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Thanks for adding me to the Achilles Blog. Here’s my story: I just ruptured my left achilles playing freestyle frisbee on the beach here in Santa Cruz. I’m 58 years old, lead a fairly active life. I’m 5′10″ 165lbs. I go in to see the podiatrist tomorrow at 8am to see what the plan is going to be. This is actually the 3rd time I’ve had a torn achilles tendon. I had a complete distal rupture of the left back in 1998 (playing hard court basketball). I went the non-surgical route and it took about 10-12 months from date of injury to come back to being a low level functioning person. Not long after that I developed planter fasciitis in my right foot (probably from over compensating and trying to come back too quickly). Over time the injury completely healed and I had no restrictions.
In 2001 I stepped in a divot on the field running, playing Ultimate and felt the horrid spike/explosion on my right foot. I knew immediately what i had done. This was a partial tear but it was still tough. I went the non-surgical route again. Since it was not a complete rupture, the timeline was accelerated up to 8 months to being back and functioning at a low level (cycling, walking, playing golf).
Now here it is 12 years after that injury. This one is a partial tear but I can not press off the front of my foot. Thomson’s test reveals some response. I’m now of the frame of mind that I’m going to go with the surgical route in the hopes that I can comeback with a shorter recovery time. And advice is most welcome. I also want to retain some level of conditioning as I come back. I’m an avid cyclist and I plan on buying a bike trainer to help keep my cardio up and a general conditioning base. I also figure that when it gets to the point I’m rehabbing, I can gradually increase the weight bearing on the recovering tendon by gently increasing my resistance on the bike trainer.
Wish me luck, I’ll need it.
Welcome! Waving from the Bay Area–I’m over the hill from you. Sorry you are back for round 3. Most unfortunate. I’m sure someone will chime in with opinions. Mine is a complete rupture and I’m going non-surgical. Best of luck. Keep us posted.
(btw, you can delete the “Hello World” post and put your own title and post in–right now your intro is in the comments and might get missed by other readers.)
Unfortunately I don’t have any advice for you since I am a rookie but with your Achillies experience you may have some advice for us. Good luck with your recovery and hope hear about your progress.
Thanks Kellygirl and Cole. I’ll keep everyone posted as I go through this ordeal.
Jammer, you’re very unusual to rerupture the same AT that already healed. Did it clearly rupture at a different part of the tendon? Me, I’d recommend the “shorter recovery time” (aka fast rehab) without the surgery, but it’s obviously your choice not mine.
Hi Normofthenorth. I still haven’t had to clear review of the injury but it certainly is torn in a different location. My first rupture of my left was Distal (tendon pulled off the bone). This is a tear a few centimeters up the tendon. Thanks for he advice, that’s the direction I’m leaning.
I had a full tear just over one year ago. The advice from my specialist was to go for non-op although he felt it to be a borderline case because it had been misdiagnosed for 10 days and was 100% torn.
My rehab protocol was ‘accelerated’ and exactly the same as for a surgical case all the way through but without the risks - oh, except for some swelling as we stepped up the physio after about 3 or 4 weeks. I was in a lightweight cast for 2 weeks, then a Vaco boot to week 9.
If your wound isn’t complex, surely it must be non-op for you. You and a very others here could be leading the way in the USA.
OK, good info Hillie. When were you able to go to PWB and FWB?
From week 3, wearing the boot, I began to weight bear, weaning off the crutches/knee trolley during week 3 and 4. This became easier still after week 4 when my boot had a range of movement which was subsequently increased once every 2 weeks.
I began light physio from week 3 and started on my static bike, with boot on, in about week 4.
Although the protocol had a modern, fast schedule, similar in parts to UWO but with improved boot (time has moved on, although UWO was only 2010), my Ortho Centre described it as ‘conservative’, although this was only compared to ’surgical’ which had same timeline. With ‘conservative’ of course, there is little or no post-diagnosis trauma.
The key element is gaining mobility early, led by a good physiotherapist - less atrophy in the calf muscles, improved blood flow, retention of muscle memory (possibly a reason in some cases for problems with heel lifts further on in the recovery cycle), improved feeling of well-being. The downside? You need to take great care of your good leg - one foot will be higher than the other and you need to build up that foot by an extra few centimetres - I didn’t do this soon enough and my ‘good’ knee and hip suffered for it.
Just saw the Physician’s Assistant and I’m scheduled for surgery next Friday June 14th. I’m looking forward to getting past the surgery and it to the healing phase of this injury. Had an ultrasound on the injured tendon and there are a few strands intact but it’s not much.
Hi Jammer
What happened? I thought that you were going non-op. From my non-medical point of view, and my real life experience, never mind the fairly recent research, I can’t see any advantage in having surgery. You’ve even got the strands to show the repair the way home.
None of my business, just curious.
Best wishes and good luck.
H
The Ortho said it was more extensive than I was led to believe. There are a few strands intact but it’s mostly gone. Plus with my pre-existing injury, the though was this would make it more stable and prevent another rupture. I’m just going along with what the Ortho is suggesting at this point. And it should make it stronger and speed up the recovery time so I’m all for those things. Wish me luck.
Tearing the tendon off the bone (your first injury) is one of those cases I would have guessed to be better treated with surgery. In a ‘normal’ tear, both sides can participate in the magical process of the tendon ends finding eachother and knitting themselves back together. In a detachment from the bone, I would guess the non op repair process must work quite differently. A surgical repair for the two injuries is certainly different. I’m a bit surprised that it worked at all, but no more surprised, I suppose, than when I learned that nonop can work for many ‘normal’ tears too.
I am curious about your comment about it taking ~12 months to get back to low level functionality. That is very slow. On the other hand, the original tear must have been strong enough to survive whatever forces caused the new injury.
Hi Ryan. it seems as though the treatment of AT injuries has come a long way from when I did it the first time back in ‘98. When I sustained this injury I was functioning as a competitive athlete. So getting myself back to being able to compete at a low level was my point of reference (12 months). I believe the issue with going non-surgical at that time is you would need to staple or fix the tendon to the bone. But I didn’t do much research at the time. The internet wasn’t as full of information as it is now. And I was just following my Ortho Doc’s suggested plan. Looking at the old injuries on the Ultrasound yesterday showed some scar tissue but both of the old wounds are completely healed with no issues (no nubs or protrusions). Thanks for all these comments! It’s great being able to have some open dialog about this. My mindset now is to go the surgery route. It would speed up the recovery phase and would also help guarantee against a future episode of this kind (re-rupture).
Jammer, in ‘98 — in fact, until at least ‘07 — it wasn’t just the Internet that thought (knew!) that non-op was a bad idea for ATRs, it was the world. And it’s not unreasonable to say that the slow “conservative” non-op treatment of ‘98 is STILL a bad idea, though some Docs and hospitals and regions still offer it as an alternative. Malpractice I’d call it, but way more common than prosecutions.
I agree with maybe all of Ryan’s points (not for the first time). And I wonder exactly what you’re calling “low level”, since you started very high. At 10-11 months after my forst ATR, I thought my volleyball speed and vertical were 100% of pre-ATR levels, but if I’d been an elite athlete I’d have measured everything and I might have found a deficit that I didn’t notice subjectively. One study of US pro football players with ATRs (& fancy care) found that ~15% returned to their pre-ATR levels of play. Maybe biased by the (probably high) avg age of the subjects — i.e. their level might have faded WITHOUT an ATR…
Good points Norm. Another factor that played into my slow recovery back in ‘98 was I was a brand new father for the first time. I literally walked my new born son from the delivery room back to our room in the hospital wearing my walking boot. So my frame of mind was less on ‘getting back to where I was’ than it was enjoying fatherhood for the first time. Similarly in ‘01 I had a three year old and a one year old to tend to. Thanks for all these comments, helps keep me going.
Sounds like you have a plan and you are sticking to it. Good luck, Jammer!
Surgery this Friday. I’ll report back after that.
For those veterans of AT surgeries, how long were you on on the Heavy Meds? Were you able to manage any of it with Tylenol? I’m heading in for surgery tomorrow morning. Wish me luck.
Good luck
I had surgery last Wednesday . I’m still taking a vicodin (mostly at night) anda muscle relaxer for spasms as well. You will do great tomorrow , try not to worry.
Thanks 1shann! Are you also taking tylenol during the day? Was your surgery from Wednesday of last week or two days ago.
New here but is surgery still the preferred option for AT treatment? Seems over-the-top after reading up non-surgical methods and recent research, which seem to show repairs just as strong but without the blood and guts.
Any thoughts or even opinions from those who’ve been there, got the t-shirt, etc?
Hi Jammer, I hope everything went well for you today. My surgery was on 6/5. I haven’t been taking Tylenol. I cut way down on the painkiller 2 days after the surgery and became very sad and spent a big part of the next 2 days crying. The ortho nurse urged me to take it as prescribed for the next 48 hours whether I felt like I needed it or not. She said healing cannot happen when you are so stressed out. I followed her suggestion and felt way better… Another mistake I have made is waiting for the pain before taking medicine. It does seem to be more effective when taken on schedule (although, I must admit that it has proven difficult for me to follow this advice myself).
Hope you are doing well. Get lots of rest
Hi Jammer,
I had surgery two weeks ago and I was able to be off the meds after two days. I had a nerve block that lasted a day. My advice is to take the meds as you need them and try to stay ahead of the pain. If you are four plus days out and still in significant pain, you probably should give your doc a call. Also, us older guys just don’t heal as fast as we used to……..
Hi ATR buff
Normofthenorth had both op and non op, he prefers the non op route and in my opinion an authority on the subject backed up by data , I’m so far glad I did non op, mant people think sports people should go op, I say check out brady browne on you tube, that being said I do see benefits of op, and those successful like 2 work colleagues call me daft for going non op, but data is data
Hi Rip…
As far as I can tell, for most folks non-surgical gives results just as strong. I know that there are some with complicated or stale injuries that must have surgery, but for the others is it worth the risks of an operation, together with the additional pain and risk (30 per cent I read somewhere) of infection, and surgery that may not work? Then there is the much higher cost.
Even from reading this blog it is only too obvious that surgical and non-surgical repairs can both re-rupture.
BTW, I’m non-surgical too, climbing mountains and trekking with big rucsac, and that’s 2 years post-injury. For other ‘bodywork’ I’ve had surgery and it was right for that condition, so I am not anti operations, just that it needs to be the right thing to do.
More feedback from anyone afflicted?
I just came out of surgery. All seemed to go well. The Ortho Surgeon said that my initial injury didn’t heal correctly. The tendon was overly stiff and brittle which led to the re-rupture. It was so stiff it pulled a piece of bone off. The doc went in and reattached it and supported the tendon with another tendon from the foot (not sure which one, I can look it up). So it’s on to the healing part of the injury finally. And thanks for all the feedback on managing the meds. I’ll keep posting my recovery progress.
Yesterday was brutal. Surgery was on Friday morning. When I came out everything seemed to be fine. My leg was numb below the knee so the lack of sensation equated to no initial discomfort. Then the side effects of the drugs started kicking in. Sensations slowly returned to my leg in the form of tingling follow shortly there after by abject pain. I immediately dosed up on the Oxycodone and the Hydrocodone Acetominophin. I spend almost the entire day sleeping. When I’d wake up I would start retching. The anti-retching drug didn’t have much of an effect. And the pain and discomfort continued through the day. Things slowly abated late in the day and I started using over the counter Tylenol. Now things seem to be good. Pain is mostly gone. No other side effects. Glad that part of the recovery is over.
Today was much better pain wise. Yesterday (day 2 post surgery) was still exceedingly difficult. But today the pain has subsided and I’ve been able to manage it with over the counter meds. I’m still mostly laying around which I’m sure is a very good thing.
Yikes! I’ve read that this surgery is awful. Glad that you have the pain managed now. Rest up and heal on
It’s day 10 post surgery and I just got back from seeing the Ortho PA. Got the cast/splint thing off my leg. Scar from surgery is healing nicely, no complications. I’m currently wearing that cumbersome walking boot all you AT veterans are so familiar with. I can put some limited weight (25%) on my foot starting this Friday (day 15 post surgery) then slowly progressing on two week increments to 50%, 75% then full weight bearing at 6 weeks post surgery. So I’m still crutch mobile for a while longer. Patience is a virtue.
Hi Jammer: Small world, I live in Santa Cruz too. My injury happened two days after your surgery. The whole decision-making process went by very quickly: Urgent Care got me to the orthopedist’s right away, and although I had googled a little information prior to seeing the surgeon and was holding out hope for a non-surgical route, he dismissed that out of hand. He said the re-rupture rate was really high, and that if I hoped to return to my active life (and how here doesn’t?!), surgery was the only way. I found this site after surgery, so obviously I’m second-guessing what happened: he was summarizing results for the “old” cast-only protocol, not the “new” quick-return-to-activity protocol.
Best not to name names on a public site, but I’m wondering…is your ortho part of Palo Alto Medical Foundation? I’m limited to them because of insurance, and I took the surgeon who was available. I wonder if they have a “house policy” about their preferred treatment protocols, and whether they have even worked with the new one.
Luckily my recovery from surgery was easy compared to what you went through. Hope you’re feeling better!
kiki….. my orthopedist strongly encouraged me to go the surgical route. I refused. Tomorrow I get casted and I am going to show him an example of an aggressive protocol.
I hope he is receptive. Glad to hear your healing nicely.
Jammer - I hope your doing better also.
Hi Kiki, I’m with Dignity Health Care (Dominican) and my Ortho is Dr Abidi. I’m fairly well connected in the local medical community and he’s held in high regard so I consider myself lucky. Feel free to shoot me a personal email if you want: skippy_jammer@yahoo.com
I’m curious who your Ortho is.
And superjewgrl, I’m doing my better, thanks for asking! The first week was very tough but I’m now able to do a bit of walking (25% in my boot) and I’m only 14 days Post-Op. So I’m well on my way. First Rehab appointment is this coming Monday.
Best of luck to both of you on your recovery!
Jammer
I’m making steady recovery, far quicker than I anticipated. I’m able to walk around in my boot 18 days post-surgery. I still have a very long way to go but being even partially mobile is a revelation. I started PT on Monday with some very gentle range of motion exercises. The PT is trying to get me to stand more centered on my feet and less on the ball of my feet. Easier said than done after decades of being in that position. Has anyone else had this type of mandate/instruction?
Just got back from the Ortho and am glad to report my progress. I’m day 24 post-surgery. I’m off crutches, took one of the three wedges out of my bledsoe boot and am progressing well. I’m projected to be out of the walking boot in 3 weeks. I can also start doing some rehab work in the pool. I’m a bit frustrated by my Physical Therapist tough. I’ve been twice and came away frustrated by the lack of insight or progression. But maybe it’s just me. Hopefully things will improve on that end.
Sounds like you had a tough surgery and doing great! I went the op route as well and really everything happened so fast I never stopped to question it, I have talked to my doctor about it and granted he is a surgeon but said for me and my injury that was the way to go. I think that was the right way to go. I have only just started PT at 6 weeks, (something I have done for many things many times_ and I just think this is a sssssllllooooowww progression. We are both still in a fragile state.
Now I will have to be asking my dr about getting in the POOL. When I saw him last he said I still could not get in. He is being super conservative with the incision!
Hello lodinpdx. Thanks for your post. The Ortho said I coujld get in the pool to do some ROM exercises and some gentle pushing off the bottom to work the tendon (gently). So that’s a progression. Are you having any issues with your surgery? Sounds like you’re a bit behind my schedule but no two cases or injuries are identical so often times it’s not relevant to compare timelines.
Hello. My dr seems to be on the fast track for most things but not the pool. One reason he told me is that there is not a lot of blood flow in the Achilles and sometimes the incision can reopen even after quite a few weeks. I still had a little bit of scabbing left so he said no pool not even a bath, No soaking. I think it is vetry rare but he has seen it happen so he is just being conservative.
PT told me today she thought all looked good and I could give it a try as long as I did not do too much. Now the problem I have is that the pool I have access is a lap pool and not sure how I will get back out - no steps. I can see it now….
Hi everyone, I’m new to this blog and still trying to find my way around it. I had a full tear and surgery done on June 18th. I just got my sutures removed on Monday July 8th so I’m still very nervous about putting my foot in water but my surgeon told me that in a few days I can even start some swimming if I wanted to. But my question is, what do I do in the pool once I’m in at this stage of my recovery? I don’t want to do anything that may cause damage since I bet it’s still very fragile. I haven’t even been able to fully see the incision yet because those little strips are still on. The surgeon said I can get them wet its not a problem. But I feel a little unsure about this whole process.
I found this site after starting my own blog about my experience too : achillesrecoverylog.blogspot.com - I’m still catching up on posts to present day though
Anyways any help and advice would be awesome. Thanks!
Oops. Surgery date was June 23. I donno why I said 18!
Sorry you’ve joined this elite group but it will be a lifesaver. People encourage you when you’re down and you get a lot of good info from various sources. Regarding your okay to swim - my PT siad going to the pool would be good but that for the first while I should only walk forward, backwards and side ways and for quite a short period of time (10 minutes). She said that the foot/achilles wasn’t quite strong enough yet to be doing any flutter kicking. I , personally found that my PT seems to be much better at rehab suggestiong etc. than the surgeon. Think surgeons are good at surgery but not so great in the rehabilitation process.
Thanks Louise! That helps a lot. And in terms of the incision, if it still has a scab on it then do you recommend waiting until the scab is gone and fully healed to get in a pool? I heard there may be risk of infection if you still have a scab and go swimming.
For what it’s worth, my Ortho cleared me to go in the pool even with my scabs still in place. I’m still pleasantly surprised by my rapid progress. I wonder if this is due to my injury not being a complete rupture. But of course this would have nothing to do with the timeline of me being cleared to be in the pool just short of 4 weeks post surgery. Good luck Louise and skim92.
I just passed the 5 week mark and am already migrating out of the walking boot. Taking very tentative steps, mostly hobbling around but it feels so liberating to be free of crutches and of the boot. Just another step closer to recovery. Best of luck to all of you rehabbing your way through this injury.
I’m at the 7 week post surgery date tomorrow. I continue to make strong progress in my recovery. Met with the Ortho on Monday and he was stunned by my progress. Said I’m ‘ahead of schedule’. On the down side,I’m on my feet all day and by the end of the day my foot becomes swollen and very sore and quite painful. It’s a reminder of how far I still have to go.
That’s great news, Jammer. Hope the end of the day pain and swelling lessens as the weeks go on. Congrats on your progress!
Good news, Jammer. Hey, I was hobbling around parents’ night at my kids’ camp and a fit-looking man started chatting about ATRs. His was 10 months ago, and Dr. Abadi also treated him–said he was “the greatest.” So there’s another satisfied, uh, customer! I have no complaints about my surgeon at PAMF, but clearly yours is on a much more aggressive recovery schedule–I’m still only PWB at 6 weeks even though everything is going fine and I have quite a bit of flexion compared to what it seems others do at this stage. So…tell your guy to keep making the case locally for the fast protocol!
I’m now coming up to week 10 in my post-surgery recovery timeline. I’m on my feet almost all day long which I believe both makes my feet very sore by the end of the day but also is contributing to my accelerated recovery. When I’m fresh I can walk with hardly a limp. It becomes more pronounced as the day goes on. But overall, I’m very pleased and can notice quite a bit of difference with each passing week. Sending out healing thoughts and well wishes to all in your personal journeys through this injury.
Update on my progress. I’m almost 13 weeks post surgery, 15 weeks post injury. I continue to make good progress but it still feels like there’s a long ways to go. I started riding my road bike up the hill to my office. That’s a 650 elevation gain in 4 miles so it’s a good long hump at that hill. I can also walk without a limp unless I’ve been on my feet for a while, then it gets sore. There’s still some swelling in the ankle, likely slowly abating. I’ve got an appointment with the Ortho doc next Monday and will report back anything of relevance. Best of luck to all who are going through this! Hang in there, it gets better over time.
I just met with my Ortho Doc and I’m at 12 1/2 weeks post surgery, 14 1/2 weeks post injury (my previous timeline was incorrect). After a quick review he told me I’m cleared and good to go. No jumping or ‘dynamic’ activities but walking, cycling and swimming are all fine. Last week I suffered through a bike ride up the hill to my office (4 miles up a 650′ hill and my foot was extremely sore during and after the ride. But the day after it was pain free, probably worked out the scar tissue. The ortho said bike riding is the perfect exercise so I’ll continue to do this as much as I can. So I’m relieved! Everything is working out nicely.