Thank goodness for AchillesBlog!
Hi all,
I am ever so glad to have found this group! You all have alleviated that feeling of uncertainty and hopelessness that can come over one after an injury such as this. I was resigned to surgery until a ray of hope came through in reading some of the posts on AchillesBlog.
Injury occurred last Saturday, May 14, while playing recreational soccer and my friends and I immediately suspected it was the old achilles. Saw the orthopedic surgeon on May 16. His diagnosis, full achilles tendon rupture; his recommendation, surgery asap. I do not like the word surgery. Just to be sure I asked for an MRI. In the meantime I had been reading up on ATR and had come across AchillesBlog. To my delight I learned that there is a good chance that even full ATR’s can be treated non-operatively, and with outcomes comparable to surgery, and without the attendant risks! Oh joy, oh joy!
The diagnosis was confirmed by MRI on follow-up visit on May 18 and the doctor’s professional opinion, which I fully respect, was to schedule surgery as soon as possible. Knowing that I had perhaps up to 2 weeks (thanks AchillesBlog!) I decided not to schedule the surgery immediately but to keep sniffing around and let surgery be my absolute last resort.
I was looking desperately for a doctor in my area who would oversee non-operative treatment protocol. No luck… until, you guessed it, AchillesBlog came to the rescue! (Deep breath) On AchillesBlog I found a link to an article that referenced Houston TX, whose co-author I emailed, who gave me the name of a surgeon in Houston, whose assistant I called, who said “of course we can, send us your MRI report”, which I dug up and did, and was ready to go to Houston, from Dallas, if that’s what I had to do in order to heal without surgery (whew!). I am waiting on confirmation that I am a good candidate for non-operative treatment in Houston.
In the meantime I thought “I can’t drive to Houston so… how would I get there? It surely would be good to get treatment closer to home”. Said my very sharp wife, “can the insurance company help you find a doctor in Dallas?” “Hmmm”, said I, “that’s a thought”! This morning, May 20, I called the insurance company, who dug up one doctor in Dallas who will hopefully go non-operative. (Did I mention that my wife is, like, really sharp?) I scheduled an appointment for Monday May 23. Keeping my fingers crossed. If Dallas does not work, then I plan to get to Houston by hook or by crook next Wednesday or Friday, May 25 or 27. I would still be within 2 weeks of the injury. Meanwhile I work out of the house the best I can and keep checking email for a response from Houston, and keep seeking Dallas doctors in case the one I see on Monday says, “I have to cut!”, in which case I will cut and run. And so it goes.
A couple of requests to AchillesBlog users:
- does anyone know of doctors in the Dallas, TX area who would go non-operative on full ATR?
- is there a cheat sheet somewhere to help me decipher some of the acronyms I’m finding on the site (NWB, FWB etc.)?
Thanks!
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HI jamo.
I was in your boat back in January, really didn’t want surgery but knew I needed it when I found out mine was a complete tear. After 4 months, I’m doing very well and am pretty sure I would not be where I am without the surgery.
That being said, if your doctor says he has to cut, I agree with your decision to cut and run. My doc strongly recommended surgery, but told me it was my decision and he’d treat me whichever way I wanted to go, with the caveat that I couldn’t whine to him if I didn’t fully recover without surgery.
Good luck whichever way you end up going.
I think NWB=non-weight bearing and FWB=full weight bearing.
I can’t offer any words of wisdom on Dallas, but NWB, PWB, FWB; non weight bearing, partial weight bearing, and full weight bearing. Generally the three stages you’ll go through in early recovery.
While the literature demonstrates there isn’t much of a clinically significant difference in calf circumference, strength, or ROM between the two routes (op vs. non-op), if you choose non-op, be sure your provider knows what he’s doing. To be as clinically effective as operative treatment, non-operative needs early mobility as part of the protocol. Lots of docs are still old-school with this and many still cast beyond 6 weeks, which is insane considering the literature out there on early mobility.
Some studies show that the re-rupture rate is a bit higher with non-operative. This is because your tendon is putting itself back together through immobilization. It’s a lot easier for a surgeon to give you the green light when they know it’s been reattached via the surgical route.
The rate of infection or other complication is excessively low for younger, active individuals with this injury. It didn’t even cross my mind to go the non-op route even after absorbing all the literature. Usually non-op is reserved for people with other health problems. I was very active before the injury and I wanted the affirmation that my tendon was re-approximated correctly and that I could be back at things as quickly as possible. Operative allows for faster recovery within a year’s time. After a year, outcomes between op and non-op are generally the same.
Although there’s also plenty of literature out there that shows there are significant strength deficits for those who go the non-op route. Really the literature is all over the place, which is typical.
Do what you’re comfortable with, and get different opinions as you’re doing. Don’t take a blog’s word for it. Ask those in the medical field who have medical training (MDs, DOs, podiatrists) who have lots of experience with these injuries.
I was terrified of surgery but quickly realized this is a quick outpatient extremity procedure that carries about zero risk of anything bad happening. As a 31 year old, very active male, I am happy that I went the surgery route.
Again don’t take my word for it, read the lit yourself. And while there’s lots of great insight here on recovery (following people who are ahead of you in the recovery process is enlightening and inspiring), listen to the doctor when forming your opinions on what route you’re choosing to go.
Hi Jamo, I think it’s very smart of you to get second opinions. I went to the first doctor my friends recommended, he was a renowned surgeon of a professional sports team. He recommended surgery, and I didn’t think about it twice. At 5 months, I am happy with the results so far, but I think it will take me a full year to get to 100%. It makes me wonder if I didn’t have surgery, if the recover would be faster.
My recommendation is that you pick a doctor who does early weight bearing (early PWB). That will speed up your recovery and reduce chance of re-rerupture. You also have to be extremely careful because the chances of re-rupture without surgery are higher specially before 15 weeks, so don’t attempt to do anything stupid, such as running early, etc. I say this because most of the re-ruptures people on this site have been on non-operative people. But you should do the research for yourself.
Jamo - The most important thing is for the tendon ends to meet when your foot is pointed down. Dr. William Wallace from Belfast Ireland has done great work with this and you can search this site for more on that or just google him. If the tendons do not meet the body will fill the gap with new tissue and you will heal long. That means a considerable strength deficit for life and can only be fixed with surgery. A 5mm gap is considered a clinical failure. Wallace will get the angle from an ultrasound and then fix your foot at that angle for a few weeks then weight bearing starts with some gentle Active ROM (range of motion) exercises. Active ROM means you only use your own muscles. Passive means you have an aid like a rubber band (theraband) or someone does it to you. Re-rupture rates with his method are as low as surgery. Other studies are Twaddle in NZ, UWO in Canada, Exceter in England. All can be searched specific at this site. Look for a Vacoped boot and get into one as early as possible. Search Vacoped protocol and you should find the early weight bearing protocols. I think you can google that too. Take it all to the doctor. The USA is very much behind the rest of the world when it comes to treating this injury and relies heavily on the knife. This may be because is pays better and most people have insurance to cover it. I would say Australia (where I live) is not too far away from the US with that either as the government health scheme pays if you go to hospital and most people have private insurance as well. England has gone the opposite way as the NHS is trying to cut costs but unfortunately they do not provide the best treatment for this injury at every hospital and many still follow the outdated routines which do have a poorer outcome for the patient. Good luck with it. There are many good non-op stories here. You have plenty of time so I will let you search.
I am 5 weeks post op, hope to be PWB next week. Slow progress, however have been feeling humbled by this journey & extremely grateful to this blog, my wonderful husband, friends & family for all the support.
pamf17, mibball, s40love, Stuart, Bobbi Jean,
Many thanks for taking the time to read and respond!! You all are amazing, and I find your words encouraging and thought-provoking. I could not figure out how to respond to your comments individually so I’ll try it like so…
pamf17,
I am at a similar crossroads right now, deciding on a treatment option. The doctor recommends surgery, but I wanted to sniff around a bit more. I am leaning towards non-op but, you said it well, it’s a tough but personal decision. It’s great to hear that you are doing well, and I wish you continued success as you heal!
mibball,
I appreciate your balanced approach to surgery vs non-op. I must admit I have a visceral, unusually strong aversion to surgery (I’ll probably need to find out why, but that’s a digging expedition for another day) but I cannot afford to discount it outright, so it helps to read your post and evaluate the pros and cons of both options objectively. It’s now looking like a non-op option is open to me, but I still have to ask the right questions before I finally decide. Best wishes in your recovery!
s40love,
Thanks much for the info! I will definitely consider re-rupture risk as I make my decision, since I definitely don’t want to come down this road again if it can be avoided 
Here’s wishing you every success on your recovery journey
I am so glad you’re recovering well, it’s all one can ask for
Stuart,
That is really useful information. Thanks! It will help me ask the right questions when I see the doctor this week. Next Saturday 5/28 will be 2 weeks post-injury. The doc in Houston confirmed I am a good candidate for non-op treatment so I will get there this week, somehow, some way.
Bobbi Jean,
I too am humbled by this injury. It leaves me so dependent on, and also very grateful for, my wife and family for their understanding and help. Best wishes as you progress in week 6 post-op. The end is 5 weeks nearer now than it was at op
Hey Jamos,
I’m sorry to hear about your injury. I, too recently, had the great honor of rupturing my achilles tendon. I’m about 4 weeks ahead of you, pursuing the non-op method, as I found scientific literature stating non-op is just as effective as op.
I actually was living in Houston when I ruptured mine. Was the Dr. you happen to mentioned a Dr. Oates? If so, I’ve gone to see him twice already, once right after I injured myself, and once a month later.
Anyways, if so, I can tell you about my experience going to see him and what he suggested. The treatment is really simple, however, I definitely would still recommend seeing a doctor, whether it be him or someone else in the Dallas area.
Hope you have a safe and speedy recovery.
Jamo - thanks for your kind words. I thought I should also say I am not advocating non-op for this injury over surgery. I am pro choice with an informed decision and the support given to each here is the same regardless. I was not in your position when it happened to me and the information I was given was not complete. I recall someone saying ‘there is no condition known to man that cannot be made worse by surgery’. I always think of that every time I go under the knife and it is a bit worrying but not enough to stop me. There are some things that also cannot be fixed without surgery but this injury is not necessarily one of them. I think a healthy aversion to someone cutting you open is a good thing.
Hey Ken,
Yes, it was Dr. Oates who was kind enough to look at my MRI report and give an opinion that I was a candidate for non-op treatment. That allowed me to hope. I was ready to go to Houston but was able to see a doctor in Dallas today, referred by my insurer (my wife’s idea), and I am now in a walking boot with a heel lift. I go back in 2 weeks for the doctor to review my progress.
Wishing you a quick and smooth recovery back to full strength!
Hi Stuart,
I saw a doctor today who laid out the options, and pros and cons, for me and left it to me to decide what I wanted to do. I chose to go non-op and am now in a walking boot. I’m thankful to have finally started.
Well like so many others, I ruptured my Achilles playing in a rec basketball league a two weeks ago. I instantly knew when I felt the pop that it was an Achilles. I’m only 25 and I played basketball 3 times a week so this has been a tough pill to swallow. I had surgery Monday morning and have started the road to this long recovery. This site has already been a huge help. I was lying here in bed with a ton of pain, foot propped but noticed that people said they would often use 4 pillows to get even more height. Boy it has helped. I was going to try and go to work tomorrow but think that I should just take the whole week off in the hopes that by next week I can actually get around without feeling like my foot is going to explode when I stand up.