Filed Under (Uncategorized) by housemusic on 05-03-2012

I am 25 weeks post surgical repair on my left ATR and still healing.
My right ATR has been very sore, specially after any activity, even a short walk.
I went for an ultrasound and the surgeon said there is a hole in the tendon and it is very likely to rupture.
Worst of all, he said there is nothing that can be done to prevent or postpone the rupture. He is telling me to wait until it ruptures and then get surgery again.
The thought of going through this again is devastating.
I cannot eat or sleep, and all I think is how I am going to go through this again.


ryanb on 5 March, 2012 at 1:34 pm #

That is certainly a bummer. I guess the first thing I’d do is get a 2nd opinion. Also, I’d want to know if this hole is an acute injury that’s getting worse, or if this is some sort of congenital defect/issue.

If it ruptures, is the non-surgical protocol a possibility? And, if so, what would be the result of starting that protocol now; seems like you’d just be ahead of the curve starting with it attached. I dunno- those are the types of questions I’d start asking-

Good luck, and terribly sorry to hear the news.

housemusic on 5 March, 2012 at 1:41 pm #

I am getting a 2nd opinion tomorrow. He did not mention this being a congenital defect. Very scared…

johnsfbay on 5 March, 2012 at 4:00 pm #

You can be sure that all of us are hoping for some positive news tomorrow from your 2nd opinion. For your mental and physical health, please try to sleep and eat, especially with the stressful job and injury to deal with! Take care!

doryt on 5 March, 2012 at 4:21 pm #

Ahh housemusic, that is aweful.
Hang in there and all I can say is you will know what you are in for… I too have a sore right AT and my surgeon tells me to deal with the ruptured one first. I pray I don’t have to go through this again. Yours sounds pretty likely to happen since they know there is a hole in the AT. I haveb\n’t had the right MRI’s …yet. Stay strong and positive cuz it is what it is! Hope the 2nd has a greater outlook for you!

Leni on 5 March, 2012 at 5:38 pm #

Oh no! Major bummer. So sorry to hear this. I hope your second opinion & the up coming journey goes much better for you. Please keep us posted. Thinking of you.

housemusic on 5 March, 2012 at 6:20 pm #

Thank you for the support.
@ryanb, I really appreciate your help with the questions that need to be answered. I agree that going straight into a boot may be a good idea. The doctor confirmed a partial tear, and I agree that going into the non surgical protocol with a partial tear is an advantage. In any case, I have to complete a business trip before I can take time off. Otherwise I will have no tendon, no job and no health insurance!
Hopefully the tendon will hold for three more weeks. In the meantime, I’ve been advise to walk slow, watch my step and avoid loading the achilles too much or too fast…
I will keep you all posted and truly hope none of you have to deal with this.
Except Norm, who has already done both. But a least he enjoyed a few years in between…

Janus on 5 March, 2012 at 6:37 pm #

Wow. Well, Norm’s a great example of fortitude and wisdom — but I don’t envy the way he earned it. I would be overwhelmed right now if I had the same news as you — you’re handling much better than I likely would. My heart goes out to you, and my best wishes for you.

Camperkate on 5 March, 2012 at 7:27 pm #

So sorry to hear about your situation ! I tore my right AT about a week ahead of you- 6 months ago this week. I followed the non-surgical route and have done well with it. Getting in the boot quickly can at least get you on the path to recovery and it will take the load off the AT while you travel/ work etc. Hopefully it might even prevent the rupture from happening. Best of luck and my thoughts are with you. Kate

kathyw on 5 March, 2012 at 7:38 pm #

I’m so sorry to hear this…the idea of going through it all again is difficult and depressing, but I agree that you should get a second opinion, and in the meantime, be very careful…get through the next weeks and your business trip with as much care as possible, and know that a lot of us are wishing you well & keeping fingers crossed…

housemusic on 6 March, 2012 at 1:46 pm #

Hello again folks, I am grateful for the support and encouragement in this board!
Today I went for a second opinion. I chose the Kerlan-Jobe Orthopedic Center in LA as they have an excellent reputation. The doctor who saw me has a long resume.I was astonished to hear his opinion. He is sure my right tendon will not rupture. In his 30 years of practice, all ATRs he has seen happened out of the blue with no prior “announcement”. And all of the people with tendinosis (which is what is affecting my right tendon) do not rupture. He said to ice it, continue with some therapy and it will heal on its own. And if it does not get better in two months, he said PRP should be the next step. Another suggestion is to wear heels rather than flats. Needless to say, I came out of the consultation baffled…

normofthenorth on 9 March, 2012 at 12:32 am #

Coupla points, HM:

1) I used to hear what your 2nd surgeon said — that nobody with AT problems gets an ATR, they always come out of the blue. But you can’t read the posts here and still believe that, sorry, because LOTS of us here had AT problems before the ATR. That Doc must have seen a skewed sample. The more recent info I’ve seen said that something like 60% came out of the blue, and the rest went to people who had some form of tendinosis, etc. (I don’t know if any of the numbers is reliable.)
2) If your right AT does rupture, you should certainly consider the non-op path, with a fast and convenient (and well tested) protocol like UWO’s. If nothing else, you’ll skip the worst of the pain, the scar, the risk of infections, a non-healing wound, and suture rejection, etc. That and knowing that there’s light at the tunnel’s end should make the second one much easier for you, as it was for me.

Unfortunately, it’s the rupture that seems to trigger the “magic” inflammatory/healing response that reattaches and rebuilds the AT, and you’ve had little or none of that, so I don’t think starting the protocol early would work the way it does after a full ATR.

3) During my ~2 yrs posting here, I think there have been at least a half-dozen (maybe more) other posters who’ve done both sides. There’s a study linked from the “studies” page (Main Page) that estimates the above-normal risk of tearing the second one, and it’s pretty huge. One-timers were ~200x more likely to tear the other side in the next 4 years, than the public as a whole. And the risk doesn’t drop to zero or normal after 4 years, either.

I certainly enjoyed the 8 years between my two ATRs, especially the ~7 years of full activity after my first ATR fully healed. OTOH, if yours is going to go, having it go soon would save you some rehab time overall, because your two rehabs would overlap some. You’re still less than 100% on the first one, but close enough that it would hold you up well on crutches. I’m just sayin’…

4) I think the last thing I’d want to do is to super-coddle the right AT. If it’s going to go, let it go and then recover, surgically or non-op, and get over it. That’s what I’d want for me, anyway. If I babied it for 3 or 4 months and then it went anyway, I think I’d injure my GOOD leg kicking myself! ;-)

BTW, I paid for PRP as part of the non-op treatment of my second ATR. Very soon after, the first controlled study was published (on AT tendinosis, not ATR), and the PRP results were indistinguishable from saline injections. Some people find them excruciatingly painful, too. I think I’d skip ‘em. Again, that’s me.

Good luck with both sides!

rosethorn on 10 March, 2012 at 2:58 pm #


I have found great pain and stress relief for my troubled “good leg” through community acupuncture sessions. If nothing else, it really allows you to focus on the feelings of challenged safety that come along with the possible threat of another ATR. Acupuncture allows for the possibility of uniting the conscious and subconscious and it’s amazing how you can challenge your fears when in such a state of lucidity. There are affordable acupuncture clinics in most major metropolitan areas and if that option is not open to you, most insurance allows for “alternative treatments” such as acupuncture. My physical therapy clinic actually has two acupuncturists on staff. Consider your options and stay positive– it’s amazing how much of it can be in your mind.

I went in for an “emergency” visit several weeks ago with cramping, shooting pain and fear of another rupture. Once I had my doctors’ confirmation that I would not rupture the compromised tendon, much of that discomfort dissipated.

housemusic on 10 March, 2012 at 10:47 pm #

did you get an ultrasound on your intact tendon? how did the doctor determine it is not at risk for rupture?

housemusic on 10 March, 2012 at 11:07 pm #

Thanks for taking the time to comment.
Point 1) I entirely agree. In fact, I often wondered if I had an underlying condition. Which explains why I ruptured while the other 400 dancers did not get hurt.
2) The only reason I considered surgery the first time was my MRI showing a 3 inch gap which four docs deemed too large to heal correctly on its own. I only have one concern with the non-surgical protocol: risk of rerupture as the tendon is weak. However, the risks of surgery outweigh the benefits, and I’m not playing professional basketball any time soon. My inclination for rupture # 2 is to follow the UWO protocol.
BTW, my surgeon also said I should let it go, as it is the stress of a rupture that promotes the long term healing.
3) I am six months into the healing process, my operated tendon feels very strong (possibly because I received an autologous transfer using a piece of plantaris tendon). I still cannot do 1 single heel raise, other than that, it’s fine and would hold me in crutches.
4) I’m hoping rupture # 2 cooperates with my professional schedule.Next week I am going to Europe on business, and I need that tendon or my job position will be in jeopardy! That is why I am being extra careful. The doctor said tendons do not rupture spontaneously, or while we sleep, sit around or walk.
I do have a tear which is visible in the ultrasound, so no running or jumping. All I do is a light gym workout and the stationary bike.
About PRP, I hear conflicting information and it is not covered by my health insurance. If I survive the trip, I may try but won’t hold my breath.
Thank you everyone1 I appreciate all of you! Rupture or no rupture, I will keep everyone posted.

Harry H on 11 March, 2012 at 3:47 am #

Hi all
Full ATR Left Leg, Age 59. Non-op
If it helps anyone I list below the stages of my recovery so far.
No real pain other than at the time of the rupture.
Week 1 - Aircast Boot fitted 4 heel wedges to keep foot at required angle.
Weeks 2 - 6 One wedge removed every 2 weeks.
Weeks 7 - 8 Final wedge removed, started Partial Weight Bearing (boot still fitted). This became Full Weight Bearing after about 6 days and I started walking a few paces.
Week 9 - Started Physiotherapy. Foot very red and swollen. Tendon very tight. Started basic stretching exercises. Walking well with boot still fitted. Started walking a few paces without the boot, occasionally without a crutch.
Fluid underneath my heel caused pain for a while. Biggest problem so far is that I cannot but any pressure on the ball of my left foot to push off when walking, hence I am rather flat footed. Just muscle wastage though and it should soon improve.
Week 10 - Started walking without boot. Still struggling on the ball of my foot but no crutches and first time in bed without the boot!!!
When walking without the boot I can be slightly wobbly as the knee and calf are also weak but the improvement on a daily basis is rapid.
Still do wear the boot when not doing my stretching exercises. I can now walk a long way with the boot fitted with or without a crutch. Crutch is helpful though due to the uneven height of the boot compared to my normal shoe on my good side.
I can now pace up and down the lounge many times without a crutch or boot.
Tried from the onset not to limp and this has worked wonders.
My biggest issue throughout was worry and how thoroughly would I recover. I was uncertain how the non-op procedure would progress but so far I am delighted. If this heals well (and so far I cannot complain) then I can recommend non-op and boot to anyone.
On the negative side, the doctor told me that the Achilles is degenerative and it is likely that my other side will also rupture at some time! Too much active sport to blame. Oh Well, I had better carry on and try not to worry about that one!
Time on the Golf Course once again is getting ever nearer, but I had better stop playing Badminton (which caused my rupture) and sadly retire my racquets.

Susan on 11 March, 2012 at 8:07 pm #

Hi House, I’m so sorry that the 1st Dr. gave you a bad prognosis. I like the 2nd Doc’s opinion much better. I think that within reason, you can not live like your right tendon is glass. You got to go on. If it helps, I was traveling for business from TX to CA this last week. At 14 weeks out, I traveled in my boot and then when at the office or other secure area, I was in 2 shoes, though nothing fancy or too high. Best of luck to you and all!!!!

kiwiclaire on 12 March, 2012 at 1:03 am #

A story re does tendonitis lead to rupture. When I went to see my physio for some advice re stretching, he said forget it and do eccentric loading (which worked amazingly!) He said the research around this was started from the following story: Two orthopaedic surgeons covered a large remote area of Norway; one had severe achilles tendonitis, so bad that he was pestering his colleague to operate on it; his colleague refused because he knew he would have to cover all his mates work while he was laid up. The first surgeon thought blow this I’m going to do everything I can to rupture it so that he has to operate on me; he did loads of full weightbearing into full stretch and instead of rupturing it got better!! and so that line of research got going and the principle is used for shoulders, knees and other tendons/muscles. My physio friend says he has had good results treating shoulders this way. However, it doesn’t sound like anyone in the states is talking about this as an option; yet again there seems to be no right or wrong way.

housemusic on 13 March, 2012 at 3:27 pm #

Thank you Susan, kiwiclaire, and everyone else. I am holding tight and just hoping for the best. At this stage, the Ultrasound shows a partial tear, so I know it will go. It is now a matter of time. I just live one day at a time. I worry about rupturing during a business trip in Europe as it would put an end to my career which already suffered a great setback with my first rupture. If I survive the trip, I can at least plan ahead.
@Harry H, good to hear you are progresssing with the non-op protocol. For my next rupture I plan to do the same.

mljackson60 on 13 March, 2012 at 7:17 pm #

I’m catching up on posts. So sorry to read about your right AT. I hope that it heals and does not rupture!

Stuart on 14 March, 2012 at 2:51 pm #

Ultra sounds are not relaible or accurate when it comes to this injury. An MRI would be the best but you have had one of those on the other so you would know that. Taking it easy is definitely the best way forward for the moment. My father completely ruptured his while the physio was getting him to eccentric load. He most likely had a partial rupture and not tendonitis. Can you fit the boot into your bag for Europe? I would take it. The financial aspect to this injury has also hit me hard and I could not afford for the other AT to go just at the moment either. I only have a year to finish my house before the building permit expires and I cannot afford to pay someone else to build it. This injury has already put us behind 6 months and increased my debt by ???? Don’t want to think about it.

Nivergvup on 23 March, 2012 at 8:06 am #

Well it is funny how your original lifeline that was this website slowly fades in importance as your regular routine returns. All the people that you shared all your thoughts with also slowly seem to fade away. I haven’t been back here for awhile and it was with great sadness that I read about what’s going on with you Housemusic! I really hope that things are starting to turn around with your right leg. Good luck and I am definitley going to be checking in now that one of the peeps that I started this process with is going through a rough time! Take care and let me know how things are going!

jean on 3 April, 2012 at 3:56 pm #

63 years old male haitian.Loving to walk.Moving too fast as usual I miss a step on a 2-step stairs.An excruciating pain around the left calf.Thought it was the fibula but Doc said ATR.Conservative treatment.Cast#1 :3 weeks full dorsiflexion.Cast#2: 3 weeks half-way.Cast #3:3weeks foot 90degree and the first privilege to touch the floor with a cast shoe.In Haiti we can’t afford any risk.Then I had to take low molecular weight heparin every day during the 9 weeks of immobilization to avoid DVT and PE.After 9 weeks,I started the boot,used a higher shoe on the left for a good balance and kicked the crutches.One week after on my one I was able to perform full range of motion of my ankle.Two weeks later I walked without the boot with a very little limp,difficult to notice.I build up my calf muscles anytime I lay down and they are already very strong at 12 weeks.I will see the therapist next week ,I think only for some professional guidelines.But I know for sure I will keep the boot by my side for the next 12 months.I will use it anytime good sense will tell me.And let’s put some mind over body. TK U very much for the blog.I am learning a lot.

mulberry bags on 24 September, 2012 at 12:28 am #

My right ATR has been very sore, specially after any activity, even a short walk.
I went for an ultrasound and the surgeon said there is a hole in the tendon and it is very likely to rupture.

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