I See You Tore Your Achille’s Tendon, I Tore My Achille’s Tendon Too…

Hello everybody! I’m new here so let me take a moment to introduce myself. I’m a 40 year old male from Kentucky. I am happily married to a beautiful Brazilian woman and we have two wonderful children. Our daughter is 9 years old and our son will be 7 in December. I own a small independent pharmacy (actually, the bank owns it, but they’re nice enough to let me work for them ;) ) and am living a charmed life… until now!

But let me give you a little backstory before I get into the meat of the matter… Our kids really love swimming and over the summer we put them on a Swim Team just for fun… It turns out that they are very good swimmers! Not only did they enjoy swimming, but they enjoyed competing… so, when the summer session was over my wife and I decided to put them on a more professional team with real coaches and regular practices… They swim for the local YMCA now and are doing well…

My wife and I decided that we should take advantage of being at the Y 3 days a week by using their facilities to help us get into better shape. For the past 3 weeks she and I have been doing various activities including walking, jogging, Yoga, and, in my case, some basketball.

I had gotten to the point where I could speed-walk (for lack of a better term) for 3/4 mile and then SPRINT (up on my toes) for more than 1/4 mile… and I did it with relative comfort. I did Yoga with relative ease… On Sunday, November 14th, I went to the basketball courts and just shot around by myself for a while…

By the time I was done playing ball I had jumped up and touched the rim… I had jumped up and hit the backboard several times… I ran a LOT of layups and got thoroughly exhausted… It felt great!!!

So, when the kids went to swim practice on Tuesday, November 16th, my wife went off to spinning class and I did my speed-walk/Sprint routine (sprinting 3/8th’s of a mile)… I felt like a million bucks… I was very surprised at how quickly I was getting into shape.

I went down to watch the boys play basketball while I caught my breath for a minute… a game finished and a new game was starting up… they were 1 man short and asked if I wanted to play. I said, “Well, I don’t think I can play an entire game but I’ll fill in for 5 minutes or so until somebody else returns…” They said, “Nobody’s coming back…” I smiled and said, “OK, I’ll play, but here’s the deal: I’m 40 years old and haven’t played in a few years. I’m gonna take it easy… I might even do a lot of walking… but I can rebound and pass you guys the ball and let you do most of the playing…” They said, “That’s cool, you can play with us…”

There were some younger kids dribbling around the sidelines and passing back and forth… not part of the game, but part of the environment….

I was happy to be on the team I was on… I had watched most of them in the previous game and I was likely on the winning team… Somebody shot for the ball and our team ended up with it. I took my position under the basket and play began…

Our guard dribbled for a moment and then just shot the ball…

He missed.

I grabbed the rebound, as promised… I landed and passed the ball and I was finished.

There was a very loud POP!!!! All the fellas heard it…

I heard it, too, obviously… and I felt a basketball hit me on the back of my ankle. I thought one of the younger kids had lost control of his ball and it had made it to the court and hit me…. I looked for a ball but there was none. I tried to stand up and get back in the game but couldn’t…. and down I went…

One of the fellas looked down at me and said, “Already, man?”

I smiled and said, “Yup! I’m sorry guys, but I have to go to the hospital now.”

Somehow I managed to walk across the gym (two basketball courts) and up a flight of stairs to get my wifes attention… I made it to the lobby and, by that time, had attracted a lot of attention. Fortunately there was an E.R. doctor in the lobby, too :) I immediately put ice on it and kept it very cold for as long as possible.

Anyway… I was able to get it imobilized within 2 hours of the injury. Luckily for me I am friends with an Osteopath who was able to see me on Wednesday the 17th. In the meantime I started scouring the internet trying to learn about what I was in for… I learned that I didn’t have to have surgery (more than likely) in order to get good results… Anyway, he verified the diagnosis and explained I could either have surgery or not… I told him I’d rather not. He said, “OK, we’ll put you in a cast in “Ballerina Position” with toes pointed down…” He explained why he was doing this and explained how things would progress assuming I was able to heal this way…

He ordered an MRI (which I got on Friday the 19th) and said we’d see from the images if non-surgery was going to work. He explained that if the tendon wasn’t close enough together that he’d recommend surgery… said it would heal but the distance would be too great and the tendon would be too long in the end… and that wouldn’t be good…

So, I’m no doctor and I don’t claim to be qualified to read an MRI, but… it looks pretty good to me! I think I had a very clean tear and I think it’s sitting snugly together… I’m optimistic.

My appointment is for 1:00pm (Eastern) today and I will find out for sure. Fingers crossed!

Incidentally, I have not experienced any pain whatsoever…. so far!!!
Seriously. None. Is that normal?

I take that back… my cast is so big it covers my toes, too… My toes hurt a little… I have been wiggling the and that has really helped… But I worry if I should be doing that???? Is it OK if I wiggle my toes? …or should I stop doing that?

But I’ve had no pain whatsoever on my achilles tendon.

So… I’ll continue reading other’s blogs and getting to know you folks… I’ll continue updating on my status… I’ll continue asking questions… etc… Looks like it’s gonna be a bumpy ride!

Thanks in advance for any information and support you will offer!

Icky

10 Responses to “I See You Tore Your Achille’s Tendon, I Tore My Achille’s Tendon Too…”

  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. Hello Icky - well done on getting your blog - can’t wait to hear from you.

  3. I typed a big entry :)
    I Saved It…
    I can view it…
    But I don’t see it posted anywhere… yet.
    I assume it’s will be reviewed before being posted :)
    Anyway… Whew! It is written :)

  4. I figured it out :)

  5. I too had very little to no pain. i went into an “aircast” after 48 hours (when the diagnosis was made)

    my ultrasound results were ~15 mm gap at neutral and ~7mm gap with toes pointed down (not sure how many degrees)

    those ‘gaps’ were within my centers protocol, so i went non-surgical and i am very happy i did

    i STRONGLY recommend asking your ortho:
    1) how many, if any, non-operative patients have you had?
    2) how would he/she compare the rehab protocols?

    I suggest getting a protocol as soon as you can, and bring it in every time with your notes / personal experience.

    I say this because, in my case, (and my opinion), I went non-operative with a slow, lets be safe type of recovery. non-necessarily a bad thing. But that route is much easier on the doc than on the patient!! And I didnt get a ton of time to discuss before my doc was on to the next patient

    Keep us posted and good luck!

  6. Is the gap size relevant? I had a 6 cm gap which seems huge, i could put my whole palm in the gap, but there was no question of surgery as a result. Norm - did you say something at some point about gap size and one of the studies you looked at?

  7. Hi Icky.

    Sorry to hear about your rupture. Like yourself I am 40 with two young children. I ruptured my tendon 4 weeks ago but I am only 3 weeks post surgery.

    Surgery was the only way to go for me because it was a complete rupture & the re-rupture rates were lower.

    From reading other peoples blogs we are on a slow path to recover. I look forward to your future blogs.

    By the way I had no pain. Could be the signs of a complete rupture like me. My sister in law who is a physio could me that tendon have a poorer supply of nerves and blood compared to muscle. This also may be why the pain was not that great.

    Happy hopping

  8. Just got back from the Doc.
    No surgery! Yay!
    He’s been at this for 20+ years… His Father for 45+ years… And their foot and ankle Doc is one of the best in town (approximate 15 yrs)

    Slow and steady… First cast off on Dec 29th…

    Busy now…. Details later :)

  9. OK… So, here in Lexington, KY we have a University (The University of Kentucky)… Besides research and medicine the University is known for Basketball (Kentucky Wildcats)… There is also a football team… And this region is pretty full of athletic types…

    According to my Osteopath there are various clinics around that treat Achilles Tears differently… some more aggressive than others… He says they pretty regularly (several a year) who come to them after suffering setbacks or reruptures due to therapy that’s too aggressive…

    One fella ended up with an achilles that was too short (not yet stretched long enough) and his therapy was too much…and he reruptured it… Fortunately he was able to take the nonsurgical route (leaving about 6mm gap) which healed nicely and his achilles was the right length.

    Anyway… he says they have fewer complications over time by just going slow and steady…

    Apparently I could be out of the cast more quickly if I took the surgery…

    Apparently I could begin therapy sooner… and even have more strength at the 6 month mark…

    But, after 1 year there’d be no difference. The strength and range of motion are virtually indistinguishable after 1 year…

    With that in mind, I’m going to take his advice and just go at a slow and steady pace…

    If it appears that I am responding nicely and we can step things up a bit, then of course that’s what we’ll do…

    So… 6 weeks post injury will be December 29th… We’ll remove this cast and angle my toes up a bit…then recast… Maybe do that again 2 weeks or so later… then around week 9 or 10 I should be in a boot…

    My target is to be wearing shoes for my camping trip planned for February. I think having a goal like that might help (as long as I reach it… If I don’t make it I suppose it could backfire and be the cause of some frustration)…

    Anyway, I’m very pleased with my doctors visit today… I am very comfortable with the plan right now… and I’m very optimistic that this time next year I’ll be doing just fine.

  10. Welcome, icky, and Hi to the others. A coupla things:
    I’ve only seen one (small) study on the effect of ATR gap size (measured with Ultrasound) on clinical results without surgery, and that study found there was NO effect! The large gaps healed just as well non-surgically — strength, ROM (=~ healed AT length), and re-rupture rate — as the tiny ones.
    It’s written up (abstract) at proceedings.jbjs.org.uk/cgi/content/abstract/91-B/SUPP_II/244 , if you’re a study geek. It also found no effect from different LOCATIONS of the tear — the treatment worked just as well on low, medium, and high ATRs.

    unluckysquashaddict, all of my fave studies that showed identical results with and without surgery (and several studies that showed the contrary, esp. pre-2007) limited themselves to COMPLETE ATRs. It “sounds logical” that partial tears would heal better without surgery, but I don’t think anybody’s ever tested it in a good study. They HAVE tested different approaches with FULL tears, and the studies with the best non-op results (like my fave, the UWO study, report at bit.ly/UWOStudyPub and protocol at bit.ly/UWOProtocol ) produced excellent results that were statistically indistinguishable from post-op results (except in complications).

    My “take” on the various studies and meta-studies is that surgery works reliably pretty well with a wide range of rehab protocols, except for the smallish minority who suffer from complications. Non-surgical care CAN work just as well, and without the complications, but probably ONLY if a good rehab protocol is used. Unfortunately, the traditional old-fashioned approach to non-op treatment is “conservative casting” (i.e., slow, with a long period of NWB and a long period of abolute immobilization), which seems to produce a re-rupture rate much higher than surgery.

    It’s ironic and illogical, of course, that being “conservative” seems to be MORE risky and dangerous than being “aggressive”, but that seems to be where the evidence leads in ATR treatment. (And it’s only one of MANY cases where the facts and the “logic” don’t seem to agree.)

    Many studies and metastudies have found higher re-rupture rates without surgery, but virtually all or all of them have treated non-op patients “conservatively”. I’ve steered people to 4 studies that all showed good-to-excellent results without surgery, and the biggest and most careful and most successful seems to be the one from UWO. They included around 70-odd patients on each side of a randomized study (~145 total), half who got the op and half who didn’t. 2 re-ruptures without surgery, 1 with surgery — not stat-sig different, and both pretty close to zero when there are so many ways to re-rupture accidentally even with great treatment.

    Some say the jury is still out, or even that surgery produces better results on average. And nobody denies that surgery produces excellent results for most patients. I certainly don’t recommend any randomly chosen non-op treatment, but the combo of non-surgical and a proven protocol like the UWO one, looks like a winner to me. (It’s very easy to bake a cake that tastes terrible. IMHO, that doesn’t prove that all cake is bad, or that all baking is bad. But if you find a recipe that reliably produces delicious cake, you have found something valuable!)

    Icky, there are many reasons to prefer a boot to a cast, and maybe especially so without surgery. Access to early exercise and PT and hygiene, more opportunity to adjust the fit and maximize comfort, better control of precise ankle angle (either with hinges or with hard-rubber heel wedges), and the ability to go “part time” — like showering and sleeping bootless, and eventually walking at home in shoes or barefoot, but in the boot when venturing out to scarier locations. If the boot is one of the fancier ones (like the Vaco) that can “hinge”, you also have the opportunity to use that feature to gain strength (later, maybe 7-9 wks “post”) while still retaining some protection against injury.

    And the consensus around here (and in the UWO protocol) is that wiggling your toes won’t hurt your healing AT, and is probably good for you. The UWO schedule has you removing the boot for gentle foot-wiggling exercise (not just TOE wiggling) starting at 2 weeks post-immobilization, which you’re not at yet, but soon.

    Check out that protocol, and its results. It seems to produce a tasty cake! A lot of medicine is “observational” rather than “evidence-based”, and I’ve made my preference for the latter known all over this site (some would say ad nauseam)!

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