full rupture returned to plaster and boot for third time around.

    I can’t tell you how hard this has been mentally and physically, with house move, young children and a new job. During all of this I have only taken 10 days off sick.

    Finally out of air cast boot March 2014, and allowed to drive for the first time in 10 months and into physio. But today all this time later still unable to do heel raise or strike off properly when walking. Bit the bullet and returned to consultant last week to discuss, scan identifies outside of tendon intact but 5cm vertical split inside and tendon has lengthened, only solution to this more surgery, FHL transfer, I am likely to delay this until after my holiday in July.

    Looking for people who may understand how difficult this is for me and can offer support and insight into their experience of FHL surgery.

    Thanks Cadders

  295. On the 18th of June, whilst sprinting, I felt a snapping noise in my lower left leg which caused me to fall to the ground. After 24 hours of trying to convince myself that it was a calf tear, I finally went to A&E and had it confirmed by Ultrasound that I had fully ruptured my left Achilles’ tendon! Not really the news you want to hear!!

    With my foot pointing down the tear was 1cm which is apparently quite typical for this injury. I was recommended surgery and had the operation on the 23rd of June. The speed of the surgery was very impressive - I was getting prepped for the operation at 10am and it was all completed just after 11am!

    I had the percutaneous procedure which involves making 3 incisions along the Achilles, stitching the broken Achilles at the top and bottom incision and then pulling the two ends of the Achilles together at the centre incision. As this was all done under local anaesthetic so I was out of hospital before lunch time! The pain has been very low since the operation so have not had to take any pain relief (yet!!).

    I now have two weeks in a plaster cast and then move into a boot.

  296. Hi all, I am now on day 16 after a full rupture to left AT. In air boot and have been since visiting A&E on day of injury - playing netball. Lots of pain at first, but after a couple of days I was managing really well with no pain relief. However saw the dr at FC last Friday, did Thomson test, and since then I am in much worse pain, unable to cope without ibuprofen, will be in tears every morning when the pain is at its worst. The pain is centred around my calf muscle and my left leg is so swollen from foot to nearly knee, despite elevating the limb as much as possible. Has anyone else experienced this? Is it possible that the dr has damaged my calf muscle? So frustrating and painful, any advice appreciated :)

  297. Hi Lucy.

    Unlikely that the doctor made it worse but can’t tell from here. You need to see a medic soon. Probably nothing too serious but worse case scenario can include a DVT, and that would need fixing now, sooner if possible!

  298. Hi All,

    Ruptured my AT 3 days ago playing football and felt like someone was playing dirty by kicking me so I was ready to scream at Someone then realised no one was near me and I wasn’t able to stand. Anyway I got to A&E and was put in a cast with an appointment to see the fractur clinic 2 days later and when I arrived I was put in an air cast which feels so much better.

    That said I still get pain my my lower calf (guessing this is where the rupture happened) so it hurts when I am trying to move around on my crutches and really struggling at the moment and just hoping the pain my in calf goes so I can just get on with my recovered. I don’t take painkillers in general and the pain is only there when I get up without any weight bare. Anyone else experienced this?

    First time injury for me so a big learning curve for me !

  299. Hello all

    Ruptured my tendon on Sunday 4th October, was put in a cast for a few days then got upgraded to a fibre glass cast. Due to have a scan tomorrow and then see the doctor on Friday.

    No one has mentioned surgery to me so Im guessing that they are waiting to see the scan (2 1/2 weeks after rupture). Really do not want surgery and hoping that I will go into the boot. One question - does surgery depend on how bad the rupture is? I can move/wiggle my toes and have a bit of movement in my ankle with cast on, is this a good sign or just irrelevant?

    Any help or advice would be very much appreciated…..

  300. Blimey this is common! I did my ATR 48 hours ago playing squash. A consultant did the Thompson test to confirm the rupture but didn’t make it clear whether it was a full rupture. He phoned me yesterday morning to advise I was booked in for a surgical repair this morning and not to eat after midnight etc. I then had a call to advise more urgent cases had come in and I would have only a slim chance of being fitted in pm but would get a call by 11 this morning to confirm. The call came but it was from a secretary to say a different consultant wanted to see me on Monday pm to discuss the options and was unaware I was waiting to hear if I was being done today. I said I was confused, I assumed that as I was booked in for today the option to do a surgical repair had already been taken? Shewas embarrassed and didn’t know so got the consultant to call me back. He was very apologetic and said I should never have been told I was going to be done today, they haven’t even done a pre-op on me and he needs to explain the options to me because there were risks associated with either option which I need to consider before choosing. I do have the option of going privately through work scheme but there is an excess of £200 in each group year so would probably be £400. He also said he has a place reserved for me next Wednesday if I elect for surgery. I have decided to go with that for now but I suspect that will get postponed as well in which case I will probably just go and book it privately. In the meantime I will read through this monster thread to try and ensure I ask the right questions on Monday! Just thought I’d share my experience so far. I’m 53 by the way but very active and pretty fit and want to return to my activities even if I do stop the higher risk sports like squash. Cycling is the least I would want to get back to.

  301. Chris - if your tendon ends touch (approximate) when your foot is pointed down (plantarflexed) then a non-op method using one of the latest protocols will produce a result as good as surgery without the complications. Since it appears you are in England your consultant may be familar with the Exeter hospital study and also Richard Wallace from Ireland. You can use the search box to do a specific search on this site or do a google search. The NHS is not always that quick to offer surgery. Look at both options but if the doc wants to go non surgical and lock you up in a cast NWB for 12 weeks then think again. That will not do you well. Early weight bearing and movement protocols are best for both treatments but more important for non surgical.

  302. Hi Stuart. Thank you for that excellent bit of advice, it’s exactly the kind of information I want to go in with on Monday. Do you mind if I ask if you are speaking from experience of having had ATR yourself or are you a medical expert?

  303. Chris - I had a surgical repair a good number of years ago and was told never told this information in hospital so I had to make my mind up without the benefit of research. I have done considerable research since and understand a great deal more now. I don’t say everyone should be non-surgical but I do know it can be done as good from the evidence of people here. It is better people have all the evidence so they can make an informed choice on the way forward for their own body. In that there is no judgement and only support from those here. I have studied anatomy and physiology and have a science degree but I am not medically trained.

  304. @Chris - Stuart is right, there are lots of studies that show relatively insignificant differences for recovery between having surgery or going the conservative (non-surgical) route. The key thing for not having surgery is to do functional rehabilitation early to promote healing. I chose the conservative route, but it may not be for everybody. I asked my surgeon things like, where the wound is located and is surgery recommended because of the location, or is surgery even possible, and age and recovery factors. The surgical route lets you get back on your feet a little sooner, but to get back to full motion, the time is about the same. As I always say, sorry that you’ve joined the club, but you’ll see that people here are wonderful and extremely supportive. It helps. We’ve all got a lot of work to do and it’s a long journey ahead; let’s keep our chins up and get through this together!

  305. Thanks guys. I had been under the impression that if I want the best chance to remain active after recovery I was better having surgery but I will now go into my meeting tomorrow with my mind open. If the only non surgicaloption they offer me is NWB I will more than likely choose the surgical option but am now much more receptive to the functional rehab route.
    Would the likely positive result of surgery have been compromised by the delay of what would be at least a week? I’ve read that surgery is best done within 48 hours?

  306. Chris - I would hope you have your foot pointed down now in some kind of restraint but if not do not be concerned. This would be more helpful if you decide not to have surgery. Surgery does not have to be done that soon either. Some doctors prefer to let if go a bit longer as the injury gets over the initial trauma. You are still within a good time frame. If you go for the surgery ask if your scar will be straight up the back of the tendon or on the side. Mine is on the side and it is much more comfortable as it does not rub on the back of shoes. This has been a problem for some.

  307. Thanks Stuart. I’m currently in a half cast (didn’t think I’d ever hear that term again!) with my foor in a “relaxed” position with toes slighty down. The trauma area, just below the calf muscle is starting to get incredibly itchy, not sure if that’s the healing process starting. That’s another great tip about the scar, I will add that to my list of questions! I can’t wait to see the consultant now, I’m also booked for a pre-op in preparation for Wednesday if I choose to go under the knife although I suspect it will get postponed again. That’s the trouble with this kind of injury, it’s never going to be life threatening like hip fractures etc and I live in an area with an aging population.

  308. I thought I’d just update my post above, went for my appointment on Monday and had a long chat with the consultant. He examined my leg and was surprised that the rupture was higher than he had been led to believe, much closer to the calf muscle. He said this made surgery much more difficult, described it like trying to sew cooked spaghetti. He said that I would probably best advised to follow accelerated rehab but I have to go back today for an ultrasound to confirm exactly what damage has occurred and to rule out surgery. I’m currently in my wedged boot which is great in that I can take it off and have a bath(bliss) but is very difficult to sleep in. I will update further after the result of the ultrasound which I won’t know until next week. Happy Christmas all!

  309. Ok, had the ultrasound which confirmed a complete rupture and not partial. It was very close to the calf muscle as the consultant had said previously but also showed a gap of 2.2 cms between the two “ends”. I was concerned about how this gap would close but the consultant seems confident that in the “toe down” position the gap will close and healing will take place with no issue. He stills feels that surgery is not required and is indeed not recommended so close to the calf. I now only have a fortnightly appointment with the hospital to gradually reduce the wedges and I don’t need to see the consultant for 8 weeks. If anyone has any knowledge or experience of gaps and subsequesnt healing it would be much appreciated.

  310. Chris - all you have been told is correct. The gap is good and surgery is not really possible when the rupture is close to the muscle. Tendons change structure at either end. A bit like muscle near the muscle and a bit like bone on the other end. You may get a better blood supply near the muscle which will aid healing. Early weight bearing and movement protocols are best for you. Hope your consultant is following one of these. Some good research has come out of Exeter but with the NHS there is no standard treatment.

  311. Thanks Stuart, very reassuring. I’ve been told NWB for 2 more weeks and then start to walk with the aid of the boot and crutches, gradually increasing and lose a wedge every 2 weeks. That seems to match the suggested treatment from the Exeter study and Richard Wallace. My leg definitely “feels” like it’s improving but that’s probably just the original trauma settling down. The boot is an instrument of torture though, really hard to keep on and to sleep in it is horrendous! I think I am getting used to it though, had my best night so far last night!

  312. Chris, if you are propping up the boot when you sleep (in order to keep the leg elevated), then try to have leg weight distributed throughout the heel to the calf. In other words you don’t want to have the weight of the leg and boot resting upon your heel. If you do you may get a pressure blister which is hard to get rid of and will hinder mobility. I found this out the hard way and have a small pressure blister at my heel. Now when I try to walk the blister hurts.

  313. Hi Andyw. I don’t have it elevated to be honest, he didn’t tell me I should. I just tend to lie on my side or stomach and hang it slightly over the end or side of the bed. I’m back at work now as well, I can turn it into a just a desk bound job so not too much of an issue and allows time to pass a bit quicker! Thanks for the heel tip though, I will make sure I don’t allow it to get sore.

  314. Really useful to read through these and get some sense of what’s going on and the things to consider.

    A&E didn’t put mine in a cast straight away, instead referring me to fracture clinic two days later. Crutches were given but I hope that delay doesn’t affect the healing process.

    Current plan is the conservative treatment in an equinus cast with a follow up after 2 weeks. I just want to do whatever will make it heal properly with no long term effects.

  315. Welcome Phil, to our community, recognizing that none of us really wanted to have the achilles tendon or heel spur issues. :-)

    I had a two day delay before being put in the equinus cast, so I don’t think you’ll have any problem with the recovery. Hope they put you in a CAM boot soon, though.
    Good luck!…………… Manny

  316. hi folks,

    hello from Scotland. just thanking you for an amazing effort that has allowed me to stay as calm as possible.

    i had my tendon rupture on Thursday 28th of Jan, so i’m one week and a day in. A&E and the specialised fracture clinic in Glasgow wouldn’t scan, i had three separate physical examinations and they all concluded the same: full rupture, got a hard, heavy cast (looked like a butcher did the job) and was sent awa.

    i managed to convince them of the seriousness and they ‘fast tracked me’ to an orthopaedic specialist on tuesday 2th of February (three days ago). such ’specialist’ examined me and concluded the same and sent me off in a lightweight cast.

    i had to argue with him for about 20 minutes, and finally won, so i’m scheduled for next tuesday 9th with the ankle specialist and the fracture clinic. I am hoping he will definitely do at least an ultrasound to check whether a non-op will be ok.

    question, what are your experiences of getting the vacoped boot on the NHS?

    this article helped me a lot

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436906/#!po=26.4706

    thanks in advance.

  317. good to read these blogs going back so long
    now into my 10th week with ATR
    5 weeks in a cast 5th week in a boot
    wasn t given surgery option because of my advanced age and not a complete rupture (age not too advanced other than to NHS
    I m now in my 2nd week of easy exercise physio and hopefully get my last wedge removed next week
    weather improving and longer days definitely improving my mentality which I msure all will agree sometimes gets low
    good tip for boot wearers get an Evenup available on line improves your backache no end
    good luck everyone

  318. Hi. Popped my AT playing football.
    Had a slad cast for 10 days with foot elevated for same time.
    I got a boot on day 10 as part of a study (NHS lothian) and told I could weight bear right away.
    Reading other posts this seems really early, is this wise?
    A wedge removed in 3 wks then boot removed 4 weeks after.

  319. Hi Everyone, I’m Tony from Farnham, 8 weeks ago i had a full Achilles rupture in my right leg playing tennis. I started at the NHS then into private care (same people) Due to being a business owner and father, i needed to be driving again as soon as possible and get some sort of normal life back. With some own personal research, diet and outside help, i was healed enough for my consultant to let me begin driving again after 6 WEEKS. I’m doing well and getting my walk back. Happy to share my experience and discoveries if anyone is interested….Tony

  320. hi Tony

    ‘good’ to hear we have another member, of course not but not that you joined the club it’s nice to see you’ve found us. this website kept me sane.

    you’ve done some amazing recovery there! are you out of the boot or still managing with it?

    keep the great work going and let us know of your further progress

    suerte

  321. Hi,

    I had the pleasure of an ATR 11 days ago. I’ve been reading blogs and watching YouTube blogs with Brady Brown and Evan Brown, both who went non surgical as I have chosen.

    Bad timing for me as I’m due to go on holiday in 2 weeks from now!

    Currently in a moon boot, discomfort pretty much throughout the day but mostly when I’m vertical on my crutches. Anyone else had the throbbing calf upon standing? My main concern is when the hell will the pain subside? The bruise is on its way out which I hope is a god sign. The weight gain and diet as well as when o can start doing any type of working out are my other concerns.

    I’m planning to hit a 2000 calorie diet to lose weight whilst I’m inactive.

    Where’s everyone else at?!

    Mark

  322. Hi Mark,

    I am 11 months post surgery. I used to get a throbbing calf when I stood up, all of a sudden it stops, but it will take time. I still get niggle now after intense circuit training.

    Re your holiday.., I bought and IWalk 2.0 (the hands free crutch) you can buy it on amazon in the USA, I am in the UK so I bought it from one of their franchise dealers. It was the best thing I ever bought.

    I used it all the time and used it on holiday (2 weeks after surgery) to get around I hired a wheelchair in Malta for when I was tired. When I was not tired I used the wheelchair as a walking frame with the IWalk, it meant I could keep up with everyone and push the beach bags!

    I did not drink any alcohol for 15 weeks and I think using the IWalk also helped me keep the weight off, I dropped 14lbs (some of that muscle wastage). I did not know how many calories I burnt using it until I got the IWalk out again to cut the grass as I was scared to push off my bad leg. I was absolutely worn out after I had finished.

    I put the weight back on once I was walking, drinking alcohol but not exercising 5 days a week like I used to.

    Good luck to you, remember it is not a sprint and listen to your body, you will get there in the end and be back to your old self!

  323. Thanks for the rely Rebecca. 3 weeks post rupture now and the calf pain has subsided dramatically!

    I was fairly active prior to the rupture, crossfitesque circuits and cycling. I made the silly decision to return to the basketball court despite my ortho telling me no impact sports post rugby retirement and a wear and tear injury in my hip.

    Not being able to train will support weight loss, currently 183cms and was around 200lbs. Hopefully with my macro counting I’ll be down to 180lbs which will improve my hip position and getting back to fitness. I’m not really a drinker so that’s not a problem.

    I’m hoping to be partially weight bearing 4-6 weeks and well back on the road to recovery at 3 months.

    We will see!

    Mark

  324. Hello everyone,

    Did my ATR two weeks ago playing football. I went straight into the VACOPED the next day after attending A&E. I got conflicting opinions about whether surgery or not is the best option while at the hospital in Lewisham but through my own research this seems to be the case everywhere even in the medical literature.

    Overall i’m quite mobile, can move about on one crutch, and only have had upper calf pain a couple of times; a lot of strain goes on my fully healthy leg and can be tiring, however.

    A big concern about my ATR is that i face a 6 week wait for a scan, in the meantime the injury could be getting worse or better and no one would have any idea, has anyone else faced this problem or had to wait this long and can offer any advice?

    Thanks,

    Elliot

  325. Elliot - Has the boot been adjusted so your foot is point down say 20 or 30 degrees of maybe you have some wedges in it. This boot is great and for the NHS to put you in one straight away is fantastic as long as the tendon ends meet when your foot is pointed down. If you have to wait 6 weeks from now for a scan (or even 6 weeks from the injury date) then you are well on your way to good functional non-op recovery and I would not be looking to surgery. Early weight bearing is the key. There is a great deal on this site about it and maybe you should do your own research. The scan will be good anyway but you could be walking out of it in 2 shoes by then. If your toe is not pointing down then you should adjust the boot straight away as in 6 weeks time the body will have filled the gap in the tendon and you will heal long. That will mean surgery later to repair it and a start over.

  326. Nightmare so far!
    Complete rupture of my right achilles tendon at nephews wedding dancing 21/4 after simmons test in north devon district hospital put in back slab half plaster given pain killers and crutches as i live and had to travel back to manchester 4 days later. Told by doctor to get appointment back home. Rang local surgery 25/4 told to go to local A&E tameside hospital because it would take 2 weeks for doctor to get appiintment. Went to A&E 4 hour wait to be told no fracture clinic appointments available. Also asked them to reduce plaster as cutting back of leg and causing bruising/pain. Was asked about family history and was given blood thinners to self inject. Was informed until swelling went down nothing could be done. Btw incompetent nurse tried cutting cast with scissors then after stabbing me admitted she didnt know what she was doing.
    26/4 extreme pain in leg worse after being elevated pain felt worse than when i had ruptured it, so much so i was crying uncontrollably rang 111 who ordered an ambulance 12:40 am was advised that A&E were undersfaffed due to strike and i was not taking enough medication alsotold to ring hospital next day and beg for a fracture clinic appointment, the paramedics convinced me not to go to hospital.
    27/4 pain unbearable when trying to lower leg. Rang hospital and begged them for appointment or it could be 2/3 weeks before specialist saw me, luckily they took pity on me and said i might be sat there for hours but they will fit me in today i was soo relieved. 2:45 pm arrived at fracture clinic. Ortho saw me took off backslab said i needed a doppler scan for dvt asci had explained the pain was horrific. Doppler scan revealed a dvt in my peroneal calf vein. Was very very upset as explained paramedics were called out night before and didnt even check for dvt. Was offered surgical route which i declined and opted for non surgical route. Plaster was put on below knee ( dr wanted above knee but i could not cope with any movement if above knee) sent to ambulatory care, who were fanrastic had blood tests injections and had to return nexr day.
    28/4 returned to ambulatory care unfortuneately via ambulance as awoke 6am screaming in pain and unable to breathe so had to attend A&E where i was told off via a trainee nurse and made to feel awful.
    Was put on rivoraxaban 2x tabs 21 days then 1x 3 months. Was asked why i was put in cast and then taken back to fracture clinic where plaster was cut off and a langer ROM boot agled at 30 degrees was put on. This took 8 hours trying to sort out but ambulatory care were amazing and so too were the fracture clinic. Was informed that north devon hospital should have given me injections due to long journey back to manchester and my family history.
    Those were my initial appointments since then numerous blood tests due to extremely dark urine suggestions of myoglobin in blood, muscle wastage and urinary tract infection all of which have been dealt with disgracefully via my GP when i chose to complain i was treated as though i am depressed, i am not even through all this im positive regarding my injury just annoyed at lack of organisation and trying to find out information.
    Had first check up was told not to take boot off at all, even though fracture room said i could. I did once but to alter sock but felt uneasy. Am following their directions to the letter. Been told approximately 12 weeks until im walking if its healing naturally if not surgery and back to square 1 and another 12 weeks.
    Back for appointment 8/6.
    Currently having heel pain even with elevation and resting but feel its good pain if that makes sense, also having involuntary foot twitches at night again off putting but feel its part of the healing process. Anyone else get burning in heel during elevation?

  327. leandraweb - Quite and ordeal but I am no longer shocked at how inconsistant the NHS is after reading many stories here. Some have been fantastic but many are like yours. I fail to see what the point is of putting you into a boot and then telling you not to walk on it. That is what it is for. I suggest you do a bit of research and there are many links on this site which will help you. NHS usually goes the non-op way to save money so it is unusual for them to offer surgery straight up. For the best result non-op you should look up the studies conducted by Exceter in England, Richard Wallace in Belfast, UWO in Canada and Twaddle in New Zealand. All show early weight bearing and movement decreases the risk of re-rupture and provides a better functional outcome. There are many here who have done it successfully. The orthodpedic community seems a bit divided on treatment and many doctors prefer to go with treatment from the middle of the last century. Casting above the knee is ridiculous and I have only read of one other here who had it forced on them. This tells me the doctor advising you does not read current literature on this injury. How you proceed is entirely up to you and do not take anything I say at face value. You could be weight bearing now and back in shoes within a month give or take. That does not mean you are healed though and you will still have to be carfeful for a couple of months but locking up the tendon for 12 weeks with no weight bearing does not encourage the collagen type I to develop and the risk of re-rupture is extended for another 6 or 8 weeks. You could also be taking the boot off now with the leg supported to do some gentle foot movements such as writing the ABC’s. While you have the time do some searching of this site specifically (top right corner of home page) and also search the studies I have listed. I could do all that for you but far better to find it yourself. Hope the nightmare improves for you. P,S. Those pains seem very common but should be easing. Many will also have those pains when they start weight bearing. Twitches are very normal.

  328. many thanks stuart
    i am very positive of recovery and will indeed take a look at all the literature.

  329. Hi stuart thanks for your reply.

    I’m now at three weeks after my ATR. My boot is currently set to the highest degree and has not been changed since i had it fitted the day after my ATR. I don’t have any wedges either, not even sure what these are, i only have the boot and the rocker sole… I’ve only seen the specialist once, not sure how to see the orthopedist again as pretty sure it is hard to get a referral in London from my GP who doesn’t really seem to know much about ATR’s so i’m not that clued up about things.

  330. Elliot - this sound all good to me and you are on your way to a recovery. If you have the scan in 6 weeks or at the 6 week mark it will be useful to make sure things are going well. If you google the vacoped achilles protocol you may be able to pick up how the early weight bearing protocol goes. I did it recently as someone aske the question here and I found a pdf document. I am sure it has been posted on this site as well so you site specific search if you like. Let me know if you have problems. Your tendon should be joined by now as long as you have not taken the leg out of the boot but it is still very weak and not able to bear weight on its own. Generally the boot is adjusted over the coming weeks to bring your foot to neutral and your weight bearing increases as tolerated. It is an explosive force that will cause a re-rupture so while in the boot, if properly fitted, you are protecting the tendon. It is also protected by the angle of the foot. You should also be able to start some light range of motion exercises with the boot off and the leg fully supported and only using your own muscles. This is called Active ROM and it will help you to get things moving or awake. Mostly it is just writing the alphabet with your foot and can be done 3 or 4 times a day. Walking in the boot with it at 30 degrees is a bit hard I know so to give the same angle sometimes a wedge, which is just like a shoe insert only harder and only under the heel, is placed in the boot. This lifts your heel and takes pressure off the tendon and allows the boot angle to be adjusted up for easier walking. They are about 1cm thick and stack onto each other with some sticky aheasive. Two should be enough but they must be stuck to the boot so they do not shift. They come with the adheasive tape usually and you should be able to buy them from a pharmacy. Physios have them too. Wedges are also handy for when you go back into shoes as you can place them inside under you heal and it will help you walk without a limp until you build strength. Do some of your own research on early weight bearing and in particular the work done by the Exeter hospital. You can search specific for this on this site or the web but come back if you have questions or cannot find what you are looking for.

  331. Hi Stuart,

    All good advice thanks very much, i since i am approaching 4 weeks in the VACOPED and since my ATR with no adjustments and still at 30 degrees i wonder if i should lower myself by a fraction. I had assumed i’d be seeing the orthopedist every couple of weeks but this does not seem to be happening, and according to the VACOPED guidelines by week three i should start the process of decreasing the angle. I just wish i could speak to a specialist but going through my GP is very long as it’s tough to get a referral and the only numbers you can call on the NHS are 111 which is non-emergency urgent medical advice.

    Elliot

  332. Elliot - If you choose to follow the Vacoped protocol then you should not hurt your tendon. It has been tried and tested but you have to decide what to do yourself. I like to question everything and load up with lots of information then make an informed decision. I also had a doctor tell me not to lift anything more than a cup of coffee for 6 weeks and when I went back to him he asked how much I could lift. I told him a cup of coffee and he said that was not very good. You could go back to the surgeon for the next appointment at 30 degrees in the boot and he will say ‘why are you still at that angle?’ I am sure you will know what the best thing to do is for you.

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  334. Sneaky feeling my ortho has buggered up.
    My gp was sent a letter saying my foot was angled at 20 degrees in a rom boot at around 5 weeks, i had an apointment at 6 weeks 6 days and questioned him saying angle hadnt been altered at all and gp was given wrong information.
    To say he looked worried was an understatement. He looked at leg first time since initial injury and then stated the angle will be changed every week!
    Went to 20 degrees thst day, 5 days later moved to 10 degrees and given new boot ( which is causing me major discomfort as very heavy)
    My heel is aching alot, calf is hurting and getting nausea, this seens to quick since initial 30 degrees for nigh on 7 weeks. Am being moved to flat 22/6 which will be 9 days after last change!
    I am very light weight bearing and doing light exercises. When i move foot flat or above heel/calf is very sore and majorly tight
    Was wondering if this will ease or could tendon be too short and what is protocol if it is malformed

  335. leandraweb - I would not get too concerned about the angle but I would be moving to a bit more weight bearing as I have mentioned before. Your tendon will not end up short because of the angle but rushing it to get more flexion is also a bit silly. Many people stay at 30 degrees for 12 weeks and the tendon is not malformed. Probably more pain and discomfort the way the doc is doing this rather than causing any damage. Your poor NHS experience continues. Sorry for that.

  336. Thanks i have started more weight bearing after seeing the specialist again, he decided for extra safety he would leave it at 10 degrees for a bit longer and said to me to weightbear. I first tried with crutches then moved to 1 crutch and have done some steps crutch free, my problem or worry is this! Maybe im imagining it but…… when walking fwb i hear a clicking coming from my leg not sure if ankle/tendon or knee area, heel is tender tendon area sore and swelling. My husband kept hearing it clicking too, am i overworrying as once i ice and elevate i still have good movement with ankle.
    I dont have intense pain but the more i look the more i think i see a dent lol.
    The boot doesnt seem to cushion my ankle at the front because of the hinge
    Please put my mind at rest!
    Doc said PT to start in a weeks time and wants me out of boot in 3/4 weeks

  337. Bye the way im leandraweb

  338. Jacqueline - With your leg locked up it is normal for some of the small bones to click when you start to walk. I do not say it is good as it is not a normal thing for your body but common with this injury. Probably need to locate the problem. Most common are the small bones below your ankle. Support you leg fully and with the boot off rotate your foot or write the alphabet. This will help free up those little joints. Sometimes a tendon will click if it does not glide properly over bone. Same thing as before. I doubt it is your AT.

  339. Again thanks it is very off putting have rung hospital and tbh you have given me more info than they could

  340. I heard my Achilles pop on 3rd June - whilst energetically dancing at my daughter’s wedding. My sober brother drove me straight to A&E where a lovely nurse diagnose a complete rupture and told me my calf was no longer attached to my foot!! I was put in a cast and an appointment made for the fracture clinic 10 days later!! At this appointment the consultant decided it was only a partial tear after doing the Thompson test and then sent me for an X-ray!! Once he checked that there were no broken bones he decided to book me for an ultrasound the following day. The radiographer told me it was a complete rupture. I saw a different consultant the following week who said it was a full rupture but strangely I could still do the Thompson test. I was booked for surgery the following day. When I arrived for surgery the surgeon decided after looking at the scans that it was not a full rupture and surgery was no longer an option. I was then fitted with a non-weight bearing boot with 4 wedges and told to come back in 2 weeks. I have been off work since it happened as I can’t drive. It’s been nearly a month since the incident and I have no confidence in my consultants at all after so many different opinions. I will see what my next appointment on 8th July brings.

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  342. Still worrying!
    Went to neutral last week during first PT haven’t had alot of pain until this point.
    I found keeping boot on overnight helps to stretch AT. My problem is this i can walk/hobble ok and the more i weightbear the easier it is, however when i rest i get shooting pains and severe throbbing in the back of my ankle and calf around the AT area is this due to DVT or am i damaging my tendon. Scared to death. Noticed a slight lump on rear right heel about 3cm above actual heel. Everyone else mentions no pain mine is about 7/10. I am supposed to be transitioning into shoes in 2 weeks. My boot is extremely heavy even PT commented on this. Just praying tendon is ok and its my body playing up

  343. After worrying when i went neutral with pain its normal due to my dvt etc.
    Good news. Was walking fwb after 2 days visited orthopod who says everything is good a very solid heal. Wanted me to use shoes in the house, scared of coming out of boot so I did it as soon as i got home to overcome the mental block.
    Felt weird but got some great asics trainers. Went for physio a day later in trainers with boot in a bag just in case. Walking is slow but im ensuring im walking correctly rather than limping feels good (hesitantly speaking)
    I am fortunate that i laugh at nearly everything including myself it helps. Still quite painful but its a positive pain. For those just starting out, keep your chin up, 12 weeks + goes quickly once you accept it. I had loads of complications and was in a boot 1 week after accident but non weightbearing for 7 weeks. When nothing is happening its drags but once they start mobilising you it flies.
    Hugs to all struggling ive cried and laughed loads its taught me not to dick about.x

  344. Hi to every one, as I am in fact eager of reading this weblog’s post to be updated on a regular basis.
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  345. Hi

    My UK full ATR NHS treatment so far…

    Saturday Injury
    Sunday - decided it was serious and went to A&E. X-ray. Simmonds/Thompson test. Back Slab.
    Wednesday - Ultrasound. Rupture confirmed. 4mm gap even in extreme pointe.
    Following Wednesday - Saw Orthopaedic surgeon. Urgently given Fragmin which A&E had missed. Put in aircast boot with 3 wedges.

    Hired a Stride-On on day 3 absolutely transformed my life. Can’t imagine NWB without it. Even managed a weekend in London.

    Referred for a further scan because the ultrasound showed such a big gap. Back to Orthopaedic surgeon next Wednesday once I have had the scan to see if they will continue to treat me conservatively. Surgeon says that he is worried that the tendon will reform long and I wont have a full strength push off so surgery may still be an option.

    So far so good. The early weight bearing, mobility and then slow rehab makes sense to me from all I have read. This blog is marvellous! Only negatives are the Fragmin and the time between appointments particularly if I have to have surgery next week and go back at square 1.

    Think I should have more than 3 wedges in boot?
    Is a 4mm gap too big for non-surgical approach?

    Liandra, I hope you are a “2 shoes” and getting back to normal now? Cried and laughed as well - have to make the best of it. Not entirely sure it has taught me not to dick about though. x

  346. Should have said that I am being treated in South East England. Maidstone and Tunbridge Wells NHS Trust.

  347. Robotmummy - 4mm is not too much but the important thing is for you tendon ends to touch when you point your foot down. The can determine how many wedges which equates to the angle your foot needs to be at for this to happen by ultrasound. Your treatment has started but if the doc is concerned then surgery is still an option. NHS is a bit hit and miss with the quality of treatment. Hope you have a good one.

  348. Thanks for replying Stuart.
    Apparently gap was 14mm in neutral but they were able to get the ends to touch in extreme equinous so I am back in a cast and nbw for 3 weeks!

    I will be back in Aircast boot after that but I am seriously considering buying a Vacoped and following that protocol. Anyone have any advice or experience to share?

    Tara

  349. Hi. I’m a 43 yr old female living in Essex and I ruptured my achilles on 5th May 2017 while dancing at a Ceilidh. I went to GP on the Monday who diagnosed the rupture and sent me to A and E where it was confirmed and I was put in plaster. I had an appointment 9 days later at the fracture clinic when the consultant diagnosed it again and referred me for an urgent scan. I was told by the radiology department that I had to wait at least 4 weeks for this but luckily the consultant intervened and it was brought forward to 6th June. I went back on Friday 9th to see the consultant and he has recommended surgery because the gap between the tendons in 1.8 cms and he feels anything over 1cm needs surgery to repair. Fortunately he has a cancellation so I am scheduled to have the op next Monday 19th June (fingers crossed).I’ll then have another 6-7 weeks in plaster then 3-4 in a boot. It has been very frustrating especially as we are in the middle of an extension. Not being able to drive is difficult with two children aged 5 and 7 who go to school several miles away. Fortunately friends have been brilliant. I bought a second hand StrideOn Knee Scooter which was recommended by the man who has done the plasters for me. It has been a godsend as I can get around the house, cook and do other jobs. I’ve been able to go to town for shopping (around a mile away) and take the kids to the park. I’d highly recommend it as I would be going mad without it. You can hire them but it would have cost me more for the number weeks I’ll need it for. I will probably sell it afterwards. It’s great fun to whizz around on (as long as the surface is smooth - lots of pavements here are very bumpy and the dropped kerbs are not very helpful) and my fitbit thinks I’ve been on a bike so I feel like I’m keeping up my fitness a tiny bit and also it’s so good to get outdoors. I love swimming and I’m finding it tough not being able to do that. Good luck to everyone with recovery.

  350. Sam - you are the second person here who ruptured dancing Ceildh to my knowledge. Ali39 is her blog but she is long gone. You can search the list on the left of the main page if you like. Must be pretty aggressive dancing. You are very fortunate to have a consultant with the NHS who is taking this amount of interest. It is most common for this injury to be treated without surgery in the UK but your circumstance is the exception. If the tendon ends do not meet when your foot is pointed down then you will have a strength deficit for ever (unless repaired later by surgery). In reality the only scan needed to do check this is an ultra sound and that should be readily available even in the NHS. Hope it goes well for you and although a set back I would consider it a blessing.

  351. Hi, I ruptured the AT on right leg 4 weeks ago playing badminton. I am 68 and thought I would try a U3A group in Congleton, UK. After playing for 30 mins I lunged forward to take a shot, and heard it snap. Instant pain and shock, I was helped off court, and the leisure centre staff called an ambulance (after I threw up and passed out with the pain). Macclesfield A&E was pretty good, I had an ultrasound - (diagnosis an almost complete rupture) and was casted and sent home along with blood-thinning meds to be administered by syringe into the stomach. 2 weeks later I couldn’t keep the follow up appt due to being snowed in, so had the cast for a further week. Yesterday I had the cast removed and a walking boot fitted, with 3 inserts. I take one insert out every 2 weeks, and will therefore return for a follow up in 6 weeks. The consultant has recommended non-surgical, probably due to my age, plus NHS cutbacks no doubt. He said the long term outcome is as good as surgery although with slightly increased chance of re-rupture. Not too much pain so far, but the boot is really awkward, and I’m still on crutches. I considered taking it off for sleeping, but after reading some other posts, have decided to retain it for safety, but loosen the velcro for comfort. Might reconsider in a week or so. I obtained a good waterproof sleeve from amazon to fit over the cast for showering, but it doesn’t fit over the boot. Am in process of rigging up a bin bag tied with string over the knee - not willing to risk stumbling in the shower. Hoping the walking with the boot will improve - very lopsided at the moment, and I haven’t risked weightbearing. Looks like a long haul.

  352. Peter - order an even up so you don’t walk lopsided. Very easy to get on amazon. I got a cast cover on amazon that I could use with my boot too. It was able to cover my entire leg so I pushed it down just above the knee.

  353. Thanks, I’ve now got an even-up insert to go in the hiking boot I’m wearing on the good leg. I can now hobble reasonably well around the house. I take the first of 3 wedges out of the walking boot this week, hopefully without too much resulting discomfort. The whole foot has stiffened up, though, with the big toe joint becoming inflamed - controlling this with ice and ibuprofen.

  354. Dear All,

    I would like to share my - so far bad experience - and possibly get some advice from some of you went through this before.

    I have injured my achilles tendon on the 4th of July by pushing my my car. Heard a pop which was followed by some pain (not an extremly stong one though)

    Went back home and as my wife suggested we went to the Queen Elizabeth hospital in Woolwich London, to get it checked out as I couldn’t feel the tendon by tuching at it.

    So 4 hours waiting on urgent care nurse send me to xray and gives me a half cast , advising that fracture clinic should get in contact with me within 6 days.

    Few days later I have received a letter from fracture clinic, appointment was 18th of July.

    So two weeks after my injury Im attended the fracture clinic, first time a doctor see me… as soon as I sit down he said “it seems you tear your achilles, so would you prefer surgery or non-surgical treatment” advising that recovery time would be the same. I said first of all I would like to know whether it is a full rupture or a partial tear so I can decide. He has done a Thomson test and said it is negative but he thinks it is maybe partial as the gap seems small and both of my legs holding the same way. So he has referred me to MRI as “urgent”.

    Another six days later I had my MRI today, so went back to book another appointment with the doctor. Fracture clinic receptionist extremely rude (not just with me, but with everyone else), she said now I need to wait 3 weeks before the MRI will be analized, so appointment is for 15th of August…

    ???? Im shocked, but completely. Is that serious that it will take about a month and a half before I get a diagnosis, and no treatment is started as yet????

    Any idea how to speed this up please let me know. As I have seen it in here most of you had a fairly quick diagnosis and treatment started quite soon.

    Any advice would be highly appreciated.

  355. Steve, not sure I have any “advice“, but I had an MRI completed on a Friday, and by Monday and I was sitting in the doctors office being advised that it was a full tear. Surgery took place 3 days later.
    Three weeks to review an MRI seems unacceptable. Hope you can stay persistent and get some
    Resolve.

  356. Steve, i was lucky to have a scan and cast the same day as the injury. I have followed non-surgical route, after an almost-complete rupture. It’s been a long haul, but am now back to normal activities including driving. Still getting physio - this seems to be the key to full recovery. I would have thought that since you were casted straight away, any other delays in treatment won’t matter so much, as healing should start to occur from casting, so long as they angled your foot down sufficiently at the time.

  357. Any advice regarding return to normality would be greatly appreciated. I had surgery for insertional tendo Achilles tendinitis with FHL tendon transfer to improve blood supply. Was 4 weeks in plaster then 4 weeks in air boot. Had physio at week 5 to begin small ROM excercise. The physio was very good but go 3 weeks between appointments. I’m now 18 weeks post surgery and still suffering bad swelling causing bad limp. Having to resort to using 1 crutch when out and about. Am currently sick from work as on my feet all day as a Health Care Assistant in a Hospital. Just wondered if my recovery sounds “normal” in relation to others. Thought I would be back at work and limp free by now. I’m swimming twice a week and just started gym to do treadmill & bike and rowing machine. Would love to hear your recovery stories.

  358. Hi everyone,

    This blog has been so helpful and informative, maybe the NHS should prescribe this as part of the rehab!
    Did ATR total rupture on 25/08/18 playing football. Landed and felt like someone had kicked me really hard on the ankle. Went to A and E and was diagnosed really quickly and put in a open backed cast with foor pointed down.

    I can take the pain, but I have one major problem. I get married 22/09/18 ( 4 weeks after injury) and then go on honeymoon to the USA straight after. I’m really worried about what state I’m going to be in to do the vows, first dance and then after that fly long haul. The orthopedic surgeon said that I have the option for both the non operative or surgical route. Which is the best route to get the best out of the wedding and honeymoon?

    Any help and advice would really be appreciated!!

  359. Hi Ashley,
    Sorry to hear of your injury so close to your wedding. Your surgeon might better answer your question. But, my opinion would be - surgery is hard. It is invasive, requires general anesthetic, and is surprisingly exhausting. There are also recommendations for flying (or NOT flying) for a certain period of time after surgery. If it were me, I’d go non-operative. My surgery was for a Haglund’s deformity removal, and Achilles reconstruction, so not a rupture, but sort of similar procedure. Good luck!

  360. Also wanted to say sorry for the timing of your injury. I didn’t have the option due to the separation of my Achilles and had to go surgery. Fortunately I have had no complications. The procedure was only about 3 hours total including recovery. I have read that surgery route is a little faster overall healing time than conservative.

    With all that said everyone’s experience is different. Certainly there’s some more pain initially with surgery and small risk of infection.

    Ultimately your Dr is your best resource on which way to go.

  361. Ashley - I agree with Shell - check with your doc. Have him/her write up the timeline of when you’ll be doing what with each option and tell them what you have going on. I think the non-op route gets you walking in the boot sooner but a lot depends on your exact injury. I had the same bone spur removal surgery on both feet and already the protocol differs between them due to the differences the doc found during surgery.

  362. Hi, thanks for all your advice, really helping having people in similar scenarios passing on knowledge and experience.

    I have since been told non operative treatment, been put in a Vacoped boot for 8 weeks.The rupture happened near the calf so I’m hoping with greater blood flow around that area the healing process might be slightly quicker. Already managed to walk around the house a few times FWB with no crutches which I’m really happy about!

    Will be married wearing my boot but at least I can now concentrate on being as mobile as possible, don’t want to let my lovely fiance down! Haha.

  363. Glad to hear you found a path that will keep you upright at your wedding. Seems like you have a good attitude about the whole ordeal. Good for you.

  364. Hi Ashley, all the best for the wedding. I had non-surgical for almost complete rupture and am now virtually back to normal, and have been taken off the physio regime. It’s amazing how quickly you get used to the walking boot, especially if you get a level-up support in the other leg. I did have to wear the boot for a while in bed though! You can’t risk the re-injury by standing bare foot too soon.

  365. This is a very shortened version of my story. Original rupture to AT on May 2nd and 20 weeks later, it goes again doing a one legged heel raise as part of my rehab programme.
    Managed to get an emergency clinic appointment a few days later and sent referred for an emergency ultrasound and MRI. US reported a 2 cm gap but had to wait for MRI results before treatment plan was decided. Next appointment I could get was 3 weeks after the MRI, subsequently cancelled and ended up being a 5 week wait. Decided I could not wait that long and paid to see a private consultant. He could not see the MRI scans but managed to chase down the MRI report. Report stated there was a 0.2 cm gap which is tiny. Advised to keep foot in boot. Returned for my NHS appointment and was told I had a gap of at least 2 cm and required surgery using a graft from my big toe, also said it could be a 4-8 week wait for surgery. Bit of shock when two weeks earlier I was told it was 0.2 cm. Rang up the PALs hotline to query it and added an extra 2 week delay whilst they investigated it. They also removed me from the waiting list whilst they investigated which was nice of them.
    Anyway, I am now booked in to get it sorted privately and have a date of 20th Dec for surgery. It will be roughly 3 months after the re-rupture and if I waited for the NHS, God knows when it would be. Mentally, it has been tough but hopefully I will be sorted soon.

  366. Wow. Very sorry to hear about the re-rupture and subsequent red tape. Keep your head up and best of luck to you!

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