Just ruptured your Achilles?
Here’s some helpful information for people who just ruptured their Achilles tendon:
- Should I go to the Emergency Room or instead go see my doctor (or orthopedic surgeon) as soon as possible? Here is a discussion regarding this topic: Emergency Room or no?
- WebMD’s nice overview on ATR surgery and whether it’s right for you.
- Revolutionhealth’s nice article on: Should I have surgery for a ruptured Achilles tendon?
- How much does it cost for the entire Achilles Tendon Rupture medical care? (With or without health insurance) Cost of Health Care
- PreOp Patient Education: Achilles Tendon Repair.
- Interesting article about new advances in Achilles Tendon surgery (Thanks Doc Ross!)
How to determine if you have ruptured Achilles: Thompson’s Test:
PreOp Patient Education Orthopedic: Achilles Tendon Repair: (Part 1)
PreOp Patient Education Orthopedic: Achilles Tendon Repair: (Part 2)
I ruptured my Archilles Tendon on Sat. playing basketball. My Group Health Ortho told me she does not believe in surgery so she casted my leg. She said it would heal the same as surgery. When I have researched online it appears that surgery is the best option. I do lead a very active life and need to return back to work as soon as possible. My concern is that Group Health is forsaking surgery to cut costs.
Do you heal up quicker with surgery or the nonsurgical cast method? My treatment right now is a cast which will be changed every 4 weeks for 12 weeks, then a walking cast for 8 weeks then a boot for 6 weeks. I need to to anything I can to speed up this process.
Vance
I think the tendon generally heals quicker with surgery. A nonsurgical approach is usually followed to avoid some of the possible complications of surgery (sural nerve damage, infection, blood clots). My understanding is that the paitient is generally able to get back to normal activity earlier following surgery. However, I’m sure that your doctor is doing what he or she feels is best for your situation.
Vance
You need to read the research on pros and cons to surgery vs. non surgery.
Did you have a MRI?…that will seal the deal in my opiinion..complete rupture needs to be repaired surgically.
Also I talked with a surgeon and he said if the patient is not very active than non surgical approach is fine but if the individual is young, active and wants to return to running sports than surgery is the way to go.
Sounds like you need a second opinion.
Sooner the better
Doc Ross
Vance-
I am in the hoopster group as well. I opted for the surgery and feel very confident I made the right choice. As Doc said if you want to get back to highly active life you should look hard at surgery. From everything I have read recovery time is similar if not faster…..when fully recovered chance of rerupture is much less with surgery. With no surgery your tendon works its way back together but it heals with mainly scar tissue. With surgery they use very strong sutures and many say after full healing the tendon is as strong if not stronger. While any surgery has its risks so does not having it.
vance -
You’ll find relevant information here:
http://achillesblog.com/atr-rehab-protocols/
Also:
http://achillesblog.com/posts-worth-reading/avoid-these-hazards/
Vance - I believe the incidence of rerupture is much higher for non-surgical patients…something like 20% versus 2-4%. There is some research on that somewhere on this site I believe. I am probably wrong on the numbers but the conclusion is the same.
In terms of total time, brendan’s worksheet indicates the time immobile, in a boot, etc.
Vance,
I received the non-surgical treatment and the treatment for me was 10 weeks in cast ( 4, 4 and 2).
I am currently at the end of the 2nd phase and due to get my final cast fitted on Thursday 24th at which time I will be able to FWB.
As far as I am aware there is no speeding up of the early recovery process, it’s just a sit it out and wait scenario.
Vance..
Just watched the video of my surgery again. There was a 1-11/2 inch space between the two ends of the achilles tendon…and it was by no means a tendon, just a mess of tissue. I cannot see any way that the two ends will migrate together over that space and be anything resembling a tendon.
Wish I could post it..Brendan/Dennis any ideas…its about 20 minutes long.
Doc Ross
Ross - I use a free upload site called Vimeo: http://vimeo.com/ You could try to post it here. My guess is that it needs to be compressed a little though. I’m not a video expert, but if you sent me the DVD in the mail, I could probably figure it out….unless there is anyone else on this site who has a better idea?
Ross - What format is the video in?
If it’s on a vhs tape, then it needs to be digitized. So that’s a little tricky and the process can get a bit involved. There are places where they digitize it for you. Probably some places where they develop film, etc.. (maybe some places online where you can send your tape.)
If you have a DVD of the surgery, then it’s a bit easier. There’s software out there that can do it. I think VideoReDo Plus is one of them.
You Tube?
Doc Ross -
If you are on a Mac and your video is on a DVD, you can use HandBrake to get it into digital format. Then you might need to compress it (I think You Tube’s size limit is around 1 gig). You can send it to me if you want, I’ve got all the software - I’m a web designer. I’m curious to see it!
Thank you for all the great info. I have been working with Group Health for a week now to get authorizaton for a 2nd opinion.
Vance - GET THE SURGERY! I had a doctor recommend the same ot me, but he was old and I think at the end of the day just wasnt comfortable with hte procedure. Your rehab will be much shorter. Also, you’ll notice that all major athletes ge tthe surgery…there is a reas on why. good luck!
I just ruptured my achilles tendon 3 weeks ago at a gym and I opted with a sport orthopedic surgeon to go non-operative. I am a 40yr very active person myself. I don’t jog or run much but I like working out at the gym (till now of course). I’m in a airboot cast now with a heel lift. I am really bored keeping my leg up watching tv,reading, gameboy, computer, etc. I want to go back to work but I’m out for the summer. I feel so helpless can’t carry anything on crutches unless w/backpack any ideas to cover this thing up so I could swim in a pool?
april - You might want to check out this section for the cast protectors for swimming: http://achillesblog.com/things-you-might-need/cast-covers-for-swimming/
I ruptured mine two days ago playing ball with the kids. I researched it and went to the ER for verification. The doc admited that he didn’t have a ton of experience with this type of injury but after a Thompson test and an ultrasound, verified my self-diagnosis of an ATR. He then made a call and I’m scheduled for Sugery Thursday (ATR +5days). After reading some of the great posts here, I’ve decided to get a second opion re surgery. A generic diagnosis and surgery call by a doc with no real experience with this injury just doesn’t work for me! I’m sure he is a great doctor but I need to be sure for myself here.
Keith, Did you ever see and orthopedist, or just the ER doc? The ER doc may have called the ortho doc and scheduled your surgery, but the ER doc won’t be doing the surgery. I would want to meed the guy cutting me before I had surgery.
Jim, I called another emerg to see if they had an ortho on call. Spent most of Canada Day waiting but yes, I did get to speak with a specialist. he gave me some good feeback and I opted for the non-surgical approach. I left with an aircast to hold me over for a few days and I got my leg cast on yesterday. needless to say, I cancelled the schedule surgery that the first emerg booked for me.
I can’t beleive that I actually miss the aircast! I see the ortho again July 14
Anyone here had a Partially ruptured achilles? Doc said it is only a partial rupture where the tendon meets the calf muscle…..No sugery….just rest and an boot cast for 3-4 weeks. He isn’t even talking about Physical Therapy yet and I am very active. I don’t want to heal so tight that I can’t get back to my sports and running soon.
I’ve just ruptured my achilles while rugby training, no contact, just snapped.
Ortho has recommended me non-surgical, 6 weeks in a cast, being changed every 2 weeks to raise my toes.
Can I go back to being as active as before (rugby, squash, jogging etc, or do I have to resign myself to the rugby retirement home at 32 years old?
I have come back to work as I have a desk job after 6 days.
Jonathan,
I personally see no reason in returning to your sport, but like us all it is down to what you put in at the PT on the return trail.
The recovery time for non surgical and surgical is similar i.e. 12 months.
I am currently 5 months 2 weeks after non-surgery, 10 weeks in plaster, and still to start running again, although cycling is not an issue.
Log on for a blog and shre your progress/story with us all.
Johnk
Cheers johnk,
I will try and sort out a blog, although gutted that I won’t be running for 6 months at least.
Ah well, nowt I can do about it now.
Jon
Hi guys
I was dancing at a friends birthday party when it felt like someone had jumped on the back of my ankle. I felp a pop and my leg just collapsed. The pain was intense. I hobbled to accident and emergency (uk) and they told me I had “probably” torn the soleus muscle and was sent home with nothing not even painkillers. I couldnt sleep for the pain. I went to my doctor two days later and she didnt examine it as she had the doctors report from the hospital, told me to elevate and rest and gave me painkillers. Now 4 weeks on the pain and swelling isnt getting any easier. I can feel a gap in the tendon just above the heel, I can flex my foot upwards with difficulty and pain. I am worried now that it may be too late for treatment and the damage will be permanent. Any advice you could give me would be grately appreciated,
Hi Karen,
you must have a test for an ATR as soon as possible. I would go to hospital and get it done now. Phone the NHS Direct helpline now (0845-4647 they diagnosed my ATR and sent me to hospital).
It sounds like you have had some poor treatment.
A normall achilles is well defined so the fact you can feel a gap (I assume no gap on the other?) doesnt sound good. Get an ATR inspection ASAP and let us know how it goes.
Elevate your leg and put cold packs on it (ice bag/frozen peas wrapped in a tea towel can work well) and rest it. Im sorry you are having such a rough time and hope it goes well. Its never too late, so get on the phone now. Good luck!
I don’t understand the non-surgical approach. How does a complete rupture heal? I had a complete rupture on APril 17th playing basketball. I am 26 years old.
I had the surgery on April 24th, and had a splint on and no weight bearing for 6 weeks after surgery. I moved to a walking boot with partial weight bearing, with or without crutches. Whatever I was comfortable with. I started PT during this time also. My range of motion was pretty good, so I primarily worked on strengthening my leg.
Now a full 3 months out, on July 24th, I am walking with no pain or swelling. I am in a regular shoe. I am on target. THe doctor said it was a 4 month process.
SO now its up to me to get my leg back into shape. I
I also monitored NBA player Elton Brand. He ruptured his completely in August 2007. He was back to practice with his team 5 months later in late January 2008.
He was cleared to play in real games in April of 2008. A total of 8 months between the injury and his return.
I just don’t see how this would heal on its own without surgery. If there is a huge gap, it is not going to magically jump back together. If it does I would think it would easily rupture again!
Darek,
I can shed some light on the nonsurgical approach. Around every tendon there is a sheath, a covering that encloses the tendon, that helps to bind the tendon. With ATRs the sheath is usually intact and lets the tendon heal within the confines of it. This apporach leads to a scar tissue formation that is haphazard in alignment, think big knot, that can lead to other problems in the future….bursitis, tendonitis. It is important with non-surgical treatment to adhere to a strick PT protocol and to continue with it for a year. I had my surgery videotaped and you can see the sheath being cut prior to repair. There was a gap of 2 inches, too long for me to allow a non-surgical approach.
Let me know if you have any questions.
Doc Ross
Week 9 - Non-surgurical
Hello, again everyone. This site is great with so many suggestions. I am now at the point in my recovery that I am starting to take off my boot twice a day stretching and walking good foot first for about 5-8 min. each time with crutches. I’m not quit able to roll my ATR foot into walking form yet, tendon too weak feeling and shakey. So half step for now as per physio directions. Swelling down alot over the weeks. Still have to put foot up alot but normal I`ve been told. Getting around more sure helps with feeling caged. I sure would love to hear any other non-surgical recoveries.
I have a huge question. I go for an MRI on Friday to find out how bad my tendon is. They think it is fully ruptured. My question though is can I move my foot or toes with it being fully ruptured? I don’t understand anything about this and I have researched it so much. All I know is my heal burns sooo bad and my calf throbs and I’m in a cast until my MRI. When I injured it I heard and felt it snap.
Angel,
I had a complete rupture as big as it gets said the Surgeon and I walked around for a few weeks before I had the operation. I was not and still cannot lift up onto my toes but was always able to flex the foot left, right and up and down. I have had terrible problems with heel pain right through until just recently you may have to learn to live with it. It was worse at night and did keep me awake.
Need any more information, create your own blog, you will find there is always someone on this site who is able to help and support you through the long process of healing.
Good luck
Annie
Annie,
Thank you so much for that info. That is what I was afraid of. Oh well it has been done and no reason not to still smile and get over it and learn to live with what comes. Good luck with yours and thank you again.
Hi Guys
Thank you for your reply jacksprat. Sorry I havnt been able to get back in touch but have been through hell and back with my tendon injury. Yes!!! it was finally diagnosed exactly 4 weeks after it happened. I had to go back to A&E because the swelling and pain were inbearable. I was in fracture clinic the next day and in surgery the day after that. I am now 4 weeks post op and they are slowly bringing my foot uo to 90 degrees. Another 4 weeks and I should be in a boot. Just wanted to tell everyone that if you suspect you have an achilles tendon rupture then please dont be fobbed off by medics who say stupid things like torn muscles etc. Leaving my injury for 4 weeks means that my recovery is going to be much longer (casted for up to 16 weeks) and more difficult. I am in the process of suing the hospital as it was clearly medical negligence and i will let you know how i get on with that and if you decide you want to do the same then feel free to e-mail me @kazbat05@hotmail.co.uk. Anyways just in case anyone is interested i will continue to post my progress. good luck every one kaz xx
Hi all,
Found this site doing some research into rehab. I snapped my achilles tendon three weeks ago warming up for kendo (I was doing some small hops back and forth). Classic case - 40yo male weekend warrior, left leg, recent increase in activity, felt like bat across back of leg then “crack” everyone heard it go. I went down like a sack of spuds, screaming WTF (the three letter acronym described in FAQ).
Got taken straight to ER, passed Thompson test, then decided to see my own othopod. He slotted me in next morning, confirmed the snap, explained pros and cons of surgery/nonsurgery (I focused on better quality healing outcome), put me on the end of his list and operated that afternoon so less than 24 hours after injury. I’ve had a plaster cast for a week, then replaced with a fibreglass one for the next five weeks, crutches, no weight bearing. Don’t know yet what happens after that.
I have not missed a day of work, have leg propped on another chair. Its not above the heart, so swells up a bit. I put it up as soon as I get home for next 12 hours. And all weekend. Hope this is ok.
Got a shower chair and camode chair. Got a watertight showerbag which has a rubber gasket seal around the thigh, its great.
cheers
Adrian
Hey there, I found this site looking for some info on recovery.
Snapped archilles just over 12 weeks ago playing netball, but looking back I think it was building up over a few years running without warming up. Had surgery too.
Looking for some excercises to get more mobile and want to know how can doctors tell it’s all fixed just by squeezing my calf!! I’m very paranoid now!!
Rovena
I had a chainsaw accident 3 days ago and took my achilles and the fibula out. Since i have taken about 3 cm of tendon out of my foot - is the recovery process similar to that of ATR?
Oh good grief, what a horrible, horrible accident.
Not sure about the time scale but I would have thought it would be about the same, but I really wish you well.
Annie
Mike
I am amased that its only 3 days… and you have the courage to surf the web… after such an accident….. its it like an ATR… no idea… what do the doctors say ?
Where and when do I take the club oathe? Thank you sir may I have another.
I was in AZ playing pickle ball with seniors when mine snapped. Talk about embarrassing, as I’m 42yrs old.
I wanted to wish everyone a quick n speedy recovery, and to also say thanks for all the useful information as well.
Cheers!
Craigar
Seattle, WA
Hi all,
Great blog site!
I ruptured by achilles tendon 1 week ago today, had surgery 2 days later and now trying to adjust to a sedentary lifestle that I’m really not used to.
I am paranoid about rupturing the tendon on my other foot now - both feet have been subjected to the same activity and stresses over my life. Has anyone out there had both achilles tendons rupture?
I hav a million questions but will browse off of these blogs as I’m sure the answers are in there somewhere…
Cheers,
Paul from Perth, Australia.
Hi Paul,
We were all in the same boat when we had out ATRs. Don’t feel that you can’t ask even stupid questions on anything on this site. Everyone on here is really supportive and will try and offer their assistance as treatments and recoveries differ from person to person.
Hang in there bud.
Jon
I ruptured my achilles tendon on Wednesday (today is Friday). I’m 28, very active and definitely want to have this repaired surgically (I have no movement or strength in the foot). I am going to see the doc on Wednesday (one week after the trauma), and his OR day is Friday (I am hopeful he can get me in that soon). My question is this- if I have to wait longer than one week and two days for the surgery, am I increasing any risks for failure?
I would guess that the sooner the better. There are several others on the site here who had their surgery delayed for one reason or another. I believe you should be okay. I had my surgery 14 days after my rupture. Check the blogs here I am sure you will get some of your questions answered. There are doctors and nurses here as well as all the others suffering from ATR. You can read my story —> http://achillesblog.com/maestro/
I was told by my doctor that the reason I or any of his other ATR patients are rushed into surgery (within a week of injury) is that the longer you wait the greater risk that your tendon will roll up into your calf. Consequently he would have to cut you open further to retrieve the tendon and the recovery becomes a little more difficult.
Well, nearly 2 weeks have passed since the rupture. Things I have learnt:
1. Don’t overdo things in these two weeks.
I was out shopping in crowded grocery stores (in a wheelchair with a raised leg), at a Halloween party and various other social events and climbing flights of stairs in those first few days after surgery - all of which really hurt my leg and put me at risk of a fall. After taking it easy at home with my leg elevated the last 5 days the pain and swelling in my leg had improved markedly.
2. Set us the house so you can move objects around easily without using your hands.
I have a trolley (an old TV stand with wheels) with two ropes tied on to it - one going to the kitchen, the other going to the couch. I make a cup of coffee, stick it on the trolley, then crutch back to the couch, where I pull the trolley to my position via the rope.
3. Working from home (if possible) is great.
I get so much more productive work done compared with going into the office, all from the comfort of my couch. If you’re an office worker all you need are a laptop computer, internet connection, a phone and an understanding boss!
4. Tighten the boot as it loosens due to calf muscle wasteage.
As you don’t use your leg muscles, the calf quickly shrinks and the boot became loose, which was painful for the area of my surgery when it moved around. Tightening up the velcro straps on the boot really helped.
5. In some ways this experience has forced me to slow my life down and appreciate the family and friends around me, relax and read a book. In normal life I would have seen sitting down on the couch as a complete waste of time when I could be out there doing something. But relaxing is enjoyable.
Cheers,
Paul, Australia.
PaulT,
So nice to have another aussie on board - well, as nice as it can be when we’ve all torn our achilles.
To anyone worried about making a full recovery because their surgery was delayed 2, 4 weeks or even longer, I’ll just repeat the advice my surgeon gave me when he saw me for the first time, about 8 weeks after my injury: you wil get to 100% eventually; it will just take a longer than the average. Of course, while I’d really like to take his word for it, I’m going to wait a year before deciding whether or not to believe him.
I really don’t like to not trust doctors 100%, but given that my general practitioner (what do you call them in the US? primary health provider?) and the physical therapist (physio to an aussie) he sent me to decided that it was just a minor tear that could be healed fully:
a. without a boot (they recommended that I wear supportive, high heels - I’m not kidding);
b. with physical therapy twice a week;and
c. daily exercises,
when in fact I was rehabilitating just a few strands of achilles that after 8 weeks snapped off completely when I rolled my ankle when walking across a busy New York City street, I am always, always going to seek a second opinion if I ever injure myself / have cause for health concerns, again.
Also, I note that karen is in the process of suing the medical practitioners who treated her in the first instance, as her surgery was delayed 4 weeks from injury. I’m a litigator and so don’t think that the thought hasn’t crossed my mind, but, trying to focus on my recovery, I’m just so unwilling to seek advice on it. That said, I can’t say I’m not reconsidering. Does anyone have any thoughts on this?
Hello everyone,
I ruptured my achilles playing basketball on the 19th of October. I was unable to get immediate surgery done on the injury. My surgery date was the 31st of October. I was placed in a cast till Thursday the 6th of November. After six days in a cast my doctor said I was healing nicely. Based on that and the level of fitness I was at previously, I was scheduled for immediate rehabilitation. Unfortunately the soonest appointment is the 12th of November. However he gave me a few simple exercises to perform till then. So far so good, my range of motion has definately improved and I feel little to no pain. I am anxiously awaiting my first day of real therapy.
Hi all, well I just ruptured my achilles tendon playing gridiron on the 8th Nov - pretty much went to the ER straight away then had surgery to reattach the next day… Now am sitting with my leg up in a Cast on day 2 after surgery
Pain’s alot better, but still getting used to those Clexane/anti-clotting injections :p
…something occurred to me tho as to how it all happened - I was wearing ankle braces during the game, and am wondering if they were too tight and high up, so that my calf movements were restricted (thus making my achilles overcompensate).. anyone got any thoughts?
fleaster - were you running backwards at all? that’s how I ruptured my achilles.
Hey Dennis, yeah I was playing cornerback at the time, so I was backpedalling, then planted a foot to stop, but when I pushed off I felt my achilles give out…
Ironically i was having tedonitis in my LEFT achilles before, but had never had some much of a twinge in my RIGHT one - but this is the one that ruptured… which is scarey, cause i could never see it coming…
I just ruptured my left leg. My first achilles rupture ocurred a year ago but to my right leg. It is hard to be patient about the recent injury!
Wow for a second I thought I was reading my own posting. I too have suffered two achilles ruptures. My right one on Oct 1/07 and the left one Oct. 25/08. Both playing basketball… I feel your pain and frustration literally!
This is so weird to read everyone’s postings because your story is SO similar to mine. My first achilles hurt before I ruptured it but then a little over a year later I was back peddling on defense (basketball) and pushed off to go forward and POP! I ruptured the other one
I’m five weeks off surgery now and not looking forward to the long road ahead, that we both know all too well.
I ruptured my AT on November 12, 2008 while playing soccer. I heard and felt the snap and I knew immediately what had happened. My surgery was on November 25, 2008. My doctor told me that my tear was not horizontal but more like diagonal - so it took him a little longer to repair it. They removed my sutures on December 11, 2008 and put me on the walking boot. I am scheduled to start my PT after my next appt. on January 8, 2008. In the meantime, I am doing exercises to get the blood flowing - moving my ankle back and forth…BTW - I admire people who decide to go back to work while recuperating from this injury. I would be affraid of a rerupture during my daily commute…
I ruptured my AT on 18 September, 5 days before my new son was born. It was not diagnosed until 28 October! A sad reflection on the UK public health system. I had AT reconstruction on 29 November including, because of the delay, borrowing a tendon from my foot (flexor hallucis longus). Wound breakdown and infection set in around 2 weeks following surgery meaning that my cast was removed and replaced every week to change the dressing. Have been on oral anitbiotics almost constantly since then. Into walking boot on 6 January. Readmitted to hospital 15 January for intravenus anitbiotics. Infection clearing slowly. Hopefully start some physio in another 2 weeks. It has been a slow and painful journey so far!
Surgery to repair a completely ruptured tendon took place on 12/23/08. I am a 58 year old female who has never had an injury in her life. This journey is and has been an eye opening experience. Never again will I underestimate those whose mobility is impaired in any way.
I live in a home whose bedrooms are UPSTAIRS. The demands placed on my family to assist me in dressing (couldn’t get the pants over my toes while wearing the fiberglass cast which went to my upper thigh); to provide me with enough food for the day (it seems my appetite worked only too well- I will have to remedy that as well as my tendon) and bathing (from a sink) required ready supplies and towels. They have been selfless in their care. I have trouble adapting to the lack of mobility.
I am now in a cam boot, 6 weeks post surgery, still no weight bearing with inflammation each evening. Anyone else inflammed at night?
Also, the early exercise everyone refers to- what form of exercise do you refer to?
Please tell me this gets better….I have had a problem with achilles tendonitis for about 5-6 years, kept getting worse and worse went to the ortho, he referred me to an ortho who specializes in foot/ankle/achilles tendons…scheduled an elective repair to debride the tendon and heel, and lo and behold, before we could have surgery done, I tripped over an object in the floor and ruptured it.
I have not ever felt such pain like this….am now 7 weeks post op, in a boot, physical therapy, one crutch, weight bear to tolerance…
I am at a point where I feel this will not ever get better, but that is not the case, am better now than i was before rupture….
Any words of wisdom, advice, etc? Could really use some at this point….thx
landlockedtxn - It’ll get better, just be patient. My advice would be to read blogs of all the others who are ahead of you in the recovery to get a sense of what to expect in the future. Start a blog and share your recovery story. We all understand some of what you are going through.
thanks, Dennis….
appreciate the words of wisdom….after surfing and reading this site and others, I realize how blessed I am to have two great orthopedists and that I didnt wait and see….
My main frustration is no house cleaning, no grocery shopping, hubby is doing a fine job, but I am at that point where I feel much better, just limited on motion.
My surgeon is one of the let’s not let the tendon get stiff believers, while the doc i work for is one of those let’s wait til 8-12 wks are past with a cast/boot/nwb…lots of confusion abounds…
However with that being said, I have noticed on other blogs, the longer you wait, it seems the harder the recovery is…so I am glad I am getting to move a little more…and I realize it depends on the injury as well.
I didnt rip the tendon in two pieces, I ripped 90% of it out of the bone in one piece with the other 10%still attached…surgeon removed the bone spur, debrided the tendon, used a suture bridge to reanchor…and here we are…..
If it is torn or ruptured get the surgery and do the rehab. You will be back 100%. Rehab is just as important if not more important then the surgery. Do The Rehab!
Hey Now,
I am one week post op. A complete rupture playing squash. I thought my playing partner had hammered me hard with his racquet. Ouch did it hurt.
If anyone our there is non weight bearing, you must rent or buy a knee caddy. This device has made my life significantly easier. (and easier on my girlfriend)
I was even able to grocery shop with ease. If you can find one with a basket attachment get it. These litlle buggies are a must!!
Cheersand heal well
KellyU
Ah Yea!!!
I’m three weeks post op and doing fairly well. Yesterday I was on the knee scooter and it slipped from under me and I stupidly used my bad leg to break my fall (full weight) but with cast. It hurt like HELL and very scary. Hopefully nothing happened. I called my P.A and he said not to worry if my cast didn’t break and I’m not in pain. Reminder, take it slow and carefully. The scooter is great but almost too fun because you can cruise fast down hills and at the gym.. BE CAREFUL!!!!
If anyone wants to talk one on one let me know.
lendoggg1979@yahoo.com
Good luck on the progress,
LEN
landlockedtxn, all I can tell you is to be patient. I am 13 week post-op and little by little I am starting to feel better. I wore the boot, full-weight bearing for about 8 weeks. I began wearing sneakers then and I am now starting to get used to dress shoes. I am attending PT, which I think is essential for complete recovery. I still walk with a little limp but I can feel my range of motion is improving by the day. Not everything is perfect though as I still deal with pain on occasion. Make sure you follow your doctor’s orders and make sure you go to Physical Therapy. You will be fine.
Ocall,
thanks for your resopnse….patience is the name of the game right now..Am glad to hear it gets better. This past weekend was very frustrating..
Am 8 weeks post op…PT is addicting cause it always feels better afterwards, and I have home exercises as well…
Am in two shoes one half a day with an achillotrain brace well worth the money….It makes me feel like I can conquer the world and then reality sets in…seems like I can only do a little then the soreness, tiredness set in…but with that said, I am at least upright, on two feet without crutches unless I have to go outside for something..am taking it day by day right now…I see a small, small, light at the end of the tunnel…
How did you tear yours?
I am nearly 12 weeks post op and have just begun to wear regular sneakers. I limp when I walk too fast and heel burn/discomfort comes when on my foot for more than an hour. I would appreciate any info or past experience from anyone who has had a ruptured achilles tendon before.
landlockedtxn,
Hello again. I hope everything is well with you and that you continue to feel better. I ruptured my AT playing soccer. I jumped for the ball and as soon as my left leg left the ground I heard the “pop”, sounded like a gunshot actually. I knew right away what had happened, luckily, the pain only lasted that one day. It didn’t hurt afterwards.
You are right about PT. I do feel a lot better after my sessions. Right now I am going twice a week and I am starting to focus more on weight training to build my leg muscles back up. Make sure you keep doing your home exercises, they really help.
keep us informed of how your rehab is going…just remember that there are going to be good days and bad days…don’t get depressed!
How much effect does the achilles tendon play in plantar fasciitis?
My podiatrist says all the pain is caused from the tight achilles tendon, is it true.
I was playing Netball in Jersey and ruptured AT on 28th Feb, surgery was suggested, but i had to travel back home on a plane on the 2nd March.
went to A & E at home and I now have to see the consultant on the 4th to see if I want the surgery, if it’s a partial rupture do i select the non operative method. I’m in a quandry?
Three weeks PO. Does anyone have input on early weight bearing? I am eager to try, but my surgeon advises not. From what I have read, all studies indicate a swifter recovery which equals better quality of life. I have heard of full weight bearing by week 3 and returning to competitve sports by month 5. Additionally, there is no evidence of higher incidence of rerupture. So why wouldn’t we all start earlier?
I had Achilles Tendon transfer surgery on Jan 26, 2009. At week 5, I was able to puit 50% of my weight on my injured foot. My doctor is not very forthcoming with his “plan” for my recovery and I don’t feel I am getting one story from him.
Can anyone tell me what I should really expect? I just want to know when I’ll be able to drop my crutches.
Frustrated!
I think everyone recovers at thrir own pace and Doctors take a diferrent approach. Some are more conservative than others. That being said, I had Achillies Surgery that required a tendon transfer on Jan 2, 2009. I was NWB until Feb 12. ( 6 long weeks). I transitioned to FWB (still in theboot) two weeks later Feb 26. I’ve been walking w/o the crutches since then. I don’t start PT until Mar 13. I think I should be in 2 Shoes 2 weeks from then.
I’ve finally gotten over my paranoia of standing in the shower bootless and while I feel some pain in the heel it is getting better.
I think we all have to get a grip on the length of time these things take to heat properly.
I hope this helps.
I’m partial weight bearing(50%) at 6 weeks postop. I just take things easy and slow, but still try extra weight on the ankle, stretching, and toning on my own. Standing in the shower without a boot, walk around the house without the boot on crutches to lightly stretch the achilles. My philosopy is to listen to your body, it will tell you when you are ready for more. If it hurts back off. Remember you can’t eat an elephant in one bite.
Kelly, My best advise is listen to your body and what it’s telling you. Of course you want to try weight bearing, just remember if it hurts back off a bit. My doc hasn’t told me anything I didn’t think I wasn’t more than ready for by my own light testing etc. Listen to your body and remember you can’t eat an elephant in one bite.
Thanks for your responses - they’ve helped. I did get my PT to talk to me some about the typical protocol. He said I could be FWB at 6 weeks and get moved out of the boot by 8 weeks, or he may keep me in the boot for another 4 weeks. So he doesn’t even know.
I’m going to talk to the doctor on MOnday - I hope to know what to expect.
Thanks again.
I’ve chose not to have an operation. i’m in a cast and have been for two week. any advise……i have even attended work. where i get total rest for my leg all day.
MoPo,
Was it a partial tear or full? If it was full then you probably should have gotten the surgery, that is if you want a strong achilles. No surgery means no true connection of the achilles and a lot of scar tissue as well as longer stretched achilles (less strength). Also rerupture rates are upwards of 20% (no surgery) VS 2-4% AFTER surgery. I’m 1.5 months post op now and am starting to walk again. I’m glad I got it done. If you are active then getting surgery is the best option for optimal recovery results. It’s a no brainer
i presume it a partial tear, it was the registrar that stated that it might be better to go for the non sergical route first. he stated that we could always review this in two weeks when i have the first cast off. as he will then have a better view of how bad/good the rupture is. Does that make sense to anyone..Please let me know. if it is only a partial rupture then it should heal fast. shouldn’t it.
mopo. Here’s what my doc told me. He goes the surgery route on all full 100% tears and goes non-surgical on all partial tears even if its 95% torn. that if it is partially torn most of the tendon should reconnect with full tears surgery is the best way to go. from what i understand the conservative treatment keeps you NWB longer in he beginning but after a few months you are caught up. hope this helps
Mopo,
I’m suprised you don’t know if it is partial or full rupture. Thompson test would tell you also and MRI would be a positive confirmation. You are wasting time in a cast if it is fully ruptured. I would definitely be more proactive in your care.
Also, Partial ruptures don’t heal faster than surgical… and they don’t heal stronger, this is for sure…. Bestof Luck.
LEN
Hello fellow ATRs
I torn my AT on feb.14 (nice valentines….).
Surgery on the 20th.
Front slab till apr. 3
walking boot with wedges since.
which leads me to my 2 Qs
1.when can I safely ditch my walking sticks?
2. I’ve been sleeping with my boot off (sounds creepy)
is this ok?
thanks and cheers fellow ATR
ps sorry for any blog breeches of protocol, as I am a blogger 101 (aka newbie)
Hello everyone,
Surgery will definately speed the healing process up. I was in a cast for 4 weeks, walking cast for 2 weeks, boot for 2 weeks then back into shoes. So in two months I was back in shoes. Walked with a limp for awhile, but therapy took care of that. Just came up on 7 months post OP. All is well.
Good luck
Glen
Jack,
I slept with my boot off. If you get up in the middle of the night, make sure you put your boot on. Yes it’s a pain, but you have to do it. Makes you think a little more as you get out of bed. Take it slow.
Take care
Glen
I’m 8 months Post OP. I’m glad I had the surgery. Seems that a non surgical process takes much longer. 2 months after surgery I was back in shoes. 4 weeks cast no weight. 2 weeks full weight bearing walking cast. 2 weeks walking boot. PT for 4 weeks. Today I feel great.
I’ve partially ruptured my achilles 50% torn near the top. I did it on a friday. Finally got seen at the hospital on Tuesday, they gave me a moon boot and told be I can go back to work today. Does this fit with what others have been told?
Ric - when I first ruptured, I was allowed to be FWB (full weight bearing) with the boot, as necessary (picking up our baby), until my surgery - my doc said I couldn’t really hurt it anymore than it was, but to use crutches and stay off of it as much as possible, Ice, evevation, etc to get swelling down prior to surgery. Are you having the surgery or going the non-operative route?
Hi Marianne
I’m going non operative. I’ve spoke to four doctors and the only one strongly for surgery was
the youngest and charging 3x the going rate for an op
I wasn’t aware surgery was so common until coming on here.
I have my foot on my desk at work and get a taxi home.
And as far as I know I keep the air-boot on for24 hours during the next 2 weeks and then I can start taking it off at night. At 6 weeks I take the boot off. I’m using crutches and putting no weight on it during this time.
Then I start physio.
It seems less complicated then anything else I’ve read on here. I hope it works
Hello all,
I think I ruptured my achilles today - jumping rope for a little exerscise - HA! anyway, I felt the pop and pain, but not really like described here. I didn’t go to the ER (swine flu, no insurance due to recent job lay off), but I can drive, put weight on it and it really just feels like a sore calf, like when you work out and it’s sore. I can’t walk normally, but if I bend my knees and walk I can walk pretty normally. I’m trying to figure out if I really did rupture it or just strech/pull it because it sounds to me from these posts like if it really did rupture, I’d be pretty incapacitated. Any thoughts from anyone? Thanks, any input is greatly appreciated.
Lucy, sounds like a rupture to me. Can you lift your heel off the ground onto your toes on the bad leg, if not you need to see a doctor sooner rather than later. I was able to walk on my leg for nearly 3 weeks before finally getting treatment. Don’t leave it. It will not go away on its own….
Annie
Lucy get it checked out. If it’s not bad they may be able to do therapy. But if you wait it may turn into a nightmare!!!
recovering from complete rupture and 12 weeks post op -right leg At what point can one resume driving and when does one stop using the boot
Toes feel numb at times and the foot has an ‘odd feeling’ at times. pins and needles feeling and just different than the other leg. Is this a common thing?
Still working with PT and the boot is at 2.5 on the plus side for position
I just recently ruptured my achilles tendon 3 weeks ago playing basketball and had ATR surgery two days later. Currently I have been in cast (the sweetest purple cast ever) for about a week and am told I would be in a boot in the third week. I’m only 20 years old and this couldn’t have occurred at the worst time. For the entire year I have had a two month backpacking trip in Europe booked a week for after my college graduation this June. The ortho already said it was probably not realistic to be able to do such strenuous walking in only 6 weeks after having surgery. I figure I’m young and I would go anyways and just would be cautious and take it easy. Plus I’ve always been very active, play sports and been an avid runner. However as the time nears I’m not so sure if this would be the smartest decision. I don’t want to risk re-injuring it while abroad or risk long term complications. I already have my plane/train tickets booked. I don’t know what to do but I have to tell my travel buddy soon whether I’m canceling or not. I have my heart set on it and am pretty torn, not to mention just extremely frustrated with this injury in general. However everyone I’ve talked has stressed the fact that rehabilitation is key to an injury like this.
Realistically, what would be best for me?
An - Really sorry to hear about your backpacking trip to Europe. I would really talk to several Physical Therapists and get their take on this.
Anyway you can delay for another month and go in August-September?
An - You should really speak to your doctor, but it’s probably best to postpone your trip if you plan on doing a lot of walking.
6 weeks isn’t enough time for a backpacking trip.
Sorry to hear about the injury/bad timing.
50 year old active thin female.. injured achilles area playing tennis 5 weeks ago. Little to no pain, iced for 3 days, had dr. look at it.. he said nothing was broken or likely torn.. to use crutches for a few days.. I have been able to stand on foot since day one.. and after 2 days could go on toes.. just can’t balance on just that foots toes yet… no pain, just alittle swelling in foot base if I work on my feet for more than 3 hours.. but its not completely healed.. and I am going on week 6.. does it sound like if I take care for another few weeks, it is healing well without surgery… or do you all suggest I get an MRI since its week 7 and I still walk with alittle bit of a limp…? thankyou
while at work i stepped down to a lower step on a locomotive engine when my calf gave out. the ultra sound showed no DVT, so they diagnosed me with a ruptured achilles tendon. but the pain is in my calf not my heel. i can stand on it can walk on it with pain for very short strides. i even tried to go fom flat foot to tip toes but cant even get the foot to move up. is this a problem anyone here has experinnced?
Chris I am a locomotive engineer and because of the climbing up and down and walking on uneven ground my doctor still hasen’t cleared me to work and it’s been 12 weeks. Good Luck
What does ‘active’ mean (in considering surgery or not?). I ruptured my achilles a week and a half ago playing netball, the doctor at A & E said that surgery wasn’t an option because I’m not an athlete. The orthopaedic guy (who spent a whole 5 mins with me) gave me surgery as an option but didn’t advise either way. The thought of surgery made me feel ill so I opted for a cast. BUT - now that I’m reading this site I’m questioning my decision.
I’m 36 and fairly active (play netball, tennis, jog, gym, pilates). I intend to give up the more jarring sports after this, but what does ‘active’ mean? Am I likely to re-rupture if I plan to do more hiking, walking and gym once I’m recovered? Should I be considering the surgery option? Is the surgery really horrible? Do they tend to operate under general anaesthetic?
Any advice?
Thanks, Berni
Hi Berni, I ruptured mine on May 21st while playing softball. ( I wanted to play like I was 12 , but my body reminded me that I am actually 34 and should know better, haha) I had my surgery on May 28. It was not bad at all. I was under general anastesia, and a bit groggy when I got home, but I am back at work (at my desk job) and now am in this cast for another 3 1/2 weeks. But so far, I have had no complaints about having the surgery. I just can not wait to get off the crutches!
Hi Alison, hmmm - you know I never really thought that 30’s was old - but, you’re right, we’re certainly not 12 anymore
I had a good chat with my orthopaedic surgeon and we’ve come to a compromise: he’s going to do an ultrasound next week, and if my tendon is knitting well, we’re going to continue with the conservative treatment, and if not, he’ll operate. I’ve done lots of research in the medical and sports science journals and it seems to be 6 of one, half a dozen of the other. I also can’t wait to get this cast off. I hate not being able to drive and having to be so dependent on other people. My friends tell me I’m learning a good lesson, ugh! Good luck, 3 weeks isn’t long to go.
Berni
Hi Berni, you are right, 3 weeks is not long to go, I should keep things in perspective. But as I am sure you probably understand, it seems like forever with a cast and crutches!!! I also do not know what is going to happen at that point, if I get another fashionable fiberglass cast, or something else. I can not wait to get this one off!! I agree it is a difficult adjustment to depend on others to do things that used to be so simple. (maybe this is a hint I need to slow down ” smell the roses” haha) Too bad that can’t be done on the beach!! lol
I hope everything goes well with your ultrasound next week and everything is healing well. If you do end up having the surgery, it is a piece of cake!! I checked in an hour prior to surgery, and was home 4 hours later with a good movie! Take care. Happy Friday!
Allison
Hello Berni - I was reading your story and I definitely suggest you have surgery, specially if you consider yourself an “active” person. I ruptured mine last year (11/12/08) and when it was confirmed that my AT was torn, I knew that surgery was the only way to go. I also consider myself to be a very active person and knew that surgery would give me a better chance to heal better and allow me to practice sports again. So far, no complaints, I was jogging 3 1/2 months after surgery. I am going to the gym every day now, I am increasing the speed in the treadmill little by little and somedays, I forget that I had this terrible injury. There is still some stiffness in the mornings but once I start walking, that is gone. Berni - in the end, it is your decision but I tell you, surgery I think is the best way to go.
Let me know how it goes man!
Good luck!
Hi Berni, did you have your ultrasound yet? How did it go?
Allison
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Ruptured my AT 2 weeks ago playing netball and had surgery the next day to reattach. Last Thursday the Doc put me in a walking boot as i looked “trustworthy” not to put my foot down. Have to see him in 4 weeks time but has warned me not to weight bear for that time or i will rerupture. I have read here that everyone was in a cast for approx 8 weeks before going into a walking boot. Should i still be in a cast?? Will this hamper my recovery???
Tina - that doctor’s phrasing sounds remarkably familiar - wonder if we are being treated by the same doctor….
SalW - If you’re an Aussie, we could be!! I don’t know what happens after the four weeks, what have you been told. How is your leg going in the walking boot?
I’m now at 22 weeks post-op. I’m able to walk and function however I am a bit concerned about internal scar tissue. If I plantar flex, it feels as if the tendon is still very stiff and at the junction where it meets the calf muscle I feel as if the tendon is pushing in. Visually I still see wrinkles where the scar ends.
I have had some ultrasound at PT. I am in the process of decreasing PT and increasing home exercises.
Has anyone experienced the same feeling as I described? How long does it take for the scar to soften up? If so what did you do?
Hi Tina - I am an Aussie (yay).
I ruptured mine in mid- May and I just went back to the docs and he said I could go without the boot and go onto physio. So - that was about 2 weeks in cast, and I’m just starting to partial weight bear on my foot with use of one crutch - so that’s what happens after the four weeks. But at least with the boot you can remove it to shower and do a bit of wriggling your toes and slight moving of the foot etc.
Wish we could compare notes and see if it is the same doc.
Hi again SalW,
NSW South Coast ring any bells?? Went back to my GP today and told them my calf was aching heaps, dizzy alot with low blood pressure, (not so good when on crutches hey!!!) so now i’m getting an ultrasound to check for a blood clot!!! Other than that, i agree about the boot being better for movement and washing. Scared to use the foot again though and to start driving! Wish it was the left foot!!
Hi rho1372 - not sure about scar tissue just yet but I’d imagine that there are things your physio could do to soften it somewhat. Can’t wait to be where you are though - walking!
Hi Tina. Nope - my surgeon was in Nth Sydney. Maybe they all get together and chat about what phrases to say to their patients. That’s not good about your calf aching and being dizzy - fingers crossed that there’s no clot and the symptoms will pass.
I’m off to physio this week so hopefully there will be some rapid improvement - maybe driving in a month or so.
Hey SalW - Found out i did have a large clot in my leg and am getting blood thinner injections. Just happened to mention the ache while at the docs with sick kids. Lucky eh!! Good luck with the physio, i hear it is going to be pretty extensive for a while. Let me know how you go driving, All the best for a speedy recovery!
Sorry to hear about your blood clot but lucky that you mentioned it and got some treatment.
Physio tomorrow - eek! Nervous but hoping it’s going to be a step in the right direction for recovery.
Just saw Tina’s mention of blood clot and thought I would get some thoughts on my ankle.
I, mistakenly, detailed my experience on the re-rupture site (http://achillesblog.com/re-rupture/, July 24), but in summary, I am a newbie to ATR (good fun), had the operation. Just got my cast, but soon after I had felt a lump building in the lower part of the calf (as if they put a ball there and then put the cast on). Didn’t think it was a blood clot because I could find positions where I didn’t feel it and it didn’t throb. Was getting more uncomfortable, and was intending to go to emerg early this morning…but when I woke up it seems to have subsided (although my leg was much more swollen than before). I figure this is better, but I still don’t know what happened or if I should be concerned. I am guessing that it was a blood blister of sorts and that my incision wept a bit because now it feels like my cast is sticking to my leg. Any thoughts?
I also had difficulties and much pain in straigthening my leg, which is not expected.
Jimbo:
In my humble opinion what you are describing is not normal. I would advise a trip to the ER like right now!!
Good Luck.
Hey Jimbo,
Its better to be safe than sorry re blood clot. I was in agony every time i stood up as the blood would rush down and stop at the blockage. They say you can feel lots of heat where the blood clot is but don’t massage it as it could break up. Mine was a large one and detected 2 weeks after surgery when i mentioned the pain to my local GP while taking sick kids to be checked out!! Very lucky!! I agree with Doug, check it out ASAP. Let us know how you go.
Tina
Thanks Tina/Doug.
After reading your advice and talking to others who had ATR, I went back to the doctor and, voila, he found a small intra-muscular blood clot (likely a result of the trauma I gave myself when I fell a week after my operation, not fun). He wasn’t overly concerned about it as it wasn’t in one of the major vessels, but put me back in the half cast and will monitor. It is a good thing that I went back, eh. Funny thing happened at the hospital though…when I got there and decribed my pain, the attendant took the cast off and upon seeing nothing on the outside they wrote me off with the “you just injured yourself so expect some pain” lecture and were going to throw me back in the cast. I did feel like an idiot after not seeing anything externally as I thought I would, (I very much don’t want to be there for nothing and have not experienced the joy of ATR before and so recognize that I am not the expert on how things should or should not feel) but we pushed to see a bit more to see the doctor…..got a really nice one who took some time and sent me for the doppler and the rest is history.
They also gave me arthrotec (an anti-inflamatory and analgesic…typically for joint pain, arthritis)….not sure how I feel about it though in terms of side effects (heartburn, gut discomfort, etc). I figure I will just wiggle my toes a bit more often
Thanks again for taking the time to provide me your throughts. Take Care and I will keep you posted. Jimbo
I was given anti coagulant for 2 weeks after the surgery. I guess it was useful.
Yeah, we know how they seem to think at the hospital that we are complainers and it is our favourite past time to go there….
No problem Jimbo. We all have to look out for each other, thats what this blog is all about.
So, I went back to the doctor to see about the small thrombosis and it just so happened that I had developed another pain up the calf a bit….nothing serious, no swelling, but thought I would mention it. Turned out to be DVT (deep vein thrombosis) behind the knee (so it was a bit on the move). Now I am on the wonderful world of anti-coagulant injections (1 week) and pills (3 months). Good times!
Hey Jimbo,
Glad they caught it, mine was in the same spot. I too mentioned calf pain to my surgeon but he just said it was from the surgery, mentioned it my local doc and she got an ultrasound and found the large DVT. Moral of the story, always speak up no matter how trivial you might think it is. Hang in there with the injections, you might feel like a pin cushion after a while with the blood tests as well!!! Lucky you getting 3 months, i’m on them for 6!! I am nearly 8 weeks post op and down to one crutch and working on no crutches so yay, a spare hand at the moment!! Good luck with the rest of your recovery. Tina
Just wondering about people’s use of a recumbent exercise bike whilst non-weight-bearing in a cast? Did you need consultant’s or physio’s go-ahead or have you just done it?
On the rucumbent bike…I asked my dr if I could ride it with just the good leg and not the ATR leg. He said sure…I have…but it’s sure harder than with 2 legs, LOL
just snapped it yesterday…sprinting after a street thief (yes i caught him)..partial tear of left tendon..about 1cm i have elected for surgery (i box a bit)…here in spain they gace me ultra sound and blood thinning injections for 30 days along with pain killers…thye seem to think i may have to wait a long time for surgery so it may heal in the interim..about six weeks….does this seem right to you guys?
got a heavy cast on now.. is there an alternative lighter cast? i have scoured the net looking for one but to no avail…
any advice?
Saw your blog and posted there but in answer to this…
I’ve had fibreglass casts the whole time - surprisingly light..
Didn’t have blood thinning injections though? Took the odd aspirin after surgery to help with potential blood clots but nothing else ever mentioned to me. Perhaps the heavier cast you have? Or tightness of it?
Yes after 6 weeks in cast the ATR should/could be healing itself, you don’t want to start the whole process again having surgery AFTER 6 weeks if you can help it.
Push for surgery sooner if that’s the route you want to take or just go with the casts straightaway.
Best wishes, Sam
Hi , rumptured my achillies tendant a week ago today playing football , the normal effect ,felt like i had been hit in the back of my leg.
went to the walk in centre (hospital) the next morning and diagnosed as a partial rumpture and was put into a cast for three weeks ,then another for 3 weeks and then one i can walk on after that, they said i should be in one for a total of 3 months ,,read loads of your blogs which answered loads of my questions, but still a bit unsure about what type of pain killers i can take as i read you cannot take aspiren or ibuforon? ,keep getting told its worse than a broken leg for healing! its the fact of everything being such a task with the cast on thats the worse. and not being able to drive is a nightmare hope you all recover well
mark
newcastle england
This is a very interesting Blog site.
My situation is a bit unusual - I’m a Foot & Ankle surgeon who just ruptured my achilles two days ago.
Having surgery Friday.
I have a new appreciation for disabled persons.
Esse
Esse - glad that you found this site. I wish you luck on your surgery, and let us know how it goes.
Hi I am a 26yr old female and ruptured my archilles 5 days ago playing netball, had surgery that night and now stuck with a huge cast for the first time in my life!!! It gets downgraded to a lighter one in4 days time, still a little unsure on wether I had a partial or full rupture, still on some pain relief and doing some work from home so I don’t go crazy, how do you stay positive if you are a person who leads a very active life??
Great website
Anna,
Sorry to hear you’ve joined the club, but welcome anyway, Best way not to go crazy is to log in here regularly and see that you are not alone - there’s loads of us in this boat! And then find new ways to be active. And then admire your new bulging shoulder muscles after a couple of weeks on crutches! And then realise what a great bunch of mates you’ve got and what a very resourceful person you can be when you have to be. It’s a sh***y injury to get, but you needn’t have a sh***y time while you get mended. Take care!
Smoley
Hi Anna, welcome to the club. Sorry to hear about your injury, but if there is one good thing going for you - it is your age: you are young so you should heel faster and well compared to most old timers on this site ! Good luck!
Thanks smoley & 2ndtimer for your inspiring comments
Found this site while resting in bed recovering from the ATR surgery a week ago. This site has been very helpful and the stories have been ispirational.
Like most people, I ruptured my right achilles while playing basketball. The surgery was performed the day after my injury. The doctor prescribed vicoden but elected not to take them. After three days of surgery, I am feeling an intense cramp on my right calf when I get up to use the restroom. Also feel escursion pain below the right calf and around ankle during night time. Is the normal because I am not taking the pain medication? (blood clot?)
I have been elevating my injured leg as advised by the doctor. Next doctor’s appointment is next week. Thank you in advance.
Hey Tom,
Go and get that leg checked out straight away as it sounds like my symptoms (when standing, blood rushing down and stopping at a point with massive cramping). Told the hospital about it and they weren’t concerned, told my local doc and had an ultrasound and it was a large DVT. Have been on warfarin (blood thinner) for 4 months now with another 2 to go. Its better to be safe than sorry. Good luck with your recovery. Tina
Tom take Tina’s advice, doesn’t sound right to me.
I never actually had much pain after the operation and certainly no cramp.
Get it check as soon as possible.
Tina and Annieh, thank you for your advice. I went in for a 2 weeks post OP follow-up today. Splintter was removed and a cast was put on. Told me to come back in 2 weeks for another cast. Discussed the pain with the doctor. He told it was expected due to the right calf muscle resting at this time. I am still experiencing a little pain around the ankle at night. Doctor said the pain is going to fluctuate like a “wavelength” through out the day. Will monitor for blood clot.
Hey Tom, glad you checked it out. If you get any more cramping or pain in your calf, don’t hesitate to go straight in. I thought the pain was from the op but it was high up in the calf and hurt like hell every time i stood up and just didn’t seem right. My DVT was discovered 2 weeks after my op, so keep on monitoring and i hope you have a speedy recovery. Tina
hi all just found this site while browsing i ruptured my achilles fully on sat playing football when running for the ball thought someone kicked me went down an relised there was noone there !and new straight away what i had done .now in a cast and seeing consultant on weds to decide on my options . i am a very active 51yr old telephone engineer ,so reading the site sways me to the surgury option . on crutches now forgot how hard work it was as broke me leg twice nearly 20yrs ago ..so here we go …
Andy, Just looked at your blog and similarly am a comms enginner who ruptured his achilles tendon playing football. Simply jumping to chest the ball down, landed with a sudden pop,acute pain lower calf and looking for the pot hole in the ground I suspected I had fallen in to, which was not there! A & E that evening after realising symptoms were not good , splinted immediatly. Op 5 days later with foot planted, then cast change after 4 weeks and foot levelled to nearly 90 degs.
Slight weightbearing at 4 week point. Removed cast post 6 weeks op, crutches and very careful walking . Now at 9 weeks post Op , theraphy ongoing. Everyday a little better but slow, too much activity your body soon tells you. Walking with slight limp, but gradually going. Hope to be running 5-6 months post OP, no more football or team games ..too scared….
Hi All,
I’m so glad I found this site, I thought I was the only one!! I ruptured my Achilles on the 5th Dec 09 Playing football (UK) I was told all sorts of horror stories in A&E, things like I would be in a cast for up to my thigh that I would never return to the football field as a player, (all bullshit!!!!!!) I opted for the surgery (best option) and was booked in to see my consultant on Tues 8th Dec, who did the thompson test and confirmed that I had ruptured my Achilles, had surgery the following morning and things couldn’t have gone better, I will be in an awful heavy cast for 2 weeks (23 Dec) the into a boot or lightweight cast, I have been informed by my consultant that I will come back stronger than ever if I do my physio and workout to strengthen it….. There is light at the end of the tunnel!!!! Just a note but I have had little or no pain (Aches sometimes) and have always had full movement of my toes without any pain. (is this normal?) Good luck to everybody on this site…. God Speed and a Merry Christmas!!!!!!!
Hi, Gary! I’m about a month ahead of you- ruptured on November 3- haven’t had much pain to speak of (although I did have a nerve block for the surgery) and I have always been able to move my toes with no problem. Don’t listen to the horror stories. I try to tell myself that this isn’t tragic- it’s just inconvenient. Hang in there.
Hi everyone,
Thank god i came across this site doesnt make me feel as though theres no light at the end of the tunnel any more.I ruptured my achilles tendon on the 4th dec(i live in uk) dancing of all things!!! heard a “gunshot” sound felt a heavy thump in my calf and down i went.Am in non weight bearing cast and go back to clinic mon 4th jan to have pot removed and another one on gradually moving my foot to diff angles .Thank goodness we have borrowed a wheelchair as this allows me a little independance,not too clever on the crutches although have stopped falling over as much!Trying to be optimistic and not have a miserable face but at least on here others know how you feel.Take care all julie x
Just did mine on Thursday, Jan 7 and am very thankful for all of the information on this and other ATR blogs. The info has lead me to see a foot/ankle specialist rather than the orthopaedic generalist I saw on day 2. I see the specialist monday with my MRI pictures and will chart a course from there. Like most I am sure, I hold out hope for a “minor” rupture and non-surgical repair. Does anyone have any guidelines in terms of gap for non-surgical consideration? 1cm?
There’s an article somewhere on this site, sorry can’t remember where, which is a study of the results from surgical and non-surgical treatment, re strength/flexibility etc.
From what I remember the best results for non-surgical were achieved if the injured leg was set in cast within 48 hours of the ATR.
The specialist should be able to advise.
Best of luck.
The article is HERE it was on Simons blog.
Pete I was told my achilles was hanging on by a thread (rupture is rupture) complete break I would say its an op job. I ruptured mine on 15Nov09. Chose non operation. The cast was on from pointy toes to part way up my thigh. This was to be on for 3 weeks. Couldnt stand it so after one week they cut it below the knee. After 3 weeks they move your foot so many degrees so that the tendon can meet. i couldnt fatham how it works and the doctor explained . if you put your fingers in between each other and then slide your fingers apart i.e. north south that is how the tendons rip apart to different degrees depending on the individual. Every two weeks they did this until my leg was 90 degrees (neutral) took 7 weeks, 3 days. I have been in a huge boot which I can take off at bedtime and bath. In the boot for 6 weeks. starting 5Jan2010 My first physio is on the 15th Jan 2010. I feel sorry you have done this just hope the info helps a touch take care annette. They say if you are really sporty and want to get healed quicker then the op with 4/5 % rerupture to 7/8 reruption for non operation. However the op will leave a scar and apparently as there is little blood healing can for some be difficult as with some who can get infection. Not to scare you this was told to me by my doctor. My consultant said when I asked him will this heal - he said of course it will!
Thanks for the article…think I had already seen it. I guess everything depends on the philosophy of your doctor. I have read waaaay too much already - hope the guy I see tomorrow knows as much as I do. Freaked out at the prospect of surgery, that’s for sure. General anasthetic would be the way to go for me, but the intubation aspect is terrifying as well.
When you guys had just ruptured yours, were you able to walk at all? I can shuffle around when I am “warmed up” (blood in foot for about 5 minutes) - is that bad to do? I am being very careful and sometime wear the walking boot I was given by the general ortho guy Friday (can you believe he didn’t give me crutches?)
Leiulu,
Thanks for sharing your experience…hadn’t seen your post when I wrote my last one. So did your docotor recommend no surgery because of the hanging thread? Was it age/activity related? I turn 38 today…some birthday. And the 7 weeks were in a hard cast, followed by the walking boot (that I have now) for the rest of the time?
Pete,
Before I knew I’d ruptured (misdiagnosis in A&E) I thought I was doing better putting my foot flat to the floor and being able to put a small amount of weight on it, with the use of crutches.
My surgeon was horrified that I was doing this and told me to elevate “sky-high” to get the swelling down for surgery.
I only had a small gap, and was offered either treatment but chose surgery because of the delay in proper treatment and because I has heard of a few people rerupturing after non-surgical treatment.
I had 9 weeks in fibreglass casts, 3 weeks in each position, then straight to 2 shoes with a heel pad and crutches for some time afterwards.
Yes, I have a scar but I;m glad I chose surgery - think I’d have been worried about rerupturing otherwise.
My blog is under sam66 if you want to read anymore.
thanks for sharing. hmmm, maybe I shouldn’t be putting weight on it with no crutches…swelling isn’t as bad as with the multiple ankle sprains I have had, but going from elevated to ground doesn’t feel good. I am still trying to convince myself that no surgery would be OK if the gap is tiny based on the studies out there…seems like there is far from concensus on any of this.
Hi Pete,
I was able to shuffle around after my rupture, until I saw the doctor at emerg - when he diagnosed me (Thompson test) gave me the crutches and told not to put weight on it. I could feel the gap when I touched it. But they took no MRI nor ultrasound. However he gave me a splint at 90 degrees that was not good I think…. 2 days later the ortho put me in cast with pointed toe… After 4.5 moths I re-ruptured it. Then I had surgery. What is the moral of the story? I do not know.
2ndtimer,
that’s about the scariest thing I have ever heard…tell me you did something out of the ordinary to snap it again? sounds like they mistreated you from the start though, even if they were going conservative?
I just made a wrong step in my bedroom when it snapped again. Probably it never healed properly. It felt solid when i got out of the boot (after 11 weeks) but as I started walking i had flare ups, swelling, pain in the tendon.
I did not get an answer what went wrong. I think even if the surgeon knew, did not want to implicate his collegue. Maybe the gap was too big. Maybe because I fell while in the cast? Maybe I walked too much once I got out of the boot? Maybe the lower the tendon breaks the harder it heals?
I was not offered surgery first because I am over 40 and do not do sports regularly. Or maybe the surgeon was too tired, it was the end of his day. Not many people seem to get MRI though. Too expensive.
The second time around the diagnosis was not simple either. First the emerg doctor thought I did not re-rupture, as it was pretty hard and swollen. He said I would not get surgery anyways, if I did not get it first time. But just in case ordered ultrasound. Then they diagnosed full rupture. After that they called down the ortho surgeon to emerg and he offered surgery.
I didn’t like the lack of knowledge from the general ortho I saw Friday, nor did I totally trust the thompson test. I wanted to know “how bad” the rupture is so I got an MRI (not to mention it will help them know where to cut in case I get surgery). I am taking the MRI to a foot specialist tomorrow morning…that guy had better know more than I do or I am on to another doctor. I wonder if I am no longer a candidate for conservative treatment given my delay in seeing someone competent and continued (careful) weight bearing. Fact is, the general ortho gave me a walking boot not crutches…what an idiot.
Frustrating isn’t it. My 2nd surgeon said the re-rupture rate with conservative treatment was 1 in 5. Hah. That is not what we read in the article above. I hope you get in good hands tomorrow. I had no health issues previously and this was my first surgery, so I was not enthusiastic about it, but it worked out well. Good luck.
Thanks. Yes it is frustruating. Surgery is what freaks me out. Did you go general or local anasthesia? I have played sports all my life, and while I am not in fantastic shape right now, I am in decent shape and lighter (weight) than I have been in 9 years. Plus, I wasn’t doing anything remarkable or particularly explosive when it happened playing basketball on Thursday. Guess I just want to get on with the healing process…wish I could include these last 3 days.
It seems to be always general anesthesia. (we have an expert on it here - see ultidad’s blog)
I think most of us did not do anything remarkably strenuous - just getting old. Over 40?
The thing about general is that I hear you have to be intubated to breathe…and until you wake up…which would be a living nightmare. I will go have a read.
I had the choice. Could n;t face surgery, Being female did not want a scar. Felt confident I could heal without it. The surgery is good for push off il.e. more control so if your a very active i.e. sporty person they recommend the op. I am not sporty but the atr was done whilst playing net ball. But I do like the gym, like to dance so does that make me active and should have had surgery - no thanks. Age perhaps does come into it as one gets older its harder to heal i believe but 38 is young.
Everybody reacts to things differently. I was so upset about the re-rupture the surgery was no concern anymore. Also I had no time to worry: diagnosed at 4pm - surgery done 4 hours later. I do not remember anything about the tube. Put the mask on my face and I was off. Waking up had pain - that was no fun, but was given morphine and after that it was lala land. Did not need any more pain killer after first day.
They let you go into surgery without fasting, etc…? Wow…wish I didn’t have time to think. I commented on that other guy’’s blog…hopefully he checks it to answer my anasthesia questions…although I suppose I will find all of this out tomorrow morning anyhow.
No, you have to fast a bit - he asked me when I ate last time, i think it was at noon, and not much, so 8 pm worked.
I think they give you something to calm you down in the iv.
It will be over fast. it is rather the 3-12 months to full recovery that you have to worry about.
do you remember anything at all?
No. I remember the nurses chatting among themselves but in half a minute I was out I think.
Maybe you need a glass of wine this evening and a nice long bath - you will not have that for a while with the cast!
don’t they make cast covers so you can shower? I did go get a haricut and shave yesterday in anticipation of next week.
Pete,
You may or may not have a cast, depends entirely on your surgeon. Mine doesn’t use casts for ATR so only ever had the boot, from the time I ruptured it until I got to FWB.
You can buy a cast cover or you can use large black plastic trash bags and gaffer’s tape. It took me a while but I finally got to where I could use the same bag probably a dozen times before it need to be replaced. The trash bags are a lot cheaper than the fancy cast covers too.
There will not be too many options for anesthesia. They will ask you if you’ve had it before, how that went if you did and if you have any allergies to drugs, but this isn’t the sort of thing that’s done under a local. At least I’ve never heard of it and I sure wouldn’t want it done that way.
The first couple of days after the surgery are the worst. Make sure you have pain pills that you know work. You may also want to have something muscle spasms. I had some really nasty muscle spasms after my last surgery and immediately called and go a muscle relaxant. The pain and muscle spasms only lasted a couple of days. After that I just took Ibuprofen.
I would be thrilled if my guy doesn’t use casts…will find out tomorrow. I have definitely heard of local…shots in the spine and or leg…awake for the whole thing. Not what I would like except for the intubation aspect of the general.
What is gaffer’s tape and where does one buy it?
Pete- I’m trying to post my answer to your question on my site, but I keep getting “Error: Please enter the anti-spam word”. Except on my blog, there is no place to enter the anti-spam word. Help, Dennis?
So, here is what I tried to post:
Hey Pete- sorry to have to welcome you to the club.
As far as surgical concerns go, I’ll let you get that info tomorrow. I would suggest taking a list - write it down - of your concerns. It is really easy to get overloaded w/info and forget to ask questions.
From the anesthesia standpoint, I hope that I can help you. My subspecialty is pediatric anesthesia and nearly daily I tell the parents of my patients that overall, from a statistical standpoint, it is safer for their child to have anesthesia than it was for them to get the child to the hospital. We (people in general) tend to underestimate the risks of driving because we feel like we are in control; we tend to overestimate the risks of anesthesia because we feel that we’ve lost that control. Very similar to the statistics of flying vs. driving
That said, there are a few decisions that you may or may not be presented with:
1. General vs. regional anesthesia:
General anesthesia means that you are completely unconscious, you won’t remember anything, and you won’t feel anything. GA is normally induced w/medicine given in an IV, although those of us in the pediatric world tend to have our patients breath anesthetic gas via a mask. Most of the time, GA is maintained with inhaled anesthetic gas, with the patient either breathing on their own or being controlled/assisted by a ventilator. The gas can be delivered by a mask, a breathing tube, or any of several other airway devices. Most GAs are what we referred to as “balanced anesthesia”, meaning that in addition to the gas, other medicines are given in the IV, such as sedatives, narcotics (pain medicine) and muscle relaxants. Currently, nearly all GAs also include the administration of anti-nausea medicine and antibiotics.
Regional anesthesia (for the purposes of ATR repair) normally means either a spinal or epidural anesthetic. These two techniques are very similar in that a needle is used to go in-between parts of the bones of the back (the bumps that you feel/see in the middle of the back) to get to a certain spot. With a spinal, the needle is advanced until the tip reaches that place where the spinal fluid is. Local anesthetic is then injected. With an epidural, the needle is advances slightly less than with a spinal. Again, local anesthetic is injected with similar results. Sometimes, narcotics are mixed with the local anesthetic with either technique. The extent of numbness with either technique is usually from the lower chest/upper abdomen on down. Regional techniques are typically accompanied by the administration of IV sedatives and/or narcotics so that the patient isn’t completely wide-awake during the surgical procedure, but is in a state referred to as “twilight sleep” (although I dislike that term). Depending on the technique, the medication used and the dosage, RA provides surgical anesthesia for 1-3 hours, with pain relieving effects lasting 4-8 hours after surgery.
2. Nerve block - yes/no:
There are several different nerve blocks that can be pertinent to ATR repair, but the one that is most frequently used is called a Popliteal Block. By “nerve block”, we mean that local anesthetic is injected around a specific nerve, causing cessation of nerve signals in that nerve - numbness to pain as well as inability to move. With the popliteal block, a needle is inserted in the area behind the knee to numb up the nerves that go to the foot and ankle. It is possible to do some surgeries on the foot with this block alone, but I don’t think that it provides adequate coverage for ATR repair (blocking other nerves higher up in the leg can accomplish this). Mainly, this block is performed to provide post-operative pain relief. The block is normally administered before surgery - usually before the main anesthetic is administered as well, although in pediatrics, we typically do nerve blocks after children are anesthetized. Usually some IV sedatives/narcotics are administered before performing the block. Although it is possible to perform this block unaided, frequently either a nerve stimulator or ultrasound is used to help with locating the nerve before the injection is done. These blocks can provide pain relief for up to 18 hours. When I perform nerve blocks, I always stress the importance of starting oral pain medicine before the block wears off. If you read enough of the stories here, you”ll see that several people have been awakened in the middle of the night with a great deal of pain. To me, this points out the pros/cons of the block: you wake up from surgery with absolutely no pain, but have the potential for more pain later than if you had been taking oral meds from the time that you woke up (as well as making sure that your pain was under control with IV meds before you leave the recovery room).
Overall, if you look at things from the perspective of 1 week post-op, there is no difference in patients depending on their anesthetic technique - GA vs RA +/- nerve block. Like most things in life, we all have our opinions about what is best in any given situation. My surgeon preferred that I not have the nerve block, so I didn’t push for it - a typical argument against the block is that it would mask symptoms of nerve damage potentially caused by the surgery. As far as GA vs RA, in an otherwise healthy person (which describes most of us who have this injury) there really is no difference in risk. Even being in the business, I was fully prepared to go whatever route my anesthesiologist recommended (I had GA).
I hope that this helps. I’m not going to re-post my email address, because I saw an upsurge of unwanted emails after I did, but if you have any other questions, you can find it here: achillesblog.com/gerryr/2009/09/23/third-surgery-scheduled/. Good luck, Ron
Pete-
OK, now I’ve read the above comments and I’ll add a couple of things:
1. Intubation is not as bad as it sounds. In nearly 15 years of practice, I’ve only had one patient remember the tube going in (a “crash”, emergency C-section and I warned her that she might remember) and I’ve had no healthy patients remember waking up w/the tube (I say “healthy” because some patients remain intubated after surgery, but they are usually sicker or having more extensive operations like open heart surgery)
2. If your anesthesiologist/surgeon combination thinks that a spinal or epidural is best (my father had a spinal when his ATR was repaired at age 58), it is highly unlikely that you’ll be wide awake during the surgery.
Good luck tomorrow, Ron
Thanks, Ron. I guess I would prefer GA but am concerned about intubation and remembering that or coming out of GA with tub in?
well…our posts crossed. Glad to hear that. Still freaks me out a bit as I am a large man 6′5″ 270 and have woken up before for other things like teeth extraction and endoscopy…
Gaffer’s tape is used in theater and also by professional studio photographers. It has very tenacious adhesive but doesn’t leave a residue even after long periods of time. You can also use duct tape but I found that gaffer’s tape worked better. You can buy it at professional photography supply shops and theatrical supply shops.
So…I am scheduled for surgery on Friday the 15th. I wish my new guy had spent more time discussion the MRI and “degree” of rupture so that I could have more seriously considered non-surgical treatment, but he did say that since I did it 4 days ago I have kind of already missed that window for getting the best non-surgical results. (would angle your foot right away, etc…) Curiously, he wasn’t appalled at the fact that I was walking…though he did say that after the surgery I wouldn’t be weight bearing for a bit. On the bright side, this guy seems to be aggressive in recovery. I don’t think I am getting a hard cast at all, which makes me happy. I guess I just need to survive the surgery now and try to get on with the healing. I am supposed to hear from the hospital re: anesthesia, etc…soon. The guy said I would probably have a mask with a tube that only goes to the back of your throat and that you would never be aware of or remember it?
Pete- the “mask with a tube that only goes to the back of your throat” is not really a mask, but it does go to the back of the throat, not all the way into the trachea. Its full name is Laryngeal Mask Airway and the word “mask” is in its name because the early ones were designed to be covered by a regular anesthesia mask. Google it to find out way more than you need to know. Without seeing you, but you being the size that you report, I would probably intubate rather than use an LMA. For the surgery, you need to be on your belly, and if your airway obstructed during the procedure, it could be a bear trying to correct the obstruction. Now, the anesthesiologist who you have for your surgery may take a look at you and say that (s)he is not concerned and you can have an LMA. Another concern that I have with LMAs and ATR repair is that sometimes the surgeon needs to have muscle relaxants given and it can be more challenging to ventilate a prone patient who has an LMA. As far as the “never be aware” part, there is really no greater likelihood of remembering a breathing tube vs an LMA. I do have to say that the only time I say the word “never” is when I say, “I never say never.” I’ve been doing this long enough to know that nearly anything is possible and I can’t guarantee anything. I do hope that all this info is helping, rather than giving you more things to ruminate over. The bottom line is that, just like there is no “best” way to treat ATR (surgery vs. non), there is no “best” anesthetic plan.
Thanks for all of the info, Ron. I haven’t talked to the actual anesthesiology guy yet…and yes, all of this stuff does freak me out. But at the end of the day, if I won’t remember any of it, I suppose it doesn’t matter once you are out. Not having the surgery until Friday is giving me way too much time to think about everything. I could have done it today but with 3 kids under 5, we wouldn’t have had child care sorted, etc….
Well, I made the mistake of telling the pre-op nurse that I might have sleep apnea (never diagnosed…snore loud). Super. Now I am told that I get to spend an extra 3 hours in recovery Friday. Ron, any way to reassure them? Might they change their minds in the moment or is it a set outcome based on the pre-assessment?
Sleep apnea has become a real attention-getter lately, mostly because people with severe sleep apnea are exquisitely sensitive to the respiratory depressant effect of narcotics, which means that they can stop breathing with doses of pain meds that would be easily tolerated by someone w/out sleep apnea. Ask your wife if you ever stop breathing, or if you just snore loudly - your anesthesiologist will probably ask something similar. If your wife says that you don’t stop breathing, you might be able to avoid those extra 3 hours. But if you do stop breathing at night and stop frequently, it might be safer for you to actually spend the night in the hospital, rather than just an extra 3 hrs in recovery. I gather that by now, you just wish that the surgery was over already!
My wife says she can’t really answer that question as we are usually awake at the same time and she was used to the snoring anyhow - but feels like I don’t snore much any more for what that is worth. I did get a mouthpiece a while back for tooth grinding issues, so that may have helped the snoring. I do wish I were on the other side of the procedure…read a post on this site that said the guy remembered a tube being pulled out of his throat - not what I wanted to hear…but maybe he had a bad anesthesiologist? As for me, do you think they will be able to tell anything while I am under in terms of apnea? Oddly, since the first operating venue determined that I have sleep apnea, I could no longer go to their facility as it closes before the 3 hour window would be over. I am now going to the hospital, and had to re-do the pre-op questioning today. Answering the same questions in the same way (and indicating the conclusion the other venue came to), this nurse said she didn’t think I have apnea and didn’t flag me as such…should I now be afraid? I suppose I will get to speak with the actual anesthesiologist before I go under anyhow, right?
Answers in order:
1. Not necessarily a bad anesthesiologist - guy might’ve awakened quicker than anticipated (like most things, response to anesthetics is a bell curve)
2.Doubt that possible sleep apnea would be detected while you are under - the anesthetic state, although compared to “sleep” is really a much, much deeper state of unconsciousness.
3. Sounds like the first venue was a surgery center. Since those facilities are usually not equipped for overnight stays, they tend to be overly concerned/cautious about caring for all but the healthiest patients. I don’t think that you need to be afraid.
4. As I’ve said earlier, I won’t say anything is 100%, but it would be highly, highly unusual for you to not meet your anesthesiologist beforehand. If if seems like they are taking you to the OR and you haven’t met an anesthesiologist, insist on meeting yours.
Pete - Just thought I’d offer some thoughts based on my experience with this injury, although it looks like Ron has already provided some really, really good and detailed information. I’ve had two achilles surgeries and had general anesthesia for the first and spinal block for the second. Both procedures went fine and I didn’t have any side effects. Going into the second surgery I was planning on having general again because I’ve never had a problem with it in the past, but after talking with the anesthesiologist prior to surgery, I decided to try the spinal block. They also administered a popliteal block to manage post-op pain as well as a sedative prior to the procedure. I was out like a light and don’t remember anything about the surgery. As I recall, I was a bit less groggy when I woke from the second surgery.
I mention my experience because it sounds like you have concerns with intubation. The spinal block was very effective for me and I know plenty of others have gone this route rather than general, and I don’t remember anyone mentioning complications. The spinal block may be a good option for you as it would avoid intubation. I would recommend you mention your concerns about the anesthesia with the nurse first thing as they prep you for surgery. Mention that you’d like to have some extra time to speak with the anesthesiologist.
Good luck with the surgery. I know the anxiety of the situation can be draining, but it will be over with before you know it and then the healing can begin. Try to keep positive thoughts.
Thanks for the advice, Tomtom. I am not sure I ever want a needle near my spine…how was the initial dosage of sleepy serum administered? And with the local, you don’t remember anything at all? No “tugging on the foot” or surgeon banter, etc…? Did your anesthesiologist recommend the local or just present the options? I think I would prefer to be totally out…but with the guarantee that I don’t want up until I am supposed to and not with a tube in my throat…if such a thing can be given. Ron, when do they take the tube out? In recovery right away, or does someone stand there and wait for signs that you are starting to come out of it and then yank? I do look forward to being able to start the healing, although I do see surgery as a major hurdle. Also, since I can shuffle around now and don’t have too much pain except when transitioning from lying down to standing up, I am bummed that I have to get worse first to get better…but that is the deal I guess. EXTREMELY helpful to read the experiences and get advice from folks like you…thanks again.
OK, I was not going to say anything but Ron probably won’t be around until much later. My younger cousin’s husband needed some relatively “routine” surgery a couple of years ago, actually heart surgery but a very common procedure, just don’t recall what. Like you the idea of someone cutting him open totally freaked him out. He was even considering not having it done even though it was absolutely needed. My wife is a psychiatrist and talked with him at length about it and finally told him to call his doctor and ask for a prescription for Xanax, pronounced “Zanex.” It is an anti-anxiety medication and it worked wonders for him. He later said he wasn’t sure he could have gone through with the surgery without it. BTW, he is also a big guy, 6′4″ or 6′5″. You won’t need a lot, just enough to get you through to the night before surgery. Your surgeon should not have any problem with it.
I appreciate the suggestion, Gerry…but won’t they give you something like that in your IV once they put it in? I probably won’t sleep much tonight, but maybe that will make me sleepier during/after the procedure. As you might guess, I am not a big fan of popping pills if I don’t absolutely need them.
Once you’re out, you don’t need anti-anxiety medication. This is to calm you down before you ever get there.
Pete - I can promise you I don’t remember a thing about the surgery. I was alert when they administered the nerve block behind my knee, but then I don’t remember much after that. The sedative was administered through an IV the nurse hooked up. I recall heading into the operating room and briefly speaking with the staff. I don’t know if the sedatives started to kick in or if the spinal block was uneventful, because I don’t really remember it. The next thing I know I’m waking up in the recovery room with my leg in a cast and propped up on a foam block.
The anesthesiologist explained both options but also recommended the spinal block. Not exactly sure why that was his preference, but he really pushed it. I actually didn’t care too much for the way he suggested I opt for the spinal, but I listened to him nonetheless, and it was very uneventful.
Also, you will likely have some post-op discomfort during the first 48 hours, but most people, including me, will tell you it isn’t that bad. As a word of caution, you will want to take your pain medication regularly for the first 24-48 hours and continue to do so if you’re still in pain. I’m like you in that I don’t like popping pills, but this is a case where you want to be proactive. It is more difficult to manage the pain if you wait to take the medication once the pain sets in. Your medical professionals will most likely go over all this information with you and your wife.
Pete,
I second everyone. I remember the anethesiologis singing a song to me in Russian which I thought was very funny and then I woke up in the recovery room. I also had a sciatic nerve block so I never took any pain killers as there was nothing to kill
The drawback, from what I understand, was that my leg was really numb for at least another day so I had to be really careful.
Good luck - you will do great
Marina
Interesting. so the chronology was: sedative, leg block, then spinal, then something else in IV to knock you out or cause you not to remember?
I have an unrelated practical question for recovery: How in the hell do you sit down on the toilet without putting ANY pressure on the hurt foot? Maybe it is because of my height, but I am going to have to be a contortionist? Or is light heel pressure OK?
Thanks for the well wishes Marina. Sounds creepy that guy singing in Russian just before sleepy time though. So they must whack you out on something else after the block is in? No pain killers? Does that mean that by the time you regained feeling in the leg there was no pain? Was that by design or did they overdo the block?
Pete,
Yes, this was by design. The anethesiologist had suggested that I get the nerve block but said it was my choice. He was a boyfriend of my friend so I trusted him. And yes, but the time the numbness wore off there was no pain. There was a discomfort from the swelling but nothing that required a pain killer. In fact I had 30 people over to celebrate my b-day two days after the surgery. I could not cook much, but was able to help cutting the salads
Pete - I believe the sedative was given after the leg block. I don’t know if it took a few minutes to kick in or if they gave me a second dose right before the spinal block. That part is pretty foggy. Like I said, I don’t really remember the spinal block at all.
As for the toilet, light pressure on the heel should be okay while you’re sitting down. You can also rest the injured foot on top of the good foot while sitting down.
If you are really lucky, the toilet is near a door. What you do is lean both crutches on the wall where you can easily reach them later. Then, while standing on one foot, you shut the door and lock it. Then you hold onto the door knob with one hand and reach down for the the toilet seat with the other. Keeping a grip on both you can both lower and hoist yourself on and off. Probably only possible in very small bathrooms like mine, where I could reach both at once. Admittedly unhygienic, but it worked for me.
I have been practicing a version of that…but it only works in the main bathroom where the sinktop is close enough to use as a proxy for the door in your example. I would tear the door off its hinges for sure in the bedroom bathroom…this is another one of those times where being big and tall is no advantage (another that comes to mind is airplane seats). I just hope I don’t mess up the other foot/leg with all of the acrobatics I am likely to be doing over the coming weeks.
http://www.amazon.com/Jobar-International-Deluxe-Toilet-Support/dp/B000H8Y9GG/ref=sr_1_3?ie=UTF8&s=hpc&qid=1263522604&sr=8-3
Here are some toilet grab bars you can buy on Amazon.com, or lots of other places online.
Good looking product…needs a higher weight limit though. I would consider it if I end up having complications that make me NWB for a prolonged period of time for sure. Thanks, Mary.
Gerry’s figured out that I don’t get computer time until after my kids are in bed :). Let’s see, as far as when the tube comes out differs for most anesthesiologists. Personally, I extubate (technical term) with the vast majority of my patients still deeply asleep - a technique that I was taught during residency, but use to a far, far greater degree in my practice. Most of the time during residency, our instructors made us wake patients up before we could extubate, so I imagine that if one were to be a patient in a university setting that had a lot of residents, that might be one’s experience. As far as the general vs spinal as well as nerve block vs no, there are a ton of factors that go into why a particular anesthesiologist would recommend one over the other, such as surgeon preference, room turn-over pressures, availability of ancillary staff, patient health/anatomy factors, etc. Sometimes it is simply “that’s the way we do it here.” Some of those factors also make it very difficult to predict exactly what the sequence of events will be on any particular surgery day. And re: the toilet issue, I just used my crutches to help me sit down, but I’m 5′8″, so I had much less of a distance to lower than you do, Pete.
Interesting…hope these folks use your technique…even though I will be in Boulder, a college town, I doubt they are crawling with interns - but I could be wrong I suppose. Someone suggested to me that my size might dictate the anesthesia choice - do you make any of your determinations that way? Does 6′5″ 270 put me in a category where a choice is forced? I won’t be able to bug you for much longer…Dday is tomorrow around noon.
Up in Boulder, you’ll probably have an anesthesiologist who is well out of training. As far as your size and anesthetic choice, I could make an argument for either way. The extent of spread of spinal anesthetic is determined in part by the patient’s height - taller people need a higher dose to obtain a similar level of anesthetic - although in ATR repair, the level is not as important (it is easy to get the legs and feet numb). That could be used as a reason to not use a spinal. However, you need to be prone (lying on your belly) for the surgery to be performed. Larger people are harder to position after they are asleep (if you had a spinal, even if you were sedated, you could at least help in getting your upper body positioned) and can be more challenging to ventilate when in the prone position. That could be a reason to not use general anesthesia. Stop me if I am sounding like Vizzini in “The Princess Bride”. As anesthesiologists, we are trained to be professional worry-warts, which is why I list negatives for each technique. The bottom line, however, is that your size is not an absolute indication for one technique over another. Hope that you get some sleep tonight - good luck tomorrow.
Well I got the popliteal nerve block and I was sure glad I did. Lots of blogs here about people having lots of pain for days and days after their surgery. I took one little percocet on Day 3 after my surgery, otherwise never needed any pain meds at all except for Ibuprofen. I also think that maybe having the nerve block was why my swelling and pain have continued to be so minimal- things never got “all worked up”.
I like the Vizzini reference: “And I can certainly not choose general because of the risk of apnea.”
“So you’ve made your choice”
“Not even close! You weighed in at 270, so I can clearly rule out spinal, but you are 6′5″, which makes it difficult to position you on the table regardless.”
I’ll stop there…guess I will find out in a few hours anyhow. If it’s all the same to them, I would rather be out completely and wake up with an unobstructed airway. I just hope everything goes smoothly and that I am back online tomorrow some time saying how easy it all was. Have a great Friday all.
Alive! Very happy to be alive, but I can’t say I feel great. I didn’t sleep for a single minute last night. The 5 mg oxycodon (take 1-3 every 4 hours) was/is entirely insufficient. It gives mild relief for maybe 1:45 out of the 4. Called the doc this morning and he said I could take more/more often and add in some ibuprofen. Any other tips out there?
In the end, I did general anesthesia…really wasn’t presented with another option, which was fine with me. I think they knocked me out with IV sauce and then did the intubation for the other stuff. My throat was sore waking up, but I don’t remember the tube which is nice. I am told my achilles was a pretty “clean” break and therefore lent itself to a good fix. If I can just get this pain under control I am on my way.
anyone have any tricks for lessening the pain of going from elevated foot to foot near the ground? I tried once today and it was extremely painful. Or should I not even consider moving about for a few days after surgery?
If you are still up and suffering, try alternating meds, esp if you have pills that just contain oxycodone with no acetaminophen (tylenol). I alternated oxycodone and tylenol every 3 hours because I didn’t know that I could take ibuprofen. You could try a schedule of taking something every 2 hours - oxy, tyl, oxy, ibu, repeat. That way, you’re taking the oxycodone every 4 hours, but have something else in between. The good news: time will make things better. Also, I found that for the first two weeks (at least), every time that I got up from having my foot elevated, I could feel the pressure of more blood staying in my foot. That lessened over time as well. Glad to hear that you made it through in one piece!
Sound advice, Ron. That is what the Doc said to do (with ibuprofen) and it helped a ton. Don’t know if it was the ibuprofen, the combo with Oxy or just time going by but it definitely got better. I still didn’t sleep like a baby, however. I don’t think my body likes that Oxy stuff at all - gives me a low grade fever I think. Anyhow, day 2 post surgery is here…more NFL to watch and perhaps even a trip to the restroom. I don’t even know when I am scheduled to see the doc again. Is that ususally a few days to look at the wound or a few weeks? This splint sure doesn’t seem very robust…hope it hold up until I see someone. On the bright side it feels much looser, hopefully indicating less swelling? I feel like I can move my ankle a bit if I want to…should I? Thanks again Ron for all your help/advice - I sure knew what to ask the anesthesiologist the other day. Doctors must hate the internet for that…
True, once my doctor laughed and said, “Sometimes I hate Dr. Google!”
I saw my surgeon first the first follow up at the 2 week mark, and that seems pretty typical based on what I’ve read here. Be very careful on those trips to the bathroom, they are treacherous. I swear if I could’ve used a urinal thingy I would have!
Truly, you have a dizzying intellect! One of my favorite scenes from the Princess Bride.
I think you should not even consider moving about at first. The goal is elevate and ice. So I kept my knee above heart, foot above knee pretty much around the clock the first 2 weeks. It seems paradoxical, but going slow now will help you go fast later!
It has been 2 days since surgery, and I just took my first trip to the restroom (the largeg gatorade bottle has been sufficient until now). That was an acrobatic feat…the worst part of which was having the leg below the heart…throbbed nicely. Mary, did you have a cast for the 2 weeks or just the splint? My splint seems awfully flimsy/loose…doubt it would make it 2 weeks.
Another question. I am trying to get away from the Oxy…and I think I feel like crap because of it? Did you have the same experience? My foot doesn’t hurt too much worse, I just feel crappy. How much ibupofen can I safely take, or should I alternate between Tylenol and Advil?
Hi, Peteco! I had the plastic splinty thing with the gauze wrap deal for 2 weeks, then cast for 2 weeks, then boot, of course. I only ever took one percocet the whole time. Painkillers makes me so nauseous (even with prescription compazine) that they’re not worth it for me. But I was taking prescription strength Ibuprofen for 30 days! (poor liver)- 800 mg 3X day. It also helped that my nerve block lasted forever. The time will go by faster than you think. Get better every day!
that’s right..forgot you had the popliteal (I am Pete who finally signed up as peteco)…I can see how that might have helped as that first night was pretty miserable. The ONLY good thing about it was that surgery was in the past. So far so good on the Oxy weeing…haven’t had one in almost 6hrs, but I am not sure 600mg of Advil is going to do the trick every 6 hours.
800 and ice, baby, ice
can’t really ice through this splint?
Yes! And of course you want ice that can actually wrap around the splint at the site (or where you guess it is.) I found these ice packs at the drug store that were filled with little spheres of ice (like frozen peas) and I always had one under the splint and one on top, with the one on top wrapped in a dish towel. Another thing I wish someone had told me- try to keep your calf turned to one side or the other, so when you are elevating you’re not putting all the pressure right on the site. Also, when in bed, try lying on the opposite side of the surgery with pillows between your legs so the leg is elevated but sideways to relieve the pressure.
can you even feel the cold through the splint? It is terrible if the wound gets wet, right? As for positioning, I think (obviously never seen it) the cut is towards the inside of the leg and not directly on the back…haven’t really felt the site yet, just general pain down there. I just hope I can sleep tonight.
True, you don’t want to get it wet, so don’t even mess around with real ice- and wrap the ice/gel thing on top of your leg in a dish towel- to catch any condensation. As to where it is, mine is just barely to the inside.
Good idea.
So I moved from bed twice today on crutches, but unless I keep my knee as high as possible towards my stomach, the pain is brutal. Does that go away? Do I need to give the leg longer to acclimate to full blood flow?
Hey there I have recently ruptured my Achilles Tendon and have an appointment to see the specialist tomorrow. I was initially misdiagnosed by my GP as I could walk reasonably comfortably although with a limp and felt no pain and he thought that I had probably ruptured my plantaris tendon instead. I insisted on the ultrasound which confirmed that I actually had a complete ATR but also that I had a highly developed plantaris tendon which was the reason why I could walk, support weight relatively easily and had quite a free range of movement in my foot. I’m just wondering if anyone else has experienced this? Also my GP said that by having this tendon hold everything in place it should help with my recovery.
TJ:
Interesting. I ruptured my Achilles and limped around for 2 months before it was diagnosed as an ATR (they called it a calf tear originally). My fault, I should have been back in 2 weeks when it did not get better, but hey, I was new to all this. My doc never explained how it was I was still able to get around with an ATR - maybe (a strong plantaris tendon) this is the answer.
Interestingly, they harvested the plantaris to reinforce the ATR repair (weaved it right in). The plantaris is unnecessary and is often harvested for all kinds of other surgeries. In fact, 9% of people don’t even have one. Glad I did!
I ruptured mine 4 weeks ago and had surgery 2 weeks ago. On my second cast but was wondering what other people have done at this stage (2 - 4 weeks after) surgery?
I want to get out some but don’t want to do something stupid. Drove to a meeting and was on crutches for a half hour a couple days ago and it was a disaster.
All my doctor said when I asked him what I could do is “use adult common sense”.
Any feedback?
jr,
Take a look at my blog page. You do pretty much nothing first 4 weeks. I’m at week 3 and just starting to move around on one crutch. Have not really left the house except to go to Dr appts and a party down the street. Canceled 5 business trips. I think it’s best to lay low and focus on healing for the first 4-6 weeks. That’s what I’ve learned from others on this site and my own experiences. Good luck and keep up the good spirits - it makes a difference.
Hi Jr…I can echo norcalsurf70’s message…first two weeks were literally on my back with my leg above my heart…drove me crazy. After that it was a lot of sitting with my leg up. I was FWB about a month after surgery but I still had to had my leg elevated as much as possible. when I was first in the boot FWB i noticed the leg would swell quite a bit when i was upright for a while…Slow and easy wins this race!! The more rest you get in the first two months the better….get as much sleep as possible…you will be amazed how your body can heal
Thanks for the feedback.
Not easy sitting around. Drove a couple times but can’t get a comfortable position for my leg.
Nice to hear from other people going through the same crap.
Sorry to have to post again but I went into some blogs and everyone seems to be in a different situation that me. My achilles was completely torn with a 3 cm gap in the tendon Had surgery 3 weeks ago tomorrow.
The doctor said after 2 weeks that he wanted to cast me for another 4 weeks and I can’t put any weight on the foot the entire time.
Seems like other people are getting boots much earlier and putting weight on the foot as early as 2 weeks after surgery.
Is my doctor being overly conservative????
JR,
Recovery protocols are all over the map. From reading this site, it seems to me that they favor casting for anywhere from 6-10 wks outside the US. Inside the US, there is a still a wide range, from the boot after a week or so up to and including various casting regimens extending out to 8-10 weeks as well. I seem to have an aggressive ortho, but maybe that is because he is a foot/ankle specialist. I hit 4 weeks today and have been OK’d for FWB since day 10 in the boot. I would say that there is no reason you can’t have a discussion with your doctor about being more aggressive. Some on this site have even taken studies in to their doctors to try to convince them to go out of their comfort zones in treatment. There is no WRONG way to go, but so far I am pleased with what my doctor has me doing. I feel like earlier movement/weight bearing doesn’t allow the calf and supporting muscles to atrophy as much, making recovery time shorter. Time will tell. I will blog again after I see the doc on monday.
jr, it sounds as if your doc is on the conservative side of average, and probably on the conservative side of optimum (or at least AVERAGE optimum). 8 years ago, when I tore my first AT (and got surgery), I fought with my conservative surgeon frequently, to get into a boot, to get into physio, etc., etc.
Mostly, he did what he wanted and kept telling me that he was a conservative guy and we didn’t want to re-rupture my AT. Eventually, I got into a hinged boot — the first patient of his who had ever done so. I loved the hinged boot, and I’m using it again now, since 7 weeks into the NON-surgical protocol for my second ATR.
This non-surgical protocol is 100% boot, no casts, and much quicker (physio, PWB, and FWB) than what I had 8 years ago. So far, it’s going fine, and I’m doing way more than I could at this time with the first one. I think I’ve also lost less muscle tone and balance and such than I did from 3 casts in a row in ‘01-02.
On the other hand, my first ATR ended up healing beautifully, and I returned to aggressive downhill skiing 5 months post-op, racing small sailboats less than 6 months post-op, and competitive volleyball about 10 months post-op, and all of them at the same level of strength and intensity as before the tear. A number of folks here have done a lot worse.
In fact, the only real problem I had that time was when I went too fast, not too slow. Check out my blog for details, but I lost a month (and it was a painful month, too) after a physio pushed me too hard, too soon.
So there are hazards on both sides. Slow and steady usually gets there, but there are usually advantages to getting moving and getting weight-bearing a bit sooner than your doc seems to prefer.
There’s a link on my blog, first post, to a recent study that produced excellent results with a pretty fast (and all-boot) protocol WITH and WITHOUT surgery.
I think the only thing I’d change about it is that I’d use a boot that can “hinge” (like the Donjoy MC Walker I’ve got) instead of one that can’t (like the AirCast Walker I’ve got). Soon after you can be FWB, I think it’s great to start walking around in a hinged boot, protected from toe-up dorsiflexion, but with the freedom to toe-down plantar-flex, without the nuisance or scariness of doing the “silly walk” in two shoes.
Just my $0.02 — but hey, I’m an expert by now!!
4th WEEK EXERCISES????
4th WEEK EXERCISES?????
Saturday is the end of my 4th week since sugery. I originally was supposed to see the doc but he is on vacaction so I am not going in until the 6th week. Still in a cast and totally NWB until the end of the 6th week.
Does anyone have exercises that they were given to do at this stage with a cast? I am worried that the docs vacation is going to set me back and I can’t imagine how bad my muscles will be without any use for 7 weeks (1 week in a cast before sugery).
Any suggestions would be greatly appreciated.
Hi all from sunny New Zealand!
Great reading all the advice. I did my achilles on Monday at tennis interclub. My opposite number tool me straight to Drs, who sent me to Emergency Dept at hospital, where they did what I now know is the Thompson test, and found a gap in the tendon. I was sent up to Orthotics Dept where they confirmed diagnosis and have been put in a cast for two weeks (nice purple one) and have to go back then. Having read blogs I phoned my Dr to ask about surgery option (he’s a family friend so knows my activity level well) but he says that it isn’t done routinely here unless you are a young professional athlete. As a 48 year old “weekend warrior” I don’t exactly fit the bill.
So here I am on crutches, (which seem to be the most painful part of the whole thing) trying to figure out how to cope with house and kids for the next 6 weeks while I am NWB. And boy am I worried about muscle tone after I’m done with all this.
I think your Dr’s advice — that the non-surgical protocol can be as effective (for strength and ROM and return to sports) as surgery — is correct. Or at least it’s consistent with the latest randomized controlled studies, including one from NZ and one from Canada.
But 6 weeks of NWB is quite a bit slower than the protocol I’m on, which was used in the Canadian study. They used a rigid (AirCast) boot, no casts, and went from NWB to “protected WB” at TWO weeks, then to “Weight Bearing As Tolerated” (WBAT) at FOUR weeks!
In addition to getting good rehab results, this really decreases the time you’re at risk from making false steps with your crutches. And it gets you closer to “normal” sooner.
My first blog at http://achillesblog.com/normofthenorth has a link to the Canadian study results and protocol.
I’m way older than you (64), but I’m guessing that I’m even more serious about my competitive volleyball (etc.) than you are about your interclub tennis. If I thought that surgery and its risks would likely bring me a better result in performance, I’d probably have gone for it.
My surgeon (the one who talked me OUT of the surgery!) is the chief surgeon of the local professional football team. NZ and Canada both seem to be on the vanguard in terms of following the evidence on this, while many parts of the world (esp. the US) are still doing surgery (and fighting infections) at full speed.
Check out my blog before digging your heels in to get the operation. (And there are lots of blogs here about surgical complications.)
But I WOULD dig in my heels about the speed of your rehab protocol! ALL the evidence — post-op and non-op alike — suggests that 6 weeks of NWB doesn’t have any benefit, and probably has serious dis-benefits. And that’s in addition to the extra nuisance and lifestyle disruption and risk of tumbling down the stairs!
And try to get a boot , too, CoolKiwi. My fave is a hinged boot like the Donjoy MC Walker (and there’s a much cheaper one that LOOKS the same online), but a fixed boot (like the AirCast) is still way better than a series of casts.
One more thing, CoolKiwi: Why are your crutches causing you pain?? Crutches are a bloody nuisance, and sometimes scary (e.g., on stairs or in snow). But they shouldn’t be painful.
If the “armrests” are hitting your armpits, they’re adjusted too high. The hand-holds can be padded, as can the verticals around them, which can be filed “rounder” and/or padded. And there are lots of tricks to substitute kneeling or leaning or sitting for crutch-standing-on-one-foot. . .
Hi there normofthenorth, and thanks for your replies. Re the crutches - that’s pretty much muscle soreness in my pecs, shoulders - am using muscles I don’t normally. Just makes getting around stressful. I’m having no pain at all from achilles/foot/calf ironically! (Not sure whether that’s a good sign or not actually!!) I have got an office chair which I’m using to roll around our kitchen/family room (we’re open plan with a wooden floor) but the nurse said I had to use crutches as much as poss.
Re the surgery - yesI will def read your blog after this reply. Seems that in US surgery is very much ‘the things’ whereas not so over here. The protocol here is current cast for two weeks, another cast for another two weeks, then ‘moon boot’ NWB for another two weeks, then start WB after this. Am very interested in anything that gets me WB earlier - will have a look at the hinged boot you suggest. Problem is here that I am in the ’state’ system, so it’s very prescriptive. However I do have a very good physio/acupuncturist who has sorted out my shoulder before, and am going to give him a ring re all this too.
Great to hear about options available - had problems having kids in the past and was amazed at info available online that never quite made it to our local Drs! Always good to be able to ask “knowedgable q’s”
I experienced same problem with crutches, don’t worry, you’ll eventually get used to them and stop causing you pain. I had no pain either on the tendon while in cast and boot, so I thought it would be pain-free all the way to healing, but guessed wrong..PT killed me.
hi all,
I’m new here.
I torn my right Achilles tendon when ski last weekend.
and that happened in ski firm boots - very rare.
the next day I got cast and now how to make design about to continue “passive” way or get the next week surgery.
I’m in 40th and like to be active.
somehow I feel that torn tendon parts already closed together as I can apply light pressure to force my foot touch bottom of cast (that applies down pressure to my foot to upper part of foot).
Is it nonsense to get it so fast in 4 days? I asked other person to check when I moved foot down to confirm it isn’t in my shocked mind.
No MRI was taken as doctor in ER and after in Kaiser Orthopedic dept run Thompson’s Test and said its torn for sure and no MRI is needed.
Now I’m worrying about that at surgery doctor has to cut tendon to clear from damaged rapture pieces and it has to start re heal again.
At first day I was unprepared to give answer if I want surgery or not. So now I’m confused even more.
Hello Mike, welcome to the club..
Maybe you ruptured it partially, maybe there’s still one thread of it still attached, but there are also nearby smaller tendons on your ankles that can make you move your foot a little. I got a Thompson test but also an MRI (probably the hospital wanted to make money) to confirm and also see the distance of the gap.
If you’re active and want to remain like this, I would suggest surgery. Not that it’s not happening without having it, normofthenorth has done both feet, one on surgery, other not, check out his blog if you like.
Hi Mike 753
After tearing my achilles I still had full range of motion and could walk with a limp. Doc could not find tear but MRI showed full rupture. If you have a strong lower leg which I expect you do, other muscles can still allow you to do these things such as ROM and pressure. After two weeks when I finally got surgery I actually walked into the surgery room and they stood at the table looking at me. I requested MRI because of my situation and got one but most of the time docs do not need them for diagnoses and they are costly. I think mine was important because the doc was able to pinpoint the rupture and limit the incision instead of searching around for it since he couldn’t find a rupture point. I did show a positive Thompson test at every attempt and my calf and ankle turned dark blue so I bled a lot. The body immediately begins to repair itself but four days IMO is very unlikely to allow reattachment.
thanks for the reply.
I have to make design by noon today.
Doctor told me I’ll be fine ether way.
With surgery I’ll NOT have early mobilization as they don’t practice this. And my estimated recovery time would be the same with cast vs surgery.
Another thing is I’m with Kaiser (HMO) and surgery would cost my insurance, not me. Kind of conflict of interest.
However, surgeon I think gets more money from doing surgery then “just looking around”.
So far in my case I don’t see much upside moving with surgery, based on today talk with doctor, if any.
With surgery I’ll get into boot after 7-8 weeks and phis therapy will start after 3 months only, the same as without surgery.
So far I already pass pain point and in healing. Moving with surgery will get me back to pain point and a week of setback.
What do I know?
Based on my experience (having done one each way!), I’d skip the surgery. Your foot motion is likely from the other tendons in your foot. And I’d stop hobbling around in shoes ASAP and get immobilized “in equinus” (toes down) to give the healing the best chance to get it done right.
Check out http://achillesblog.com/normofthenorth for my story. Jump to the bottom and there’s a link to “earlier entries” or some such.
I should have said “Based on my experience (having done one each way!) AND BASED ON THE LATEST RANDOMIZED STUDIES, I’d skip the surgery.” My first blog entry includes a link to the newest study, from University of Western Ontario (not far from here).
I also found a slightly earlier New Zealand study that gave the same results:
When randomized ATR patients are divided between a surgical and non-surgical protocol, both with relatively quick rehab progressions –
- from NWB to FWB @4 wks and
- from “equinus” to neutral @6 wks and
- into physiotherapy @~2 wks –
their results (in strength and ROM and re-rupture rates) are NO DIFFERENT statistically! There ARE usually differences in the rates of surgical complications like infections and DVT, the former probably VERY dependent on the specific location and professionals, and how well they do their hygiene and infection control.
(I wish this page allowed quick “edits”! But no.)
Marina’s advice is exactly what I was told 8 years ago, when I tore my first AT. And I followed that advice. My recovery was slow (”conservative” surgeon) but quite successful. (That AT is a bit shorter than before, but it works just fine. Back to competitive volleyball, a bit MORE aggressive than before, no apparent loss of “vertical” or other criteria, though I don’t measure except subjectively, by competing.)
Three months ago, when I went to one of Toronto’s top sports-medicine surgeons (the chief surgeon of the local pro football team!), he talked me OUT of the surgery, based on the latest studies. He had personally stopped doing ATR surgery 4 months earlier, and had already had good success with a few patients without the surgery.
There are lots of fine folks here, including Marina, who have had the surgery, and I sure don’t want to undermine their emotional well-being. (This recovery is difficult enough without second thoughts and self-doubts!!)
But the scientific evidence has started coming in, and (at least based on the two most recent careful studies), it no longer supports ATR surgery for us serious athletes who want to return to high-risk sports.
Good luck and good healing, whatever you decide!
I think it’s clear that BOTH protocols rely heavily on natural healing, despite the big bucks the surgeons get!
normofthenorth, thank you for such prompt reply
This is exact info I was looking for.
I think I’ll go with NONE surgery way.
I’d like to ski and play tennis, surfboard, bicycle (<10ml) again.
But, I’m not pro athlete for past 20 years any more and no plans to earn money doing sports.
Any how I can send you private msg? I don’t see such option on your blog or here.
very funny what avatar / icon I got
it’s exactly how do I look like right now
stay on one LEFT leg and scrabbling my head - what to do? what to do? looking around
And mine is like a nutty chicken running around! Can we choose these in our profile?
Good luck with your healing — and your eventual return to sports, too, if you can think that far ahead! (At 12 weeks after “the boot”, I’m starting to bounce athletically from foot to foot, as if I’m going to receive a serve or something!)
I’m hoping to live long enough to see some of the pro athletes go the NON-surgical route after tearing an AT. My surgeon and the authors of the U.W.Ontario study are pushing for it, as soon as one of their jocks tears one.
I don’t think there’s a PM function here, but I might be wrong. My name’s normrubin, and I’m a user of gmail. . .
update: after getting other opinions I opted for surgery and scheduled it for coming Tuesday
now I started warring - hope it will go well
expected combo anesthesiology
Tough decision, either way. Good luck with it! Are you in the States, Mike?
yes, I’m in US, San Jose, CA
this is near Stanford Medical center, but I’m not going there.
My health insurance with Kaiser and I’ll go there.
yes, it was tough - going from no pain to potential pain / risk again.
hope to move through it fast and smooth.
to bad I didn’t make my mind at the first day …
I had a complete break playing badminton just over a year ago when in the UK. I was seen by a nurse immediately and then went to the A&E room at the hospital. The ortho surgeon recommended non-surgical solution but the ER doctor advised I get a second opinion when I got home as all the data indicated better faster recovery and dramatically less reruptures if you have surgery. Sure enough I saw a Professor when I returned and he indicated surgery was best for a big break. I had surgery 5 days after the break and was in an airboot for 6 weeks, walking on it for the last week. I could drive again and went to Africa on safari a week after the boot was removed. The physio was very important and I did this once or twice a week for 3 months after the boot was removed and I still do the exercises when cleaning my teeth every day!
for most active people with a complete break surgery seems to be best. Don’t let one doctor put you off being sure it is not right for you.
Stephanie, I think everybody should have the right to choose their medical care, within reason. But “all the data indicated better faster recovery and dramatically less reruptures if you have surgery” is just plain wrong!
The most recent data from the first decent scientific studies that have ever been done — the first in New Zealand, and the second at Univ. of Western Ontario in London, ON (Canada), clearly shows that surgery adds NO benefits to a good non-surgical protocol. On average, statistically, scientifically, in a randomized study.
Details of the UWO study can be found at
http://www.medscape.com/viewarticle/588904 .
Of course, it’s also a fact that many surgeons and physios are way too busy to read the journals or keep up with the data. But they all have time to give their opinions, and make claims about the data. Pick any side of most technical debates — take Global Warming, please!! — and you’ll find confident appeals to “the data”.
On the early pages of my own blog, we had some funny discussions about Evidence-Based Medicine vs. the more popular alternatives, including Eminence-Based Medicine!!
My first ATR was repaired surgically 8 years ago, because EVERYBODY knew it was the way to go for a serious “jock”. When I tore the other one in December, the fanciest sports-med-ortho surgeon I could find talked me OUT of the surgery, based on the latest, best data.
My surgical cure turned out great, and I hope yours does, too. But people shouldn’t be herded into surgery based on misconceptions.
The reason the OLD data showed better results from surgery was (IMO) because we used to compare the results from two very different patient groups having two very different treatments: The so-called “conservative” cure was applied to the old and infirm, and the surgical cure was given to the young and fit and motivated.
Probably even more important , the “conservative” cure was VERY conservative, and kept patients immobilized WAY too long, leading to a bunch of bad outcomes, including a high re-rupture rate. Meanwhile, post-op patients got moving quicker, and got physio and exercises — partly because they were getting better care, and partly because they were concerned about returning to their sports.
What’s new in the new studies is that the “cures” are selected for individual patients randomly, and that both kinds of patients are getting exactly the same rapid rehab protocol. So the only difference is surgery. Does it make a difference? Yes, in complications, but No, not in strength, Range of Motion, or re-rupture rate!
In an excess of fairness, the UWO study did find a small and non-statistically-significant difference in re-rupture rate, in favor of surgery — something like 3 re-ruptures vs. 2, out of around 85 patients in each group. That’s nothing like the rates that some surgeons tell their gullible vulnerable desperate patients. It’s also very low, and every one of them may have an explanation, like somebody falling or otherwise screwing up. Scientific studies don’t deal with such “excuses”, just the facts. And statistically, those two rates are equivalent.
That’s what the data says, and I wish the world’s medical (surgical?) establishment would admit that it exists. Check my first blog page, or the linked study, for a comparison to religion!
Anecdotally, I’ve been following the non-surgical protocol used in the UWO study (with a few minor changes thrown in by me and my health pros). I had a relatively large AT gap (I think they told me 6 cm, a bit over 2″!), relatively low. So far, my recovery has been on schedule, which is WAY faster than post-op 8 years ago. At 12 weeks post-non-surgery, I’m pretty sure that I’m very close to having a real “push off” at the end of my stride, and being able to do 1-legged heel raises. (At 12 weeks post-op, I was still in a cast, waiting for a boot! Times have changed, Thank God!)
Thank God for the Internet and websites like this where patients can learn from each other, too! Without it, the surgeons and physios would still be quoting 1960s data 100 years from now!
Good luck Mike. Tough Decision but I chose the same route as you. I’ll be 4 weeks post surgery Monday and feel good. Worked in the yard for six hours today and sometimes forget I have this boot on but don’t get me wrong I am hoping to be able to take it off in two weeks. If your surgery is like mine they will give you a nerve block in your leg and then put you to “twilight” sleep. I am no doc but I would try to encourage your doc weightbearing in boot after you get your cast off 10-14 days post surgery. I hardly have any atrophy and my leg/calf feels strong. Also keep the leg elevated first 72 hours and for me the nerve block slowing wearing off was the worst part(about 8 hours post surgery. After that the pain subsided and was off any meds the next day. If i remember correctly the doc said to stay away from advil because it will make you bleed and can inhibit fast heading. Use tylenol once off oxy or vic but obviouslycheck with doc. I felt set back at first but baring no infection you should heal fast. You’ll need some help while your in the cast but once you are weightbearing I went back to work right away 13 days post surgery.
While we’re on the subject of taking stuff, I trust that anyone who is down for surgery takes arnica tablets before and after? Reduces swelling, brusing etc. We take them as a matter of course in New Zealand, but unsure of how homeopathic support is viewed overseas? On a similar point, I will be seeing my chiropractor as well as a physio as soon as I back into shoes.
I’ve been surprised how many people here (above) have been given Advil (ibuprofen) or other NSAIDS for pain control after ATR surgery. (I was also surprised a few weeks ago when I had oral surgery and my periodontist recommended high-dose Advils. I didn’t have bad pain, so I didn’t take many, so I didn’t bother quizzing him.)
Sure, it’s an anti-inflammatory drug and there’s lots of inflammation, but it’s also a blood thinner and an anti-platelet drug. I paid BIG bucks to have some extra concentrated platelets (”PRP therapy”) injected into my torn AT, to encourage the kind of clotting and scar-formation and healing and mending that we all need more of. (During that time, I was specifically told to AVOID all NSAIDS.)
Everything I’ve read about NSAIDS like Advil/Ibu suggests that they’re not good for torn tendons. Anybody here got any good solid info to the contrary?
thanks every one for answers to me
I plan to ask for local / nerve block and IV - fuzzy sleep.
I got IV once and was just fine after it - didn’t remember a thing, but doctor said he spoke to me at that time and I responded … I hope I didn’t say anything bad …
How about Vicodin? Is this Ok for post ATR surgery?
Not sure I can speed up my post surgery treatment schedule as doctor said he’ll follow standard time table - 2 weeks + 3-4 weeks cast.
Also been told that I’ll sleep better later as I’ll not have double thoughts about re rapture and why I didn’t choose surgical way - this is more on mental side.
normofthenorth,
Thanks for the info
pls. don’t take it wrong - in my local SFBA most people got ATR surgery vs no surgery. It could be local or surgeons “pushing” for this way or else - I don’t know. My surgeon told me 50/50 - ether way I’ll be Ok and I have to make the choice. All friends of my friends went with surgery, no I don’t know personally those.
they gave me vicodin but I never used it. Took oxycodeine while the nerve block wore off but went off it the day after surgery. The first hours you will have no pain because the block takes time to wear off. The doc will tell you to stay ahead of the pain and take meds right away because when the block wears off it throbs/aches pretty bad. The protocols for these injuries are very different per doctor. Obviously you’ve got to listen to your doc but there is a ton of evidence toward early weightbearing beneifts with boot. It also lets you get back to as close to your normal routine as possible soon after surgery. My blog and others have some info on this.
I was told no Advil before surgery because it thins the blood and could imped the actual surgery. But after surgery, the same doc who said no before said fine after, for what it’s worth. For me, the oxycodine stuff made me feel more weird than pain free.
First, “what mikeJ said”! Early WB is a Good Thing, and early mobility (initially w/o WB) is, too.
Second, mikek753, you’re at a FASCINATING moment to be making your decision where you are, because the tide is just starting to turn in the most “hip” parts of the US, including the San Francisco Bay area. Just that fact that a US surgeon told an athletic person that the decision is 50/50, instead of a no-brainer in favor of surgery, shows that the new scientific studies are starting to “get through”.
If you go back to your surgeons a year or two from now — e.g. with the OTHER AT torn (God Forbid, but it happens!) — I bet they’ll tell you to avoid the surgery, as my “hip” top-level sports-medicine surgeon told me in December.
These things take time to change, but facts are facts even when some people haven’t gotten the memo yet, or are too comfy and set in their ways to believe it.
Me, I’d still advise you to be an early adopter of the newly-revealed facts. Knowing what I know now, I wouldn’t let my sister have ATR surgery.
For Mike and Stephanie and others who still think “the jury is still out” on surgery vs. non-surgery - -or worse yet, that surgery is the obvious way to go for serious athletes who want to return to top performance. . .
I just reviewed all the recent studies I could find online, and posted the results at
http://achillesblog.com/normofthenorth/2010/03/08/a-more-complete-review-of-the-options-surgical-vs-non-operative/ .
Folks, the jury has returned, and surgery — at least the kind of ATR surgery that’s practiced widely in the USA and a few other places — has risks but no benefits. The evidence seemed to prove the case for surgery until around 2007, but the studies since then have been more scientific, and they’ve ALL shown that the non-surgical protocol works as well or better than surgery!
(In all the studies since 2007, I only found one single data-point on performance that was significantly different at all, and on that one, the NON-surgical patients came out STRONGER!)
There may well be times to do the popular thing in your neighborhood, whether or not it really makes sense. But submitting to useless and risky surgery doesn’t strike me as one of those times, even if all your pals are doing it. . .
Dear Norm
I have a friend who went the non-surgical route 10 yrs ago. Today that leg is a fraction of the other, non-injured side.
He was playing tennis with me when I ruptured mine and advised surgery. Yesterday we played light softball practice (pitched - hit - no lunging for catches) in a group of 15 players at exactly 6 weeks post-op, in sneakers. Was walking 2-3 miles/day for weeks in boot/cast.
Norm or anyone: Does anybody know of a detailed progressive physical therapy protocol written up anywhere? I’m having trouble finding anybody in my area who has experience with an accelerated rehab for a non surgical repair. thx
Gunner, if you click on the link I included above (to my latest post) and click on the study linked there (I think it’s #3b in my outline), you’ll find the reasonably progressive protocol I’m following now.
The study used it on both sides, for non-surgery and for post-op. The other modern studies (2007-09) that I linked there also give some idea of their protocols, but maybe not as detailed.
Lou, I’ve got a friend like that, too. He’s made peace with his skinny calf, and gave up squash, too.
Ten years ago, the non-operative protocols were all very “conservative”, and the results were pretty bad, even worse than 10-year-ago surgery. Strength, ROM, and re-rupture rates, all pretty rotten by today’s standards, and compensated only by the lack of surgical complications. (”Conservative”.)
We all have tiny amounts of personal data (even those of us who’ve been through this TWICE, like me!), but it’s super-important and vivid and dramatic to us, so it’s natural to over-interpret it. The orthos and physios have a bit more data, and they naturally tend to over-interpret it and over-generalize from it, too.
That’s why the carefully controlled and randomized studies are so important, if you care about the real truth. And one great time to care is when you’re choosing a care protocol for an ATR!
I just read on the BBC that David Beckham has “torn” his left Achilles Tendon during a match. I wonder if he’ll have surgery or not? Will he show up here?
Yesterday I’ve read that David Beckham had his surgery done in Finland. Apparently he has heard about that Prof./Dr. and elected to do it there.
Hi there can I use some of the information from this blog if I reference you with a link back to your site?
My cousin recommended this blog and she was totally right keep up the fantastic work
wow It’s a great blog. I love it.
Hi, where did you get this information can you please support this with some proof or you may say some good reference as I and others will really appreciate. This information is really good and I will say will always be helpful if we try it risk free. So if you can back it up. That will really help us all. And this might bring some good repute to you.
top shoes, it would be pretty helpful to know to whom you are addressing your questions. You might try going to that person’s blog and asking there instead of here.
Dennis, this place feels as if a big tour boat just docked nearby! Did you just change the way Google lists it or something?
I downloaded Tom Clancy’s Rainbow Six Vegas torrent from http://www.games-iso.com about a week ago and, even though its a”dusty” game, its the best PS3 game ever made in my opinion
The spammers have found this place and are trying to load it up with their trash, like Heath Leavenworth and I suspect top shoes as well. It appears there isn’t in “anti-spam” word required to post this either.
The missing “anti-spam” word is allowing all these dirtbags to post their garbage.
I think Dennis can enforce / limit comments to registered users only.
Actually, you can require that anyone posting to your blog must be logged in. I made that change this morning. It is under settings then discussion.
If Dennis can require prior registration on these general pages the same way we can on our blogs, I think “It’s time!”
I appreciate the info.
Norm and GerryR - Ok, finally fixed it! I’ve enabled the spam words again, so spam comments shouldn’t be as a big problem as it has been for the past few days. So even if you don’t require registration for people to comment on your blog, you should be getting same amount of spam comments as before.. (which was very small).
Considering that there’s at least one spam post after the anti-spam word was enabled again, I think it is time to allow only registered users to post.
Hi guys,
I ruptured my Achilles tendon playing basketball just under two weeks ago now. Wasn’t doing anything out of the ordinary just went to push off my left foot and POP! I then was driven to the hospital where the doctor performed the Thompson test. Diagnosis was full rupture! I then was scheduled to see the surgeon 1 week later.
After speaking with the surgeon about the options available to me. I chose the “conservative method” (Non-surgery). I was until this a very active 26 year old..now retired basketball player who coaches for a living professionally. I just wanted to know how long it takes for an Achilles tendon to heal naturally? So I can get back on the floor and coach without crutches!!!
Glad you found us and welcome to the fairly exclusive club of people who didn’t have surgery. I had surgery on August 3 and have since had three more to correct complications generated by the first. If I had known then what I know now I would have refused surgery. I was told that if I wanted to return to cycling and running I had to have surgery and my wife who is a doctor, said that might be true. Needless to say that surgeon will never get near me with a scalpel again or anything else for that matter.
Be sure to click on the “Create Your Own Blog” at the top of the page so you have your very own place. It really makes things so much easier and since you went the non-surgical route it is even more important for those who come later.
The questions you have are best addressed by your doctor, but there many different rehab protocols, some take a long time and some do not. What has your doctor said about how long it will be before you can ditch the crutches? Mine outlined a very specific plan prior to surgery so your doctor should have a plan. The person here with the most experience with the non-surgical approach, don’t call it conservative, are normofthenorth and
(accidentally clicked submit) Norm will be around. Also check doug53’s blog for his very aggressive rehab.
Good luck and go get your blog.
Yup, I’m here, and so is my blog. One of my pages (with tons of replies) is about the latest studies I found, mostly about surgery vs. non-surgery. And I posted (linked from one of the replies) the exact non-surgical rehab protocol I followed, which my surgeon got from the people at U. W. Ontario who did the latest study.
Two others here (mike753 & gunner) said no to the surgery based on those studies and have followed that protocol pretty closely, and are both doing pretty well, as am I. They may both be working harder, and regaining strength faster, than I have, and I’m doing pretty well and having fun, with amazingly little “suffering”.
I don’t think there’s any good reason to go any slower than the protocol we’ve been following. Going faster might or might not work well, it’s a gamble, with no study to establish the “odds”.
If I were starting again, I’d only change a few little things: I’d use a hinge-able boot (Gunner loves his fancy high-tech waterproof one, check his blogs), and I’d make the withdrawal of heel lifts more gradual. Actually I DID a bit of both of those (as outlined on my blogs “in real time”), but I might start a bit sooner with both, I’m not really sure.
Kennedy, have you retired from basketball because of the injury, or independently before the injury?
If you haven’t gotten a clear schedule, roadmap, protocol, whatever, either insist on one from your Doc, or present him with the one from the UWO study that the three of us have followed. (It’s linked from my blog.) If your Doc’s protocol is either significantly slower or untested in a good study (or most likely both!!), then convince him to “let” you follow the UWO protocol, preferably with a hinge-able boot like Gunner’s (or at least my lower-tech non-waterproof one).
And start a blog page and keep us informed. And avoid false steps!
Norm,
Where specifically is the link to your PT protocol? I’m going to be restarting PT in about a week so I might as well take them one that is fairly aggressive.
Gerry, my actual protocol (from the UWO study) is at achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/ . It’s linked from one of my own comments to my March blog page “A more complete review of the options — surgical vs. non-operative”.
That whole page, with comments, is also linked from the “ATR Rehab Protocols, Publications, Studies” link on the main page here, though it’s buried among a bunch of other items (some of which I highly recommend, others “not so much!”)
I’d be interested in your comments on the whole thing, including the PT protocols. I find the latter a little vague, and only a hint of what my PT actually did to me (while following that protocol)! E.g., he spent a lot of time applying gizmos to me (Difference Current muscle stimulation, Lasers, and Ultrasound), none of which are mentioned in the protocol.
Norm, I met a gentleman from Jacksonville, Florida, wearing an airboot. Obviously, I enquired about his injury.
He ruptured his AT while excercising in the gym-jumping, I think he said- a little less than 2 months ago (April 19). His “surgeon” put him in an airboot right away. He gave him an excercise regimen- no PT. I was impressed that he walked without unaided a limp.
I encouraged him to join this blog and give us more information. I hope he does.
Ifixteeth, I hope he shows up here, too.
When you say “he walked without unaided a limp” I assume you mean in the AirCast boot? According to the UWO protocol, he should have been “weaning” off the boot starting a couple of days ago, into two shoes, after 8 weeks (assuming he got into the boot on April 19th).
About a week before I got out of my boot at 8 weeks, no surgery, I was walking with a bunch of my young sailing friends, from a club meeting to a pub. As luck would have it, I was walking so fast that they couldn’t keep up with me on the sidewalk! I had switched from the AirCast to a hinged boot (Donjoy MC Walker), and in order to keep talking to them while we were all walking, I spun around and started walking backwards, still at high speed. I immediately discovered that walking fast backwards on a recovering AT (in a hinged boot or 2 shoes) is VERY different from walking fast forwards — much more strenuous and scary!! I quickly spun around again and resumed walking forwards!
I think almost everybody who’s on a reasonably aggressive/modern protocol should be able to walk very well in a boot (forwards!!) well before 8 weeks. All that really takes is upper leg strength and the ability to be FWB plus a bit. (If you’re limping in a boot then, it’s probably because your other shoe is too thin/low, and you’re out of alignment.)
The trick after that is being able to walk without a limp in two shoes, which usually takes quite a bit longer, because it depends on calf and AT strength.
Hi Guys
I ruptured my right achillies tendon playing badminton 4 weeks ago. Heard a pop when I was standing ready to serve. Didnt think it was a serious injury until I got to the hospital A & E. The doctor performed the thompson test and said it was a full rupture.
I was given a plaster that night and given an appointment to see the orthopedic surgeon the next day.
After speaking with the surgeon, I was offered surgery or non-surgery. He said both option is much the same recovery time. However he did mention the non-surgery have a much higher rate of re-rupture and with surgery there could be complications & wound infection. I opt to go for the naturally healing method.
I am now in my 4th week in the cast. Can anyone tell me when i will be on my feet and drop the crutches. When can I go back to sports?
Stephanie
You will find some great stories on here which should give you a guide to the timescales involved - my recent experiences of rupture then re-rupture are on my blog.
You will also notice that experiences and timescales differ widely, as do the treatments - there is a healthy discussion about the pro’s and con’s of the various approaches. Again, take a look around (but take particular notice of norm’s blog / comments as these tend to be the catalyst for much of the current discussion).
If i could presume to give a piece of advice, it would be to become informed and take control - push your medics for answers based on being informed about other people’s experiences. Often during my recovery time i have been prescribed an approach by medics, only for that approach to change markedly based on me asking simple / informed questions.
For what it’s worth, my non-surgical repair was based on 6-7 weeks in plaster then into a ROM boot for a similar period (curtailed by re-rupture). I ruptured playing squash, and initial prognosis for return to the sport was minimum 6 months, possibly a year.
daviduk
Hi Stephanie,
Rotten luck.
Feel free to check out my blog - it’s at this address:
http://achillesblog.com/kevinh/
I haven’t updated it since the five-month mark (I reached the seven-month milestone just two days ago), mainly because nothing dramatic has happened; I’m now seeing my physio for a clinic session (massage, ultrasound, assessment) once a month and attending a gym to work on rehab exercises. I can cycle easily (and have been for about three months), jump, jog (treadmill) and even play a bit of gentle football, so it’s going fairly well.
But my blog will give you some idea of timelines - I went non-surgical and - off the top of my head - had roughly six weeks in cast and crutches (with foot moved at different angles every 2-3 weeks), then three weeks in an Aircast boot. But the detail’s all in the blog - hope you find it useful, and good luck.
Thanks Kevin. Will definitely check out our blog. Glad to hear you have also opt for the conservative route and now back to exercising. I will be getting my 2nd cast on monday 21st june.
Thanks for the “plug”, David!
Stephanie, your Doc was wrong about the different re-rupture rates, non-surgical compared to surgery. When the patients are streamed RANDOMLY (instead of “jocks get surgery and crocks get a cast”!), the re-rupture rates are statistically indistinguishable. Strength and ROM, too. The 4 latest studies — the ones that randomize the treatments — are all linked from one of my blog pages (the 3rd or 4th most recent one now, if you go to achillesblog.com/normofthenorth and scroll down).
The timelines question is different, with two huge variables: (1) what your Docs prescribe for you (or rather “what you do”!), and (2) how your “personal” body reacts and heals. Both of those variables are hugely variable.
The protocol I followed — the one used in the latest study (and most modern studies) — is quicker than the one you’re on so far, and has produced excellent results, on average, with AND without surgery. There’s a link to it in a comment to the blog I mentioned above. I would recommend following it, with only a few minor amendments (which I outline toward the end).
After only TWO weeks, “we” were starting physio and beginning “protected” (aka partial) weight bearing, and at only FOUR weeks, (full) “Weight Bearing As Tolerated”, so the crutches get ditched soon after 4 weeks. The heel lifts get ditched — all at once, which I’d change — at SIX weeks, and the boot gets ditched (”wean off”) at EIGHT.
I can’t see any good reason for anybody to go more slowly, now that THAT pace has been found to produce excellent results.
About strength and returning to sports at close to 100%, there’s a fairly wide spread — again, probably partly depending on how much “work” you do, and partly on more mysterious and personal factors. Any specific timeline on the calendar will be only a rough guideline that might not apply to you, in either direction.
I’m a bit of a gardener, and when somebody says “plant these seeds on May 1st,” I say “maybe”. But when somebody says “plant these seeds when the Maple trees are in full leaf,” I believe it, because it sounds sensible, related to reality.
The rule of thumb I was give after I tore my first AT (yup, I’ve done ‘em both now, 8 yrs apart — same sport, same move!) sounds sensible to me in that same way. My Doc said I could go back to “scary” high-risk sports when I could do a bunch of 1-leg heel raises without grunting or groaning. I’m not sure exactly when that happened, but it had clearly happened by around 10 months, which is when my Volleyball season was getting started again.
Several people here have started back at their sports sooner, but usually (a) the sports are lower-risk, less explosive, like running instead of basketball-soccer-football-squash-badminton-volleyball-etc., or (b) they’re not competing “flat-out”, letting the good shots go, etc.
Your story of rupturing “when I was standing ready to serve” is unusual. The classic move, that probably tears 45-50% of ALL ATs, is switching hard from “reverse” to “forward” gear. There are lots of other “moves” vying for second place, though I tore BOTH of mine doing exactly that.
But the worst ankle sprain I ever got was on the squash court, standing on the “T” and waiting for my opponent to hit the ball! Sounds a bit like yours. . .
Good healing. If I were you, I’d print out “my” protocol and maybe one of the modern studies, too, then roll them up, and slap your Doctor around with them, until he speeds you up to that protocol!
Thanks for the advice David. Can I ask how you re-rupture the 2nd time round. Opting to go for the non-surgical route does make me worry if there could be a 2nd time for me.
Stephanie
I re-ruptured whilst walking through my kitchen! Long story short, we have a dog and, walking in bare feet, i stood on one of his toys and went over on my ankle - and bang!
One of the things i have learnt on here is that the transition from boot to shoes is a risky time - exposing one’s repaired tendon to the world again, without cast or boot, is a time to be careful. I am approaching the same sort of period in my recovery again, taking the first tentative steps out of my boot. This time i am being very careful!
daviduk
Hi Stephanie: After a tennis ATR and no surgery, I went from the boot to the Vaco Cast at 3 weeks, and feel strongly I could have gone at 1 or 2. With a good boot/cast (strongly recommend you look at the Vaco Cast) which permits walking you can immediately begin to transition from crutches, provided you can elevate your good leg to match the boot setting on the healing leg.
I agree with what David said - don’t allow your doc to control the process. Become informed and take charge yourself. Get the recovery protocol on Norm’s blog, take it your doc/PT, and negotiate a path forward.
happy healing. gunner
Stephanie, the randomized trial reports say you’re no more likely to rerupture after a good non-surgical rehab than after a good surgical one. Of course if you’re the 1 in 100 (as David was, unfortunately), the world will look different. But the statistics say the results (inc. re-rupture rates) are no worse without the surgery — and better, if you include the surgical complications.
Getting slapped into a series of casts for months is NOT a good rehab, with or without surgery!
Hi Norm
I will definitely print out your recovery protocol and take it with me to see the doc on 21st of june.
Great. I think your priorities are (1) to get into a boot, no more casts — and a HINGED boot if you can, too! And (2) to get some agreement on where you’re heading, like a written road-map (or agreement from your Doc to follow the UWO-study protocol you’ll take to him), so you can have some info and certainty and “say”.
Make sure he knows that this isn’t just “my” protocol, but one that was used on around 150 patients (half surgical, half non-) in a randomized study, and the results were excellent overall (e.g., only 3 re-ruptures in ~150 patients, if that’s what he’s most worried about).
If he wants to see a compilation of the studies on surgical vs. non-, send him to my blog, where I’ve discussed and linked them all. If he wants to see a compilation of the studies on faster vs. slower protocols (most of them after surgery, unfortunately), Dennis has gathered a bunch of them together in his page (linked here and on the main page) on “ATR Rehab Protocols, Publications, Studies”.
The modern scientific info is out there, and we’ve even made it pretty easy to review!
Dennis, I know you set this all up a couple of years ago, when “jocks” had to get surgery (the way you and I both did, my first time around), and I would have done it the same way after my first ATR when nobody knew any better. And changing it could be serious work, which you’re not getting paid to do. But the world has changed a lot since then, and it’s changed the answer to the most important and urgent question a new ATR patient has to face!
The most important and urgent info somebody needs who “Just ruptured your Achilles” is whether or not surgery helps!! And with all due respect (and I love this website, as you know!), neither of the two authorities you link above — that “nice” WebMD article, and Revolutionhealth’s “nice” article (from 3 years ago!!) — has that info right, in June 2010. They are both totally oblivious of the latest FOUR scientific studies on that subject, which are the ONLY studies that randomized patients into the surgical and non-surgical streams! (The earlier studies, until 2007, really only proved that “jocks” heal better than “crocks”, but pretended to prove that ATR surgery produced better outcomes!)
And as you know, all four of those studies found that the surgery adds NO statistical benefit — NO increased strength, NO increased ROM, and NO lower re-rupture rate! (And it still does increase the rate of serious complications, of course.)
Can you please re-jig the links at the top here? Me, I’d kill the WebMD link and the Revolutionhealth link entirely. (If they were paid ads for ATR surgery, they’d be vulnerable to a legal attack as “false or misleading advertising”!) And please add some links to the 4 new randomized studies. The biggest and latest is summarized in an easily readable article at http://www.medscape.com/viewarticle/588904 entitled “AAOS 2009: Nonsurgical Rehab After Achilles Tendon Rupture Better Than Surgery”. If that’s the only link here on the subject, it will steer people in the right direction, so they’ll at least be tempted to learn more, and question the guy with the white coat and the scalpel!
This site has done a world of good to a lot of patients over the years. And I may be biased (Lord knows!), but I think helping to educate mike753 and gunner enough (under pressure!) that they could skip the surgery and follow the science, is among its finest hours. The links at the top should make that education easy, not tricky, IMHO!
Hi everyone. Just found your blog. Ruptered my Achilles 4 weeks ago and had operation 3 weeks ago now. Been in a back slab cast since then and going to my fracture clinic today to get a boot. I noticed a few people rerupturing when going from boot back to shoe. Has anyone tried ankle brace or rigid support as I want to get fully mobile asap. I understand I have a bit of time to serve in a boot but want to get mobile again.
All - thanks for the great posts, the stories and the varied insight.
I’m a very active, athletic male into week two of non-surgical rupture recovery from a freak basketball injury. My ortho has already changed the first cast, realigned the foot 15% and wants to see me every seven days. From some of the other posts I’ve read that seems a little agressive. Anyone else seeing their doc that often? Thanks.
Welcome to recovery world and congrats on chosing the non surgical route. Several of us are very pleased with that decision and hope you’ll have similar results. I’ve seen the doc, who is a good friend also, only twice since my ATR 18 weeks ago. My advice, get into the boot by week 2 or 3 and get to a good PT who will start you on the modest therapy you begin at that time. You can find more on my blog and Normofthenorth’s. I’d recommend you print out Norms recovery protocol and take it with you to the doc to get agreement.
I also encourage you to start a blog and keep us posted. best of luck.
hi all i ruptured my achilles 4 wks ago playing soccer got stitches out after 10 days at 3 weeks moved my foot up to neutral position and was wondering is this good progress to have in neutral after 3 wks.
dave,
Sounds reasonable so far, should be moving to PROM, AROM, and mild exercises pretty soon, assuming no complications.
The key is to read as much as possible about your injury so you can make a self assessment and be ready to challenge your doc and therapist if appropriate. Everyone’s situation is a little different. Most of the info or links to the info can be found on this website. With the right info you can be proactive if you feel confident directing your own recovery.
jski,
im in a fibreglass cast for another 8 days at least, so hopefully after that i will be able to start some ROM,
the doc has mentioned heel raises for my shoes but no mention of the removable boot once the cast comes off i imagine i will be nervous about this, im in ireland so protocol probably varies in different countries.
dave
dave and jski, I’m three weeks in a fiberglass cast for non surgical recovery. During yesterday’s appt. my doc says another two weeks in the cast then if all continues to look good, a transfer to a walking boot. He had me perform some very slight ROM movements yesterday and said he could feel the tendon re-attaching (i hope so).
So you’re correct, style and protocol differs with in each case. Good luck.
Ejerone, I had a similar experience- a plaster cast for 2 weeks and a fiberglass cast for another 4. Hearing about the advantages of EWB, I started to put some weight on, with the cast on for the last 2 weeks. Seems that many doctors don’t want to”risk” putting you in a boot earlier.
Ejerone: I’m at 20 weeks post ATR and non surgical. I would recommend you get in to a high quality boot as soon as possible. The VacoCast which I used is identical in safety features to a fiberglass cast, can be hinged to change the flexion, allows walking with no support (provided compensation is made to the other heel elevation), and most importantly, can be removed for therapy which you could be doing already.
Good luck to you
Ejerone, the modern UWO-study protocol, which is pretty quick and conveneint but produced excellent results in a study with 145 complete-ATR patients in it (half surgical, half non-op) is posted at bit.ly/UWOProtocol .
The (long) discussion about the studies, including that UWO study, is at bit.ly/achillesstudies . Or you can check out en.wikipedia.org/wiki/Achilles_tendon_rupture, go to “treatment”, where the 4 modern studies are linked to footnotes 4-7, with the UWO study at #7. (At least until somebody re-edits that Wikipedia article!)
The idea of a personalized rehab protocol — based on frequent examination or testing of your particular leg — sounds very attractive. But the 145 patients in this study did remarkably well following a “stock” protocol that didn’t even change based on whether they’d had an operation or not!
They had only 3 re-ruptures in 145 patients! I doubt that it’s possible to to get the re-rupture rate much lower than that, given the “background” risk of falling down stairs on crutches, or slipping on a banana peel on crutches, or otherwise accidentally re-rupturing a vulnerable AT. . .
With the results they got, I don’t think there’s much justification for going slower — which is what surgeons usually recommend when they get “hands-on” involved. Going slower sounds “conservative” — like a good way to avoid re-injury. But the studies all suggest that a slow rehab isn’t really safer.
I snapped my achilles on April 12th 2010 and have spent 8 weeks in a plaster cast.
2 1/2 wks later with 2 shoes , walking and driving my leg gave way and I had re-ruptured it again.
This time had surgery , but no the normal way.
doc said he couldn’t pull the 2 pieces back together (bout inch gap ) as the tendon was so thick with scar tissueand was like a piece of wood.
therefore he cut further up calf and pulled another tendon down and attached this.
problem is i will only have 75% strength in achilles.
Has anyone else heard of anything like this before??
cheers
jamie0168
Jamie, I’m very sorry for your loss! Having a surgeon apply a graft to the repair (either from part of the AT or another tendon of yours, or from a cadaver) is not very unusual. But having a 25% strength deficit as a result is unusual. If the deficit is really all in the tendon, I wonder if your calf muscle will be “smart” enough to stay 25% weaker, too, or if you’ll always have to take it easy. Ouch!
Good luck and good healing. I hope your surgeon is wrong!
jamie0168,
Sorry to hear you’ve had problems and may not come back 100%. I have read about your procedure, pioneered in Japan I believe, but not in the context of a re-rupture.
Thanks for sharing your personal story, it beats reading about a statistic in a medical report and it may help others evaluate the various risks of different treatments in making that difficult decision on what is best for their situation.
I ruptured my right achilles tendon on 4th of July playing tennis. Classic symptoms. Stepped forward to return a serve, brain said WTF, and I fell to both knees from the horrible pain. I thought the fence surrounding the court fell on my achilles. We all laughed. I alleviated my leg on a bench, with a cold one under it, and drank a cold one. Not wanting to be a drama queen I waited until July 6th for normal doctor office hours. X-ray negative. Thompson test positive. See an ortho tomorrow. I’ve decided to have surgery unless my ortho provides me with a compelling reason not too. My question to you all: How does an ortho know that you haven’t damaged other tendons/ligaments at the same time that need to be repaired? After a week in a wonderful splint, I got the hebegebes and ripped it off last night. I have ring around the foot! A bright purple/red bruise starts on the inside of my right ankle and runs the length of my foot, where my toes meet my foot is black and blue, and the bruise then runs down the other side. Oddly enough there is nothing on my heel or up the back of my leg?! So I’m wondering it is really my achilles or another tendon?
Heyteacher, I think it’s common to have a lot of internal bruising during an ATR, and to have it migrate and show up in different spots. On average, if you keep the foot down, the visible bruises often move down, at least in my experience.
Your positive Thompson test is pretty strong evidence that your AT is torn.
There’s arguably no “compelling reason not to” have surgery, though my fancy ortho surgeon and I found four very recent scientific studies — all since 2007! — that demonstrate that there’s also no longer any compelling reason TO have the surgery! Most patients recover well with it or without it, and the results (IF you get a good modern rehab protocol) are essentially identical in every way, except for some surgical complications — many of which you can find described anecdotally in blogs on this site. The surgical cure is (much) more painful, but usually only for the first week.
My first ATR (in late 2001) healed up great after surgery, and my second one (Dec. 2009) is coming along fine (all healed up, still some calf-strength deficit) after no surgery. The new studies were done in-between, and my fancy Ortho Surgeon (the chief surgeon of the local pro football team here in Toronto) actually stopped doing ATR-repair surgery after seeing the latest study and talking about it with the authors.
I’m glad he talked me out of the surgery, and I think most surgeons will eventually “get the memo” and stop doing the surgery, too — or maybe the US insurance companies will stop paying for it first. And for the same reason, i.e., it doesn’t seem to convey any benefit that you can’t get more easily and more safely without it.
It is very rare for our kind of “normal” over-stress ATR to damage other tendons/ligaments at the same time that need to be repaired. With or without surgery, they’ll all get the longest “rest” they’ve ever had, for one thing! Some people do ATRs falling out of trees, or getting sliced by a sheet of glass or a chainsaw, and they obviously can damage LOTS of things. Their cases weren’t tested in the new studies, and I think they should probably all go under the knife. You, “not so much”, based on the way I read the evidence.
The clearest summary of the new evidence — with links to the four studies — is in a paragraph (which I wrote!) in the Wikipedia article on ATR, 4th paragraph under “Treatment”. The four references (#4-#7) will take you to more detail on the four studies (NOT written by me!
).
Whatever you do, good luck and good healing! And start your own blog, and keep us posted, too.
hi,just an update on my progress visited my consultant today 5 wks 3 days post op they took my fibreglass cast off and then for docs to assess my AT to my relief they said it looked great and scar had healed well, i can get my foot past neutral position so they said no more cast and told me i can ease into walking with shoes and heal raise of 1cm i was bit surprised at this aggresive approach.anway im delighted to be out of cast,just got out of bath what a great feeling to WASH my bad leg despite dead skin everywhere.
Dave
Norm,
I believe there is a compelling reason not to have surgery and that is the possibility of complications; like MSRA, other infections, and rejection of the non-absorbing internal suture material.
Gerry, I was thinking of you when I said ARGUABLY no compelling reason not to have surgery! You KNOW which side of this argument I prefer to “argue”!
Hey Gerry and normofthenorth,
I’ve read both of your threads throughout the page. I totally appreciate your thoughts on surgery. I’m going into for surgery at 2:30. I’ve given it a lot of thought. For me I believe it is right. The ortho said say much about the blood pooling. She was able to provide to me that there is no other damage, and that indeed it is torn. Sheath she believes is intact. She is really conservative in the when I get to WB. Two months. I’m gonna have to direct her otherwise. She said to “bring in the protocol” on found on this site and she’d love to work with me on it. So I’m gonna print that out. Take one last sip of water, and pray that I made the best decision for me. Perhaps I will start a blog! Thanks again dudes!
Good luck Heyteacher.
Said a little prayer for you as it is almost 2.30.
Am presently waiting to see the “surgeon” for my 4 month check up(non surgical). I usually have to wait for 2 hours before I see
him and I’ll be lucky if I get more than a couple of minutes of his time. Wondering if I have to keep seeing him if all is going according to schedule according to my fellow bloggers. Besides giving me the option of no surgery, which I am gratefel for, he has just been monitoring my progress. I have got a lot more help from this site, especially from normofthenorth. Hey Norm, have you ever thought of teaming up with your “surgeon”. I am sure it would free up a lot of his time and it will be a valuable help for ATR patients.
I was happy that I managed the 2km walk to the hospital quite easily although I did bring my cane along as the limp gets more pronounced as I tire.
Good luck from me, too, heyteacher. I can pray for your speedy recovery while disliking your decision, no problem for me!
And good luck with reforming your surgeon’s ideas about rehab. I hope you get enough access to her post-op to have some influence.
Ifixteeth, I feel like I’m teaming up with (and sometimes against) ALL surgeons by blogging here! My own Doc doesn’t spend that much time with his (non-op, mostly happy) patients, and he gave me good answers quickly whenever I saw him, so I don’t think there’s a lot of time to be saved. (I’m also sure I’ll eventually move on from my current addiction to blogging on this subject!)
espana,sorry to hear about your AT rupture, and congrats on spain winning world i was delighted they won because of holland’s dirty tactics.im 6 weeks post op now got cast removed 13-o7 and walking now with aid of crutches.
dave(ireland)
Thanks for the well wishes. Surgery was great. Got a nerve block behing Again great, great job!!
Dave glad to hear your walking.
Hey everyone, just want to follow up on a message I posted a week or so ago. Had AT surgery (open surgery) 4 weeks ago, had stitches taken out about 2 weeks ago (ortho said healing went very well, no infection) but the uncomfortable pins and needles and burning feeling in the ankle/heel has not stopped and is uncomfortable enough that I can’t sleep (2 percoset does not help) and the ortho has now prescribed me something called Lyrica since he thinks is Sural Nerve is irritated. Has anyone else had this medication, or knows anything about this medication? Supposedly its really for epileptics but can be used for people that have nerve problems. I only really plan on taking this to go to sleep but am somewhat concerned that 4 weeks into the surgery and its not getting any better. Any thoughts?
Hi all,
6 weeks post op now and back in two shoes and would like some info on what are the best type of shoes/trainers to wear after AT rupture.
thanks dave.
Have you got a pair that fit the injured foot? That was the biggest problem I had when I finally got to 2 hoes, my left foot was quite a bit fatter due to swelling. I bought a pair of Crocs and wore them around the house and also at work, although I didn’t wear them to work. Crocs, running shoes and hiking boots are all good bets.
gerryr
my bad foot is not really swollen luckily, the swelling is more around my ankle i went to the shops today and bought some trainers with a good heel on them and there pretty comfy.thanks for your info dave.
I’m four and a half weeks post ATR, going for the non-surgical option of recovery, and just had to fight with my Ortho surgeon to get into and air cast (he hadn’t ever heard of a hinged boot) as he wanted to put me into another fiberglass cast with my foot at 15 degree dosiflexion for another 4 weeks (no way). He wasn’t even going to come in to do any sort of physical assessment, he just gave instructions to the cast technician. In the end, he acted like a little boy who didn’t get his way and was less than professional about the whole thing. I left feeling very disappointed and belittled. I’m a nurse and work in the OR at another hospital in town, to which I am planning on transferring my care considering his poor quality treatment.
Now that I got that off my chest, I’ll get to the question I was intending to ask: now that I’m in my aircast, I find it hard to accomodate for the height of the boot. It feels good to be in a platform shoe, but not so safe, especially when I come in to work (they have me doing a lot of data entry, policy revision, and error corrections). What have some of you used? Especially the men who wouldn’t just have a couple of pairs of platforms in their closets!
I had the same problem! In fact initially I had to have my boot at quite a high angle (I had to insert 5 heel-wedges for comfort - am down to 3 wedges now). At first I wore sneakers on the good leg, but I was walking lopsided and the arm on the bad side started to feel numb - probably some sort of nerve injury. So I wore sandals on the good leg - not high heels, nothing pointy, but platform-soled-wedges, with a buckle at the angle. I had to go through all my shoes to achieve the equal height as the bad leg. Sure I got horrified looks but seriously, what are you supposed to do. And I stayed quite well balanced, and in addition felt tall for once, which made me happy. Now I have to find a shoe for the 3-wedge-height.
How dare you question you Surgeon Kris, I have spent almost 5 minutes with my surgeon split between 2 visits and I feel like my questions are not welcome. Thank god this website.
Hey all. I don’t update enough for a separate blog - so here we go. My last post was on July 10th. I’m five weeks into non-surgical recov’y of ATR. Yesterday I visited my ortho for my fourth scheduled visit in those five weeks (his recommendation - not mine). He got me out of the fiberglass cast and am now in an Equalizer Pre-Inflated Air Walker (manufactured by Ossur), anyone familiar?
For the next three weeks he suggested I gradually ween myself off crutches while wearing this. ie 25% pressure first week, 50% second week and 75% the third. Then totally off those sticks after that.
Needless to say, I’m already cautiously moving around without the crutches somewhat while in the house. No pain at all. Actually haven’t had any pain since the initial reputure on the basketball court on June 20th when this happened. Just wanted to give some of my flavor to the peeps out there since we’re all in this together. I enjoy everyone’s updates and I’ll keep praying for you all and I ask that you keep me in yours too if you so incline. God bless.
Regards,
Kris, I’ve outlined my ways of elevating my uninjured foot up to the level of the injured-and-booted foot elsewhere, including on my blog. One gizmo I used is usually called a “cast boot” or a “cast shoe”. It’s designed to wrap around a fiberglass “walking cast” and add a non-skid sole to it. They’re quite cheap items in surgical-supply stores and online. (I had one left over from my third cast after surgery for my first ATR in late 2001.)
For me, especially for indoors, a little “exercise sandal” slipped inside that “cast shoe” worked well, and that’s what I used indoors. For outdoors, I had a pair of low-cut boots. (Merrell makes similar slip-on low-cut boots with deep and aggressive treads.) Adding some footbeds inside one of those got me close enough to the height of the boot — an AirCast with 3cm heel lifts=wedges.
Ejerone, there’s no mimimum frequency of updates for a blog, but it keeps most of your comments and reponses in one place, and if you install the widget at http://achillesblog.com/dennis/2008/03/08/achilles-timeline-widget/ , it also lets us easily check where you are, which foot, how long ago you got into this, etc., etc.
That boot seems like a good basic fixed boot (not hinged) with a “special” liner, and at a very attractive price. I’m not sure what’s so great about “pre-inflated” liner myself, but if it’s comfortable and stays that way, they you’re ahead of the game.
You seem to be “catching up” with the UWO Protocol after 5 weeks in a cast. I’d recommend “cautious and sensible impatience” as you do that. You’re probably relatively OK — there are risks everywhere in this rehab — accelerating the WB some, as long as you stay in your boot and Watch Your Step! The boot should protect your AT from being externally over-stressed, but (e.g.) if you strip and start falling, you would need the inner control of a Buddhist Monk to keep from trying to catch yourself, and that could include using (and flexing and stretching) body parts that aren’t ready for thoae move yet.
When you get out of the boot, you’ll probably be at even greater risk for several weeks, even though your AT willl be stronger (and your ankle more stable) by then.
Hi everybody,
I started a blog on wordpress but not sure how I can link to this site, here is the link:
http://firstdayofsummer10.wordpress.com/
ATR 5 weeks ago, non-surgical treatment.
I’m an elite 26 year old female athlete (current olympian) and i ruptured my achillies tendon 23days ago while training, well walking back to do another running rep. YES i did it walking :s. Saw a sports orthopedic surgeon and he used my plantaris tendon to repair the achilies. Meaning i’ll be back sooner (jogging at 12weeks) and it’ll be much stronger. So where i’m at now is 2 weeks in plaster then a boot for 6 weeks
i’ll keep you posted……….
Jumper, I think you just took “the prize” from Misty May-Treanor, US Olympic Beach Volley Ball gold medalist, who tore one of her ATs while practicing for the TV series Dancing with the Stars!
If you have the time and inclination, start a blog of your own here, and we can all “pile on” with questions and suggestions and such.
I’m one of the more compulsive (a) bloggers and (b) evidence/study finder here. I’ve assembled one huge page here on studies comparing surgery to non-op protocols — at bit.ly/achillesstudies .
Part-way down (search for “Japan”?), I link to a recent report from two Japanese surgeons who seem to hold the Gold Medal on fast recoveries from ATRs. They reportedly did not use a tendon graft, just lots of strong sutures. (Then they skipped the cast and boot completely — details if you find and follow my link, or ask here and I’ll find it.)
I’m a big fan of the new-fangled NON-op rehab for most of us, including serious competitive non-elite athletes, like the one that produced results as good as surgery in the large recent study I cite, from U. of W. Ontario. But if I were David Beckham or you, and Hell-bent for the fastest complete recovery possible, I think I’d fly to Japan for this fancy surgery. If Beckham recovered as fast as their AVERAGE patient, he could have played for England in the recent World Cup!
I haven’t seriously studied the relationship between grafting — like your surgeon’s use of your plantaris tendon — and recovery time. But from my casual reading, from memory, it’s far from clear that grafted repairs heal faster, on average. Several bloggers here have been told by their OSs that they have to take MORE time (longer NWB or immobilized or pre-PT or in equinus) because their repair was more complicated than average.
I hope you’re jogging at 12 weeks, as planned. For one benchmark of rehab speed with pretty good results, I’ve posted the UWO protocol here at bit.ly/UWOProtocol . It has only 2 weeks of NWB, then FWB (”as tolerated”) at only 4 weeks. PT starts at 2 weeks. For an example of how one of our own bloggers here (an ATR patient who’s also an MD) pushed his own rehab faster than almost anybody withOUT extra Japanese sutures, or a graft, or professional PT, check out achillesblog.com/doug53 .
Alas, many of our most competitive athletes here have found the psychological toll of ATR recovery even higher than average. The more active, the more competitive, and the more results-oriented you were before the ATR (for most folks), the harder it is to be immobilized, even if only for a few weeks. Of course, you will probably be working harder at maintaining CV fitness and tone in the rest of your body than most of us, and that should help physically and psychologically.
Good luck, good healing, and please keep us posted!
Hello All,
I’m so thankful that I found this site. I am a competitive Brazilian Jiu Jitsu fighter. I’m 35 and I have fought in 4 world championships. I have been competing for 11 years. This is a pretty intense sport with techniques seemingly designed to rupture parts of the lower leg. i.e…Heel Hook, Calf crusher and ankle lock. So I was very surprised to rupture my AT while playing with my dog. Just hoping around the yard without a worry and BAM! Like most stories loud pop, sharp pain and only able to walk by pressing my heel to the ground. This happened Aug 14th. I assumed it was a pulled or torn muscle since the pain was coming from the middle of my calf. I feel fairly well versed on treating injuries so I began my treatment routine. Three days very little movement no work and of course R.I.C.E. (rest , ice, compression, elevation) I have a 5gal bucket I filled with ice and submerged my left leg up to my knee three times a day. Day 4 came and no improvement but I had to return to work. Two days of work (rolling around in a chair) and my calf was getting worse. I went to the Dr. on the following Monday the 25th and he felt certain that I ruptured my AT and it would require surgery. I now have an appointment to see the specialist on the 28th. I started to feel like this was the end of my fighting career but I feel much more hopeful after reading your posts. Thank you all for sharing it really does help. I will check back in and see how everyone is doing and give you updates.
Normofthenorth,
ATR last Thursday in Toronto and recommended surgery.
i would be interested in a 2nd opinion and read your post that your surgeon from TO was a proponent of non-surgical therapy.
would you be able to share his name?
thanks
Sure, Adam. He’s Dr. Zarnett at Sports Med. Specialists on Eglinton just E of Yonge, maybe 150 Egl. E. They’re in the book. I have no idea if he’s in town, or has availability, or is accepting new patients. I got a reference to him last December from the UofT Sports Med. Clinic, and I got right in. (I THOUGHT I was seeing him to schedule ATR surgery, but no!
)
Actually, I bet he is in town, because I’m scheduled to see him (maybe for the last time) in a day or two.
Good luck! The good news is that most people recover well, eventually, with any of the standard “cures”. The disputes and choices are really about maximizing the odds of good outcomes while minimizing bad ones, and also minimimizing disruption, nuisance, and suffering.
Hi,
I ruptured my achilles tendon about a month ago at bball. I first went to a urgent care facility and the doctor there put a splint on my foot and said i should get better in 3-7 days. After 3 weeks it still wasnt much better and i went to an orthopedics to have him check what was wrong with it. He took an MRI and said the tendon was through and through. I had my MRI on Tuesday, results on Wednesday and surgery on Friday. Now i have been lying on the couch for 4 days and am already bored out of my mind. I just found this page and read over some of the info available. I was wondering when most of you went back to work and in how far that slows the healing process.
Thx,
Mario
Thanks Norm,
thats where my family MD had me go today for a 2nd opinion and i have elected to go the non-surgical route. Did you get the PRP? how challenging is the physio?
thanks again for sharing your experiences
Adam, you should probably start a blog of your own so we can take this exchange (and others) “offline” from this general page. Welcome to the non-op cure, AND the U. of W. Ontario protocol — which I’ve posted at bit.ly/UWOProtocol .
I did get the PRP, though I have no real indication or confidence that it helped. The evidence is mixed at best and negative at worst — not that it makes anything WORSE, just that it has been shown to be no better than saline injections for AT tendinosis. (No studies have reported PRP results for ATRs yet.)
And it’s expensive and painful. For me the pain was only notable while the injection was underway, and was quite manageable, though others here have reported excruciating and longer-lasting pain.
I got PT from Chris. It started out quite gentle, with lots of gizmos, and eventually transformed into gym exercise. That was when Chris handed me over to another PT, and I dropped out soon afterwards.
Mario, if your job allows you to elevate your leg a lot, you can probably go back to work soon. With the non-op cure, many or most people don’t lose any work days at all. With surgery, there’s often a week of moaning and groaning (plus or minus) before back to work. And if you work standing up — or chopping down trees or digging ditches — you’ll have to wait much longer, either way.
Hello
Ruptured ATR on 23 July 2010, opted for conservative treatment and now 10 weeks afterward the event there is still a gap evident on ultrasound- does anyone know if that will heal spontaneuosly. I figure that those who mobilise early ie within 4 weeks or so will still have a gap, so hoping that this gap does not mean surgery.
Am waiting to see the orthopod next week but wondered if anyone had similar experience?
Any thoughts?
FWIW, JP, I don’t have much faith in UltraSound (or MRI either, for that matter). I got 3 US exams done after I tore this AT, my second. The US was used to guide injections of “PRP”, which is another story. But while they were looking anyway, I asked them to tell me what the ATR looked like by US. Same technician, same US machine, same doctor, 3 exams at 1 week intervals (~1, 2, & 3 week post-ATR). Not goofs or slouches, either. (The Doc is the chief Doc of our local pro hockey team.)
The first time, he said it looked like a complete ATR, which is what my surgeon said after Thompson test and palpating the rupture. (I didn’t have surgery. Non-op, following the protocol at bit.ly/UWOProtocol, after my surgeon heard the authors of the UWO study present their results at an AAOS conference. It’s on my blog.)
Second time, he said it looked like a partial tear, and third time, he said it looked partial but multiple. WTF? (I still have no idea which version is correct, but now that it’s all healed, I don’t care much, either!!)
Did you undergo the US exam because there was a problem, or because it’s routine for your Doc, or what? Have you had a Thompson test done recently? If the Thompson test shows AT function, I’d personally ignore the US results. If your foot doesn’t move when your calf is squeezed (Warning: this test is VERY hard to do on yourself!), then I’d say there’s cause for concern.
That UWO study, and 3 others done since 2007, showed excellent results without surgery using that fast protocol. The UWO study had very few re-ruptures (2 in 75+ non-op patients) and pretty good strength and ROM at 6 months and 12 months, even near the “back of the pack”. The other studies were similar.
Older studies, using slower (more “conservative”) protocols — summarized in a pretty fancy 2005 meta-study — showed worse results for non-op treatment, like ~15% re-rupture rates. That still means ~85% recovered without re-rupture, but I think the big difference strongly supports fast rehab for non-op patients.
The 4 new studies are refs 4-7 in the Wikipedia article on ATR — bit.ly/Wiki-ATR — and I’ve made a page about studies here — bit.ly/achillesstudies — that has links and discussions to everything mentioned above.
“My” UWO protocol had me in a fixed boot for 8 weeks (changing angle at 6), so even if you’ve been in casts for 10 weeks, that shouldn’t be a huge difference — certainly nothing that would stop a ruptured AT from healing.
If you’ve got the time, start a blog and share some details, and you’ll get more advice and experience from the group here. Of course, your Orthopod’s opinion should count, too!
Hi, I’m surprised there is a gap - i went conservative. Had a 6cm gap right after i did it, put in plaster that day, and when they took it off 9 days later (to check for DVT) it had already joined, though with a divot. Now at 8 weeks tomorrow it feels like a pretty solid join, and i’ll be FWB in two shoes with 1 wedge. Hope you’re OK.
Hi Normofthenorth
Thanks a lot for replying. I did not have US when it first occured but after 10 weeks in plaster, the consultant was ready to get me into a 1″ lift shoe and start walking, physio etc. But he said he could feel a gap, which he thought would heal with a lifted shoe but as I was a bit nervous, he ordered the US. Still by the time I had the ‘emergency’ US, the clinic had finished and he’d gone, so I ended up in an airboot until next week.
Things move but slowly and I can’t stand on the leg, not sure if am expecting too much 1 day after coming out of plaster that I’ve been strapped in for 10 weeks.
At 4 weeks, there was no gap to feel (apparently) and the same at 6 weeks but after this last cast apparently there is.
So am ready to cry floods and am despairing after all my attempts at trying to keep positive and desparately trying not to go for surgery.
hi all. i will be out of the boot this week. anyone have a recommendation re the best type of footwear for the first week or so of “two shoes?”
[context: surgery august 5th. cast removed sept 7th]
Many people here will say that at this stage you are at the highest risk so yes, you should choose your shoes carefully. Around the house, crocs seemed to work well for me (others here have suggested them too). I don’t find them stable enough for out and about use, and they can be a bit mushy. A good pair of running shoes are probably good. I use Trail Runners (Adidas in particular as I have wider feet). Trail runners have a bit more stability than street jogging shoes IMHO.
There is no such thing as a partial rupture!! You either have a small tear in it or it’s a rupture, completley snapped all the way through.
Best to start walking around the house bare footed and progress to a jogger with a built up heel.
I ruptured my AT last Saturday playing tennis. Saw the orthopedic surgeon this past Wednesday & he said I could do surgery or non-surgery to repair it. Scheduled surgery for next Wednesday–10 days out; I’m in a hinged boot. Now I’m having second thoughts after reading this site–sounds like the PT is the most crucial part of the recuperation, but that I will have 100% recovery. Is that right?
Also, my doctor said if I wanted to spend the rest of my life sitting on a couch, the non-surgery option would work. I am active–would like to walk again (!!!) and eventually get back to “gentle” skiing and tennis–but if I have to, I can give up tennis. Will I need surgery to recover this level of activity?
What should I do????
BTW–I’m 58, female.
There are several people here who have gone the non-surgical route and are doing very well. Your doctor is more than a bit behind the curve, but then he won’t make nearly as much money if you don’t have surgery. If I ruptured my other one or re-rupture I will definitely not have surgery and I am probably more active than you: competitive cycling, running, triathlons, backpacking, certified alpine ski instructor and fly fishing. I’m a 66 year old male if that matters.
The key is keeping you foot in a plantar flexed position for a couple of weeks so the two ends of the tendon can get cozy. Norm and probably others going the non-surgical route will be around and can provide more detail, but rest assured you can recover fully without having them cut on you, unless something weird has happened.
Gerry, thank you for the encouraging words. Your level of activity is impressive and gives me hope that my weekend warrior tennis is not something I need to leave behind. I enjoy being active–I live in Colorado and we are a skiing family, so getting back the full use of my leg is very important for so many reasons.
I’ve read Norm’s blog which has been very helpful, including the PT protocol. I’d prefer not to have the surgery, if I have a decent chance at full recovery. Is it the PT that makes the difference in recovery? I do have to wonder, though, why only a few people here are going the non-surgical route…
When you say the key is keeping the foot in a plantar flexed position, do you mean with the toes pointing down? Right now, I’m in a hinged boot and since I’m not sure about going through with the surgery, I am not putting any weight on the foot & keeping my foot elevated when I’m not using crutches.
If the AT doesn’t heal properly, is surgery an option then?
Thanks for all the help!
NorthRancher, the medical researchers have pretty much disproved the old saw that athletes have to have ATR surgery to get good results, in 4 good studies, all done in the last 3 years. They’re refs 4-7 in the Wikipedia ATR article at bit.ly/Wiki-ATR, so you can check the results online. Two of the 4 studies haven’t been formally published yet, but both of those have been delivered at the 2009 and 2010 Annual Meetings of the AAOS (Am. Assoc. of Ortho. Surgeons).
Most Docs, including yours, don’t attend those meetings, and don’t read the reports, so they still tell their patients the story they learned in Med School, or from their Attending Surgeon back when they were Interns. It’s a tough job, they’re often overworked, and ATRs are a minor sideline for them, so it’s understandable, if sad. (Thank God WE get 100% in our jobs, right?
)
I love hinged boots, because they can be set to hinge for later in the rehab, after you’re FWB for a while. But for now (and maybe for your first 6-7 weeks), I’d lock yours in a fixed position, at around 20-ish degrees of plantarflexion (= toes down). I think the new studies with the great non-op results all used non-hinged boots (with heel wedges at first), and the (earlier) ones I’ve seen that used early hinge-ing mostly got less great results. I still think that the hinged boot makes great sense, but later, not now.
We have one blogger here — Johanna aka “FirstDayOfSummer” — who did her own modern-style immobilization (in a VacoCast boot) for two weeks while trying to talk her Doc into letting her follow a modern non-operative protocol like the one I posted at bit.ly/UWOProtocol . She failed, and reluctantly agreed to have the operation, rather than suffer through GrandDad’s “conservative casting”. But when they checked out her leg again, they decided she was healing so well, she didn’t need surgery any more! Last I heard, all the local surgeons are new converts to the UWO Protocol and the VacoCast boot! Check out her blog, at achillesblog.com/johanna/ .
I did a week of NOT gentle skiing (in Whistler) 17 weeks after I “got the boot”, and my injured leg was never a problem, so there’s no “sitting on a couch” here! I’ve been actively bicycling and racing small sailboats all summer, with a little running on the beach thrown in here and there. Most patients get 100% recovery or very close, with or without surgery, though the last ~20% of the full recovery does often drag on. We’ve had recent posts from two post-op patients who still feel weak even after 1 year post-op, and others who feel 100% recovered after as little as 6 months, so the schedule’s very variable. Again, the 4 studies (including UWO, using “my” protocol) showed no statistical difference in strength or ROM at 6 months and 12 months, with or without surgery, and very good results both ways.
So, I’d try to “sell” your Doc on the protocol used in the UWO study, or find a Doc who will see you through it. In either case, the first few weeks and months are very important, so I’d lock the boot into a suitable position ASAP, and skip the surgery. Even if you do decide to go for the surgery, it’s probably better to have your ankle immobilized toes-down (around 20 degrees, or the equivalent of 2cm of firm wedges under your heel) in the interim. (All the hinged boots can be “fixed”, either by tightening a setscrew, or moving steel pins, or such. If you can’t figure it out, check back here with the make of the boot, and somebody will probably know.)
In the long run, society may end up “de-Doctoring” routine ATR treatment. So a Sports-Med Ortho Surgeon will confirm the diagnosis, then just refer you to a PT with a copy of a good protocol in your hand. Many of us who skipped the surgery keep checking in with our “surgeons”, but they don’t actually do much, since there’s no surgery. (I think it’s much less scary than home-birthing, which is practiced in many advanced places.)
There are more non-op patients here than you might guess — though I think it’s unfortunately impossible to figure out who, or how many! (E.g., all our timelines say how long we’re “Post-OP”, though we’re not!) But most ATR patients, especially in the US, do get pushed hard into surgery. The fact that the case for surgery USED to seem solid, until only 3 years ago, AND the fact that the surgery works best if it’s done PROMPTLY, all mean that there’s no time for second opinions or research for many patients — too many, IMHO.
PT starts at 2 weeks (post-whatever) in the UWO protocol, and it’s part of the package that produced great results, so I’d follow it. Nobody can prove how important it is, really, and we’re still guessing about lots of other facts, too. But early mobilization — gentle exercises with your foot in the air, starting at 2 weeks — seems to help, as does PT, we think.
My fancy Sports-Med Doc was pretty pushy about keeping me right on the UWO protocol, like a nervous cook following a recipe. It’s probably not the perfect protocol, but for now, it’s one of the few that’s been tested thoroughly and proven to produce reliably good results, so it makes sense to follow it. That’s 6 weeks fixed at ~20 degrees PF, then 2 more weeks in the boot at neutral, then straight to 2 shoes. The first 2 weeks are NWB on crutches, the next 2 PWB, still on crutches, then FWB “as tolerated”, which usually means walking on two feet a few days after 4 weeks “post”.
I made both of those first two transitions more gradual, removing my heel wedges gradually over a few days, and then going with a hinged boot (hingeing only DOWN from neutral) starting at 7 weeks, and using it after 8 weeks for scary outings. Otherwise, I stuck to the recipe.
Your last question should be academic, since the vast majority of non-op patients in the new studies healed properly, as do the vast majority of post-op patients. A small minority of ATR patients, with or without surgery, do end up with various problems, though, and some of those get treated surgically. E.g., 3 of the 145 patients in the UWO study re-ruptured their ATs, and they all got surgery — though our own Brock (see below!) has been doing fine with non-surgical treatment of his own re-rupture, as have others here. With or without surgery, a small minority of patients “heal long”, with excessive dorsiflexion (toes up) and inadequate plantarflexion ROM and strength. They either adapt to a non-optimal situation, or go for corrective surgery.
Good luck, and Good Healing!
Well, Norm got here before me and I think answered most of your questions. But, as to why more people don’t elect to go the non-surgical route? I don’t think there’s an easy or simple answer for that. There is a percentage of the population that thinks if a doctor says so it must be true. Unfortunately the doctor may have his/her own agenda, which may not agree with the Hippocratic oath, “Do no harm.” A doctor will not make anywhere near as much money taking a non-surgical approach to ATR compared to the surgical approach. If the doctor is part of a large medical group or clinic, at least part if not all of his/her salary is based on production(how much revenue did he/she generate). The difference in revenue between surgery vs no-surgery is probably at least $20,000 by the time you add all the associated charges. I’m not saying that all doctors take this approach, but my wife is a doctor and the clinic where she works puts a huge emphasis on generating revenue and her salary is based on production. Some doctors in her department make a lot more than she does because they schedule patients for 15 or 20 minute slots and she schedules them for 30 minute slots.
As in every profession there are good doctors, bad doctors and everything in between. I’ve fired three since my ATR for various reasons and I shopped around before having my fourth surgery. I knew what the problem was and what needed to be done and so did my infectious diseases doc, but the surgeon who did my third surgery disagreed and actually blamed the problems on my activity level. I also shopped around for a physical therapist that I wanted to work with instead of just taking whoever had an available appointment. I wanted someone who engaged in endurance sports and found a really good one who is also a genuinely nice guy. Interview therapists ahead of actually needing one and you’ll be a lot happier about it. Take the UWO protocol with you and tell them that’s what you want for rehab. Do the same with a doctor. If the one you’ve seen is not treating you with respect, find another. If you’re anywhere along the Front Range, there are dozens to choose from. There’s no excuse for the way some doctors treat their patients. I fired a spine surgeon about 10 years ago because he was a jerk and wouldn’t answer my questions. I switched to another doctor in the department and was very pleased with the outcome.
Good luck whichever approach you follow and get your own blog here. Read the third paragraph on the main page and follow the instructions for getting your own. It’s a lot more fun to have your own blog than always needing to use someone else’s to post your progress.
Norm and Gerry, I’m so glad I found this site and that you are so very knowledgeable and generous with your time in helping the newbies!
Norm, the information (including links) you’ve shared about the four studies is convincing, and I’m relieved surgery is off the table for me now. I’m 100% sure, based on what I’ve read. Seems like the next step for me–outside of informing my doctor’s office to cancel the surgery–is getting my toes pointed the right way and finding a PT with UWO protocol in hand. You raised an interesting point about the hinged boot not being as effective in the early weeks with the VacoCast boot being the preferred one. I’m not sure what to do…should I switch? Or, do you think once the adjustments are made (toes pointing down), I can heal effectively in this boot? (BTW, I’m not sure of the name/model of the walker–it says “Procare” by DJO in Vista, CA)
Thank you for summarizing the protocol & I will check out Johanna’s blog–so great to have role models here to follow:)
Gerry, I hear what you’re saying re/doctors. I have to say, in spite of the “couch” comment, my doc did not push me hard toward surgery–he gave both options–but once I decided on the spot (not smart) to have surgery, he reinforced the decision with the couch comment. (lol). Two things disturbed me about my experience–the soonest they could get me into see the doc was 5 days post-injury and there was NO conversation about what happens post-op (PT, length of recovery, etc) and second, I called the office Friday morning with questions, and I’ve yet to hear back from them. The surgeon has a great reputation–he is the doc to several professional sports teams–and I really liked/trusted him, but as you point out, this is a minor, routine procedure and I’m not a priority patient. I’m wondering about next steps…After I tell them on Monday, I need to get the boot adjusted & get on with securing a PT. Do I find a PT on my own, since I have the protocol? And, who checks on my progress? Are there ultrasound scans done? Who does them? Do you think I need to find a new doc, or does that depend on his willingness to see me though this method/protocol? There’s another ortho group closer to home, who have a state-of-heart PT facility…
Thanks again for all the great support!! I will start a blog as soon as I get settled with a recovery plan this week.
Grace,
As long as the doc you already saw is willing to follow you and support you in your decision, there isn’t any reason to find another. If he basically tells you you’re on your own then you do. Personally I would want a MRI to make sure nothing strange happened, like the tendon ends being too far apart for non-op to work. I don’t know how common that is or even if it actually happens. You can’t order your own MRI, only a doctor can and you need someone to read it and show you the results. I would be more inclined to trust MRI than ultrasound. Norm will disagree with me because he doesn’t think much of either test. As for finding your own PT, I think you should. If the doc recommends someone specific, by all means interview that person, but you need someone who will work for you and with you, not someone who will just say “this is how I do it and there are no exceptions.” If he says just have “anyone” at this or that facility do it, to me that’s useless. You can bet if he were in your sport he wouldn’t accept just anyone so why should you. The PT will consult with your doctor about your progress and you want that to happen so the doc can learn that non-op, early weight bearing does work.
Rancher, I agree with Gerry on everything except the part he said I’d disagree with!
I’ve personally had, and also heard of, many confusing diagnoses and mis-diagnoses from both US & MRI. If you did something that can tear an AT, it felt like you tore an AT, and your Thompson test (and a surgeon) say that you’ve torn your AT, I’d proceed with treatment. This time, I happened to get THREE Ultrasounds at 1-week intervals (to guide PRP injections, which I don’t especially recommend), and each time I asked the presiding Doctor what the ATR looked like. I got three different answers!! Full, partial, and partial-but-multiple, in that order! What does that MEAN, and does it help me make any decisions?
I’ve told the story elsewhere about the three MRIs my ~94-year-old Dad had on his spine, at monthly intervals. They showed that he had an extremely serious spinal infection, and each MRI showed it had gotten much worse than the previous one. Dad did start with a terrible backache, but by the time of the third MRI, it had mostly gone away! He checked out of the hospital and had no more backaches — and no more MRIs! — for his remaining ~4 years!
So color me jaundiced on the subject. After my first ATR in late 2001, my meeting with the surgeon was postponed ’til I could get an US, and have it referred back to the Sports Med Clinic (where the surgeon was NOT). The Doc at the SMC who looked at the US told me he never would have ordered it, but would have sent me straight to the surgeon! He also said that any ATR-type patient who comes to him, whose Thompson test indicates an ATR _AND_ who tells the story I told him about climbing up stairs, gets referred straight to a surgeon without delay or further exams.
This was 8 years ago, when everybody knew that surgery was best. The story I told him about climbing up stairs (which he considered “diagnostic”) is this: The first time I put my injured foot on a step going up, and THOUGHT about transferring my weight to it, to climb the stairs, my life flashed past my eyes. And I immediately twisted the foot so ALL of it was on the step, and “gimp-climbed” up the stair case that way.
Finally, about using MRI or US measurements of the gap in the torn AT to decide on surgery vs. non-op: The UWO folks have published an analysis of their non-op patients to see if there’s any relationship between measured (US) gap size and how well they healed. It seemed logical that non-op would work better on small gaps, which is a story that’s often told. They found NO RELATIONSHIP at all!! The patients with the biggest gaps ended up with just as good strength and ROM(!) as those with the smallest! So the evidence says it’s irrelevant, despite the apparent logic!
About your comments and questions to me:
1) I DON’T think you need to get a different boot (though people who’ve used the VacoCast seem to love it). But if it’s now free to hinge back and forth, rather than maintaining a constant, immobilized angle to your ankle, you should change THAT. As far as I know, all hinged boots can be “fixed”, usually in one of the ways I outlined above. There’s a time for hingeing, but it’s not for another ~6 weeks. For now, you want your ankle immobilized “in equinus”, toes down, ~20 degrees.
2) As Gerry indicated, everybody goes through this rehab — even the non-surgical ones — in the care of a surgeon. So you should have one, who’s happy to supervise the treatment you want. That may or may not be the one you’ve seen, depending on how he responds when you suggest it. SOME day, I think we’ll have “normal” non-op ATR patients spend much less time with surgeons, and let the surgeons spend their time on surgical patients. But we’re not there yet.
Is your hinged DJO “Procare” boot like the one at procaresoftgoods.com/index.asp/fuseaction/products.detail/type/2/cat/17/id/323 ? (Or another one listed in their online catalog?)
The round gizmos near your ankle bones are where the hinge adjustments are. In addition to hinge-ing in many configurations, “Uprights lock in fixed positions of 0°, 7.5°, 15°, 22.5°, and 30° plantar- and dorsi-flexion.” What I think you want is to lock the uprights in a fixed position of 7.5° or 15° plantar-flexion, and leave it there for maybe 6 weeks (that’s the UWO schedule). We can check the trig later, but my calculator is telling me that 7.5° is fairly close to UWO’s 2cm of heel wedges.
(If you have trouble doing that, but can lock it in the neutral = 0° flexion (90° foot angle) position, you could do that , but use 2cm of firm rubber heel wedges instead.)
I used the Donjoy hinged boot that’s virtually identical to that Procare one. It’s not as high-tech looking — or as waterproof — as the Vaco, but it worked fine for me, and I’d expect it to work fine for you.
While searching for your boot, I stumbled onto DJO’s corporate website at djoglobal.com , which indicates that DJO owns Procare and Donjoy and AirCast and a bunch of other companies that I thought were competitors!!
Norm and Gerry,
Thank you both again:) I went to my doctor’s office this morning & saw his PA & nurse (the OS was in surgery) and they were both very supportive of this non-surgical decision. Although, when I first said I had decided against surgery, they were speechless and they looked at each other with incredulous expressions. (This made me a tad nervous…) The PA–who originally did my Thompson test–said my tear was further up the leg and not at the ankle and was an ideal candidate for non-surgical repair, although he expected it would take longer. My boot was adjusted downward at 30 degrees (maybe 30 instead of 20, because of the location of the tear??) and I will be NWB until have an appointment in two weeks. At that time, they’ll check to see how I’m doing.
I asked about PT, and was told the leg needs a couple more weeks of healing in this new position first, which sounded reasonable. I did mention the studies & VacoCast and they weren’t aware, but said they will pass it on to the OS. I really felt supported, even though the PA said he has never had a patient opt for non-surgery!
Does all this sound about right? I hope I’m not being humored, as in let’s give it a couple of weeks and we’ll see…I think they were very sincere once they turned the corner & supported moving forward with this new direction.
I am thinking “happy healing” thoughts and hope in 2 weeks, I get similar results as Johanna:)
I don’t have a copy of the UWO protocol in front of me but waiting a couple weeks before starting PT doesn’t seem out of line. If you had surgery it would be a couple of weeks and with surgery you have something holding the tendon together. I think it’s great that the nurse and PA were both supportive, but I have trouble believing you are the only person who ever elected not to have surgery.
So, it now entirely on your shoulders to create a sea change in how ATRs are handled by the doctors in your area. So don’t push it too hard or do anything dumb. Don’t let us down. LOL
Gerry, LOL. No pressure, huh? I will do my best to stay out of trouble and be a good case study:) I could not do this w/o the support here.
Your experience so far seems quite similar to mine. I chronicled my journey on my blog (gunner), including when I started PT and what exercises I did at what stage. Gerry is right, you are charting new ground for some of the professionals you are paying to treat you, and, if you get the same results most of us have, you will, in fact, make it more likely that the non surgical/quick rehab protocol will get more serious consideration for the future members of our elite club.
I found this “trail blazing” part of the experience extremely rewarding and developed quite a bond with my OS and PT through it. Not enough to make me hope for a similar experience soon, though!
My advice on the VacoCast - tell them to get it or get it yourself. You won’t be sorry.
It sounds good to me.
BTW, I just left a little comment on your brand-new blog (congrats!), and it says it’s “awaiting moderation”. I’m not sure why, since it didn’t contain any links or anything else “suspect”. There are some setting choices available.
If you’re afraid you’re being humored and then they’ll suggest an operation, that’s very unlikely. For one thing, most OSs don’t like operating on ATRs that are more than 2-ish weeks old. In addition, most surgeons don’t like operating on ATRs that are up high, near the calf muscle.
FWIW, the same little sub-study that showed no relationship between measured (US) gap size and how well they healed non-op (within the UWO study) also looked for a relationship between gap LOCATION and outcome. They found no relationship there, either.
So AT tears higher up the leg don’t heal NON-op any worse or better than tears anywhere else (and they all do pretty well on average). But tears higher up are a nuisance surgically, for reasons I don’t totally understand. (Maybe because the AT splits there, to connect to the gastroc and the deeper soleus?)
I’m still scratching my head about converting degrees of plantarflexion (boot settings) and centimeters of heel wedges. When I posted a few days ago, I was thinking that 20 degrees was in the same ballpark as UWOs 2 cms of wedges. But my scientific calculator comes up with very different results! It says that a 2cm deflection over (say) a 20cm-long foot (8″L) is only around 6 degrees angle. If that’s right, then even 20 degrees is pretty huge, and 30 is huger. (20 deg =~ 7 cm heel lift; 30 deg = 10 cm heel lift.)
I’ve only seen one study comparing the effect of different PF angles, and it was a study on cadavers, where they plotted the effect of flex angles on the gap size of a torn AT. They found diminishing returns from large angles, but I don’t remember their actual recommendation.
The difference will matter more when you go to PWB and FWB, because a big PF angle will raise that leg a lot farther off the floor than a smaller one. So you’ll have to work harder to build up your other shoe, to be able to walk straight. It may be a bit like walking on stilts!
In the alternative, you could change the angle gradually, one “notch” every few weeks. That’s not what UWO did, but it’s a very common approach, and your surgeon may be used to it. I found UWO’s prescription — a sudden switch from 2cm of heel wedge to zero, at 6 weeks — too abrupt for comfort, so I spread it out a few days, on my own. (I was actually at 3cm by accident, so jumping to zero was even more abrupt, and felt uncomfortable.)
Congrats, good healing, Watch Your Step, and keep us posted!
Hi Norm,
Your trigonometry problem may be due to using the whole foot as the hypotenuse.
The hypotenuse should start at the middle or even toward the front of the heel pad, (depending on how much the front of the pad compresses). The hypotenuse should end at the ball of the foot, not the end of the toes, unless the boot forces the tips of the toes to stay directly on the plane of the fulcrum and the ball of the foot.
Perhaps that shorter hypotenuse will help the numbers look better.
I hope this makes sense,
Doug
@ norm: interested in your comment that OS’s don’t like operating on ATRs more than 2 weeks old…here in NZ, they only operate if you are outside 48 hours as some study (the auckland one??) showed that non-operative works best if put in healing position quickly as possible. ?
Doug, you’ve got me thinking, and mostly agreeing — thanks!
I think my heel wedges were actually wedges, i.e., triangular cross-section rather than rectangles, so the full 2cm (or 3cm) lift was only near the back of the heel. But you’re definitely right about using the ball of the foot rather than the tips of the toes.
For my size 10-ish feet., that’s only ~16 cm. But that’s still only around 7 degrees for 2cm wedges. Even with a smaller foot, it’s still hard to get to 10 degrees, not to mention 15, 20, or 30.
I still think that UWO’s 2 cm is a pretty modest PF angle, and 20 and 30 degrees are way more. But the 2cms seemed to work well, and it presumably makes the transition to neutral much less strenuous and scary later (even if they do it all at once “cold turkey” at 6 weeks). (Many Docs who start at 20 or 30 degrees also start shifting toward neutral earlier, and in stages.)
Bronny, I haven’t noticed any of the new studies being fussy about being as quick as 48 hours, so it’s news to me.
UWO included anybody within 14 days from their injury. I don’t think I’ve ever seen the full text of the Twaddle et al (NZ, 2007) study, so it’s possible they only included brand-new ATRs. Let us know if you find out. It does makes sense to me that the initial flush of inflammation could be very useful in healing, if it were immediately harnessed into a non-op cure, with NWB immobilization in equinus. (Maybe we’ll live long enough to see that standardized — with walking boots stored next to the defibrillators in all the gyms!
)
Well, I am a new member of this club, so I opted for the surgery, being 50 and with a 12 year old son to keep in mind. The surgery went well on 11/20/10. I was given some Percocet for pain relief, ( which my body immediately rejected), so next best thing was muscle relaxants, working fine. But not much of a pill person, I don’t care for those as well. Works better for me however. Get re-checked in about a week, for status. This website has been very inspirational to me and I do have the upmost respect for the “disable”, as this is what I am also. I guess rest, rehab and repair are now my “3 R’s” currently. Thank you to all the posters, sorry “WE” had to endure this pain, but glad to know we all can share our pain. Truly makes me continue to be humble each and every day.
I ruptured my achilles on 11/22/10, playing basketball. I do p90x and insanity, so my calf muscles and achilles tendons are/were strong. The game was a little physical and someone stomped on my exposed ankle, while I was pushing off to run. It was a very loud pop that was heard by many, but it took a while for people to figure out what the sound was.
Nevertheless, I had surgery on 11/26/10 to repair a full rupture, and was in the initial cast for 10 days. The surgeon took out my staples on day 10, stretched me to 90 degrees, and put me in a walking cast. I was told that I would be non-weight bearing for 4 more weeks, but I told them that I planned to attempt walking much sooner. Thus, he felt my repaired achilles, stretched it up and down slightly past 90 degrees, asked about my pain level since surgery, and gave me a walking boot on top of my cast! Yea baby, that’s what I’m talking about, working with your patient.
He said that I should try to put weight on it slowly, progress to walking with crutches or a crutch, and in as soon as 2 days, or as much as 2 weeks I should be able to walk without the crutches. He then decided that I could have my cast removed in just over 3 more weeks (12/30/10).
When I first tried to put weight on it that afternoon, a sharp pain shot up my leg. Ouuuuuch! I tried again 15-30 min later (very lightly). Within an additional 2 hours I was fully standing on the repaired foot. Later that night, I was walking all over town (with my crutches assisting me), the next day I used one crutch in the morning, and was crutch free by bedtime. I have not picked up my crutches since.
I am 35 years old. I stretch every morning while in my cast, and I dont see any noticeable deterioration in my calf muscle. Today (2 weeks post-surgery) I did Yoga-X for 45 minutes. My only problem is the need for occaisional elevation cuz of the swelling.
Fellow ATR recoverers, know your body, your fitness level, and don’t be afraid to work at a speedier than the normal (IF YOU R CAREFUL, AND UR DOCTOR IS GOOD WITH IT).
Good Luck everyone. I will be back with an update next week.
My friend said that my “just over 3 weeks” calculation was wrong. So, here was my timeline:
11/20/10, injury
11/26/10, surgery
12/6/10, first cast removed (staples taken out)
12/8/10, walking
12/30/10, walking cast removal (3 weeks and 3 days after it was put on)
Good luck on a speedy recovery
I ruptured my Achilles 3 weeks ago and I am in a Cam Walker boot. I’m doing the non surgical route as the doc suggested since I don’t have insurance. I was playing basketball when it happened and hope to someday return playing. I know recovery takes 12 months and I’m willing to do that. But should I be excited that I’ve been walking in my boot with no issues. I’m trying to figure out the best way to let it heal. I’m supposed to start therapy in a month or so. in the meantime, i wear the boot wherever I go and only take it off when I’m showering or going to sleep….
I completely ruptured my achilles, rt leg, while working out with my trainer, September 24, 2011. I had immediate surgery the following morning, followed by a cast for 2 weeks, then a cam walker. My doctor was very progressive with my treatment and I was back walking without crutches/boot by Thanksgiving, and was cleared from rehab by Christmas. I still have days where I can feel the “stress” on it, usually days I don’t wear my orthodics and over do it. I’ve been very lucky!!
For those of you who have been “cleared” for sometime, when does the fear of injury go away?? I’ve begun working with my trainer again, but even with “clearance” from my doctor and rehab therapist I can’t stop worrying!
Cy, the proven-successful protocols for non-op rehab all involve 2 weeks (or so) of NWB, on crutches. (Cf., e.g., bit.ly/UWOProtocol .) I have no idea what you should expect if you skipped that step completely.
Swenny, there’s good news and bad: After 5 months, it’s probably time to relax about your right AT, and start worrying that you’ll rupture the LEFT one! There’s a study on our elevated risk of such a “translateral” ATR, linked in the “studies” page that’s posted on the Main Page here. But you’re probably at low risk of that until you return to high-risk (usu. sports) activities.
I never worried about re-rupture in the first place, nor do I worry about rupturing the other leg. Life is too short and there are just too many fun thing to do without worrying about such relatively trivial stuff. Yes, rupturing my Achilles tendon was certainly not enjoyable, but worrying about it happening again won’t change anything. So stop worrying and start enjoying.
I completly ruptured my right AT on 8/20/10, had surgery, a partial cast for 1 week and a hard cast for 3 weeks, I was able to start walking and was in a shoe before I started therapy. I was released by 12/1/10. I was given the ok to start playing volleyball (not competively by any means) and DR gave me the ok. He told me if anything it would be the other tendon I would hurt. And….after 9 weeks of playing, our last game of the leauge I partially tore my other tendon. This time I did not go with surgery because my dr. was insistent that since it was not completly torn that it was the way to go.
I have had a cast up to my thigh for 2 weeks, I go tomorrow to get a short cast for 2 weeks, then another 2 weeks with a cast with my foot a bit flatter.
It was very defeating to do the same injury to the other foot 8 months apart! I am trying to stay upbeat and positive, but it is a bit hard to! I keep telling myself that at least I will be out of a cast for June!
My question is to anyone who did the non-surgical route how long was your cast on for? How was the pain when you started to walk? I am still feeling blood rushing to my foot after this long, should I expect it the whole time?
People who went the non-surgical route will chime in but, as one who is used to talking back to doctors(married to one), I would just refuse the next cast and a vacoped boot. Frankly 6 weeks in casts is just craziness, especially up to your thigh? I am appalled at that.
Gerry would “just refuse the next cast and GET a vacoped boot”. (He’d also be able to edit his posts here, if he could!
)
My story’s a bit like yours, nmcasta82, since I tore my right AT first, got it operated on, returned to aggressive “high risk” sports (mostly competitive volleyball), tore my left AT, and had it treated without surgery. But my ATRs were 8 YEARS apart, unlike yours. (My details are in my blog.)
Several Qs, several As:
- Some Docs used to cast above the knee for ATRs, but very few still do, because there’s no advantage, and no reason to lose all muscle tone in the thigh, etc.
- Immobilization for 6 weeks, or 8 weeks, IS consistent with many good modern protocols, but they usually use boots instead of casts, for several good reasons: Easy fit adjustment, better padding, access to early exercise and PT (often ~2 weeks “post”), better hygiene, better PWB & FWB, “softer” transition to the 2-shoes stage (first sleeping w/o boot, then walking around the house, etc.), etc., etc. Incidentally, early boot-fitting should also be cheaper for the hospital than a series of casts, though the professional cast-makers may not appreciate being treated like travel agents — and none of us loves to change our ways. . .
One good fast modern protocol (boot-based) is at bit.ly/UWOProtocol , and the full study that demonstrated that it produces excellent results, with or WITHOUT surgery, is listed and linked here in the “Studies. . .” page, at achillesblog.com/files/2008/03/jbjsi01401v1.pdf . I’ve never seen any study suggest that casts produce better results than boots, or that a slower protocol than this one produces better results.
I found your posting to be insightful! Thank you.
My rupture was a ‘typical’ one playing soccer. I went to A&E (UK) the next day and was seen by the surgeon who opted for the non-surgical route, but he was very vague with his information regards recovery, other than issuing me with a ’sick note’ from work for six weeks!
I have been in a plaster cast for three weeks, with my toes pointed downwards, so am wholly reliant on crutches. I am bored senseless at the moment, but am due to see the surgeon again in four days time.
I have a (relaxing) holiday booked in just over a month’s time (meaning seven weeks since rupture). Does anyone know if this is realistic for me in any way…preferably out of a plaster cast?
I haven’t seen any posts regarding how long it takes for bruising to fade away. I felt my ankle go playing squash on 04/15 and chose non surgical route. I was plaster casted the same night then put into an aircast 2 days later @ 30 deg. for two weeks now @15 deg. I still have a marked line of bruising half the length of my pinky finger on the interior of my heel and the foot swells quickly if not resting.
I try to keep my leg elevated as much as possible but the ceiling is not a very responsive conversation partner…
Any comparisons on bruising clearing up?
bmac, I ruptured mine just 2 days after you (04/17) and went the surgical route a few days later. I can’t tell you when the bruising will go away, as i’ve often wondered that myself!! I have the same as you, bruising on the interior of the heel about the same size or maybe a bit bigger than yours. Hasn’t seemed to change in the past week and a bit? So you aren’t the only one, but i’m hoping it will at least START to go away soon!! Least for me anyway it doesn’t seem to hurt or do anything so i’m not too worried? ;P
The black-and-blue will eventually fade. It’s also “sagged” from gravity, so it’s already way lower than where the actual injury was. The inflammation (swelling) is now separated from the visual bruise, and it will follow its own schedule, which varies a lot among us. Mine lingered way too long this time (I’ve done both ATs!), and I eventually posted a blog page with a title like “This swelling and elevation is getting OLD!” (Naturally, it started fading soon afterwards!)
Various kinds of circulatory stimulation, like massage and vibration, will probably eliminate the visual bruise a bit faster than otherwise. But it’s pretty harmless, since your career as a foot model is probably finished anyway, at least for a while.
Hey Guys,
I cut my ankle on glass April 18th, went to ER, they stiched it up and said I was fine. I went back to hospital three weeks later for swelling. Again, they t old me I was fine. I did not feel fine, went to ortho doc May 23rd and I have a full achilles rupture. Can’t have surgery due to having an open wound already. I am in a aircast to my knee. Got my MRI last Wed. I am not off work, walking on crutches and I got a little scooter at Goulds Medical Equitment to help me get around better. I am so bored. Wondering how long it takes to walk a little and drive a car agian?? I am sueing the ER doc and another doctor I went to (twice) My ATR was missed five times. I kept walking but i my foot turned to the side, and I had a horrible limp. Not to mention the pain I am in.
Bummer, Sylvia.
A couple of points pop to mind:
1) I saw one sports-med surgeon in Toronto after my first ATR (late 2001) who said he doesn’t even bother sending patients for scans, once they tell him that they’re walking up stairs with their heel on the next step. As far as he’s concerned, that’s as good as the Thompson test and those people have ATRs. (I don’t know if you could get him as a witness, or if you need him.)
2) There are reasons to believe that a sliced/cut AT may be different therapeutically than a torn/ruptured AT. I’m a huge fan of the non-op treatment of torn/ruptured ATs, with a modern fast protocol like the one at bit.ly/UWOProtocol . I think we’ve seen one or two sliced/cut AT patients here who’ve done OK with similar non-op therapy, though cases like yours are quite rare. But the odds for you sliced/cut-AT folks may be significantly better with surgery than without.
The logic goes like this: One would THINK that non-op ATR patients would generally “heal long” (with a longer AT than before), esp. in comparison to the surgical patients, because it’s very difficult to get the two torn ends of the AT to stay together as well non-op as when they’re yanked together (and sometimes trimmed a bit) and stitched together. One would expect natural healing to “fill in the gap”, which would add length.
That “healing long” would normally translate into a bad ROM, with excessive dorsiflexion and inferior plantar-flexion, as well as inferior plantar-flexion strength — not a great clinical result.
But the modern studies seem to prove that that does NOT happen. (E.g., achillesblog.com/files/2008/03/jbjsi01401v1.pdf , aka “the UWO study”. And also refs 4-6 of the Wikipedia article on ATR.)
One theory to explain the “magic” of an ATR healing back to its original length without surgery, is that the healing is “guided” by the sheath that surrounds the AT, called the (calcaneous) paratenon. With a common torn/ruptured AT, that paratenon is intact, surrounding the torn AT. But in the case of people like you, with sliced/cut ATs, the paratenon has ALSO been cut, so it’s not there to do the “magic”.
Nobody’s ever tested ANY of that bunch of logic, and — unless some terrorist slices 200+ ATs with some diabolical weapon — nobody probably ever will, so it just sounds logical. (Mind you, most of what “sounds logical” in this field has been proven false — like “slower is safer”, “surgery works better”, “NSAIDs are good for inflammation”, “PRPs should help ATs heal”, and much more!)
I didn’t know that an open wound rules out surgery. Is that a universal rule, or just what your OS, or that one hospital, says?
Another reason to think that surgery might benefit you, is that your ATR waited a month before it was properly immobilized, in your AirCast. The “magic” of a successful non-op cure is probably dependent on the healing/inflammation response that’s triggered by the original injury, or by surgery. In your case, I’d be surprised if there’s a lot of that magic still hanging around.
Good luck!
Hi - I ruptured my achilles tendon 5 days ago playing tennis. I saw an orthopedic surgeon yesterday and he strongly recommended surgery and even scheduled one for Monday. He only did the Thompson test is sure that the tendon is fully ruptured. I have no pain. I’m currently in a splint. Should I get another opinion & get an MRI to be sure? I’m 32 yrs old and have never had surgery and would like to hear from both sides…non-surgical recovery and surgical recovery. I’m fairly active and would like to confidently continue to go to the gym (do yoga, spin, zuma, run). I’m feeling pressured to make a decision quickly. How long should I wait? Can I get a cast first and take my time deciding on surgery?thx
if you want a second opinion, naturally, you’ll want to see an Ortho specialist/surgeon. If you are fairly active and would like to be active again, that sounds like my position when I tore my AT. My ortho recommeded surgury for a few reasons: (1) you are less likely to tear is again following surgery (sutures make the tendon alot stronger — there are a number of studies to corroborate this (2) recovery to full activity tends to be faster. Again, many many people on this blog have gone with the conservative or non-surgery route. Quite a few have had surgery. For me, there was no question– I wanted my tendon repaired by a surgeon. I injured my AT in tennis on Saturday 6/4 and had the surgery on Sunday 6/5. Good luck.
i ruptured my achilles tendon 2 weeks ago..went to the ER, they put me in a splint and told me to contack a clinic for follow up care..the clinic scheduled me for an appointment in 2 weeks..right now im not feeling any pain..theres no swelling..im still in the splint..now waiting to see an ortho on july 18th..i dont know if its a partial or complete tear…But when i ruptured the tendon i was able to drive home..the pain was moderate..i was wondering if i’ll be able to walk in 3 weeks.
I had a complete tear and couldn’t drive at all. If you were driving normally I’d think you only had a partial tear. But, if you are pretty active you may have enough strength in your ankle to move you foot with enough pressure to drive. If you run you finger down your achilles is there a palpable dent?
I wouldn’t bank on walking in 3 weeks if it’s a full tear.
Is your splint pointing your toes down (plantar flexing)?
ya the splint is pointing my toes down. and one doctor told me it might be partial cuz i was able to push his hands like i would on a gas pedle.
Being able to extend your toes (or the ball of your foot) against moderate-light pressure isn’t diagnostic of anything ATR-related, partial, complete, or none. There are other tendons and muscles that can do that job, they just can’t do it against high resistance, like your body weight.
One sports-med surgeon I went to (after my first of two ATRs, both sides) said that if you can’t walk up stairs normally, without putting your whole foot on the step (semi-sideways), then you’ve got a complete ATR in his books.
will i b able to have surgery 4 weeks after the injury
the longer you wait will not be to your favour. if you want to do the surgery route do it asap.
Yes. They are considered acute ruptures up until 3-4 weeks & chronic after 4 weeks. Sooner is definitely better if only for the reason that you are in recovery sooner. I’m a great example for this. I had surgery 3 1/2 weeks after the injury and I’m now about 3 1/2 weeks post op. Had I had surgery sooner I could be like 7 weeks post op instead of 3 1/2. Also, atrophy has increased because of the delay. Another reason is percutaneous surgery becomes less of an option after 10 days or so. This means open surgery which could leave a more noticable scar. However, folks have recovered successfully after surgery for a neglected rupture. I was very stressed for my delay, but the delay gave me time to get things ready for the long recovery ahead, which has made recovery much less stressful. Sooner is better, but if there has to be a delay use the time researching and preparing for your recovery.
My ATR occurred July 3rd. Like a dummy I thought it was just a sprain and could tough it out on my own. Fortunately I got in to see my doctor and got the diag on the 14th and am now scheduled for surgery on the 20th. One thing I forgot to ask was how long I’d be laid up. I work in an office environment and this is not a good time for a lengthy absence. Can anyone give a general run down on my road to recovery? Thanks-
I have been “laid” up longer than I expected. If working from home is an option at all I would try to make that work. I am a project estimator, so being in the feild is critical for me. However, I found a lot of ways to still bring in jobs and create new business from home. The short answer would be, as long as you can keep your leg elevated for the first 10-21 days, I would say you could go back anytime. However, it is VERY important to keep your leg elevated, only letting it hang down for 20-30min at a time for the first 2/3 weeks. My toes would turn a deep purple and my foot would throb a lot during the first 2 1/2 weeks. After that time, it improved a lot. Being disciplined about elevation will actually speed your recovery in the end. Once your co-workers understand the extent of the injury and the importance of the intial recovery I think you’ll find some sympathy and patience. Hang in there, the healing really starting being noticable for me right around the three week mark and that bench mark came around pretty quickly. Stay positive and maybe use this time to get your bathroom set-up, bedroom set-up, you’ll need food and ice nearby, maybe bring a week or two worth of work home with you, etc.
I was playing basketball Sunday morning like always do. I play half court either 4 on 4 or 3 on 3. I sometimes get tight calf’s or calf cramps so I know I always have to stretch prior to playing. I did my normal stretched prior to playing. During the third game I went to step forward after the opposing player lost control of the ball and I went for the loose ball. As i went to step off my right foot I immediately fell. It felt like someone either kicked me, or tripped me or even threw a basketball really hard at the bottom of my right calf. When I looked behind me no one was there. A player on my team said he heard a pop or sounded like the sole of my shoe ripped off. I went right to the ground with some pain. Feeling a little numb and tingly. The pain was no so severe, so I was thinking maybe just a bad strain or pull. I have turned my ankle and have had muscle cramps that were much more painful. On Monday morning i got an MRI and sure enough I ruptured my Achilles tendon as well had some calf muscle tear. I have a meeting with an orthopedic surgeon tomorrow to discuss surgery options. I am only 30 years old. I want to heal and recover and be back stronger than ever. I know this will take lots of mental strength and confidence. This blog will be part of my support and rehab.
Well, Golden, welcome to the ATR club! You have come to the right place, as there are many others who are in the same boat, such as myself, and there is a lot of support and great info on here. I am a little over a month after surgery and u will hear this over and over….patience is huge in this recovery! Wish ya a speedy recovery my man!
Hi Golden!
I’m so sorry to learn that you have joined “the club”! This is a wonderful site filled with truly lovely people who have been an enormous help to me. I had ATR surgery on June 7th, 2011 and have learned so much over the past weeks about this unfortunate injury.
All the very best to you in your ATR recovery!
Hi Golden, I tore my first Achilles 20 years ago playing tennis. I also played alot of basketball.
I opted for surgery and chose an orthopedist that was affiliated with Professional Sports teams in our city.
I wanted to be treated like an athlete that needed to come back to play in the play offs or the next season.
I took about 6 months before I could play again, and was dunking in about a year.
It takes a while, everybody heals differently, but in time you will be as active as you were before.
Reading golden’s entry on 8/2 gave me a freakish sense of deja vu due to the near-identical circumstances and description of his injury. I too sustained a non-contact right Achilles rupture (after proper warm-up/stretching) during rec b-ball on 8/8 and will have surgery tomorrow. Hope all of you are recover/rehabbing well and will look forward to reading further insights & tips from my ATR brethren. I’ll try to blog a post-op update and prognosis this weekend.
Hi everyone - partial rupture on the 21st July (1-5mm) was in cast for 10 days and have now moved to boot - no pain just increadibly uncomfortable. What is the recovery timframe for this level of injury?
cheers
John
I tore my Achilles on 7-12 when I misjudged the steps in the middle of the night. Went to the ER and they didn’t think it was the Achilles, even though I told them it felt different than a sprained ankle and the pain was in my calf. I went to an ortho dr 2 days later and had an MRI asap. The MRI confirmed the tear and had surgery on 7-27. I was in a partial cast since the surgery. I started therapy about a week ago and am almost at weight bearing level. I got a boot yesterday, because I’ve had some pressure sores develop on my heel from the partial cast. Thankfully I have a great hubby and sister in law who have helped me very much.
I completely ruptured my achilles on 6-20 playing softball and had surgery on 6-23. I am 33 years old male in ok shape. I had a soft cast for two days and have been in a walking boot adjusting the angle slowly until 8-29. Including 4-5 weeks of no weight on the foot. I am now boot free, but walking slowly with a heal lift in my shoe. Still nowhere near normal but glad to be moving again. I must admit that the pain level never reached above a constant four for me. If you are reading this, it is likely because you are reading about what to expect. Don’t. I have talked to many people who have had this or a partial tear and never heard the same story. That is with the exeption of the 24 year old that had the same surgery same day (and surgeon) as I did. he is about a week ahead of me but both of us seem to be ahead of the curve. If you read this and are in central Wisconsin and need a surgeon recommendation let me know.
Scotty B, you talking around the Wausau area? I too am from Wisconsin. Had surgery in LaCrosse, from the Black River Falls area. You are about a week ahead of me in this process…however, I am not in two shoes as of yet. Good luck man!!
Hey everybody , i’m glad a came across this site.
Ihad my ATR 5 weeks ago. 4 days later i had my surgery and 12 days after my surgery i got my cast removed and Dr. put me in aircast boot.
I’m in Canada and to me seems like the procedures are not the same.
I hope my Doc is doing the right thing :)))
he really seems like he knows what he is doing.
I’m doing great and will see the Doc on 27-th. Every evening before bed i remove the boot for short period of time and last night i decided to sleep without the boot. It was awesome :))
Since there is so many blogs about this i decided to do my own and answer any questions you have for me.
Check me out at
http://joe-tryingtoblog.blogspot.com/
thanks
Joe - I know you have the blog elsewhere but you can have your own page here. I found it difficult to post your site. You would get more feedback and it would come quicker than running one of your own. There are also a few from Canada here but not me. Regarding physio, I would suggest that you cannot get through this without it. The physio is going to be your next best friend by helping you build your strength, showing what and when to do things. Pushing things can be different for each person but you are only at 5 weeks and the hard work hasn’t started yet. If you do something you shouldn’t then you may re-rupture and will be back to square one. You may also run the risk of healing long which will mean less strength in the calf forever or until you have surgery to fix it. I am at 20 weeks and have just started running again. Treat this injury with respect and don’t be a hero. I would start searching for a physio now. Make some calls and find one that has experience and good results with this injury. What you are doing at the moment does not sound like you are pushing things. Sleeping without the boot should be OK at 5 weeks but walking without it may not. Writing the abc’s with your foot while sitting is also good. Do not use anything artifical to stretch the foot. Just use your own leg muscles and you should not take it to any extremes that would cause damage. Good luck with the doc on the 27th.
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Hi all,
I ruptured by achilles last Friday (9/30) playing basketball. I went to box someone out and pushed off my left foot to get the rebound when suddenly it felt like I was kicked full force in the heel. I went to the ER that day, and the ortho 3 days later who confirmed the complete tear. The doc told me I probably wasn’t kicked, which I wouldn’t believe if I hadn’t read all the posts on this blog! I go in for surgery on Friday.
What a great site. It’s amazing how similar some of these experiences are. I’m 32 years old, and it was pretty depressing when the extent of my injury sunk it and what this means for the coming months. this has all happened so suddenly. But it’s encouraging to read everyone else’s experiences.
Spot on Gabe, the advice on this site is good, as is the encouragement from people in exactly the same position
Set yourself a blog, you can look back at milestones and forward to next big steps …. I’m not much into blogs tbh, but this one has been helpful mentally, and if the mind is healthy the body should follow suit
Good luck with your fix
Wow. I ruptured my Achilles on my right leg on Sunday during a step class. Typical unfit woman in early 40’s trying to improve fitness! Suddenly felt incredible pain in back of leg and heard most amazing crack. Assumed everyone else must have heard but music pumping so just me. Thought I had bashed my ankle on the step and only when I tried to put my foot down realised something more as felt like putting my foot into quicksand and foot felt disconnected from my leg. Very odd. Luckily ignored gyms advice and went straight a&e who immediately diagnosed it and put my leg in a cast and booked appointment fr orthopaedic surgeon the following day. Good friend of ours is OP and he said non surgical would e best if possible as risks associated with surgery are best avoided if you can and as I had been set in a cast within hours of doing it my chances were good. Now in cast for 8 weeks. So fed up with lack of mobility. Finding crutches very tricky as the weight of cast and angle of foot make me feel very unbalanced. Found reading all the comments positive but feel so sorry for myself- not a sitting person.
Naja, jedenfalls habe ich hier auch einen relativ interessanten Artikel auf meiner Website dazu geschrieben Pc bauen
So much great information & to be honest I’m a little overwhelmed. I ruptured my right achilles tendon on Sept 3, went to the ER 3 days later at which point they diagnosed it as a bad strain. I hobbled around for the last 4 1/2 weeks & decided to see my physio therapist & GP. They determined after an ultra sound it was a full rupture. Initially when I spoke to the surgeon he stated surgery. Then today when I saw him decided non surgical approach as it was less invasive. So, needless to say he put me in a fiberglass cast, no weight bearing for 12 weeks. Every 2 weeks it will be repositioned. I am 29 year old female, moderately active. Has anyone had a similar experience?
Joe - I too am in Canada.
Emma.
Would question your surgeon about conservative treatment for a rupture undiagnosed for 4 1/2 weeks.
Has he seen the ultrsound?
I would have thought that after 4 1/2 weeks the gap that will have developed will be too large to heal without surgery.
Dont want to scare you but I would question your surgeon.
Thanks jonboy - appreciate the response.
I was thinking the same thing & have called my GP for a 2nd opinion. He did not look at my ultrasound with me. Which made me question has he at all…………
Every other medical professional I saw since last week stated surgery. From what I gather on all the information I have read - that like you said after 4 1/2 weeks surgery is the only option.
Thanks again.
Ruptured my tendon September 12, surgery September 21, stictches out September 30th and recast. Will be in cast for three weeks, then removed and recast for another three weeks. Achilles tendon was completely detached at the ankle. Getting around on a push scooter at home and work. Downside is I live in a second story condo. Looking forward to PT to begin 5 weeks and get the cast off!!
I am 1 day behind you. I ruptured my left mid-calf on the 13th, surgery on the 20th, staples removed on oct. 5th and my cast is on hill November 7th. I am then hopefully moving to a boot but I don’t want to get my hopes up and be crushed if it doesn’t happen. My PT isn’t supposed to start until December……
How are you feeling mentally? I am struggling a bit. I wish you a very speedy & full recovery. I found the steps easier if you use the knee on your bad leg and push off with your leg & hands. I have stairs as well and I was afraid to fall backwards.
Good luck!
I think that I may have ruptured a few peoples Achilles during Jiu Jitsu competitions. They should have tapped when I locked up those leg locks.
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I was playing basketball with my kid, as I was taking off, I heard a loud pop and fell to the ground (similar experience as others have described). I went to ER, where they put me in a boot and advised me to go to Ortho. 2 days later went to Ortho and she did the thompson test and confirmed I ruptured my Achilles Tendon. She called in a surgeon to talk about the options. At that time I was still dealing with the diagnosis of ATR and he was throwing percentages and blah blah about the 2 options. Needless to say I left kind of in shock and with a dilemma. Surgery or cast? Does anyone have an idea if surgery and cast will heal (strength) the AT as close as possible as before (not including that yes cast has higher re-rupture rate). I will see the surgeon again to talk about it in more detail! Any comments are really appreciated. Thanks for sharing your experiences.
Hi Brian check out Norm’s blog achillesblog.com/normofthenorth. He is a strong proponent for the non-op route BUT with an active recovery program. He refers to a number of studies that show that with the Uni. W.Ontario protocol (http://achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/) recovery is as good as with surgery without the risks of complications that surgery entails.
What kind of boot are you in at the moment, and at what angle is your foot? For non-op it should be at more than 30deg plantar flexed (toes pointing away from you).
I only came here after having had my surgery (which went fine and is healing nicely). I did however find from many of the people’s blogs here that a careful but active recovery is key, whichever route you go.
I would definitely have considered the non-op route if I had seen this site before. Best of luck to you!
Hi Wilco, Thanks for the Info. They have me in a MC Walker @ 15 degrees for now unitl I make my decision within a week!
I would be nice if on this site it would be easy to find success stories of non-surgery option and how “active” they are after the healing process. Reason for that is because that’s how the surgeon presented the options to me…. Surgery or Cast? It depends if you still want to be active.
Brian- I’ve been doing lots of reading up on the subject too. The advantages of the two options seem to be:
Non Op: No risks associated with surgery (infection, anesthesia, etc.). No costs associated with surgery. No pain (incision, etc.) associated with surgery.
Surgery: May get active a bit sooner (tendon healing starts immediately), may have slightly reduced risk of “healing long”.
The studies I’ve looked at mostly exclude “major complications”. I don’t know if there’s a statistically significant difference in re-rupture rates, for comparable activity levels - Norm might know. I’d like to know
For elderly/sedentary folks - where risks associated with surgical complications are highest, the non-op route seems to be preferred now. Some people really don’t like the idea of surgery, and the non-op route appears to almost always be viable if you choose it. On the other hand, some people just “want it fixed”. I think the duration of immobilization is longer with the non-op, which (I think) is likely to lead to a little worse atrophy. This might not be desirable if your goal is a return to sport ASAP.
I don’t think there’s a “right” answer, you’ve got to pick your poison.
FWIW, I went the surgery route- but you want to know how it turned out, you’ll have to ask me in about a year.
Most of the new RCTs used the same (fast) rehab protocol for surgical and non-op patients. They mostly found re-rupture rates that were “statistically identical” — though the non-op numbers were generally a bit higher. E.g., the UWO study had 1/75 post-op and 2/75 non-op.
Opinions, conclusions, & interpretations may naturally differ among reasonable people. Personally, I think both of those numbers are very low, and very close to “zero” — i.e., about as low as the frequency of accidental falls etc. is likely to get.
OTOH, the older (<2005) studies showed much higher re-rupture rates without surgery. Many of those studies did NOT select the treatment randomly (though some did), and virtually all of them used slower rehab protocols for non-op patients (think “conservative casting”) than for post-op patients.
I don’t think there’s a difference in the risk of “healing long”, based on the comparative ROM stats at 6 months and 1 yr in (e.g.) the UWO study — although some surgeons do try to shorten the AT length surgically.
And if the rehab protocols are fast either way, the risk of atrophy shouldn’t vary — though the UWO study did show that the post-op patients generally had a bit more strength (despite the identical protocols).
Several studies compared the risk of serious complications, and they were overloaded (or 100%) on the post-op side — infections, non-closing wounds, DVT, etc.
In addition to Ryan’s list, there’s a benefit from not having a scar (even if it heals OK), and there should be less internal scar tissue non-op (though I’m not sure any of the studies tested for that).
I’d push the vast majority toward non-op, provided they can follow a good modern protocol like bit.ly/UWOProtocol . And avoid casts — get a boot either early or immediately. OTOH, the vast majority end up fine, either way.
Personally, I’ve done a bunch of running (& a ton of bicycling & small-sailboat racing) post-non-op, and I plan to give (beach) volleyball a try in the next week or two. (My return to v-ball has been delayed by a heart-valve replacement.)
There are many bolggers here who had great results non-op, including returning to full sports activity. Gunner comes to mind offhand. I’m blanking out on the ID of the woman from New Zealand who went non-op about a year ago, but I think she’s also back up to full speed now.
Hi Brian, That is the exact same boot as Norm had, and similar to mine. So that boot goes to 30 deg, and with a small heel lift the first two weeks you should be fine, in case you go non-op. There is loads of medical research on this subject, but here is a recent PhD dissertation available for free, in case you really want to read up on differences: http://igitur-archive.library.uu.nl/dissertations/2009-0924-200131/metz.pdf
Also Norm can provide some more links if you want to read the source material yourself.
Good luck, Wilco
With regard to complications, the studies referred in the dissertation above show that there IS a chance of DVT / embolism with the non-op recovery as well (you DO have a big tear and will be immobilized for two weeks at least), but the risk is much smaller. Just so you don’t get the impression that there are no complications at all with the non-op way.
I found this blog awhile back, but never posted, just read everything…. It’s been a nice source of inspiration and also interesting to read the other stories of how people did it…
Here is the blog I created to track things for my own purposes…
http://anotherachilles.blogspot.com/
I really have zero interest in the op vs non-op debate, people choose it for their own reasons and I respect that… I think the reality of what people say is neither as bad or as good as it seems and is probably somewhere in the middle.
My doc is taking a somewhat slower approach, I have that in the “My Recovery Protocol” of my blog, which I’m ok with, it feels perfect for my body. I never had a cast or boot or even really surgical dressings, just bandages and ace wrap, so my range of motion and swelling are nearly the same as my “good” leg, which seems incredible given the circumstances.
I couldn’t have local anesthetic due to an allergy in the surgery, so waking up to that sucked… but overall it hasn’t been bad and I’m fortunate to have found this blog…
Correction to above, I never had a cast or boot or dressings post surgery and was allowed to work on range of motion as long as I was sitting… At 6 weeks I got the VacoCast to do full weight bearing walking in…
The NZ woman who’s recovered well non-op is ‘bronny’, though she hasn’t posted much here since her 6-month mark. Sorry about the “brain fart”.
I just watched two and a half men on http://watchitonline.co/series/two-and-a-half-men/ … HILARIOUS
Interesting, I just read the full text of the UWO study that gets touted so much here, seems like people just like to take snippets to push their own agendas… I think the biggest thing to get out of the UWO study is to get moving early and often and you’ll heal better, regardless of which method of recovery is best for you…
http://www.smbs.buffalo.edu/ortho/residency/uosjournal/211h.pdf
“There was a small but significant difference in the plantar flexion strength ratio (affected to unaffected limb) at 240/s at one year (mean difference, 20.25%;
95% CI, 0.07% to 40.4%; p = 0.05) in favor of the operative group.”
“There was a small but significant difference in the
plantar flexion strength ratio (affected to unaffected limb) at 240/s at two years (mean difference, 14.15%; 95% CI, 1.12% to 27.19%; p = 0.03) in favor of the operative group, which could not be explained by differences between groups with regard to the unaffected limb (Figs. 2-A and 2-B).”
“The side-to-side difference in plantar flexion range of
motion was greater in the nonoperative group than in the operative group (mean difference between groups, –2.21; 95% CI, –3.9 to –0.5; p = 0.01).”
“The limitations of this study include its small sample
size. Although the current study is the largest study to date comparing the outcomes of patients with an Achilles tendon rupture who were treated either nonoperatively or operatively and whose rehabilitation included early weight-bearing and mobilization, it is underpowered to provide definitive conclusions about rerupture rates. Our original sample size was
calculated by assuming that the rerupture rate would be similar to those in other studies in which patients were treated conservatively (13%) 12,34,37. It appears, however, that the addition of early weight-bearing and mobilization may have resulted in a substantially reduced rate of rerupture (;4.6%). Proving that such a reduction is indeed real would require a sample size of 1275 per group, based on the absolute risk difference of 1.7% (relative risk difference, 40%) estimated from the pooled results of the current study and previous
studies.”
And also:
“A meta-analysis showed the rate of rerupture to be approximately 2.5% following operative repair of an Achilles tendon rupture and 13% following nonoperative treatment 34. Thus, seventy-seven patients per group would be required to detect a difference of 11% in the rerupture rate (one-sided type-I error rate = 5%; power = 80%)”
I also wonder why this recent study is never quoted…
http://www.smbs.buffalo.edu/ortho/residency/usmjournal/1214a.pdf
I read it but on the online journal so would be prohibited from putting it online here. Good that you found it on a free access site. Anyway, their conclusion is:
“The results of this study did not demonstrate any statistically significant difference between surgical and nonsurgical
treatment. Furthermore, the study suggests that early mobilization is beneficial for patients with acute Achilles tendon rupture
whether they are treated surgically or nonsurgically. The preferred treatment strategy for patients with acute Achilles tendon rupture remains a subject of debate. Although the study met the sample size dictated by the authors’ a priori power calculation, the difference in the rerupture rate might be considered clinically important by some”
Though I will concede that I do find 6 re-ruptures vs 2 (non-op vs. op) significant, (though apparently it is not according to their chosen level of significance).
Another important quote (to support my arguments of early mobilisation, op or non-op):
“The rerupture rate decreases from
approximately 5% to 2.3% when using a functional brace
instead of a cast in surgically treated patients, and from
12.2% to 2.4% in nonsurgically treated patients”
I completely agree that, as you said, early mobilization is the key thing that should be taken out of these studies. Even the study authors were cautious to make a definitive statement about surgical vs non-surgical as is being touted here.
I think normofthenorth means well, and truly believes what he is saying. But telling people there is no difference isn’t quite reality. There were small differences between surgery and non-surgery, and even after 2 years the UWO study showed small advantages for surgical in certain aspects of plantar flexion. Both studies definitely showed surgical having a faster recovery of strength, with non-surgical getting close at later times.
Really, it’s up to people to make a decision based on all the facts, not incomplete summarization of abstracts which don’t paint the whole picture.
In fairness, if you’ve read enough of norms posts he doesn’t promote one way of healing or the other, what he does do is show that long term there is negligible difference.
Anyone who has been or is at the later stage of the injury can tell you that although the earlier stages seemed important at the time, they actually aren’t that much. Personally the biggest progression when dealing with the injury is getting in the boot and FWB. Everything before that is a pain in the ass and after that is just the long slow road to full recovery whilst actually being able to do anything useful!
Agreed Bcurr. What is important about the blog is the patient/user experience and the support offered on this understanding which is invaluable here.
Yes, WAND, I’m sure we both — ALL — mean well, and believe what we post. But if you interpret my long post above as “telling people there is no difference”, then I’m not sure you actually read it. In fairness, my statements from 12 and 18 months ago — before the publication of the full UWO study, and also the numbers from Nilsson-Helander’s study — were pretty close to that, but my statements have gotten much more qualified and nuanced since then, as I think a fair reading of that post above would indicate.
The Nilsson-Helander study was always one of the 4 modern studies I cited, though initially my comments were only based on an early article describing the results (ref #6 in the Wikipedia ATR article). Her actual numbers (esp. the rerupture stats) were way more lopsided than the earlier article suggested, as I recall.
BTW, if you are the person who recently edited the “Treatment” section of that article, I think you did a very nice job. And I generally agree with your summaries of the evidence above, too.
But your reference above to the meta-analysis? Is that a quote from the response/commentary that was published along with the UWO study? That meta-analysis (unless I’m mistaken) was published in 2005. It did a good job of summarizing what had been discovered before then, but (a) nothing that was discovered later (which was a LOT) and (b) it included virtually no studies that used identical and fast/modern rehab protocols on both sides of the RCT. My post above did refer to those pre-2005 high re-rupture rates, but I view them as demonstrating the ill effects of long immobilization (& NWB) rather than of non-op.
At this point, I would still steer a volleyball buddy away from surgery, though the data — even a “meta-analysis” of the 4 most recent studies — do now suggest that there is a small but non-zero benefit of surgery, in strength and probably also in rerupture rates. And as I said at the start of my post above, reasonable people can certainly disagree on the “bottom line”.
I do continue to believe that what the average OS (esp. in the US) apparently STILL tells brand-new ATR patients about the two options is somewhere between Just Plain Wrong and malpractice. (There are exceptions, Thank Heavens!)
You suggested above that patients should read the entire studies and not just summaries of the Abstracts. Sure, but most of them get a lot less than that — and it’s often not at all qualified or nuanced — from their Surgeons, their ER doctors, their teammates, or their coaches. And most of that info is much more strongly biased toward surgery than the best evidence would suggest, IMHO.
Finally, I think the most important question on this topic is something like “If we could compare the clinical outcomes from the BEST surgical and non-op treatment of typical ATRs, what would we find, and what would we recommend to new patients?” The rotten results from old-fashioned “conservative casting” are irrelevant to answering that question, right? In fact, if several new studies use different protocols and one produces superior results, I’m not even sure the other studies are really relevant.
Thank you Norm, and honestly, I want to give you a lot of credit. I think because of your posts, the ideas of early mobilization despite whichever treatment is used, has definitely been given a lot more light. The studies were out there, but you’ve called a lot of attention to them.
To be fair, without a known great podiatrist with lots of references and a personal history with him, the surgery route would have scared me immensely. On the patient end we’re fairly helpless and almost a passenger along for the ride in the first few days if surgery is chosen. We can do research all we went, but if surgery is chosen it’s really up to the surgeon. Get a bad surgeon and all bets could be off. In that aspect, with the potential complications, non-op can be a valid answer.
In my case, being in my 30s and active, having a good podiatrist with great references and a personal history with him and knowing he’s a big fan of early mobilization, and reading the different studies, surgery was worth it to me given the slighter higher incidences of re-rupture for non-op. The 1-year and 2-year differences in specific aspects of plantar flexion strength were also a big consideration for me, simply for how I “reasoned” things would have to work mechanically.
The Nilsson-Helander study strength indicators weren’t statistically significant for all but a few aspects, but looking at the numbers they were clinically significant to me when weighing my options, and I think that’s what people need to do, weigh their options. Unfortunately, people are presented with “we’ll do surgery tomorrow” when they go in and say their leg hurts, without all of the available information. And to be fair, if they are going to operate it has to be soon.
What I would really enjoy seeing is a 5-10-15 year follow-up to the given studies. What was the rate of re-rupture? Where are the strength indicators now? etc.
To be frankly honest, even with surgery, I’m terrified of the possibility of re-rupture given the nature of how it initially happened. I keep asking myself what I’m going to do differently (warming up, specific strength exercises, slight changes in activity, etc) so it never happens again in either leg. It’s a big mental game with myself, that so far I haven’t won….
WAND/Norm, for somebody who’s just suffered the injury, they are faced with a pretty immediate decision (op or non-op). Sure, they can go read through all the studies, try to parse out the statistically significant facts, weigh the risks, etc… but that’s a whole lot to ask of a lay-person under duress.
It would be great (I think) if we could put together a easy-to-digest summary for people to look at. Something that addressed the risks and benefits of both options. What the studies found - pointers to the studies for somebody inclined to try and draw their own conclusions from them.
I’m wondering if that might be something the two of you guys could put together (and maybe maintain, as additional data rolls in), and then have Dennis post it on the site.
Another possible format to consider could be a pro/con editorial (opposing viewpoints).
That’s a pretty good idea as the immediate decision is overwhelming… I was also thinking, for the surgery route, it may not be a bad idea to keep a registry of doctors and the experiences with them. From the success stories and the horror stories, it’s very clear that there is a large disparity of care given even within the context of surgery. We obviously wouldn’t want it to be maintenance nightmare for Dennis, but it could be very helpful.
I also like Ryan’s idea, but there’s something pretty similar in the “Treatment” section of the Wikipedia article on ATR. I was thinking that WAND might be the person who had edited it (to incorporate the newer publications = UWO and Nilsson-Helander’s study — the previous substantive edits were mine), but I’m just guessing. Either way, it’s not a bad summary of the state of the evidence, IMO.
My view of (a) the urgent need for an honest evidence-based appraisal of the op-non-op choice, for brand-new ATR patients and (b) the positive role that this blog could play in meeting that urgent need if it tried harder to do so, is a lot like Ryan’s and WAND’s. OTOH, this subject area has been the most divisive on this blog, and prompts most of the complaints that Dennis gets from users — including a number of them with my name included! So he might be reluctant to highlight that issue more than it is now. Or not, maybe depending on how well we can present a civil and balanced presentation of the evidence.
For now, I think one of the few issues that divides WAND and me is how much weight to give to less successful RCT studies. E.g., Nilsson-Helander’s study got really second-rate non-op results. I haven’t taken the time to examine her rehab protocol and compare it to UWO’s and Twaddle’s, but I’m guessing that hers just wasn’t as effective. If the details seem to reinforce that guess, then I’d suggest that we all stop paying attention to her re-rupture rates and the rest of her results. We all know that it’s not hard to get BAD results in ATR treatment, either with bad surgery or with bad non-op treatment. We can help some individual patients avoid bad treatement, but I’d like to focus on steering patients toward what seem to be the (2?) BEST approaches.
For non-op, I’m guessing that either UWO or Twaddle (NZ) is likely to be the best so far, and for surgery, their approaches are probably close to the best apart from the super-strong (and super-fast) Japanese surgery I discussed on my blog ~ a year ago. Most ATR patients don’t have access to that Japanese surgery, but virtually everybody can get a boot and some heel lifts (or a hinged boot), so there’s a need to compare and present the evidence-based expectations from traditional open surgery and one of those (”best results so far”) non-op protocols.
Again, I think the Wiki article takes a fair crack at that, and maybe our efforts should be spent in trying to keep it fair and up-to-date, and urging visitors here to read it, and ask Qs about it here. (I’m guessing that the Wiki article gets as many visitors as this blog or this page does, but I’m just guessing, and I’m not sure it’s easy to find out.)
Hi Norm, it was me who edited the Wikipedia, I tried to be as fair as possible.
I hadn’t heard about the Japanese method until you mentioned it, but reading on it here it appears that’s what I may have had. My doctor sat down and went through the surgery with me, from the tools used, to the sutures used, to illustrations of the entire surgery and it looks similiar. I was also told to start doing range of motion while seated pretty much the next day. My doctor also spun out my own blood in a centrifuge and applied the platelets (I think?) to my tendon for faster healing since blood supply is low there.
It definitely differs as far as weight bearing though. I was non weight bearing for 6 weeks (if you don’t count weight while sitting, which I was told to do) and at the 6 week mark I got to do full weight bearing, but in my VacoCast. I’m doing single leg toe raises, but while seated, I really doubt I could even do a double leg toe raise at the moment.
Wow, reading through that I may have just gotten lucky with a great surgeon….
FWIW, during that day and a half where I had to make this decision, I really wondered about the credibility of the Wiki stuff. Knowing that anybody can edit the wiki, it was hard to tell if somebody was trying to push an agenda. I definitely read the info, but didn’t weigh what I found there too heavily. For some reason - I trusted the info I found here (achillesblog.com) more - probably because I perceived it to be written/controlled by patients, people who had already been through this injury, and weren’t likely to have a reason to bias there opinion one way or the other. The info here was just a little diffuse, and hard to digest in a hurry (there is a lot of it).
I do think, regardless of which option you choose, you’re a little likely to promote that option, as it validates that you made the right choice (so long as things turned out well). But, keeping that thought in mind, this was actually the primary place I went looking for info.
The wiki is probably a fine place to keep tabs on recent treatment options, results, and protocols. If I’d found something here (achillesblog) that told me that the wiki was a solid resource to find that info, then I would have been a little less hesitant to do so.
Actually, I just tried, at 8 weeks I can do double leg toe raises (with cheating from my good leg) and they feel surprisingly good! I’m not crazy enough to try a single…
I know from the seated single toe raises I’ve been doing that just under 20 lbs is where I can’t lift on to my toes, I weigh much more than 20 lbs… 
I’m in week 8 too WAND. Something I’ve started is to do a shoulder width two-leg toe raise- biased onto my “good” leg. Very slowly, shift my weight - laterally - towards the injured leg. Continue shifting weight until the injured heel starts to drop (or until something feels a bit wrong). It’s an isometric way to work towards the dreaded single leg raise
One day, I expect I’ll be able to shift all my weight, lifting the good leg off the ground.
Awesome! To be honest, I haven’t made it past the paranoia on some of this yet… My doctor has been clear since day one of the surgery to move it around as much as possible, saying nothing I do off my feet is going to be able to hurt it.
It’s crazy to me that I have no swelling and almost full range of motion, it’s been that way since about week 4 I think. He’s cleared me to walk in my boot, but I’ve been paranoid to do anything else even though it feels good… I’ve been standing bootless to dress, take showers, and stuff like that, but I’m too paranoid right now to do anything else without my boot, it’s like a security blanket.
Ryan, I think the psychologists call it “confirmation bias”, and most of us practice it. (Of course, having had an ATR treated EACH way, I could.claim to be immune! ;-( )
I know that paranoia well. One of my recent posts talked at length about the mental difficulties of going to two shoes… I like your analogy to a security blanket. I managed to shed the boot (at 5.5wks) after only ~10 days of FWB; so I never quite got *too* comfortable with it
For the first few days, the Achilles felt so weak and ineffectual, that I kept reaching back there to check it- to make sure it was actually still intact.
Hey everyone,
Well just found this website and since I am going crazy doing nothing decided to do some reading!
Had a full rupture on Oct 12 playing v-ball and surgery Oct 14.
Was on T3s for 24 hours, but havenot needed to take anything since then. I have no idea why, but it is really staritng to feel good, but have no idea what I should or could do! There are so many varying thoughts.
Have an a couple of slips that did cause so pain, but other than that it has been pretty good!
Have my first follow-up appointment tomorrow and would really like to push for a boot and for for a little weight bearing, but not sure if this is even possible yet! Right now I am in a cast (not sure what it is called) which is hard on the front and has gauze on the back to allow for swelling. The swelling is almost completely gone which makes everything abit loose and allows me a range of motion that is probably not good for me! lol
Just looking for some advice on what I can expect and how much I should be pushing myself!
Any help I can get would be greatly appreciated!
Have read the Doug53 articles and would love to think that this rate of recovery might be a possiblity!
Thanks
Please help me. I’m losing hope.
This is my first post. 56 yr old male in DC area. Completely ruptured rt achilles playing tennis on 2/15/11. Surgery on 2/23/11. Just passed 8 month post-surgery date.
Did 30 PT sessions from March through end of June (when med ins benefits exhausted). Worked hard on home program, complied with all PT and Dr. instructions.
Have never recovered ability to do unilateral rt heel raise. Can’t jump, run, walk much. Developed scar adhesions between incision site and achilles tendon so skin moves/bunches up when achilles contracts. Also painful lump at bottom of repair site (about 1/2 inch above tendon insertion in heel). Finally, developed plantar fascitis which is most painful at bottom of heel (can feel a small lump) precisely where heel bone exrts pressure when I put weight on foot walking.
Went to a different, well-regarded foot/ankle specialist in September because I can’t walk without limp, have become quite depressed, am in lots of pain, and basically have been unable to work or wear any right shoe with a back on it.
Leaving for PT now (been going 3 times per week since early October). I really am becoming desparate and need some help/direction/support. Please, please.
Dear TH, that sounds really miserable. I don’t have much advice but just to say I also have PF which is not much fun. Two questions - are you still doing stretches and massage (Im sure you are), wondering if a really good sports massage helps. Also, for my own interest, have you worn any splints overnight to help with the PF? Do think about setting up a blog if you have time.
Hey TH…..I would go to the main page on this website and put your post there! That’s where everyone goes and reads everything, so that’s where there may be someone who can help you! Wish I could help more, but I have just recently just ruptured my achilles and have no idea what to tell you! Try and stay postive and I wish you all the best!
hey I actually loved your publish. appears to be like like i will be again. hold up the good operate
usually surgery is the last option, sometimes there are alternatives better search more
Of course, what a great site and instructive posts, I definitely will bookmark your blog.Have an awsome day!
I ruptured my achilles in 2003 and had surgery the same day. It took a long time to heal but nine months later I started running, 100 meters at a time by 2009 I had run 5 marathons and one at 2:52 including the Boston Marathon. I was 40 when I ruptured it playing squash. I am six four and 205. Surgery is the way to go. Althought ensure you have a very good surgeon and get a ton of massage on your achilles as I have quite the scar tissue buildup.
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Hi all.
Its been more than a year since ive visited this site. Im fully recovered from an atr. I went the surgical route and was walking at 6 weeks, any way i cant believe norm is still on here and his beloved UWO protocol.Norm i really think you should take up another hobby for the new year. Happy healing everybody.
Dai
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Ruptured my right Achilles Tendon in mid Nov 2011, after several visits to my GP and hospital, finally got an MRI scan last week, full tear, booked in for surgery next week Feb 2012. Only been limping around for three months, but still so not looking forward to the surgery and months of rehab.
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Ruptured my left Achilles Tendon last Thursday, March 8. Went to the doctor the next morning. He diagnosed my ATR and referred me to a podiatrist. Podiatrist office called today to schedule my appt to discuss surgery/non surgery options. They can’t see me till next Tuesday, March 20. That’s almost 2 weeks after my injury! I have no idea how long it will take to schedule surgery after that. I have never had an injury of any kind before and would appreciate any advice I could get. Does it usually take that long to schedule surgery? I want it done as soon as possible so I can get on the road to recovery!
Jennifer,
I am sorry you have joined our ATR club. I had a similar situation which was made worse by the fact that surgeons were too busy to accommodate me and I was finding a lot of conflicting information regarding surgery or no surgery. In the end, I had an MRI and it showed a complete rupture, with a 2,5 inch gap.
I ended up getting surgery 14 days after the rupture and went through quite a few complications.
Have you considered the non-operational protocol?
This may be an option and there are several people on this board who did well without surgery.
My doctor recommended I have surgery. I am an active 40 year old woman and I don’t want to risk re rupturing it. I did not have an MRI, but he said he could see the gap and it is completely ruptured. Don’t know how many inches. I’m trying to educate myself as best as I can before my consultation appt. I’m just really concerned that it’s taking them so long to see me.
Hi Jennifer, I was facing long wait time to see podiatrist and they dont do the surgery anyway, Which many of us will advise you to do the surgery if you want the quicker recovery, without takes twice as long. Get an appt with orthopedic dr asap. they will get you operated on asap. Keep us posted remember we are here doing the same thing trying to get through this and get back to our normal lives. I’m getting my 3rd cast this Thurs. This is my 2nd time around. I re-tore at 10 weeks.
You’ll find alot of good info reading this site, like things you’ll need to make getting around and showered easier.
Harleylady, thank you so much for your advise. I will call my doctor tomorrow and ask him to refer me to an ortho. This website is giving me tons of info as well as peace of mind. I will keep you posted. Good luck with your recovery.
Jennifer - I know it is easy for me to say but hard for you to absorb at this early stage. You will learn a great deal about patience with this injury. Some doctors do prefer to wait a week or more before surgery to allow all the trauma around the rupture to settle. They may feel it is better to see the ends that need attaching and there is less chance of nicking a nerve. Others like to get it done within the first few days. In this part of the world I would not let a podiatrist cut my toe nails let alone operate so seeing another ortho is a good idea. The re-rupture danger period is up to 12 weeks and declines from there. Surgical repair still has a better result regarding re-rupture but once the tendon is healed either surgically or non op it is unlikely to rupture again. Early weight bearing and movement has shown to aid the recovery so speak to your doc about that. It is going to take time regardless but like will improve sooner than you think. The first few weeks are the worst. Good luck with it all.
Jennifer-
I had the surgery, and still think it was the right choice for me. However, there are good results with the non-surgical route, and it won’t take twice as long to recover. With surgery, I think you can progress through some of the early phases faster (maybe twice as fast for some things), but this is a VERY long recovery process (probably a year to 100%), and in the grand scheme of things, a few weeks isn’t that long. The decision to go surgical or non-surgical is kind of a tough one- I’m just saying that time to total recovery probably isn’t a big factor in that decision. The good thing about your situation, is that you’ve got a little time to learn about and weigh your options.
Thank you Stuart and Ryan for your words of wisdom. I am trying to be patient and I think once I’ve had the surgery I will be patient and cautious during my recovery. I do NOT want this to happen again. I am just having trouble waiting to see the podiatrist. 12 days seems like a long time to discuss my options. I have gone through several blogs on here over the last 2 days and over and over I see people write that they had the surgery within 1 to 4 days after injury. It’s frustrating, is all. Ok. Going out to breakfast with a friend, going to smile and laugh and appreciate what I can. You’re right after all, in the grand scheme of things, 12 days is nothing.
As you learn more, you’ll discover that early weight bearing and mobility result in better healing and fewer re-ruptures.
Be cautious; but don’t be TOO cautious. Optimal healing requires just the right balance. Unfortunately, there’s no hard and fast rules to follow; timing seems to vary with many factors (age, fitness level, nutrition, etc.) There are, of course, some good general guidelines to follow, but to some degree, you’ll probably have to find your own path to full recovery.
Hi Everyone,
I think i am the only one on the site who is Irish, so HAPPY ST.PATRICK’S DAY.
5 wks in and it’s not getting any easier. A glass of wine and then up on to crutches, not a good idea.
Harleylady: I wish my husband was a good cook.
Sandiego 21 : How r things with you?
Have a good week end
Sharon
Hi Everybody,
Achille’s tendon breaks in Italy too
Broken 2 weeks ago, surgery next Tuesday.
Hope to learn a lot from this blog and share experience with all of you.
Any suggestion before the surgery? Thanks and good recover for everybody! puglo
I am 43 yrs old and ruptured my Right AT while playing ball on a cruise ship on March 10th. Went to the medical room and they threw me an ice pack. I kept it iced/elevated next few days, but continued to limp around on it for another 10 days until I returned home from my vacation.
Next day after arriving home my PCP confirmed it was a complete ATR, put me in a splint and sent me to Ortho the same day. Seen by Ortho PA and Surgeon, both seemed to really recommend the non-surgical treatment, they stated that recent studies show little difference in long term outcomes. Put me in a cast and told me if I’d like surgery they would do it, but to think about it overnight. I decided at the time to go with the non surgical treatment.
Now one week later, 18 days post rupture and after doing some more reading, I’m having second thoughts my decision. I’m very active, run 4 miles 3-4 times a week, did several 10k’s last year and am on my feet a majority of time while at work. Much of the info I’ve seen over that past week recommends non- surgical treatment for those who are elderly, inactive or have additional health problems which might complicate surgical recovery.
I haven’t seen any specific timelines so far as to length of functional recovery time with surgical vs non-surgical treatment. Anyone on here who has had good long term results with non-surgical treatment?
Will I be able to return to work much sooner with a surgical repair and how much sooner? With the non-surgical treatment will I be able to return to my normal running routine? How many folks on this forum have gone through the non-surgical treatment and back to running and other sports?
Is it too late for me to change my mind and have it surgically repaired? Any info greatly appreciated. Aloha
Hi Lee, I’m a little curious about your treatment as well. I ruptured mine then ignored it for almost three weeks. I went on about my business club-footing most activities swollen, bruised and slowly. At that point there was a significant separation and my muscle was pulling further and cramping. I don’t understand the non-surgical fix in this kind of situation. Recovery has been slow but has progressed. I hope your recovery goes well, but from all that I’ve seen it will take longer than the surgical correction.
Lee - Your non surgical recovery will depend on how it is done and it can be as good as a sugical repair. Visit Normofthenorths page and drop him a line. He is the resident expert.
Lee, your 11-day-post-ATR start is well within the guidelines of the most successful study of non-op vs. surgery, the so-called “UWO” (Canadian) study — presumably the study your protocol is based on. You can review the full text of that study to see what you think, because it’s on this site, at achillesblog.com/files/2008/03/jbjsi01401v1.pdf . You can also see some of my views on my blog, most recently the 2nd-last page, called (+ or -) “The case for skipping surgery”.
For your specific Qs: Your recovery time should not be affected by your choice, except that surgery now will reset the clock at the start of the process. My own post-op rehab was much SLOWER than my later non-op rehab — not because post-op is usually slower than non-op, but because my first surgeon liked to slow everybody down “just to make sure” (totally non-scientific, even counter-evidence!), and my second non-op surgeon followed the proven results from the UWO study.
I agree with your Docs about the long-term results: UWO showed near-zero rerupture rates both ways, essentially identical ROM results, and strength results that were overall too close to be statistically distinct (in a sample of ~150 patients), but they did show a small raw-result strength bias in favor of the post-op patients. (IIRC, the 2007 NZ showed identical strength results except for one measure where the NON-op patients were stronger, using a similar protocol.)
What you’ve heard about non-op being for your Grandfather, etc., is basically out of date, IMHO, though some “experts” keep retelling the same old story instead of reporting the latest results from good careful studies using fast protocols. (Old-fashioned slow non-op protocols definitely produced high rerupture rates, so avoid them.)
Personally, I went back to crazy high-impact sports (though not long-distance running) after both of my ATRs, one fixed surgically and the other done non-op 8 years later. My main such sport is competitive volleyball, usually 4-on-4 court v-ball, and anything from 4-on-4 to 2-on-2 on sand. (I’m mid-60s, but most of my teammates and opponents are 20-35 — and NONE are within 20 years of my age!!)
As you can see from my blogs, my own “UWO” calf strength is still much less than 100%, but I honestly have noticed NO functional deficit while playing volleyball(!) or bicycling, or skiing downhill (at high speed on lumpy runs in bad visibility in Whistler!) or doing anything else, other than doing heel raises!
If I were you or if I were advising a volleyball buddy, I’d recommend staying the non-op course, but many surgeons will operate outside the usual ~2-week window, so you probably still have a choice if you really think the surgery is better, and worth the pain, the scar, and the complication risks.
Good luck and good healing, whatever you do. Most of the “repair” seems to be done by our bodies, with or without the op.
Thanks for the great info Norm, very encouraging to hear form someone who has actually gone through the non-surgical route and had good results. My surgeon is following the UWO protocol and gave me a copy of the study. I’ll be going in for my first 2 week post-cast checkup this week, hoping everything is progressing well!!! Lee
Im going to try and keep a chronological diary of what is happening with my achillies tendon rupture. day one when it happened i was playing softball rounding third and heard and felt a pop. wasnt that painful but I knew what I had done. wasnt able to put any pressure on it at all. Hospital gave me some good drugs , took x-rays and put on a splint and scheduled me with an orthopidic surgeon in the morning. Pain started setting in at night. Yesterday had mri, proved I tore my tendon along with taking some heal bone with it. No real option for me just surgury. My pain level is down a little to like an 8. Surgury is scheduled in 4 days… i cant wait. 3rd day now and the pain is still like a 7. If bumped it jumps to a 10–.
its april 8th and my surgery is in 2 day. can’t wait. still alot of pain if bumped or stand on crutches to long. pain level like a 6 or 7. sleeping sucks. Prior to the rupture i have had achillies tendonitis so I have had a series of cortizone shots in the past few years which I know weakens the area. Just dying to walk again
Hang in there mark! I have bilateral tendonosis and have had iontophoresis with little success been a runner for many years. Did u have a nodule or bump on your tendon in the years leading up to rupture? Good healing to you keep in mind what Bruce lee posted on his bathroom mirror when he was 6 months recovery from a severe back injury “walk on” you will get there before you know it.
Surely the best aim is usually increase website traffic, while you can’t beat Ultimate Demon and need rest. It is actually top rated tool you can purchase.
I had the original injury in Feb. I was doing Zumba and heard the pop and had immediate pain in my calf. I ended up with swelling and black and blue around the Achillles. Doc did an ultrasound and diagmosed me with a ruptured Plantaris muscle. I was healing nicely and even able to wear wedges again. I went to prevent my dogs from fighting and jumped sideways and knew immediatly my Achilles was torn. Doc put me in a cast 3 weeks ago. He believes that the non surgical approach is more effective and there’s less of a chance of complcations and infection. I was fine with that option as I hate surgery. But, I am going stir crazy not being able to walk. My biggest concern is not being able to ever lead a normal life again that allows me to exercise.
Great site, im bookmarking it for future use.
New here and it’s a great resource.
Rupture on 6th March, Surgery on 10th. Now been in a cam walker since the 20th March and next appt on Tuesday. Cannot wait to drive again, hopefully sooner rather than later. Ruptured the Right AT but have an auto and left foot brake normally so hoping to get back behind the wheel again.
Feel like a caged animal relying so much on family and friends. Have been back at work (behind a desk) since getting the boot. Lots of muscle wastage in the calf and not weight bearing unless in the boot.
No more Taekwondo for me! Was going in for a big kick, powered up through the right side then “POP”. Looking forward to getting in the pool soon though.
Greta site, see you around
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New here too! I fully ruptured my left AT on march 29 2012 while doing gymnastics. Heard a pop felt dizzy and just thought I put a whole in the floor. This wasn’t the case when I tried to take my next step and felt like I was stepping into a whole. I couldn’t feel the floor!
I had surgery on April 5 and i have had no pain at all not even when the injury happened. I have been very lucky. Only swelling the first 5 days post op and no more
I went for a check up on April 16 and was put in a Bledsoe boot NWB. Next doc visit is in three weeks! Do you think he will let me start PWB? Since i am already in the boot.
Surprisingly he says I should have a full recovery and do regular sporting activities in 4 months! Hope he is right that’s really fast!!!
Julia:
I went non-op got my boot 4 weeks after my ATR. The doctor said I could go FWB as soon as I felt comfortable to do it I went PWB for about a week and then was FWB after that.
On the average, 4 months sounds a bit optimistic but being 17 gives you an advantage so it is possible. It seems like the latest research indicates that a fast recovery protocol produces the best results.
Just wondering at what point have most folks transitioned from boot to shoe following the Non-Operative treatment. I am just starting week 6…hard cast first 2 weeks then walking boot up until this point with weight bearing and no heal lift the past two weeks.
I have been following nearly the same non-surgical protocol listed on Norms page, exceptions being that my Ortho Surgeon told me I could go down to 1″ heal lift after week 3 then no heal lift after week 4. He also didn’t recommend any professional PT only the ankle ROM listed in the protocol on my own . I’ve been sleeping with the boot off the past 3 weeks, swimming, walking in the pool, and doing ROM exercises. I won’t see my Ortho PA for another week, but feel really good when I’ve tried walking around in a shoe. Does this sound pretty normal for the Non-operative coarse?
Also at what point are most folks able to return to a full day of weight bearing with shoe? I’ve been off work for the past 6 weeks and am hoping to return within a few weeks. I’m and ICU RN and on my feet probably around 70% of the day during a 12hr shift. Lee
Lee:
I am non-op and at 9 weeks after my ATR. Tomorrow I will have my 4th PT session and will begin transitioning to to 2 shoes.
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Well explained, i appreciate you posting this. very informative.
I ruptured on the 26th march my cast was removed 4th may and replaced with an air cast boot. Or the first week left the boot on apart from bathing, week commencing 14th may started rotation and flexing on problems no pain. Even able to stand barefoot with no pain, managed a couple of beginner steps at walking. Wednesday 16th may whilst getting dressed slipped off the bed and jammed my foot against the wardrobe resulting in my shin travelling forward and the dreaded pop was heard. The tendon has re-ruptured time to start all over again.
Nigel, I’m so sorry to hear this. Thanks for sharing it though. It makes me think that maybe I should just take my time and be willing to listen to my doctor about slow and steady. It is a long road.
The plus side is that you already know what to expect for the first few weeks. Good luck.
Wow, very sorry to hear about that Nigel! When did you have your first surgery, or did you go non-Op? I wish you the very best.
I previously had the non op, but I am now sat waiting for the swelling to go down then require the surgical procedure. Should have surgery within the next four to five days.
I came across this great site whilst trawling the web, trying to understand more about achilles ruptures, treatment and long term prospects (re-rupture etc) .
I ruptured mine on 19th May, playing football (the soccer variety). I’ve never suffered anything other than a few fairly minor muscle strains and tears before, and I’ve been blown away by the severity of this injury. Mine happened on a Saturday (big hit/tackle from behind on my trailing leg, there was contact, which seeemd to contribute). I couldn’t continue on playing that day, and hobbled around for the next 5 days, wondering why my ankle was slowly disappearing as the swelling ballooned up. A lot of major brusing also gradually appeared around the edges of my foot. So, off to the phsio. I went, who promptly dispatched me off to the otho. dept at the hospital. Scans showed that I have a total rupture, but that it’s high up on the calf muscle. They advised on surgery, but then decided to go for non-operative, based on the fact that it’s high up on the muscle and accordingly, should have a good chance of a successful recovery from non-op treatment. They didn’t discuss the pros/cons, success/fail rates of op vs. non-op, so I’m having to try to work that out from info. on the web. There seem to be a lot of factors involved in the risk of these rutures re-occurring. I’m 51, and I cycle a lot and want to continue on playing football, skiing etc, and I’m really hoping that I can get back into those sports.
I’m now into Day 11 of the cast (foot angled down, non-weight-bearing etc), 16 days post incident. Some occasional sharp pain from the middle of the calf, which seems to originate from the site of the injury, but the doc. suggests that it’s likely to be from an upper muscle pulling on the lower leg. I’m also due to fly from NZ to UK in 2 week’s time, which is a 30-hour journey. That could be ‘interesting’ ! They may put me into a boot beforehand, which would give me 3 weeks in a cast, rather than the ’standard’ 4.
So, I’m trying to gather information. The things that I’m really concerned about right now are as follows, and I’d truly appreciate any info./experience that anyone on here might have on theses:
Does a complete rupture that’s high up (i.e. on the actual muscle) generally give a good repair when treated non-operatively ? The surgeon suggested that this is why they decided not to operate - i.e a good chance of a successful result without the know risks that are associated with ‘the knife’.
Also, has anyone had to a big, long-haul journey so soon after this sort of injury, and if so, any advice ?
I guess I’ll be following the prescribed cast to moon-boot to rehabilitation process, which will be another ‘long haul’ for me, but at a slower speed that a 747 !
Thanks very much. And here’s wishing anyone that’s on here with an injury a very speedy and successful recovery !
Hi Chris,
Sorry to hear you are another one of us soccer/football ATR victims! Did the MRI say exactly how high up your ATR was the from the heal bone ? Mine was also rather high, 7.5cm up from the heal attachment site, and my surgeon originally thought he might need “fancy sutures” that attach up into the calf muscles. However, once he “got in there”, turned out he didn’t need to go all the way up into the muscle. He did say that higher ruptures take a little longer to fully heal and that they have a slightly higher re-rupture rate. Norm can direct you to the UWO study which is a great one regarding the non-op route–I am not sure if that study disclosed exactly how high up the Achilles the ATRs were for each of the participants (?) but it didn’t seem to matter…? Regarding your 2nd question, it’s certainly safer to travel if you go the non-op route as airplane travel after an operation is not recommended due to increased risk of a DVT.
Brian
Chris:
I’ve heard that because of the better blood flow in the area, in general a high rupture heels better. This is purely anecdotal and I don’t have any study to back it up nor if there is any difference between op and non op. Like Brian said, Norm would be the most likely to know.
When you get your boot, be sure to look into compressions socks. These help greatly with the swelling, especially on a long flight where you will probably not be able to elevate your foot. The reduced time in a cast probably won’t be a factor.
Wow! What a great site!
I ruptured my AT 1 week ago and have a split cast on with my foot pointed downwards. ER was of little assistance as I was not provided with any at home treatments I should be doing ie. ice/elevation etc. I see an ortho tomorrow where I should learn more about my course of treatment.
Like Chris, I too will be traveling in 4 weeks time and I am extremely concerned with travel. Does anyone have any experience on a long flight (Calgary to Maui distance)? Any tips?
Thank you!!
Brian/Starshep, thanks very much for the information.
My tear is located quite high up, somewhere around 15-20cm above the heel attachment, so I think that it’s well up onto the muscle, with, I have been told, some muscle tearing as well. So, even though it’s a big tear in terms of the amount of damage, I’m hoping that with the association of the muscle tissue and a relatively strong blood supply, there will a chance of a strong re-attachment.
I’ve had a good look for op. Vs. non-op and high vs low tears success and re-rupture rates. The plethora of information on the internet can certainly have you feeling totally positive one minute, and then plunged into the depths of despair the next ! It must me a medic’s nightmare when we arm ourselves with th range of information that’s available. Anyway, the studies do seem to show a lot of variability. Some indicate little, if any long-term differences between op/non-op, but it does seem to be quite common for surgeons to suggest that the operative treatment gives a lower chance of re-rupture. A lot of this seems to be anecdotal, as you also suggest Starshep. Like a lot of medical things, there are obviously so many factors involved, and individual variability in terms of a person’s physical condition, age, tendon shapes, lengths and so on, coupled with the details of the actual treatment and physical rehab. activities, that there’s little wonder that the outcomes can be so variable.
Regardless, I’m now a couple of weeks into the non-op route, so I’ll just have to do my best to follow protocol and keep my fingers crossed that I’m one of the lucky ones (in terms of getting a good sticky joint, with little scar tissue). One thing that I’ve done is to minimise travel over the past fortnight. I’m very fortunate in that I can work from home, and that I have a very sympathetic employer. I’ve found that just moving around the house throughout the day stresses the injury (well I assume so, on the basis of pain occurring at it’s site), and so I don’t think that getting to and from work, stairs, meeting rooms and so on would aid recovery at all.
I’m using a small wheelie-chair to get around, which is great. So far, I’ve had 2 falls from the crutches (on slip on a wet floor, lesson learned there, always check those smooth surfaces very carefully now !), and the second one when trying to get back into the house after getting the mail from the box, tripped over step due to tiredness and feeling a bit blank I think (lesson learned again, stay put as far as possible when tired !). Both of these bashed the leg with the injury, with a hard plant of the foot resulting (it’s so automatic just to put the foot down when slipping that it was impossible to stop), so I’m hoping that no damage resulted.
I’m back with the othro. tomorrow, which will be 2 weeks after having the initial cast/immobilization, so I’ll see what the story is (hopefully) when they cut the cast off and have a look.
I’m still planning on flying long-haul next week, which will be 3 weeks after the initial cast was applied, so I’ll post onto here what the story is with that, and if I manage to pick up any words of wisdom or tips for other travellers that are in the same predicament ! I’ll certainly be looking for compression socks, as suggested, thanks.
Eva, I hope that you go OK with your travel plans.
Thanks again to all, and best wishes with your recoveries !
Cheers
Chris
Eva,
About the best tips I can offer you as far as long distance travel goes is to try to get into a boot before you go so you can wear a compression sock. That might help with any swelling. Also let the airline know of your condition. They may be able to provide you with a way to elevate your foot and the flight attendants might also be able to provide you with ice for your ankle area. Lastly make sure your doctor knows. Assuming you are now on blood thinners, he may want to have you continue on them to help prevent blood clots.
Chris, my impression of the establishment’s general preference for non-op treatment of very high ATRs is that it has more to do with the challenges of surgery near the calf muscle, than with the wonders of non-op cure on ATRs in that location. I’ve only seen one small study trying to correlate non-op success to ATR location (or size). It was a pre-publication analysis (2008 or 09) of a subset of the data from the 2010 UWO study.
They searched through the ~75 non-op patients in the randomized trial, and selected all those who had good-quality Ultrasound examinations of their ATR pre-treatment. Then they examined those 25 cases to see if there was any correlation between the excellence of the clinical results and either (a) the location of the ATR or (b) the size of the gap. They found no correlation with either of these variables (though admittedly in a small sample). The UWO study as a whole (available on this site in full-text) generally found no statistical difference between surgical and non-op results, so their non-op results were generally very good, including in complete ATRs, high up, even with large initial gaps.
It’s hard to say for sure what effect those post-ATR pratfalls have on our eventual recovery, but I can certainly tell you that you’re certainly not unusual to have had a couple. I think all of us who didn’t re-rupture just assumed that our “oopsies” were completely harmless, though it’s hard to prove. I’d try to get off the crutches by ~4 weeks, a la UWO protocol — bit.ly/UWOProtocol — partly to minimize the time you spend at risk of crutch-falling.
If you have trouble finding the full UWO study or the pre-pub analysis of the gap size and location, ask here and I’ll post links.
Thanks Starshep for the advice. I will definitely buy the compression socks if I am lucky enough to be in a boot by then! I’m not on any blood thinners but I will be sure to ask the ortho.
Safe travels to you too Chris. I don’t leave until July 2nd, so if you find any tricks please share.
Just a quick follow-up on my previous post.
I had my 2-week check up last Friday, which is 2 weeks post pot being put on, and almost 3 weeks post accident (I hobbled for a week).
The main things that I came away with were as follows:
I’ll be able to fly this coming Friday, which will be 3 weeks after the pot was put on. They’re going to take me out of that w week eaerly, and get me into a boot, with the continued, stricly ‘no weight bearing’ mandate. On that topic, I was told that that using ones toes for balance is OK, which I’d been concerned about. Basically, as long as no weight is transmitted up through the ankel and leg, and particularly no jolting. Basically, I’m becoming very adept at balancing on one leg, with the lightest of touches from the toes on my other leg used to balance. It works fine for me, and is enabling a few activities to be just that little bit easier.
They will advise on compression socks and what to do about elevation/movement once I have the boot fitted on Friday, so I’ll try to post on here before I fly if you’re interested Eva ?
I had a discussion with the Registrar that I saw around that ‘old chestnut’ of high/low ruptures and op/non-op recovery/re-rupture incidence. Well, he was very clear. In his opinion (from experience) there is no doubt that for high tears (that’s ‘on the muscle’ ones - mine is a total rupture, maybe 15-20cm above the heel, and right on the calf) the strength of recovery is generally very much greater for a natural repair as opposed to a surgical one. They always go for non-op for that reason. The recovery may be a bit longer, but he said it’s worth it in terms of repair quality and a lowering the later chance of a re-rupture. So, make of that what you will. There’s a lot of variability between individuals’ physical condition, physiology, and the types and locations of tear, but if anyone is in a situation where their best course of action/treatment is not blatantly obvious, and they’re going through the “what’s best, as I have to make a choice”, then maybe this will be another bit of information to help them along with their difficult decision.
It will be 6 months until I can start serious sporting activities again. i.e. no skiing this season, even 2-4 months post incident (I was hoping…!), maybe some very gentle start-up cycling. But, the advice is wait, build up very cautiously, and start in earnest after 6 months, which will be January for me. The patience will be worth it. He said, “yep, we can fix more or less anything that you come back with, and yep we can be pretty sure that we will be seeing you again to do some sort of fix if you get stuck into skiing, cycling, sports etc., within that time period. Cue the end of that part of the conversation.
So, my best friend is still this big settee that I’m currently sprawled on, and I’m expecting that our relationship will solidify and develop over the coming weeks and months.
Other things that I picked up were that (sharp) and occasional pain at the site of the injury is commonplace, and it’s not generally a cause for concern unless accompanied by other problems. He told me that this often occurs for the first 4 or 5 weeks, and then subsides thereafter, as the healing progresses.
Just a couple of other things, which folks are probably aware of, but here goes anyway. I have only just discovered leg covers that are specifically made for showering. Bliss; pulling on a giant condom sure beats the multi-layers of plastic bags and rolls of parcel tape ! My little office wheelie-chair is a great piece of kit for getting from A to B with those cups of coffee and plates of slippery pasta !
I’ll try and post some info. on my impending long-haul flight - the easy and/or hard bits thereof… All the best to folks in their recoveries, take care, and have a speedy repair folks.
Yes Chris, please follow up with any information you have. I would greatly appreciate it.
I have my own update to report. I just had my follow up 2 week appointment today and to my surprise he took me out of the split cast and I’m now in a aircast/boot. I am to be non weight bearing other than slight touches for balance. As well, I begin physio on Thursday. He said overall I was healing well, that there wasn’t a gap and that I would heal alright. I’m excited about the progress so far, though I know it’s a long road ahead.
I am a 40yr old male, I am 6ft 2″ and weigh in at around 115kg’s, some I am overweight but always considered in good health.
The rupture occured 28th May 2012 playing badminton, the way it happened was identical to Beckhams 2010 injury but on the opposite leg… simply took a step back, then needed to launch forward and POP.
Funny thing was with all the recent press that Beckham had had, I knew what had just happened…. still a bit sad to be proven right, just good that because I recognised it, I went to ground immediately, and got carried onto a wheelchair and zoomed immediately to hospital.
So I was in the ER (or A&E as we in the UK call it) within 40mins of the event, within 3hrs I had been diagnosed and had a temporary cast in equinus ( I kept my foot in this position from the moment it occured), ultrasound within 72hrs and specialist appt within a week….. for the UK’s often strained health service, I have to tell you guys, this is impressive.
Like Chris above me I have a quite high full tear (15cm from heel), that is reasonably clean (according to the ultrasound) and with my foot in equinus the two parts are totally touching.
The decision was conservative (non surgical) repair, foot is now in a fibre cast and at a full 21days since the event I already feel that I could take the cast off… I am not in any pain, I keep wanting to move my ankle etc……. when I do within the confinces of the cast, it feels normal.
However, my ultrasound appointment is not for another 11 days and the results appt with the specialist is 15days away…. so rading everything I have so far patience is virtuous and seems to pay off……
NWB around the house with a leg in cast, I still go up the stairs on my backside but am now adept at hopping down the stairs.
Moving around the house, it’s tight, my agility with crutches leaves a lot to be desired, but I manage (sometimes clumsily manage), my better half is exceptionally brilliant at suporting my needs as well as keep the house running like clockwork.
Using a ‘Manbag’ to carry stuff (phone etc…) it allows me to be slightly less than useless, I don’t really travel outside the house though and if I sit at the computer with my leg down for more than a few hours, the cast starts to tighten up.
I’ve not showered since it happened and body washes stood up are not dignified, there’s certainly nothing relaxing about personal hygiene when you only have the use of one leg.
I sincerely hope to be doing more after I see the specialist on 3rd July…..
I am glad I found this blog, I think I am just hitting a wall of frustration which I am sure most if not all of you have done at some point during this period.
Andrew, if you’ve got a strong handrail on the same side as your ATR (facing downstairs), the easiest and safest way down is with both crutches under your other arm. Split your weight between the two arms, using 2 crutches as 1. There’s no similar magic on the way up, tho most of us mastered crutches on stairs w/o disasters. Injured foot goes up first, lifo your body high on the crutches and uninjured leg, then slip that foot up a stair, knee Andrew, if you’ve got a strong handrail on the same side as your ATR (facing downstairs), the easiest and safest way down is with both crutches under your other arm. Split your weight between the two arms, using 2 crutches as 1. There’s no similar magic on the way up, tho most of us mastered crutches on stairs w/o disasters. Injured foot goes up first, lift your body high on the crutches and uninjured leg, then slip that foot up a stair, knee bent. Then straighten up on that leg, move the crutches up a step and repeat. The trick (IMHO) is to separate the “lift” from the “step”.
I just put up a new post/video on the topic of stairs and crutches-
Update at 5 weeks post injury, and 4 weeks into treatment.
After 3 weeks treatment (in a cast), I had to fly from NZ to UK (30 hours + travel time).
Cast to Boot:
On the day of my flight, the cast was removed, and I was put into a moon boot (with the max. wedge height), which I was told was a week early. This was to allow me to fly, and reduce the chances of DVT. The advice was to treat this as a cast, with zero weight-bearing, and no removal for showering etc, but to loosen off as necessary on the flight. There was no advice given on the finer points of fitting the boot. For those who might not have used one of those beasts, the one that I have has 2 fixed straps across the foot, and 3 removable ones along the calf area, and a lot of velcro. It’s difficult to work out exactly where to site the straps, and how tight to have them. There’s a lot of velcro on the boot, and so it can a little be tricky to work out how best to put it all together in order to maximise and balance the comfort and effective treatment.
Long haul travel: I have good crutches (with the wing-type handles), I’m strong, and I’m quite mobile on them, but, the big airports require very long walks (15 to 20 mins. on good legs, Auckland, Hong Kong, Heathrow all included). I was advised to request assistance, and reluctantly did so at initial check-in.
In Auckland this didn’t materialise, in HK and LHR it did. Wheelchair assistance or a ride in one of those motorised carriers is essential, there’s no alternative. I wasn’t happy, but that’s how it had to be. If you’re travelling, be prepared to do it.
Boarding - was priority, first on, which really helped. Onboard, crutches were taken away and stored somewhere up front, meaning that I had to call for assistance on order to get them returned before getting to the bathroom etc.
First (12 hour) leg, there was no chance of getting leg elevated, so wherever possible, I stretched it out with toe wedged under the seat in front (which actually helped maintain the toe-down position).
Took Asprin and Voltarin (following medical advice). I did have a little swelling, but little notable pain or discomfort. I kept well hydrated throughout.
Part way into the second leg (which was around 24 hours after leaving home), I started to feel some pain and swelling (in the ankle area), and after asking if there was any way that I could raise my foot just a little way for a little while, I was given a row of 3 seats on which to lounge (yay !), so I happily spent 6 horizontal hours (thumbs up for the hostess for sorting this). She also mentioned that it might be worthwhile to ask at check-in if there’s any chance of them blocking multiple seats for you if the flight’s not full.
At Heathrow, I was delivered to the passport check by motorised transport, and then straight through kiosk labelled ‘medical’ (for folks in wheelchairs, on crutches etc). This avoided a long stand and queue-crawl on crutches. At the baggage pick-up, an airline representative came over, unsolicited, and found my bag. I didn’t realise, but it had been labelled up as ‘Priority’ and had been put into a special area for pick-up.
Almost a week after the journey (5 weeks into treatment, 1 week after moon boot fitted), the injury rupture site (high up on muscle) is feeling good (little to no pain), but I have substantial constant ankle swelling (either side of Achilles, around the knuckle), which I think is a direct result of too much time on my feet and moving around on my crutches. This is the first week that I’ve not spent substantial time during the daytime with my foot elevated, and I think it’s telling.
I have another couple of weeks before I do the return journey, so will be hoping that I can get through unscathed !
Andrew- keep at it mate - I’m 5 weeks along now, and have accepted that I’m in for the long-haul, the frustrations are still there, but I’ve found that as time’s gone on, I’m managing to focus on those end-points. Moving around, sleeping and doing those basic things that we take so much for granted are all becoming a little easier as the days progress.
All the best to everyone, safe and speedy recoveries to all….
Chris.
Thanks for the travel information Chris! Did you have compression socks on at all?
Hi Eva. I did have some, but in the end didn’t use them. But I did have some of that elastic stocking inside the boot, which provided a bit of compression. Good luck with your travelling !
Just a random comment: I’m now 14 weeks post op and doing pretty well overall but I literally shiver and cringe when I read the narratives of other ATR stories or when I think back on mine. WE ARE WARRIORS! That is all :S
Hello,
Thank you all for your posts, it really is helpful to know that there are many people out there who have experienced this. I ruptured my achilles on June 30th while I was on vacation in San Diego. I was working out at the gym doing jumping squats on a platform when i caught an edge and missed a step. I went to a local doctor right away. He did a few muscle tests on my leg and quickly answered that it was a “sprain.” I was in complete shock and so much pain to know any better, I decided to listen to his advice, take the medicine, elevate, and ice. Two days later, I had a feeling that something was wrong. I went and had an MRI, only to come find out that i had completely ruptured my achilles. Yesterday, July 10th I had surgery. For anyone who is just about to have surgery, make sure you have the block put into your let. Mine JUST wore off but the doctor also gave me this new type of “at home local anesthesia” called ONQ. The website is http://www.askyoursurgeon.com. It has really helped with the pain. Not 100%, but enough to be able to not scream and cry. I’ve come to accept this accident but am still pretty low about the recovery time. I know that the medicine can only help with the pain so much. Does anyone have any extra tips as to help deal with the pain? Also, how long did it take some of you before you returned to work? I mostly sit at a desk were I can elevate my leg, how long till some of you went back to your desk jobs? I would appreciate any feedback or help you all can give me… It actually helps to talk about it and write it out on this blog.
Anyone on here gone through bilateral atr? I have torn both and am scheduled for surgery in 2 days on both. I am being told 6 weeks no weight bearing. Not sure how I am going to make it through this and know of possibility that both could fail again.
Torn playing basketball at 41 yrs old was a big mistake after not playing for nearly 10 yrs. I just want to get back to walking and living a normal life and able to play with my kids.
Ohh man, that is terribly bad luck to do them both together like that and I really feel for you.
I can only imagine how this feels right now - but be focused and stay positive, time heals all wounds and this is so true for Achilles ruptures.
There’s loads of information available on this site and I personally found creating a blog (an online diary of the rupture and my recovery) right here on this site has helped me keep things positive thus far.
I wish you a speedy recovery from a terrible double injury.
Well I really wish I would never be on an Achilles rehab site but here I am :). Partially (severe) ruptured my Achilles 11 days ago now and hopefully in two days my cast will be off and into a walking boot, still crutches to help though. Was very lucky to have surgery the very next day and apart from fairly bad pain two days post surgery all ‘feels’ well in the cast. No additional pain from potential infection and achiness has calmed down. Spent my time researching Achilles rehab and from such recent research developed a rehab programme to present to my consultant for his opinion. Taking an active, very important not to fully immobilise over time, but sensible and progressive stance. All my goals work around ROM & pain free load bearing. Also lucky to have an Alter-G treadmill at the University who I lecture for in the Physiology Lab. so Incorporating that after 7-8 weeks hopefully. Even trying collagen supplements, 50/50 on whether they will help but hey give them a blast. After reading some blogs I would say set your programme around YOU, just because someone might load bear early does not mean it is right for you. Age, health, prior activity, severity of rupture all play a part. I do believe it is important to be active though and not leave the tendon immobilised for a long period, tendons heal better when used. Well good luck all, I am gutted as I am sure everyone was but just trying to be positive. I was due to complete a charity bike ride London to Paris this week!! BOOM.
I’ve been reading this blog since I ruptured my AC on 6/15/12, chasing my dog. Wasn’t put in a cast until 6/27/12, it has now been almost 6 weeks. Get a new cast put on this Wednesday for a week moving my foot to a more level position, then next week another cast with my foot level or back to normal. I really want to go into a boot, but I doubt she will let me. I am really tired of being in a cast, but I guess I have at least two more weeks before I get a boot. Just hope it is healing ok.
hi all, been reading from this site, since i ruptured my left leg last week. went to the docs the day after and after a few chats with different people/doctors i opted for the http://www.vacoped.com - non surgical approach.
i’m 37yrs and play football, thats how i ruptured my tendon. just slightly slipped back on an artificial pitch. but what concerns me is how active i will be after ive recovered and gone through physio. should i have gone the surgical approach? are these new vacoped a good option to fully recover? i guess each solution has its pro’s and cons. look forward to hearing from anybody with good advice. and also motivation - im getting bored of the boot! lol
andygreen,
From research I’ve seen, as long as you follow modern fast recovery protocols, it doesn’t make much difference whether you have gone surgical or non surgical. I went non surgical and after about 20 weeks I was back at the gym putting as much force on my AT as my atrophied calf muscles could generate. Others further along such as normofthenorth have returned to the sports of their choice after going nonsurgical too. You can read up more about the fast recovery protocols on normofthnorth’s blog.
Enjoy the boredom. Once you start physical therapy, things get pretty challenging.
cheers for that starshep, much appreciated.
yes the boredom has already started. luckily i work from home most of the time. so im back working. but the feeling of not being able to go out for a drive, exercise etc… is really annoying.
a friend is bringing round their rowing machine which looks pretty good, hopefully that will keep the fitness levels up and keep me motivated.
Andy,
I would avoid the rowing machine until you are well out of casts - I think this type of exercise has a reasonable risk of extending / damaging the healing tendon through the back and forth flexing of the foot. I would stick to upper body exercises like kneeling push ups, seated dumbell presses etc at this stage. Crutching around is a great workout as well. Have a look at some of the links on the left side of the main blog page to get some ideas on safe exercises which can be done while in a cast.
Nathan
Andy I agree with what Nathan said you should stick to upper body exercises until you are fully recovered. If you dont you risk making the injury worse if not just have to start all over with the healing process.
Well folks
This injury is from months ago, but is finally getting dealt with.
Background: was finally diagnosed 2 months after it happened (Last May). At first, I thought I had just badly sprained my ankle during a basketball game. The Ortho Dr. put me on Anti-inflammatory drugs a brace for my ankle and ordered an MRI and told me to start light PT. After finally getting the insurance to approve the MRI 4 -5 weeks later the Ortho Dr. said it was ruptured and hadn’t even begun to heal and requested that I be seen by a foot and ankle specialist. I finally met with him a week ago (4 months later) and he says the tendon still hasn’t heal and will need reconstruction surgery to be repaired. At the moment I’m still waiting for approval for my surgery and the doctor said it a 8-6 week total immobilization before I can get fitted with a boot.
To be honest I have had a hard time finding information on the surgery. He said the procedure involved cutting part of the center of the tendon out and folding was was cut out and sticking that to what from the other side of the tear. He also said they might need to use part of a tendon/ligament form the left side of my big toe, if it needed to be stronger. I’m hoping I can find someone who has had any similar reconstruction surgery, such as this other than just stitching the tendon back together. (Post-op, recovery, etc…) The Dr. is also said no work until the wound is healed (3-5 weeks, Cast for approx. 6 weeks, and a boot for 3-5 months, then obviously lots of PT).
I know that reconstruction surgery is my only option at this point, since it is painful daily and I still limp.
Any info would be greatly appreciated.
Thanks for reading
So glad
i found this website.Had a complete rupture of the AT on 10aug .did’nt want surgery.so it was in a cast for two wks.When it was removed there had been no improvement the gap was too big.My surgeon said the longer you leave the longer it takes to repair.So I had the op the next day, and have had the cast replaced every two weeks each time flexing the foot a little nearer the leg putting more pressure on the tendon.
I was always very active, and this is really teaching me how to have patience,two more casts and a boot to go,bored today have to go up and down the stairs on my backside cos its so narrow ,feeling flabby due to lack of exercise have managed to keep up a little yoga.Any suggestions as to how to prevent me from cracking up??????
PaulaROI
I’m curious about your ATR not closing up. When the doctor said there was no improvement in the gap, was the gap still visible to you? Did he do a thompson test?
I started doing yoga as well early on. I was worried about my back since I was sitting so much. So I did yoga on my bed, using my knees to post and hang my cast over the edge. I was also able to do push ups using my one good leg and propping up my bad one on some cushions. Gotta get creative!
Kkirk, too bad about the wrong diagnosis and bad advice. Now I’d get a second opinion, too. Yes, surgery is indicated once the injury goes stale. But the super-slow rehab your surgeon is suggesting has never been shown to produce reliably good clinical results in any published study I’ve ever seen, and I’d fight to avoid it.
Many OSs are turning to the graft with the big-toe tendon, and several people here (& David Beckham!) have recovered well and reasonably quickly afterwards.
The studies I’ve seen comparing grafted and simple sutured repairs have shown no benefit from the grafts, but the fashion persists, especially for “stale” ATRs. It sounds logical, and may someday be backed up with evidence.
But the equally logical assumption that going slower produces better results — taking longer immobilized and/or NWB without exercise or PT — has been shot down again and again by real evidence, including several studies linked from this site’s page of studies and protocols. One of the newest and best studies — the “UWO” study of 2010 — is linked there too (under “op vs. non-op”), and used a very fast modern protocol with excellent results with and without surgery. I’d try to follow it post-op, regardless of the details of your surgery. The UWO protocol is linked from the end of the study, and I’ve uploaded another copy of it at bit.ly/UWOProtocol .
Good luck, start a blog and keep us posted!
PaulaROI, there many suggestions on this site for how to “win the mental game”. Many of us are almost “designed” to make it hard — active, sporting, getting a lot of our joy and fulfillment that way, and BOOM we’re immobilized then on crutches, then booted then limping, etc., etc. Yee-Yikes!! OTOH, if you can find the inner strength to pull this off, you should be confident about coping with future challenges.
It’s bygones now, but the only evidence I’ve seen relating ATR gap size to non-op outcomes found no correlation — i.e. the large gaps seem to heal up as well as the small ones. (That’s just one more time in this field that logic and evidence disagree!) None of the fancy successful studies I’ve seen did any testing at 2 weeks into non-op treatment, so I have no idea what they would have found. No matter, the surgery works well for the vast majority, and with luck you’ll sail through “bump-free”. Good luck, and keep us posted!
Kkirk, let me tone down one of my statements. I said “But the super-slow rehab your surgeon is suggesting has never been shown to produce reliably good clinical results in any published study I’ve ever seen…”, and that’s too strong. Slow rehabs have never been shown to produce BETTER results than fast modern rehab like bit.ly/UWOProtocol — but post-op, they can produce pretty good results. But there’s no proven benefit to balance all their PITA costs, despite the natural logical assumption that they’re safer and more
“conservative”. OSs love to say “After all, you don’t want to do this twice” when making you go super-slow, as if there was some evidence to back them up — but no.
Thanks for all the info norm, and I will discuss some of these issues post-op with my surgeon when the time comes. At this point I’m just ready to start the process (surgery > immobilization > rehab), since its been 4 months already.
But I have to be honest with you, I a little weary even after reading some of your information of setting myself back or even a re-injury. Mainly because today when I was meeting with my Gen. doc, I’m walking back into the patient room when my injured leg (right) pops and searing pain set in. Doc said I probably tore the rest of the tendon or ripped some scar tissue. Still hurting and been icing it tonight, but thoughts crossed my mind of moving too fast and re-injuring the tendon during the rehabilitation period.
Hi all , i ruptured my achilles 9 days ago playing football i had my ultrasound tuesday and although its not fully gone the guys exact words were hanging by a thread or 2 , today i spoke with the Nhs doctor who wants to go the non op route because of it being a mid tear we dont usually operate blah blah (is it easier for them) after a conversation ive been booked in to see another doctor in the morning whos more a specialist and to double check i just dont know which is a better way to go,any comments or advice would be cool thanks, and good luck to everyone
j g,
I went non op and at 31 weeks I am very pleased with my recovery. I can walk fast without a limp, jog and hop up on things. I’m back at the gym doing a complete weight lifting routine. Being non op, I had no chance of infection from an incision, pain from an operation, the scar not healing or even scar tissue to deal with. My recovery was about as quick as anyone surgical or not. Whether you go surgical or non surgical the key is to go through a modern fast recovery protocol like the UWO. You can learn more about the UWO protocol on normofthenorth’s blog.
Hi j.g.
There’s a lot of information on here re. op. vs. non op. As suggested by starshep, the plethora of information from Normofthenorth is extremely informative.
Personally, I (fully) ruptured 18 weeks ago (football). I went non-operative. My rupture was relatively high up, on the lower calf muscle, rather than the area immediately above the heel (where tendon is more ‘exposed’). I was told, with total confidence by the specialist, that non-op. gives excellent results for such higher ruptures, and the he was adamant that the recovery/ success rate is no different at all to the op. rate. Discussions with a few doctors at the hospital gave the same collective opinion: non-op. wherever possible (and that wasn’t based on costs, but more on their overall experiences and reading the literature etc).
As you’ll know, it’s a long road that requires immense patience and adherence to what the ‘experts’ tell you, as well as listening, very carefully, to what your body tells you.
Personally, I’m delighted with how the non-op is turning out, with a seemingly very strong repair, progress with walking, flexibiliy, minimal discomfort etc. Although it’s very difficult to make the chioce regarding which way to go, you can at least utliize the massive wealth of information on this excellent site - most of it objective, and as it’s a catalogue real-life experiences, it’s probably a richer source of information overall that talking to one individual. All the best, I do hope that you get to decision that you’re happy with.
Thanks chris & star shep ,the input is very much appreciated, Ive been all over these sites even before i went this morning im sure he was a nice enough doctor but its good to be aware and double check rather than end up back in the same position,chris mine sounds like its in a similar place i would say where i usually tape up my shin pads at the bottom to hold them up kind of area ,i had warning signs but thats life and to be honest there hasnt been any pain except for when gravity takes hold,its been great to read about other peoples injurys and recoverys and store as much info as i can so im feeling more positive , thank you so much i will read up on norms blog ,good luck to every single one of you.
Jg, if you’re not immobilized in equinus and NWB now, while you’re thinking, you should be! Good luck.
Thanks normo ,i can put loads of pressure backwards still sore and swollen when pushed upwards by the docs tests not trying it myself not for a bit anyway, heres what the speicalist said and done today ,hes put me in a vaco ped boot NWB for 2 weeks,back for adjustment ,then adjust again and 1 week later and PT and supports i think after,he said ive been lucky with the place of the rupture and its good its still connected even just a bit ,and i should be able to play footie in 4 months or so , provided i take care and do things the right way but i think i may ease my way back in for next season and concentrate on healing then walking then running and faster etc plenty of slow stretching,no point going flat out, that makes me happy as yesterdays doctor basically said no more high impact sports, im 34 and i could still run the 100 metres under 11 secs i hope i get near that again , i know mines not as bad as some i feel for everyone who has this,what a real git of an injury take care all..
I partially ruptured mine playing basketball 5½ weeks ago. I went to the ER and they stuck me in a temporary cast until I could see the specialist a few days later. He did not do an ultrasound or MRI, as there was still some response in the tendon and he estimated about 50% of it was still intact. He suggested non-op and put me in a slightly more comfy cast, saw me a week later to check everything was okay, then put the cast back on. I had another appointment two weeks later, at 3.5 weeks post injury, and this time the cast was replaced by a boot with a 1.5cm heel insert. I’m scheduled to go back in 3 weeks time (7½ weeks post injury) and have the insert removed. I’ve been advised not to put any weight on the foot until then and to keep using the crutches. I’m not sure what’s going to happen after the next appointment — but I am hoping they won’t tell me I can’t put any weight on it for *yet another* 4 weeks. I’ve gotten used to the crutches and I’m managing well despite living on my own up two flights of stairs… but it really is driving me crazy not being able to do anything at all outside the home without asking someone for help.
That should be “I partially ruptured mine… 4½ weeks ago”. I *wish* it was 5½.
Both of you should check out bit.ly/UWOProtocol and try to stay as close to it as possible. Not because it’s definitely better than any protocol that’s a slight variation in one direction or the other — it probably isn’t. But it seems to be the one that’s demonstrated the best results so far, so the burden of proof is on anybody who claims their slight variation is better.
If you’ve gone non-op, are there any signs to look out for of the tendon not healing as it should? Mine was a partial rupture and I’m 6 weeks post injury, in a boot which I’m under instruction to keep on at all times except for when washing etc. For the brief periods when I’m out of the boot I slowly and gently move my foot up and down to get some circulation going in the foot and the ankle joint. There’s no pain, occasionally a bit of tightness in the tendon area but I don’t raise the joint higher than the heel insert in my boot would allow me. Unlike the first few days after the injury, my foot is no longer “floppy”, but I have to really concentrate to get a smooth motion and I although I’ve been unable to test this properly, it appears I can still only apply minimal force when pushing back.
Is it standard procedure for the doc to make sure the tendon is 100% healed by means of an ultrasound or MRI before they declare you fit to try and wean yourself off the boot? I want to know for a fact that the ruptured half on my tendon has re-attached itself before I proceed with physiotherapy.
GG
I went non-op and in my case, the doctor just ran his finger along my tendon to determine the scar tissue had filled in the gap, then it was off to physical therapy. An ultrasound would not show anything and an MRI is pretty expensive.
Currently @8 weeks and my doctor is pleased. I’ve been told to gradually wean myself off the boot and start using normal footwear, but to keep the 20mm heel insert until my next appointment in 4 weeks time. I’m wearing two shoes at home and it’s so nice to finally be able to walk with a somewhat normal gait again… I went back to using the crutches for a day, simply because I was a bit scared, but I don’t need them around the house anymore. I will continue to wear the boot to work for at least another week. Physio starts in four days.
Hi all
I ruptured my left Achilles just over a week ago whilst playing on a scooter! Pushed back and pop!
I went to A&E straight away and after just a few tests they convinced me the conservative route is best and gave me an aircast with 5 wedges which I have to remove over the next 8 weeks.
I,m a little confused as my heel feels fine and I have no pain! I can wriggle and push down with my toes fine and lift my heel slightly. The only thing that is stopping me from lifting my foot up is that the doctor told me to keep my toes pointed so it can repair. I,m pretty sure I can’t push down with any force though.
I haven’t had any scans and the doctor seemed quite sure I would be fine.
Has anyone had the same symptoms? Is it a partial tear? Any help would be really appreciated.
Russell
Hi there,
I ruptured my AT on 22/12/12 playing ball hockey. Felt like someone slashed me as hard as they could on the back of my ancle (much like many of your stories).
I went to a sports clinic the next day and was treated. Great job at Pan-Am Physio in WPG.
My major question is whether I should have surgery or not. The doc advised me that surgery was kind of an old school method and that there is very little difference in successful rehab. I could have had the surgery this friday the 28th, but passed and was planning to go the non-op route.
Norm seems to know a lot about the pros and cons (as many of you do, however, just started reading the blog today).
I’m just hoping I’m making the right decision to notn operate, as I would like to be close to as athletic as I was before the ATR.
Have many of you gone the non-sugical route and had success?
Do any of you attempt to drive with your left foot (non injured foot)?
What is a realistic but motivated goal to be walking without crutches?
Sorry, just lots of questions and not sure I’m posting them in the right place (1st time blogger).
Right now I’m in a splint (toes down) and will see my PT on Jan 9th. I’m hoping to get a boot anfd looking forward to recovery.
I am new to the site, too. I ended up getting 3 different opinions before deciding to go with surgery. 2 said surgery and 1 said none. I went with surgery and the doctor that seemed the most confident. The other surgeon said I definitely needed surgery but he was a little negative with my outcome so he was eliminated next. I had 2 rupture sites and a bone spur that needed to be removed so I felt surgery was best for me as I am active and have 3 kids to chase. Not sure if it was the right decision yet as I am still in a cast and only 4 weeks post op. I injured my left leg so I was able to drive about 2.5 weeks post op. Driving was not as much of an issue for me as getting into and out of car and struggling in stores filled with busy holiday shoppers on crutches.
Hello everyone..i ruptured my left achilles on Dec the 10th playing basketball..i have been quite active cycling, going to the gym and windsurfing a lot since i live in a greek island…this injury psychologically has killed me…going from super active to non active is so stressfull…after seeing a doctor and after having an ultrasound i was adviced by him to opt for surgery as rehabilitation is faster and according to him this solution is more preferable to younger and active people..im 31 years old and this is by far the most serious injury i’ve ever had…im sure that nobody except everyone in this blog understands the seriousness of the injury and its really comforting to read stories of others that are or have been in the same situation…my tendon was almost ruptured completely..doc said that a small thread was still there allowing to have some movement after it happened…doctor used the minimally invasive method so i have no scar, no infection or any problems…from day one i had no pain whatsoever and now almost 3 weeks after i feel my leg ok…my leg was put in a cast boot from day one and doc said i will use it with croutches for 6 weeks…during this time he will adjust the angle on it probably once or twice..im now in a 120 angle and before i take it out it will have to go to 90 degrees…i have been reading so many things about this injury that one could easily get so confused…there are cases of elite athletes that their career ended after such an injury…sure..no doubt about that…but i know for a fact that former nba star dominique wilkins had an ATR at the age of 32 and continued to play in a high level until he retired…so dont believe everything you read…at least thats what i do…i get strength from people that have had a similar experience and now they are fully recovered and back to where they were before the injury…after all i dont think there’s any elite athlete in this blog!!! :-)..i think following your docs advice and taking it easy and slowly is the key to success…im determined to fight this injury and make my leg as strong as before…the great greek phiilosopher Socrates once quoted: ”patiance is bitter, but its fruit is sweet”..i wish everyone a happy new year with lots of health and no injuries for the years to come, love and piece…take care everyone and stay strong…and please excuse me for my english or any typing mistakes you find!! Να στε όλοι καλά!!!
Good message Lefcas81,
I’m learning o need to be more patient. Being only one week in non post op, I’m finding it hard to do nothing but rest. Usually I’m helping out around the house, but now everything is such a chore. Being up and around on the crutches I start to get more confident, but it turns out that can be a danger as well.
Last night was walking with the crutches and carrying a glass of milk as well, but the crutch bottom dragged and was about to fall/drop the glass and then put my injured foot forward to help brace myself. It kind of hurt. I’m just hoping now I haven’t done anything too bad to set myself back. It feels a little more achey today so far, but am hopeful all is good.
I’m sure many of you can understand the feeling of being virtually useless - I’m assuming the first couple weeks are the worst, but also most crucial to a good recovery.
The biggest challenge being only 1 week in, has been the mental one for me. When I try to go beyond what I should be doing, that’s when my leg throbs or am liable to hurt myself.
Otherwise, sleeping great and staying positive!
@hendrenville, you should buy a “travel mug” with a screw top (no slider or pop-open for drinking). Sold for coffee, but works fine for milk or whatever. Get used to wearing a backback or fanny pack, or at least keeping a few bags in your pocket. I had some mesh bags with drawstrings that would hang off my crutch, or my thumb, or whatever.
It’s scary to be creative with your rehab protocol (I say stick close to the ones that have produced the best results), but it’s brilliant to be creative with your equipment and ways of surviving while handicapped.
@lefkas81, I didn’t even know that I had the Greek alphabet on this computer until I saw the end of your post! Your doctor’s “opt for surgery as rehabilitation is faster and according to him this solution is more preferable to younger and active people..” is arguably out of date, since a few new randomized trials (2007-2010) have produced excellent non-op results — statistically as good as post-op results — with fast protocols, actually a few weeks faster than the one your surgeon is planning for you! E.g., they got rid of the crutches (FWB) at around 4 weeks post-either, rather than your 6 weeks.
The best of the studies — 2010, we call it the “UWO” study — is available in full on this very site. Main Page, then look for studies and protocols, then look for that study, by Willets et al. Their protocol is at bit.ly/UWOProtocol . Compare it to yours, and I’d say try to follow it. Show your doctor the study and the protocol, most doctors don’t have time to read the literature on “boring” injuries like ATRs. And many surgeons don’t want to know that non-op treatment can produce results as good, and as fast, as surgery. (”If your only tool is a hammer, all your problems look like nails.”)
Your tiny scar sounds amazing! I thought minimally invasive surgery usually had two scars, because two instruments went in at different spots. Just one? 10 or 15 years ago, it looked as if the minimally invasive ATR surgery was going to take over, but it hasn’t happened. Partly because a number of studies and lit review have shown that the results are no better than open surgery, and present higher risks to a big nerve whose name I forget. (Sural?)
Good luck, and good healing, and keep posting here!
hi normofthenorth!!…i found and read the publication you mention above…great stuff!! and by the way i was wrong..i didnt have the minimally invasive surgery..i had the percutaneous method…i have 8 small holes at the back of my leg…my mistake…i have to admit im a supporter of the early and aggresive rehabilitation protocols about ATR and i will definately show the publication to my doc…after i take out the boot i will visit another doctor as well to take some advice from him..one year ago i had a meniscus injury while windsurfing and after seeing 3 docs, one of them, a sports orthopedic specialist told me to follow a rahabilitation protocol and ever since i have no issues with my knee unless i drive for many hours…only then i get some pain…the other 2 docs suggested surgery something i didnt want…so i pretty much trust this doc…Monday the 7th im cutting my stitches so i’ll discuss with my surgeon about the fast rehabilitation program and i will also discuss it with the sports specialist doc…after my meetings with them i’ll post my news…take care everyone and be strong!
Hi all, I am so pleased to have found this site and am completely new to blogging. I am one of the rarities that fully ruptured both of my achilles on xmas eve. Had surgery on xmas day and am now in my 4th week of fibreglass casts. Not something the docs see everyday, so my treatment protocol is a bit of an unknown but they are being as conservative as possible. In casts for another 2 weeks, then onto what we call ‘moon boots’ (I’m in NZ). I have found some great information on this site and appreciate feedback. I realise it’s a long road ahead, but am intrigued as to how long those with one achilles ruptured have taken until they were walking confidently. I am completely non weight bearing and spend my days in the wheelchair or bed, Trying my best to keep my legs elevated all the time as my feet tend to swell when I put them down (making the casts really tight). Another challenge is that I have to inject myself daily to prevent blood clots due to being a higher risk of DVT since both of my legs are inactive.
My hospital physio has given me some exercises to do to try and keep my other leg muscles going, but the atrophy in them is already evident. Being completely reliant on others is very frustrating, but I’m lucky to have 3 teenagers who are learning what is involved in a running a household…that makes me smile
This is my new favourite site to visit, am always keen to learn new things. Take care all
I just was diagnosed with a ruptured achilles tendon an hour ago. I’m running the full spectrum of emotions. Being an active person who still competes at a high level, I’m extremely nervous I’ll never be 100% again. Any suggestions, I’m all ears. I will eat, work, sleep, do WHATEVER I have to do to Fully Recover from this!
Sprinterguy, most of us do return to our fave sports at our previous levels (or very close), with or without surgery, though it does take a while — and that while seems especially long to the kind of people who rupture an AT while playing a sport, aka most of us here. It can help to start a blog here, it helps a lot to get a written protocol (rehab schedule) from your Doc or PT, and it helps even more to get a GOOD rehab protocol that moves you and your healing tendon along quickly. Ironically, the fastest protocols tested so far — like the one at bit.ly/UWOProtocol — have shown the best results, with the lowest re-rupture rates and the best strength and Range of Motion, with and without surgery. So don’t fall for any nonsense about taking it slow to make sure you only go through this once, better safe than sorry, etc.
It is certainly possible to get into trouble by doing too much too soon, but going at the fast pace of the best modern rehab protocols works better than going slower. That seems especially true if you go for a modern NON-op protocol, but even with surgery, going slower doesn’t seem to do any good. (Going slow without surgery clearly produces worse results than going at the full speed of the UWO study’s protocol.)
Staying sane during the rehab is important, and trying to keep the rest of your body in shape is also a Good Thing, and both are a challenge. Many suggestions on this web site, though.
Patience is a virtue with this injury, be an advocate for your recovery. Do your research. Explore some of the blogs and read others experiences. Make your own blog to document your progress.
These are all things you can do to reassure yourself and education yourself about your recovery. I have a collection of rehab materials on my site and make sure to check out the UWO study on Norms. Good luck with your recovery.
Hi all. I injured my left ankle a week ago (Last Thursday) snowboarding. Had it checked out at a hospital in eastern B.C (Canada) where they x-rayed it and did an ultrasound of the tendon. He saw what looked like a tear with blood in between the tissue and suggested I follow up with my Ortho when I returned to the states this week. I saw the Ortho Monday AM, got the MRI that night and had to follow up this morning when he told and showed me that it is fully detached. Surgery is scheduled for tomorrow afternoon.
I’ve been wearing the boot (most of the time) and the initial swelling is going down a bit. 3 days ago my whole foot looked like a football, and now I can see the tendons going to my toes. Pain level is not that bad but I’m taking pain meds to help keep it that way.
As far as post-op; Dr said I’ll be in a cast for first 2 weeks with NO WEIGHT at all on the foot. After 2 weeks, probably go to air cast with slight weight on the foot. PT will probably start sometime around then.
I’m feeling quite optimistic after reading so many entries from so many people who have gone through similar circumstances. I love snow sports, and am also an avid bicyclist (road and mountain) along with Spinning. Am thankful that my overall fitness level is pretty good for an old guy (my 57th birthday was last Wed and I GOT THIS THE NEXT DAY! NICE BIRTHDAY PRESENT, HUH!!!!!!!!!!!
I’ll keep looking and posting as things move along.
JackInVA, you should have no trouble returning (eventually) to Snowboarding, though it usually takes longer than getting back to skiing, because of the soft-vs-hard boots. Start your own blog if you can and keep us posted there. You’re bound to have questions. And try to follow a good fast modern rehab protocol like bit.ly/UWOProtocol if you can.
I’ve seen all kinds of conflicting and just-plain-wrong diagnoses based on MRI and Ultrasound both. For my second ATR, I got 3 Ultrasound exams, and 3 different diagnoses(!). I’m guessing that ONE of them was actually RIGHT, but I’m not even sure about THAT!!
When my Dad was hospitalized at about age 94, he had an MRI of the spine because of a miserable backache. They almost rushed him into massive emergency surgery as a result, but they held off. A month later, a second MRI showed an even MORE massive infection of the spine. Another month later, the third MRI showed a further progression, making it look as if he was totally crippled and at death’s door.
In reality, his backache had gone away by then, and he checked out of the hospital and lived backache-free ’til he died pain-free at 98. None of the many MRI technicians or fancy MD specialists ever bothered to contact him or us to say “Oops!” much less “Sorry!”
I’ve now heard TWO different international medical experts say on CBC Radio (#2 from Australian Broadcasting) that they would NEVER agree to have an MRI on their own spines. One of them even suggested donating a back MRI to your worst enemy!
Modern medicine is increasingly driven by supposedly objective tests, including MRI and Ultrasound, but I’ve been shocked at the rotten results — useless or WORSE — I’ve seen from both of those.
Thought I would add my experience to this wonderful site. I am glad to know that I am not alone in this.
January 21, 2013 - The day of the annual Faculty - Student basketball game. Of course, the forty year old decides to show them youngsters up and play. The good news was that we beat them 36 -24. The bad news is with about 4 minutes to go in the game, I went up for a rebound, came down funny on my ankle and then immediately had an eighth grader come down on my lower calf. I thought that I had ruptured my Achilles but I also figured I was just an old guy and possibly just had a pulled calf muscle or at worst a sprained ankle. Never having sprained the ankle before, I decided to tough it out and wait the weekend to see how everything played out.
That Sunday I went into the Emergency Room where the er doctor had xrays taken of my leg and ankle and a sonagram of my leg to make sure to blood clots were present. Xrays came back negative, of course. The doctor said I had a moderate ankle sprain. RICE for 72 hours. Crutches for two weeks. Limited activity for four weeks. Back to regular exercise by 6 weeks. I was concerned about the Achilles because it felt unlike an Achilles should feel. It was soft and mushy as opposed to rigid and hard. He said that due to the swelling of the ankle it caused the Achilles to feel that way. Dreading an Achilles injury I went with his advice.
Fast forward, four and a half/five weeks weeks (February 23rd). I wake up to a purple foot and a calf that extends all the way down to my heel. I described it as a tree trunk. So it was back to the ER I went. This time the doctor told me that it was a high ankle sprain, much more severe than a moderate ankle sprain. He placed me in a boot for six weeks, immobilizing the ankle and allowing it to fully heal. He also gave me a referral to an orthopaedic.
Still believing in my heart of hearts that I had initially ruptured the Achilles I made an appointment to see the ortho on Monday, March 3rd. He took about two seconds to look at the leg and feel the leg as well to know that I had in fact ruptured the Achilles. (Of course, me flying through the roof and crying out in severe pain helped as well.)
All of this, fortunately, falls under workers’ compensation. So not only do they get to pay the bills but also drag their feet when it comes to actually allowing me to have the surgery. I was scheduled to have gone under the knife today but am now on hold until, hopefully, tomorrow afternoon.
I hope that all goes well whenever I do have the surgery. It is wonderful to know that so many have had success stories when it comes to repairing a ruptured Achilles. Out of all the injuries I could have suffered, this is the one I had nightmares about ever having. Now I get to live the nightmare.
Godiago: Sorry to hear of your facult/student injury. Your story is practically a mirror of mine. I to was playing my 7th grade students in a faculty-student basketball game (May 23rd), when after going up for a rebound and a student coming down on my shin, I ruptured my AT. At first I though I had an ankle sprain and strained my calf, since I’ve had both these issue before. My GP doc thought the same and gave me a brace and some muscle relaxants, and not much different at the ER. I finally went to the ortho 4 weeks laster and began fighting Workers Comp. 1st for the MRI that showed an almost complete rupture, then a 5.5 week wait to see the specialist. I spent most of the summer limping and finally gpt an appointment with a foot ankle guy in August. I had another month delay waiting for the surgery, because the doctor reschdeuled, but finally got it fixed and I’m now 21 weeks from surgery and slowly progressing. Good luck with your surgery and keep us posted. You should create your own blog on this site to.
The cruelness that is the American health care system. It’s amazing the emotional toll it takes on a human’s psyche.
Received a call from my contact person at worker’s comp who was very nice and caring asking about how my appointment went on Monday and if they had scheduled the surgery yet. I gave her all the relevant information and all seemed to go smoothly.
I place a call to my surgeon’s office to talk with them and confirm that the surgery will in fact take place tomorrow. Needless to say I am ecstatic because, something that should have taken place 6 weeks ago, is finally going to happen and I can begin this process of healing. Lo and behold, the surgeon’s office is waiting upon approval from a third party entity that the worker’s compensation people sent my paperwork to. In a matter of moments, my emotional high is kicked back into utter reality.
So, as of this post, I am in a holding pattern. I am to take the day off tomorrow, start fasting at midnight and proceed as if the surgery was actually going to take place. Which of course means getting things prepared at the house, wife taking a day off of work, getting the mind totally prepared for the event, only to possible be told 30 minutes before I am to arrive at the hospital that the surgery is going to, once again, be postponed. This is so aggravating.
I’m glad I found this website. I ruptured my achilles Tueday march 5th, playing basketball.
I was in the middle of a pickup game, beating the same team for the 3rd time in a row. On the last game to 7, a guy from the other team shouted to go to 11. I should’ve walked off the court. The pop was so loud, it sounded like someone squeezed a bag of chips.
I’m 23 years old 6′9, very athletic and mobile. I play basketball 3 times a week, and go to the gym almost everyday that I can. Ive always been a optimistic guy, but the devastation of this injury really got to me this morning after seeing the ortho. I sat in my car for about 20 minutes thinking of what I could do when I realized the time machine doesn’t exist and shoulda, coulda, woulda, doesn’t help.
Im ready… there’s a long journey ahead I know. I hope I can use this community as a crutch, no pun int, for the year or so of recovery. the doctors have told me that my recovery looks promising pending the surgery. young and healthy is a good combo. Good luck to those out there. may we have a speedy recovery.
Gentleman we can rebuild them… better, stronger, faster
Good luck, Godiago! You’re due for some.
Ender, you’ve been “kicked in the head”, and none of this was your fault. But there’s no choice now, other than making the best of it. The good news is that your recovery prospects are very good, with or without surgery, and rehab keeps getting faster, less inconvenient, and more effective. Read bit.ly/UWOProtocol and make sure you don’t go any slower. Some Docs didn’t get the memos… If you’re interested, I’ve got a page called “the case for skipping surgery”…
Normofthenorth,
So did you opt out of the surgery? Had it this morning everything went well. I’ve seen all kinds of stories on cast time and boot time. Guess it all depends on your doctor. From the looks of it I’ll have 4 weeks cast, 4 weeks boot, then trying to walk. From what i have seen this seems to be the more conservative route. I’m all about aggressive treatment, however the last thing I want is a re rupture.
Yes, ender, I opted out of the surgery ~3 years ago, for my second (left) ATR. 8 years earlier, I had surgery to repair my first one. Based on the best evidence back in late 2001, almost everybody who was fit enough to survive surgery — and especially people who did their ATR in sports and wanted to return to that sport — were pushed into surgery, and rightly so. Since then, much faster and MUCH more effective non-op treatments have been developed and tested against surgery, and have produced results that are virtually identical to post-op results in the important metrics (strength, ROM, re-rupture risk), and free of most of the scary and painful and scarring bits. Anyway, it’s all on that blog page of mine, and a few others.
Your last sentence sounds logical UNLESS you’ve had a peek at the evidence, and then it sounds like you’ve got it backwards (’cause you do): Aggressive treatment — e.g., as used in the 2010 “UWO” study, schedule at bit.ly/UWOProtocol — produces the LOWEST rerupture risks. The HIGHEST rates of reruptures came from old-fashioned super-slow “conservative” treatment. Mind you, that counter-intuitive “curve” seems “steepest” for non-operative patients. The rerupture risk for post-op patients doesn’t seem to vary as much with the choice of rehab. (But to the extent it does, faster seems safer and slower is worse.) It’s hard to wrap a human brain around this, which is why so many surgeons and PTs still have it backwards, despite around a decade of good evidence.
4 wks in a cast then 4 in a boot is not terrible, though 2+6 would be much better, with PT and gentle exercises and PWB starting at 2 wks, like that UWO Protocol I linked above. But if “then trying to walk” means you won’t be doing any PWB or FWB until 8 weeks post-op, that IS terrible. Check the protocol, and get a written one from your Doc. “Mine” has a big fancy study with great results attached to it; what’s his got? Nobody cares as much about your recovery as you do, so get with it!
No, when I get in the boot I’ll be PWB. When I say try to walk, I meant FWB without support. I’ve printed out your schedule and I will running it past my doctor. Either way i cant do much in this cast.
You ruptured both feet?? you sir are a champion.
Norm
First of all my apologies - I’m responding late to your post of Feb 14 about MRI scans and the spine. “I’ve now heard TWO different international medical experts say on CBC Radio (#2 from Australian Broadcasting) that they would NEVER agree to have an MRI on their own spines.”
Your dad and these guys had plenty to say against MRI scans, for good reason by the look of things.
In my case, many years ago I had severe back ache which the doc’s followed up with x-rays and which contributed to a diagnosis of a herniated disk, and I should rest, take pain killers, etc. The pain carried on and I paid to see another consultant, another hospital. He immediately had me scanned by MRI.
The highly visible result - a malignant tumor on the spine acutely compressing the spinal cord. Emergency surgery and radiotherapy followed and the continued risk of recurrence. If left alone I would possibly not be typing this now, or could be at least paralysed from the waste down - I guess I wouldn’t have had my atr a few years later though, would I?
I would hate anyone to be influenced by misinformation caused by personal experiences, then suffer the potentially dangerous consequences. Maybe an MRI is over the top for some atr cases but used well by experts in appropriate circumstances - a life saver…
Oh no! I spelt “waist” as waste”. Still appropriate in a way?
Fair enough, plummy. Like you, I’m glad you got that MRI, and that the cure was effective, too!
A large part of the issue here is how much weight we should give to the harm caused by “false positives” from diagnostic procedures (patients who are given scary or nasty diagnoses, and sent for scary or nasty procedures, who either were OK all along, or who wouldn’t have suffered from the diagnosed problem if it had remained undetected). Many professionals don’t give these cases much weight, especially compared to the “true positives”, like you and your tumor. But others do.
Here in Ontario and I think in many other places too, this issue has recently blossomed in the context of mammography screening. (Not talking MRIs here.) Basically, the test seems to find a number of real cancers AND an often larger number of “false positives” — women who are (a) terrorized and (b) sent for a number of further tests, several of which have their own downsides and risks. In that context, the consensus recommendations seem to be shifting in the direction of less screening: starting screening later, with older women, and screening every 2 or 3 years and not every year. But some of the cases that will be missed by that approach may be as important and life-saving as yours was, and the false positives are more likely to be “merely” inconvenienced or traumatized than to lose their lives. Somehow, we (or the Medical societies, governments, doctors, patients, etc.) have to come up with relative weightings of these “apples and oranges” to decide whether to go ahead or not.
I saw the MRIs of my dad’s spine (and I think I still have them on a CD or DVD). The “shadow” that the techs and MDs (an impressive group, too) thought was a massive and fatal infection was indeed a “highly visible result”, even to me — or else they wouldn’t have recommended emergency surgery. And it clearly got bigger and darker over the 2 months (and 3 scans).
I still don’t know what that shadow was, or why my Dad’s back kept feeling better and better while this MRI shadow grew and grew. I doubt that anybody knows, now or back then. And I still love science, and knowledge, and diagnostic tests. I just have a feeling that the rate of false positives with spinal MRIs is scary high, at least so far, and I’ve been reinforced by the expert opinions I reported, too.
The issue of diagnostic tests for ATRs is also complicated, and every sensible “rule” has a nasty downside. Back in late 2001, when “everybody knew” that surgery was the only excellent treatment for an ATR, one very smart surgeon told me that he doesn’t even bother with UltraSound or MRIs: Once a patient reports that (s)he’s had to put his heel on the step when walking up stairs, this Doc would schedule them for ATR-repair surgery. And almost everybody here who’s sent for an X-ray after an ATR thinks it’s a stupid waste of time, way dumber than an UltraSound or MRI. Yet there are ATR patients — including at least one or two who’ve checked in here — who’ve had their AT pull a tiny bone chip away from their heel bone, to cause their “rupture”. That’s a rare injury, but one that would probably never heal properly non-op, might be beyond the skill level of some OSs to fix once discovered, and might never be diagnosed properly without an X-ray.
So what’s the answer? For maybe 99.9% of all suspected ATRs, an X-Ray may be a useless waste of time, money, and radiation exposure — but for 1 out of 1000 patients (yes, I made up the ratio), it may find something that otherwise might go unnoticed (at least in the non-op stream) and cause trouble. Should the 999 patients get to skip the X-Ray, or should everybody have to get one? I don’t claim to have the answer, and I do think it’s a tricky question.
An interesting response Norm. Lengthy, but interesting.
In most cases, even where a scan makes it crystal clear what the problem is, further tests are carried out (well, they are over here) to understand the severity of the injury, infection, tumor, etc. They might include blood tests, biopsies and other scans, followed by a comprehensively informed decision as to whether to operate or not, program chemo, radiotherapy and so on. But you and everyone else already know this.
If there was the possibility of some serious infection, surely your dad had bloods taken, and maybe a lot else too.
For their own sake possibly, and their future health, I just hope that your 2 Aussie experts were just mouthing off when they were so damning about MRI scans and stating that they would NEVER have a spinal MRI . But have you heard Australians talking about cricket? Just as unequivocal there… And so wrong.
I posted a few more comments, too, plummy, but they’re awaiting moderation for some reason. I can see them. . .
Firstly i am so pleased i have landed on this blog, it has given me a great insight into my injury and a positive attitude toward recovery.
I actually ruptured my achilles 3 weeks ago whilst playing football ( soccer). The most frustrating and annoying thing was is that it was from nothing, stopping the ball with my left foot, i heard a crack in my right ankle and felt like someone had kicked me from behind.
I had been playing to a quite high level of amateur indoor football and had been in the best shape and fitness level i have ever been in, considering i am 37 i was fitter than allot of 18 year olds i was playing against. Having been told that it was a full rupture, i was disraught as i was meant to represent my country in a tournament in 2 months time and now feel like i will never get another opportunity as the next time around i will be 41 and who knows what level i will be at.
i wanted to find out and feel re-assured ( if possible ) that a top level of fitness is achievable after the injury? I am feeling positive now and have calm to terms with my situation, all i keep saying to myself is that if i could get to such a high level of fitness at the age of 37 there is no reason why i can’t get to 85% of that when i am 41. Playing soccer 2-3 times a week and going to the gym 1-2 times a week.
Thank you all again for your positive comments throughout and hope to hear from some of you.
wish you all a full recovery and to never have a re-rupture. As always, there are definitely worst things in life and we need to put it all into perspective. A quick example is that the day after i ruptured it and walking in a boot and crutches, i sat next to a 14 year old kid who had lost his right leg by standing on a land mine, now that is a reality check….
meant to say come to terms and not calm.. sorry
A quick question for most of the new guys here - why has surgery been recommended for your atr?
@Hillie: The first OS I saw recommended surgery saying that the re-rupture rate was lower and recovery time was quicker–that some one my age and activity level is better off having surgery so I can resume normal activities more quickly. I went for a second opinion who said that I could opt for surgical or non-surgical–that it was my choice but that most of his patients opted for surgery. He also said that strength and mobility at the 1 year mark were about the same for both procedures. I think that most doctors in the US like to operate–they have had success with it so they continue to believe it is the best option.
For those who just ruptured your achilies, consider yourself lucky…
Ruptured my right achilies on March 10 and had the operation on March 15. Reruptured it again on May 21. Five weeks after my operation I developed a blood clot which settled into my lung. I was told that I was very lucky to be alive. Had to spend a week in the hospital. The second rupture happened above the original. After I discussed the 2nd injury with my Ortho, I chose to not have surgery as I am now on blood thinners and would have had to have a filter put in my heart. Now in a cast / NWB and will have it removed on June 19. I can feel my calf muscle as I move my foot up/down in the cast with is a welcome sensation.
Hi cooper,
Sorry to hear about your re rupture, but you are now in recovery so upward and beyond,
RRR
Hi there Cooper
Sorry to read about your second rupture. How did you do it again?
As for others being lucky - when I hit the floor with my atr, my first thought was obviously “Oh, aren’t I lucky…?”
Not sure any of us are that lucky to end up here, but hope you heal well and don’t have any other complications.
fulofhope
I’ve been having similar thoughts as you with respect to being able to come back. Complete rupture on Jun 15th and surgery on 17th. I was nowhere near the level of representing a country but at 43 I played 1 to 2 sports regularly a week. Played harder, stronger, faster than most of the guys in early 20s including ones in very good shape.
So as far as the age goes, you have lots left I would say. Focus on using your positive view on your rehab. Don’t worry about 41, I would guess you could get close to 100% or even more when it comes to age. You also develop certain psychology/strategy/confidence in sport into that age. Sport as life but moving 100x the speed, experience of the mind is an advantage. This is perhaps one reason why you never see coaches in their 30s in pros (even ones who don’t play).
FIRST FEW DAYS POST SURGERY QUESTION
Please let me know if there is a better section to post this. I had a complete rupture on June 15th and surgery on June 17th. Massive pain post surgery for first day. That is much better now when I am lying down (on meds).
However, as with everyone else i get massive pain when I stand up on crutches (NWB) feels like foot is on fire/exploding. I know this as i go to bathroom. I want/need to get back to work (desk job) and am wondering if i just left my foot down for longer than just a couple of minutes if that pain will dissipate.
Or is that going to go away altogether soon (i am day 4 post-op). I don’t want to sit and experiment letting it down for 3, 4, 5, 6 minutes if the pain is not going to dissipate. I will keep foot up at office but I will have to get from parking lot to elevator etc. etc. By now i would have thought carefully hopping around on crutches would not be so painful. Appreciate any advice.
Hi,
I’m 4 weeks post op and currently in an adjustable boot. Is it normal to have a burning sensation in your lower leg calf area?
Yes! I am at 10 weeks and have had nerve burning pain down the outside edge of my calf from my knee to my ankle. I’ve had it from the beginning. my doctor says it’s from not being able to stretch out the muscle. I have just gone from my armored boot to two shoes so I can now massage it and have started resistant band flex exercises. I’m hoping to start deep water aerobics. It’s so uncomfortable and painful. I was worried that a nerve had been damaged. But a I’m able to move more the pain is decreasing. Ice packs and massages help. Be patient and keep trying to flex your calf. It will heal, though slowly.
Hi everyone. I ruptured my Achilles tendon playing tennis yesterday. I am a 38 year old former professional tennis player in excellent shape and injured it sprinting for a ball - it felt like my calf got shredded with a bizarre (but not particularly painful) sensation. I have a friend who is an orthopedic surgeon who has an excellent reputation who can perform the surgery 8 days from today (he is on vacation this week). A doctor at the tournament did the Thompson test and he is positive I have a complete rupture. My friend thinks surgery is 100% the right way to go for me and I agree based on what I have learned from this great site. My question for others here is whether or not 8 days is too long to wait - should I try to find someone else to do it in the next few days? Are there any implications? Thanks for any ideas.
Hi Cgroer. Firstly I’m sorry you ve had to join this elite club. I, like many have taken great comfort and learned a huge amount about ATRs from the people on this site.
I waited 9 days before surgery in a half cast. This period of waiting was considered perfectly normal for me in the Uk.
Unfortunately you’re in this for the long haul so a few days waiting for an op isn’t so bad.
I wish you well. You’ll find solidarity with the members of this blog site
I waited ten days. The doc wanted to do it sooner, but I had somethings to do. He felt the delay wouldn’t harm me. You may need to get tests done prior to your surgery, so it may be further than eight days out. Be sure to set up a blog and let’s us know how you are doing.
.
Complete tear of proximal Achilles musculotendinous junction with a 1cm gap. Ortho doc says non-surgical is a viable option. Any opinions from others that went non-surgical.
@JJnunn: There are quite a few non-ops here who have had successful outcomes. Hillie, Trin74, micah1, AndrewC, Alton to name a few. Take a look at the YouTube videos of Brady Browne. He’s a Canadian Football player that had a remarkable non-op recovery too. I’m sure others will chime in but it is well known that aggressive non-op is extremely viable. Good luck!
@JJ Nunn: I had my surgery today after full rupture 4 days ago. I discussed nonsurgical option w 3 different doctors. While open to the idea they all felt that fastest and best recovery option for me was surgical. I am very active 38 yr old male if that helps.
I agree with cgroer. Two surgeons who looked at me both said age plays a big factor when determining non surgical options. They really didnt even want to discuss non surgical route because I am only 28. I am now 2 weeks post op and I feel great, considering. Still NWB, but sutures came out at 1 week post-op, already into a boot, and have been off pain meds for the last week. What surprises me is I never had a cast. I was in a boot from injury to surgery, a splint and ace bandage from surgery to week 1 post-op, and a boot for the long haul. SOunds like a lot of people are in casts for quite sometime
In search of Large Vacocast used for sale. Any ideas on where to look? Is there a classified page on this site? I searched craigslist and ebay already.
First, thanks for this blog! I had a full rupture ten weeks ago, came home and after googling like crazy, I found this site and it was a big help.
I have read a lot of posts on other websites, and some comments here, that say recovery is 6 months of hell. I guess for some, it is, but I’d like to give a little sign of hope to those who just had this happened.
The first month SUCKS !! I’m not going to lie, I was crawling up stairs, struggling to do anything, and hating life. But due to a busy schedule, my doc couldn’t do the operation for almost two weeks after the rupture and the two weeks post-op in a cast were no picnic.
ADVICE #1 - Get to the doctor ASAP! If you heard the pop and can’t even imagine standing on your toes - go to the doc and get on the list for surgery (or start the non-surgical method) Two weeks post-op my cast came off and I got a Cam-boot.
ADVICE #2 - Buy the Cam boot while you’re in the cast, order it from Amazon instead of some mom and pop shop. I bought mine local and paid $120 for a $40 boot.
I bought regular crutches and forearm crutches because I liked the way they looked on Breaking Bad….don’t, they don’t really help. Instead….
ADVICE #3 Rent or buy a Knee Scooter !!
They sell them for $250 on Amazon or you can rent one (mine was $50/month in NJ) They rock!! I’m a photographer so I walk for a living, I couldn’t lay down for a month without foreclosing on my house. The knee scooter was amazing and having a basket to put stuff in and a place to sit is invaluable, you can’t carry anything with crutches. Which leads me to…
ADVICE #4 Carry a backpack so you can have your water, wallet, phone, etc with you while on crutches.
If you have a ton of stairs or rocky terrain, the Knee Scooter might not be ideal, but anywhere else you’re faster than regular walkers. I thought I’d get a speeding ticket at my local Target and Home Depot. Honestly, I miss it….*sniff*
I heard a lot of people talk about sitting with your leg raised and, I guess, staring at the friggin’ TV all day, but I was having none of that!
-I was scootering right after surgery
-kayaking one week post-op
-walking on my cam boot 3 weeks post-op
-and in a sneaker a week before my doctor told me it was ok.
ADVICE #5 Buy a waterproof leg protector bag for your leg so you can take a shower, you can even swim in it.
ADVICE #6 I didn’t buy one, but I recommend a shoe leveler, otherwise your hips will hurt from being off balance. Crutch covers and crutch pockets would have been nice too.
I’m not saying this is for everyone, I’m 43, in pretty good shape, always been flexible, and probably very lucky, but last week my doctor told me I was the fastest recovery he had ever seen! I did take my aspirin every day to prevent blood clots, use protein powder for muscle growth (don’t know if that helps tendons), and took it pretty easy, but I only spent about an hour a day sitting in front of the TV.
Be careful and don’t push yourself, you’ll know when to stop. I slipped getting out of the shower a week after surgery, landed on my bad leg, and screamed like a little baby! (I know what that sounds like, my wife gave birth the same week as my surgery!…June was a CRAZY month) If your the type of person who is dreading sitting around doing nothing more than the surgery…you’re probably like me and this method might work for you.
Ten weeks in and I’m walking a few hours a day, sore when I’m done, but only a slight limp and no pain.
Good Luck !!
Well it has been 5 days post op. I am really having a difficult time getting around the scooter sounds good. Could others who have used it comment I am guessing that it works well around the house. When were others driving after surgery as my right foot is the one in a cast. The Dr told me that at week 2 I would be in a boot with controlled movement by him on the boot. Has anyone had this so I know what to expect.
I ruptured my first achillies at 26 jumping for a rebound, it destroyed my life because I was self employed. Then I tried the Kobe approach and came back, I could dunk again, and my life had finally recovered from 9 months of hell. I was invincible, bought a 450k dollar house and that same day I went to play basketball for the 3rd time since the injury, with a 2700 dollar mortgage I dunked on the first play then the “pop” there went the other one. This destroyed my life. Sank me to the core, my business gone now, and many took advantage of me. Finally, I was a superstar white 6-2 athlete 195 lbs. It destroyed me and generally now I walk and move slow , force of habit.
I heard the “pop” nine days ago — stepped into a rabbit hole while jogging across a field at my son’s cross country race. I decided to have the operation. I was influenced by my experience with a torn ACL several years ago. With the ACL I took a non-surgical approach at first, but kept reinjuring the knew and had little stability for court sports especially. I am very glad I had the ACL reconstruction and I’m hoping for a good result with the ankle. So I am going in for surgery tomorrow morning — wish I could have scheduled it sooner, because I’m already getting impatient. But I am so glad to have this source of advice and tips. Thanks to you all for sharing your stories and information, and wish me luck!
Hi Joinaine, welcome and good luck. I had surgery Aug 8 and will be hoping all goes well for you. Keep us posted.
On the late evening of October 5, I ruptured my right achilles playing badminton after a 1.5 yr break. Rupture happened an hour or so into my playtime during an intense match (I thought my partner stepped on my calf area when I collapsed, but he was shocked at my accusation!). I have read a lot in the past few days and am glad this site is here.
I went to see the doctor on Oct 14, had MRI on Oct 15, and was put on a cast on Oct 16.
1) I am going the nonsurgical route since my rupture is not very long (surgeon said its small and somewhat higher above the ankle than most ruptures, so better blood flow). However, they have put me in a cast for 4 weeks starting on the morning of October 16. It seems like the research indicates going to an inclined boot right away? Should I ask the surgeon to be put in a boot in two weeks?
2) In case of a re-rupture, does anyone try the non surgical route a second time?
3) Do people get ultrasounds or MRIs done every few weeks into their recovery?
4) While wearing the cast (pointed down), can I rest the foot flat while standing? So far, I try to only rest it heel down on pillows at my work desk.
5) I have been reading even 4 cm ruptures being cured the non surgical route. How is that possible? Does the body regenerate that much tendon just naturally (I assume that it can’t connect the two broken ends even with feet flexed toe down when the gap is 4 cm long). So some kind of program tells the body that this gap can only be filled with new tendon and not remain a gap or get filled with fat/muscle/water/blood?
5) Finally, are their any blogs of people who did almost nothing serious like weeks of casts and boots and still saw tendon regrowth? Reason I ask is that I was able to walk and drive relatively pain free for the first week after my injury (hence my seeing the docs 8-9 days after the event) despite having a limp. While walking during that time, I tried to use my right foot as little as possible (mostly just dragged it along).
Also, to add to the above, is their any site on the internet where one can post their MRI images to try to get feedback from the lay person? There was only so much I could ask the surgeon. I want to know more details about the exact height of my tear, the width of my existing achille’s and how it compares to an average man (since I assume wider means stronger), whether any other tendon weakness can show in all the white streaky marks, etc…
I’m no NormoftheNorth but I’ll take a stab at a few of these since I’m non-surgical and at 24 weeks. 1.) I was casted for four weeks, NWB and then transitioned to FWB in a Bledsoe boot at week 5. Some people go straight to a boot but my Dr. didn’t want to do that and it worked out all right for me. 2.) It’s my understanding that re-ruptures are usually surgically repaired. I *think* because scar tissue needs cleaning up. 3.) I never had an ultra sound. The Dr. palpated and did a Thompson test to confirm that the healing was intact. 4.) There was no way to comfortably rest my casted foot on the ground while standing so I didn’t. 5/6.) I don’t know the answer to this.
Hopefully someone else will chime in. Good luck. Sorry to hear about your injury.
Hey kellygirl thanks for the detailed reply! Do you mean you went from cast to NWB to FWB, or do you classify the cast as NWB (i.e., same thing here)? Still learning the lingo.
When I said resting my foot down, I meant that while using both crutches when standing (especially outside my door to get some air), I sometimes feel like gently having my rupture foot rest on the ground. My only concern here is that I might move the foot within the cast from its initial downward angled position placement. I think I might have already moved it upwards (closer to 90 degree normal angle) just resting the foot on pillows while working at my computer. I do not think my cast is tight enough to prevent some movement inside, although maybe I am imagining. Maybe I should go to the doctor after a week rather than after 4 weeks to see if they can tell.
@hyperhid: The cast was NWB. I pretty much skipped PWB and went to FWB in the boot. Some people have more discomfort with the transition but it was fine for me. It was mostly a matter of me trusting myself to try it. I think I kept my toes off the ground most of the time when in the cast. My leg was perpetually bent and pointing to the back and I would hunker over my crutches and balance. I wouldn’t try putting any weight on the toes while standing but resting, I imagine would be fine. (The way my foot was cast, it was awkward to get my toes down anyway–I think that’s why I usually just balanced.) I can’t imagine that your foot has gone from equinus to 90 degrees in the cast–my cast loosened up but the angle seemed to stay the same. Curious.
Thanks again. In case you did not know, my username name means excessive sweating. I have crazy sweaty feet. Hands were cured by a surgery (ETS), but feet still sweat a ton. Wonder if that affects the feet’s position in the cast due to accumulated wetness. They did make a slightly different cast for me due to the sweating (maybe more cotton in there?) and the top of it is not plaster of paris. Wish I could post photos here, but maybe if I start a blog I will. I have seen others with no sweating have the same cast though so its not very different. Am thinking of just moving to boots at 2 wks if doc allows it.
Some quick A’s, HH:
1) Boots beat casts in every way, unless you’re irresponsible enough to get in trouble while it’s off.
2) Some do (and a few here have done OK that way), but most go under the knife. Most of their surgeons say “It’s lucky we operated, because. . .”, but I have trouble telling truthful statements from “good bedside manners”. (Most of us who had ATR surgery were told that our ATRs were way worse than average, and I was also told thesame thing about a heart valve I had surgically replaced. But surely HALF of all these injuries are LESS bad than average?!?)
3) Maybe never. If any of us had an US or MRI machine at home, we’d probably get scans daily or more often, but there’s virtually never any clinical benefit. It’s a bit like the old joke about the farmer to kept uprooting his carrots to make sure they were growing OK. . .
4) I think letting the cast or boot rest on the ground still counts as NWB. But if you lose your balance, you’re in danger of accidentally loading it up. . .
5) The mechanism is unknown AFAIK — essentially “the magic of healing”. And the results would be inferior if the body did fill the gap with new tendon, because the new AT would be much longer than the original one, which would present biomechanical problems — search for “healing long” and “healed long” etc. for sad stories. One theory is that the (usually undamaged) sheath or “paratenon” that surrounds the torn AT somehow “programs” the healing so the two torn ends are brought together for healing — with the help of immobilization in equinus = ballerina = plantarflexion, which brings the torn ends together. One small study checked whether non-op patients with small initial ATR gaps healed better than those with large gaps (determined by UltraSound), and they did NOT.
5) (Yes, you had TWO 5’s!) There are people who’ve ingored ATRs and just walked on them. They survive and generally get around, but most of them never walk normally, much less run and jump or play sports normally. Without immobilization, the healing that takes place usually heals both torn AT ends separately, rather than together.
I’ve tried a few times to convince the authors of the 2010 UWO study to analyze their data and tell us (= publish) whether or not there’s any correlation between how “fresh” the ATR was when it was immobilized non-op, and how well it healed. They excluded patients whose ATRs were more than 14 days old, but I suspect there’s a correlation within that 0-14d range. If not, that’s also interesting. So far, I haven’t heard back.
I ruptured my AT almost 6 days ago doing West African dance, but was told after X-ray, sonograms, MRI review and surgeon palpating the area that surgery is not an option since the near complete tear is right up at the 8cm line and there is nothing the sew the tendon on to. I don’t plan to return to dance as a career but I would like to continue choreographing and dancing the rest of my life. I am relieved there is no surgery but am also wary the results may not be so strong. They have isolated the area with a simple L made out of fiber glass and covered with ace bandages until my AT boot with a wedge comes in. The surgeon seemed to think I would be putting weight on it in 2 weeks. I am hoping this function rehabilitation will work. Any thoughts? Looks like I am going to have to pt the hell out of the next year if there is any chance or regaining the strength.
Functional rehabilitation - obviously
Lulu, your high ATR may be a blessing, because the best ATR care these days (IMO) is non-op with a fast modern rehab — like bit.ly/UWOProtocol or the newer and even faster Exeter (UK) protocol. With a lower atr, you might have been talked/rushed/pressured/misled into surgery, which adds significant risks and virtually (& maybe literally) no benefit.
Your goal should be 100% recovery with no barriers to doing whatever you want to do. Yes, PT and exercise are a big part of the path, but no more for non-op than for post-op.
Thanks normofthenorth for posting so often! Wish more people came back here to post. I was going through the blogs of those who had re-ruptures after surgery, and most do did not seem to update once they crossed the 6-12 month market after second procedure. It would be so useful to get more updates of those who are 3-4 years post op, both first-timers and re-rupturees.
By the way, is there a place that lists blogs of only those who went the non-surgery route?
Norm, I thought the MRI clearly showed the location of my tear and possible the exact height of the tear in one of the images (need a professional to help me with that one). Why are you not a big fan of MRIs?
Also, why do all athletes get surgery if non-surgery can potentially lead to the same results?
Just decided to get scooter. Two days on crutches was more than enough! I wonder if I can use the scooter to go to a nice grocery store 1 mile away?
The scooter saved me in the house. I have used it for short trips but nothing long. Of all the tips I have seen on the site, I would most heartily second the suggestion to rent a scooter.
Hi everyone. I just found this site. I’m so glad to had found it. I ruptured my tendon… well waiting for MRI results and to see if surgery will happen. I’m nervous about the surgery. I’ve never had major surgery before and it makes me a bit anxious. I’m hoping to hold it off until the week before Xmas when my work shutdown comes up. I don’t want to miss a lot of work if I can help it. I would have about 17 days to recover so it would be ideal to do.
jtarnopolski, you may want to create you own blog and a timeline. This way, you can ask questions and get answers more easily.
With that said, hopefully Norm, Kellygirl and other non-ops will chime in because you do not HAVE TO have surgery. Withstanding, the Thompson test (above) is quick and simple and anyone can do it (either your calve muscle moves or it does not).
An MRI will tell you how badly the AT was torn, but in most cases, they will not really know if there are clots,etc., until they open it up.
Either way, if it is an AT, you should be in a boot or something, already. If you wait 3 weeks, wear the boot because you can develop DVT”s and tear it even more - That’s what I did.
Regarding 17 days to recovery, it takes more like 6-12 months for a full recovery. However, you may be able to PWB with crutches at 2-3 weeks. Search for PROTOCOLS.
Good luck and keep us posted.
Ron
Patiently Moving Forward.
Hi Ron,
Thanks so much for that. I’m already in a boot using it in concert with a crutch and staying off of it as much as possible. In terms of the 17 day timeline, I was referring to if I had the surgery and when I may be able to return to work after the plaster cast has been removed. Luckily my job is an office job, so I’m pretty much sedentary most of the time.
The ortho was really trying to push surgery on me and said 90% of the time they recommend surgery which I know is bullocks. When I meet him today, I will be telling him I want the surgery closer to home and see what he says. If he’s truly looking out for my best interests then he’ll refer me to someone closer to where I live. I get my MRI results today and will probably be getting a second opinion next week. That way I buy myself some time to see if surgery truly is necessary. The pain is close to my calf, so I’m guessing the tear around that area somewhere. But the pain actually isn’t bad at all. In fact, I don’t really need to take any pain killers (although I have them just in case).
jtarnopolski - No doubt you know the results of the MRI by now. Waiting a long time for surgery is probably not the best option but since you are already in a boot, hopefully with it fitted correctly, then you are on the healing road. By Christmas you wll be one month down the track. High ruptures are often not treated with surgery anyway as they difficult to sew. My father had a high rupture and went straight to a boot (non op) FWB so you can in fact continue to work as long as you manage your pain. If you are working now then there would be no difference. Most surgeons like to cut and will offer advice based on that. Don’t be scared off non op with threats of re-rupture rates and being locked up in a boot or cast for 12 weeks. Very old school. I am surprised Normofthenorth, Hillie or Kellygirl haven’t chatted with you yet. All successful non op with modern protocols.
Hi xplora. Thanks for that. I just posted yesterday. I’m a complete newbie here. Honestly, after chatting with my cousin Clint in Canada who is on his 2nd month still waiting on surgery to be performed, I don’t feel so bad. Looks like it’s a complete tear of the tendon. I will be possibly looking at surgery in the next week or so. It’s a tear about 2 inches above the heel.
The good news is everything else in the MRI came out normal. No other damage
JT, I can second what the others here have said about modern non-op ATR treatment, and there’s lots more on my blog pages, especially two: an early one on Studies. . . comparing op and non-op, and a more recent one called (+/-) “The Case for Skipping ATR Surgery”.
As Xplora said, high ruptures are often treated non-op even by scalpel-crazed surgeons who recommend ATR surgery to 90% of their patients, despite the newest and best evidence. BUT, while there’s lots of evidence of super-successful non-op cures when the treatment begins promptly — at least within 14 days, and sooner may well be better — there’s very little evidence of success with ATRs that were left untreated or semi-treated (or mis-treated) for longer. All of the successful treatments with excellent published non-op results start with at least 1 or 2 weeks of NWB, with TWO crutches, with the foot immobilized in equinus, usually 20-30 degrees PFlexed. (I think there is one new UK protocol that began with “PWB as tolerated”, but I think that’s the one that hasn’t published its clinical results, unliike UWO and Exeter, which spent 2weeks and 1week NWB respectively.)
As others have also mentioned, you’re odds of escaping serious pain and days off your desk job are much better non-op than op. But if you’[ve been padding around on that foot all along (even with one crutch), you’re not following a well-proven successful recipe, and you may be strengthening the case for surgery.
The theory here is basically that all ATR recovery is based on the body’s own healing and reconstruction. The non-op version harnesses the body’s frantic and potentially brilliant response to the initial injury, by setting up and protecting the torn tendon so it knits together and rebuilds, guided by a relatively rapid (but carefully timed) introduction of motion, exercise, PT, and WB.
But if that initial frantic bout of response (inflammation, increased circulation, etc.) is misspent, then it has to be restarted, which surgery does in spades, by trimming the torn AT ends and slicing a bunch of other nearby tissues too, all the way up to the skin. That gets the swelling and healing going double-time, and knits the (stitched) AT ends together quickly. Unfortunately, it usually also knits together layers of tissue that used to be separate, creating “adhesions” that can impair function if they’re not broken up, often by energetic PTs.
I’ve so far failed in a few attempts to get the authors of the UWO study to analyze the relationship between post-ATR delay before non-op treatment begins, and clinical success. So there’s no scientific evidence of just when the “window closes”, or how suddenly, etc. But all of the successful studies excluded patients whose ATRs were more than 2 weeks old, and most of them may well have been in the first week post-
ATR.
They also got great results without MRIs, and only 25 of their ~75 non-op patients had UltraSounds.
OK, I now see that your ATR is 2″ above your heel, so typical, and not especially high. BTW, all the modern studies that produced non-op results as good as surgical results included ONLY complete AT tears. Partial ruptures and old ruptures were excluded from all the studies. (Most people ASSUME that non-op works even better on partial tears, but there’s no evidence, much less proof.)
A sub-study of the UWO data that analyzed the 25 non-op non-op patients who had UltraSounds showed NO correlation between initial ATR gap size and how well they recovered — strength, ROM, or rerupture rate. Most people — heck, most OSs — would probably have bet against that result. (And many of them still don’t know that that evidence even exists!)
Where does Canadian Cousin Clint live? Here in Ontario (I’m in Toronto), I think we’ve got pretty quick access to world-class surgery, at no cost to the patient. My surgery for my first ATR was scheduled promptly, though that was about 12 years ago. For my second ATR, around 4 years ago, I got to see a very fancy sports-medicine OS (chief OS for our pro football team!) in a hurry — though he talked me OUT of getting surgery on that ATR.
A year later, when I finally decided to schedule open-heart surgery to replace a heart valve that was mal-formed since before I was born, they offered me my choice of dates, and the first date was so soon that I had to choose a later one(!). And that was with a very fancy cardiac surgeon (lots of published articles and the President of the Canadian Society of Cardiac Surgeons).
OTOH, I’ve heard horror stories about long wait times for care in Alberta and Saskatchewan. Like democracy, publicly funded health care seems to need some attention to get it right. Privately funded health care is no picnic either.
Hey Norm, Clint lives in MB. Waiting times there can be horrendously long. I feel bad for the guy as I will likely be out of my boot by the time he gets in for surgery. I haven’t actually seen the MRI photos but because of where the ortho was (close to my work, not my home), I got a referral for surgery to possibly be done closer to home. I would’ve gone on Friday to meet the new ortho but everything’s closed thanks to Black Friday.
The finding says it’s a complete tear and there’s a gap. It’s really not as painful as the damaged cartillage I had in my early 20s (that was excruciating). Pain is every once in a while but not bad at all… surprisingly
Wow, Explora, so impatient! All for a good reason I’m sure,
Unlike some here, laid up or at least a little idle during injury recovery, I really don’t have so much time to pop in here anymore, My injury, a complete atr, was 20 months ago and I have been ‘back on the road’ for a very long time now, having made a full recovery after an accelerated rehab protocol.
JT…
Take a look at suddsy’s comprehensive blog sometime ago which includes lots of good stuff from a number of contributors:
http://achillesblog.com/suddsy/2013/06/24/end-of-wk-2-wow-progress/
I know that Ron has kept up his relentless flow of advice since then, and Norm too.
Good luck with your recovery and stay informed - do that and you’ll be ahead of many of the medics.
Good on you Hillie, I thought the mention of a few names would spring people into action if not direct our newbie to some good resources on your pages. Like you I am not here as much because life takes over (for some at least). Can always count on Norm to be around to give support. Big thanks to Norm for his dedication.
JT - I can’t image why anyone would be waiting 2 months for surgery for this injury when they could have been walking again by now without surgery if properly treated. Surely a doctor would have seen that as an option given the circumstances of such a long wait. Hope you have advised Clint to visit this site. Hope too that all goes well for you which ever way you go. I went for surgery and had a great result but if the other one goes then I will not have any choice but to go non-op and treat myself. I live in a remote area now and for the last week the local (1 hour away) hospital didn’t even have a doctor. I would have all confidence going that way given the information I now have but it was not given to me as an option when I was first injured. There are many good pages from surgery candidates as well. You can visit mine if you like and RyanB has plenty of information (he is not around much now either).
Pleased to help but just coincidence I was passing. Will be even less in future I’m sure.
Explora, there’s a fine line between dedication and addiction!
JT, the amount of pain people feel from an ATR is unbelievably variable. Like you, I escaped essentially pain-free from both ATRs. The surgery on my first one hurt for several days, but even that was mostly the fluid pressure when my foot got lower than my body. Of course, swelling is always uncomfortable, but not painful, and not even uncomfortable when properly controlled. Others have described excruciating pain. Just the luck of the draw, AFAICS.
I am curious about what happens to people in villages in developing countries who often do nothing after an achilles tendon rupture. Considering that collagen and scar tissue grow in the gap between the ruptured edges when in cast irrespective of gap size, why would a person who does nothing (i.e., no cast, boot, immobilization or surgery — ever), not also heal over the long term even if it takes longer?
I assume that if you do nothing, you could limp forever, but it seems like there can be no studies done on this in the developed world to prove it. It would not be allowed!
Hi there,
I just came across this log and its so nice to hear that I am not the only one!
I had my operation 2 weeks ago, got the boot on 2 days and today I accidentally put too much pressure on my foot and immediately felt pain. I didnt hear a pop sound like when I ruptured my AT first. Went to local GP, did the thompson test and the achilles looks like its still in tact. Can move my toes and when my calf flexes, my toes move which are all good signs!
I was just wondering, should I go get an MRI just in case its slightly torn? Its sore (more stingy) or leave it a few days to see if the pain eases??
Any advice would be great!
our company had a “team building” soccer game. I am 40 and in good shape. totally blew out left AT playing soccer. the irony: the company fired half the “team” the next day while i was trying to put my leg back together. they didn’t fire me but now i am lame. I am so angry that they had the ‘team building’ exercise when they knew what was coming. now my wife is giving me no sympathy and telling me it is my fault. She is also being incredibly unsympathetic about it all as is my employer. I feel like suing the company I work for and divorcing my wife. seriously. i have never been injured in my life and suddenly everything is not what i thought it was: i can’t walk, my wife is a bitch and my employer is acting like it was my fault and goading me to get back to work (started the day after surgery from home.) I am a very angry teddy bear right now and don’t know what to do. literally, I am thinking of limping out the door, getting into the car, and dissapearing and starting a new life some where.
i forgot to mention my AT blew out on 26 FEB. i had surgery on 6 march. my employer screwed up and didn’t have our BUPA insurance activated until, yep, MARCH 1.
lucky for me i had my own ‘back up’ plan in place which covered it. honestly i am so frustrated i want to scream and kill a few people at work and my wife…who thinks ‘oh, it’s not as bad as you say…quit being lazy…you always have to be the centre of attention…you’re not a real man now…it’s not the companies fault, its your fault for playing so hard…don’t complain or they will fire you.
honestly, i am not sure if she thinks this kind of verbal abuse is supposed to be ‘tough love” or what, but i have just realized I am married to a psychotic, heartless, money grubbing bitch.
Exciting stuff, Al! Most of us had the opposite experience, at least at first. After a month or two, lots of people hang out here because “nobody understands me”, but you deserve better, esp NOW!
For the wife and marriage, I’d say take a deep breath (or a pill!) before burning any bridges. The job too. Your new “clarity” may be the way things will look a year from now - or not. This is a tough time for all three of you, and nobody’s born knowing how to deal with it.
Hello everybody,
I just had ATR on my left leg playing BB on Wednesday night. I am close to 40 and still thought I could run with the young guns. Got into the ortho doctor the next day and he explained the options of surgery vs non surgery. He highly recommended the non surgical route as he has seen identical results with less complications this way. As I read a lot of the comments on here I am starting to wonder if I made the right decision. I am not overly active and can live without BB. I am just dreading the long road ahead. What is the normal recovery for those that went the non operative route. Thanks for the comments.
After reading through decided to sign up for an opinion.
Was playing Basketball & suddenly felt the dreaded ‘kick in back of foot’, was ready to get angry at whoever did it, and realised I was alone. Due to there not being much pain, thought it was a typical ankle roll, so attempted to carry on playing, which failed as I felt I was standing on an uneven surface. Stopped playing, and drove home (about 10mins away), then got convinced to check it out (luckily).
After 6 long night hours in A&E had an Xray & then doctor said I had an Achilles Rupture. This is where the problems began.
Doctor didn’t look at the X Ray, but said he knew the injjury & I was to go in a plastter cast, toe pointing downwards. The person who fitted my cast fit it with my smallest toe tucked under the rest, which became painful as days went on.
2 weeks on, went back to Fracture clinic, cast was taken off.
Clinic was amazed at the fact I didn’t have a scan to assess the rupture, and had already been put down to take the surgical option. They said that it may not indeed be a rupture and may be a minor tear. Also at the time, realised I’ve lost most movement in the tucked toe, and my whole foot has swollen quite bad.
At this point they put me in the boot (ran out of heel wedges so have placed some cotton there which I personally see as VERY dangerous), and booked me for a scan. 5 days on, had the scan, & have now been confirmed an Achilles Rupture.
I’m now currently waiting for my next Fracture Clinic appointment in 3 days time, but feel as if they’ve already wasted close to 3 weeks in which I could have used to recover. All of the surgeons are advising me to go the surgical route (although none have seen the results of my scan yet), but I don’t feel comfortable with having surgery with any organisation that can make mistakes on small details, what’s to say they won’t cock up the surgery?
On arriving to the hospital I did explain my worries at the fact my current job is cash in hand, and if I don’t work, I don’t get paid. I don’t need much movement but need to be able to stand, and the longer they delay, the longer I’m out of work.
As 3 weeks have already passed, I’m now leaning towards the conservative route of treatment. Just wanted to get opinions on here of whether I’m in the right frame of mind, or indeed over reacting.
Nate,
I just ruptured mine last wednesday and the orhto I saw who has 30 years experience gave me both options but said the conservative route would be the way I should go. Honestly told me he had a good friend go the surgical route and ended up with some nerve damage and would have been better off without surgery. I have been doing a ton of reading on this since I have loads of time now and it seems the non operative route is recommended more and more. I am close to 40 and told the doctor I could live without BB, just want to walk again. Good luck on your recovery.
Thank you @bacmeron1007.
Had a slight update, I’m 24 years old, used to play Pro Basketball when I had more time to commit to it but currently don’t. Hospital has called back and said after seeing my scan they advise surgery as I won’t heal properly otherwise.
In my position I don’t mind not playing as much as before, as even after surgery the thought of re-rupturing will be in my mind, I just want to get back to walking as soon as possible.
They’ve scheduled me to come in this Thursday to operate, and when voicing that I may want to choose the other route they have been very pushy towards operating (not one person has said they can treat it otherwise, they all advise to operate, all without assessing injury properly)
Hi Nate,
Yeah my doctor didn’t do any scans, MRI’s, or x-rays. Just did the thompson test and said full rupture and then told me to do conservative route because of less complications. I understand there is a slightly higher risk of RR. I hope the doctor is right going this route. I guess I have to trust him with his 30 + years of experience. Let me know how you progress. Best of luck for a speedy recovery!
Nate (and BC), I’m usually one of the biggest proponents of non-op care around here, based on the 6 newest studies and the newest meta-study, which together show that there’s basically no benefit from ATR surgery, and a number of increased risks — PROVIDED that a modern fast protocol is followed and not the old “conservative casting” program that always produces higher rerupture rates.
BUT that doesn’t mean that surgery is NEVER indicated for an ATR. Traditionally, I’ve recommended surgery for anybody who’s been untreated — especially walking around on it, and not immobilized “in equinus” — for more than 2 weeks. Interestingly, the newest study — involving almost 1000 non-op patients in Ireland — suggests that non-op treatment can achieve just as low a rerupture rate (<=2.7%) on “stale” ATRs as it does on “fresh” ones, _at least the way they did it in Ireland!_
The key to their success was simply that the senior OS checked (with his eyes and his hands, no MRI or U.S.!) to ensure that they could find an “equinus” (plantar-flexed) angle that brought the two torn AT ends together. If so, they immobilized the patient at that angle, gradually sliding toward “neutral” position. IF NOT, they operated.
This sounds so basic, simple, and Obviously Right that it’s amazing — if not criminal — that every hospital doesn’t treat every ATR patient this way. But they sure don’t, so it’s up to every ATR patient to be their own Patient Advocate and get the best care.
P.S. While MRIs and ultrasound may be unnecessary for best ATR care, AND while X-rays can’t detect soft-tissue problems like ATRs, it probably IS a Good Thing that most of us are given an X-ray when we present to the first doctor or hospital. The reason is that some small fraction of ATRs involve the AT pulling a chip off the “calcaneus”, the heel bone, and that changes the prognosis significantly. And an X-Ray is the best way to spot that.
Norm, thanks for your input. My follow up is on April 9th when I am supposed to go from full cast to cast below the knee I hope. I will be at 3 weeks at that time. I believe the doctor said then another 3 weeks with shorter cast then boot. What questions should I be aware of to ask him at 3 weeks? Thanks so much for your input. Brad
Quick update, have since decided to go Non-Operative route, due to the lack of organisation in the Hospital I’m at.
Had surgery scheduled for Thursday morning 9am, got there and they said they have to re-schedule to Tuesday due to an emergency. My mother works there fortunately, and over the weekend saw someone who had similar surgery come in. They came in to have it re done due to surgeons placing a disk upside down (or something like that) and an onsetting infection, so that’s totally put me off.
I’m now on week 3 post ATR, in a boot (Had to buy the heel lifts myself as the hospital had none), and after calling them up they’ve said if I’m going NonOP route I need to rest until 5 weeks, non weight bearing.
I can pretty much walk, painless without crutches at this point too, and have zero swelling. I also take off the boot twice a day to lightly flex my foot up and down, movement gets better each time I try.
Thinking to transfer hospitals as this passive approach usually is what leads to RRP, what do you guys think?
BC, boots beat casts in almost every way, and full casts are torture with no benefit. And 6 weeks casted non-op is clearly associated with worse outcomes than going faster, like the best new studies. Ask your Doc if he believes in evidence, and if he’s got any to compete with UWO and Exeter (which you should print out and share).
Nate, it’s always nicest to be in the hands of an expert who’s headed in the same direction you are. But you have all the protocols here, somewhere. bit.ly/UWOProtocol is UWO’s.
Howdy guys
New to this so forgive if im in the wrong place. Ruptured my right Achilles tendon on the 18th Nov 2013 whilst playing badminton. Operated on 24 nov 2013. All was going well, I was starting PT doing ok but around the 3 months post op period I felt there was something not quite right. My ankle would be quite swollen and a lot of edema(fluid retention) my ankles were sweating a lot..lol.
I told the physio team and they didn’t seem to take much notice. Anyway I gritted on and on my next pt appointment I asked the head physio to contact the surgeon who had carried out the op to see me. She said she would and let me know on my next visit. On Sunday it was a nice day I went out for my 2 mile stroll along the local canal. 20 minutes into the walk my leg gave way slightly and a sensation of a strand coming away from a rope was felt. There was localized pain around the ankle and incision site.
To cut a long story short, eventully got to see my surgeon who put me in a vacoped boot and then sent me off to have an mri scan. told me to come back to see him a few days later. Few days later I saw him, he says mri shows rupture to tendon above the site of where he joined my tendon, however on thorough clinical examination he says the tendon seems intact and healing fine. Anyways I have to now go for an ultrasound to see what the next step is.
Sorry to have bored u guys with so much info but it helps to share .
I am 54 years old and play baseball on weekends and yes that is hardball in an organized amateur league. On April 26, 2014 I slid on second base, but my left cleat got stuck on the ground as I was sliding and twisted my ankle in the process. I left the game and applied ice on my ankle. Two weeks later I went to see a doctor, took X rays and showed a stress hairline fracture in my fibula close to the knee. He didn’t see the need to put a cast on, he just suggested to go back in 3 weeks to take another X ray. It has been 5 weeks since my injury. I still walk with a limp due to a minor discomfort in the back and outer side of my calf. I can not stand on my toes, but I performed the Thompson test and I do have movement on my foot. Some of the symptoms I have seem to point towards a Achilles tendon injury, I don’t know to what extent. I have not had time to go back to see the doctor again. I’m dying to go back to play baseball, but I can’t run right now… Is this something that can heal by itself and if so how much longer do I have to recover? What can I do to speed up the process? Or is it the fibula fracture that is causing the discomfort?
jsenties - if you have done the Thompson test correctly and there is no movement then you should see a doctor immediately. The indications are there of AT damage and if you want to return to baseball it should be treated. You could find another doctor who would be willing to do an ultrasound or MRI to confirm the diagnosis as the injury would now be classified as stale. This is the first step to speed up the process. If the AT has been damaged it could be 6 months before you play again and it will be at least a year before you feel normal. Many doctors misdiagnose this injury particularly when there is another injury in the same area. You may not have completely ruptured the tendon and that makes it harder as well. Keep us posted.
Newbie! Having surgery on Tuesday complete tear 5 centimeters above insertion while playing tennis. I am 46 active. I remember about 4 yrs ago playing softball on a run to first base and I injured it. Took it easy and things got better. Well here I go. Self employed and newly married (poor guy). Time frame between injury and surgery is about a month kinda freaked but more accepting each day. Glad to have found site. I have read so much on it very helpful. Trouble sleeping have my leg propped up and I think when I dose off my foot drops into flex wakes me up. Darn painful ahhhh nice to be able to vent
As the name suggest, this is (sadly) my 2nd tour of duty! Left ATR was back in 2007 and lightning struck twice this past weekend - Saturday 2nd May to be precise, and the right one ruptured.
Maybe it’s because I’m in my mid 40’s now and ‘been there done that’ but you know, it really is ‘what it is’. This too shall pass
What I WOULD like to do is say a huge thanks and kudos to Dennis for setting this up, and everyone else for contributing.
Even though I have been through this before, the injury is still very sore, and I came online in search of some info, and I’m just so impressed to see such a stellar group rooting for one another. Great stuff!
‘Deuce’
We need a club for people who have a set of ATRs, especially for those of us who did the left one first, and now the right one. I didn’t have a knee stroller the first time, but got it now. Anything to not have to constantly use crutches. I don’t have any great advice. Just keep positive and know that it has to get better, even though it takes a while.
Does anyone have any workout routines to do for core and upper body? I want to start lifting again next week when I hit 2 weeks post op.
Live in the UK. Ruptured my left AT last Wednesday. In plaster waiting for consultant review next Wednesday 3 Feb. Hoping it isn’t as bad as it sounded when it went!
Welcome to our blog, BlueCountry.
Please do read all the posts, specially the “pre” advice that we all gave Metonia (it would be in her blog replies), though other users have also given great advice on what to get or do before going surgical or non-surgical.
I will I had read this blog before I had the cast put on, and then before I put on the boot! It would have allowed me to be calmer.
The other point is that your fellow UK bloggers can give you hints as to how to work with the system.
For example, I read that the UK is now promoting non-surgical repair of your Achilles Tendon. since I am also non-surgical (also called “conservative” in some posts), I can also suggest you check out the “aggressive rehabilitation” protocols, and comments on the “moon boot” you will be using. there are a lot of brands out there, an apparently the Vaco-Cast is the best. I use another brand which is OK.
Good luck, and remember that we are all here to support each other!
Thanks for advice. I will check out the posts. Interesting regarding the non surgical approach. I was set on the aggressive approach but will review. Thanks again.
hi folks,
hello from Scotland. just thanking you for an amazing effort that has allowed me to stay as calm as possible.
i had my tendon rupture on Thursday 28th of Jan, so i’m one week and a day in. A&E and the specialised fracture clinic in Glasgow wouldn’t scan, i had three separate physical examinations and they all concluded the same: full rupture, got a hard, heavy cast (looked like a butcher did the job) and was sent awa.
i managed to convince them of the seriousness and they ‘fast tracked me’ to an orthopaedic specialist on tuesday 2th of February (three days ago). such ’specialist’ examined me and concluded the same and sent me off in a lightweight cast.
i had to argue with him for about 20 minutes, and finally won, so i’m scheduled for next tuesday 9th with the ankle specialist and the fracture clinic. I am hoping he will definitely do at least an ultrasound to check whether a non-op will be ok.
question, what are your experiences of getting the vacoped boot on the NHS?
this article helped me a lot
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436906/#!po=26.4706
thanks in advance.
Pozaicer, what a bummer when a doctor refuses to see and help you the minute you show up. Been there, done that… But as I see it you are already in the non-operative protocol (which I followed), and the use of a CAM boot would definitely be a great option for you (assuming you have a similar injury/physical condition as I do). the VacoCast is state of the art and the best CAM Boot available. But the one I have is not bad, and any of these cam boots with heel inserts to help your achilles tendon heal while you put weight on it is a wonderful thing to have in comparison with the regular casts.
I suggest you read different posts and find out what you have to prepare for (last two weeks have had lots of “get ready” postings for upcoming surgeries/treatments) and feel free to ask questions. We are a bunch of recovering survivors and are always ready to give a hand and some advice to new members of the clan (wow! I managed to make a “scottish” pun) LOL
Good luck! And remember you are not alone!
Manny
hi Manny,
thank you so much for your response. i had not had a chance to get back to the blog and find the comments! i’ms are i’ll get better with time.
i’ve had my appointment today and been pleasantly surprised with a caring and patient doctor who spent the time discussing options and my personal situation.
i’ve settled for the non-operative protocol (i did get the option for surgery, but i do not have any intention to return to competitive and high endurance sport) and was given the assure ‘rebound air walker’ boot. i hope it is just as good as the vacocast/vacoped.
it is only 7 hours from fitting but already my life is a huge deal better.
i’m reading loads of protocols on how much to do in terms of ROM exercises, etc, and it is really helpful.
one thing i have read, several places, is that in the boot you are only suppose to touch/bear weight when you feel it in your ‘heel’ and NEVER in your toes. i’m three days from starting this, but i need to get it right, if you have any wisdom please share it.
a very happy chap now, and glad to be part of the clan!
(it is amazing how limited the world becomes when you have less mobility than the average person, a very humbling and eye opening experience!)
suerte
Carlos
Carlos, I’m glad you bot the boot!
Being able to use the boot is a blessing since you can move around and even learn to walk in the boot.
As for the question about putting weight on the toes, the boot supposedly keeps your toes down, no matter what, and I suppose you have wedges in your boot to keep the toes all the way “down”.
Moving or flexing the foot inside the boot is quite difficult if you keep it snug.. maybe even impossible, but I have seen people do impossible things before. the important thing is to learn to “roll” on the bottom of the boot. And, you whould level up the other foot to put both beels at the same height. How? amazon sells inserts, as well as special over the shoe “even-up sandals”, to help. You can also have heels put on your shoes, or use socks as lifts within the shoe… I bought lifts that have 4 separate wedges, and used the medical sandal I was given when my foot was put in a splint at the emercency unit.
The lifts can be moved from shoe to shoe, and I use them in my sneakers for therapy, in my snow boot and shoes when needed. I will continue using them when I go to 2 shoes, too.
There are some videos on walking in the boot, so check the blogs.
Good luck then, and keep the weight off your toes for now!
Manny
thanks Manny, will check them out. i’m a mere wk 2 so there’s no need to rush. i’m starting some gentle pwb tomorrow with the boot will see how it goes.
you are right, it’s quite difficult to do anything bad with the boot, and i’m not doing any attempt to walk till week 4 anyway
i’ll stick to pwb then fwb till the physio starts properly. i do have wedges etc, and will keep an eye for the lifts in four weeks. you keep up your amazing progress. thank you pal
suerte
Hi everyone!
We at iWalk have created a great injury resource center that includes causes, diagnosis and treatment of achilles injuries. You will also find advice on how to stay positive and active after ATR, so please feel free to utilize this resource!
Hi all,
I was playing basketball and felt the infamous “kick” on Feb 28, 2018. Its been a little over 3 weeks since the injury. The day after the injury, I went to the doctor and got an MRI, MRI stated that I had a grade 2 partial tear–called it a severe case of tendinosis. The doctor showed me how the tendon was still attached. He then put me in a boot right away without any wedges and FWB–stating it heals better with more functionality. He told me to wear the boot for 8 weeks then slowly wane out of it. I was thrilled as I was expecting a full tear and surgery. After going home and doing some reading, I was concerned as not many protocols were this aggressive.
A week later I got a second opinion, just because I felt like it was the right thing to do. The second doctor was less optimistic. He said it does not require surgery as it is attached, but he wants me NWB for 4 weeks then boot with wedges. This was more in-line with the readings online.
I was not in pain from the immediate weight bearing prescription from doctor 1–I could walk fine with FWB in the boot, but I still tried NWB for 4 days until I just could not deal with the struggles of NWB. So I resorted back to FWB. Before I went back to FWB, I got some 2 cm heel inserts just so I have some peace of mind.
With that said, has anyone been told of a similar protocol for a partial tear as I was told by doctor 1. I’m 3 weeks in and I can do a lot of things I am seeing people write and youtube themselves doing at week 5-6. Any feedback would be appreciated.
saheelm24! I, much like you, tore my left AT while playing basketball. Took a big, quick step left after coming down for a rebound and BAM! Felt like someone kicked me in the back of the leg.
Mine was a complete tear, and I am now about 2.5 weeks post-surgery.
Granted, my experience is going to be different from yours…. but I would strongly encourage you to take it easy and take it slow. You’re fortunate to have had a partial tear. From what I have read and heard, the most common risk of rupture/re-rupture or delay in recovery comes from rushing the rehab. Remember, the AT is not like a bone or even a ligament in your knee. The AT gets very little blood flow and takes a LONG TIME to heal.
In my eyes, you’re better off taking the next 8 weeks slowly (and I’d think that would mean NWB for a few weeks) so you don’t end up with a weak tendon or further issues. NWB sucks, but I’ll tell you what sucks even more… surgery and 6 months of recove