Do I Need Surgery? Or Not?

Hi my name is Manuel, I ruptured my achilles on June 30th, 2010 , playing softball:  rounding 2nd base, i tripped over 2nd baseman,  felt a pop on my achilles, fell to the ground , but made it to 3rd base !!!!!. I could not walk on my own power, i had to be assisted to truck. I was able to drive home ok. ( luckily it was my left ankle. I can still drive.) I choose not to go to ER. i thought it was like any other ankle sprain. Boy was i wrong. One week after injury, i played in a softball tournament. I could not run, just hit. I played first base, I did well. I hit 4 home runs that day( we won). I know it sounds crazy, why would I play when i have an achilles injury. I guess it is safe to say i have a high tolerance for pain!!!!!… And can not and will not let anything slow me down.

August 1st, 2010

I waited around one month before I saw my primary doctor. I was now able to walk on it, but now with a bad limp, needed a cane. had a lots of swelling still.I did not use an im-mobilation boot, just a plain ankle brace. I was not even told by by doctor that it might be torn . we thought it might be a sprain that needed some PT. He recommended that i start exercising it. I declined to go to PT, i said i can do this on my own: Pool, weights, ice, etc… I could not do the following in a swimming pool: walk forward or backward, do calf raises( i felt pain on my achiles where the tightness was.).I had a large tightness in my achilles over 6 inches long. this is what was keeping me from recovering.I would feel  a lot of pain if i tried.

After 2 more months:  Oct 1st, 2010, I was now making lots of progress, doing  my own therapy. I was using a TENS unit to assist with pain, swelling. I was now able to walk in pool forward, walk backward in pool, do calf raises in pool, did not need a cane any more, but still limped a little bit. The  tightness in my achiles in now reduced from over 6 inches long to around  2 inches. This has now enabled my to walk without a limp, do cardio for over 20 to 30 minutes long. (walking treadmill, Precor 750, Stairmaster.) I feel no pain at end of my cardio session. Great news, I may be able to beat this?????? with out surgery??????…

I also went wakebording in September, but did not feel good about jumping the wake, so i just stayed behind boat. I felt good after I was done.  My ankle is holding up very well at this point. But now i started to realize I ‘am at a platua, and I am not seeing any more improvement. I went back to my primary doctor, who decided to refer me to specialist. ( HMO Insurance). I was advised by my Doctor to be very careful and not let the foot specialist operate on me right away. I guess he’s convinced  my recovery is going very well.  Do MRI and see what are the results, and how I am progressing on my thereapy.

Oct 15th, 2010 I  had an appointment with foot a specialist, He looked at the size of my ankles and said my bad ankle is way smaller that the good one. I could not see what he was talking about, it all looked the same to me. But where he got me is where he asked me do a single calf raise on the good foot, then the bad one. I flunked badly, i could not even raise my ankle at all off the ground. He said is due to the complete tear in achilles. I asked him how come I’am progressing. He says it is because it is healing wrong. ( term he used is healing long). He is recommending surgery to repair achilles tendon. Also plans to take some tendon from big toe and insert into torn achiles. May take me 6 months to 12 months to fully recovery. So now as of Nov 2nd I still awaiting approval from Insurance to approve an MRI.

I plan to do MRI, and see if they can put results on a CD so i can get a 2nd opinion from other specialist. I very against surgery on my Achilles. I would rather live with some limitations, than take a chance on surgery that does not offer no guarranted results. I may be better off doing my own therapy. May also see if i can get an im-mobilation boot to wear part time, when not doing PT? hope that this is possible.

I will keep you all posted when i do my MRI, so in mean time I will keep doing my own PT: weights, cardio, swimming.  go to gym around 5 times a week.

Peace…

11/3/2010: In response to some questions that normofthenorth has:

1: I can lift my toes off of the ground while flat footed. ( both toes are same distance from floor,around 2 inches)

2: I can touch the wall with my knee while flat footed:

a: good foot around 6 inches

b: bad foot: close to 4 inches . ( it starts to hurt where my tightness in AT is)

3: Walking up the stairs: I cannot do this properly. I have just about my entire foot on step as i go up. If not i will start to feel a lot of pain in AT ..

thanks for you advice. Also MRI is now scheduled for wed 11/10/2010.

11/15/2010: MRI Results;

I went to Specialist today to finds out my result of my MRI. It is partially torn, with approx 20% of tendon left.There is a gap in my AT. He said  running and jumping can totally rupture AT. He said that they would take a pig intestine and insert into AT to make up gap.They had me take CD of MRI home with me.

My question I have for some one out there,  is this really sanitary to have a pig intestine inserted into a human body?????????

He said he would like to get me in surgery ASAP. If I choose not too, there is a chance that it can fully rupture. If this happens he says that they may not be able to repair it. This has now got me really thinking. I am beginning to think that surgery is the only road for me to take now!!!!…

10 Responses to “Do I Need Surgery? Or Not?”

  1. Hi, this is a comment.
    To delete a comment, just log in, and view the posts’ comments, there you will have the option to edit or delete them.

  2. Manuel, at this point I doubt you’d get any benefit from immobilization in a boot or cast. Your ankle and AT have kind of stabilized now, they’re not actively creating a lot of new tissue any more. You’ll probably still gain some more strength, but it won’t be as dramatic as where you’ve come from.

    “Wrong” and “long” are in the eye of the beholder, which is really you. If you’re content with where you are now, and where you seem to be headed (slowly, on a “plateau”), there’s no law that says you need to have surgery, to try for better or “perfect”. If you’re not content, I think surgery is the only thing that will make a big change. You say you prefer the limitations, over the prospect of surgery. I think that’s exactly the choice, and you’re exactly the person who has to make it.

    Good luck — and happiness!

  3. Hi Manuel
    The MRI will determine if you have a full or partial rupture. If its a full rupture you only have I believe one option which is surgery and meanwhile you should be careful with your exercise routine not to damage the tendon further.
    If its a partial rupture you may get away with physio and a stringent exercise routine, i.e. Eccentric Exercises ( heel raises etc) but this is itself a long slog with no certainty that it will fully recover.
    I have gone thro a similar problem over 12 months
    ( tear) and eventually fell over and an MRI confirmed a full rupture.
    I await surgery as we speak!

    Best wishes and Good luck

    Birdieboy

  4. Hi Manuel,

    I’m unclear about the point of the MRI. What question is it going to answer? If the tendon is still fully ruptured, a simple exam can tell that. In particular, can your push the ball of your foot with at least a fair amount of strength? A simple exam can also answer the healing long question. In particular, if you completely run out of strength at the plantarflexed end of the ankle’s range of motion, because the calf is fully contracted before the ankle is fully plantarflexed, then you have healed too long. If the latter is the case, you can choose between surgery and living with what you have, as Norm described.

    One detail I’m not sure about is if your picture changes if you wait longer. My hunch is that you can continue to live with what you have for now, but you are not burning any bridges by not having surgery now, as you can always have surgery later if you change your mind about having a too-long tendon. If you are unsure about surgery, ask your doctor if there is any price to be paid if you delay the decision.

    Strictly speaking, Birdie, a calf raise is not an eccentric exercise. Eccentric contraction is when the muscle is trying to contract as it lengthens, as when lowering oneself slowly down after a calf raise. If you drop down quickly after a calf raise, there is no eccentric contraction

    Good luck,

    Doug

  5. Manuel, you say you walk without a limp. That would be a miracle if your AT was still disconnected, IMHO. When you walk up stairs, do you do it normally, or do you still put your whole injured-side foot (including the heel) on the step, or do you do that normally now? That’s a tough test of an AT.

    If you pass both of those tests, you’ve definitely GOT an AT, though it is probably longer than the other one. The best tests of AT length are simple ones, IMO: How high you can lift your toes, how far from a wall you can plant your foot (flat on the floor) and still push your knee to touch the wall. You haven’t reported those results yet.

  6. Manuel/Doyouski, you can post “replies” to your own blog post. I’d recommend it, so your answers follow our questions in order on the page. (Folks, Manuel has responded to my questions way up above, with an added edit to his original post.)

    Basically, I find your symptoms puzzling, and I’m not sure what to recommend! (That’s unusual for me — references on request! ;-) ) Your two tests of AT-length with dorsiflexion BOTH suggest that your AT is NOT healed too long. (That’s good news.) But your continued gimp-walking up stairs says that SOMETHING is missing, but maybe only calf strength.

    I’m assuming that you did those tests while your leg was NOT very swollen. (Any serious swelling can restrict your ROM quite remarkably.)

    I’ll go scratch my head about your leg, and let others pipe up. . .

  7. I tend to agree with Norm that it doesn’t appear you have healed too long. Where he and I diverge is that he’s puzzled you have trouble walking up stairs, and down stairs too I suspect. The general time frame to be completely healed and back to 95-100% is 12 months after the rupture or surgery. You’re only at 5 months and you’re been making up your own therapy as you go, which isn’t always a bad thing, but it is easier to over stress the healing tendon when you’re just winging it. Like most people here you were undoubtedly quite fit before the rupture and it is really hard to know your fitness level is declining. However, I would recommend you lay off all the fitness stuff and only do ROM exercises for a week, basically don’t do anything that puts any stress on the tendon. Your fitness level will decline some, but it won’t be a huge amount and after a week of not doing those things, you may well find your tendon feels a lot better and that you’re walking a bit better. If nothing changes, you haven’t lost much. But, I would highly recommend you seek the advice of a good physical therapist to guide your calf .

  8. somehow I lost a word at the end and the word is “strengthening.”

    You can go into your dashboard and flip the switch that allows people to edit their own posts on your blog. Right now the switch is off.

  9. Hi Manuel,
    I completely ruptured my left AT almost 12 months ago I went down the route of no surgery and a full cast for 8 weeks and boy am I glad that I did my AT has repaired, you have to be dedicated to your recovery and have an awesome physio. 15 years ago I completely ruptured my right AT and went down the route of surgery to this day my right leg still gives me problems where the scar is I have the same if not more flexibility with my left AT as what I have with my right AT for me the non surgical repair was better.
    Best Luck Amanda

  10. Amanda, it’s great that you’re so happy with your recent results — and sorry about the first time! My story is almost identical to yours — tore the right one in 2001, got surgery, eventually tore the left one in 2009, skipped the surgery.

    My non-surgical cure was generally much faster and WAY easier (and completely scar-less, of course!), but my longer-term functional results are a bit the other way around — my first (post-op) leg regained full strength faster than my second (non-op) leg has. (At ~11 months, I’m still doing a half-height 1-leg heel raise. No problems doing normal things, but not that, not yet.)

    I think there’s a lot of “luck of the draw” natural variability thrown into the pot, so we’ve got to be careful before we take a comparison of two legs — even if they’re both the SAME PERSON’S LEGS!! — and treat them as if it’s a statistically significant control experiment. Everybody’s different, and every leg is different, and stuff happens, with any treatment.

    (BTW, I am one of the local leaders of the “skip the surgery Glee Club” here, so I’m NOT just saying this!!)

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