Am I taking a risk?

Just about 11 weeks since start of treatment - non-op. At last appt 2 weeks ago, new UK NHS doctor at the hospital said that I seemed to be doing pretty well but I should stay in aircast boot another 3-4 weeks and then probably go into 2 shoes at that time depending on next examination. Past few days though I have only worn boot (plus one crutch) if going out for longer journey on foot (like to church on Christmas Day - 10 min walk) but have been walking round home either barefoot or in shoes - I’ve been careful, particularly going up and down stairs etc. But is what I am doing too risky? Should I be staying in boot in the house regardless even though i find wearing the boot painful on the underside of my heel. I can’t really walk without a limp without boot (but unsure if limp is due to my achilles, or calf muscle (or prob a combination of both). I’m not in any pain either (although its strikes me reading these blogs that pain may be more as a result of having had an operation which, of course I haven’t had.) I’m due back for my next appt in 2 weeks now and will, of course, be wearing my boot for it and am assuming - barring accidents meantime - that I will then be told i can do what I’m mostly doing now anyway with doc’s approval. I can do double heel lifts at the moment but find the idea scary so don’t push it. have not been recommended physio at all. I do have a redundant exercise bike which I could use - and no doubt will shortly, but so far have been dubious about using it. Any advice from others who have followed a non-op recovery?  One other query.  My hamstrings both feel particularly tight and uncomfortable, particularly in the mornings.  Has anyone else found this to be the case?  Might it be a result of having my heels elevated (1.e when i was using the boot also used to put a balancing heel lift into my other shoe.)

Meanwhile a belated happy Christmas to all and wishing those in achilles rehab a swift recovery in the year ahead.

13 Responses to “Am I taking a risk?”

  1. I can only address the hamstring issue. My hamstrings have been really tight.

  2. For what its worth I never wear my boot unless I leave the house. Otherwise I have my foot elevated as much as possible.

    I was taken out of a cast after the 1st week…..seems odd but Ive had minimal to no pain. Ive also put zero pressure on the foot & it hasnt seen the ground in 4 weeks. For Post-op week 2 I cant complain.

    I can say that the boot did re-aggravate a bunion before surgery so im not looking forward to walking in it, which is why I only wear when necessary.

  3. 11 weeks immobilized would be a LOT. The very successful UWO study specified “wean off boot” at 8 weeks into treatment (w/ or w/out surgery) — see . Are there risks? Sure, and they don’t disappear if you stay in a boot for months, either! So definitely Watch Your Step, and try to avoid slips and falls and other injurious errors.

    When you’re limping bootless, concentrate on having your “bad-side” toes facing straight ahead — or at least as straight-ahead as normal. If your gait is shorter when you step over that foot, or if you “dip” at the end of the stride, then fine, and “welcome to the club”, and “this too shall pass (eventually)”. But avoid the temptation to find new and creative ways to walk, like with your “bas-die” toes pointed out. They can cause other problems, and be hard to “lose” later.

    An exercise bike is a great way to stay in shape while recovering. By shifting “that” foot forward on the pedal, you can apply as little force to the calf-and-AT as you like — kind of like standing in the water while you do heel raises!

    Many of us (including you and me) had very little or no pain, apart from surgery for the post-op crowd, while some others suffered terribly.

    Luigi, if you’re boot is properly sized, there should be a way to protect your bunion. You may need a wider boot. . .

  4. I was 8 weeks NWB and in a boot till 10 weeks where I went to FWB a week later. I’m now at 14 weeks, 2 shoes and walking better every day. During my recovery I’ve found the advice on this site is really good, there is a lot of it though which can be frustrating. Here’s what I’ve learned and works for me.

    1. Don’t be overly concerned about being immobilized longer than many others on this blog. An extra 4 weeks in a boot won’t seem like much a year from now. However, you have been immobilized for a long time as was I. We both have lots of scar tissue and a stiff repaired tendon. It will take us longer to achieve the flexibility we want versus a protocol with a shorter period of immobilization.

    On the other hand if you feel the doc is not up to date on current recovery protocols then let him (or her) know and share the info from this site. My surgeon who is experienced with ATR learned stuff from here. Guys like Norm, Stuart and Ryan have taken the time to gather a lot of info and share it.

    2. Walk without limping no matter how slowly. If you need to go faster use a crutch on the opposite side but don’t give into limping. See Norm’s post earlier today about walking gait, as usual he’s spot on.

    3. Do your home physio exercises without fail! We’ll all be doing these for a very long time, if not the rest of our lives. And don’t forget to stretch your hamstrings, they have not been used much these last few months.

    4. A stationary bike and elliptical are great for cardio and stretching the tendon. My stride is a little longer after an elliptical session, that’s a good thing.

    5. After walking for a while, alas not a very long while it’s likely you’ll have pain and by the end of the day, swelling. That’s normal, there are a lot of small muscles waking up after a long period of dormancy and they’ll be cranky.

    6. Elevate your foot as often as you can throughout the day and ice it in the evening, every evening. Suggest you firmly wrap the ice packs with ace bandages to get some compression.

    And finally …

    Buy yourself a good pair of “recovery” sneakers or shoes. In my case they are Merrell Jungle Mocs a half size bigger (and wider) than usual to leave space for .25″ lifts and some end of day swelling. When we’re fully recovered we can have them bronzed like baby shoes :) Merrell, Brooks and New Balance are all good brands and offer wide widths in many models.

  5. I too was non surgical and am very happy with the results. I believe you need to listen to your body. I was out of my boot around the house a ling time before I did that out and about. Use the boot for protection but when at home go for it. I think physio is really important not only to build strength but also stretching and flexibility. The exercise that really brought it home to me bizarely was when the physio made me stand on my good leg with my eyes close in a door way and I had to hold on to prevent me falling over!!! Its not just your leg thats affected. Good luck with your healing but try and get some physio. LL

  6. Hi
    New achilles complete rupture, non-op.
    Any 1st hand experience of the healing process will be welcome here.
    New Years Eve and I decide to play badminton and SNAP went my left achilles!
    Now just 1 week later, wearing boot with 4 wedges, sat here, leg raised, extremely frustrated and naturallty quite worried.
    Are these boots sided? When I look down everthing seems to be facing left by about 30 degrees. surely they have not fitted me with the wrong boot have they?
    I know better than to rush things but at the moment I regularly curl my toes downwads, stretch them upwards, raise my leg up and down to try keep my thigh strong, does this help or hinder?
    Getting around the house OK on crutches. Wobbling on them half asleep to the bathroom during the night is very risky, so I now go to bed at about 1.00am to try prevent having to do this.
    I sleep in the boot and dare not remove it at all for fear of harming whatever may be mending at this early stage.
    Having a bath is difficult!
    Feeling very frustrated at loosing my independence and now being almost totally relant on my good wife and kids is alien to me .
    Makes me once again appreciate what others with more serious problems have to cope with!

  7. Hi I am new to the blog and just now setting mine up. I had to comment on the boot. I LOVE my Vaco cast! The boot Kaiser insurance gave me is the “ole standard black velcro put the heel wedges in boot” you and everyone gets. I thought the same thing about it. My ATR is the left and with the “bad boot” my knees were knee knocked while my left foot swept outward 30 degrees. Trying to start PWB with this boot was not right! With the Vaco is more comfortable with the liner forming to my foot and the way the boot buckles down it does not put squeeze my foot to death and nor do I have strap marks on the ankle and top of foot. The sole of the Vaco gives a natural heel to toe rocker and easy to walk! Today I walked 2 miles and have only been FWB since 12/19. Instread of putting in heel pads in my right shoe (like needed 6-8 of them) to even me out I wear a comfy platfom wedge heel. Wow you opted for a non-op? How does the achilles reattach itself????

  8. Hi
    Nobody explained to me how the two tendon ends re-attach non-op so I checked it myself on the internet.
    The foot is held in the boot or cast with the toes pointing downwards so that the two tendon ends “meet”.
    I understand that the healing process is similar process to a broken bone and the tendons, grow and mend on their own as the fibres regenerate, albeit never as strong as before. What I am not sure about at this stage is how they will re-attach and also be “correctly aligned” as they would be with an operation!
    An operation was briefly mentioned to me but I was then directed to the room where my boot was fitted and I was sent on my way non-op and no real oportunity to request one. No real guidance either of how to cope!!!
    Disapponted at the hurried treatment and my next appointment is in another 10 days. I intend rsearching this injury and asking the consultant (or his assistant who I saw initially) some relevant questions at that time.
    I was told by the nurse who fitted the boot that I could remove it for sleep and shower!! Surely this can only be harmful, especially in bed. My boot is staying firmly fastened until my appointment!

  9. First some immediate advice. Yes, do not take off your boot for any reason! It’s there to immobilize your injured leg in an optimal healing position, essential during the first weeks of healing, especially for a non-operative recovery.

    It sounds like you are receiving bad, uninformed or at best inattentive care. Follow your instincts and actively manage your treatment and recovery. Recovery for ATR is complicated, much more so than a broken bone.

    This blog is a fantastic resource, folks with our injury tend to be active, curious and involved. And importantly share a lot of information based on personal experience and hours of research.

    There are a few people you should particularly read including for exhaustive data on non-invasive recovery protocols, for aggressive recovery strategies and, for thoughtful insight. You can read my posts too, mostly I complain a lot that my leg hurts.

    Your initial experience sounds exactly like mine. For my initial diagnosis I was with the ortho for 15 minutes, given a boot and told walking was OK (although not to take the boot off) and then to come back in a month. I suppose because I’m 57 the doc saw me as someone who was not active (not true, I am) so why bother spending resources on such a patient? Don’t know what she was thinking but whatever it was clearly not in my best interests.

    I got second and third opinions, ended up having surgery (which was the only way my tendon was going to heal remotely well) and was on my way to the long slog of recovery. It’s been 15 weeks since then and I’m walking in regular (2) shoes; but not without good care, 9 weeks on crutches and a lot of hard work.

    Your recovery is going to feel interminable at times, this injury is life changing. Your rehab and recovery will take a long time, how fast it progresses is a function of the injury, how your body heals and your resolve. I spend 60+ minutes a day on injury related exercise, and will probably do so the rest of my life.

    So, welcome to the ATR club! To paraphrase Groucho Marx, not a club you really wanted to be a member of :) But it’s not all bad, the members here are a pretty good bunch of folks.

    Good luck!

  10. Hi all
    Many thanks for your advice, it is greatly appreciated.
    I will continue reading this very helpful blog and also keep posting my progress so that it may help others with a new achilles rupture.

  11. Addressing Harry H’s comment and jjniss’s response -Its horses for courses. I chose to go non-op, was immobilised in a cast for 5 weeks, but then put in a boot which I did take off at night and to shower. Gradually weaned myself onto walking and can now walk pretty well normally in 2 shoes after 12 weeks. Very slight trace of a limp. Still pretty cautious though and do use the boot if I have to walk longer distances outside. Turning point for me was about a week ago when I did walk quite a long way outside without the boot. Found it tough going towards the end, but no soreness in the tendon and was certainly limping noticeably. But since then the limp has virtually disappeared altogether when walking around the house. it does strike me that once past the initial healing stage then perhaps the more one uses the tendon the better the healing process progresses. Have hospital appt. this week when I’m pretty sure I’ll be told I can officially go to 2 shoes, even though mostly doing that already. Not sure on the comment that healing non-op you end up with a weaker mend than operative. Any additional comment or data on this appreciated. Also on relative strength of a healed tendon vis-a-vis an unruptured one. Sure I’ll carry on walking very cautiously for quite a long time to come, but I do seem to be getting to the stage where I don’t have to think too much about the tendon while I am walking.

  12. Hi lawwill & jjniss
    Thank you so much for your comments and advice.You have been most helpful and I am sure your comments are also of benefit to others.
    I will continue post my progress so that it may help those particularly with new Achilles Tendon Ruptures.
    Take care

  13. Once the ruptured AT heals, with or without surgery, it seems to be at least as strong as it was before. I’ve never heard of anybody who re-ruptured an AT that had fully healed (like say 6-12 months post-whatever or more), and we ALL ruptured one that had NOT torn and healed. Moreover, the science is clear that we’re all at elevated risk of rupturing the OTHER one (as I and several others here have done), again suggesting that the healed AT is stronger, not weaker, than before.

    It USED to be clear that non-op (formerly called “conservative”) AT treatment carried higher rerupture risks and brought a less complete recovery. Newer studies (>2007), using faster rehab protocols than used to seem prudent, have produced non-op clinical results that are either identical to post-op results, or a bit better or a bit worse, depending on how you lean back and squint when you read them. One of the best, from Canada’s U. of Western Ontario (”UWO”) is available on this website in full text. Even in one of the larger studies of its kind (~150 patients), their non-op results were all statistically indistinguishable from their post-op results, though there were some “insignificant” differences that some patients might care about. And of course, the risk of surgical complications was one-sided.

    I would stay in the boot for the first 2 weeks without exception, and probably sleep in it for several weeks thereafter, esp. if you often get up in the middle of the night. The UWO protocol — e.g., at — prescribes exercise and PT (out of the boot, of course!) starting at 2 weeks post-whatever (op or non-op), and PWB then, too. FWB “as tolerated” at 6 wks, and “wean off boot” at 8. And their results were among the best in print. I think it was around 5 weeks post-non-op when I started showering and sleeping bootless. (I’m sure my blog remembers!) It’s mostly a risk-vs-benefit thing.

    As for how the tendon ends will re-attach and also be “correctly aligned” as they would be with an operation — it’s a good question, and like so many things in science, we discover WHAT happens many years before we discover why or how it happens. In this case, it’s only in the past 4 or 5 years that we think we’ve discovered that they DO reattach non-surgically (with a good non-op protocol) to create comparable strength and ROM (the best measure of tendon length), and I’ve only heard theories about HOW. My fave theory is that the AT, torn or not, is surrounded by a (not torn) sheath (”paratenon”) which guides the healing process to arrive at more-or-less the original tendon length. But we don’t really know, so I sometimes call it “magic”.

    One small study examined the UWO study’s non-op results as a factor of the patient’s original ATR gap size, as measured by UltraSound. “illogically”, it seemed to make no difference — the big gaps healed non-surgically just as well as the small ones! (One scientist once said that it was easier to prove that a bumblebee could NOT fly, than it was to explain how it actually does it!)

    I think it’s unfortunate whenever any patient feels that his/her treatment has been decided arbitrarily, without some discussion, education, and informed consent. Personally, I think more ATR patients are still rushed into surgery without time to think than are deprived of surgery arbitrarily, but I wish both practices would stop.

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