Re-rupturing your Achilles

It is common among people who rupture their Achilles tendon to worry about re-rupturing their repaired tendon, as well as their other, healthy tendon. The re-rupture rates with surgically repaired Achilles tendon are low, but it is still a concern. Also there are a few people on Achilles Blog who have ruptured both of their tendons on different occasions.

There are a few people on this blog who re-ruptured their Achilles while recovering from surgery. To learn more about their experiences, please visit their blogs:

In Dave’s case, he was fitted with half-length boot that came up to middle of his calf, not all the way up to just-below his knees. They say that it is better for lessening calf atrophy, but it doesn’t provide as much protection. Dave re-ruptured his achilles while wearing this type of boot. He was fitted with a full length (up to his knees) boot the second time around.

Chip had recently started walking in 2-shoes when he slipped while going up stairs and re-ruptured his achilles. It’s a really fragile period when you start walking without the protection of boots or casts. So you need to be cautious after you are out of boots for several weeks.

In addition, here’s are some excellent posts by Brendan and Tom on re-ruptures:

433 Responses to “Re-rupturing your Achilles”

  1. I believe I re-ruptured it Saturday - July 12 and got an MRI Friday the 18th. The MRI tech says he sees a hole which means a rupture. I am devastated. I believe it is a partial re-rupture because I can move my foot. I am in pain. The waiting for a second surgery is killing me - I want to get onto healing. Does anyone know if waiting for the surgery is detrimental? My initial surgery was May 24 - following a flying glass accident.

  2. Hi, catnboot…truly sorry to hear the news. I can only speak for myself but after my re-rupture, I could still press down with my foot. The doctor said sometimes the muscles compensate and can move the foot. He wanted a MRI and that showed a gap…complete tear. Subsequent surgery confirmed it. I hope not the case for you and will keep my fingers crossed.

    I think the window of surgery varies greatly. My doctor says he likes to operate between 7 and 14 days after injury to allow swelling to go down. Others have had it done same day.

    Keep your chin up. The second time really sucks but at least we know how to handle it. And begin healing again.

  3. My first surgery was Mar 24. After 6 weeks in the non-weight bearing cast then 4 in the boot I was all ready phyched to be moving on to complete recovery and get back to normal. I went to doc on June 3 and he & another doc agreed it wasn’t healing & I had surgery again on June 4th. I tried to get him to give me a few days to get my ducks in a row for surgery, but he said “no, tomorrow is the day”. Unlike the first surgery where it was done as an outpatient, this time he kept me 2 nights pumping IV antibiotics. The wound was not infected butg the antibiotics were to help aid in healing this time. What a disappointment. Back in the hard non weight bearing cast for another 6 weeks. Now am in the boot, but doc said to be on the safe side no weight bearing for 2 more weeks. I then start PT and who knows what happens from there. This has been the worst medical problem I have ever had. I would not wish this off on my worst enemy! I guess like the rest of you there have been times when it has taken its mental toil. I just want to walk.

  4. I got a call from the doctor the tendon is re-ruptured. He will have his office call me with a surgery date. I hope it is soon. My fear of re-rupture is even greater than before. What can I do to prevent a re-rupture again. How long before one can feel out of the danger zone? I am so devastated. I live alone and have no family for help or moral support. I do have a friend that has been helping. I am afraid of wearing her out. I have two dogs that have to let in and out. I have my bedroom and bath upstairs. Plus I have to keep my job –and insurance that goes with it. I am having a tough time getting a grip on my anxiety. I feel like this will never end.

  5. catnboot,

    Boy–do I know how you feel! I live alone in a 2nd story apartment in a house downtown. I’ve had to battle everyone for on-street parking. Had to ration my favors, too, but that garbage has to be out on Monday night, whether I can get up and down the stairs or not. I’ve been very lucky in my friends, my incredibly supportive workplace, and lucky that this happened to my left foot so I could still drive, etc., etc.

    But it sounds to me like you are on the verge of a bit of a (justifiable) panic and need to take a stab at a slightly more official help. I know that in Erie we have an organization called Voices for Independence. They will provide help to disabled individuals—whether permanently or temporarily disabled—and there is no income limit. That is to say. you can’t make too much money to qualify for services. They do all the simple things that are overwhelming you right now—take out the trash, let out and walk your animals, do the dishes, run some laundry. This is SUCH a dibiliating injury! Many don’t understand. Crutches for the span of a sprain is do-able—you can skip laundry for that long—but not for months and months! ASK FOR HELP! It is out there. Be creative in how you look for it, too. Churches are there and want to help! The ladies at my church made me a full week of soup twice. ASK. It’s there. There’s plenty of life left to be proud and self-sufficient…that time is not now. Chin up, catnboot!

  6. thank you — I am in Dallas, TX — I will check if there is such a service.

  7. I tore mine on March 20, went through 2 slab casts and when I was in my walking boot, managed to fall and retear it - luckily no second surgery. When I see other blogs, people seem to be well past me, as I stil have lots of pain and swelling when I do too much and can’t even think about running and I’m at 8 months form initial tear, but I forget that I’m not “really” that far because of the retear.

  8. hope everyone posted above is well on path to recovery and independence/comfort of knowing that you’re not alone.

  9. I ruptured my achilles playing soccer three weeks ago today and had surgery two days later. the hard cast was removed after a week and replaced with a boot, and i began light therapy. everything seemed to be healing well, but two days ago, i had my boot off (just for some air to my foot) and was walking with my crutches (stupid) over to my kitchen a couple of steps away, and i fell and landed on the injured foot. the pain felt almost like the first rupture, but without the snap. i was devastated and convinced I had re-ruptured. but it seems like i can move the foot still. i see the doctor for prognosis first thing tomorrow morning, but from the other stories of re-ruptures he has told me about, i would guess he will be disinclined to do surgery again. does anyone have any advice about whether a 2nd surgery is a good idea? it has not even been three weeks since the first surgery, but perhaps its best to have the problem corrected now? i will know more tomorrow once i have the docs prognosis. i welcome any advice from anyone who has gone through this.

  10. Dennis-
    I joined the ATR on Jan 10, surgery Jan 20. I found your site last week as I was searching for answers about starting PT in one week. And then, 5 weeks post-op, NWB, I tripped reaching for my crutches. Re-ruptured. New surgery coming this week. Hoping to start blogging soon. I’m curious if other ATRR (reruptures) had questions they wished they asked before 2nd surgery? The site is great. Thanks

  11. Marianne, I am eight months ATR post injury/post op. I had a serious fall six weeks ago in the ice and snow (walking my dog!) and probably tore the sheath (paratenon) about two inches above the repaired completely ruptured tendon. The skin around the injury turned dark from the bleeding. I originally feared another ATR, but was lucky. The new tear was painful and still bothers me at times…but it seems to be healing. The scar from the actual AT surgical repair is nearly invisible due to plastic surgery after the ATR repair surgery. I returned to work about six weeks after my surgery…I work in a bank and spend most of my days sitting at a desk. I was told by my orthopedic surgeon to be very careful because of the risk of a re-rupture at my age (65). I still go through my PT exercise stretching and exercise routines. Good luck and hasty recovery!

  12. JIm- Thanks for your encouragement. It sounds like you’re well on your way back to recovery - good for you! Did you have an MRI?
    I felt more pain the second time around. Burning on either side of my ankle. More swelling. Black and blue. My scar was beautifully straight before - who knows what it will look like now.
    Gotta love these anti-spam words! Definitely keeps me thinking positive. thanks again.

  13. marianne - I am very sorry to hear that you’ve re-ruptured your achilles. I recommend speaking to daveleft and check out his blog: http://achillesblog.com/daveleft

    Also, you may want to check out: http://achillesblog.com/re-rupture/

    I hope all goes well with your second surgery, and keep us posted on your recovery process.

  14. I fully ruptured my achilles (doing plyometrics) on september 16th 2008. It was treated conservatively. I thought I was on the road to a full recovery. Had been doing bike rides of over 100ks and no problems. leg was still weaker than the other. I went to see my doc for a six month check and he had me do single leg calf raise and we both heard a tear. I let out some expletives and wanted to cry. went for a ultrasound scan and they couldn’t see anything so then had a mri scan. luckily I had both scans done the same day. The doctor rang me up the next day and says I have re-ruptured. I am booked in for surgery this time. which i wanted when it first happened. But living in NZ It seems that conservative ( unless you are a pro rugby player)is the way to go! Both times I have been lucky in that it hasn’t been painful. I don’t know if lucky is the right word when you have an atr. So I now I have another long recovery to look forward to.

  15. Gary - so sorry to hear about your re-reputure! I also recently re-ruptured, although I was only 5 weeks post-surgery. I heard that awful tearing nose - it almost sounded like paper ripping. Keep your spirits up if you can. There is someone else on this site that re-ruptured going up on their toes at PT, can’t remember who right now, but if you search around, you might find them. Good luck with the surgery.

  16. Does anyone know of anyone who has reruptured (the same leg) long after a surgical repair, say one year or more later?

    A philosophical thought: Achilles tendon rupture is a price we pay for walking on two legs, which leaves our hands free to do so many things. (Difficult human childbirth falls in this category, too, because two-legged walking leads to a smaller opening in the pelvic bone for the baby to squeeze through.) When our hands are busy with crutches, we are in the same boat as four-legged animals, and we find it frustrating, don’t we?

  17. Hi Guys,

    I need some help please. My Doc didn’t really convinsed me about his Knowledge. I had my surgery on the 12th of March. 5 weeks post operation I had to go back, and the nurse pulled up my leg a bit closer to 90 degree. My tendon was really stiff thou. The second day( Saturday, 18th of April) the worst happened. I fall on my injured leg. Horrible pain, like I had it when I ruptured my tendon, and straight to E&A. After one of the doctors tortured me called another Doc, who was dealing more with that kind of injuries. He convinced me that my tendon is not re- ruptured and I don’t have to worry I don’t need anohter surgery. HE placed my leg in a neutral position again and said I should consult with my Doc on my next appointment which was the next friday ( week later ). They couldn’t do an MRI at the Emergency , but I passed the squizing test, and the torturer also checked the tendon. However now on friday when I got back, the Doc was saying something that I might need a second surgery, however, because the tendon is swallen he is not doing an MRI. I’m absolutely confused. This Friday ( 1of MAy )will be nearly two weeks past injury. Is he going to find out that I need a surgery now? That sounds nonsense. The first reason why I went to the E&A on that saturday to make sure if is re-ruptured than we should go for the surgery as soon as possible. Did anyone had some similar situation? The worst is that I still don’t know if there is any problem and I would say I waisted another 2 weeks for nothing. In this case I would definitely skip the next surgery and go with the cast in neutral position for longer. Please let me know what do you think. Now it’s nearly 7 weeks post surgery and I’m devasted. I can’t even work with this plaster on me. Thanks again for help.

  18. Hi Dancingfeet,

    I’m really sorry to hear about your re-injury. I was wondering if you heard a pop sound when you slipped. If you did hear a pop then you may have re-ruptured. However, the Thompson test (calf squeezing test) would most probably confirm a re-rupture or not. I’m not sure why swelling in the foot/tendon would prevent an MRI. In addition to MRI an Ultrasound may also be a useful tool to diagnose a re-rupture. With regards to swelling and operating, I have come across several websites where surgeons tend to wait for a week or so (to let swelling down) before operating for first time ruptures. From my personal prospective, at approximately 3 weeks post-op I accidently placed some weight on my bad foot whilst trying to close the window. I did not really experience severe pain - more pins and needles. I guess the cast is designed to give you some protection in those situations.
    I think it’s important to confirm wether or not you have re-ruptured before deciding on treatment protocol. All of the following (or combination of) may provide you with a definitive answer - Thompson Test. Simmonds Test (similar to Thompson Test), MRI, Ultrasound, gap in the tendon through palpation. However, the presence of scar tissue from your original rupture may make it slightly difficult for diagnosis, but experienced surgeons/radiography staff should be able to make a good diagnosis. In addition, it may be useful to have an X-Ray to rule-out any foot bone fractures from your re-injury.

    Regardless of outcome, I truly wish you the best in your recovery. I would also like to say that I am no medic nor orthopaedic surgeon and the above advice is purely from what I have read on the internet.

  19. Hi Rudedog,

    Thanks for advise I did take everything into account and I will ask the doctor for a final answer this Friday. I know that some doctors prefer to wait a while with the first surgery , even so that I believe the quicker the better.I recall that the doctor was explaining me something regarding the healing tissue ,probably that’s the reason why he didn’t done an MRI or ultrasound, but I don’t really understand what will be different this time, two weeks past the accident. It all seems very strange. I didn’t hear a loud pop, thou it was very painfull. I didn’t hear the popping sound on the first injury either. The true is that the accident happened so fast that I didn’t really experienced anything else than just horrible pain. I don’t even remember how did I step on my injured foot. I know it’s bad, but I still hope the best. :)
    Well I will insist to get an exact answer on my next appointment. As you said it’s important to confirm my state and what should be the treatment. Thanks for your support , it’s very kind of you. Take care and hope you will shortly step in both of your shoes :)

  20. Hi guys, I’ve really found this site informative and it has actually perked my spirits up. Had bit of a bad day yesterday with the ‘why me’ syndrome. I ruptured my achilles on 12th May 09 whilst playing badminton. Had surgery on 21st May and still in cast with foot pointed. Due to see consultant tomorrow - 3rd June where they will hopefully align my foot slightly and re-cast. I have two children and a very helpful husband but feel totally helpless and hate being in this situation. Last night I attempted to tidy up a bit more than usual and ended up putting weight on my leg. I just hope and pray that I haven’t re-ruptured because we are due to go on holiday to Portugal on `6th July and I wont be very popular if I am still in a cast.
    Is is possible to re-repture with a well fitting cast?

  21. Hi Debbie, It is very unlikely that you have re-ruptured with a cast on they are so strong, I had lots of scares and trips with mine on without any damage.

    Did your consultant say how long you would be in a cast? I was in it for 10 weeks. You should be OK and be able to use crutches when you are away. You will find lots of ways for getting around the house over the next few weeks. Here in UK is seems we have quite different regimes to over in America.

    We went to away when I still had a cast on last year without it causing any problems. Check with doctor about travelling and any precautions he thinks you should take.

    Hope you get back to playing Badminton soon, I used to play years ago, I’m now too old and too unfit to play anymore.

    Good luck
    Annie

  22. Annieh,
    thanks for your comments. I had another cast with my foot slightly re-aligned so it feels more ‘normal’. This will be on for another 4 weeks and I have to go back for another one. I was reassured at the hospital that I would be able to take a removeable cast on holiday for the plane, pool etc. They also said that I would probably be able to put weight on it as well. That seems unlikely at the moment but I’ll be optomistic. I notice that I said I was going on hols on 6th July - I acutally meant the 18th July. Think this injury has affected my brain as well :-)
    Thanks again for your kind words
    Deb

  23. Deb….don’t rush things….especially if you’re having NHS treatment.
    I ruptured my AT in March when my ankle was grabbed by an escalator. The local hospital surgeon said i could only have conservative treatment (Plaster) due to my age (63) As an ex international athlete and medical research scientist, I asked for surgery, but it was refused. I went along with things…2×4 week-periods in plaster, then started physio. Generally treated like a nuisance by NHS staff.
    The tendon re-ruptured after 3 days.
    Then went private. First consultation with a top sport surgeon…£150, MRI scan £650.
    Repair operation then Aircast boot …£3000.
    2 weeks pre-op. no problems, and hobbling well on Aircast boot.
    My advice…always have surgery, go private if you can…the NHS give cheapest treatment, not the best.
    Don ‘t rush it!…re-ruptures are not nice.

  24. Hi Mal
    Thanks for your info. I have to confess that I have found the NHS second to none so far. I am getting used to crutches now and don’t see my injury as a reason not to do most things. I am due to go back on July 1st. I will have had this cast on for four weeks. Thats six weeks in total since the operation. It certainly feels as though it is mending as I have no discomfort at all. I appreciate what you say about a re-rupture. I definitely do not want to go through this again. Thanks for your comments - hope your ankle is getting better now.

  25. crutches - ouch

    I am getting on really well with my crutches but my wrists are now really painful especially my left one on the outside near the bone. (ruptured my right achilles so this may be the reason - all weight on left hand side)
    Anyone any ideas on what I can do?
    Deb

  26. Lump feeling on lower calf

    Hey all, I’m wondering if you could give me some thoughts on my situation.
    - just joined the world of the completely ruptured achilles (1st timer)
    - had surgery and was fitted with a half cast for two weeks before getting a full cast
    - one week after surgery, was finally feeling good, but crutch slipped on a wet floor and I landed hard on my foot
    - went to get it reassessed, they determined through ultrasound that at rest the tendon was still aligned (this is good), but when stressed a bit it separated (not ideal). They felt that it was still good enough to proceed with the cast and not go for another round of surgery. Just got a full cast yesterday.

    Now my question,
    - Since getting my full cast I found it very difficult to even straighten my leg (finally successful after some slow stretching). But more concerning is that I have the sensation of a lump in my lower calf. It feels like as if someone put a rubber ball on the outside of my leg and then put the cast on. I didn’t notice it before with the half cast because of the flexibility in the tension bandages.
    - thought about blood clot, but doesn’t throb and there are positions where I don’t feel it, where I understand that it should be painful and always present.
    - my thought is that some of the tendon has rolled up again….but am not sure.

    Any thoughts and advice before I re-enter the lines of the emergency room and or push for a second opinion. Thanks.

  27. I am no expert on this maybe swelling….
    Could be bleeding with the new injury?
    Supposedly the swelling is going up after injury for about 4 days.
    I found a new cast always tight, (wearing my 5th…) takes a few days to get used to.

    But I do not understand why you have difficulty straightening the leg??

  28. Thanks 2ndtimer for your quick response! Such localized swelling is what makes me question what’s going on.

    But apologies all for my mistakenly posting on the re-rupture site (It should probably heal first before being a re-rupture, eh). I hope, like everyone, to not find myself in the position to post here. Best of luck to all.

    As for me…I have continued my story on the newbie side (http://achillesblog.com/just-ruptured-your-achilles). Thanks again.

  29. I ruptured my achilles in April 2008 and was operated on the next day. The orthopedic surgeon said it was progressing okay a few weeks later and I started physio sometime around the end of May.

    I progressed really well at physio for a couple of months, but at some point I plateaued and never got any better. The physio said I needed to strengthen my atrophied calf and this was reiterated by two other physiotherapists at two different places right up to the beginning of summer 2009. I had hardly improved almost a year and a half later when I finally got to a doctor who diagnosed a re-rupture within about 2 minutes. The re-injury could have happened well over a year ago but I don’t remember any particular event when it happened.

    All of the re-rupture stories seem to be about people who had a second rupture and were operated on soon afterwards. Does anyone have any experience with a re-attachment of an achilles after many months?

    I finally

  30. Hello,

    I think my little incident that led to a part re-rupture could be useful for you guys to hear about. It’s an easy mistake to make - and a little bell may help you prevent the re-rupture tragedy.

    I had my first ATR in April 2007, played basketball, was 29 at the time. I was in a cast for 4 weeks before I got a boot and was allowed to slowly start weight bearing with the help from my physio. My doctor allowed me after 2 weeks in the boot (so 6 weeks post-surgery) to take the boot off at night.

    One Sat morning, 6 weeks after surgery, I was vast asleep when the door bell rang. Half asleep I could hear the postman shouting that he had a package. When he rang again like a maniac I suddenly jumped out of bed - right onto my wrong foot. I had completely forgotten that I couldn’t walk properly yet. Because the door bell made such an awful noise I just instinctively tried to rush to the door.

    The pain I had in the minutes after this were ten times worse then the first rupture. My scar, my tendon, everything had still been a bit tense. My wound had healed well but then blood shot out of the scar again. I was on my own in the house, all my flatmates were out. Crawling to the phone and waiting for the ambulance was terrible. I was in agony and totally mentally devastated.

    I hadn’t fully re-ruptered but I was back in a cast for 2 weeks to stabilise things. When I got the boot after that iteration I did not take it off at night for donkey years (weeks) as I was totally terrified of doing it again. When I finally did take it off I put a little bell on my toe with a string. I was hoping that an unusual noise and feeling a string would make me aware that I need to be careful. The door bell hadn’t rung again at a mad hour so I can’t tell you if it really worked but it made me go to sleep easier.

    When the ‘jumping out of bed’ incident happened I had been back to work for 2 weeks and things were very stressful. I was still on crutches as well.

    My advice: Make sure you don’t get sucked into other things and worries while you are recovering. I’d say till 2-3 months after the surgery the only thing you really need to focus on is your leg. Things that don’t work out at work or elsewhere are really unimportant - nothing is as bad as not being able to walk again. Not even loosing your job or the end of a relationship. Just think about it. Being calm, being on top of your mind and being fully aware that your Achilles is limited at ANY time is crucial to prevent any silly little move or reaction.

    I’ve now unfortunately ruptured my other Achilles 4 weeks ago, playing hockey this time. I was devastated for a day - but since feel I have just been given the chance to prove to myself that I can deal & cope with this much better then I did last time.

    Last time there was a lot of “but soandso should have phoned to check how I am” and “I must go back to work asap and in full steam”.

    This time there is “I’ll phone soandso and ask her if she could come and help me with X. And if she is busy I phone the next person on the list” and “I’m not reading work emails while being off sick. I’m not going back to work full-time straight away. I will ask if they would pay for a cab to get me there”.

    Everything happens for a reason. A silly as it sounds.

    Take care everyone. We’ll all get through this. Luckily I did proof it to myself already last time so this time it’s easier to be convinced at all times. And yes, crawling up and down the stairs to your loo sucks. But hey, how lucky are you that you only have a temporary disability.

    Claudia

  31. Last addition: Apologies for writing a novel. Hope it helps someone someday….

  32. Claudia,
    Your story brought tears to my eyes. I have a similar story. I ruptured my right tendon in April 2007 playing indoor soccer. I opted not to have surgery (which I now know is a mistake.) Within one week of having my cast off, I re-ruptured my right tendon after a piggy-back ride gone wrong. Then went in for surgery. It was a full year before I felt anywhere near normal.
    This past spring I started playing soccer again, and then the worst happened. I ruptured my other Achilles! My second experience has been much better than the first. I had surgery within 2 days, was in physical therapy in under a month, and at 4 and half months out was given the okay to start running.
    I would love to hear from you or others about your experience having ruptured both.
    Thanks,
    Monique

  33. I am trying to figure out what to do. I ruptured my Achillies on Oct 30 and had a surgery on Nov 4.
    2 weeks after the surgery doctor took the stiches out and replaced my splint with an ACE tape. “This is to prevent swelling only” he said. I was very nervous about doing something to my foot, and it turns our for a good reason.
    2 days later I lost balance and put full weight on my big toe of the injued foot. I did not hear a pop or experienced any pain. But then it was only 2 weeks and 1 day afterf the surgery.
    Today, 5 days later, I finally saw my surgeon. He told me that since there is swelling around the ancle he can to tell for sure if I re-ruptured the tendon or not. He wants me to wait for 10 days so that the swelling comes down and then see him. He said he might do an MRI then.
    I dont understand why an MRI cant be done now. Also, I did not feel any pain when I fell / stood on my big toe. Did any of you experienced anything similar? What do you think I should do? I am trusting less and less into my surgeon.
    Thanks,
    Marina

  34. Marina,

    I agree. What your doctor is saying doesn’t make much sense to me, either. Leaving you without some protection option (splint, boot, something) is certainly odd, too.

    If there was no pain or pop, I suspect you are okay, but that’s just an educated guess. Can you wiggle your foot up and down at all?

    An ace wrap, applied with the right tension, can get rid of swelling (albeit temporarily) very quickly, especially with a little “pillow” to press the swelling up of those hollows between the tendon and the ankle bones. That “pillow” could be a large sponge, or a ziplock bag punched with small holes (to let the air out) and filled with some polyfill (like the stuff found indside a real pillow). Then, you could feel the tendon yourself and see if it is still one continuous rope.

    Do you still have your splint to wear part time? Can that be held on with an ace wrap?

    I hope this helps,

    Doug

  35. Doug,

    Thank you so much for replying!!! On my visit this Tue (3 weeks post op) I asked the doc to give me some protection and he put the splint back on. Wednesday the leg felt great, but it swell again yesterday towards then second part of the day.
    Since I am in a splint, I would need to take it off to apply the ice, which I am relactant to do right now. It seams to me that the doc pointed my food down with the splint which made it feel better. I am not sure I would be able to get it back on the same way.
    I will try to apply ice over the ACE wrep.
    I am thinking of either getting second opinion or pushing my doctor to do an MRI to see what had happend. Is there any downside to an MRI? Is it possibly that the picture would not be accurate if I still have swelling?
    Also, how do I find a good surgeon if I decide to switch? I live in New Jersey.

  36. Hi Marina,

    Unless your splint is somehow more complicated than most, putting it back on should be pretty simple. Just put it on your foot and wrap on the ace wrap. Getting the wrap tension right might take a little practice, but all in all it’s an easy thing to do. After my five day postop appointment, I was taking mine off and putting it back on several times a day,

    Wearing the splint is not all-or-none. You can take it off to do some walking or exercises in a safe situation, and wear it when you want the protection.

    A MRI could be done, but it is expensive and probably unnecessary. If you can squeeze out the swelling (as in my last note) and feel that the tendon is not broken, and you can push your toes down a little, you should be fine.

    Doug

  37. HELP PLEASE! !!!

    I think I re-ruptured my achilles. It has been 10 days since I lost my balance and landed on a big toe of the operated foot. @ the time I was 2 weeks and 2 days post-op and only had an ACE wrap on with my foot pointed down.

    My surgoen finally saw me 5 days later, but could not tell if there was a re-tier due to the swelling. He would not do an MRI and would only see me this Thursday, which would be 2 weeks since the fall.

    I am terrified that I re-ruptured the tendon since the swelling is not coming down dispite me keeping my leg up and icing.

    Can anyone recommend a good surgeon in NJ or NY? I would like to get a second opinion and an MRI as soon as possible (ideally tomorrow).

    Thank you all in advance,
    Marina

  38. hey marina, that sounds horrible! I actually live in NY, but my orthopedic is in Stamford, CT. It’s about a 25 minute drive from where I live in Westchester. Dr. Schmidt has been great so far, I have never seen a doctor so informative. He actually takes the time to sit down and explain what exactly is going on with my achilles tendon rupture, and his plan for the recovery. He has even go so far as to draw sketches of the healing process, and what he did during the surgery.

    Here’s the link to his practice.

    http://oasmd.com

    I hope everything is alright, I can’t imagine what you’re going through right now.

    Don

  39. Dr. Martin O”Malley at the hospital for special surgery. He did my achilles surgery 12 weeks ago. Not that this makes him the best, but he operates on numerous professional athletes. Good luch

  40. Don,

    Thank you very much for your reply! Unfortunately, I am too far away from Stamford - probably about 2 hours.

    Marina

  41. Hal,

    Thank you very much for the referral. I took a look at Dr. O’Malley bio and he looks great. If I can not find anyone in NJ, I will probably go with him.

    Marina

  42. I think I have reruptured.

    Original injury occured December 1st 2009 and was operated on December 9th. I was in a cast for around 8 weeks and had been in my cam boot for almost 3 weeks with the instruction to be 30%WB for 3 weeks, 60% WB for 3 weeks and then FWB for 3 weeks and then I could lose the boot.

    I was so excited about my progress and was about to stand (without boot on) and even walk a little within about a week and a half. I didnt do this often, mainly around home (small 1br apartment).

    On Saturday night Feb 13th I was ready to go to bed, my boot was off and I got the fright of my life when a massive cockroach flew onto me and I jumped up…right onto my injured leg. I felt/heard a pop and suddenly there was a gush of blood.

    [my original surgery gave me a DVT which turned int a Pulminary Embolism and so I am on blood thinning medication]

    It was probably more painful than the original injury and worse there was a gaping hole in the back of my ankle…not in line wit the surgical scar but rather, running across it!

    I drove myself to emergency but they were pretty useless. Ultimately ended up having an ultrasound yesterday and this seems to conclude a full tear. I see my surgeon tomorrow.

    I am beyond gutted. I’m a runner and I’m only 28… I’d only just come to terms with the fact that I’d be unlikely to be running again til the end of the year! I live on my own up 2 flights of stairs and hate asking for help (though I’ve had to learn but I feel a burden). I’m already on anti depressants (for other reasons). I suspect that mentally it’s going to be tougher to deal with this time around although I know what I’m up against!

    I guess I will find out the full damage of this bug attack tomorrow!

    I feel like the world is out to get me!

  43. Oh, Stella, I am so sorry to hear about your re-rupture. You have youth and condition on your side. You got through this once, you DO have what it takes to get through this again. Please keep us posted. Sending you healing thoughts and prayers.

  44. Stella,

    So sorry!!! I would not pretend I know how you feel, but I can guess. I have had my moments all throughout this journey. One day I was in the store waiting for my husband and the old lady stopped by. She asked me what happened and then if I was healing Ok. She then said she knew what I was going through as she ‘broke her knee’. Naturally, I responded “Oh, are you Ok now?” She said “No, and I will never be.” Imagine that? That really put things in prospective for me. Yes, this is a very long and painful route. But guess what - I WILL heal eventually. It may take longer, but I have a chance of complete recovery. The poor old lady is done - she is handicap for life!

    You will get throught this! Try not to focus on the past - it is in the past now. The base thing you can do is learn from it and move on. GOOD LUCK!!!

  45. Aw thanks guys… I was having a rough day dealing with reality that day!

    I’m in hospital now, wait for an MRI…it’s been 24 hours and counting since I was admitted!

    I’m resigned to the fact that its a rerupture, I just want them to make some decisions so I can go home!

    Due to my issue with having gotten blood clots after my last surgery and therefore being on blood thinning medication they may be reluctant to do another surgery but I think I’d prefer them to do one if they can… I just want the best possible repair!

    For now I just need to keep sitting tight and waiting (damn public hospitals!)…I just wish the food was edible - how on earth do you make potatoes taste bad!?

    I will keep updating and I appreciate the kind words :)

  46. Hi everyone! I just wanted to share my re-rupture scare. I was 5 weeks post surgery and was fully weight bearing for about 5 days. I would alternate between being in the boot and out of the boot. I didn’t like the boot because it made my foot hurt more and it was very hot. Anyways, it was my husbands 30th birthday party and I was walking around the party with no boot on when I just felt the pain like someone had kicked me again.

    I immediately sat down and was so worried I had re-ruptured. I didn’t hear a pop and there was no blood or anything but it hurt (not as bad as the first time). It was painful to walk on. After doing the Thompson test and feeling the achilles, I am confident it’s not a re-rupture. The next day I am able to walk on it without much pain. I will mention it to my doctor and physical therapist and keep you posted. And I will definitely be wearing the boot 24/7! Thanks for all the info!

  47. Flygurl, I’m not sure there’s anything you can do about a very hot boot (other than taking it off whenever you’re SITTING), but you should be able to tweak it so it doesn’t make your foot hurt. As long as you don’t make it TOO roomy/sloppy, you should be able to make it fairly comfy — unless it’s the wrong size altogether, which is also possible.

    It’s also quite possible that you’ve partially re-ruptured your AT. (Our AT’s don’t usually feel like we’ve been kicked for nothing, unless we’ve been kicked!) If we all knew that was the case, it would probably make sense to re-start a non-surgical “cure” — add some heel lift or boot-hinging to your position, go easy on (or even avoid?) weight-bearing for a couple of weeks, don’t dorsiflex past neutral when you’re out of the boot. . .

    I’m all for high-speed progress, but part of your AT may need to re-knit, which it will do without another operation, but only if it gets the chance. That usually means immobilization “in equinus” (plantar-flexed) for a while, and usually with a couple of weeks back on crutches, too.

    Nuisance for sure, but (a) it may save you some grief later, and (b) it’s way less nuisance than letting your Doc re-open your AT to have a look-see!

  48. BTW, if you think the scientific evidence on treatment of an initial and total ATR, don’t even bother LOOKING for statistics on different treatments for partial tears or re-ruptures!

  49. Norm,
    Thanks for the advice. We’ll say maybe it was less of a “kicked” feeling and more of a pull/something dropped on it. Definitely not as bad as the first time, by a long shot. (But I had also had a few drinks so it’s hard to tell if the pain was dulled by the alcohol). But you’re right it might be a partial retear, so I am getting my crutches back and planning to take it easy and will call the doc in the morning.

    BTW really liked your summary of the surgery vs. no surgery options. I ended up getting the surgery but if I had to do it again would probably not. It’s frustratingly almost impossible to find a doc in the states willing to treat you with early rom and weight bearing without the surgery.

    And you’re right I know it’ll be impossible to find any good studies on the best treatment for re-ruptures. Sigh. If it turns out to be a re-rupture I think I will fight harder not to have another surgery.

  50. Thanks for the kind words. BTW, when I said
    “BTW, if you think the scientific evidence on treatment of an initial and total ATR, don’t even bother LOOKING for statistics on different treatments for partial tears or re-ruptures!”
    I obviously left out a few words, and I can only guess now what they were! If you think the evidence. . . is just preliminary. . .?? only a few studies?? Who knows?!?
    Good luck, I hope it’s not a major setback for you.

  51. Went to the doctor yesterday and he confirmed that it’s not a re-rupture. His recommendations were the same as Norms (adjust the boot to a more pointed toe position and no weight bearing for a week).

    I do wonder what the pain was - I think it might have been an ankle sprain, maybe due to the whole ankle being weak from lack of use. I plan on taking the recovery slow - I definitely don’t want any more surgeries.

  52. It is a bit of a tight-rope, trying to advance quickly without a serious setback. It reminds me of trying to hit a winner in a court sport like tennis, squash, badminton, or volleyball: If you hit the out-of-bounds line, you’re probably a winner, and if you miss it you’re definitely a loser. So you don’t aim to HIT the line, you leave a reasonable safety margin. How much margin is a personal judgment.

    Here you’re obviously not talking about just losing one point in a game, so a good-sized safety margin seems rational to most of us. But if you REALLY play it safe, the studies show you’re not even that safe, and you’re definitely messing up your life!

  53. Rerupture here, did conservative treatment the first time. This time I was about two weeks fwb out of the boot and it snapped. It happened last week while I was climbing stairs and pop. The snap was bone chilling, but I knew exactly what it was and drove to the hospital and got it confirmed.

    I get surgery tomorrow and hopefully that will fix it right this time. Strange thing is that I could still flex my calf and have very little pain, but there are very noticable deformities along my tendon now

    Worst part is now I’m losing my job and with that my health insurance. Wish me luck, because I havent been getting any on my own lol.

  54. I sure wish you luck, Mike! If you can, start a blog and catch us up and keep us posted.

    You’re one of several people who’ve recently posted a story about re-rupturing after “conservative treatment”. Yet all four recent careful studies on the subject found very low re-rupture rates (with AND without surgery), at least with their modern and fairly aggressive rehab protocols — like bit.ly/UWOProtocol .

    What was your treatment protocol like? You mention “the boot”, so it obviously wasn’t an ultra-archaic multi-cast thing. Can you compare what sequence you followed, to that protocol? Does “fwb out of the boot” mean that you weren’t FWB in the boot, or am I misreading your “tea leaves”?

    I guess with your surgery tomorrow, there may be a little “pause” in your communications, but I hope you return to give us some more details — and some good news, too!

  55. Good luck Mike. This injury is tuff enough when everything goes your way. Keep your head up and keep us posted. I really think posting my atr helped me out mentally

  56. My surgery went good! Ive heard some bad stories so I’ll just consider myself lucky even though my hand is still numb. Now I just have to keep my fingers crossed that I stay infection, dvt, etc free.

    On the previous conservative treatment I received. It consisted of two months in a hard cast, starting in aquinas(sp?) position with recasting until I was able to keep my foot at 90 degrees at the end of the two months. Then I was given a removable boot cast, which I was told I could walk around fwb, this was done for a month. Then I was given the green light to walk without the boot, along with starting pt. Two weeks later snap.

    Has anyone heard of waterproof casts? My dr told me I can get one once the wound heals but Ive never heard of it.

  57. Glad the surgery went well, Mike. Keep healing!

    Yup, that sounds like the traditional (old-fashioned) “conservative” treatment, with the ~15% re-rupture rate, rather than the new aggressive non-operative rehab protocol like the UWO protocol, with the ~2-3% re-rupture rate! That was in the States somewhere? 8 wks NWB is 6 wks too many, and casts don’t give results as good as boots, either.

    There’s at least one waterproof BOOT, the VacoCast (called VacoPied in Europe). Gunner and a few other bloggers here have used it, and I think they all recommend it highly. Fiberglass CASTS are pretty waterproof, too, but you’d never dry out the inside if you went in the water with it.

    I started this rehab in an Aircast. It isn’t hinged like the VacoCast (and hinged is GOOD!), and it also doesn’t advertise itself as waterproof, but it is. The shell is all molded plastic, and the liner is all washable foam, with the slabs held together with Velcro. With any boot you’re planning to swim or bathe in, I think it would be a great idea to get a second liner.

  58. Not to familiar with the difference between the different non-surgical protocoIs. I was treated at the Mayo clinic, so I pretty much just left it in their hands. The dr. said that hes never seen a rerupture with the surgery option, so Im feeling pretty comfortable this time around.

  59. Hi everyone, Just want to share my story and seek for some advices and suggestions ( I will try to keep it short :) )

    Apr 19, first time ATR while playing baskeball, it wasnt that painful (I thought it was only a sprained ankle) until I realize I torn it and I have to do surgery.

    June 2, after spending 6 weeks on cast both of my foot finally can have a taste of the ground, and believe it or not it lasted only 2 hours until I tripped and fell. Blood poured out and I could see a hole in my achillies, I cried, screamed but its useless, I ruined it again

    June 4, doc said he suggest to put a piece of the tendon near the calf to do a ‘reinforcement’ to make the tendon stronger, I trusted his expertize and let him do whatever that he thinks its best for me

    July 16, cast off, the scar is 11 inches long, it looks disgusting… but this time around i felt pain on the achillies, i remember when i had surgery the first time there was no pain at all, just stiffness, but this time I do feel a sharp pain once in a while, does anyone in here have simliar surgery? and this question might be stupid(but i would ask anyway) is it normal to have pain and how long will it last? its just the ‘reinforcement’ part that is scaring me and I m afraid it will be a permanent pain. wish everyone a speedy n sucessful rehab!

  60. some correction- I meant they took out a piece of the tendon near the calf and put it on the achillies, the re rupture was on the exact same spot

  61. Alex, most people find that getting sliced open and stitched together hurts a lot, and that the pain goes away as it all heals. Sometimes quickly, sometimes slowly. This should pass, though it’s already been a while. 6 weeks in a cast is “old school” in a few ways, and you’ve suffered through it twice now, poor thing!

    Straight from a 6-week cast to 2 shoes again? Be careful, because you’re still very vulnerable. Are you getting any PT? You may well have “attachments”, where things have healed together that should be sliding over each other. (I’ve still got a tiny one of those from my first-ATR surgery in late 2001! When I point my toes way down, I can see the top of the almost-invisible incision puckering, because something is “stuck”!)

    Most Physios have experience at breaking up those attachments and getting things sliding again. Maybe a bit of EXTRA short-term pain, but there should be some long-term gain there, too.

  62. Mike0900, if you read this page, you’ll see that your Doc is about the ONLY person who’s “never seen a rerupture with the surgery option”! He obviously doesn’t hang out here (or read many studies), because we get re-ruptures after both treatments. With a super-slow “conservative” version of the non-surgical cure, the risks are especially high, as they seem to be with a super-slow rehab after surgery. And underneath it all, there’s the 2-3% who are going to slip or fall or get their foot stuck somewhere, etc., etc., and blow it while it’s still weak and vulnerable.

    I’m disappointed that you got such a slow rehab protocol from the Mayo, in this day and age. Maybe it’s just the one surgeon, maybe he doesn’t do many ATs, whatever.

    Check out bit.ly/UWOProtocol for a good modern high-speed rehab protocol that produced excellent results in 145 complete-ATR patients, with and without surgery. It’s also been working well for at least 3 of us here. I don’t think there’s any good reason — certainly not one based on evidence — to go any slower.

  63. thanks for the prompt respond norm, in my country all the top doctors works in private hosiptals, I am too broke to go private so I did it in a public hospital, which is another reason why I m afraid they messed it up, I read alot of stuff about ATR, the boots and stuff but they dont have it here, 6 weeks on cast then both feet on the ground is what they suggested(i might not have my re rupture if i m on boot)… but forget about the past, i look forward to have a pain free healthy life again

    I went to see PT 5 days ago all she suggested was to do more streching as my tendon is still stiff, nothing more, but I do have an appointment w/ a specialist tomorrow and i ll see what he has to say, as for the attachment u mentioned, I do feel pain when i touch the ‘attachment’ but i dont have any pain on the cut itself, hopefully it will leave me soon, will keep you guys posted, take care!

  64. hi everyone :)

    So glad to see all posts & updates, definitely helpful & i hope to gain more knowledge as i recover from ATR.

    I had an ATR on RIGHT leg 8 years ago (27 years of age playing top flight basketball for my province) opted for surgery & can honestly admit i didnt do enough rehab, strengthening etc (calf atrophy?) to ever play sport again but as time went on, & playing basketball regularly for the last 7 years, my luck finally ran out & ruptured achilles on LEFT leg 3 weeks ago! This time i opted for non-surgical treatment & have convinced myself it was the right decision…lol

    Been in a fibre-glass cast since accident & unfortunately have DVT which means taking Warfarin daily & fortnightly cast changes for the next 3 months (which include angling foot) & with plenty time to think of decision to have non-surgical treatment, i’m hoping to find some comfort in your stories of bravery, hard recovery & endless rehabilitation.

    Cheers, take care all & look forward to hearing more from everyone…

  65. gqsmoove7, start a blog and give us the details, including installing the widget at http://achillesblog.com/dennis/2008/03/08/achilles-timeline-widget/ so we can all see (or remind ourselves) where you are, how long ago it happened, etc.

    Non-surgical treatment works every bit as well as surgery according to the newest (and best) studies, but only if you follow a modern aggressive protocol like the one at bit.ly/UWOProtocol . The old slow “conservative’ non-surgical treatment did NOT work well, with excessive re-rupture rates.

    Do you know if your Doc has slowed down your protocol since discovering the DVT? Or was it always slow?

    I think DVT can occur with any leg healing (like ATRs), though it’s much more common after ATR surgery than during a non-surgical rehab. Taking Warfarin is a bummer, as is being casted for 3 months. But check if that latter is something to do with the DVT, or just the normal “torture” practiced where you’re being treated!

  66. hi Norm, thanks for your reply!

    Im not sure protocol Doc has me on but i gather it will be slow considering my DVT will limit my activities for few more extra weeks when cast finally comes off, well at least until im off the Warfarin. As for being casted for 3 months/fortnightly changes, i think that was always going to be the case, however im going to follow protocol you’ve suggested, getting both calf muscles to near 95-100% is my goal & i definitely believe it will help me.

    But for now i will start blog, timeline etc & keep reading on updates, thanks again for your knowledge & look forward to the healing.

    :)

  67. Maybe some other patients here, or one of the doctors here, can enlighten us all about the relationship between DVT-and-Warfarin and rehab speed. it’s not obvious to me offhand that this complication is helped by adding time to total immobilization, or to NWB time. But I’m certainly no expert on DVT, not even an AMATEUR expert!

  68. While watering down the dust when the excavation for my home waterline connection was being filled in, the side support outriggers of the machine that was compressing the dirt stepped on me..in Oct of 08. The operator couldn’t see me and the machine jarred me for a while until a laborer spotted me. The achilles seemed okay after a few days. In January it began to ache, especially while teaching snowboarding. It felt better in the spring and I was able to wakeboard and hike. But last winter it again became painful. In May I finally consulted my son’s ortho doc and had an MRi taken. An operation was performed on May 10. I am able to bike, hike and wakeboard again now.

  69. hey guys, havent update for a while, the reason being, i was in the hospital again, this time for an infection, its kinda odd as I had my re rupture dated way back on june 2nd, i discovered the infection on aug 12 and had surgery on aug 14 to remove the pus, was on antibiotic for the past 4 weeks, just as things cant get worse, i now have plantar fasciitis, its really frustrating, everytime i think i can finally do some rehab excercise i have to stop, sigh

  70. Alex, you should put this, and your future news, in a blog of your own.

    All the talk about infections and pus is really making me glad I was talked out of surgery by my surgeon, sorry.

    Have you tried gently massaging your heel by rolling it over a ball while you sit in a chair?

    Good luck, I think you’re due!

  71. Alex,
    You definitely MUST get your own blog. Follow the instructions in the third paragraph on the main page of this site.

    i am very curious about your infection. It sounds like you had an abscess, correct? What was at the bottom of the abscess? I had an abscess and it was caused by the huge knot in the non-dissolving sutures. If you had an abscess caused by the suture material and all they did was clean out the abscess, you stand a very high chance of getting one again. My second surgery was to clean out an infection - a waste of time and money. My third surgery was to close the incision that refused to close after 2 months - another waste of time and money. My fourth surgery was to remove the knotted suture material at the bottom of the abscess. I am now fine.

  72. wow I m sorry to hear what you have went through, I was so clam this time around when the doctor said I need surgery again, I got to a point where I was like screw it, I clearly remember what the doctor said when I had my first rupture. “the 2 worse scenarios you can have post op is 1)re rupture 2) infection” well I gone through both in the past 4 mths

    I got infected by a virus called Staphylococcus aureus, I m thankful its not MRSA or else I would be really screwed. My doctor removed all the suture material as hes afraid there is virus hidden there. I will start blogging and give the details later(I have horrible memory so I better start soon), the past surgery I had(abscess removal) was done by an experienced doctor in a private hospital so I have more faith this time. As for how I got my infection, I don’t really have an answer. There was a hole in my achillies when I had my re rupture so virus might got in at that time, As for how the hole was like, just think pac man, thats how it was like, I had to use my hand to grab the 2 pieces back together to stop the bleeding. When I had my re rupture surgery, I was staying in ward and 1 patient got infected by MRSA, and one got infected by regualr SA, I was concern and guess what, I got infected as well. Other than that I can only think of a tiny tiny cut, maybe 1 mm on my ankel(dunno how I got it) so I really have no clue of exactly where the infection was coming from

  73. Pretty cool post. I just stumbled upon your blog and wanted to say that I’ve actually favored studying your blog posts. Anyway I’ll be subscribing to your weblog and I hope you put up once more quickly!

  74. In any case, I can basically salute to all details. Excellent post and thank you for it.

  75. I agree with all the things you’ve said, however like you mentioned at the finish, I always end up going again to how I used to do things. It’s a by no means ending circle. Writing things down is a great idea. I’ve recently beginning storing modifications in each day processes in spreadsheet information, so I can use them like a check list. The only problem then is that the list gets too long and I start missing bits out! Getting right into a rountine when one thing is modified is the best recommendation I can give.

  76. 32 yr. Active male
    original rupture (pop) playing bball June 6 2010 doc reccommended non surgical with boot locked at 30• I was leaning towards surgery and was informed to late to do after 3-4 weeks post injury, oh well..
    Repupture (not horrible, no loud pop just reaggrevated) on September 12 2010 walking without boot, reccomended to go back in boot to heal, not happy.
    November 25 2010 pop, bad, was just back to walking again this time I wanted surgery and was reccomended same. Had surgery December 1 2010 with flap down technique, was told was very bad condition and prob no sports / activities.
    I feel devestated and like on my own island, didn’t do anything outside of what docs reccomended but hopefully 3 times is the last for me :)

    Anyone else out there with some advice / help?

  77. Hi all. Original rupture August 19, 2010 was called a transverse rupture11cm proximal. “Normal” rupture is 4-6 cm. Anyway dr. that owns my office building treated me (podiatrist). 8 weeks casting. Every two weeks we removed the cast and flexed the foot a bit to put some stress on tendon. For the last 3 weeks with cast on I walked on it. More like lumbered around on it. Following pt protocol at home mostly. Ultrasound tx at therpaist and I would stretch and do calf raises at work and home. Ice when needed. Foot always swelled up as day went on with a fairly large bumb right above my heel.
    Well I was walking up stairs today and felt excruciating pain. Felt like I got kicked again. Thompson test has good movement and I can flex toes and move foot. Moderate burning. Doc saw me today at his office (sunday). Need MRI. I am expecting partial or total re rupture. What to do this time? Conservative following UWO? Surgery? Not to excited about surgery and after reading norms comments about studies maybe not needed. This is devastating physically and mentally. Tough to take. Just want to do what is best. Thanks for help

  78. hi lavalamp,

    if your thompson’s test is good, then your tendon is probably still attached. i went through something similar at 8 weeks, 2 weeks after going into 2 shoes. was just walking down the street and i felt the same dreaded sensation of being kicked. my whole ankle swelled up and i couldn’t walk on it. but it turned out to just be some scar tissue tearing and my AT was fine. after 3 days the swelling went down and i was back to walking, although it did leave me with a lump of presumably balled up scar tissue on my heel. if you can feel the full length of the tendon you are probably ok. good luck

  79. 3timer, the only advice i have is take it REALLY easy. if i were you i’d probably be overly conservative and stay immobilized for longer than the first time (or 2). the downside is obviously that you are going to atrophy a lot but i would imagine a 4th rupture would be very bad news. good luck and keep your head up.

  80. Kaston,
    Thank you for your reply. That is good to hear (sorry at your expense) that you had something very similar. I am walkingon it very lightly and mri prob today. I hope it is scar tissue and thought that it might be but the suddeness of it concerned me. The lump of scar tissue actually looks smaller today and last night. Why wasnt I fully dipped in the river styx:)

  81. Lavalamp, the last time somebody popped up here thinking about treating a RE-rupture non-surgically, I tried (unsuccessfully!) to talk him OUT of it! I’m not into non-op, I’m into evidence, and there isn’t any on non-op treatment of re-ruptures, AFAICS. Maybe it works just as well on re-ruptures as it does on fresh ones, but it’s just another maybe.

    Meanwhile, I think it was Brad here (if not, correct me somebody, please) who re-tore his and went for a UWO-like non-op “cure”. Last I noticed he was happy, and it’s been a while.

    I hope you haven’t re-torn it. Good luck!

  82. Kaston, you’re reminding me a bit of the “ultra-conservative” surgeon who fixed my first ATR. I’ve never seen a scrap of evidence that indicates that “being overly conservative and staying immobilized for longer” is actually safer from re-ruptures, than following a good and tested and relatively fast protocol.

    Personally, I also wish we could start fining anybody who tries to win a point by saying something like “after all, you really don’t want to do this again” or “another re-rupture would be terrible news.” Of course, of course.. But the implication is almost always “. . . so go slower”! But if the evidence shows that going very slowly makes you as likely or MORE likely to re-rupture, then it’s more an empty slogan than a reasoned argument.

    Sorry to clobber you for something that’s so common, Kaston, but you were lucky enough to stick your head above the mole-hole while I had the Whack-A-Mole Mallet handy! (Besides, I just found out I have to stay in the hospital one more night, because they didn’t get my blood-work lined up before time started running out, and I’m p!$$ed!! I was all showered and changed into my street clothes, and VERY much looking forward to getting home.)

  83. norm, sorry to hear about the extra night in the hospital. glad to hear your heart surgery went well. doesn’t sound like it’s kept you down at all.

    3timer’s case is pretty simple. he has re-ruptured twice while walking in shoes. without knowing the details of his rehab, i’m suggesting taking it a bit easier and maybe getting back into shoes a little slower this time. from your vigorous opposition to this advice, i can only assume that you think he needs to get back into shoes faster than the last 2 times that he re-ruptured. while in shoes. sorry to be blunt, but i think that might be worst advice given in the history of achilles tendon ruptures.

  84. You may be right, K, and I may be. . . that other thing. Or not. I believe a lot of the “conservative casting” came about historically, through a series of applications of exactly the same straightforward and well-meaning logic you’re applying. Patients (esp. the non-op ones) were kept in casts until their legs turned to noodles, with no chance for their ATs to learn how to become a tendon.

    After 10-12 weeks or so, they were cut free and got into shoes. And a WAY high proportion reruptured. The Doc and the Patient both agreed on those platitudes I hate (in my last post), so they made a mental note to go even slower. Only one problem: It never worked very well!

    OTOH, a WAY faster non-op schedule that “logically” seems scary and fraught with risk of re-rupture, has been shown to have a near-zero re-rupture rate, indistinguishable from surgery! I think it was Seppo Marx’s line: “Who you gonna believe, me or your own eyes?”

    We can’t keep 3timer out of shoes forever, so the question is only how, and when, he gets there. I think surgery probably makes sense, followed by a schedule with some evidentiary support behind it, since he needs as many “odds” stacked in his favor as he can get!

  85. norm, none of those studies you quote for evidence deal with 2 re-ruptures. i think his case is a bit different

  86. MRI confirmed re-rupture. Also reconfirmed that the tendon has severe chronic tendonosis. Doc said re-rupture prob would have happend regardless of treating with/without surg (no surg first time). Does that make a case for no surgery again. Opposite might be true too. Dont know dont know. Anybody been through something similiar? rerupture was a near full rupture. A few strands may remain intact report said. UGH

  87. Lavalamp, sorry to hear the bad news. Most of us ATR folks DON’T have severe chronic tendonosis, though some sure do. Maybe it changes the best treatments, but I’ve never seen a study that takes it into account.

    The guy here who treated a post-op re-rupture WITHOUT surgery is actually Brock, not Brad. Check out his blog for his story. He’s still happy, but that’s no guarantee (and there aren’t any!).

    The non-op approach may or may not work reliably, though, while surgery has a fairly high rate of solid results. Or maybe I’m making a distinction where there’s none, since there’s actually no study proving that surgery works well on re-ruptures, either! But because the magical healing that facilitates the non-op success is poorly understood in the first place, it’s conceivable that it’s not as well triggered by a re-rupture? (Dont know dont know.)

    In fact, I think ALL the new studies that have proven that the non-op approach works well on initial ruptures, actually sent all their own RE-ruptures “under the knife”. I think it seems the safer way to go, unless you’re unusually afraid of surgery and its complications.

  88. Norm because my tendon is in bad shape with long standing inflammation, two surgeons (good friends) I chatted with said that the surgery would help bring some bleeding to the area and help heal my otherwise “very unhealthy tendon” as my doc says. Thinking I am headed for the knife. I am gonna start my timeline here to hoefully help others who could eventually b in same situation. I will check out brocks blog. Oh and my current non surgery doc said no basketball and that I could not go back to my triathlons. That immediately depressed me further. Ortho guys think I could get back to tris if I do surgery. Guess that answers it

  89. Ya, I wouldn’t have taken the “you’ll never do THAT sport again” option, if there were another option available.

    Good luck! And keep us posted.

  90. Lavalamp: I had the severe tendonosis prior to rupture as well. First surgery, ortho just stitched back what was left of the Achilles. Second surgery with a foot and ankle specialist, the surgeon augmented the Achilles a little. He initially was going to use my toe tendon but when he got in there he decided to use some sort of a graft jacket (something from a pig I think). You might ask your surgeons if they plan on putting in some sort of reinforcement material to help strengthen the area.

  91. Thank you for your info. It is nice to know someone else went through something similiar. Do you mind to tell me your timeline on first rupture then re-rupture? Were they both at the same level? How did you feel after the first surgery? How did you feel after the second surgery? How do you feel now? Thanks for the info. I am trying to learn from what others have gone through.

  92. Norm new study out yesterday out of Canada. Level 1 type. Commentary on an article by Kevin Willits, MA, MD, FRCSC, et al.: “Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation”
    I have not read full article yet. Trying to get access. THought you might like to see this evidence based discussion. Boy am I going through the emotions. Yesterday I thought knife for sure and today I started out thinking cast only but now leaning toward getting cut if my tendon can be reinforced with something to make it stronger. No guarantees just a tough decision. It puts strain on my family to take care of me and strain on my business as I will be out. I guess I need to do what is best for me. Only I know that.

  93. lavalamp34, that’s the “Don’t believe it!” Commentary that was published at the same time as the UWO study. I don’t know what happened yesterday, maybe the print version? The study and the Commentary were both available on the pub’s web-site since Sept. or Oct. I found it just a day or two before it appeared, and posted the note here and (ref #7) on Wikipedia.

    I think the Commentary makes a few reasonable points and a WHOLE BUNCH of silly and unworthy ones. Too much of it is contrasting the evidence from the study with “popular understanding” or “general practice” or other things, as if everything’s just as important and just as valid. Bleggghhh!!!!

    There is still reasonable room for doubt about whether the best non-op re-rupture rates will be EXACTLY as good as the best (or even “standard good”) surgical re-rupture rates. On Strength and ROM, I think the boat has sailed, and surgery apparently adds nothing (except speed, if you go fast like doug53).

    But if you care more about (say) 4% vs. 2% re-rupture rates than you do about surgical complications that are much MORE likely, then it may be true that there’s a small re-rupture-avoidance advantage to the surgery. Or not.

    Mind you, ALL of this is about treatment outcomes for PRIMARY ruptures, not re-ruptures like you. As I said before, I’m “Mr. skip the surgery,” but I might well go under the knife after a re-rupture. If there’s a general tissue problem, then just listen and learn and make your best choice. Of course a non-op boot is much more work-friendly than surgery (I didn’t miss a day of work!), but if it looks like there’s a “long-term gain” on offer, it’s worth some short-term pain to get it.

  94. Norm,
    What do you mean by the “dont believe it commentary?” I like the long term gain through short term pain comment. I agree with that. What I can deduce so far for me is that I think both would provide a good outcome. However, the rest of my tendon (outside of the two healed ruptures) is not in good shape and could possibly get some benefit from being reinforced during surgery with pig intestine or some sort of mesh.

    It s not like I need to get back to a pro athletic endeavor or even a minor one but I sure would like the option to be as active as possible. Running and lifting or big outlets after a long stressful day for me.

    On the other hand, my father just went through total shoulder replacement and is now dealing with a MRSA infection. Sure don’t want ot go through that. I am not the sky is falling type of guy but I do enjoy looking at all angles and trying to make an informed decsion based on what I can learn on my own. Current doc is a podiatrist with lots of experience and wants to stay conservative. All orho docs I talk to want to cut for the most part but also think that consevative is reasonable.

  95. lavalamp34, I just meant that the main theme of the Commentary to the UWO article was. . . “Don’t believe it!”

    Reinforcing and grafting seem eminently logical, either in providing a stronger FINAL product, or in providing a srtonger INITIAL product and therefore a quicker or safer recovery. Unfortunately, the careful studies I’ve seen testing it have mostly found that it does NOT produce better results than simple surgery — which in turn, doesn’t produce better results than NO surgery, for initial ATRs!

    OTOH, the reinforcement with the patient’s own big-toe tendon (which at least 3 people here are undergoing) may have proven benefit. I’m not sure I’ve seen proof, but that doesn’t mean it doesn’t exist.

    I’m fond of skipping ATR surgery, but I’m nervous about skipping it for a re-rupture, because I like following evidence even more than I like skipping surgery. (You’ve heard that from me before.)

    BTW, have you been immobilized in a suitable toe-down position for all the time post-re-rupture, and how long has that been? It seems like it’s been long enough to produce some non-op healing, which might help inform your decision-making — kind of the way that johanna ended up skipping her scheduled operation.

  96. Lavalamp: Here is my rough timeline. 13/14 years ago started with tendonosis. 12 years ago had partial rupture in right which was casted for a few months. Continuous pain in both legs. July 2006 had a full rupture on right with surgery. Continuous pain and weakness. MRI in May 2008 showed Achilles dwindling down to threads again plus a few other issues with my heel. Achilles also needed lengthened. Surgery #2 on right side in July 2008. January 2009 had surgery on left. This one had not ruptured yet but was on it’s merry little way according to the doc. This one was also lengthened, work done on Haglunds and heel bone. This one also had to have the sheath removed. No augmentation need on left only on right.
    I am now mostly pain free. I have to keep my legs pretty warm or I get zapped. I can do most anything I want just in moderation. I am not as fast in sprints but I don’t sprint that often anymore. Switched most of my cardio training to non-weightbearing just to be safe but still enjoy the other. I am really thankful to be pain free and active.

  97. Smish,
    Ummmmmm WOW! You have been through it! After my initial rupture on left, I always felt a lot of tightness after casting and huge ball of swelling during healing above heal. I feel better right now ater second rupture and swelling is less? No pain after second rupture (after initial worst pain of my life for 20 mins). My thinking is that initial rupture put a lot of stress on a crappy tendon that contributed to second rupture. I think thsi would have occured if I had surgery first time or not. Great to hear your story. Sorry you had to go through that but thanks for sharing. I have scheduled surgery for a week from today! Looking forward to recovery and rehab. I am ordering the vaco boot today and my surgeon likes the aggressive nature of rehab I have toalkled about. He has chatted with me on the phone a couple of times at length. Nice to actual talk to a MD!!

  98. Norm,
    Boy I tell you I sure enjoy this forum. Really nice to talk it out. I have scheduled surgery for this Friday (week from today) I am currently in plantar flexion in a fibergalss cast. Injury happened 5 days ago. Zero pain and I actually walk a bit on it (although it is impossible to put pressure on foot because of dorsi flexed position). My decision was based on the fact (fact as best I can tell) that some reinforcement could not hurt my chances and letting my body bring some blood and healing nutrients to the tendon by way of the surgery. It is so tough to know what is best. I chatted with others on the phone last night that ruptured and had surgery (no re rups though) and they I very happy where they are right now. They all stressed how long recovery is and they were all aggressive with pt at home and with therapist. I think this is the difference. I am ordering vaco cast today and my surgeon likes the idea of weight bearing at two weeks and following the therapy. I am nervous and relieved at teh same time. Following surgery, are you usually in splint that allows for wound inspection and placment of ice? I would think so but have not asked surgeon yet.

  99. lavalamp34, I’d vote +99 for “It is so tough to know what is best.”!! And that’s for simple straight-forward sports-type initial ATRs, of the sort that dominate the populations in the scientific studies. Your leg and situation are obviously not straight-forward at all, so it’s all judgment and expertise and logic (none of which have distinguished themselves whenever we’ve tested them with evidence!) and what you’re comfortable with.

    Fortunately, it’s not hard to find ATR folks who are “very happy where they are right now” — surgical, non-op, recovering from re-rupture either way, in boots, even in casts. For most of us the healing process eventually makes us happy, with a broad variety of treatments. Most of the arguments are about the sizes of the small minorities that aren’t happy.

    FWIW, I think you’re making the same decision I’d make in your place. And when normofthenorth chooses surgery for an ATR, it’s GOT to be worth at least a COUPLE of “votes”!

    Your immobilization during the first ~2 weeks post-op is very personal to your surgeon. Some use splints or wraps, some like plaster casts.

    Most won’t want you getting the wound wet, so ice may or may not be OK. It’s also a terrible idea to contaminate the wound, including just touching it with “ordinary” hands, etc.

    My surgeon went for the plaster cast. I spent about a week in bed with my leg up on bolsters and pillows, as I recall. I tried two basic techniques, alternating between the moaning and the groaning. I also used a big jug as a urinal to minimize trips to the loo, especially hurried ones. Occasionally, my wife still reminds me of that delight, 9 years later!

    All the best!

  100. And lavalamp34, now that you/we have totally taken over this general thread, I think you still really should start a blog of your own to keep us updated. Dennis makes it easy, though nobody’s born knowing how to use WordPress! And install the little ATR Timeline Widget so we can all instantly remind ourselves of your basic facts, too.

  101. Norm,
    Sorry about taking over this thread. I will start timeline. Good to hear you would choose the same routine I am doing! Gonna b laid up for Christmas this year. “All I want for Christmas is my two good tendons” You dont want to hear me actually sing. I am gonna set it all up when I am laid up for a week straight. My wife will be taking care of me and our four daughters at the same time. I am gonna be in debt to her for a long time!

  102. We both hijacked it, lavalamp34, with a little help from our friends!

    Play your cards right, and it can strengthen your relationship. Most of us find it easy to be appreciative when we’re relatively helpless. Live in that!

  103. I hope everyone keeps warm & stays safe!

  104. I’m lying here thinking I’ve re ruptured my Achilles. I think I’m in denial over it…..my scar is bleeding and I heard a pop. Guess it’s time to go to hospital. What a shit year.

    If it’s bleeding does that mean it’s probably ruptured?

  105. Hi Mike I think you need to go and get it checked out, the what ifs are probably worse than the actual diagnosis. Hope it goes well and it’s not the worst case scenario. Let us know how you get on. LL

  106. Mike: Really sorry about the possible re-injury. I hope it isn’t as bad as you think.
    Just curious, what were you doing that may have caused a re-rupture? How many weeks out from surgery are you? It might help the rest of us to know for future reference.
    All the best to you.
    Chuck

  107. Thanks guys.

    I was drunk and was going up stairs, when sober I put my foot sideways to spread the weight to my heel. Obviously I wasnt thinking and put full weight on my toes.

    I went to my local hospital and they said it looks like a rupture and could feel a gap and he did are half effort Thompson test. I then go to main hospital basically for surgery they do the Thompson test and say my tendon is attached and wanted me to do a calf raise. I wasn’t confident in his decision. I have physio tomorrow night for a 3rd opinion. I’m still not sure.

    I’m at 6 and a half weeks post op. I was recovering well, walking in regular shoes with heel insert and doing stationary bike etc…walking was improving daily.

  108. Few questions.

    Would I still pass a Thompson test if a partial tear?

    Do re ruptures usually happen in a different part of the tendon to the original rupture. Mine seems like an inch up, hard to tell due to swelling.

  109. I’ve just done Thompson test on my self while kneeling and my foot definitely flexes. I’m starting to believe false alarm, there is definitely some sort of gap on my Achilles, hard to tell due to swelling. Could a minor partial tear happened allowing me to pass Thompson test

  110. Hello everyone,

    I’m new to the site and will be starting my blog shortly but have a re-rupture question.

    I ruptured on 5/16/2011 and had surgery on 5/24/2011. I’m now on my second cast which comes off on 6/22. As the days go by I’ve been trying to combat atrophy by wiggling my toes and flexing my calf in the cast. My question is :

    Is it possible to re-rupture your tendon by pushing to hard inside the cast? I dont want to go back to square one by doing something stupid.

    Thanks

  111. I think the sad answer is probably “Yes”. Your calf muscle is probably strong enough to tear your injured-and-repaired AT. I can’t recall hearing that anybody had demonstrably done it — though I suspect that some of the re-ruptures from slips and falls in casts were caused by the calf pulling hard in reflex, rather than the fall itself. Some of us have also worried about post-op calf spasms. Some have gotten pills to lessen them, but I don’t recall anybody actually re-rupturing from a spasm, at least during the 1.5 yrs that I’ve been paying attention.

  112. It turned out I didn’t rerupture my tendon….just hurt it pretty bad and made a lot of bleeding and swelling etc…set me back about 10 days….but at exactly 8 weeks post snap/op I can walk pretty well.

    Your calf will atrophy whatever….after 4 weeks it will be nothing, you’ll probably get your cast off at 6 weeks and then try and start strengthening it with seated calf raises(I started a little after 4 weeks because I had a removeable cast by then). Mine has actually improved loads in the last week and I can easily flex it, I reckon another 2 weeks before doing one leg calf raises on it. The muscle has came back pretty quick, once I get walking 100% it should be back to regular size in no time.

    I doubt you will rerupture by wiggling toes and pressing on cast, I used to do it all the time and destroyed my 2nd cast by standing on it and loosened the bit by my toes significantly by moving my foot. It’s controlled pressure, it’s the people that aren’t very good on the crutches that are at risk, I never once in the 4 weeks slipped or made a mistake with my crutches, but I’m quite light and can do lots of dips. Only thing that ever worried me was big twitches when I was sleeping.

    Read up on cissus and vitamin C mega dosing…not sure if it has helped at all, but I took it anyway and I seem to have healed quicker, even with a set back.

  113. Glad you didn’t rerupture, Mike, and I hope your forecast for one leg calf raises comes true. Many of us (including me) kept revising that forecast, on a “frustrating plateau”.

  114. Yeah I’m always overly optimistic about everything, but I’m pretty lean and I got age on my side. Plus I’m starting to do a fair bit more in the gym now. I was doing leg curls at about week 3(was told by physio not to start these until about week 8-10 at 6 week mark)….also began doing straight leg deadlifts the other day.

    So I’m pretty optimistic at the moment because I’m actually training my legs fully at the moment. Once I can begin squats I will be over the moon.

    I obviously don’t advice others to be as stupid as I am, I’m just a really inpatient person, reason why I snapped it in the first place.

  115. Mike, glad you didn’t re-rupture. That would have scared the hell out of me, so I am sure it is a relief. I too am optimistic and push everything as far as I can go. I am at 4 weeks, and back in the gym, although not much with the legs yet. Just some leg lifts. By the way, for those of you that have the option of a boot over a cast, I highly recommend the boot. I was out of the cast after 10 days, and in a boot. It makes a world of difference to be able to get home at the end of the day, take the boot off and just sit in a chair with the leg propped up. Showering is another good thing, although you have to be careful. The best thing of all is being able to take the boot off to sleep at night. I sleep with the injured leg bare. Probably not the smartest thing, and I won’t recommend to everyone to be as stupid as me, either. You really have to be careful when you get up to go to the bathroom on crutches at 3 am, but I sure sleep better than I would otherwise.
    Cheers to all!

  116. Hello All -

    This is a great site, thanks for all the information.

    Not sure what to make of this, but last night (1 week post surgery) I was going to the fridge on crutches when my crutch hit water and slipped from under me. My bad foot came down hard (I’m in a splint, up to knee) and the pressure forced my toe/foot upwards close to the 90 degree position (I don’t know how close). I was only on the bad foot for a second, but it hurt like heck.

    The pain went down to almost nothing in 30 minutes (with leg elevated), but the throbbing is more intense if I’m standing on crutches or sitting in a chair. The throbbing in these positions is similar to 3-4 days post surgery, whereas 6 days post surgery (prior to the accident) it was almost nothing.

    I have my post op in 6 days, and don’t plan on doing anything (other than being more careful) between now and then. Are there a lot of ’scares’ out there that don’t result in re-rupture?

    Anything I can do that may tell me one way or the other? I can’t do the Thompson’s test because of the splint.

    Thanks!
    -Todd

  117. Todd, I think almost all of us had similar slips at various stages of our crutch-time. Most of us did NOT re-rupture, though some did. 6 days may be a reasonable time to wait then have it looked at, so there may not be much to do — other than wait, elevate, and. . . worry, of course!

    We had one guy here who re-ruptured post-op recently (~4 months ago?), and his surgeon decided to treat it NON-operatively(!). Last I heard, he was doing fine, though that sequence is very unusual. Going the opposite direction (non-op, then op) is more common.

    Putting away the crutches is one of my fave reasons to follow a fast protocol — though virtually any protocol would still have you on crutches at 1 week post!

  118. I am a 61 year old male and had my ATR on my left foot. Surgery was 16 days ago, and went back to the doctor 10 days after surgery to remove the stitches. He put a cast on it. That evening I was very uncomfotable with the cast. I felt it was hot, tight, and suffocating. I could not concentrate on anything else, but kept thinking I could not be in this cast for another two weeks, when I am supposed to go back for the CAM walker. The next day, I went back to the doctor’s office and he reluctantly removed the cast and put me in the CAM walker. My wife was not happy about it, but I went against her wishes. On a scale of 1 to 10 for being uncomfortable, a cast is definitely a 10, while the CAM walker is a 5. I don’t like the CAM walker either, especially sleeping in it. However, it beats the cast by miles. In addition, the doctor said it is okay for me to loosen up the CAM walker at night, and that helps a lot. I also pointed a fan at my injured foot when I sleep, and it helps.

    I wanted to know if there are other folks out there with the same problem on the cast. To me, it was worse than the surgery.

    My wife has been great in taking care of me after surgery. However she will be visiting her folks out of the country for three weeks starting next week ( a prior commitment). I will be by myself. My wife has cooked up a lot of food and put them in the freezer. Between the frozen food and the take-outs, I am okay. I am living downstairs for now, and will continue to do so after she leaves. There is no shower downstairs. My wife suggested that I should skip taking showers for the first week after she leaves. Sometime during the second week after she leaves, I would go back to the doctor’s office and I think I would then allowed for PWB. She said then I can go upstairs to take showers by myself.
    I am thinking using a sponge to clean myself during the first week after she leaves. The other option is is ask a friend nearby to help me with the shower.

    Any suggestions would be appreciated.

    BTW, all the re-rupture posts really scare the S**T out of me.

    Best of luck to all.

  119. I think your problem is more common than you think or people let on. I was doing great after surgery for 4 days then I woke up one night feeling hot like a fever and then cold. I thought I may have had an infection in the wound so I ended up back at the hospital. My blood pressure was 183/133. Hours later it hadn’t dropped much and eventually they got around to taking the cast off to check the wound which was fine.

    As they put a new cast on I immediately felt the constriction and started to feel hot (flushed). It was like I was feeling claustrophobic. I saw my own GP the next day and he started a series of tests to make sure there was no medical reason but I was becoming more certain that it was due to anxiety. I remember it happening to me 12 years ago when I broke my arm but it was never diagnosed or treated.

    The stress of the injury couple with the death of one of my oldest and closest friends was taking its toll. I was due to move interstate to start building my new house on the farm I own. I was now looking at months of sitting around until I was fit to do any work. I am not used to sitting around and I suspect you may be the same.

    I made an appointment to see my specialist and told him the situation and he was very sympathetic, allowing me to get a range of motion boot set at 10 degrees plantarflexion with heel raises. My GP also prescribed some low dose Valium that I only used at night if needed. He also said that I would be able to PWB through the heel of the boot to support myself with crutches.

    The valium worked great and I found myself needing it less and less as I sorted my mess of a life out. I monitored my blood pressure and found that the hot feelings coincided with a significant rise in pressure. Valium is addictive and was concerned about that but was disciplined only to take it as needed. At day 20 I borrowed a set of forearm crutches, which meant I could use my hands when needed and they are so much more comfortable to use. The boot gave me confidence and while it is on there is very little chance you can rerupture. If you fell over, you are more likely to hurt something else than your injured AT. The more mobile and independent I became the better I felt. I found myself wanting to do more on my own including showering. I also found doing some exercise on unaffected muscles kept my mind and body in good shape.

    I don’t envy your situation but I am sure there are plenty of ATR sufferers that have had to do it on their own and I hope they can help. You should at least be able to get your wound wet now. Personally I wouldn’t risk the stairs on my own until I was confident with any sort of weight bearing. I think the idea of a friend coming over is a good one, even if it is only to make sure you are safe getting up and down the stairs.

    You will probably find that you will be getting around and doing things for yourself sooner than you think. Personally, I would consult a PT or an occupational therapist to get some ideas tailored to your situation. I know how much they helped my elderly father after he broke his hip. They helped set up the house and showed him the right way to do things.

    I am 9 wks today and am doing well. Now that I am wearing two shoes I am also worried about a rerupture as this would set me back months again. I am bleeding money at the moment and can’t afford another set back. I plan to get the foundations poured in about 2 weeks and my specialist feels I should be able to climb a ladder at 3 months but thankfully I will have a bit longer before I have to do that. For the moment all I have to do is make the 9 hour drive and supervise.

    All the best with your recovery

  120. My post above was intended for Kai. Sorry if it was confusing to anyone

  121. Thanks Stuart,

    I am glad that I am not the only one who could not stand a hard cast. My wife is still unhappy in my decision to go to the CAM walker directly, but she has subsided. She thinks a cast would have a better protection and heal faster than the CAM walker. Are there anyone out there who can tell me if she is correct?

    I have decided to do sponge baths while I am alone to avoid taking risks of going upstairs. I cannot afford to take the risk of a re-rupture. This experience is not something I want to repeat ever in my life!

    Best of luck to all.

  122. Kai,

    I think your problem with the cast is a blessing in disguise. I too, was moved into my boot early (10 days) after I got water in my cast. And if the CAM walker is anything like my Ossur air cast I also think you should be able to go PWB any time now. My surgeon told me when I got it, that I could put weight on it right away, with crutches. I was fully weight bearing one week later. It’s “to tolerance” so if it hurts too much, stop. But you’ll be able to care for yourself better and it’s so much safer once you get rid of the crutches.

    There are plenty of studies that suggest early weight bearing is MUCH BETTER for healing, strength and a faster recovery. Less chance of rerupture as well. This is just one study I found:
    http://www.physioroom.com/research/reviews/200311_review_achilles_tendon.php. I don’t want to unduly influence you against your doctor, but I’ve realized it’s worthwhile reading all you can so that you can advocate for yourself.

  123. Kai,
    I would encourage your wife not to worry about having a boot instead of a hard cast. The import thing is to keep it on to protect your healing tendon. There are significant advantages to healing with a boot. My doc allowed me to take it off from 3 weeks Post op to start some active ROM. I was allowed to sit in a chair and gently move my foot within its limitations. I could also get ice on it and started some gentle massage. Some people have commented that Doctors don’t like the boots because some patients just take them off when they are not suposed to but they offer every bit as good protection as a cast.

    As far as a re-rupture goes, the most dangerous time is from when you go back into a shoe until the tendon is completely healed. The CAM boot should protect your tendon for 99% of any circumstance.

    This is another link for you
    http://ajs.sagepub.com/cgi/content/abstract/31/5/692

    I have read the full version but this is a good sumation.

  124. It is a little bit more than 3 weeks post-op.

    My wife has been gone for four days, and I am getting used to living by myself. I am eating food from the freezer. I get around in the house using the knee scooter. I also rented another knee scooter to be used exclusively at work. I am also getting used to the CAM walker. I am still at the NWB period. I am going back to the doctor next week, and see if he will let me have PWB. I read in some blog that I could ask for a report on the surgery. I think I will do that.

    I had my first beer tonight since the surgery. Now it is just a waiting game. This probably will be the loniest 4th I have ever had.

  125. Kai,
    Didn’t realise you were back at work. Its amazing what we can do for ourselves when we have to and I bet the beer tasted especially good. I’m not sure what sort of boot you have but if its like mine with a washable inner then it may get a bit woofy until you can get it washed. It it does then give it a spray with some antibacterial air freshener. Keep some in your bag for work so you don’t put your colleagues off :) You sound like you are doing great. Your confidence will increase as you do more.

    You will probably try to put some weight on your leg before you see your doctor. I think it is just in our nature. Just remember to keep the boot on if you do and if it hurts then stop. I think Deana’s words above are quite tempered and worth bearing in mind. All I could add is if you are not confident understanding all the scientific information you find in these pages, don’t try to make it up yourself

  126. Suart,

    I never had a chance to ask my doctor about my surgery, and I wonder he will remember much about it four weeks later. Do you think asking him for a report is a good idea? Would that offend him?

  127. The surgeon would have made notes or a report so that when he reviews you he can remember. Its hard to say whether he would be offended or not but if you ask in a nice way then there wouldn’t be much reason to be. Just make sure you have your reason ready in case he asks why. If he gets offended then that is his problem and he shouldn’t make it yours. I didn’t get mine but I have read one someone posted (can’t remember where) and it was interesting.

  128. Hi Kal,

    I got a report like Stuart said describing the details of my surgery. My surgeon didn’t plan on saying anything about it either but immediately after the surgery I had the nurses find him to see if everything went ok.

  129. Day 25 post-op

    Continue to survive by myself while wife is out of town. My grown daughter calls daily to check up on me. This is the fourth of July weekend, and I don’t have to go to work tomorrow, I asked the newspaper delivery person to put the paper in the mailbox. Every morning I would hop into the car and drive to the mailbox to pick up my paper and the mail from the day before. Its been working pretty well.

    I also called a gas station which has full services (hard to find these days)! I will go to this gas station next week when I get off from work.

    Yeah life sucks when you are handicapped. It makes me think of the poor folks who are permanently disabled.

  130. I’m Tim and I’m 15 days post op from AT re rupture, yesterday was my b day. Not the greatest but could be worse. Keep in mind I’m doing this blog from my Blackberry..its a pain but it gives something to do. It gets better every day, I look at it as one big obstacle course. Even though I get frustrated a lot it only goes to a certain point because what can you do? Nothing. I have 2 or 3 more casts before they give me my cam boot. I already have mine ready to go from my original AT partial rupture that was more like a full rupture. Wow what a road of injury I’ve had.I know how it is all too well…

  131. Kai,
    Yeah it sucks but strangely enough I only realised yesterday that I seemed to have found a new routine. The first 6 weeks went so slow but advances seemed greater. I’ve been in 2 shoes for 3 weeks and am at week 10. The last 4 weeks have flown but advances seem slower. Its like what I am now is becoming normal for me. I guess people with permanent disability may feel the same or at least I hope the do. They get on with life as it is for them. I must say that some people never adjust and for them it must be hard. Years ago I stopped a man from gassing himself in his car. I spoke to him after at the hospital and he told me how he couldn’t cope with the constant pain from his injury. His life had definitely changed for the worse and the prognosis was not good. I spoke to him about the pain and anger suicide leaves behind. He looked at his wife and realised what he almost done. You’re right though, we are so fortunate.

  132. whoah this blog is wonderful i love reading your articles. Keep up the great work! You know, a lot of people are hunting around for this info, you can help them greatly.

  133. Day 29 post-op

    I went back to the doctor today, and I was pleasanty surprised when he said I could go full weight bearing. I was kind of expecting PWB. I also asked him about the surgery. He said my rupture occurred at the bone, which is not typical as compared to younger folks. He used an anchor for reconnecting to the bone. There was quite a bit of inflamation already existing at the tendon.
    The other good news is I can now take off the boot when I sleep. This is a BIG plus! I was told I would start PT in two weeks.
    I know I have a long way to go for recovery, but I feel like I can see the light at the end of the tunnel. There were times I was so depressed.
    I celebrated tonight with my second beer since surgery.

  134. WOW! Congratulations! FWB at 29 days sounds amazing! Are you able to walk without pain? I am at very PWB, but I do walk carefully at home. But, I pay for it. My foot is usually killing me by nighttime. Good luck and hope you do great!

  135. I walked a little bit today with crutches, and there was no pain!
    Taking the boot off to sleep for the first time in three weeks was wonderful!

  136. As posted a few days ago, my achilles rupture is different from a normal rupture. The tendon was detached from the heel bone, and my doctor use an anchor for reconnecting to the bone. Has anyone had similar situation? I want to know how successful this procedure is?

  137. My first rupture was also from the bone. It was attached via 2 dissolvable screws. At 7 weeks out I fell and ruptured the tendon again up higher in a different place. I guess this means the heal attachment must have been pretty strong since it held. I’m now about 9 months out from my second surgery and all is going good.

  138. RJ,

    Thanks for sharing your experience. This re-rupture thing is hanging like a dark cloud over most of us. Good luck to you.

  139. I think I have met four person, including myself, who ruptured their achilles. Two are co-workers, and one is my sister-in-law. That is not a whole lot of all the people I know. Therefore the question is: what is the chance for someone (from the general population) who may epxerience ATR sometime during his/her lifetime?
    I think I have read somewhere that the occurance of ATR is approximately one per ten thousand per year. This means, for the population of 10,000, there may be 80 ATRs over a life time of 80 years. This is about 1 per 100, or 1%.

    Brothers and sisters, we are in that 1% category.

  140. 6 weeks after surgery

    I have progressed to walking with one crutch only. Sometimes I would even walk without crutches in the house. Things are looking up. I will be going back to the doctor next week, and I think I will be starting PT then.

    The best news is my wife is coming back in two days. Things are definitely looking up.

  141. Hello again Kai, Been able to have a shower yet? I was certain you would find a way to manage things without the wife. You are going well. Hard to believe its 6 weeks for you. It may be good to have the wife back but I bet at first it will be a little strange having someone else around to give you a hand. Enjoy.

  142. Hi Stuart, thanks for checking up on me. I have not taken a shower since my wife left, a promise I made to her before she left. I have been taking sponge baths, and my co-workers have not complained to me yet that I stink :-). I am looking forward to my first shower in three weeks after she is back.
    There were times I was tempted to go ahead and break the promise in taking a shower, as I am pretty sure I can manage. I decided against it.

    Yeah you are right. It will be a little strange having my wife back to help me. It is something I am really looking forward to.

    Kai

  143. Almost 7 weeks post-op

    Went to the doctor today, and he told me to start PT. I made an appointment tomorrow to start my PT sessions.

    He also said I should starting easing to get rid of the boots in a few weeks.

    I am glad, but also cautious at the same time.

  144. Almost 8 weeks post-op

    Making tangible progresses this past week:

    1. started PT (3 sessions already)
    2. got rid of the crutches
    3. started easing into sneakers at home and at work; still wearing boot when going out
    4. played my first mahjong game since surgery

  145. I’m 7 weeks post-op and this past weekend I fell in my kitchen without my boot on. I landed directly on my injured foot, but did my best to absorb the impact. Unfortunately, the doc thinks I re-ruptured the tendon. I had an MRI today and will get the results tomorrow.

    I still have pretty good range of motion in the foot and the pain has subsided. He also ran his fingers along the tendon and said it felt intact. However, when he did the “squeeze calf” test my foot did not move, thus his concern that I re-ruptured it.

    I have a question though - I am able to flex my calf muscle (or what’s left of it) pretty well. Would I be able to do this if I had re-ruptured the tendon?

    Going to be a long night/morning as I await news of the MRI exam.

    Cheers
    Brad

  146. Hi Brad,
    Sorry to hear about your fall! As misery loves company, I felt compelled to write to see what your outcome was as I too fell on my casted injured leg 5 weeks post op.
    I think the “squeeze test” is a good indicator of intact vs. ruptured Achilles..unless there is a lot of swelling. I had my cast removed and there is more swelling and bruising after my fall. My doctor opted to wait on MRI until swelling goes down and recasted in a “downward postion for 2 weeks, then reevaluate. I had excruciating pain for several hours after fall, much more pain than original injury. AS to your question, I think you can still flex somewhat, but pointing your foot is compromised….not sure.

  147. 10 and 1/2 weeks post op

    Things are moving pretty fast… I started PT three weeks ago. I ditched the crutches and the boot two weeks ago. I am walking again! (I will also lose my handicap parking at the end of this month.)

    I am planning an overseas trip in 2 weeks, and things are definitely looking up.

    There is life after ATR, bros and sis.

  148. Kai - Hard to believe its been that long for you. Good to hear you are getting some of your life back. That re-rupture risk will start to slide about the time you head off on your holiday. I am sure you will be careful anyway so enjoy the well earned break.

  149. Hi All

    Wonder if someone can update me on their experience of Physio post op. Am 8 weeks left atr and now in the boot for last 2. Ruptured my right atr 9 years ago (both times playing football) and pleased that this time around I’m not in plaster for 12 weeks!
    Anyway, on last appt told by registrar that physio wont be required if in boot as wedges are removed 2/52 until next appt and so this will compensate. However informed by his opposite number in same department that the recommendation is physio at week 8 onwards.
    Bit confused and would appreciate if latter correct or any positive experience of former.

    Many thanks

  150. Hi all,

    I wonder if anyone can relate/advise on my situation?
    I am approximately 18 weeks post a full rupture. I had no surgery but, after 10 weeks in plaster and two weeks in a CAM boot, recovery seemed to go well.
    Although I had never quite reached the point of completely shaking off a walking ‘limp’, I could do most of my physio exercises okay and seemed on the road to a full recovery.
    However, after a recent four-day holiday with friends which saw me on my feet/walking quite a lot, I heard and felt a ‘popping sensation’. The pain was very mild and absolutely nowhere near what I felt first time around (I collapsed to the floor then!)
    I am now struggling to walk and have only limited range of motion, but when I saw my physio this morning, she did the ’squeeze test’ and thankfully, there was some movement and the Achilles itself felt intact.
    What I have been left with is a lot of swelling and an area of purple bruising about six inches above the bottom of my heel which feels very tender.
    The physio has basically left me to ice and elevate the leg, and advised me to rest it as much as possible.
    Does anyone have any ideas what could be wrong, because I am very concerned? I don’t think I could take (or afford) another long rehab!

    Thanks.

  151. Pwilky - I would not leave this with the physio if you are this worried. It may be a muscle tear or it may be a tendon tear. The achilles connects to the muscles around where you have described. Tjhe tendon branches to 5 to connect with the muscles heads. It is much rarer for someone to rupture the same tendon at another spot but it does happen. I don’t want to scare you with this information but the physio would not be able to tell by doing a thompson test. A muscle tear will subside with ice, rest and elevation in about a week. You could wait and see or you could see a doctor to get a referal for an MRI. My other advice would be in the interim, if you have an adjustable walking boot, wear it with the toe locked down and don’t put weight on it. Good luck.

  152. Thank you Stuart.
    I will rest, elevate and ice for a week and just hope it turns out to be a muscle tear.
    Could it be a partial rupture? If so what is the re-hab? Can I avoid a plaster.

    Thanks

  153. Pwilky - It could be a partial rupture or it may be something less. If it is a partial rupture then the rehab will be the same as a full rupture. You can avoid plaster with a CAM boot or similar and if it is a rupture high up near the muscles then surgery will not be an option. I am not sure what you did last time for rehab apart from the cast and boot but there is plenty of information about early weight bearing and movement at this site so it may not take you as long. If it is the worst case then it might be better to find a more progressive consultant. 12 weeks locked up is very old school. You can still have a good result doing it this way but it will take longer. Lets hope it is a muscle tear. Where you doing anything at the time that was a bit explosive. It sounds like you were just walking a lot.

  154. Stuart,
    First time round, I did it playing five-a-side soccer. It hurt like hell and I collapsed to the floor as though I had been kicked. Though I was able to just about drive myself home, the pain got so bad during the night that I eventually ended driving myself (in agony) to A&E at 4am in the morning.
    My rehab was simply three different plaster casts at different angles and a CAM boot for weeks 11 and 12 .
    My initial recovery was good but I had seemed to have ‘plateaued’ in recent weeks. This latest injury occurred whilst simply walking in France two nights ago. As I said the pain wasn’t as bad (though alcohol may have dulled it) but i heard a worryying ‘pop’. And over the last 48 hours, the swelling/bruising is a progressive dull ache. The whole Achilles area is now sore and tender when touched,
    That said, I was able to drive myself to my regular physio session without too much problem (certainly easier than last time) and I do seem to have some limited movement in my Achilles ( unlike last time).
    Somebody mentioned a Bursitis - could it be that?

  155. Pwilky - It will not be bursitis if it is that far up the leg. Bursitis occurs in areas where muscle or tendon goes over or connects to bone. It sounds like some kind of tissue damage but there is no way it can be properly diagnosed here. An ultra sound is a cheaper way to have a look. Tendons are much stronger than muscles and since you where only walking your tendon would not have been over stressed. Becuase of your inactivity for so long your muscles would be a lot weaker and more likely to tear but again walking is not particularly violent so who knows. This is about the limit of my limited medical knowledge. Let me know how things turn out.

  156. Stuart,
    I think you are right, it is shaping more as tissue/ minor tendon damage.
    A few days rest, elevation and ice has seen the swelling subside significantly and the aching ease.
    There is still some discomfort when I walk and plenty of scar tissue. All in all, I think my recovery has probably been set back about six weeks.
    Lessons have been learnt, and I am going to take things steadier this time around - I realise now, I was doing too much, too soon!

    Thanks for your words.

  157. Pwilky - I would still get an ultra sound or MRI to confirm. If it is muscle damage, the treatment is different and should not put you back too far. If it is tendon then again you have to get the appropriate treatment or you may end up with ongoing problems. The treatments are vastly different for each scenario. Long term it would be worth the money spent.

  158. Almost four months post-op

    I have not checked back at this website for a while. Things are starting getting back to normal: work, house chores, yard work, shopping, etc. are all coming back, and I am finding less time chatting on this website.

    I am still walking with a slight limp, but I have stopped going to PT (about a month ago). I am back at the gym: swimming, walking on the tradmill, weights, etc. Somehow I will need to lose the five pounds I gained.

    I hope everyone will keep the chin up. This injury is bad, but you can come back given time.

    Best of luck to everyone.

    Kai

  159. Hey all, just new to this site. So I ruptured my tendon on Aug. 27th. Had surgery on Aug. 31, 2011. Had the open plaster cast for about two weeks, then got my walking brace on Sept. 13, 2011. On Oct. 6th, I had my boot off and lost my balance and landed weird on my right foot. I had intense pain and ended up going to the hopstial. Turns out that I re ruptured my tendon. The stitches are still in place holding the tendon to the sheath they put around it, but the center between the stiches is what ripped apart again. Now I have to go back for surgery but have no idea when it is scheduled for yet. This is ruining my life and jeaporadizing my career as well!!! As well, living in a very snowy city (which will start soon) is not a good thing either. I’m so down right now. I received an email from one of my employers after I told them the bad news…they said they would have to hire someone to replace me and they cannot guarantee my Supervisor shifts if and when I do decide to go back. I’m already upset from hearing that I have to go for surgery again, and now my employers are being huge asses about this. It’s not my fault in a sense. I was supposed to have my boot of this coming Tuesday anyways. FML. Any thoughts??

  160. Hi, sorry you are having such a rough time. I’m sure you’ve thought of this, can you offer to do something at work using a knee scooter or wheelchair when you are ready or work from home if you can’t get a lift in?

  161. Hi Ali,
    I’ve spoken with my employer, and they are going to make an exception to my start back date, and they will let me sit to do my job. I work at a bookstore at an airport, and I am a supervisor there as well. They said they will just put chairs everywhere for me so I never have to stand for any long periods of time. Now to get to the airport….that’s another story! LOL

  162. pkent- very sorry to hear about the re-rupture. Time-wise, I am right there with you (ruptured 8/26, surgery 8/28) and I can’t imagine how devastating it would be to have to start this all over again. Is the surgery essentially the same as the 1st time? Or, is it more complicated (grafts, cadaver parts, etc.) now that it’s a re-rupture?

  163. Pkent - well that sounds a bit more of a reasonable adjustment…also know you know this but you will need somewhere to elevate your leg. I managed to find a colleague to give me a lift in but I had to search (not easy) to find somebody. Hoping the weather is kind to you right now. Happy healing this time round I hope. :)

  164. Pkent, I should have added I had to find more than one person for a lift (it went on a while in my case……!) An airport is a big place, I hope somebody can help out.

  165. pkent, sorry to hear you re-ruptured, it’s the big shared fear of everyone here. Good to hear that your employer is making an effort to accomodate your (temporary!) situation. You’ll be in a boot in no time and basically fully functional in 4-5 weeks. Take care and good healing.

  166. So I had my surgery on Saturday. It’s not as painful as the first surgery which is excellent. Hobbling around my parents house now with my cast and crutches. My surgeon says he wants to see me in 12 days, not two full weeks. Then….hopefully it’s walking brace time!

  167. Hi I was just wondering, how do you know if you have re-ruptured your achilles tendon after surgery. I am 2.5 weeks post op and got the boot on 3 days ago, I am allowed to put my weight on it. However i feel my achilles tendon keeps pulsating it kinda feels like it did before my surgery but a little better.

  168. Georgia- If you got your boot 3 days ago, I assume the doctor checked it then too. Since then, have you had any bad falls, a hard calf cramp, or any other “events” where you suspect you re-tore it? (felt a “pop”?) If not, you’re almost certainly still “intact”. If you re-ruptured in the last 3 days, you’d likely know exactly when and how you did it.

    Want to be sure? Just take the boot off, and feel around back there. You should be able to gently pinch your tendon, gingerly wiggle it side to side a little, and feel that it’s intact. If it’s re-ruptured, it will be a big mushy mess, likely with a void somewhere along it’s length. There were times - at various levels of insecurity - when I bet I checked mine 3 or more times a day.

  169. Or, have a friend to the Thompson test… apparently, it’s pretty hard to get a good result on yourself.

  170. Well, here goes. I am 46 years old. On October 5th I ruptured my Achilles playing basketball. Just a simple run towards the hoop after a missed 3 pointer to try and grab the rebound. First step, boom. Left Achilles ruptured.

    My Ortho surgeon gave me both alternatives, surgical and self healing. She stated that there is no proof that one is any better than the other. It was not a complete tear. I decided to go with toe down method in a cast for 6 weeks.

    On October 31st I got a nice Halloween surprise with a very painful feeling in my back on the left side under the last three ribs. Went to the emergency room. Pulmonary Embolism, both lungs. Even lost a small portion of my lower left lung. Spent 7 days in the hospital. Now on blood thinners for at least 6 months.

    November 14th was a great day. Got my cast taken off and given a boot. Doc says wait two weeks and then you can start physical therapy. Had that all lined up on the first Monday that I could do it. Very excited and looking forward to starting. Tendon was real stiff, but as time went by I could feel it loosening a little here and there. Was sleeping comfortably without the boot after about 3 or 4 nights. Hung around the house without the boot on to let my foot breathe and continue to let the swelling go down after being cooped up in a cast for so long.

    November 26th, 2 days after a great Thanksgiving. In the a.m., went into the kitchen to get some coffee without my boot on. Turned to head towards the living room, and boom! Just as soon as I turned, the left crutch slipped out from underneath me and I fell to the floor in excruciating pain. I knew exactly what my dumb ass did. This never even came close to happening before, even with the cast on.

    Monday morning, doc says that we gotta start over again. Says she absolutely won’t do surgery because of the blood clot issue. I’m not really interested in it anyway because I’ve read too many horror stories about what could happen.

    Anyway, I wanted to post here because I want people to understand, when they say wear the boot…wear the boot. We tend to get comfortable in situations and forget that one small accident, and you’re screwed. Nobody is beyond this happening to them. My mental state is ok at the moment. It was hard enough to deal with the initial injury, followed by the PE. I’m trying not to go insane.

    The doctor has said that she will have me wear this cast for 3 weeks and assess things at that time. I don’t think that I tore it this time as bad as I did initially, so I hope for a shorter period of time in this cast. I am an avid hiker. I missed hiking this fall and seeing all the beautiful fall colors. Had me a brand new pair of hiking boots. I don’t want to say that I take these hikes for granted, but boy are they missed, and I don’t think that I really realized how lucky I was to be in the places that I was on my previous excursions. I’m really hoping that I’ll be able to start back late in the spring. Keeping my fingers crossed. I know it won’t be easy, but I’m determined.

    Any advice, be it nutritionally, mentally, therapy wise, exercising, etc. would be much appreciated.

    Peace out and thanks for listening,

    Rodney

  171. Thanks for posting your story Rodney. An important takeaway is to not discount the risk of blood clots when going non-surgical. Makes me wonder how common that is, or if you’re a 1 in a million case there… I’m especially surprised it happened with a partial tear.

    If I read this right, you still - even after the kitchen mishap - have an attached tendon, right?

    I’m a big believer in nutritional support- poke around the early part of my blog, and you’ll find my thoughts on supplements to aid tendon healing.

  172. Hey Ryan,

    I have what is supposedly supposed to be one of the top Orthos in the Atlanta area, but I feel like she’s always very rushed. In the meantime I kinda feel like I don’t get the whole story. She told me that she has had another guy that did this using the conservative treatment, and that he’s playing basketball today. I do ask questions, but the answers seem to be very simplified. From my standpoint it didn’t appear that I tore it as bad as the first time, but it was pretty painful when I did it. It sure seemed to be in pretty good shape prior to the accident.

    I would really like to know from others who have had a re-rupture without having surgery, how their recovery went and how well they healed up, i.e., were they pretty normal afterward?

    Forgive my ignorance. I am very interested in supplements and such, but I’m not finding exactly where you listed them. Could you help me out with that?

    Thanks

  173. Try this Rodney:
    AchillesBlog.com/ryanb/2011/09/26/tendon-nutrition/

    Posting links here is sometimes tricky:
    link.

  174. Coupla things, Rodney:
    1) As common as surgery is for initial ruptures, it’s a bit MORE common for re-ruptures. And re-ruptures are rare in the first place, so you’re looking for a subset of a subset.
    We had a guy here recently (~6 months?) who had surgery then re-ruptured, and was then treated non-op, but that was unusual. I forget his login name, sorry, but he was doing well the last time I read a post from him.
    Suthrnman went non-op initially and again after a re-rupture. He posted fairly recently at 17 weeks, doing pretty well.
    2) Take a look at bit.ly/UWOProtocol — the protocol from one of the recent studies with the best demonstrated non-op results — and see if you can get your schedule sped up until it’s close to that one. 6 weeks casted then a couple more without FWB is a LONG time immobilized and NWB, and the studies from “the old days” when that treatment was the non-op norm demonstrated much higher re-rupture rates than the new ones (like UWO) that went much faster. Going slowly SEEMS “conservative”, but the results show that it isn’t safe, so it’s not really conservative, it’s just irrationally timid — IMHO, at least.
    DVT and other clotting problems are significantly more common post-op, but they do also happen with non-op treatment. I don’t have the UWO study in front of me, but I think they had something like 3 DVTs in the surgical group and 1 in the non-op. The study is here, linked from the main page, so you can check.
    Good luck!

  175. BTW, one of my fave reasons to prefer protocols that get to FWB sooner, is that I think they’re SAFER. The whole time I was NWB on crutches — BOTH times (’cause I ruptured both sides) — I felt constantly at risk of taking a pratfall. And not just going up and down stairs, though then for sure. But also coming in out of the rain or snow or slush, or wherever else a crutch might hit a wet spot on the floor. Once you’re walking in a boot, I think you’ve left behind one of the biggest risks of re-injury including re-rupture.
    I don’t think that’s the sole reason for lower re-rupture rates in the faster protocols by any means, but it’s part of the story.

  176. Hello All,

    Need some advice. I teach and played in an alumni vs faculty basketball game. POP and achilles was torn on Nov. 18. and surgery on Nov. 22. Cleared to teach again Dec. 6 with a splint and knee walker. Had to get back because of grades and finals this week. I took a spill off of the knee walker Dec. 9. Landed on the heel of the injured leg. PAIN! Went to urgent care and was told they couldn’t do anything and were too busy. Home to rest.

    Can’t take the splint off to check. Will meet ortho on Wed. - 3 days from now.

    Pain is gone. Can feel the stitches. Feel some tingling in toes. It comes and goes. Is it “normal” to feel the stitches pulsing or the toes tingling?

    Didn’t hear the pop when I fell just felt pain. What does re-rupture feel like?

    Much Peace.

  177. Hi ring. The worst part of my re-rupture, besides the second surgery and recovery, was the interminable wait for the final word. And, yes, it is normal to feel the stitches pulsing and the toes tingling…especially while dwelling on the potential re-rupture day and night.

    What does a re-rupture feel like? I think the best way to describe mine was that I just knew. The initial rupture was like an internal gunshot. The second was a more genteel pop. Neither were excruciating pain, just a general throb.

    Based on what you wrote, I’m hoping it is not a re-rupture. There’s probably three scenarios–no tendon damage, just an aggravation to the wound; a partial re-rupture (if mine was a partial, up to 75%, my surgeon would have just kept me in the boot longer); or the dreaded re-rupture. As far as I know, the only way to confirm any of the above will be a MRI.

    I’ll keep my fingers crossed that it was just a painful slip…which happens to all of us. Good luck.

  178. Dave - thanks for the info and encouragement. I see Dr. tomorrow and have told my students and friends to send positive vibes that everything will be okay. I am nervous and little scared.

    Jerry — send you the best.

    Much Peace Everyone!

  179. Thanks normofthenorth. Sorry, but I’ve been away for a little while, but came back and noticed what you posted. Thanks for your opinions and your references. I will take a look.

    She’s supposed to take the cast off on Monday and take a look. At that time if she decides she’s putting it back into a cast I’m gonna really push back…and my wife will be there too, and I know that she’s not going to take that very well either. She already thinks that I should have switched Ortho’s a while back, but everyone I talk to says this lady is really good. Anyway, I hope that she puts me back in the boot so that I can make my way to PT finally.

    Thanks again

  180. Does your site have a contact page? I’m having trouble locating it but, I’d like to send you an e-mail. I’ve got some ideas for your blog you might be interested in hearing. Either way, great site and I look forward to seeing it expand over time.

  181. My inital ruptre was in a ankle that was undergoing treatment for tenditinits. Rupture outside the US on a dive trip while walking. Rupture Dec 9 Surgery Dec 16. This past week was 5+ weeks post op today was 6 weeks. Earlier in the week was cleared to put down crutches and walk with boot for 2 weeks
    Caught the boot on something at home last night, severe pain up the back higher up than where the initial rupture was and there appears to be the divot again. Emailed and sent a pic to the doc who is in surgery today. This was a distal tear and there was much caution due to the location of the tear near the heel/bone. I am a 59 year old man who in on the verge of tears as I was hoping to be back out in the world after working at home, was supposed to be in shoes with lifts in 2 weeks. I am very scared and thats putting it mildy

  182. hi have a re rupture of achilies tendon.
    1st time at oct 2011 n had surgery.
    post 3months surgery was involved in an attempted snatch theft when just start walking and this time heard clear “pop” sound
    it is a rerupture!!!!!
    what a luck
    Now round 2

  183. hi have a re rupture of achilies tendon.
    1st time at oct 2011 n had surgery.
    post 3months surgery was involved in an attempted snatch theft when just start walking and this time heard clear “pop” sound
    it is a rerupture!!!!!
    what a luck
    Now round 2
    just to let all of you to know ,sometime though we try to be careful and mind our steps, we should also be aware of our suuroundings like being pushed by someone!!

  184. Hi amarjit,

    I ruptured my achilles tendon in October 2011 and after doing a few stretches today. I walked away and felt it POP, so I know how everyone feels. I’m completely devastated, I’m 4 months in from my first rupture and it kills me to think I have to go through that entire process again. I really hope I can recover from this. I love sports and love the out doors so I am very upset that this has happened again. The Dr said they will have to harvest a tendon tissue and weave it in to the Achilles tendon. So this time round it will be a more complicated surgery. Has anyone on here fully recovered from a rerupture??

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  188. Hi ranui
    Mine was a complicated surgery where they took the tendon near my calf.
    Exact procedure not clear
    I am now in my 5.5 weeks and t’row my appt with doc.
    He told me I should be starting to walk. Let us see
    Going thru a re rupture really devastating
    When they took out my stitches at week2 it was long and 25 -30 stitches
    Really for me is prayers .
    Let me know how is your situation
    Anyway I now see sense in the phrase “time heals”
    At the beginning I really broke down.
    This time want to do everything slow

  189. Second time on same ankle! I’m on week 5 post surgery left leg. Started with a sharp pain in calf last august, started limping, pulled again and again not knowing what it was. Saw Family dr. told me not to let it get stiff so do light stretches! What was he thinking? Should have went into boot right then. Finally it tore so much that couldn’t walk. Had surgery day before Thanksgiving. Changed cast every 2 weeks moving toes up, after 6 weeks went into boot for 4 weeks. No more pain little limp. Check up Dr said didn’t look right sent to MRI, you guessed tore again! Same Surgery Feb 5th. Still off my feet only walked for 4 weeks in boot. Doc is determined to go slower this time. Wondering now if I’ll ever walk again let alone ride my Harley. Going to have this 2nd cast for 4 weeks instead of 2. Probably 2 more casts at least 2 weeks each.
    Can’t wait till boot, never thought I would say that. When all this started I purchased a Portable ultrasound to use on my calf and ankle to stimulate blood flow twice a day for 5 minutes. You can buy them on aidmyachilles.com or on ebay. about $100-150. My husband uses it on his planter Fasciitis swears it helps. Plan on Using soon as cast comes off.

  190. Harleylady:
    Slower does not always mean better; especially with this injury. Early weight bearing and mobility can often lead to better results and a lower risk of re-rupture. Do some research on this site, Norm will point you to the UWO study. 10 weeks of immobilization (6 cast + 4 boot) is a lot. Especially, after going through this once already.

    Good luck, and keep us posted. One of the few things left on my “still-to-do” list is kick-starting my old pan-head with my injured leg.

  191. Harleylady:

    My advice is to be patient with rehab, really take it slow and easy, do not start aggressive rehabilitation for at least 2 months post op, don’t push your self to go weight bearing until you have gone through the basics of just getting the movement into the tendon, slowly loosening the tendon, the later you start weight bearing, the less chance you will have a re-rupture as you will give the tendon more time to heal. Don’t try to walk n it straight away, and slowly get into it. Take your time and listen to your body, i made the mistake of walking on it for long periods straight after my cast came off. What a mistake, I snapped it again 4 months post op.

    Apparently studies have shown, younger people have a higher chance of re-rupture, because they are simply more active and have a higher chance of putting the tendon through unnecessary stress during rehab.

    If you find that your Achilles Tendon is still swelling 3 months post op. Demand a MRI to see if the Achilles has healed or could there be a partial tear or rupture from pushing too hard. Its much better to find a partial tear and go back to more conservative rehab, then to have a complete re-rupture and further surgery..

    I found the only reason doctors and physio recommended early weight bearing and more aggressive physio is to get you back to your feet sooner, if you feel this is not really necessary or are afraid of a re-rupture, then take your time to heal. It’s important to let the tendon heal as much as possible. However, physio doesn’t mean you have to go through intense pain, you just have push it at a comfortable level, say a pain barrier of 5 out of 10.

  192. Did I break the record for the fastest ever re-rupture?

    I am 43 yrs old and ruptured my right Achilles for the 1st time on March 8th near the end of a very intense soccer match. MRI a couple days later showed a complete tear all the way across, with about a 0.5cm separation (not bad). I had my first surgery on March 14th and all went pretty well. A splint was put on the back of my calf muscle and wrapped underneath my foot. The pressure on my Achilles was pretty painful, but I decided that I would wait until March 21 for my first follow-up appointment (probably a big mistake). On March 20th, I made my own very bad mistake and tried hopping up the stairs with my good foot while talking to someone…I tripped and landed on the tip of my right foot and felt the excruciating pain as before (this time it felt/sounded more like Velco snapping apart…). MRI the next day confirmed indeed the stiches in my Achilles ripped right thru and I now had a 1cm separation. They fitted my with a new splint, this time on the front of my shin and top of my foot (MUCH better!!) and told me 2nd surgery will be on March 28th.

    For the 2nd surgery, they took out old stiches and re-connected tendon as before, but this time wrapped the Achilles with a GraftJacket (I have a picture of my Achilles wrapped in GraftJacket that I can share). I was an all-state athlete in both soccer and track back in high school and have stayed pretty competitive in soccer ever since (had a on-and-off Achilles tendinitis in my 30s). The doctor said my Achilles was pretty badly degenerated and I quizzed about whether any possibility of augmentation. He said the GraftJacket is the only method he would recommend, although cautioned that some people later complain that the Achilles doesn’t feel the same. Anyway, after the surgery, they put the splint on the top of the shin and foot and no problems so far. However, I got my foot wet (water somehow leaked thru the heavily taped garbage bag) in the shower a couple days in a row and noticed the sking peeling off my feet. Went into the doctor yesterday and he said I was lucky that the water stopped 0.5inches from my lowest stitch, that would’ve almost certainly caused an infection. They cleaned me up and put on a fresh splint. Almost took the stiches out yesterday because it looked so good. Also did the Thompson test and confirmed my Achilles is indeed intact and looking strong. Stiches come out next week.

    I took Vicodin the first 3-4 days after each surgery, and also Naproxen for 8 days. Today is my last day for Naproxen as no swelling at all this time and I am dying for a beer tomorrow!

    Anyway, just wanted to remind everyone about the danger of getting your stitches wet at all during the first couple weeks. Be very careful! I am going with the sponge bath the next few days. I also cannot emphasize more about being very careful not to ever let those toes bend upward (dorsiflexion) the first month or two. Finally, do NOT hesitate to go back to the doctor if you are having any pain at all with the splint or cast!!!

    This blog is great, a lot of very useful and encouraging info! I am amazed with the wide variety of post-op/recovery/PT options. Being a very active person, I am constantly wiggling my toes around and even pushing downward a bit–the key is don’t induce any pain at all on the Achilles! I am anxious to not let my right calf shrink too much–it was already 0.5 inches smaller than my left calf right before the 2nd surgery!!

    Anyone else out there that tried out the GraftJacket? I see that Shaquille O’Neal is a famous (and successful) example…

    Anyway, more later…

    Brian

  193. Post ypur picture Brian I too had the graftjacket and would like to see it.

  194. Hi doryt,

    Ok, but those of you who are squeamish, don’t open up the JPG link shown below! :) Here is a link to a JPG showing my Achilles wrapped in the GraftJacket, right before they sewed up the skin:
    http://www.brian-hamman.com/Achilles_GraftJacket.jpeg
    You can see where they stitched up the GraftJacket. I think the tendon sheath is already wrapped around the GraftJacket in this pic.

    Doryt, I will have to go check out your story, but how are things going? I hope you’ve had a good experience with your GraftJacket??

    I want to also mention here that I am very happy with my orthopaedic surgeon…this guy is very experienced in sports injuries (affiliated with the USA men’s soccer team and several MLS teams) and I’ve heard great things from others about what he’s done with their injuries.

    Cheers,
    Brian

  195. Brian, Good picture. I never did get to see mine. That’s what I would imagine mine looks like too. Though my re-attachment is much lower. I’d say just about a 1/2″ above my ankle bone and and center back of the heel.
    I really don’t have a fantastic drama of a story. Injured on box jumps. Never have experienced any pain even at the time of rupture. Just this issue with the incison being so darn stubborn to close. I am not one to find fault or reason so keeping a attitude of “it is what it is” and dealng with it. I decided early on in my recovery to take it on the conservative side because I am always explosive in whatever I do. I have a strong mental grit and it has helped me most. When I hit my 100 days In January I took a break from the blog as I was beginning to feel so obsesed with my recovery charting every little thing Then I had family company all Of Jan & Feb. Today I went to Cross Fit and worked out privatly with Gordon. I actually did some 60lb one legged deadlifts, lots of them I lost count. I think I was dreaming. But maybe not as I’m feeling them as I sit on the couch now.Anyway thanks for the pix and I’ll have to go back and read your blog again.

  196. Ok, back from the doctor, 13 days post-OP…..13 days after my 2nd surgery due to re-rupture that occurred 5 days after my 1st surgery. Wound healed nicely and all stitches were taken out from my 3 inch incision. Pictures of my two calf muscles next to each other were kind of depressing, though, can’t believe how much my injured calf has shrunk since my initial rupture on March 8th….must be at least 2 inches smaller already!

    Doc says the Achilles looks great, nice tension in the Achilles and calf, everything on track. However, he said that since this is a re-rupture and significant degeneration in my Achilles, that I will probably need to wear a cast for another 4 weeks rather than his norm of 2 more weeks prior to the boot.

    Doctor told the P.A. to try moving my foot to 75-80 degrees (90 degrees being neutral) before putting on the cast. However, I started feeling significant tension at 70 degrees and that is where I am right now in my new cast. I will go back next Monday or Tuesday and try a new cast, this time hopefully getting past 80 degrees. The goal is to get to 90 degrees in the cast before I can then move on to the boot….

    Brian

  197. My story- I ruptured my achilles completely on Dec 24, 2011 playing basketball. I am 50 yrs old and was moderately athletic before the injury. I seriously debated surgical v. non-surgical treatment, but decided on surgery on Dec 27, 2011. For me, the surgery was performed on an outpatient basis (an afternoon) and went very well. I needed pain killers for only about 1 day. I was in crutches and a boot until approx the end of Feb (8 weeks), but I was walking with only the boot by just over 9 weeks. About a week after starting to walk with just the boot, i decided to not use the boot as it was irritating my surgical area and causing significant swelling and pain. I removed the boot and tried to walk slowly and carefully for a few days and found the swelling in my foot went away quickly. Progress has been slow but steady. I started riding a stationary bike just to move my legs even when I was still using the boot. At first, 10-15 minutes at a very easy resistance was enough. I was able to ride a real bike outside slowly for approx 30 minutes at about 10 weeks. Its now been approx 13 weeks for me at this point. I am getting close to full motion, but still working on getting back to full strength. I have little or no pain at this point. However, I found riding a bike (either stationary or outside) has helped tremendously and can now ride 60-90 minutes a few times per week. I still walk with a minor limp depending on the day and how much I have stretched or flexed the area. I have even done some very gentle skiing. My recommendation is to get surgical repair, mostly because the surgery signals a clear “day 1″ that starts your recovery and also provides greater confidence on the repair of the tendon. Obviously, there are risks with surgery that have to factored in. I would like to do some hiking this summer and am optimistic that I should be able to do that. Its a long process and seems even longer, but I have recently started to feel optimistic that I’ll recover close to 100% in another couple months (about a 6 month total period from surgery)

  198. Hi Smitty,
    I’m right there with you - surgery on Dec 28, 2011. And sounds like we are on identical track. Slow, but progress in the right direction. I am also targeting 6 mo’s as a goal to be doing everything I like to do… although I think full-out running and jumping might take a bit longer. Good luck & here’s to hiking this summer!

  199. Thought I would share a little good news from yesterday, 19 days after my 2nd surgery (recall that I re-tore my Achilles just 6 days after the first surgery). I went in to get my cast changed yesterday and we were able to change the angle of my foot from 68 degrees (22 degrees plantar flexed) to 83 degrees for my new cast. Doc was very happy with the progress and said that I should set up an appointment for next Tuesday to switch over to the Bledsoe boot (27 days after 2nd surgery). The Bledsoe boot is fixed at 90 degrees but they will insert heel lifts to start me off at 80 degrees and will gradually begin PWB. I can hardly wait to begin PWB, 2 weeks earlier than we originally thought, and can finally start to see the light at the end of the tunnel !!

    It seems the Bledsoe is the most commonly used boot for starting PWB, but last time (few days after my 1st tear) I felt like the straps were putting pressure on my Achilles…has anyone else had the same observation? Is there another boot out there that is more comfortable that can be used instead of the Bledsoe?

    Thanks,
    Brian

  200. Ruptured my achilles on 1/19/2012. had surgery 2/15 all was going excellent, started PT and aqua therapy a couple of weeks ago. Saw Dr. on Monday she gave ok to wear shoes with heel lifts & to start driving again. Today I was walking down the hall and tripped, heard a loud rip and excruciating pain. Saw Dr. she said she didn’t think it was a rerupture but couldn’t tell for sure until some of swelling has gone down. Still have strength in the leg which she said was good, will know more on Monday. Really devastated by this whole thing, and makes me a wreck thinking I might need surgery again.

  201. So sorry to hear that, kb60. Said a prayer for you and I hope that everything is still ok.

  202. Also very sorry to hear that kb60. Sincererly hope its not a re-rupture

  203. Just wondering, what did it feel like when you reruptured. If it is the case, I had much more pain this time. Instead of the loud pop like the first, this was a definite ripping. Just trying to keep my composure while I am waiting to find out for sure,

  204. Sorry to hear that, kb60. The pain was sharper with my re-rupture, but it went away faster than the original rupture. In my case, the sharp/ripping pain was the internal stitches tearing thru my Achilles. I knew right away what happened and doc confirmed the next day with a Thompson test and a MRI. The fact that your doc couldn’t tell (they presumably did a Thompson test?) might be a good sign. Are you doing a MRI? Please keep us posted.
    Best wishes,
    Brian

  205. She is waiting to do any further testing until Monday. She did do the thompson test, but wasn’t definite. It certainly is really depressing, such a long recovery.

  206. Good & bad news, good news is Dr. thinks the repair is still intact. Maybe some scar tissue tore, but did severely tear the ligaments in my ankle. So now back in the walking boot for several more weeks (bad news). No returning to work for several more weeks, wanted me back in Aqua therapy asap. Went back to therapy today, amazing how weak with the two injures that my foot has gotten. Really kicked my butt.

  207. Initial surgery on 10th march, cleared from moon boot etc on 24th April. Re rupture on 28th April just hobbling down the sidewalk. Currently sat in hospital bed waiting for the repair in a couple of hours. I followed Drs orders to the letter and it still gave way.

    Be careful folks.

  208. Sorry to hear about the rerupture, coxyp. Seems the majority of re-ruptures reported here occur within the first week or so after either FWB or in 2 shoes. I just got my cast off today (5.5 wks post-op, after re-rerupture 6 days after first op) and cleared up to full weight bearing as tolerated in the boot. Your message reminds us how vulnerable we are even at these later stages of the healing process. I wish you the best of luck this next time around.

  209. Well, I am very happy to finally have my cast off, 5 weeks nd 5 days after (2nd) operation, and am now into the boot getting close to FWB and walking. I do have a noticeable amount of swelling in my foot and ankle areas, even a little bit more than 2 weeks post-op right before the cast. Is this swelling normal at this stage, right after getting the cast off? Does it go away by itself or do I need a physical therapist to help get rid of that swelling?
    Thanks,
    Brian

  210. Brian: I had some swelling after getting my cast off too. After 2 weeks, my doctor told me to put on a compression sock and the swelling virtually disappeared in 2 or 3 days. I was then told to keep using the compression sock for another 2-3 weeks.

  211. Thanks, starshep, that sounds like a good idea. Did you also go into a boot right after the cast? I noticed the straps leave large indentations on my calf after I take off the boot, probably als due to the residual edema? Some good news is that I actually started walking this morning in the boot, man did that feel good being able to carry my coffee over to the computer!

  212. Brian: I did go right from the boot into the cast but didn’t have a problem with the straps leaving indentation marks. The boot liner pretty much kept that from happening. What brand of boot do you have? It does make a huge difference to be able to carry things.

  213. starshep, and anyone else who used a compression sock to reduce swelling: what length of compression sock do you recommend? I still have a little swelling in my foot and lower leg (especially just above the incision). Should I get a compression sock that goes just below the knee, just above the knee, or all the way up to the groin?
    Thanks,
    Brian

  214. Brian, My socks are just below the knee. I seriously doubt if you need something that goes all the way up to the groin and I don’t think that getting socks that go above the knee will be much better than below the knee. Until you get the technique down, these things can be a challenge to get on and the longer they are, the tougher they are to get on. The compression level of mine are medium (15-10mm Hg) and of course the higher compression level, the more difficult they are to put on too. I got mine from discountsurgical.com and their prices are about a third of what the drugstore charges.

  215. I was at a wedding taking pictures.

    4.5 weeks post op
    In walking boot with wedges
    I was without my crutch, slipped and stepped forward with my boot, the velcrow came off and my foot bent forward I felt a sharp pain were my Achilles was stitched together. Enough to make me lay down. Then swelling, but currently no pain, just sensitive. I did not feel a pop but it was a sharp pain. Pain lasted an hour and disappeared. My doc
    Isn’t in till Monday and it’s currently Friday.

    Prior to this I could push my foot to 90 degrees but that was it. After the accident it would go about 5 degrees past it easy.

    Should I be worried? Could it be a rerupture?

    Thompsons test shows nothing but it showed nothing post surgery either

  216. Jin,
    No answers - just sympathy. I’d call your doc if you’re really stresses about it.

  217. Jin, A few people here have had similar incidents. Some have been lucky and not had a rerupture and others have. I asked my doctor when I was at about 4 weeks after my ATR if I would hear a pop if I reruptured and he said I would not at that point. Wish I could be more assuring for you but about all you can do for now is rest it, ice it and call your doctor.

  218. He won’t be in till Monday and the anxiety is killing me :(

    I have been elevating it, no ice, and it’s not swollen at all, no pain, when I lift my toes I feel tension where my achilles is.

    I read above about just tearing scar tissue? Could that be a possibility? Should I be in pain at all cus currently I’m normal, it’s just tender more than usually at the Achilles which I would think normal cus I did slip.

    Thanks for all the responses. I’ll be posting my blog journey in hopes to help others.

  219. Jin, Anxiety can be tough to deal with. Yet thinking about it won’t help. Just take each day at a time and each minute at a time.

    My guess is that feeling tension is a good sign. Scar tissue is what is holding the 2 tendon ends together at this point so if it is a rerupture, it will probably be in the scar tissue. It also might not be a complete tear. No way to tell right now. Even in the worst case, maybe all you lost is about 4 weeks. My doctor told me that one of his surgical patients slipped and reruptured his tendons so rather than going through surgery again, he elected to go non-op. Pain or lack of it isn’t always much of an indicator. When I first ruptured mine, I had almost no pain. Yet either way, at least you aren’t in agony.

  220. Jin - If you can dorsiflex your foot on your own then things have to still be connected. Do some ABC’s with your foot but don’t use any artificial means to move it. See how that feels. If there is no problem then you can worry less.

  221. Thanks, starshep. I will go get some compression socks today (15-20mmHG, just below the knee). Where did you primarily have your swelling? Mine is primarily in the foot, especially on the top and towards the outside–it hurts a little bit, like a bruise. I just wonder if the compression sock works just as well with the foot as it does with the ankle? Thanks again.

  222. Stuart, did you mean PLANTARflex not dorsi? Alas, people with complete ATRs can usu do both (tho they really don’t WANT to DF). But df feeling a pull on the calf sounds good.

  223. Brian, My swelling was all over the place below the knee. It was mainly in my ankle and foot but my calf was swollen too. I frankly had a hard time believing how quickly (about 3 days) the swelling went away once I got the compression sock on.

  224. Jin I did something similar in April. Dr. had just put me in 2 shoes, and three days later I slipped a bit in my house. I heard a horrible rip and a lot of pain. I was lucky it was in the am and I was able to see the Dr. right way. It was so swollen, she couldn’t tell whether it had reruptured or not. Put me in a soft cast for a week or so till things calmed down a bit. Turned out I had torn the ligaments and the scar tissue. She put me back in the boot until just last week.. So hang in there. It is so hard.

  225. Thanks, starshep, you have been very helpful ! I bought compression socks today and wore them for a few hours before I went swimming (man, did swimming feel great!) and already noticed some diminished swelling… One last question on this issue: did you wear your compression socks 24 hours a day during those 2-3 weeks?
    Thanks again!
    Brian

  226. Brian, You’re welcome. Glad I can help. I wear my compression socks 24 hours a day. The doctor said I could stop wearing them a week ago but since I am still in my boot I keep wearing them. Once I got the hang of changing them, I find they feel no different than regular sock.

  227. Well stitches didn’t come out as planned, they waited another week. However it still wasn’t closed and was weeping. I asked Dr to send me to wound clinic. It’s been a week now with some silver looks like Spun cotton, pushed in incision, which by the way is totally open again. Looks like dr just cut me. Never dreamed I would have such Bad Luck. I’m not diabetic! Wondering if I will ever walk again. Dr says I need reconstruction surgery after they close soft tissue. It better heal quick, I don’t want him cutting on me again. I now know I’m allergic to certain kinds of sutures. My ordeal started Sept 2011, haven’t walked in 6 months. Haven’t seen anyone with the set backs I have had. Rupture, re-rupture then staph, now won’t heal. Tendon is still ruptured since Dr took all sutures out when I got staph. Happy some of you are doing good! I’m sure Not!

  228. Holy cow- that’s terrible news HarleyLady. Staph is nothing to mess around with- I once spent a week in the hospital with it, on heavy duty anti-biotics (got it after a motorcycle wreck of all things).

    What’s the plan forward? If you’re still ruptured, are they planning to go “non op”? Or, will they eventually suture the tendon back together?

    Good luck- you sure need a dose of it!

  229. My heart just dropped reading your post. I’m so sorry you’re having this torturous experience. Just want to wish you well, this is such a horribly discouraging injury as it is, to have these complications to deal with…What can you say? I wish you the best and I will be praying for you tonight. My heart goes out to you HarleyLady.

  230. harleylady, we wish you much grace during recovery. Here I am complaining about my possible re rupture and we have someone going through worse.

    I too will say a pray for you tonight.

    As for the rest, I will keep you updated after my MRI tomorrow. (Hopefully tomorrow)

  231. Harleylady,

    Sending you the luck of the Irish for a speedy recovery from here on in. Its such bad luck, it can only get better. Keep in touch with us and try not to get to down.

    Sharon
    (Ireland)

  232. Harleylady - so sorry for all your bad luck with healing. Praying things will turn around for you soon. Kim

  233. Hi guys,

    For those who are just reading this without any of my previous posts, I slipped while in my cam walker. My cam walker was loose because it was hot that day. My foot bent upwards past 90 degrees and I felt a sharp pain in my achilles that had me laying down for an hour. I was afraid I had re ruptured it. I am 4.5 weeks in from op.

    The doc pinched the back of the achilles to feel if it was still intact. He also pushed the back of it in. That hurt so bad as it was still stiff from the operation. He then placed his hand below my toes and told me to push down. As i was pushing down, he was pushing up. That was painful but I was able to push his hand down slightly.

    He then started massaging the back of my calf. Then again put his hand under my toes and pushed my foot to 90 degrees and said push down. I did.

    He said everything was still intact and that if I had re ruptured it, I would not be able to push down with any force at all.

    I was worried and ask if it was possible that I partially ruptured it and he said no. But to be safe I was supposed to start PT in 3 weeks, that is now pushed to 4.

    My foot dangles more than it did before. It was stiffer but now looser after my accident. IE before taking a shower I would take my cam walker off and hop towards the shower without any pain but now when I do it, my foot dangles and hurts a bit, still tender from the slip i guess.

    I believe I did do a lot of damage but prayer and support really helped me out. I don’t believe in luck and I thank those who gave good thoughts and prayer my way.

    In the same way HarelyLady, I will be praying for you during my journey.

    Biggest advice i could give from my experience to others: Take it slow. I was already going FWB at week 4. Trying really hard to recover faster. After my accident and possible re rupture I got to read how people at 4 months slip and re rupture. This is no joke and it’s not a sprained ankle. Take it SLOW. a few extra months can save you a year of recovery.

  234. PS he also said i would have had to slipped hard to have ripped my sutures. Not sure if that’s any relevance.

  235. Jin, I don’t think there’s any advantage to going slower than the proven protocols (like UWO), but you should avoid taking extra risks. IOW, instead of stressing “GO SLOW”, stress “BE CAREFUL”!

    For example, hopping to the shower without the boot sounds a bit nuts to me. I got to my shower on crutches while I was NWB and PWB, then stepped inside and sat down, rested the crutches outside the shower, took off the boot and rested it outside.

    After the shower, I CAREFULLY crutched out of the shower barefoot (first making sure there were no wet spots on the floor to make my crutch slip — BOY can that do harm!!) and sat on the stool I had in front of the bathroom sink. Carefully dried off and put the boot back on before crutching away.

    Rerupturing at 4 months is very rare, and would mostly happen to somebody who’d gone way too slow, IMHO. The vast majority of reruptures occur within the first 12 weeks of treatment, with or without surgery.

  236. Congrats, Jin, happy to hear things are ok. I didn’t say anything to you until now because your description sounded too much like when I re-ruptured at 6 days post-op. I also wish HarleyLady the best of luck and my warmest sympathy!

  237. Just a little update from me. Yesterday, 6 weeks and 5 days after my 2nd surgery, I put on two shoes and walked around the house. It actually felt much easier than walking in the Bledsoe boot. However, I still have swelling in my heel and foot, and the swelling in the heel was too uncomfortable (chafing) and I had to switch back to the boot. So until I can get the swelling under control, I will need to stick with the boot. Although the compression sock helped swelling in my ankle and lower leg, the swelling actually got worse in my foot, so that option doesn’t seem to be the answer….have my 2nd PT session today, hopefully they will have another option for me to try…?

  238. Thank you all for the info and updates. As for swelling, I can’t seem to control it other than elevating the foot or compression socks. Compression socks work at times but not always. The nurse told me to elevate and that was it. I’m a graphic designer so i lay on my stomach at work with my feet up or i sit on the floor with a pillow under my knee.

    My ankle area is still extremely numb and my surgery site leaks clear fluid once in a while which i read is normal. No signs of infection, just numb.

    When does swelling usually go away?

  239. Jin, FWIW I was 20 weeks in, non-op, when I started a blog
    Page (still up) entitled “Swelling (& elevating) is getting OLD!” The good news is that is that it didn’t last a lot longer, but I was already WAY tired of it. YMMV, we’re all different in this, no idea why.

  240. I’m still somewhat new to all the acronyms.

    FWIW-
    YMMV-
    UWO-

    FWB - Full weight bearing
    PWB - Partial Weight Bearing

  241. Sorry, Jin, those aren’t Achilles acronyms, they’re mostly just Web shortcuts I’ve adopted!
    FWIW = For What It’s Worth, YMMV = Your Mileage May Vary, and UWO = Univ. of Western Ontario (here in Canada), where the best of the 4 recent randomized trials on operative vs. non-op ATR treatment (with agressive rehab protocols) was done. It was published as Willets et al in 2010, and the full text is on this site, linked from the page with all the studies listed.
    BTW (= By the Way), entering those cryptic acronyms into Google usually gives the right result in a hurry.

  242. Did 50 “fist push-ups” yesterday in my crocs and no strain felt on the Achilles. First time I did push-ups in over 3 months. Today my chest muscles are a little sore, but not even a trace of soreness in my triceps or abs as these muscles stayed fit via 6 weeks on the crutches (bright side of crutches)….

  243. Yesterday I had more intensive (strengthening) PT and also rode a stationary bike at the YMCA for 20 minutes last night. Also received my Aircast Cryocuff yesterday and within a couple compressed icings my swelling went down to almost nothing. Today I went back to the compression socks, this time making sure the compressed part went all the way out to my toes, letting the loose/non-compressed part of the sock hang over and wrap under the toes so that my entire (swollen) foot and beyond were compressed. Almost all of the veins in my “bad” foot are now once again visible with swelling almost 100% gone and I walked around at work today in two shoes w/minimal limp (8 weeks post-op). I am very confident that I will be walking w/o a limp in the next 2 weeks and will start running again 2 wks after that. Ok, time for another Cryocuff before I go to bed. I truly wish the best of luck to all of you in your recovery, this blog has been very valuable to me!

  244. I am using this “Re-rupturing your achilles” page to give occasional updates on my progress. Last weekend at just over 8 weeks post-op I rode my mountain bike over 5 miles on the flat road at ~20mph in top gear. It felt great getting blood flowing through my “bad calf” and I think biking really helps the walking as well. On Tuesday at PT they increased the strengthening exercises including the leg press machine and standing on my bad foot while throwing a 5 pound ball at a trampoline and catching it….for the latter, my goal was 3 sets of 30 but I couldn’t do more than 15 in a row without losing balance….this exercise put some serious work on the weak Achilles and Soleus! On Friday at PT, just over 9 weeks post-op, I increased the leg press up to 3×10 sets of 300 lbs and it felt great! I was also able to complete over 30 consecutive one legged “catch-and-throws”, so some clear progress! Yesterday, I rode my mountain bike 10 miles at ~20mph and got the best workout since my original ATR on March 8th! I followed the bike ride with an over 2 mile trail walk in my crocs with almost zero limp. I can now very easily do a bunch of 2-legged heel raises at just over 9 weeks post-op….I wonder when I should attempt to try a one-legged heel raise with my “bad leg”? I will probably attempt one within the next week. Right now my only “issues” are still some occasional swelling in the ankle, a blob of apparent scar tissue at the bottom of the incision, and an unusually hard Achilles and Soleus. I wonder when I can have ultrasound or some other technique to loosen up scar tissue? PT gives me a massage at the end of each session but that no longer seems to be improving the scar tissue issue. Anyway, best wishes to all of you, keep trying to think positive!

  245. For those of you following PT protocols, thought maybe you’d like to see mine. Below is what they had me do at my 6th PT session, 3 weeks after getting out of the cast and going to FWB. This is 9 weeks after my my surgery for a re-rupture accident that occurred 6 days after the first operation:
    1) Warmup: Ride stationary bike (in my Crocs) for 7 minutes at an easy warmup pace of 15mph and middle gear. This is the 4th session where I started with bike warmup. The rest of my session was done barefoot as usual…
    2) Stretching: A) Stand (two legs) on a vertically inclined board for 3×60 seconds keeping balance with hands on a bar. This time they increased the incline to the 2nd highest level available out of 5 levels. I didn’t ask how many degrees dorsiflexion, but both feet definitely look like at least 15 degrees. B) Seated towel stretches 3×30 seconds, first with leg extended then with knee bent 45 degrees.
    3) Basic ROM exercises: These went in the sequence of 3x Alphabet, 30x circles in each direction, dorsi/planta flex up and down 30x, lateral ROM 30x, “surfboard ankle circles” (don’t know what to call these!) 3 minutes in each direction.
    4) Strengthening exercises: 30x seated calf raises sampling entire dorsi/planti ROM (”bad” leg only), 30×10sec of both vertical and lateral leg flexion extensions (”bad leg only”), 3sets of 10reps of seated two-legged press set at 300lbs (up 40lbs from last session), 3sets of 10 reps for seated hamstring curls set at 75lbs (same weight as last time but machine set more appropriately).
    5) Strengthening and Balancing exercises: A) Stand/balance on bad leg while throwing a 5-10lb ball at an angled trampoline aiming for 3 sets of 30 consecutive catches. Increased my “PR” from last session’s 12 to this time getting 32 consecutive catches. B) Stand/balance on bad foot on unstable foam surface for 3×60seconds. Much more challenging than last couple sessions where I stood on a firm surface. This time I never completed a full 60 seconds without having to catch my balance on this shaky foam surface…something to shoot for next session!
    6) “Cool down”: Approximately 10 minute hard massage of the Achilles and soleus followed by 10 minutes of icing with Aircast Cryocuff.

  246. Brian,
    Those “catch and throws” sound like something even more sadistic than my therapist comes up with. Otherwise, it seems like we have a lot of similarities in our protocols. The leg press/calf raise machine uses some type of elastic bands. I don’t know how much weight I’m lifting right now. If I ask, I’m afraid he’s going to tell me something like 20 lbs. LOL

  247. Starshep,
    Your message reminded me that I forgot one other thing they added to my protocol the last few sessions: they have me do the Theraband flexes (all 4 directions…these are too easy) right before the seated leg presses. The seated leg press is one of those machines you see in just about every gym–I start with my knees bent so they are within maybe 6 inches from my face, with feet up about face level, and I then push the big plate forward until knees fully extended. The machine only goes up to 400lbs…once I get back to that level, should be done with PT! :)
    Cheers,
    Brian

  248. Hi there, im 17 and have been told i have a partial ruture of my arcillies tendon the injury occured on the 5 june, so one month ago from yesterday. I had to have cast split last night at the Hospital as the swelling was so bad, should i be expecting surjury?

  249. Stephanie,
    I had a full rupture and had my initial cast on for 2 weeks, then another cast for 2 more weeks and a CAM boot after that. Once I got into the boot my foot swelled up like a balloon. I put on a compression sock and within 3 days the swelling was gone.

    Your swelling does not necessarily indicate a need for surgery but you might want to talk to your doctor about the possibility of going into a boot with a compression sock.

  250. I agree, steph, you have options…I’m a long distance runner & had a partial rupture, I’ve recovered well with out surgery…Others have gone the surgical route and done well also. Talk it over with your Doc & parents. God Bless you I know this sucks but the time will pass & as long as you are willing to put in some effort you will heal, your youth should help accelerate that process.

  251. I had my surgery a year ago on June 9. I am pretty much back to normal with my activities, such as walking, swimming, and a little of jogging on the treadmill. I still cannot do the toe-raise on my injured foot.

    Best of luck to all.

  252. Dear all,
    Just passed my 10 weeks post-op evaluations last week. Doc was surprised how almost no swelling existed (usually takes up to 6 months) and we agreed it must be the compression sock and once a day Aircast Cryocuff icing. Ditto with the swelling measurements that showed no difference between right and left feet. Unassisted dorsiflexion is 15 degrees for both feet, with lateral ROM (both to the right and left) also identical. The unassisted plantarflexion was still only 42 degrees on the injured side compared to 50 degrees on uninjured side. Told both doc and PT that my status right now is “walking with almost no limp” and they cleared me for ultrasound (scar tissue just below and above incision site) and gradually more intensive calf muscle exercises. I can already easily do ~40 two legged heel raises but need to be able to do single legged heel raises (haven’t tried one yet) before I think about running again. Doc said that I still need to be careful to avoid any sudden lateral leg thrusts and obviously no jumping.
    Best wishes to all,
    Brian

  253. Awesome, Brian! I found some new Cryo cuffs on eBay for $79 - I’m so excited to try it out! Sounds like you’ve really gotten your swelling under control - which I need help with. Sounds like you’re almost back in the game!

  254. Now I am in my 4.5 mths after my re rupture surgery (1st rupture was about 8 months) . Am still walking with a marked limp.
    The back f the heel still hurts and there is still swelling
    Is this normal?

  255. Hit my goal last week as I started walking without any limp at 11 weeks post-op. I actually did a couple 20-30 yard “slow jogs” that day, barefoot. Am now doing (barefooted) leg presses at 380 pounds, 3 sets of 10, without any problem. Today, after doing a 10 mile bike ride at 20mph, I walked a couple miles with my kids that included 4x~50 meter runs–I feel nothing in my Achilles when I jog but do feel something in the inside front of the ankle as the speed increases. Later today, I did some jumping and single leg heel raises on my bad foot *in the swimming pool* and it felt great! Tomorrow, I will just do some light stretching and heel raises, and Tuesday I will do my twice a week PT session (including leg presses, etc). Wednesday, I will do my first one mile run (at 12 weeks post-op). Keep thinking positive everyone, this nasty inury can be beaten with patience and perservance!

  256. Speaking of patience and perserverance, please google Ariane Friedrich. This woman was one of the best high jumpers in the world until she fully ruptured her *jumping foot* left Achilles back in 2010 during training. She had surgery, etc., and didn’t compete at all in 2011. Yesterday, she won the German National Championships again in the High Jump and is currently only 4 inches (10cm) away from her PB as we approach the Olympics. This nasty injury CAN be *fully* overcome!!!

  257. Sorry for the typos….it should be “perseverance”, not “perserverance”…(too many beers on Father’s day)

  258. Brian,

    You’re an inspiration to my son, age 18, who is desirous of running again after his complete achilles tear right before going to state in 3 events in track. It’s nice to read of those who are successful in a reasonable amount of time. My question to you is at what point can you submerse your foot and perhaps swim? My son is 4 weeks post op, boot, FWB, no crutches, no stitches. Any words of wisdom? He swam competitively in high school and needs to retain some upper body mass whike not running. Thanks for any tips and continued good luck to you in your recovery!

  259. StateChamp- I started swimming at just over 4 weeks (day 32). I would have started sooner, but had to wait for the incision to fully close. Post surgical infection is one of the big complications to worry about, and my doctor wanted me to be very conservative with the incision - making sure it was completely healed, before getting into the pool.

    I do recommend swimming as a great rehab activity- my ankle and Achilles always felt better after the swim sessions. The pool is where I first started to work on heel raises too; and I practiced walking in there as preparation for going to two shoes.

  260. Exactly what Ryanb said, soon as the incision is 110% closed. For me, I didn’t get out of the dreaded hard cast until 6 weeks post-op but went straight into the swimming that same day. Swimming is a fantastic exercise during rehabilitation…one can of course do a variety of other great exercises in the pool as already discussed. I also started riding my bike again within a week after getting out of the cast and that has been my primary source of aerobic exercise.

  261. State champ.
    Depending on the equipment your son has access to, there is a wide variety of things that he can do from a seated position and a couple of dumbbells. I’ve been doing curls, flys, lat raises, back flys and lying triceps extensions. Here is a great site for more ideas: dumbbell-exercises.com

  262. State Champ,
    Your son will also be able to do push-ups and sit-ups again very soon, maybe within the next couple weeks. I started within a couple days after I got my hard cast removed at 6 weeks post-op. Push-ups and sit-ups are a couple things they will test him at basic training so he will be ready. I forgot whether the Army (maybe only the Marines?) tests for standing broad jump and pullups? He should be able to start doing pull-ups within the next month, just make sure he lands on the uninjured foot. I am probably at least another few weeks away from trying a broad jump, but I just turned 44! Anyway, barring any accidents, your son will be kicking butt again by the time he heads off to basic training!
    Brian

  263. Well I had the dreded rerupture last night. I’m 7 weeks post op, been walking well for the past two weeks. I was just walking up the stairs, heard a pop, sharp pain and got off the leg right away. The worst part is that my wife and I are going to be on vacation in Mexico in two weeks. I can still walk on it with minimal pain, so I’ve decided to let it heal on it’s own this time. I just won’t be immobile again and have my foot un-usable. I feel like if I can walk with little pain, then I will have to let things heal and then back to PT for things.
    Seems like with UWO protocal has been working well for lots of people with reruptures, and that’s the approach that has worked well. I feel like I set myself back a few weeks with my recovery though that’s for sure.
    Any body have any advice on dealing with things?

  264. Thanks to all for the replys regarding swimming and other excersies my son should think about starting! He seems hesitant to exert too much because of fear of pain but needs to do something other than reread the Harry Potter series for the millionth time! He has his first PT today! Will let you know how it goes!

  265. Rcastelda, DO NOT leave your reruptured foot in a shoe. It will NOT heal properly, and you’ll limp forever! Follow the UWO protocol if you like, but FOLLOW it, starting with 2 wks of NWB, part of a full 8 weeks in a boot (6 of them on heel wedges). Don’t be creative with this injury, please!

  266. I was on this page back in April I silpped just 2 days in 2 shoes. Something ripped Dr. checked it out, PT said I still had strength everyone determine achilles still in tact. My Dr. leaves the practice, wound at 20 weeks starts to weep, go and see the Dr. who is taking over and he doesn’t like the look of my scar, lots of adhesion and weeping. Orders MRI I get the news today, that I have a rerupture and it had to have occurred back in April, haven’t fallen since. Looking at more surgery and possible tendon transfer. WHat the heck, I was getting ready to be discharged from PT. I walk but with some pain and limp. Debating whether to go the surgery route or just let it be and deal with it.

  267. Wow, that’s hard to believe, kb60, that you had a re-rupture back in April but they didn’t diagnose until 2 months later!?!? Very sorry to hear about this. Do they at least have you back into a boot with foot pointing downward? Similar to Norm’s advice to rcastelda, you should at least try a boot and the UWO protocol this time around. I wish you the best of luck.

  268. Kb60, I often try to steer people non-op, but you might well be better off letting the surgeons clean this up. No guarantees ever, but the prospects for leaving it as is don’t cheer me up. Just one opinion from a non-doctor stranger, but there it is.

  269. The problem with Brian’s plan to “go UWO” now, is that you’ve missed the time window when you’re body did the most frantic inflammation and healing, immediately after each rupture. Another blogger here followed the UWO protocol several weeks after a rupture or rerupture (I forget which), and was happy for a while then it ruptured again, too easily. After a rupture gets “stale”, it needs surgery to trim off the healed ends to re-start the magical healing process.

  270. Norm,

    I am wearing the boot. Things have been feeling better each day. Seems like I had the same scare that others have had with it. Still have movement in the foot, ankle, toes, ect. Burning sensation when trying to walk much like tendonitis which makes me think I was pushing too hard too early.

    Now it’s going easy for the next 2 weeks before the wife and I are in Mexico.

    Thanks for the advice.

    Rico

  271. Norm,
    I wouldn’t call it “Brian’s plan”, I simply suggested that he should *at least* try the UWO protocol as opposed to nothing at all. I fully agree with you that it would be even better if he gets surgery at this point. Thanks for the clarification and sorry for any confusion.
    Cheers,
    Brian

  272. Just another little update for me. Two days ago, at just under 12-weeks post-op, I tried doing a single legged heel raise after I returned home from PT and just couldn’t do it without some assistance from my good leg. It could be I was afraid to put that much pressure on the “bad leg”, but I think it’s more a matter of it still being too weak….so that is something I obviously need to work on. However, I lived up to my goal that night and jogged a a very slow (9 minute) mile. It sure felt weird (very little “spring” in that foot) but at the same time it felt great! No pain at all except a touch of something on the inside/front of my ankle when I briefly tried “pushing off” at an increased pace. I will try again in a few days, gradually/painlessly increasing the pace back to pre-injury (around 7:00/mile, 4-6 miles, twice a week) before I try increasing the distance…no idea how long it will take, but will write an update again in the next week or two…. My upper calf muscle (gastocnemius) was a bit sore yesterday (even today) that tells me the running might be the best way to rebuild the calf strength back so that I can do the single heel raises. Meanwhile, still training on my mountain bike for aerobic fitness… Best wishes to all of you in your recovery.

  273. AARRGGH!!!

    First off, let me thank all of you who post onto this site. When I ruptured my achilles I was devastated and had no clue. This site has been a great resource. Here’s my story, I snapped my achilles on May 14 playing soccer - jumping up for a header rather innocently. Didn’t hear the pop, didn’t feel any pain. Only noticed it when I couldn’t push off my foot. Worst fears came to light and off to the hospital I went. I chose the non-op route following the posts here and the research from the UWO study. I am now just starting my 6th week in the boot at 0 degrees. I have been PWB and occasionally FWB (around the kitchen) starting week 5. Leaving the office Thursday to go to PT while on crutches, my foot solidly in the boot engaged my achilles and I felt a pop followed by pain that almost had me passing out (the poor receptionist was terrified as I yelped in pain). Here’s my situation today: My PT says not to worry. They have good experience with ATR and examined me, squeezed what’s left of my calf with a positive response - my foot moved - as far as I can tell, as much as before the pop. Laying on my stomach I can point my foot out, push with my foot etc. They believe that I pulled some scar tissue loose and in their opinion it is a good thing. They also tell me it would be near impossible to rerupture in the boot without a fall, trip etc. God, I hope they’re right. I have an appt with my doc Thursday. Because I am with the local hospital’s fracture clinic, if I want an earlier appt I need to go to emerg and work the process. Anyone else with this experience? My fear is I reruptured and will have to start all over again. Does scar tissue pop? The area is still tender.

  274. Philip,
    I strongly encourage you to get a MRI so you know for sure what’s going on with your Achilles. The answers to your questions are “yes” and “yes” and sounds like the Thompson test was encouraging, but you really need a MRI to know for certain. Good luck to you!
    Brian

  275. Philip I originally. Rutured on the 26th march after 7.5 weeks whilst in the air cast boot I had removed it and slipped whilst getting dressed resulting in a pop and a full re-rupture where the tendon had rolled upwards. I had surgery on the 1st June. My consultant removed the stitches on 21st June and I am now back in the air cast boot for the next three weeks. Have you had the ultra sound since you heard the pop as the calf test will move the foot even if you have 10%of the tissue fibres still intact. I would ask for another ultra sound to confirm the extent of the damage if any. The surgical procedure is a speedier recovery but it will take time either way hope everything is ok and you recover speedily.

  276. Brian. Reading your post and seeing that you are currently jogging but you are struggling to complete a single leg heel raise. I have now ruptured both my Achilles tendons over the years and am currently recovering form my latest rupture to my left leg. When I ruptured the right Achilles ihad the same problem but after a lot of persuasion from our physiotherapist and my team mates giving me some stick I realised that it was more in my mind holding me back in cases injured it again. If it is any consolation to you within two weeks of completing my first single leg heel raise, I was back on the weights for my legs.

  277. Phillip, if at all possible get Dr to do an MRI. I had surgery in Feb went to shoes in April, I slipped just a little walking heard this horrible rip almost passed out. Went directly to the Dr. they thought I had just torn the scar tissue. I was in a soft cast, for week the a boot for two weeks. I still had strength in the ankle, could even do toe lifts. At starting having problems about two weeks ago, a spot had open in the incision and was draining clear fluid. My Dr. had left practice the end of May, due to family issues. I saw another surgeon, one look and he ordered an MRI. Thinks I ruptured it back in April all the increased activity was causing it to swell and the surgical site was pulling apart. I was swimming and riding a bike and due to be released from PT. I remember saying to everyone the past few weeks it really pulls and feels tender. I was told I needed to work through the pain and yes sometimes it is a mind thing. Sorry about going on and on, but your case sounds so similar and I hope nothing is wrong. I am looking now at surgery on the 2nd and they will have to transfer another tendon to help reinforce the damaged achilles.

  278. Philip, KB0 is right. Might help to read Polly’s blog, she had a few problems with scar tissue and sounds similar (just checked the date, 2nd Aug 2011). Hoping its nothing more serious.

  279. Norm, kb60, and Rico,

    Norm might have been referring to me above regarding to late diagnosis, UWO rehab followed by rerupture. I was 3 weeks delayed getting my injury diagnosed and was cruising along with my UWO non-op rehab at week 10 when mine popped while walking to my PT appt!

    I had surgery about 10 days after that and am recovering quite nicely so far. I just couldn’t bear the thought of starting UWO over again and running the risk of having it re-re-rupture down the road. Plus the surgeon said there was a fair bit of scar tissue to clean up which is what likely prevented it from healing properly the first time.

    Durwood

  280. Philip,

    I’m sorry to hear about your setback. It’s a mental blow to think you’ve been making progress and then have it wiped out (or at least wonder if it’s been wiped out) in an instant.

    I agree with kb60’s comments above. It would be great if it was just a scar tissue thing but it could likely be worse. Hope for the best but expect the worst so you are mentally prepared to reset your rehab clock.

    Maybe you only partially tore it? That would explain the intense pain (as opposed to full ruptures which tend to not hurt as much) as well as the response to the Thompson squeeze test.

    For what it’s worth, when I saw the surgeon during my rerupture referral appt they did the calf squeeze test too and thought maybe it was only partially torn because I was getting a slight response. However, during surgery they found that not only was it fully ruptured but the gap between tendon ends was larger than what he expected.

    Good luck and for what it’s worth my surgeon was prepared to do an FHL tendon transfer on me. He didn’t have to…but when he talked to me about it he said that it can really help strengthen the Achilles and is not a super complicated thing to do.

    Hope it all goes well for you this time around!

    Durwood

  281. Thanks all for the insight. I am hoping to get in to see my doc before my Thursday appt. I am preparing for the worst and hoping for the best. Following rerupture, what was your strength like? I feel like I can do everything today as I could before the pop. I am able to do sitting heel raises - abt 1/2 inch. I can push with my foot. Point my foot out while laying on my stomach. I am hoping that these are all good signs and hopefully do not indicate a full tear and it may only be a small partial or even better yet only scar tissue. Clearly I am still in stage 2 - denial. Fingers crossed.

  282. Glad to read after about a week that most seem to be progressing. Sorry to those who have had set backs! My son is at week 5 post accident and week 4 post surgery. He’s been a bit depressed lately, seeing his sister enjoying the summer while he is stuck at home. We ventured out today to the local strawberry festival and found a great walking stick for him to use as he has not used crutches for almost 2 weeks but is a little unsteady. He says it is a gift from the gods! Normally he would have been spent after a short jaunt, but today he persevered for 4 hours!!! He is even considering a trip to the zoo this week. For those of you who feel rather weak or clumsy, a great walking stick might just be the ticket. Best of luck to all!

  283. Thanks, ryanb and Nigel for your info regarding trying a single legged heel raise. After I got back from PT yesterday and read ryanb’s post that he successfully performed one at 12 weeks post-op, I went ahead and tried again…Sure enough, this time I got my heel off the ground, although very transiently! I did a fast 10 mile bike ride this morning and then tried tried the heel raise again tonight, just before I went running. Once again, I got the heel off the ground, but very transiently. In fact, I can pretty much spring the heel up an inch or two before it drops back down. More good news is that I comfortably ran my one mile course again tonight (just the 2nd time) and dropped the time a full 1.5 minutes (9 mins down to 7.5 mins)! Amazing how much difference 5 days makes although the “spring” on my injured side is still lacking a little bit and I need to fix that before going much faster and/or farther…

  284. Sounds great, State Champ! Is your son still in a boot? What angle do they have it fixed at?

  285. Rodney

    Please email me if you ever check this board again. I’d be interested in talking to your orthopedist in Atlanta about mine that just snapped.

    ryan.norstadt@gmail.com

    Thanks and I hope you are doing well.

    Ryan

  286. I am now 25 days post op. I have just been in the gym with the physio on the static bike and completed 2miles with out the air boot. Slight soreness but it feels great.

  287. Durwood,

    Things have actually been well in my world. After the initial dread of a re-rupture, things have been better everyday. It ends up it was just scar tissue that I tore. Scared the heck out of me though thats for sure. It was just enough to make me slow down with things. I would say that the depression of thinking that I had re-ruptured things was the worst part to get around, now I’m just getting excited for Mexico.

    I’ve been getting my range of motion back every day as well as strength. As protection in 2 shoes I have been wearing my ankle brace to help me feel more at ease. I just hope that soon I’ll be walking normal again.

    We’ll see how things continue, and for being 7 1/2 weeks post opp and in two shoes walking I feel very good about things. I just have to keep working things out.

    Good luck everybody! Will be sure to keep everyone posted with things.

    Rico

  288. I went to another Dr. today, for a second opinion. The first Dr. wanted to do surgery with a tendon transfer, Dr. was a podiatrist. New Dr. is orthopedist, he said the risk of complications from surgery are high. Wants me try casting for four to six weeks, with PWB. Wants me to get active said the more I move the better quicker the healing. Anyone heard of this on a rerupture?

  289. kb60, I don’t think my opinion has changed since my last posts above. Some people here have gone non-op after re-ruptures, and I think most of them have done well. The most “reliable” exceptions have been folks like Durwood (see above) whose reruptures were “stale” when they re-started treatment. Your rerupture (if that’s indeed what it is) is very stale, so I wouldn’t expect it to heal by itself non-op, without being “re-injured” surgically.

    It would be great to have definitive trustworthy diagnosis, but X-rays are useless for ATRs, and I am very suspicious of both Ultrasound and MRI (or the people who use them), based on personal experience and some other info. So alas, I don’t trust much other than the Thompson test. Does that show a rupture in your case? (Pretty much all the other strength tests are inconclusive because of other muscles and tendons, AFAIK, unless you can do a full-height 1-leg calf raise. But the Thompson test squeezes the gastroc, and only the AT connects it to the heel/ankle.)

  290. kb60
    I went non-op for my ATR repair and my doctor said that if it did rerupture, we’d just do non op again. I’m at about 18 weeks now after my rupture an so far, so good.

  291. Normofthenorth, Dr. did do a Thompson test, and it did show that it is not a complete rupture very close, but I still did have some movement, which he was pleased with. Said it was enough to at least try nonop. When I had surgery the first time it was a 6cm gap, this time MRI shows that it is a 3.6cm. not quite as bad a before. I was casted today, but it is already driving me nuts, I keep telling myself it is at least worth a shot.

  292. Just come back from physio 28 days post op first session on static bike without the brace holly Moses my heart was in my mouth all the time. My consultant reckons at this rate I will be back playing football around Christmas time. Happy healing all

  293. Just back from the Dr’s. Had an ultrasound on what I thought was a re-rupture. The good news is that it isn’t. The bad news is that I still have a long way to go as the gap in the rupture is 1 cm. I am six weeks along. The doctor doesn’t believe I reruptured as the ultrasound showed scar tissue/tendon tissue “around the gap”. So, is it a tear or not I wonder. It seems not given the tissue around the gap. Unfortunately, because they didn’t do an ultrasound at the first visit, there’s nothing to compare it too. So, I’m keeping on with the UWO protocol and going FWB to help promote the healing. Any insight from fellow ATRs on “gaps” that don’t seem to be reruptures?

  294. kb60, it’s widely believed by “logical” people that surgery is especially indicated for large gaps, and non-op works better with small gaps than big ones. But it seems to be false! The only study I’ve ever seen testing that logical theory — admittedly a small study, of 25 non-op UWO-study patients who had pre-treatment Ultrasound exams — found NO correlation between gap size and the clinical success of the non-op “cure”. (All those patients had relatively “fresh” ATRs, <14 days old.)

  295. Philip, I think mikek753 was one of several people here who could still feel a “notch” in his AT even after most of his strength returned. (Mike went non-op.) Can’t remember any others offhand.

  296. I don’t know if its just my AT, but my surgery and rehab has been horrible. The first 4 weeks were Hell. The pain was unbearable. It felt like all the skin had been sanded of me ankle and foot. Getting up to go the bathroom was the worst. Gravity, who would have thought.
    I have a compete tear. Maybe most of these posts are partial tears, but if they are complete tears.. why is mine so much worse.
    Had surgery 4-29-12 and still am not walking in the boot for another 1.5 weeks. My pain is much better, but I still have trouble with swelling and the foor turning black and blue. I was told 5 months before I could run again. Its been 10 weeks and I have not even started PT yet.
    How are all of you so far ahead???? Help

  297. @pmwhalen,
    Check my blog. People heal at different rates.
    I had similar issues with overwhelming pain and wound complications. The first three months post op were living hell. Only started turning the corner at around six months post.

  298. Everybody heals so differently. Varying pain levels, swelling (or not), flexibility, sore heels, etc.

    After a couple of months here, I’ve had the impression that most ATR’s described were full ruptures, the biggest difference being in the protocols used. Operative or non-op, cast or early boot (boot starting at anything from 0 to 10(?) weeks or so), and the attitudes/experience/preferences of the specialists.

    My case was non-operative, full tear, now at week 18, with the main issue that I’ve had being with my ‘good’ leg, affected by the early imbalance between the lower limbs. Swelling has been an issue with both legs.

    You’ll be out of the difficult spells soon. Stay strong!

  299. I had a complete rupture in Jan, surgery on 2/15. It has not been easy. Healing, drainage, reaction to suture, then slipping again and re rupturing it all. They are trying to go non op this time, if it doesn’t work then the last option will be surgery again with a tendon transfer. SIx months in and looking at least another six months in cast or boot. I remember back in Jan I asked Dr. will I be able to go on vacation to the beach in August. Answer was sure, now I will be lucky if it is Christmas!
    Hang in there!

  300. ? Does anyone try to contract their tendon while in the cast, I mean trying to see if it will flex a little. Don’t know if it is in my mind but when I try I can feel it move my calf muscles a little. Only works when swelling is down though.

  301. I am grateful to get discovered this site. Retain up the very good postings.

  302. Kb, the non-op route may well work for you, but going ultra-slow non-op has a bad record over the years. I’d hit your Doc with the UWO study — Willets et al 2010 — and its fast protocol.

  303. Norm where can I find that study you mentioned. Now the Dr. who casted me the other week told me to weigh bear as much as possible.

  304. The full text of the study is on this very site, linked from the Studies page. Go to the Main Page (achillesblog.com), click on “ATR Rehab Protocols, Publications, Studies” in the left column, and look for “UWO”. It’s listed under surgery vs. non-op, but they used the same fast protocol for both and got very good results with both. I think there’s a link to the published version of their protocol at the end of the study, and there’s a virtually identical version (posted by me) at bit.ly/UWOProtocol . (That’s a copy of what the authors faxed to my surgeon, at his request, in 2009.)

    As you will see, they stayed NWB for 2 weeks, then PWB for 2 more weeks, then FWB “as tolerated”, starting at 4 wks post-op or post-non-op. You don’t mention when your rerupture happened, or whether you were immobilized in equinus immediately or if not when. All of that matters if you’re going to follow their demonstrated-successful schedule. Slower seems to cause harm. Faster. . . nobody’s done a study of faster, so it’s unproven. We know that faster is more convenient, but we don’t know if the results are acceptable or not. . . yet.

    If you start your own blog page and install the ATR Timeline Widget, we’ll all be able to see your vital stats every time you post or somebody comments.

  305. My surgery was on 1st June for a complete tear I am now fwb and walking with a slight limp due to the stiffness in the ankle area. At present I am stretching the tendon 3 reps of ten holding each stretch for ten seconds every day. Whilst performing the stretches this morning, I felt some tearing, I immediately contacted my consultant who informed me it was more than likely just scar tissue separating from the tendon, but to be on the safe side. Cease all stretching activities for five days, but try to walk greater distances. Has anyone else had this scenario ?

  306. I am at a crossroads…ruptured achilles in Feb, my regular dr was out of town and he had a young (34) protege taking his patients…he encouraged me to have a surgical repair as the incidence of rerupture is significantly less with this type of repair…according to him….I followed all of the drs orders…nwb..in boot, on knee scooter for 6 weeks at which point the young dr said get rid of my woobie (my scooter) and walk…..Walk?? I can walk?? just do it was his attitude…unsure of myself I hobbled down his hallway holding on to the walls….this was my first time I said to myself does this guy know what he is doing?? of course I am in the boot and there are lifts in it but still I was concerned. I was then given a rx for Pt and away I go on the road to recovery…..I reported back to dr after 4 weeks of pt with a report expressing concerns for swelling and instability….he scoffed at this and dismissed the flowery commentary of the pt …what do you expect…you are recovering from a serious surgery…..drs orders were to transition out of boot to shoe over those 4weeks taking a piece of the lift out every 3-5 days until there were none in the boot and then taking all and putting them in a sneaker and one by one removing them until it was just the sneaker……pt concerned that this is too quick …but drs orders…continue with pt gaining full rom and now it is strength building time…..i repeatedly express concern as to the numbness in my foot and the lack of deveopment of my inner calf……on june 1 my dr releases me with no restrictions and i go back to work while continuing pt to try to increase strength….eventually I become discouraged as I have gained as much as it seems I will……go to 6week appt still expressing dissatisfaction…..as I have said throughout I feel like something is not right….something is not connected…..he sends me for another mri finally acknowledging my concerns saying when did this start happening??/ april my friend read your notes……I called my original dr that was out of town at the time of the injury and subsequent surgery and said i could no longer allow this guy to be in charge of me….i am now scared ..
    dr sends me for mri and guess what???achilles is detached now I am in a pickle…..I need a new surgery…..is my dr comprised….what questions do i need to ask….i am devastated and feeling like i do not know who to trust
    i cannot believe i have to go through this all over and he wants to do a ligament transplant from my toe…..i am sooooo scared ….does anyone out there have some advice

  307. Jackieo- the protocol you describe does not sound overly aggressive. If anything, 6 weeks might be longer than normal for NWB post surgery, compared to the modern protocols like UWO. The one questionable step - in my eyes - is the abrupt transition from NWB to FWB (no PWB)… even with big heel lifts in a boot, I would have recommended a gradual transition to weight bearing, using crutches to assist with walking for a while.

    That’s all water under the bridge though. Apparently, you’ve re-ruptured. Maybe you just don’t talk about it- but it’s interesting to me that you don’t mention an “event”- I think most people who re-rupture know exactly when they did it, a bad “pop” or abrupt tear that they can feel. Do you think you just slowly tore the surgical repair apart as you started walking again?

    My advice? Find and work with a doctor you are comfortable with. Get a couple of opinions on the best path forward - though, from what you describe, surgery with the tendon transfer could very likely be the right answer. This time, know up front what your expected protocol is going to be. Learn as much as you can about expected recovery rates, return to function expectations/schedule, etc., so that you’ll be able to recognize if things are taking a turn for the worse as early as possible. Get an example of a modern protocol- if your doctor wants to deviate from that (6 weeks NWB again or something) make sure you understand why. You’ve likely suffered a lot of atrophy up to this point- starting over again is going to make it worse. Don’t compound that problem by following an old school protocol with excessively long immobilization- you’re going to be starting in a deep hole, don’t dig it an deeper than necessary.

    Good luck, and keep us posted-

  308. jackieo,
    As soon as I got my boot, my doctor told me I could go full weight bearing but did not force me to at the moment. It did take me about 5 days to transition to FWB. I’m not sure in your case that going FWB was that stressful to your AT. As far as an event goes, I asked my doctor how would I tell if I reruptured and he said that at that stage (about 4 weeks) I wouldn’t know. Apparently early on in the recovery, a re-rupture can be a gentle pulling apart of the tendon as opposed to the explosive “pop” we experience when we initially rupture.

    Unfortunately despite doing everything within proper limits a successful recovery is not guarantee. In some cases, things happen. I agree with ryanb that you should get a few opinions. I am curious as to why your doctor says a ligament transfer is necessary. If other opinions indicate it is not necessary, don’t automatically reject the non-op option. When I asked about a re- rupture, my doctor said if that happened, we would just recast and start the non-op recovery all over again.

  309. Jackieo, there usu is a transition from NWB to FWB, but rushing that in a boot, plantarflexed, shouldn’t normally cause a rupture. One concern is that your Docs don’t seem to be following evidence-based rehab protocols, like bit.ly/UWOProtocol. So you may have to do that yourself.

    I’m a huge fan of non-op rehab, but I think you’re probably a bad prospEct now, because your rerupture is probably too “stale”. No Doc here, but I think you should go for another op, sorry. Quite a few people love the extra (halus longus?) graft, though I’ve never seen randomized-trial evidence of benefit. But if it’s good enough for Beckham…
    Good luck! You’re due for some already.

  310. ryanb
    the bad news is I did exactly as instructed by the “expert” although I questioned the common sense of it all I just trusted that he knew more than I..also expressed my concerns to the pts as they deal more with the post op complaints as pt begins…in retrospect the feeling of seriously sticky duct tape pulling off a really hairy leg may have been my laymans terms of saying hey what the heck is going on here and the obvious indentation on my innner calf also i feel indicated a connection problem
    i also often and repeatedly said i feel as if this is not connected
    5 months post op is in my opinion really late to recognize a problem

  311. I OPEN reruptured my Achillies on July 7, 2012. I had been clear for 8 days. I think 2012 is a non walking year for Mr. Shea. I am one of a handful of people in the world that has had an open rerupture.

  312. norm and ryanb
    thank you so much for your words of encouragement
    I am so emotionally distraught at the moment, one minute i am mad as hell, next I am feeling sorry for myself, then I am mad at myself bc I feel sorry for myself as there are others that are much worse off that me…i am going for a second/third opinion on mon…..dr 2 says mri 1 and mri 2 are practically identical…..dr 2 says the tendon would never have healed as it was too detiorated and a ligament transfer would have been necessary
    i cannot fully understand this as i went through 3 months of pt regaining full rom and regaining a decent gait with a whole lot of work
    what i could not do was stand on my toes and my inner calf was just not responding and I did express my concern as I hit the wall with progress

  313. good news for jackieo
    went to a third doctor with my pre and 5 month post MRIs and this dr called off surgery
    he said the MRI was read wrong and surgery or immobilization would be the worst possible thing I could do
    where there was increased scar tissue it created an image of a void between that and my heal…..please i encourage all to get second third and fourth opinions before you enter into this or any other surgery!!

  314. Hi all,
    so sorry to hear about everyone’s experience and wish you all the best. really need help with some questions. Fully ruptured my left achilles on May 5th. Did some research and told the ortho surg that I really wanted surgery. He told me, based on the ultrasound, that the rupture happened so close to the calf that surgery wasn’t an option (nothing to sew the tendon too). He said I had to go the non-op route. Is this true? Got the boot of on July 31st and started rehab. Heard a pop on Aug 14 and am devastated. Going to see him Aug 16 but starting to lose faith…Should i get a second opinion? thx all.

  315. Hi Roman,

    Sorry to hear this news :(

    My snap was also right under the calf muscle of my right leg so the non-op was presented as my only viable option……surgery was described as “at best, it would be complicated” for the same reasons that were explained to you…there’s nothing to stich in to.

    So far (11weeks) I am okay but reading your post makes me wary again.

    What was it that you were doing that created the pop on the 14th August?

    I sincerely hope that it is not a re-rupture.

    Best wishes to you.

  316. Hi Andrew1971,

    Thanks for the well wishes. Saw the ortho surg today and he’s fairly certain its re-ruptured. Getting an ultrasound tomorrow to see to what extent (might not be full as I still have some range of motion). Still have to go back in the boot - for how long we’ll see i guess. I’m a bit embarrassed to answer your question….but it popped when I slipped on one of my son’s toy cars (brutal). I was in the boot for just over 12 weeks…my ortho said that, at that point, my AT was 70% healed and that a risk of re-rupture during rehab is quite low (again, brutal). To be fair, physio was going well and I was gaining strength and range of motion each day. Just so frustrating that something so small (literally that lightning mcqueen toy) could cause so much damage. Hope this story helps in your rehab. Best wishes.

  317. It’s not embarassing to slip on a kids toy - there’s nothing good about a re-rupture, but accidents happen and it must of been quite the trauma and just bad luck.

    It helps me to remember that we’re still vulnerable even though we feel much better.

    Fingers crossed it’s not as bad as you perhaps feel it is :)

  318. I ruptured in Jan had surgery, then started having problems in April when I slipped and felt something tear. Keep telling PT and Dr. something wasn’t right. Saw Dr 2 who immediately did MRI and wanted to do FHL transfer. I got cold feet and got another opinion. Dr. 3 immediately casted my leg with FWB , said it was at least worth a try. Wanted me to see another Dr 4 who is one of the best in the state. He removed cast and put me in boot until mid Sept. and ordered me back to PT, At that point we will look and see if it is working or if surgery is FHL surgery is needed. So will see if the rerupture has healed nonop, I know my ROM is back to normal and I have some good strength. Scared of it not working or reinjury. It has been a long 8 months. My advice to newbies is if your gut tells you something is right PLEASE make sure you get another opinion. The last two Dr. are working together on my care and I have confidence they know what they are doing.

  319. Has anyone used the kiniesiotape for the achilles for relief and stablization during PT?

  320. Kb60 - I used the tape at different times depending on what kind of pain I was in. It helped a lot at the time.

  321. I was surprised when I first used it, my PT put it on and I had no idea what it was. It really made it feel much better especially when I was doing the PT. I thought more people should try it, I know a lot of the results say it is only in the mind. But I didn’t know anything about it prior to using it, and it worked.

  322. I was in quite a bit of pain several months post op and nearly went back to the boot, The tape helped me get through that time. I haven’t had to use it since. I also used it in the beginning when first started having problems. Its helpful stuff.

  323. I had a rerupture last week, 8 weeks since my original surgery. It seems I had too much scar tissue built up and upon taking a step my leg literally blew open. My scar ripped perpendicular and I literally had a 2 inch diamond shaped hole in the back of my leg. The doctors and surgeon had never seen anything like it. It had completely reruptured and now I’m starting again. It really is a balancing act in pushing your rehab/physio and resting. I was too agressive with my rehab and although my PT was impressed with my progress apparently my body did not agree that I was ready. BE CAREFUL.

  324. That must of been a real shock when that happened, Sorry to hear that you’ve had to start over Ryan, and wish you an uneventful and straightforward re-recovery.

  325. Sorry to hear your bad news Ryan, are you going op or non-op?

  326. Sorry to hear Ryan, I know how discouraging it can be. I had my checkup today on my rerupture. Second time around we tried non op. Dr. said range of motion was normal & pretty good strength. I can start transitioning to wearing a shoe, no walking on uneven ground without the boot on for at least another 6 weeks. Dr. said to try to get back to normal daily activities slowly and carefully. I am to continue PT for a while longer, Dr. stressed that if it happens again I am looking at total tendon reconstruction. So I am walking on egg shells.

  327. First time at physical therapy only wearing shoes, it has been a week since I came out of the boot from the rerupture. I am terrified of getting hurt again, I was so tense during PT today, that tonight I hurt all over. Had to take a pain pill first time in over a month. Anyone else have this fear and how do you ever get over it?

  328. Hi all. I am 9 weeks post trauma. i had non-op option with a full rupture. I am now really scared about a re-rupture. Just started wearing a trainer but feels sore and have a slight limp. next week pt hope for me to be out of the boot completely. is this normal. when will i be able to drive again. also someone else has said no walking on uneven ground. how do you get out and about without doing that.????

  329. When Dr. told me no walking on uneven ground, he said to stay on pavement or level surfaces. He said if I walked out in my yard or somewhere else to wear the boot

  330. lu-lops,

    I am also 9 weeks non-op. I am able to walk around the house barefoot at this point, but I have to limp. When I go outside, I use the boot for armor just in case the ground is uneven. Even the sidewalk can have surprises, so I just want to be sure. There is a mall near me that is not very busy and I will be using it to practice walking without the boot. I’ll get into the mall with the boot on, and then switch to shoes once I get inside while carrying my boot in a backpack. At this point I just want to get comfortable not using my boot.

  331. Hi .. I am almost 5 weeks … 4 weeks cast … almost 1 week boot. How do you know if you just tear it a little? Or, a complete tear again?

  332. 21ach
    You would know I think. Mine popped and snapped.

  333. Meant to say for a second time at 13 weeks walking up a very gentle slope.

  334. 21ach,
    having just read this whole blog on re ruptures it seems that early on in recovery, I am 3 weeks post op for re rupture you may not hear or feel the pop as the tendon sutures could just come apart. Usually takes a fall to do that but just be careful.

  335. I know I slipped on our hall runner, when I reruptured. Pain was horrible, I could definitely feel a rip. I was about 12 weeks, was just starting to walk unassisted in two shoes.

  336. ?? For any nonop reruptures?? I was allowed to go to the boot on 9/13, at PT the other day I was able to do a couple of calf raises. Now at the rupture sight I I can feel hard nodule or tendon which is a little tender to the touch. Showed it to the PT , she wasn’t sure what it could be scar tissue etc. Can anyone else feel something similar at their rupture sight, I know the scar tissue fills in the gap. PT said as long as it was not painful to walk that I should just watch it.

  337. kb60
    I went non-op and I could feel a bit of a lump at the rupture site. I suspect it was from the scar tissue build up from the repair. I can’t say I ever noticed any tenderness there. Initially during PT I would feel some soreness but outside of that, I really had not had much pain though the entire ordeal.

  338. KB, I think I’ve got nothing. Do you have a blog here, with the ATR timeline widget to refresh our/my memory of your timing, etc.? Second time around, non-op? How long ago? I had tenderness — well, pain — after doing too many 1-legged heel raises after my first (surgical) ATR, but none after the second (non-op) one. My pain wasn’t at the rupture site, but down low, right where the AT connects to the heel bone (calcaneus?). It lasted a month, sent me back into the boot for the whole time, and ticked me off, too. Ended well, a month later.

    Lots of answers and advice can be brilliant or stupid-crazy, depending on how far along the patient is in healing, so that Timeline Widget (on your own blog) can really help you get smart advice and avoid the other kind.

  339. I go through a number of articles regularly and in general, people lack substance however, I just simply wanted to make a quick comment to say I’m delighted I discovered your post. Many thanks, an absolute great read…

  340. Hello,
    I haven’t checked in here since late June, when I was at about 3 months after my 2nd surgery. You can see my posts in this string between April and late June to see my whole story about the 1st rupture in early March (playing soccer) and the re-rupture (slip on the stairs) a week after the 1st surgery. At just before 12 weeks, I started trying to run a tiny bit (less than a mile) and continued PT until around week 14. From mid July until late September, I just kept it pretty simple, only jogging about a mile (@~7:30) once a week, riding my bike fast once a week (~10 miles), and a little stretching and heel raises. I finally started playing a little soccer (and soccer tennis) w/ my son at around the 6 month mark and have started really pushing the running again over the last month. I am now able to sprint again at about the same speed just prior to the 1st rupture! My aerobic endurance still has a little work, but have ramped it up now to about 4 miles at a good pace (twice a week, plus one bike ride) and am finally feeling like my old self again! The single heel raise strength (also the calf muscle size/definition) on my injured side is still a little short of my uninjured side, but is very close…surprising that it doesn’t affect my sprint speed! Finally, the scar tissue is also starting “melt off” off significantly as the doctor quoted me 3 months ago. Anyway, just thought those of you in the frustrating earlier stages of this nasty injury would like hear that even a 44 year old fully recovers within 6 months after a rupture, re-rupture, and two surgeries! Stay patient but keep active…and think positive!
    Best wishes,
    Brian

  341. Hello all,
    This has been really interesting to read all the re-ruptures. I had my initial injury on July 5th skipping rope. I had surgery on July 22nd. I was in a variety of casts until October 4th and then I was liberated. Or was I? My leg felt like it had an iron rod in it — no flexibility. I hobbled with great care and favoured my foot. A week later I ruptured my AT again, this time at work. It felt 10 times worse than the first time, like my leg was ripping in 3. No holding back on the yelps of pain. At the Emerg they were not convinced it was a rupture. But there was a 3 cm horizontal tear and they decided to send me back to the OR for debridement and resuture. I woke up from what was to be a 20 minute procedure hours later only to realize then that they had discovered a new ATR and had sewn it back together.
    Lessons learned: after the cast comes off you are more vulnerable than ever. All the surrounding muscles are weak and there just isn’t a lot of support. Sudden movements, or movements where you are not paying attention to your foot can end in another rerupture. Other people don’t understand disability especially when they cannot see it. Sport a cane in those first few weeks with the cast off so that people can have visual reminders (and it’s a good reminder to yourself too). Also, start physio the day you get your cast off. I think if I had seen a physio therapist who also understood the nature of my job, they would have given me some practical advice on how to protect myself and maybe even a written letter of proof to show my superiors.
    My second tear was lower down, very close to the heal. I am not sure if a rerupture means the exact same place or just another rupture while still healing. I learned that the sutured rupture is usually quite strong which means that a weak tendon that hasn’t been used in months is more likely to rupture in a different place.
    This second time has felt like 2 steps forward and one step back the whole time. I have been in much more pain and the wound is not healing well - I can see the internal stitches poking out. My surgeon told me today that I will have to go into OR again to have the wound resutured. Ugh!

    It is so good to hear that you are back on your feet after 6 months, Brian. It is hard to imagine that I will get there, as I await my third surgical procedure. Trying to stay positive, but not seeing the light at the end of the tunnel — yet. Any tips on how to ’stay active’ would be great.
    Keep well,
    Lizzie

  342. Oh Lizzie I am sorry this has happened to you! Very sage advice, will definitely be hearing your words when I get further advanced. Take care of yourself! Best of luck for a good recovery.

  343. Very sorry to hear of your rerupture. During your first injury what kind of rehab were you doing? What kind of protocol did the doctor have you on? Either way,
    I wish you a happier recovery this time around.

  344. It is interesting to read everyone’s story - so different but we all have one thing in common. I was playing volleyball and heard the loud pop and felt the rubber-band to my calf muscle. After lying on the ground and making heavy breathing sounds (I refused to cry) I felt the adrenaline leave my ankle area. Right then I knew it was a joint. I remember tearing my knee and having no pain after tearing. When my teammates helped me up, and I could bear no weight, I knew it was my Achilles.

    I went to the ER that evening and was given a boot and told to call surgeon the next day. When I did get in to see her, the great news was it was only a partial rupture. She kindly explained that because woman have more flexible joints, it is very uncommon for them to have a full rupture. She said she has only done 1 surgery during her tenure for a woman with full rupture.

    She put me in a cast - planning on going through 3 - every 2 weeks. On Dec 19, I went in to have my 2nd cast removed and the 3rd put on. To my dismay, she told me there is a new study out for those who are nonop that they have better healing by not confining the heel in a cast during this next period. So, she prescribed my boot, a few exercises, and easing into 50% weight bearing.

    Same day, getting use to the boot (my bottom of the foot is not flush, so gap between boot and foot) I stumbled while getting my crutches. Naturally, I wanted to use my foot to brace and then there is was again - slight pop.

    I was embarrassed as I was in from of coworkers and started cussing in pain and frustration - Did I just rerupture and lose my past 4 weeks of healing?

    After the initial pain and swelling, it is doing ok, but I have elected to stay off of it for next few days, but continue with the exercise. Thank goodness for my scooter (even though I am not sure if it is socially acceptable yet).

    Has anyone else who is nonop, gone through boot and no cast? And how did it heal? Also, does anyone know if the small pop i might of felt, could that have been scare tissue vs the AT?

    Thanks - Heather

  345. Heather, there’s no way to tell a rerupture from a scare over the Internet. Most scares aren’t reruptures, but that doesn’t prove that yours isn’t. The best study on non-op rehab, with the best results, used boots and no casts. It’s available on this site, linked from the appropriate spot near the top of the Main Page.
    Officially Willets et al 2010, we usually call it the UWO Study, done at U of W. Ontario. I’ve posted their aggressive and very successful protocol at bit.ly/UWOProtocol . Check it out — and check out your leg, too!

    My $0.02: I don’t think ANYBODY should ever be fitted with a boot that leaves a gap between the heel and the boot!! That’s not what “fitted” means, and it’s also not what “immobilized” or “supported” or “protected” or “stabilized” means. GRRR!!

    There IS a role for a boot in gradually moving the ankle toward neutral, gradually un-contracting (re-extending) the calf muscle(s). But NOT by leaving a gap! (& UWO and I prefer to get to FWB walking before the ankle angle is changed, again NO GAP!)

    Off topic, Brian above joins me and a few others here in returning to sports “form” WITHOUT returning to a full-height 1-leg heel raise. He’s probably heading for one, but I’ve stopped worrying about mine — too busy playing competitive volleyball! :-)

  346. 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.

  347. Just had surgery on January 2nd and am in a cast. Last night while attempting to move from the knee walker to a chair, the chair slipped a bit and I lost my balance. My foot did not hit the ground, but my toes did flex upward and had a brief flash of intense pain. Could a movement like that cause a re-rupture. Leg feels ok now although last night was a little tough. Cant really see whats going on with the cast on, so any thoughts would be apprecaited!

  348. Hey everyone!

    I hope everyones doing better today than yesterday. It’s one day at a time with ATR’s.

    I’ve torn both of my Achilles tendons. The first in ‘08 and the second one about a year ago. Both Achilles have been repaired surgically (highly recommended if you are relatively young and were active) and both feel structurally very strong.

    I had a few close calls for potential re-rupture..Almost falling down the stairs face forward when cruches slipped..and getting crutches caught and reaching my bum leg out to brace my fall..very stupid..but fortunate to not pay for it..

    If I can give any advice it would be to give the tendon plenty of time to heal. Do not rush back too quickly. Sleep with your boot on if you dont want to risk getting up in the middle of the night and forgetting you’re hurt.

    I highly recommend getting Millennial Crutches on Amazon
    and/or getting the Drive Medical Steerable Knee Scooter (the one with handlebars) I was able to get insurance to pay for the knee scooter and it saved my life. It made rehab this second time around, dare I say, enjoyable. If you have relatively good balance it is a blast getting around. It folds up easily and is super easy to move around on.
    I have the mindset that my Achilles Tendons more structurally sound than before,ie thicker..And if I continue to moderately pick up rehab/training along with proper rest, I can return to what I could athletically do before if not exceed that..I was able to jump onto a 3.5 foot platform today with no issue.

    I also have the mindset and it might be something to pass along with everyone whose gone through this is, I have accepted the fact that I must/will be doing “rehab” for the rest of my life. Every step is a chance to make your calf/achilles better..The moment I stop working out increases the chance of re-rupture when I decided to suddenly be active again..I just want to minimize the chance of this happening ever again without being stuck on a couch for the rest of my life..
    I’m wondering if there’s anyone on here who has torn their achilles/had it repaired surgically/rehabbed as they should have/ and re-tore it again..For instance a year or two after? I’m five years out from the first Achilles tear and its doing great (knock on wood)
    Thank you for any feedback or questions. I wish we could of all met in a different blog like “People who can jump freakishly high”
    Keep your hope and spirits high..The pain,frustration,and lack of mobility will pass!

  349. Justin, a healed ATR — with or without surgery — is virtually impervious to rerupture. The other, unruptured AT is “not so much” impervious. (There’s a study in the studies and protocols section of this site that tries to quantify the risks of “doing” the other side.
    I’m curious: Where are you that you’re still hearing that surgical repair is “highly recommended if you are relatively young and were active”? There are certainly pockets of the world — most of them in the US — where that’s still the song that’s sung. But the latest evidence — a number of good randomized trials published 2007-2010 — suggests that the extra risks of surgery bring little or even no actual benefits in strength, ROM, or rerupture risk. The best of the studies — “UWO” — is available in that same part of this website, in full text (and nowhere else, for free!). But for a number of reasons, many professionals and tonnes of amateurs haven’t gotten the recent memos.

    Surgery usually works very well, and the modern fast non-op protocols do, too, according to the evidence. With or without surgery, the fastest protocols in serious use seem to produce excellent or optimal results, so going extra slow to be “safe” or “conservative” doesn’t make sense. Being careful makes lots of sense, and being patient enough to stay with a good protocol does, too. But throwing in a few extra weeks here or there the way some professionals does “just to make sure” — “after all, we don’t want to do this twice, do we?” — bears no relation to the evidence, IMHO.

  350. Hello,

    I did a full rupture on my right Achilles December 8 2102. After feeling the dreaded “I’ve been shot” snap, I knew what had happened (I’m a member of the Canadian Ski Patrol and knew the classic signs). Once in emergency, I wasn’t given the option of surgery, and was put directly into the fiberglass cast for two weeks. After that, I was placed into the Aircast with three wedges. Finally, on February 6th, the Ortho doctor felt the tendon and decided it was strong enough to lose the boot and go FWB in shoes immediately. I found this odd, as I has been on crutches for the past two months…but afterall, he’s the expert. Also started PT the same day. Anyways, on February 9th, I simply took a step in the kitchen and my wife and I both heard a “pop” coming from the same leg! I felt a small snap, and a bit of pain in my lower calf. I immediately went to emergency, where the doctor did a Thompson test and confirmed the tendon was still intact. His theory was that a couple of ligaments may have been crossed and I heard the sound of them “straightening out” (like cracking your knuckles). That being said, I was extremely relieved that I had not reruptured. However, I am still wondering if maybe it partially torn? Also, after researching on Google, it sounds like I may have perhaps torn one of the calf muscles, as there is often a “snap and pop” associated with that.

    Anyone else had a similar experience?

  351. I started reading the other entries on the site a few weeks ago without giving any thought to the “Re-rupture” page. Well, as of this past Monday night, you probably know WHY I’m making this post. Initial complete rupture was Feb 7 while snowboarding. Had surgery on the 14th and was in a splint for a week. Last Friday Feb 22 Dr took the splint off and put me in the boot (air cast,). Like a big dummy, I slept the first few nights without it on. Monday night I had to get up to go pee and I lost my balance on the crutches. Stumbled back on the left foot (that would be the one with the brand new repaired AT). HOLY F&#K! It hurt. Foot swelled up to about the same size as the initial incident. I saw my Dr. this morning, and have a MRI scheduled for this Friday, with follow up next week. Sweating bullets right now, but “it is what it is!”. Lessons learned: keep the boot ON. And keep the urinal bottle near the bed at night so I don’t have to get up and wobble across the room in the middle of the night!.
    I’ll let you know next week how this turns out.

  352. Just got home from the Dr. for the MRI follow-up. By the time I went in for the MRI last Friday almost all of the swelling had gone and there was hardly any pain at all. The posterior side of the tendon felt smooth and intact and I was really hoping that I’d just sprained something (DENIAL IS NOT A RIVER IN EGYPT!). I was able to move PWB without any discomfort at all.

    When the Dr walked into the office this afternoon, I gave him a THUMBS UP, and he immediately gave me a THUMBS DOWN! F&CK! Not what I wanted to hear, but sort of what I was expecting. MRI shows at least a 50% tear, so back into surgery we go this Thursday afternoon. He said he’ll probably have to use a graft to surround the tendon as he will need to remove even more of the damaged tissue.

    I am going to SUPER GLUE THAT BOOT ONTO MY FOOT WHEN IT GETS PUT ON! Lesson learned: NEVER try to motate around on crutches unless that boot is on. PERIOD!

  353. jackinva, I almost did the same thing! I had the boot off and was going up the stairs with the crutches when one of the crutches slipped and I fell sideways. Naturally, I put my bad foot down but it wasn’t enough to damage the tendon again. Close call, so I never again took the boot off….except when I was laying on the couch doing nothing. The Doc told me to take the boot off and go FWB at the 8 week mark. It was HEAVEN sleeping without it!!!

    Now at 12 weeks and have been going to physio for the past 4 weeks. In Alberta, Canada, the physio is 100% covered by the government (so is all other medical expenses associated with the injury). Physio has helped a lot, as the tendon is rock solid, but the calf muscle is totally gone. Even if I had to pay for it, it’s worth every penny. I still walk like “Igor”, but each day is a little better. Good luck, and keep that boot on!

  354. Thanks JSPencer.
    I’ve been beating myself up since yesterday afternoon (and my partner isn’t too very happy with me either). But we will get through this.

    One quick question: did everyone sleep with the boot ON? I tried several times and could not sleep at all. Was wondering about some sort of light(er) weight padded splint that could Velcro on for sleeping? Just wondering. If I gotta sleep in the boot, I’ll sleep in it.

    Just got the call from my Ortho’s office - I need to be at the hospital at 10:30 AM tomorrow.
    I’ll be back with you all soon.
    Thanks again!
    Jack

  355. Jack - good luck tomorrow.

    I am in an air-cast and whilst its taken some getting used to I do sleep in it. I moved into the cast in week two and I’m now week 5. I sleep with it raised up on a couple of pillows, if I turn then I now wake and move the pillows so my leg (whether lying on my back or side) is on the pillow. For me this seems to help.

    I hope the surgery goes well and keep us posted!

    Joy

  356. Jack - I had trouble sleeping in a boot and stopped around week 3 but always kept it beside the bed and never put my foot on the ground without it on. If you go to my page and look at the further reading tab then early weight bearing study link you will find a pic of a thermoplastic splint that was used for the study. I think this could be a good option for sleeping and it would not be expensive. All you need is a physio to make it.

  357. I slept with the boot on for six weeks. I hated it, and sometimes stayed up all night tossing and turning (or just watching TV until the next day). It paid off though because it allowed my Achilles to heal properly.

    If anyone is curious, I went the non-surgical route. I was skeptical, but the tendon is very strong now….the thing that needs the most work is my calf muscles which literally withered away to nothing.

  358. Infection after a year, I had surgery 2/15/12, a little drainage Dr. put me on antibotics, I reruptured and noticed drainage again same as before. Dr. put me on antibotics. I was casted by a different Dr and came out of cast in Sept. I noticed a lump on the incision, and paid started to increase. MRI showed another rupture and fluid, Aspiration done of the fluid showed staph infection. Now looking at having surgery again to clean out infection and remove ATR and an allograft transfer later. Anyone ever heard of this infection being there for a year. I had no symptoms

  359. I had surgery for a full rupture on 11/28/12. I was in a cast for 7 weeks and then a boot for another 2-3 weeks. My doctor didn’t have me go to physical therapy right away, which I thought was odd. Instead he had me wait about three weeks before starting. I started doing physical therapy about three weeks ago. I was finally to the point where I was walking without a limp. Last weekend my wife and noticed a small bump had formed on the back of my achilles.
    Monday I was walking up a flight of stairs and felt a ripping sensation on the back of my leg. I also opened up part of my scar. I knew I had torn something, but this time felt different. Last time felt like getting shot in the back of my leg. This time felt like ripping fabric down the seam. I was hoping that I had just torn some of the stitches.

    I had an MRI that day and the next day the doctor informed me that I had ruptured my achilles in a completely new place. Has anyone hear of that? From what I’ve read and seen, most people re-rupture the previous rupture. I’ve been incredibly depressed. I can handle having surgery and the recovery, but I’m extremely fearful that I’m a ticking time bomb for my next rupture.

  360. jdcarter25: Your story reminded me of this one:

    achillesblog.com/mrshea/

    He also had an open (scar tore open) re-rupture at ~3 months. I haven’t seen him around for a while, but it might be interesting to compare notes, and see how he’s progressing. My recollection is that he was having a fairly good recovery after the 2nd surgery.

  361. Hello All,

    It seems I am not the only one have problems with my tendrons and I hope all of you will recover soon and never have to deal with this again. I ruptured the right one exactly two years in a futsal soccer game ago and after surgery and therapy I was playing again in about 4 months. The tendon felt very strong, even stronger than my left. Three weeks ago (again in a futsal soccer game) I ruptured my left. The chances are very small but I have managed to rupture both in 2 years. I have had surgery two weeks ago and this morning they got rid of the cast. I have to wear a special shoe with a high heel which will be lowered every weer for 4 weeks untill I can walk almost normal again. During this time I will start practice walking in a swimming pool which improves rehabilitation. I write this last part because it seems there are many ways these ruptures are treated. I live in Belgium (europe) by the way.

  362. Jimmy, the chances are small but not very small, and there are a number of bloggers here — including me — who’ve had ATRs on both sides. Two people in the last few years even tore both ATs at the SAME TIME!! So consider yourself lucky to be able to hate those $&@)( crutches!

    You other 2 (jd & kb): Did either of you take any antibiotics from the fluoroquinolone family, like Cipro? Those chemicals are known to promote tendon ruptures in some people. There’s a link to more info on the Main Page here.
    To me, the bump that surfaces and blows up months post-op sounds more like a non-dissolving or allergenic suture than an independent ATR elsewhere on the same AT. Those seem very rare — well, they’re BOTH pretty rare…

  363. Thanks Ryan, I appreciate the link.

    Norm,

    I’ll have to go look at what antibiotics I’ve been taking. I do know that I took Cipro for an infection about 15 years ago.

    I just completed the surgery for my second tear. The first tear was where my tendon attaches to the muscle. My second tear is much closer to the bone. My surgeon reviewed my previous tear and it looks like that has healed well. One thing my surgeon told me is that I have skinny tendons for a guy my size. I’m about 6′ and 250 lbs. I’ve always been pretty active, but I’m afraid I will have to give basketball and football.

  364. Have you guys ever heard on someone re-rupturing while in the black boot with a 2 CM heel lift?

  365. No, but here is my short story, ruptured my achilles on 2013.06.09, had surgery on 2013.06.13. Everything was going great. In my cast, I stepped on a raised portion of a table on the floor with all my weight and my exposed toes. MRI revealed that I re-ruptured the achilles right above the surgically repaired portion. I am now back in a cast for two weeks, but no surgery is needed. Going a little crazy, but hanging in there.

  366. Hi all!

    Annoyingly and sooooooo frustratingly I’ve joined the re-rupture clan! I’ve got have reconstruction of my right AT using one of my tendons in my hamstring! Has any body had a similar operation so I know what to expect?

    Thanks

  367. After 7 weeks in a splint/cast/boot, I went to 2 shoes against my doctor’s advice. She is conservative. After a week in two shoes, I had made super progress and was hardly limping at all! Did something stupid with my right leg as a result (since I forgot it was bad) and I felt a sensation of someone pulling a carpet stuck with adhesive off. Do most people who get a re-rupture feel a pop? Or is that kind of carpet pulling lengthier sensation also common?

    Did you guys get far less swelling upon re-rupture compared to the original rupture?

    Also, was there a dent in the tendon after the initial rupture, but hardly any dent after the re-rupture unless your sock line is over it for a while? I think I had an obvious dent after my rupture, but after the latest accident, the dent only shows if I wear socks for a long time where the sock line hits the dent exactly. I try to always wear long socks as a result.

    I will only find out if I had a re-rupture next week, assuming I get an expensive MRI or Thompson test shows absolutely no movement .

  368. One more thing…after this accident, I felt a lot of heat and pins and needles type sensation in the tendon region….I think I had the same in the initial weeks after the original rupture.

    Do re-ruptures tend to get the heat and pins and needles type inflammatory sensations?

  369. thesingularity, I don’t know the answer. I’d GUESS that the sensations differ hugely from patient to patient, like the level of pain and the specific feelings from the initial ATR.

  370. I may have had a re-rupture, but not entirely sure. Anyway, at this point, I am making my own treatment choices depending on what my body and perhaps imperfect research is telling me. One thing that scares me is that in case I am aggressive in my return to two shoes (doc wants to be in boots for up to at least 6 weeks it seems since she thinks it is likely a re-rupture, although my first rupture was not healed and it might be a partial re-rupture or just status quo), can my tendon retreat all the way into the calf?

    I originally just had a 1 cm gap, then after 7 weeks in a cast and boot, I got into two shoes, but possibly re-ruptured a week later. I want to continue to be aggressive in my getting back to two shoes and this time am only in boots (not cast) and will probably get into two shoes by week 4 instead of 6 or 8 as the doctor wants. But, I am a bit scared in case my upper tendon portion retreats all the way to or into my calf if that is even possible in case of yet another rupture. If I then want surgery in future, it seems like a 2-5 (?) or so inch gap between tendon ends is still ok…but if the tendon is all the way back in the calf, I would then probably need a replacement tendon from a cadaver rather than from my own body parts?

  371. Hi….thesingularity….. Sorry about your situation. I went non-op on my first rupture. My first day out of the cast and in a boot I re-ruptured and my tendon recoiled up my calf. (I didn’t know this of course until I had the surgery).

    I had surgery once I re-ruptured and my doctor had to do a vy lengthening procedure (calf reconstruction) so my tendon ends would go together. If you really did re-rupture you want to start treatment as soon as possible. Honestly, getting into two shoes quickly is overrated. Your tendon must heal. I was chomping at the bit eager to get going, and still am in some aspects. But there are no short cuts with this injury and the best thing you can do for yourself is adequately recover. I was in a cast for 6 weeks then a boot for another 5 after surgery. The vacocast boot I had the second time around is top notch and i was very active in the boot.

    Good luck.

  372. +1 to Anne’s “Honestly, getting into two shoes quickly is overrated.” The best results don’t come from going much faster than the most successful protocols — like bit.ly/UWOProtocol — but they don’t come from going much slower, either. Goldilocks wins again, and the best published studies have set the pace, so it’s not a mystery any more.
    thesingularity, I’m surprised somebody didn’t administer a Thomson test to see if your AT is attached to your calf muscle now or not. It’s probably not a totally harmless test, if you HAVE reruptured, since it will probably increase your gap size a bit. But your best treatment options with and without a continuous AT are quite different, so the answer is way worth knowing. If it’s retorn, most people (incl me) would recommend surgery soon, regardless of the gap size. If not, stay the course and keep healing, and stop going faster than the world’s best protocols!
    BTW, I’ve heard of ATR repairs on very large gaps — calf way contracted — that did NOT need a graft. The calf muscle is not like a window-shade roller that can spin around too many times then need rewinding. It’s a hunk of flesh that stretches when it’s relaxed and contracts/shrinks when it fires. And it pulls on the top of the AT, so if the AT is ruptured, it pulls the top part up, away from the bottom part. (If you walk around on a torn AT, you’ll usually pull the top part up AND pull the top part down.)
    But OSs have tools that can reach for that top torn end and pull it down toward the other end. If your calf muscle can’t relax enough to stretch out while you’re knocked out for surgery, I’m not sure when it will. . .

  373. Hi all, I have found this site really helpful since I originally ruptured my left achilles tendon in the middle of September and now that I have joined the rerupture club I would be really grateful if anyone had any advice or experience that might help me.

    Story so far - tore my achilles playing basketball, pushing off to sprint. No pain at all previously. Went to hospital the next day and had surgery the next day again, so less than 48 hour wait for surgery. Had 6 weeks NWB then 5 weeks in the boot with physio and weight bearing as tolerated and was in two shoes at twelve weeks, still with a pretty considerable limp and using one crutch to walk any real distance. I didn’t get much advice about life in two shoes when I moved to that point which I regret now!

    So 12 weeks after surgical repair I took a step, had a wobble and came down very heavily on my left/bad leg. I knew it had gone right away and the skin also tore, perpendicular to my surgery scar. Sad times!

    So I went back to hospital, saw various people before seeing a foot and ankle specialist and was variously told I would have the same repair as before or a new reconstructive surgery. Finally saw the specialist a week after the rerupture and he sent me for an MRI and said his preference is not to operate on reruptures which seemed odd to me.

    The MRI showed that there is a gap and it’s a complete tear but my doctor thinks it will heal in a cast with no surgery. So I am back in a cast and due to see him again in 3 weeks.

    Anyone have an opinion on that? It seems odd to me that it will heal up okay after the trauma of the rerupture and I’m worried about being left with a weak leg or risking another rerupture down the line. I can’t find much literature on people having a rerupture treated conservatively and would be so grateful if anyone has any experience or knowledge of this? My surgeon is very concerned about infection which I know is a risk but I am pretty young (30), non-smoker and otherwise healthy.

    My sympathies to everyone else going through a rupture or rerupture, long road but we will get there!

  374. Hi deeleft, sorry to hear about your setback.

    Here is a blog is from a guy who went surgery and then conservative:

    http://achillesblog.com/scott/

  375. Thanks Anne, appreciate the advice!

    Norm, the Thompson test was positive, but even 4 weeks prior to the possible re-rupture, there was hardly any connection and the doc said “perhaps” their was a very slight movement. So there is a chance that the Thompson test was always positive for the past 8 weeks or there was a tenuous connection at best. Do you know on average when people see a negative Thompson test once they start non-srugical treatment?

    Also, I am surprised you recommend surgery after a re-rupture during a first round of conservative treatment. Any reason other than the gap might be a lot bigger? Considering your pro-conservative stance, I would not have expected such a conclusive surgery recommendation from you for round 2.

    My re-rupture, if it happened, was not due to any kind of really major misstep (missing a step, stepping on the bad leg to prevent a fall etc…). I am hoping the gap did not grow much from 1 cm and will probably get an ultrasound in a week or two.

  376. thesingularity, I’m not “pro” anything except evidence. There’s no good evidence pro or anti non-op treatment of reruptures, so it makes me nervous. Most of the good studies that tested non-op treatment of primary ATRs operated on their reruptures — also not based on evidence. If they’d dared to go non-op the second time, there’d be a bit of evidence from that, but just a bit. If I reruptured during non-op treatment, I think I’d go for the op. I’m a good scar-wound healer, but I’d still cross my fingers.

    Gap size does NOT affect non-op outcomes, according to the evidence from the UWO patients. Get over it! ;-)

  377. Ha! I will keep risking non-op.

    So on average do you know when people see a negative Thompson test during non-op? And when on average the dent closes?

  378. @deeleft, “the trauma of the rerupture” is just what might make non-op treatment of a rerupture succeed! That trauma is what creates the body’s rush of healing and reconstruction. Even post-op, that’s what gets us back to walking and running. One of the most important and beneficial things that surgery does is create massive trauma, with sliced tissues everywhere, all the way from the AT itself up to the skin. It hurts like hell and causes massive swelling and bruising, but that’s all part of the package, the body’s reaction to an important injury. The downside is (a) some of those slices don’t heal well, or get infected, etc., and (b) adjacent sliced layers often heal onto each other, instead of reconstructing their original layers, creating “adhesions” that have to be broken apart to create full mobility. That’s not always 100% successful, and is often painful or traumatic (some people think they’ve reruptured) when it is successful.

    Usually when people have chronic problems that won’t go away, they’re problems that develop gradually, without trauma, so the body’s rush of healing and reconstruction never gets triggered. Cauterizing a chronic wound is often helpful, and I think it’s because it creates the trauma that triggers the response.

    Interesting to find an OS who believes in non-op treatment of reruptures. If one or several who shared that belief and liked publishing studies, we might have an article about it, but I haven’t seen one. A few cases here, some apparently successful including scott and some others whose names I forget.

    I don’t push surgery for primary ATRs, but it’s not because it doesn’t work. It works pretty well, on average. But the newest evidence indicates that it’s unnecessary. I haven’t seen any good evidence that proves that case for reruptures, so I lean toward the treatment that seems to be proven to work OK. That doesn’t mean that non-op treatment of reruptures does NOT work, of course. And what we know about the mechanisms suggests that the more traumatic the rerupture, the better, provided that treatment (immobilization NWB at a good ankle angle) starts early.

    I hope that helps, and good luck!

  379. TS, re “So on average do you know when people see a negative Thompson test during non-op? And when on average the dent closes?” I don’t know. Most of us don’t get multiple tests during rehab, much less reporting the dates. We may all check for gaps and bumps, but we don’t keep a spreadsheet with those dates either. So I’m guessing nobody’s got a solid answer, just everybody’s anecdotal stories (which we humans all seem to over-value and over-generalizes).

  380. Thanks Norm, that is encouraging and fits with what my surgeon said - that since my tendon must have been degenerative the best thing that could have happened in the long term is a rupture so that it can heal up stronger. I have a review in a couple of weeks anyway so we will see - feeling more positive about it now anyway.

    Thanks thesingularity too, for the link. Good luck!

  381. Hi All,

    I thought I’d contribute/vent to the blog. I ruptured my right achilles playing basketball back on September 29th, 2013. Surprisingly, there wasn’t much pain. I remember that night I tried to put weight on it and it would just give way but still no real pain. The inconvenience of the injury was what bothered me the most. I’m a 33yr old male who trains in Muay Thai, Crossfit & Basketball altogether about 5-6 times a week. Resting was absolute torture. You guys know the drill, within the week a surgeon suggested the non-operative approach due to the Kennedy Fowler studies and was placed in an air cast boot for the next 8 to 12 weeks.

    Time had passed, I wasn’t able to drive either since it was my right achilles so I pretty much sulked the entire time. But at the 8week mark I began rehab and was happy to be walking around without the boot (at home). I still felt weak, but was happy just to be able to stand without leaning towards one side. I was stretching and diligently doing my exercises. I was excited to almost be back to my regular lifestyle.

    I reached exactly the 10week mark. Coincidently that night Kobe Bryant was making his NBA debut coming back from the same injury. Had a few buddies come by to catch the game. Pretty exciting watching a professional athlete have the confidence to get back to such a unpredictable, competitive sport (and he’s 36). My place has two levels and later that night my heel missed the step going up the stairs and -RUPTURED MY ACHILLES AGAIN!!!!!
    Absolute excruciating pain. That night, lying still was even painful. What a living HELL….FML and all that bad stuff…Here we go all over again. This time i’m sure I have to have surgery. No amount of anger, depression, or pity will help the process or my achilles healing any faster so why bother. I just wanted to get fixed as soon as possible and tried to focus on being positive and that theres a lesson to be learned in everything…

    Within 2weeks I was in the operating room. December 27th, 2013 right after Christmas. This surgeon also tells me that I will be in a cast for the entire non weight bearing 12weeks. This was not what I had envisioned 12 weeks ago. The job I held also decided to let me go (restructuring..bs). I was physically handicapped, and now financially. Postive thoughts, positive thoughts…

    Its now been just over a week since the surgery. The first few days were pretty tough. My body was not reacting well to the antibiotics and tylenol 3. I think now that i’ve been through this, one thing i have learned, is to be patient. Spend your time wisely, set some weekly goals (read a book or two a week). I’m beginning to get excited about another new countdown. Even trying to plan a vacation as soon as I get through rehab. Trying to focus on all the things I took for granted. Namely walking.

    One last thing, it wasn’t until the 3rd surgeon I met is that, although the recovery time of the non-operative approach is virtually identical and poses less risk, you will lose 15-20% in overall strength verses 95-98% (surgical). To me, had this been told to me the first time I tore my achilles, I would have opted for surgery. Anyways, Thanks for letting me get that out…

  382. Tough luck on the rerupture, Brian! Are you in Canada? I’ve never heard that claim about huge differences in post-rehab strength with and without surgery, and I’m pretty sure it’s solidly contradicted by the evidence from the UWO (aka Kennedy Fowler) study. That entire study, full text, is posted on this site (Go to Main Page, go to Studies or Protocols, look for “UWO Study”) including all the graphs of their raw data. IIRC, only ONE of maybe a dozen or two comparisons of strength and ROM showed a statistically significant difference between the two groups (op and non-op), though there was a general trend (non-significant) toward slightly higher strength among the post-op. But I don’t think it’s like what you’re describing. Feel free to look at the data and correct me if I’m wrong.
    BTW, the other fanciest modern trial that compared op with non-op was done in 2007 in NZ by Twaddle et al. (Go to my review of the studies and you’ll get links, at least to abstracts.) That study also found very few stat-sig differences in strength, but the one comparison that DID show a significant difference showed that the non-op group was stronger than the post-op group. So I don’t think the evidence supports your 3rd surgeon’s view, though I haven’t tried to calculate the raw strength differences from either of those two studies.

    Mind you, OSs seem to say any darned thing they want to say to patients, when it comes to preferred ATR treatment options and expected results. Sorry to be so judgmental about a whole profession — and a skilled profession with lots of great technicians and good folks in it, too. But if you stick around here and pay attention to what surgeons say, I think you’ll find it has little relationship to the actual evidence. (I just posted a note about an important-sounding reference book I found in Google Books that also seems to have its head in a dark place when it comes to ATR treatment.)

    Anyway, your job now is to recover as well and as fast as possible without any more setbacks! And our job is to help. Start a blog of your own if you can, to make it easier for us.

  383. @Normofthenorth, You’re probably right about the statistics. Perhaps I gravitated to accepting what the surgeon said since I had been on the other side and experienced some bad luck. Although a point I will bring up and perhaps up for discussion, is that all top level professional athletes end up having surgery…food for thought.
    I’m actually really glad there is a group here to add so many experiences. Definitely reassuring.

    B

  384. Your point is overwhelmingly true, though (1) a few pro’s are startting to break ranks, e.g. A Cdn pro football player on YouTube who skipped the op and went super-fast (Brady Browne?), and (2) I’m hoping to live long enough to see the “norm” switch. Anyway, it’s all academic now for your AT. Good Healing! And start a blog if you’ve got the energy.

  385. Hi all, just thought I would update about my injury in case my experience is useful for anyone else. There is a longer post from me above but here’s a quick summary - complete rupture of left achilles tendon in mid September, surgery to repair two days later, re-ruptured following 12 weeks of cast, boot, physio and surgeon decided to treat rerupture conservatively. I then re-re-ruptured at 5 weeks, while wearing the boot, due to a very minor stumble.

    So following the second re-rupture I had surgery which consisted of cutting away any scar tissue and aligning the tendon but not stitching the two ends together, and stitching up the very deep wound which occurred when I reruptured the second time. The surgeon preferred not to any augmentation or use stitches due to the condition of the tendon once he got in to have a look at it.

    So I am feeling pretty unlucky now that I have had two re-ruptures but hopeful that I will heal well this time. My surgeon is very certain of how he wants to treat my injuries and not very keen to discuss his decisions with me but he has a great reputation and is a specialist in this area so I am going with his decisions and reassuring/worrying myself by reading up online.

    My concern are is that when I finally come out of the cast after this injury my leg will be very weak as it will have been about 5 months since my original injury, so I think I will be at increased risk of re-re-re-rupturing (!) my tendon or having another injury.

    Any advice from anyone about getting back on my feet safely after such a long period of injury/recovery would be great.

    Also I am worried about how my leg will recover in the long-term and how soon I will be able to walk without a limp and get back to some kind of meaningful exercise but I suppose there is no way of knowing too much about this until I am a bit further along in my recovery.

    Good luck everyone and be warned, you can rerupture more than once and you can rerupture when in a cast/boot…if anyone has any questions about my experiences or treatment let me know and I am happy to go into more detail if it would be helpful or interesting for anyone.

  386. Deeleft, I usually encourage everybody to start a blog, but your story is obviously more involved and “interesting” than most, so do so if you are tempted — starting with the email outlined on the Main Page.

    Your fear is probably your best ally in avoiding re-injuries. With luck, you’ll soon reach a stage where you’re tempted to get confident and impatient, and it will be helpful for you to remind yourself of your fear then!

    You may well have more atrophy in your calf muscles than average, and also in all the smaller muscles that control and stabilize your ankle. The good news is (a) that many re-ruptures are at least partly caused by calf STRENGTH, so having less of that is probably protective, and (b) most of us have been pleasantly surprised how quickly we regain ~90% of our normal gait, from our initial FWB to 2-shoes, and then to walking ALMOST normally — the stage some of us call “the frustrating plateau”, when we’re waiting to be strong and flexible enough to “push off” normally at the end of a long stride.

    You wrote “The surgeon preferred not to any augmentation or use stitches due to the condition of the tendon once he got in to have a look at it.” Did he tell you WHAT about its condition prompted that decision? Do you know if he trimmed the ends of the tendon before he closed you up? Your latest repair seems like an unusual combo of post-op and non-op.

    Good luck, and good healing! You’re surely DUE for some of both by now!

  387. Thanks Norm - I will start a blog, I kept meaning to the other times and then thought it was too late but have been given the opportunity to now by the further injury - silver linings!

    My surgeon advised that the condition of the tendon wasn’t good enough to hold stitches but that there was very good blood supply so the tendon will heal well without augmentation. He is very worried about the risk of infection so he’s reluctant to do anything with too much intervention. I don’t think I am at a particularly high risk of infection as I am young, healthy, don’t smoke etc but his view is that the effects of infection can be pretty devastating and the best thing all round is for the tendon to heal itself if at all possible. He did trim the scar tissue from the ends of the tendon.

    I feel exactly as though I have had surgery but only to set up good conditions for non-op healing, if that makes sense. Before surgery the doc basically said he would look at the condition of the tendon and then decide what to do so I didn’t have the chance to be involved in the decision and wasn’t given any options to choose from. I was disappointed to hear that the condition wasn’t good enough to take stitches and would feel reassured by an augmented repair but I can understand the logic of what the surgeon decided to do.

    Anyway - I will start a blog and will post a link to it here and thanks again for your reassuring comments!

  388. Deeleft, I agree completely with your “I feel exactly as though I have had surgery but only to set up good conditions for non-op healing.” The puzzles are still multiple, though: (1) There’s precious little evidence on non-op treatment of single reruptures treated promptly, and none on 3rd-time-rounders. (2) Normal non-op treatment fixes torn AT ends, full length or stretched, often “horses’ tails”, often with a big gap that gets more-or-less closed by immobilization in equinus. Your AT ends have been trimmed neatly, your OS probably knows exactly what ankle angle would “approximate” the two cut ends (bring them touching), but that may not be the best idea, because your trimmed AT ends may well form too short an AT if they just glued themselves together. (3) As you’ve probably read, normal non-op ATRs heal best and most successfully with remarkably fast rehab. Does that apply to your situation, too, or is it different enough that a different approach would give your leg a better chance? No way to tell from the evidence, and our mechanical-medical understanding of the fundamental mechanisms is probably a combo of confused, guesswork, non-existent, and false assumptions that seem logical!
    Hmmm.
    Fortunately, there is one body of good evidence for a similar recovery: Lots of kids seem to have naturally tight ATs, often so tight that they walk around on their toes. Many of them get an operation similar to yours: Their ATs are surgically “ruptured”, and they’re closed back up and immobilized close to neutral position, leaving their bodies to build new tendon between the gaps. I hung around with one survivor of that op on both legs — my late FIL, just departed a year ago at 89 — and his two-leg op was a total success AFAIK. And I’ve heard and read of a number of other success stories from that semi-standard “op & non-op” cure.
    Do keep us posted, and good luck and good healing — and Watch Your Step, too!

  389. Yes, the lack of evidence to inform what to do in my situation is a bit worrying although as you say other people do have treatments which are somewhat similar for other tendon issues. I certainly worry about other complications down the line such as my tendon ending up too short or needing some other treatment down the line but I suppose I will just have to take things as they come for now.

    I have started a blog anyway (http://achillesblog.com/deeleft/) and will keep it up to date with progress.

  390. Need some feed back. Feb 1st a partial rupture my right Achilles Tendon, down the ankle area. Not the mid or high rupture, but the low one. Doctor says partial and not the worst he has seen either. Puts me in a boot. Tells me to take if off if I need to drive, I don’t have to sleep with it. Be mindful if I have to go to the bathroom at night without it on. Basically I got form him that I could have a some what normal life. I have desk job and I still need to work so that wasn’t an issue. I’ve done the ice and heat thing for the last couple week been going to work and moving around with the boot, yet taking showers and at times not using the boot for very short periods. This past Saturday I was in the bathroom brushing my teeth and I bent for grab something that fell on the floor and it felt like I was shocked in the area where the injury had occurred. I can only describe it as if someone played the area like an electric guitar real hard. It was for brief second then went away. Enough for me to yell and catch myself. There was no more swelling to the area, as most of the previous swelling had gone down and much the discolor was subsiding. Just today I was at work in my boot, just outside coming in, there is uneven stones patterning the sidewalk, as my boot rolled, rocked forward a bit on an uneven slab, as I thought my boot would continue rolling but wedged short thereby stretching the back of my injured area. Again, a shock and I almost fell as my foot just gave way. When I get back to my desk I check and everything look normal. I feel a tingle in the area. My next doctor appointment is this coming Monday. I don’t have insurance and just want to know if I could have tore the test of the tendons or irritated the area, what few strings are still there?

  391. Worth a phone call. Most alarms are false ones, but all reruptures start out as alarms too. Most “experts” sincerely believe that partial ATRs do even better non-op than complete ones, though there’s not a shred of evidence to prove that it’s true.

  392. The protocol — sort of a halfhearted version of a “real” non-op cure — is made-up and untested, at least in the published literature. It might work, or not, hard to know.

  393. I guess what I am looking for here is an example or stories from others who had close alarms, or calls and to what extent that was. Describe what happened and what was the result of the “rerupture” or “close call” - I am looking for peace of mind and or the truth. Like I said before, the situation felt like someone was playing that area like a punk rocker would play an electric guitar but only for a second. I really have no idea what is going on down there that area. What is my body doing to heal the “partial” ruptured tendons. Where can I get a play by play video or lesson on this in terms of the healing process. In my body filling in the gaps or my tendons reconsituting themselves?

  394. 1st 3rd week Visit. Doc said give it two more, then we can try good athletic shoe. Any advice on this? He said I had a linear (partial rupture). North South vs East west is the way I understood it. Narrow vs wide. More or in the inside of the lower right foot area. No MRI but he ran he said he could feel that is was progressing forward in a good way. He told me to ice only if it ached and then some heat. To keep blood flowing and warmth to the area during the day. He said to wrap it saran wrap, tape it up, a light compression sock over that, then the boot. My body heat would warm up the sweat and thereby create moist heat over that area over the course of the day. Next scheduled meeting in 3 weeks. He said when I am in bed at night to lightly rotate ankle, point toes if I can, slightly raise them, move toes. Therapy later would involve ultrasound among other things. I figure I will stay the course with this doc until after my next visit then I will go with a 2nd observation and opinion.

  395. welp. 1 year ago to the day I ruptured my left achilles. This year, I partially tore my right. Apparently they’re made of glass… I find out on Tuesday if I’m headed back into surgery or not…not really all that excited to do another summer of recovery.

  396. Frontpenguin, how did this 2nd ATR happen? Was it the same activity as the 1st? As someone just 10 weeks into their 1st (and, hopefully, only) ATR recovery, I go back and forth about whether I should go back to the activity that brought me here–tennis. I absolutely love the sport, but I also absolutely do not want to go through this again. Thanks, and I hope you receive good news on Tuesday. -David

  397. Same thing, slightly different circumstance. I was playing flag football. Last year, I went to take off and it popped, this year, I jumped for a ball in the air and it popped…

  398. Hey guys, need your expert opinion! I had my surgery about 3 weeks ago, in a CAM boots now. My laziness has punished me today. I didnt put my boots on to go to the toilet and unfortunately slipped and put some weight my injured foot. It was painful and started bleeding for about 5 minutes! I didnt hear any pop or anything like that but maybe it happened to quickly.

    I am afraid that I might re ruptured my achilles. The strange thing, at least to me, I can still move my anke but when i do Thompson test nothing seems to move. Any thoughts? Have anyone experience something similar?

  399. Sorry to hear about your mishap and can feel your worry (and pain).

    If you are in any doubt at all I would recommend to get it checked out, if only for your peace of mind if nothing’s else. Had you tried the Thompson test work before this fall but after surgery?

    I slipped at the 2 week mark, hurt like hell but thankfully no bleeding, your right things like that happen so quickly you just don’t know what happened. In my case I was lucky I had a follow up appointment with my OS two days later and was told everything was ok, it gave me one heck of a fright though and a reminder if how much care must be given at all times.

    Good luck and hope you’ve done no damage.

  400. Leotig, you should contact your OS and get checked-out–if for no other reason than peace of mind that your Achilles is OK. The Thompson Test doesn’t work on an atrophied calf muscle, so a negative test now doesn’t necessarily mean anything. Nearly all of us have experienced falls shortly after our recoveries began, but having one out of your boot at 3 weeks post-op is definitely worth a trip to the OS. Good luck! -David

  401. Glad to hear that nothig happen to you, it gives me a glimmer of hope.

    Thats the thing i didnt do a thompson test after removing my cast, so its hard to tell whether this is just how it is becaue of weak calf muscle or its because of the fall.

    Yeah i ll go to the hospital tmr and will see what they say. Is that an MRi acan that I need? Asking because Im on holiday in a different country so wont be seeing my consultant

  402. Leotig, after sharing your story, the docs will (should?) know how to check on your healing Achilles. An MRI would work, but an ultrasound would be much easier and cheaper. -David

  403. I see, would ultrasound be safe in a wound? Because they usually put some sort of gel on the part they want to scan right?

  404. I completely ruptured my left Achilles 7 years ago, had surgery and made a 100% recovery, and ran, jumped and did everything the same as before after a 6-9 month recovery. Yesterday I ruptured my right Achilles while exercising. After searching the internet about the most recent surgical innovations I found this forum. All I can say is that its a long road, but I’ve come back before100% and everyone should know that full recovery is achievable with motivation and determination. I’ll be following this blog during this recovery. Go USA SOCCER!

  405. Hey guys, so i did my MRI and it looks like I reruptured my tendon. How is it possible that I can move my ankle up and down, without any pain? Couldthe doctor/MRI be wrong?

    Really dont want to have another surgery!

  406. Hi Leotig

    Did the doctor tell you that your tendon had re-ruptured and that you need surgery?

    Did you ask the doctor the questions that you are now asking this (mostly very well-informed) community?

    MRI wrong - it can be misinterpreted for sure, and you may get some strong views posted here over the next day or two.

    What country are you in? You wrote that you are not in your home country, which is where?

  407. Leotig, you’re pushing the envelope on the usefulness and purpose of a community blog like this one. We’re not doctors and, even if we were, couldn’t diagnose your condition over the internet. As Hillie already stated, you need to ask these questions of your doctor and, if you don’t like/trust your doctor, then get a new one. -David

  408. And a couple of answers for leotig from a guy on the Internet:
    1) MRIs can be wrong about lots of things, probably including ATRs/re-Rs.
    2) There’s at least one additional muscle-tendon pair that can plantarflex the ankle — just as the calf-and-AT do, but MUCH less strongly. So you can point your toes down fine without an AT, but you can’t (e.g.) walk up stairs normally.
    3) We all have the ability to dorsiflex our ankle “actively” (i.e., with our internal muscles) without an intact AT, since that’s done with a different (opposing) muscle-tendon pair.
    4) Pain is never a clear diagnostic for an ATR or a rerupture, since our pain experiences with ATRs are all over the block, ranging from “I can’t believe there was no pain” to “I can’t believe how much pain there was”.
    5) For reruptures, most of us — even strong proponents of non-op ATR treatment like me — advised surgery. Not so much because there was a lot of evidence (or ANY) showing that non-op wouldn’t work, but because there wasn’t much evidence of any kind (reruptures are much more rare than ATRs, so there’s a lack of data), and surgery does generally work. There also seemed to be reasons to doubt that non-op would work as well on reruptures as it does on primary ATRs.
    HOWEVER, there’s now some very impressive new evidence that non-op treatment — at least smart modern treatment — can work just as well on a decent-sized group of reruptures as it works on a huge group of primary ATRs. The evidence is from Dr. Wallace in Belfast (2012?), and you can see his results summarized, and a link to the full study, at achillesblog.com/Cecilia/protocols .
    He treated ~945 primary ATRs non-op and had a rerupture rate <3% and a 100% Return to Sports, and he successfully treated ALL of his reruptures non-op, with NO subsequent reruptures.
    Wallaces main bits of “smart treatment” were (1) a decent modern fast protocol (essential for successful non-op results) and (2) he used his eyes and his hands to find the ankle angle that just “approximated” the ends of the torn AT, and used that angle (with heel wedges in an AirCast boot) during NWB and early PWB.
    He did encounter a small number of ATRs whose ends would not “approximate”, but ONLY among the “stale” or “chronic” ATRs, those that had gone untreated for a long time — and even most of THOSE stale ATRs approximated and healed fine non-op, with a slightly LOWER rerupture rate than the primary ATRs that were treated promptly(!!). But the chronic ATRs that would not approximate were sent for surgery.
    It’s all in the Wallace study.
    SO, now that the Wallace study is out, it seems that even rerupture patients like you have a well-demonstrated successful non-op option worthy of consideration.
    A picayune quibbler (that’s usually ME!!) might note that Wallace treated no (or very few) post-OP reruptures like you. That’s true, but I don’t see why it should matter.
    And finally, it MAY be true that many or even most post-op “reruptures” are actually “new” ruptures in a different part of the AT. Certainly some OSs have told their rerupture patients that their reruptures were in a different spot, and it may be true. Again, if Wallace can demonstrate results at least as good as surgery without the pain, scar, infection risk, etc., etc., I don’t see why that distinction matters.
    Good luck!

  409. Hey guys! Thanks a lot for all your comment!

    Well i m in Vietnam at the moment, the medical service here are not great. I got already two opinions from docs: one said its fully ruptured and need operation asap, the other said it was partially ruptured so leave it in the boots for it to recover and do another MRI in 3 weeks. So thats why i’m skeptical and thats why I asked all those questions. I understand that it’s hard to diagnose anything over a forum, but I find it really helpful to draw on other bloggers’ experience.

    Thanks guys!!!

  410. I may be mired in prejudicial cliches, leotig, but I think being in Vietnam would strengthen my own anti-surgery bias. Follow Cecilia’s link and read Wallace’s study. I don’t think you need to be Irish (or a doctor!) to use his approach.

  411. I’m one week out from AT surgery following a rupture that happened while fencing. I bashed my good foot into a cabinet a few days ago and wound up catching myself on my injured foot. I didn’t hear a pop or feel the “kick” sensation, but I definitely felt stitches popping. I’m keeping my fingers crossed that it wasn’t a rerupture. Spoke w/ my doc and he thinks it’s probably okay, but obviously I’m dreading the worst-case scenario.

    It’s been great to hear everybody’s stories. I definitely feel like less of idiot for the slip, plus I’m picking up some great tips along the way. This blog is definitely helping with the feelings of frustration and isolation I’ve been experiencing. And, as I look at the clock, the insomnia! Thanks for being here!

  412. Hi jrstrauss

    Welcome to the site that brings hope and understanding to us ATR sufferers!!
    I have only been blogging here for a few weeks but have to say it has become a welcome habit to my day - you should never feel isolated about this injury again ;-)

    Sorry to hear you had a slip…. And yes like many others, I also had one (at the 2 week mark), I too felt a ripping sensation but it wasn’t my stitches and more likely to have been scar tissue, was blooming sore though! Get it checked if you are in any doubt! Good luck

  413. I re-ruptured by pressing the flush on the right side of the toilet with my foot a few times before it worked! Can you imagine that? Anyway, all good now and here is my story with a picture of the flush where disaster struck further down the page:

    http://www.achillesbusted.com/my-achilles-tendon-rupture/

    I am glad I went non-surgery twice.

  414. Had surgery yesterday, 6/26, and the procedure on this Achilles is different then the other one 7 years ago. Per doctor (Miami Heat foot / ankle ortho) the incision now is only about 1 inch vs 4-5 previously, and bow the Achilles is anchored to the rear of the calcaneous with a small screw like manuvuer. Wait bearing in 2 weeks with active PT upon confirmation of well healed clean incision.

    Wow…technology in the last 7 years….remarkable! Wasn’t even weight bearing last time for at least 4 weeks. And pt not for 6 weeks.

  415. @badmintonrupture,

    Just read you blog, damn how you even lift your leg to high to flush! Damn that was unlucky!

    Did you wear your boots all the time after the rerupture? Or took it off while resting?

  416. @leotig yeah now that I can look back at it, I laugh a lot and even went to Applebee’s to get that toilet photo lol! At the time it happened (especially when my right foot gave way that night when I was putting on my pajamas), I was almost in tears.

    I used to be pretty athletic so it was no big deal to lift my leg that high. The foot was feeling so good and I was very proud that my anti-doctor’s preference non-surgical plan worked out so well and my limp was gone by week 9 or so! I guess the few beers also must have made me more confident.

    Yes I wore boots again ALL the time after the re-rupture. I would never risk sleeping without a boot unless it has been at least 6 weeks immobilization post rupture. 7 weeks is probably even better.

  417. Glad to hear you recovered well from the injury! Hope you are not using your leg to flush :)

    I worked out that sleeping without the boots is not an option! The moment i fell asleep my injured leg would twitch so hard that you are momentarily awaken and scared that you might have injured your foot further.

    I think you progressively should remove the wedges during that 6-7 weeks, is that right? And you should not do any RoM excercise until then?

  418. @leotig:
    I hope that you followed normofthenorth’s indication above, if you were unsure of whether no accept treatment or not in Vietnam.

    I’ll mention that I also had my own rerupture post-operation experience in a foreign land (albeit Germany, ie. perhaps not so problematic as being in Vietnam).

    Seven months after choosing a non-operative path (without a physio, following UWO protocol in my own home space with standard stuff such as walls and steps books as props, and a box full of milk cartons as weight for heel raises); I am now able to jog/ short light sprint/ play football/ dance/ cycle 100km a day/ run up steps going every second step. At age 45.

    So don’t despair - even if you are out in the middle of nowhere, so long as you can get hold of Aircast or something similar and wedges of some kind, and the right plan, and nourish yourself well (getting plenty of collagen-priority substances such zinc, magnesium, vitamin C, etc), there is still hope of successfully recovering as well as anywhere else and in reasonable time.

  419. @filosofo, it’s great to hear that you and your leg are both so happy, after skipping the op. Maybe I’ll remember your ID the next time somebody asks for examples of happy non-op campers! (But my memory is going downhill faster than my legs!)

  420. This was great. I Tore my Achilles just recently, and have documented the whole process because there is so little out there that really gets into the day to day of it all. There were lots of things from Vitamins, to accessories, that I wish someone told me, that even the doctors didn’t even know. Anyway, I wrote it all down, good and bad;) Hope it helps someone: http://wp.me/p4vf9v-dB

  421. This is everything that happened to me. Everything. Tips, tricks, trials and tribulations: http://wp.me/p4vf9v-dB

  422. Hi.
    I ruptured my achilles playing hockey on March 19th 2014. After discussion with the surgeon, and being very active generally, we agreed on surgical intervention. After a total of 8 weeks post op in plaster and 2 weeks in shoes, I had a complete re-rupture. I just stopped abruptly so I wouldn’t walk through a spiderweb is all. Had surgery again on the 2nd July, where they used a tendon from my big toe (taken from the sole) to help reconstruct the achilles. Was gutted when it re-ruptured. I live alone but am blessed with a few particularly good friends. However I am finding it pretty isolative, Kind of find myself being tearful some days over nothing, and effort to get get in the shower everyday too. Does anyone feel this way? or am I being ridiculous?

  423. Kevin, you’[re not being ridiculous. Having an ATR is a kick in the head as well as the leg, and rerupturing is a bigger kick. To get through this we all have to win the physical game and the mental game, too. The bad news is that few if any of us are born with the tools to do that, and most of us haven’t acquired them pre-ATR either. The good news is that almost all of us come out of this challenge stronger psychologically — more patient, more grateful for almost everything, more empathetic to people with problems, etc., etc. — than we went in.
    Keep in mind that exercise produces helpful brain chemicals, that you’ve been without for months and months. If you can find a way to work up a sweat without scaring your leg, or even working out without a sweat, you may find that the whole world seems a bit brighter.
    There are other tricks, too. Focus on the part of the glass that’s still full. Lots of people are never getting off crutches or out of a wheelchair, etc., but for us this is a pothole, not a cliff. You’re blessed with a few particularly good friends, which is a very important blessing. Cope with the problems as well as you can, and don’t beat yourself up if you have bad days; that just makes them worse (obviously, when you think about it).

  424. And BTW, 8 weeks in casts then straight to 2 shoes is primitive care! I hope you’re getting into a boot and onto a PT’s table a lot faster this time. Check out achillesblog.com/cecilia/protocols for some World Class modern rehab protocols — 2 of them from your part of the world, I’m guessing. ..

  425. Norm

    Maybe I’m tired but how have you worked out where Kevin lives?

    A good lesson though for those in future given the opportunity to actually discuss options with the surgeon - don’t just ask about surgery or non-op, ask about the rehab protocol, whether boot or plaster, and so on.

    H

  426. Thanks for your reply, appreciated. I’m in the UK, and have an appt on the 24th Aug to have this cast off, and then to physio again, so it will have been 2 weeks in a slab and bandages and then 6 weeks in this cast. My leg is so wasted and thin now.
    It really is as you say a kick in the head as well as the leg, reassuring to know that it’s kind of normal. Some days are better than others, I appreciate your advice Norm, thank you.
    I’m already really very anxious about it re-rupturing for the third time.
    I think that is good advice for anyone in the future, to ask about the rehab regime. I don’t feel as if I’ve been able to discuss evidence based approaches, it’s all felt quite prescriptive.

  427. @Hillie, it was an educated guess — educated mostly at this website! “In plaster” (vs. cast) was my first cue.
    “Gutted” (rather than crushed or destroyed or whatever) the second.
    “we agreed on surgical intervention” (rather than “I went surgical” or some such) was a weak third clue.

    @kevin, being anxious about rerupturing is a useful fear, up to a point; use it to keep yourself safe!

    Most of us get prescriptive care for ATRs. Even those who are given the choice of their basic treatment (op vs. non-op) are often misinformed about the state of the evidence, IMO. And NOBODY is given any meaningful choice about different rehab protocols, because every surgeon has a set and invariable version of “the way it’s done here”!

    The good news, just in case you are unlucky enough to rerupture again (and this may make that unlucky prospect seem less like going to your doom) is that a recent study by Wallace in Belfast — summarized and cited at achillesblog.com/cecilia/protocols got wonderful results treating RE-ruptures non-operatively, with a rehab protocol that’s many weeks faster than yours. You’d want it to be administered by somebody who understands and has willingly adopted that treatment approach, but if you could find that person, it could be a way of avoiding another surgery (and the anxiety from the possibility, at this point) followed by another glacially slow immobilization.

  428. Well deduced Sherlock Holmes, aka Norm.

    Kevin, spill the beans, where is your hospital, future ATR victims need to know….?

    Now, off to work for me, catch your replies later.

  429. Thank you Norm. Your comments are appreciated.

    hillie, I’m being treated at Addenbrookes, Cambridge. Which is a University linked hospital, meant to give evidence based care, but I do not feel it does in truth.

  430. Hi everbody
    My frist ATR on 17 Jun 2014,then surgery on 19 Jun 2014.
    After 9 week,when I was crossing jungle for fishing bass,I felt somebody kick my leg again.
    I was too much devastated.
    28 Aug,2nd surgery.
    And now is the 4th week.
    I wanna know, do I need longer recovery time then the first surgery.

    Thanks
    Glen

  431. Glen - should all be the same second time around considering you had surgery both times unless you go bass fishing again. Your doc may make some changes to your rehab if he/she thinks you are not going to be compliant but that would be more about stopping you from undoing all their good work. They do tend to hate that. I bet it was hard getting out of the jungle. 12 weeks is generally accepted as the time the re-rupture risk begins to slide so avoid the uneven ground and jungle trekking until then at least. Hope it goes well this time.

  432. Glen, you need longer recovery because you need to FINISH it! :-)

  433. Hi all,

    had a scary moment today and thought I would share. I am a fit 31 year old who is 4 weeks post surgery from a complete rupture to my right achilles which occurred during my basketball grand final. I had been recovering well with just a fiberglass cast on the front of the leg/foot.

    Today i was at my partners house laying on a mattress in her garage. My greyhound was tied up on a couch next to me. My partner had just finished the gardening when she came into the garage. She pressed the button to close the garage and the next thing I heard was her yell out and I turned to see my dog had gotten off the couch and was standing under the closing garage door. Now she could have just pressed the button to stop it but she panicked and then i panicked and sprung up off the mattress to get him out of harms way. I immediately had intense pain near my achilles and was basically in tears. I could see a small patch of blood on the bandage so we went to the hospital but the doctor couldnt tell me if i had re-ruptured for sure.

    He said he couldn’t feel a gap but I couldn’t dorsi flex my foot for him but I told him ive had little movement since surgery and havent tried to move it. He did the calf squeeze test and I only had a very small amount of movement from that. Can anyone tell me more about this test? Is some movement a good sign? Im preying i have not had a re-rupture as we all know how much toll this takes on you mentally. Thanks for hearing my story

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