Great site. Thankful for those that created it - helps to understand what to expect. 53 yr old male, having surgery to repair rupture on 5/25. All sorts of questions. When will I ride a bike and play golf again? When can I go back to the office? More to come.I hope as time passes, my posts of experiences will help others as yours have already assisted me. Thanks.
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Norm,
Atrophy was not noticeable by six months. One heel raise arond nine months (took longer than I thought). Swelling and thickness persisted until weeks 12-16. I’m fairly confident my accelerated recovery (early weight bearing, out of boot,two shoes etc) helped me get back to desired activity a little sooner than most of the post surgery rehab reports here. Good memory - Doug 53 was my model. As I noted, most of the benefit was mental - a perception of a return to normalcy (even if sow of itvwas not a physical reality). Glad to see you are still providing support on the site. Hope you are doing well.
Thanks for the update, GG. I know we’re all different, but do you remember when your swelling stopped and when your 1-leg heel raise appeared, and when it got good, etc.?
You went surgical and fast-aggressive (following doug53), which theoretically should minimize atrophy and accelerate the return to full strength. Did your facts match the theory?
The money in US, with the ins companies is about 25 cent on the dollar charged, “negotiated fee”. Mine was about the same 12+ K but the doc was paid about 2k with surgery, follow ups and x-rays. MRI was charged at 3K and was paid about 1K. That is why they do so meny surgeries. They need to do 3 to make what they used to get for one. Now if you didn’t have ins, you’d be stuck for the whole bill unless you negotiate with the doc, or go w\o surgery, which I now believe to be a good thing inactuality.
Your progress sound solid, Grace.
Graston has come up here before, mostly (maybe all?) positive. The search window would find ‘em all.
That $14k is probably at least $13k more than a good non-surgical rehab with a fancy boot and lots of PT. I wonder if the medical insurance companies in the US will ever react, given the new studies that suggest that the $13k isn’t buying anything.
Good to hear there are some golfers here.
I had the same experience. Have played 3 or 4 times with no repercussions and no restrictions on swing but swelling afterwards for a day or so. Have not tried to walk 18 yet but hope to try it soon.
Keep your head down, swing easy, watch the ball fly!
Great news. I did put a band-aid over the scar on my heel where my shoes were rubbing a bit. Other than that - a little swelling by the end but ice took care of that. Just be careful where you are stepping - Have fun!
Just got my go ahead from the doc to start golfing and take off the ” BOOT “, are you useing any special aids when you golf ?
I think a number of us “stumbled” into situations that weren’t safe — I know I did! But most of us just got scared, and didn’t re-rupture. Once when I was walking in my hinged boot with a bunch of friends, talking among ourselves on the sidewalk, they couldn’t keep up with me(!), so I spun around and started walking fast BACKWARDS — BIG mistake! It turns out that walking backwards (even in a hinged boot) is GREAT calf exercise, and MUCH too advanced and strenuous and hard on the leg than I was ready for at 7-ish weeks! Fortunately, my leg immediately told me so, I said “Yikes!” to myself, spun around again, and I was fine.
Another time, in 2 shoes at maybe 10 weeks (my blog knows!), walking fast in a parking lot, I got the bright idea to get rid of my little “gimp-limp” (the dip at the end of my stride, from calf-strength deficit) by walking in a slight crouch. (I figured that I could just STAY at the “dip” height, so I wouldn’t “dip” down to it.) VERY BAD IDEA, and I almost crumbled to the pavement in big pain! That was a minor version of what you did in the water (pushing hard on an ankle that was dorsiflexed too far), but my
[...]Yes the studies show about 2% at my age and time post surgery will rerupture. At 48 I’m supposed to be smart enough to not do anything stupid. But lack of guidance was a downfall. That is why I’ve been drawn to this site.
Scott, you’ve got to start a blog, to put your interesting story in one place! Gunner, part of the rest of Scott’s story is now on Mazmouza’s page.
Next time, go the non-surgical route (preferably NOT very “conservative” or slow) the FIRST time! That’s what the scientific studies prove it’s definitely great at. It may work great for you on the rerupture, too, but those are rare enough that it’s impossible to put together a good study.
So you were walking in the pool when the retear occurred?
I was a rare retear at 13 weeks, heed the warnings, I was going great but in a hurry one day stepped wrong and it all came to an end. I was cycling, walking doing a lot of ADL’s feeling like I was back o normal. My advice is until you have complete controle of the 1 leg toe raise you are still vunreable.
I’m 4 1\2 weeks post reinjury, no surgery yet, I’m trying the conservative route this time. To get my hinged boot soon. I’ll keep you all updated with progress.
Thanks for sharing that with us ggrace57. I am waiting for my surgery next week, and I am looking for some positives, like being able to put 2 shoes on and no cruches. Be safe and best of luck.
The stats I’ve seen/heard say that the vast majority of re-ruptures happen in the first 12 weeks. Maybe consistent with the first 8 or 9 being especially high-risk. And for sure, the weeks when you’re first out of the boot’s (or cast’s) protection is an especially vulnerable and scary time.
It gives new meaning to “Watch your step!”
ggrace57,
Good for you! It’s nice to get away from crutches and then the boot but be careful. From what I’ve read the tendon needs 2 months to heal and there are not a lot of nerves to tell you it’s hurting so take it easy on the sports schedule. I read somewhere here that a guy re-ruptured at 5 weeks playing golf. Waking up that calf should stop any more atrophy. Push ahead but stop at any discomfort and avoid setbacks.
GG, your “reasonable impatience” seems to be working great! Looks like a chip off the doug53 block!
Several people have posted technologies to manage internal scar tissue and lumps. (GerryR’s blog has been a magnet for those discussions lately.)
But the surgical scar often benefits from (a) being ignored, i.e., not abraded or “annoyed”, and (b) some creams and ointments that keep the skin moist and soft. And, of course, the passage of time!
After surgery for my first ATR, I had the good luck to have the scar heal well and stay very thin and faint, and then fade to the point where I have trouble finding it now, 8 years later. I don’t recall doing anything special for it, and I couldn’t even get at it for more than 2 months, because I was in a series of casts for that long!!
I don’t know why some surgeries and/or some patients (or possibly some surgeons) produce “nicer” scars than others. Obviously surgical complications like infections and wounds that don’t heal properly create “nastier” scars, but there also seems to be a big range in the non-complicated ones, too.
If you have a choice, get a boot that can “hinge” — maybe even the fancy high-tech waterproof VacoCast that gunner got!
What makes the crutches so difficult with this injury, to me, is the inability to rest the injured leg on the ground due to the plantar-flexed position. An ordinary broken leg or ankle (which I’ve had!) is a piece of cake in comparison. Get to the boot as soon as you can and your experience will improve dramatically. Hope its this coming Wednesday.
My surgeon described my first ATR (8-ish yrs ago) as “two horses’ tails”, and mine healed up perfectly, no loss of speed or agility or vertical jump as far as I could tell.
Since most of the strength will eventually come from your body’s Collagen rather than the stitches, I’d actually expect the “messy” ruptures to heal up stronger than the “clean” ones that have two tidy tight ends to them. Just an unproven logical-sounding conjecture, of course.
Actually, while I was still lying in my hospital bed, post-op, I was visited by the Assistant Surgeon. I asked him about the surgery, and he said mine was the messiest ATR he’d ever seen. Later, when my Chief Surgeon came by — very brusque and apparently sure of himself, but also with a sense of humor — I asked him about the surgery, and I told him what his assistant had said.
The Chief Surgeon first said “I’ve got to tell that guy to shut up!” Then I asked, “So was mine the messiest ATR YOU’VE ever seen?”
He thought for a minute, then said “No, it was the SECOND messiest.” Then after another minute, he said “Now ask me if that OTHER guy ever WALKED again!” Real joker, eh? An
[...]congrats! successful surgery is happy 
Take it easy for a while, and if people try to help you… LET THEM. Hope you’re feeling well!
I totally agree with Doug that the fastest post-op ATR protocols humans will pursue, will be faster than the fastest NON-op protocols. Doug’s home-made protocol may turn out to be perfectly effective for people who aren’t Doug. Unfortunately, we only have a statistically insignificant sample of one to go by, so far, so it’s hard to be sure. And even if the approach is safe, with a low re-rupture rate, he may still be at the fast end of the results.
All we know for sure from careful studies is:
(1) The most-repeated “truth” about ATR rehab — that surgery produces more strength, better ROM, and a lower re-rupture rate — is completely FALSE, at least for conventional open surgical repair with a well-tested and reasonably aggressive rehab protocol;
(1a) We also know that surgery brings a much higher rate of serious complications.
(2) For post-op and post-non-op, the reasonably aggressive rehab protocols seem to produce better results than the slower, more “conservative” protocols — as well as having significant lifestyle and psychological benefits.
Apart from that, we don’t really know a lot for sure, except for individual
[...]I detect a little “impatience” in your first note, wanting to get active again ASAP. If that is your motivation for having surgery, my blog has some concepts that might help you recover more quickly than usual.
Using one of your questions as an example, I was riding my bike out on the road between three and four weeks postop. Between two and three months postop, I could get out of the saddle as I wished, with my cleat in its normal position, as my calf was able to hold my weight.
Good luck,
Doug
My physio was Chris at Sports Med. Specialists, 150 Egl. E. I don’t recall his last name offhand (an Italian name), but he’s the only Chris there, AFAIK. I think I was his first patient following this protocol, but he seemed to stay busy with me and “do no harm” (my MAIN criterion for a good PT!).
After 10 weeks, I’d expect your leg to be roughly comparable to where a post-op surgical patient would be. Of course, some ortho surgeons don’t like PT for those patients, either. There’s a huge variation in approach, and very little of it is based on any good evidence. It’s all “TLAR” and “Goldilocks” and the assumption that safe/conservative means slow. . . And (of course) following last year’s practice!
Thank you.
Was in a cast for 6 weeks. For the past 4 weeks I have been using the LDK airwalker. I have progressed from two crutches to one crutch and now to a walking stick. I often walk on flat surfaces unsupported now.
I haven’t started physio yet as all of the ones I have spoken to are unfamiliar with the non surgical regimen and I am afraid of rerupturing. Would appreciate knowing who your physiotherapist is.
I have been doing some gardening with the boot but I haven’t been to the gym since the rupture. I may try the stationary bike today.
I am 63 but not quite as active as you.
Appreciate all your posts.
Ifixteeth, I went first to the Sports Med. Clinic at U. of Toronto, then got referred to Dr. Rick Zarnett at Sports Med. Specialists, 150 Egl. E. He’s also the Chief Surgeon of the Toronto Argos (our local pro football team, for the rest of you).
I was almost in my 60s when I had surgery on my first ATR, and it went well and has worked just fine ever since. I was 64 when I tore the other one, last December. But I’ve been playing volleyball with a bunch of 30-somethings for years now, and holding my own quite well!
Having a modern non-surgical “cure” is a blessing, IMHO. Having an inaccessible surgeon definitely is NOT. Casting is not a benefit either, as boots have a number of advantages, clinically and personally. If you’re eventually going to be fitted with a boot (as you should), then every cast you skips saves the system time and money, as well as improving your life and your expected outcome.
I’m assuming you’re NWB on crutches for the whole 6 weeks, and that’s a nuisance (and a high falling-down risk) personally, and is also apparently associated with WORSE outcomes than earlier WB, according to the studies I’ve seen
[...]Great reading your comments normofthenorth. I was very fortunate that I was given the nonsurgical option as I am in my 60s. Had to be in a cast for 6 weeks though and the my surgeon is too busy to spend more than a minute with me. As I live in Toronto it would be great to know who your surgeon is.
If your docs didn’t give you a full and up-to-date report on the latest scientific studies that have shown NO advantage to the surgery (compared to immobilization in a boot, followed by the same kind of fairly quick rehab protocol that works post-op), you should check out my blog, and click on “A more complete review of the options — surgical vs. non-operative”.
If you’re open to challenging your health professionals with the latest scientific studies (4 of them, published between 2007 and not-quite-yet) and taking some responsibility for your own protocol, you’ve got a few days to do some work!
I’m on my second ATR. Surgery on the first (8 yrs ago), everybody said there was no choice if I wanted a good strong result with a low risk of re-rupture. I still believed that old myth when I tore the other one in December, and I went to the fanciest sports-medicine surgeon in Toronto, so he could stitch my AT back together. He told me he had stopped doing the surgery 4 months earlier, after hearing a team from Univ. W. Ontario present the results from their just-completed study. And he’d spoken to them and gotten a copy of their exa
If your docs didn’t give you a full and up-to-date report on the latest scientific studies that have shown NO advantage to the surgery (compared to immobilization in a boot, followed by the same kind of fairly quick rehab protocol that works post-op), you should check out my blog, and click on “A more complete review of the options — surgical vs. non-operative”.
If you’re open to challenging your health professionals with the latest scientific studies (4 of them, published between 2007 and not-quite-yet) and taking some responsibility for your own protocol, you’ve got a few days to do some work!
I’m on my second ATR. Surgery on the first (8 yrs ago), everybody said there was no choice if I wanted a good strong result with a low risk of re-rupture. I still believed that old myth when I tore the other one in December, and I went to the fanciest sports-medicine surgeon in Toronto, so he could stitch my AT back together. He told me he had stopped doing the surgery 4 months earlier, after hearing a team from Univ. W. Ontario present the results from their just-completed study. And he’d spoken to them and gotten a copy of their exact protocol, and recommended that I follow it, starting with a fixed boot for two weeks of NWB on crutches, then transitioning to WB and physio, etc.
That’s what I did, and I’ve “enjoyed” this cure a lot more than the first one, so far. (Just past 5 months now, and back to all my normal activities EXCEPT volleyball, and my ankle-AT-calf are not holding me back, though I still go out of my way to “work” them when I’m bicycling and climbing stairs and sometimes doing heel lifts etc.
There are at least two bloggers here (mike753 and gunner) who have also avoided the surgery after learning about the studies and discussing the options with their surgeons. I think Mike’s surgeon phoned mine, to check some details. I’ve also posted the exact protocol my surgeon gave me, so anybody can use it.
So far, all three of us are pleased with our choices and our progress — touch wood, since there are no guarantees in any of this! And we’re all happier and saner because we have a protocol — a clear “road map” of where we’re going, instead of wondering what our God-like Surgeon will decide to do with us when we get to see him for a few minutes in a week or two!
So whether or not you decide to keep the appointment and get the operation, ask your Doc if he’s got a written copy of your rehab protocol to give you. And while you’re at it, ask if that protocol has been tested and found to produce excellent results in a careful study.
Good luck and good healing, whatever you decide!
Great reading your comments normofthenorth. I was very fortunate that I was given the nonsurgical option as I am in my 60s. Had to be in a cast for 6 weeks though and the my surgeon is too busy to spend more than a minute with me. As I live in Toronto it would be great to know who your surgeon is.
Ifixteeth, I went first to the Sports Med. Clinic at U. of Toronto, then got referred to Dr. Rick Zarnett at Sports Med. Specialists, 150 Egl. E. He’s also the Chief Surgeon of the Toronto Argos (our local pro football team, for the rest of you).
I was almost in my 60s when I had surgery on my first ATR, and it went well and has worked just fine ever since. I was 64 when I tore the other one, last December. But I’ve been playing volleyball with a bunch of 30-somethings for years now, and holding my own quite well!
Having a modern non-surgical “cure” is a blessing, IMHO. Having an inaccessible surgeon definitely is NOT. Casting is not a benefit either, as boots have a number of advantages, clinically and personally. If you’re eventually going to be fitted with a boot (as you should), then every cast you skips saves the system time and money, as well as improving your life and your expected outcome.
I’m assuming you’re NWB on crutches for the whole 6 weeks, and that’s a nuisance (and a high falling-down risk) personally, and is also apparently associated with WORSE outcomes than earlier WB, according to the studies I’ve seen (though I haven’t focused much on that issue). Everybody who posts here, once they’ve gotten to FWB and ditched the crutches, comments on how much better their lives have become, being able to carry things around, help around the house, etc., etc. Delaying that breakthrough in return for proven better outcomes would be a tough choice, but since the studies show the outcomes of long NWB are identical or even WORSE, it should be a total no-brainer for anybody who’s paying attention.
Unfortunately, many surgeons are too busy and overworked — and maybe also too impressed with their own unfounded opinions or those of their colleagues! — to pay attention to the best recent randomized studies published in the peer-reviewed literature. That’s where patient empowerment has to come in, I think.
I started PT at 2 weeks “post-non-op”. Hard to know whether it helped a lot, but getting to wiggle my foot around out of the boot at PT and at home sure felt like a benefit. Staying at the same toe-down angle for 6 wks (as you’re doing) is consistent with the modern protocol I followed (and posted on my blog), but staying NWB and completely immobile definitely is not.
Good luck!
Thank you.
Was in a cast for 6 weeks. For the past 4 weeks I have been using the LDK airwalker. I have progressed from two crutches to one crutch and now to a walking stick. I often walk on flat surfaces unsupported now.
I haven’t started physio yet as all of the ones I have spoken to are unfamiliar with the non surgical regimen and I am afraid of rerupturing. Would appreciate knowing who your physiotherapist is.
I have been doing some gardening with the boot but I haven’t been to the gym since the rupture. I may try the stationary bike today.
I am 63 but not quite as active as you.
Appreciate all your posts.
My physio was Chris at Sports Med. Specialists, 150 Egl. E. I don’t recall his last name offhand (an Italian name), but he’s the only Chris there, AFAIK. I think I was his first patient following this protocol, but he seemed to stay busy with me and “do no harm” (my MAIN criterion for a good PT!).
After 10 weeks, I’d expect your leg to be roughly comparable to where a post-op surgical patient would be. Of course, some ortho surgeons don’t like PT for those patients, either. There’s a huge variation in approach, and very little of it is based on any good evidence. It’s all “TLAR” and “Goldilocks” and the assumption that safe/conservative means slow. . . And (of course) following last year’s practice!