Elongated Achilles Tendon post op 24 weeks

Well, I was supposed to have my final check up with my surgeon, but bad news was given to me! So they chopped my leg up a whole bunch and reattached my achilles, and then I go through all the pain and triumphs of getting better and physical therapy! Well BEWARE my physical therapist was all happy that my range of motion was actually better in my bad leg then in my good leg, all my measurements especially the ones of when you pull your toes back towards your chest were better than the rest and I was all smiles and my therapist was all smiles.  I go to see my Dr. and he was not so happy, I was wondering why after 6 months I was struggling to do one leg calf raises and go jogging, well now I have an elongated achilles tendon, it was over stretched after surgery! So be very careful and make your therapists aware that you don’t want an elongated tendon at the end of all your hard work!

I am also wondering if this has happened to anyone else out there, I looked online and it seemed pretty common, the worst part is the only cure for an elongated achilles is SURGERY!!!!

26 Responses to “Elongated Achilles Tendon post op 24 weeks”

  1. Healing long is one of the worst things to happen and not enough is known about why it happens. There is not much information about your rehab and it would be helpful to many others if you can take the time to document how you were treated. Some people like Doug stretched the tendon in the early stages and had a good result but others have had trouble. It has been documented that most ATR sufferers will heal a little long but this is only very minor and should not affect you that way you have indicated. With the regard to the surgery to fix it. It is not as bad as the first time but I may have read somewhere of a treatment that avoided it. Will do some research for you but I may have it wrong.

  2. I have had a look but can’t find the reference I was hoping for but I did find some other information. I have my own thoughts about a non surgical way to shorten the tendon. Information I found suggests wearing high heels has the affect of shortening the achilles tendon. While I am not suggesting you walk around in drag, it may be worthwhile investigating how putting some heel lift into your shoe could offer benefit. My thoughts are that it will take pressure off the tendon as you walk and the tendon will naturally shorten. You would also have to stop running or other extreme sports in the interim. It would still take some time (can’t really say how long) to gain the benefit but you would avoid surgery and life would be reasonably normal. Leave it with you.

  3. Hi.

    I too have been told I have healed long. I ruptured April 2010. Had conservative treatment. Cast for 9 weeks with 3 foot positions. Toes pointing down, then halfway, then neutral. No boot after cast, no proper heel wedges, just foam pad in my shoe.

    Started physio, they could not get a response from the thompson test, but could confirm that the tendon was intact. After 6 months struggling with physio and not really getting anywhere, I was sent for an ultra sound.

    This confirmed that the tendon had healed long. Was offered surgery. flexor hallucis longus transfer. This transfers tendon that connects the muscle that pushes the big toe down, into where the achilles is.

    As you can imagine, I didnt like the sound of that.

    So signed on with a private physio who specialized in sports injuries. (He was physio for Hull Rugby League team)

    Physio was more aggressive at my instruction. After the second session the calf muscle was burning. The sort of burn you get when you have used a muscle for the first time in a long time. This told, both me and my physio, that there was something to work with.

    Continued physio from Feb 2011 through to June 2011.

    Exercises consist of hydro pool work walking in thigh high water and doing heel raises both 2 leg and then one leg (bad leg)

    2 footed heel raises on a step, with heel hanging over the edge. Then taking the good foot away and trying to control the decent on the bad leg.

    Resistance bands (not given to me on NHS physio)

    Whereas I am nowhere near anything like as strong as my good leg. I am in a position where I can walk for 7 miles over rough undulating terrain.

    Not sure if I will ever jog again. But 6 months ago I could not walk 1000 meters without my leg cramping up.

    I think if you can add bulk to the calf muscle, then that will take away some of the slack from the long tendon.

    If, however, the tendon is too long to get any calf contraction at all, you may be struggling. In that case surgery may be the only option.

    Let us know how you get on?

  4. +1 to what both people have written. Stuart’s plan is interesting and logically promising, but I’m afraid I’d be surprised if it worked. At 24 weeks, I don’t think the tendon or the muscle-tendon “join” can be stretched much, and I’d be surprised if it contracted/shrank much, either. Joints do stiffen up if they aren’t flexed or fully extended, but I don’t think that’s generally from a durable shortening of the tissues. OTOH, it might be worth a try for 3 or 4 weeks. If you try it, and there’s any improvement in your calf strength, then tell us all!

    I’ve got a strength deficit from my second ATR (left, non-op following UWO protocol), with about a half-height 1-leg heel raise. But my walking is perfect, and my running seems fine, too. Haven’t returned to volleyball yet (took a little detour to get a heart valve replaced!), so I can’t report on my jumping abilities. If my sore right shoulder recovers well enough from an upcoming week of dinghy racing, I’ll be trying volleyball soon, and will report here.

    So far, I’m pleasantly surprised how little “connection” there is between my 1-leg-heel-raise deficit and other activities, including running.

    BTW, I’m struck by the total 180-degree difference between Stuart’s (still untested) rehab plan and the one that jonboy1968 has actually been following, with some success. One involves scrunching the AT-and-calf together so it gets used to being shorter (and avoiding strenuous exercises which would naturally pull on the calf-and-AT), while the other involves tons of pulling and exercise to build up muscle strength to compensate for the extra length.

    Of course, trying to decide these things with logic instead of trial results is like counting fairies on the head of a pin — and very often produces wrong results in this field, no matter HOW good the logic!

    Good luck, folks!

  5. Norm - there is scientific evidence that wearing high heels shortens the achilles tendon. I am not sure if my hypothesis (more like a thread of an idea) will work but on the other hand I don’t think it will cause any problem. I also think a strengthening program in conjunction with a heel rise in the shoe would be appropriate. I have physio tomorrow so if I get a chance I will discuss it with an expert. So far there only seems to be a surgical option but I am sure you would be happy to avoid it if you were in that position. I also think 4 weeks would be a bit soon to get an idea. Maybe 6. Good luck Lindsay, hope you’re still checking in to see how much interest and discussion you have aroused. We are all hoping things go better for you.

  6. Lindsay, Norm - my physio did not receive my idea with enthusiasm. She was almost angry that this has happened to you. I tried but it seems that surgery will be the best option. This is a great lesson for everyone wanting to fast track and stretching the tendon early. I know some get through OK. We worry too much about re-rupture and almost totally ignore healing long in a bid to return to our sports sooner. It is the end game that I speak of. I cannot see that it is worth the risk. I am more than happy with my recovery and in particular my strength. Today I was cleared to started jogging. It will be 20 weeks since the surgery but the rest of my life has been almost normal for some time.

  7. Lindsay, the exact same thing happened to me. 8 months post surgery I was able to jog but my calf has been really weak the entire time. Throughout the summer I’ve been having swelling problems so I just went to see a surgeon who said that surgery again is the only option for an overstretched Achilles tendon. What did you end up doing? I really don’t want to have surgery again! Any advice would be greatly appreciated!

  8. Anju, I’m not sure Lindsay’s still hanging around here; we’ll see.

    I’ve posted my news of my athletic comeback on my own blog, more recent than my note above. More of the same for me: same wimpy 1-leg HR, but no deficit in court or beach volleyball or bicycling or anything else I do! I don’t understand it but I’ll take it! :-) i’m guessing that my Gastroc-AT link healed long, but not my Soleus-AT. Never scanned or seriously diagnosed.

    The recovery from AT shortening surgery is much like ATR rehab, though there’s an extra dose of atrophy and instability from two immobilizations.

  9. Hi Norm,

    Thanks so much for getting back to me. I will definitely check out your blog. I am going to get a second and perhaps a third opinion soon. I’ve never had an MRI or an ultrasound done so I am hoping to have these tests done so I can find out a clear diagnosis other than just an elongated tendon. I’m so glad that you didn’t have to have another surgery. I was told the second surgery will be worse than the first because they would have to use tendon from my foot to help tighten the Achilles. That does not sound good at all!
    My concern is that I will have other problems later in life if I don’t get the surgery such as knee or back problems.

  10. As much as I hate to see this happening to others, misery does love a little company i must admit. I guess its just nice to know youre not alone & feeling singled out by fate. I ruptured my left about 4 yrs ago (did the rt one too about two yrs later which ended up fairly decent) & believe I had a sketchy surgeon (partially my fault. Note: I highly recommend doing your research and find who you believe to be the best available surgeon. I felt at the time that it was imperative to get surgery ASAP. Not true). I also believe my PT was a moron and sounds similar to a story I read in this blog. She told me to stretch the crap out of it so I did and it ended up way long with a small muscle that is very weak and limits me a lot. I must also admit I was overly aggressive on my end with my rehab that likely contributed to the problem as well. I had a shortening done that didn’t seem to change anything except having another miserable surgery but it was a little easier than the first. Possible problem is that it seemed to be healing quickly and I was walking and doing some cardio activities before my surgeon gave his blessing. I thought I was doing the right thing but he was pretty pissed. My new PT guy who I like and trust as well said it was good so I don’t really know if it helped, hindered or had no effect. I wish I would have held off and got to see how it would have turned out. So recently I went in for a 3rd on that leg to try and shorten it more because my surgeon says the tension is still off. Problem was not much good tendon left to work with. He did an experimental procedure where he drilled 3 holes in my heel bone and pulled the tendon through them & screwed it down and is allowing to reattach. Since scar tissue adhesions also being an issue he took some kind of long tool and scoped up my Achilles using it to free up the adhesions. Don’t know if it will yield results or not but keeping my fingers crossed. I’ve been told if you have a muscle not under the correct tension for a length of time it can atrophy and you can never build it back up. Hope that’s not true. To address the mystery of why some people seem to heal long whereas some don’t. I’ve also heard some people have more elastin in their tissue and are more prone to have it stretch out. The conclusion I’ve come to is to be extremely conservative with the stretching. You can always lengthen but you can’t reel it back in if you’ve over stretched it. As I mentioned I ruptured my right as well. I did very little stretching and in retrospect would have done none. I got all my range of motion back and actually wish it was a little tighter. It came back to about 75% which isn’t phenomenal but its not terrible and compared to the left feels very satisfactory. If I can remember I’ll let you know how this one ends up. Peace…

  11. surgically repaired bilateral achilles rupture in ski accident.
    healed LONG. 40% calf diameter atrophy. one foot toe lift impossible. balance terrible. strength greatly reduced.
    is surgical shortening my only option

  12. Steven, I hate to dwell on your older history, but. . . You tore BOTH Achilles tendons while SKIING?? I can only recall one other poster here who’s torn an AT on skis (jumping a cornice, maybe near Tahoe, mike457 or close), and only a few who’ve torn both at once doing anything. So you’re unique here AFAIK for how you got your ATR(s).

    About your problem: If you’ve been working at strengthening for a while and your ATRs are about as healed and as strong as they’re going to get (and maybe a year or more “old”), then I think the likely answer is yes, sorry. A few people here over the years have worked hard to solve a (single) long ATR, and one guy is working hard with a creative (and blind) PT right now, hoping to solve the problem without another surgery. (We’ve had long discussions on his blog about his PT’s theories — including his belief that healed AT length is virtually never the actual problem!)

    Several have finally given in and gone for the surgical shortening, and others have decided to live with the wimpy strength they’ve got. I can’t recall anybody who’s really been pleasantly surprised by their late recovery without surgery. Logically, that probably means that once you’re convinced your final result will be unacceptable for you, you might as well bite the bullet and get the surgery (and recovery) started.

    The surgical-shortening trend (fashion?) these days is often to use a “V-Y” splice (the cuts resembling the letters) to make the whole thing shorter. Another current fashion is to use other tendons (like the patients halus longus tendon) to strengthen the shortened AT. Several patient here have been taken through quite slow rehab after these reops, though I’m sure that’s not based on any good evidence, just “judgment”.

    For quite a while, I — like Jim above — have been a “stretching dove”, recommending that ATR patients do even less, or later, stretching than PTs recommend, or than good modern protocols prescribe. Despite the non-zero risks of healing too short (as I myself have on my post-op side), it just seems that healing too long is quite common and quite unpleasant.

  13. Hey norm, i wish you on behalf of myself a very happy x mas, just dashing for my flight, and a big thanx to you I’m dashing , so far I’m a successful non op. thanx ate, ill post you my full update over x mas when I’m hoping to have a well deserved rest, RRR, p.s sorry I ain’t been in touch nfor the last month or so god bless

  14. Thanks for the thanks, RRR, and glad you’re doing well! :-)

    I think it’s time you dropped the “so far” from your progress report, since it’s way too late for a rerupture and probably for any other ATR-related problems or setbacks. Waiting for your detailed update, when your life gives you the time.

  15. had surgery to shorten elongated Achilles tendon. still unable to do one foot leg raises and have discomfort with just about every step. also have gait disturbance and unable to walk long distances. tandem issue is bottom of heel is numb…feels spongy ! Surgeon says keep working at it. Went to Podiatrist who tells me it is still long and will require another surgery to shorten. Meanwhile, using custom orthotics which have marginal benefit. Anyone else have similar experience ? Not sure if I should trust Podiatrist vs, Orthopedic surgeon who specializes in foot and ankle. Appreciate feedback

  16. Russ…what does your podiatrist base his opinion on? If you want more support I’d suggest you start a blog, instructions are on the main page. You can also use the search box tip right on the main page to put in key words to find information on that topic. There are simple ways you can look at your dorsiflexion to see if you are long, have you done that?

  17. I am about 16 weeks post-op from ATR. I feel as though I have taken a more conservative road to recovery, as I was NWB for about 7 weeks, and finally boot-less at about the 14 week post-op mark. As I have been reading more about ATR recoveries, I am starting to get more paranoid about healing long, especially since I have been going to PT, and sometimes I feel like they beat my leg up with the Graston method. How can you tell if you have healed long - is there a physical test you can do on yourself? I’m definitely not at the point where I would feel comfortable attempting anything like a single-leg calf raise, but I do have good ROM and my balance gets better and better every week. I don’t see my surgeon again for another 10 days.

  18. Armand read through ‘lump question’ on Mousta’s blog. You can find it on the main page.

  19. Hi all
    My husband v depressed after tearing achilles playing tennis 1 YEAR AGO! Despite all the rehab, physio, strengthening exercises etc. etc. his achilles has healed long and so now faces possible surgery (which in hindsight he should have been offered at the outset). Lots of comments about needing surgery to shorten in this situation, but is there anyone out there who has actually had it done to shorten a lengthened tendon? There seems to be very little information out there from surgeons etc. to say if this option is likely to be successful, or whether there is a danger it could cause scarring and or pain? My husband is already suffering hip pain, caused by the fact that his biomechanics are completely thrown out of sync, as he can’t push off his leg properly since his injury.
    At the moment, he can’t walk very far, let alone run, and suffers pain in his hips walking up stairs/hills etc.
    Hope someone can give us some useful tips!

  20. SharonT - one I remember here is TomTom and you can find his blog on the home page using the search function. He has not been here for a while but a message may still find him. How good the result is after surgery will depend on the skill of the surgeon but there is every chance it will be positive if your surgeon is experienced in this. Unfortunately there is no alternative and it seems the issues your husband is facing because of it may be the decider.

  21. Hey everyone,

    I had a bunion removed from my right foot and my surgeon also lengthened my Achilles because my foot is almost flat (Achilles was tight) so it was done for the effort of preventing another bunion. I deeply regret having the procedure done as now after 2 years I have a limp, my leg does not look as big as the other and the back of my ankle appears to be caved in.

    I’ll admit I wasn’t faithful with my physio exercises but I would have assumed that by walking on it that it would return to normal. On one of my post-op visits he informed me that my tendon was pooling at the bottom of my ankle and I should only come back if it prevents me from doing anything but now I’m having issues with my knee. I guess it doesn’t help that my gait is completely off since my left foot has a normal arch. Orthotics are wonderfully but not a long-term solution.

    I’m seriously considering surgery. I can say from experience that the high heels do work! Haha, this was my favorite part of rehab but it only takes you so far.

  22. I am another of those rare birds who tore his Achilles will skiing. It wasn’t so much torn as pulverized because some kid did a skating stop on the back of my ankle at high speed.

    18 months later I still cannot do a calf raise (except in a swimming pool) or run but can walk with limping gait. Just finished another 2 months of therapy where PT concluded yes, Achilles is too long.

    I see all the comments about the only real fix here is surgery. But what are folks’ views on chances of success and downside (other than obvious downside of undergoing another surgery).

    If it is not a high percentage, I don’t think it is worth the pain in the tuchas of another surgery.

    Thanks!!

  23. Jon Guy,
    I am 11 months post injury and went the non-op route which is common treatment in Canada, which is where I am. My Achilles healed long and as a result my heel raise is about 2 cm. Check out my blog for my earlier posts. I am considering surgery. After a 5k treadmill jog, my injured leg is weak. I feel push off weakness when I walk, but I can walk without a limp. I saw a surgeon yesterday and he tells me it is a 15-20 minute procedure, but months of recovery. I do not have any stats for you on success rate, but believe this depends on:
    - the experience and confidence of the surgeon
    - the patient following a proven rehab protocol

    Having surgery is a personal choice. Have you thought about what a limping gait might do to other parts of your body.

  24. Tore achillies tendon may 2015 had surgery. Dr. told me to start stretching foot with a belt at 3 weeks. had all range of motion back at 6 weeks and DR. said you are way ahead of schedule you can come out of boot. Long story short I healed long after second opinion from another dr. 6 months out of surgery. Only option is surgery he said. Well I cant have surgery now for insurance and work complications, (cause I have no more sick days). So I’m trying to do like some of the other post of building calf muscle and wearing lifts in heal. Hope this works I don’t think I can go through surgery again. But I’m 45 athletic and love playing sports so if I don’t get any better I guess that’s the only option. Any one else have any suggestions about non surgical route?

  25. Chris - It may be a bit early to tell how bad things will be for you. Generally you would need to wait at least 12 months to see how affected you will be. If you have healed significantly long (5mm or more) then there is no other option other than surgery however there could be a medical negligence case against the first doctor. Stretching like you did with a belt at 3 weeks is stupid and you should never have been told to do that. Even a small settlement could pay for the surgery if you were prepared to go through it again. In the mean time continue with eccentric exercises. Bent and straight knee calf raises but going down slow. Use the good leg to get you up if you need and maybe hold a bar or bench so you can push up with your arms as well. In the pool works too.

  26. I had surgery 4 weeks ago today. The day after surgery I fell on the ice and felt a stretching/”ripping” sensation on the bad leg.

    I went to the surgeon a few days later and said it still looked good..I might have had some splayed the suture a bit but not completely. 2 weeks ago I got my cast off and stitches removed….the calf squeeze test moved my foot (good thing) so tendon connected but I still had a gap present above heel. the surgeon did not know why….but didn’t seem to concerned because of the force that the calf squeeze test move my foot.

    After reading all these posts on elongation….I am completely paranoid. When is the earliest someone can diagnose an elongated tendon? Today I took out the first of 4 wedges in my air cast…I thought it would hurt or at least stretch but I did not feel a thing.

    Should I be worried?

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