Rehabilitation
Rehabilitation typically starts as early as after you start partial weight bearing.
It can be as simple as doing passive Range of Motion Exercises to following regimen set by your physical therapist.
Also, there seem to be benefits to therapeutic massage. Most Physical therapists do some massaging as part of their program, but I’ve heard that it’s good to seek a therapeutic massage therapist as well.
(Update: A lot of massage therapists do not work on people who recently had surgery for fear of doing damage to your body. I discovered that if your surgery was within the past 6 months, then they won’t even touch your heel area.)
im almost six week out of surgery and my doc has me removing the boot already. i can walk normal with out it aoready. i am a pro athlete and i know we recovger fast is there any of there athlete out there that can tell me how fast they recoverd
I had a partial tear of my right archilles tendon. Currently, I am debating non-operative course of action, over operative.
I am 60, very physically active, and my job requires driving. I cycle, and golf, walking instead of carting, so getting back my lifestyle asap is very important.
This injury occurred on the job, so workmans comp is involved. I want to get back to being active and fully funtional. From the collective blog, which course of action would you recommend?
Anyone Heard or better yet used Cold Laser Therapy?
A chiropractor I know says it can reduce the recovery time by up to 60%.
Is it worth spending a little extra cash for this therapy?
Jeff
My simple, homemade rehab had me walking well in my own shoes within four weeks of surgery. For details:
http://pseudowebpage.blogspot.com/2009/03/my-achilles-tendon-rehab.html
I’m sorry so many are immobilized for so long. In most cases, I really doubt it’s necessary.
Doug,
appreciate your story. Very helpful that someone posted details like this. My blog here is pretty detailed and I hope to replicate some of your success with small independent steps towards healthy recovery of the surgically repaired tendon. I am 4 days post-op and meet with surgeon for first review and wound check in 2 days.
Like you, I’m a 53 yr old ‘geezer jock’ that was probably guilty of doing too much the couple of weeks prior to my injury. But I have no intention of slowing down. Well, maybe for work, but not for play!
Hi Bill,
I’m glad to hear someone actually read my note! At my six (and a half) week postop visit two days ago, my ortho didn’t mind that I had been walking for three weeks against his advice. He was a little nervous when I told him I had put my toes on a bathroom scale and pushed down 140 pounds, though. My physical therapist thanked me for making him look so good.
I hope you’re walking soon, too. I’ll watch for your progress notes, so I hope you will keep us all posted.
Best wishes!
im on my 3rd week from surgury got my stitches out 2 days ago i can walk a little buy pay for it later so im following drs orders to stay off of it im just wondering when therapy usually starts
I did the ATR on June 10 had surgery on June 12. Doc said it was a clean break of the AT. After surgery had a cast for one wk. Went to first pos-op and he put the real cast on. This sucks!! I hate the crutches, by the way I have two kids (2,5) it’s very hard doing everything when my wife is at work. All is well though and God is Good! Plus all the other stories on the site make it easier to look foward in the recovery process.
Phill,
Your date of surgery was the same as mine. I also have two children 5 and 7. Being so big 130kg (325lbs) I really struggled with crutches until I really started hitting the weights again on home bench and free weights. This helped immensly. I had the cast off after six weeks and have used a boot for two weeks now with physio sessions for the tendon. I had problems with the foot swelling when I was standing up for so long but since the physio placed a elastic tube around the foot and tendon the swelling has gone.
I do stretching exercises at night and have the boot off until I go to bed, I am able to walk slowly around the house without the boot and do not have any pain of discomfort. I am feeling a little stressed about walking without the boot but really want to get into free movement again whilst still complying with the surgeon instructions. The six weeks with the cast at home I think I had to struggle with my sanity even with the TV, Tour de france and internet. Hope everything goes well.
Hi guys, being in the UK I have been advised the none surgical approach (odd as Im 24 and am pretty active…). However most of the blogs on here went down the surgucal route, can anybody point me towards a blog that went down the conservative route please?
Im currently 2 weeks down in the cast with another 2 to go before the boot for 8ish weeks. Is it me or has time stood still?
Many thanks
Hello Mustan,
See uknodgers blog .
Richard
I was treated conservatively in the spring, but re-ruptured after 18 weeks. Now I am 14 weeks after surgery and feel much better.
Other bloggers who had conservative treatment: rainbow395,
lopo1969, molelady, t1mc, highflyer, marmouza, smellygypsy,
cactus, jo, darren.
Hi. I’m new here. Could anyone tell me how I can access to ‘UKnodgers’ blog’, which has been mentioned by a few people here?
It is recommended as a useful source to get information about non-surgery ATR treatment.
Thanks.
It’s at http://achillesblog.com/uknodger/ . It’s a pretty simple system here, though it initially takes some getting used to.
Hi normofthenorth,
Thank you very much for the link!
I’ve managed to find your blog after reading your comment on another question of mine I posted. So I think I’m getting used to the system here!
Hi, I`m new to the site and I`m having a little trouble posting, so I`ll try again. I`m 41, live in Japan and tore my left Achillies playing volleyball. I`m 5 weeks post op and I can`t figure out whether I`m fast track or slow track for rehabilition. The schedule seems quite different from others.
10 days post op and my NWB cast was replaces with a FWB walking cast. So I only used crutches for the 10 days. 16 days after that, the cast was split so I could take it on and off for baths and rehab massage. I`m still in the split cast, although this is cast number three as I keep breaking them, but I`m out as of Wednesday. So a little less then 6 weeks and I`m out of the cast. I don`t know exactly what the plan is after that but I`ve been told that it`s no cast, no boot, nothing after Wednesday.
I really want to be back on the court by fall so any advice on how to advance repair would be great. I do NWB toe ups and ROM exercises everyday but can I do more? My rehab guy just about freaked when I told him that I hobbled off to the toilet in the night without my brace on. He seemed sure that I would tear the tendon again at the heel. To tell you the truth, I`ve been walking around the house a bit without the cast and it feels great. Stiff but what do I expect, right?
Anyway, any advice would be great.
Heather
Heather, your schedule seems pretty quick to me, a bit quicker than the protocols used in the latest studies comparing surgery to non-op. The main one I posted has 2 wks of NWB (you had 10 days) and 8 weeks in a boot vs. your <6 wks. I’m not sure it’s been scientifically proven to produce good results in a large population, but several individuals have gone even faster (sometimes much faster) and gotten good results for themselves.
Knowing you’re on the quick side of most, I’d recommend NOT being very “creative” at taking extra chances, and “listening to your body” as much as possible. I’ve also torn my AT (actually BOTH of them!) playing volleyball, and I’d say that your goal of returning to “full speed” competitive volleyball 5 months post-op is optimistic, but not impossible.
You didn’t get your surgery from one of the two Japanese surgeons who published a report that I linked in my blog (which is also linked from the Main Page here, if you can find it), did you? They’re experimenting with a new extra-strong kind of surgery that’s producing average results that would get you back on the team in the Fall if not sooner(!). For most of us, it’s been more like 7-12 months when we’re OK to return to the high-risk activity that tore the tendon.
My first-AT surgeon (I skipped the surgery for the recent, second one, based on the new studies) told me I should hold off playing volleyball until I could do a bunch of 1-leg heel raises without grunting or groaning, and that’s what I did. For me that was around 10 months post-op. Far from a record, but I was “as good as new” on the court — maybe better!
If you have trouble finding the link to that Japanese study, post a Q here or on my blog. It may be the future of ATR surgery. (I think David Beckham should probably have tried it.)
Hi normofthenorth! Btw, I have issue with your name. Toronto is east, not north (hehe).
Well, the surgen was not one of the ones in that report but is a rather well known dr here. He traveled with the national speed skating team to vancouver and lookd after a lot of the pro/ collage rugby players here. So this is where I got confused. When I saw that artical I thought “ah ha! This is why my schedule is faster then everyone else.” but when I asked my dr he said recovery was faster in the States. Hmmm. Yet, he seems to think that I’ll be on the court for fall and he is not an optimistic dr. When I had my acl surgery a couple years ago I had to beg him just to go serve and shag balls.
Anyway, after reading a lot of the info here, I decided that the calf raises would be my own personal test as to when I should be back on the court. It won’t be before fall anyway as I head home every summer. Plan to spend my time on my bike and walking those west coast beaches.
Again thanks for any advice.
Heather
Judging by the Americans posting here, most of them are NOT following faster schedules than yours. And most of those that have (doug53 springs to mind) did so on their own, without their surgeon’s blessing or encouragement.
BTW, if like most people (right-handers) you are “left-footed”, you may be at less risk of tearing your other AT than those of us who tore the right AT first. It’s just a theory of mine, and I don’t think anybody’s analyzed the data to try to prove it or disprove it. The data DOES show that left ATRs are more common than right ones, that part is known. I’m left-footed, but I tore the “wrong” side first, then went back to all my high-risk activities (mostly competitive volleyball) and eventually — after 8 yrs — tore the other side. That’s certainly NOT a scientific proof of anything, but I think it seems sensible that left-footed people who tear their left ATs may be at much lower risk of doing the other one, than those of us who started with the other one.
How can you tell if you are “left-footed”? When I snow board, I board with my right foot foward. And I think that the reason I did my left first is because, as a volleyball player you know this, when I approach for an attack, I push off on my left foot. That was when it snapped. Most people think it is when I jumped, but it was not. My right is quite sore now, I think from walking around on my tippy-toes to balance the cast. Anyway, I just hope that the right will be ok after all this. Thanks again for your advice.
Most people are set up on a snowboard with their “good” foot forward, which would suggest that you’re RIGHT footed. The classic test is this: If you’re playing around on an icy surface in shoes, and you run and then slide, which foot is forward?
Some people tear ATs while jumping or coming down, but it’s more common to do it while accelerating. I did mine both while accelerating forward while my momentum was (still) movng backwards, which is a “great” way to do it!
I’m a strong advocate of raising your “good” foot (by building up your shoe) so it’s as far from the floor as your “bad” foot, so you can walk straight. Some people do equal numbers of heel-lift wedges on both sides, or strap something around their shoe. I used a “cast shoe” with a sandal inside. Walking crooked is tough on too many parts of your body!
Yep, that’s exactly what I did! Moving back to get in possition to attack and pushing off on approach while still probably moving back. I play left and I’m always a little slow getting outside after covering. And I have been using a high heel sandle to balance the high cast but living in japan, shoes are a no-no in the house. My husband cringes everytime I walk in with my cast! It’s at the top end of the range that bothers me. That is to say, when I push up on my toes, it’s at the greatest flex that bothers me. I’m at pyhsio now so I’ll have the dr take a look at it.
And not living in the far north any more ( heard northern bc where I grew up got a half a foot of snow for the long weekend) it’s been awhile since I did the slidin on ice thing. Really have to think about it but I’m pretty sure it’s still my right foot I put out.
Anyway, hope everyone feels good. And I agree, listen to your body. I should have because just before I ripped it I felt a twing and should have got off the court then. It just felt too good having a good game.
Heather, your last two sentences are interesting. Probably most (or all) of us have had time to “second-guess” what might have happened if we knew we were about to tear our AT, and we’d stopped before doing it. I’m not convinced that the injury can usually be postponed much, without completely giving up the high-stress activities most of us love so much.
E.g., if you’d known, and you went for tests that showed that your AT had developed a weak or malnourished spot, what then? Either you’d want to have it reattached together surgically to make it strong enough for volleyball, or you’d want to have it immobilized NWB for a while, following a non-surgical protocol like “mine”.
But first of all, who would have enough faith in some tests to go through all this bloody nuisance and pain and discomfort WITHOUT an ATR? And secondly, the non-surgical “cure” is probably completely ineffective without the rupture — i.e., it’s the rupture itself that triggers the inflammation and the healing and rebuilding of the tendon that makes it work so well.
And finally, if you went with “preemptive” surgery, where’s the benefit of your advanced knowledge and prevention? You’re going through the same “cure” anyway, so you may as well play a few more points and tear the darned thing!!
Regrets are often pretty useless, but I think this one may be more useless than most!
Well Norm, what you said is interesting. So you think even if I would have stepped off the court and the point I felt the first pain and gave it a rest it would have gone anyway at a later date?? I thought you could recover from a pull. The only reason I’m curious is that if I ever get the same pain again in the other foot, what should I do?? Of course I don’t want to go through this again but it seems likely that if you do one side, the chances if doing the other is quite high. One of the pts at the clinic I go to just did his other one. Is there no way to prevent this?
I’ve heard or read that (1) most ATRs (75-85%) are NOT preceded by pulls or discomfort or ATtendonosis, but come out of the blue, (2) most people who are bothered by their ATs do NOT rupture them, and (3) the underlying cause of most ATRs is a “weak spot” that develops at the “seam” between two systems of blood circulation.
Basically, the very bottom of the tendon is “fed” by an artery in the foot(?), and the top is “fed” by one in the upper calf(?), and there’s a spot in-between where the
blood flow stagnates or doesn’t get through properly. And that creates a “tear on the dotted line” situtation.
I heard it from my first surgeon, and it sounds plausible. Obviously, some of us are more prone to this situation than others, which is probably the main reason (along with lifestyle — i.e., fondness for “high-risk” sports!) ATR “survivors” have a much higher-than-baseline risk of tearing the other side.
Put that all together, and it doesn’t seem to me that “giving it a rest” would avoid the tear.
I’ve heard various estimates of the “inevitability” of tearing the other side. There’s one scientific study on that exact topic linked from the main page here, and it says that the risk of doing the other side within maybe 2 (or was it 4?) years of the first one is 200 times the background “normal-person” risk. (I tore mine after EIGHT years, so I wouldn’t even count in that risk!!)
That number includes a bunch of people (like many here) who stopped playing the high-risk sport that tore their AT, so the risk of those who return is clearly even higher. The study said that the 200-times-higher risk was something like 1% or 2%, so it’s pretty far from a sure thing (including the new couch potatoes).
And I met one guy (in the Sports-Med clinic waiting room) who used to work in a PT clinic. He said that other-side ATRs were so common, they used to say “see you soon” when discharging a healed ATR patient, because they knew he or she would be back!
Without knowing how many first-ATR patients give up the activity that caused the first ATR — or suffered the first one from a freak/unique encounter with a sheet of glass or a closing door, etc. — I don’t think we can accurately estimate the risks for those of us who return to our high-risk sports. But it’s way higher than zero, for sure. If you ignore it (as I did), it’s “negligible”. And if it happens, the probability turns into 100%.
Personally, I’ve found the second one WAY easier than the first, and only partly because I’ve gone non-op this time.
Other ways to avoid tearing the other one? Nobody knows. Some drugs tend to cause ATRs, maybe other ones, or nutrients, etc. tend to prevent them. Or maybe some exercises, or massage, or vibration. Creams or salves? The short answer is that nobody knows, and not many people claim to know.
Hi Norm: Back from the beach. Pretty depressing to hear “200 times”!
The bit about slow blood flow causing it is quite interesting. Have you heard much about the impact of stretching, prior to and after, high risk activity?
My AT’s (and most of my moving parts!) have always been quite tight and I have been nursing the hope that if I can get more flexibility I’ll reduce the risk. Any thoughts on that?
Hi Gunner
Yes the area where many ATRs occur (~2 inches above the bone) is an area that tends to get less blood flow, But not every ATR occurs there. But there is no doubt that less blood means slower healing of AT microtears we all probably get from being active. So perhaps the best course of action is to allow sufficient rest for healing between strenuous activity days, especially as we get older. Massage can also help get the blood moving.
Ten yrs ago I blew my medial maleous and posterior Tibial Tendon of my right foot, and a limited PF - ROM resulted from the tendon scar tissue knot. My ATR occurred in my left foot, which had much better ROM. So it is not just blood supply, nor ROM.
Gunner, I’d say +1 to what Sully said. I think the evidence on stretching is somewhere between “it doesn’t help” and “it hurts”! Let me clarify. Stretching BEFORE you warm up reasonably thoroughly (as too many of us were trained to do!) does not seem to prevent injury during the following activity, and may promote injury. And any kind of serious stretching before sports activity has quite recently been shown to decrease performance!
I don’t know of anybody who examined ATs or ATRs specifically. But a whole whack of us “here” who tore our ATs, did so after thoroughly warming up and stretching. Both of mine came late in a long evening of volleyball — though it’s true that we occasionally “sit off” for a match then return to the court, so one could argue. . . but it wasn’t even early in the match (and I wear sweats when I sit off).
There’s a good article about stretching — including a
good video — on the NYTimes’ web-site. I found it from Google. Many of the newer summary articles have titles like “everything you thought you knew was wrong”!
It sounds logical that topical massage or a vibrator etc. could promote blood flow. But logic and truth are often different things where our direct vision is obscured, so don’t bet the farm on it!
Thanks Norm, I’ll check out the NYT article. It just seems counterintuitive to me that stretching would not be helpful. Most of the PT I’m doing now feels like stretching to me, especially squats and “step downs”.
In general though, would it not be better to have a loose, flexible AT than a rigid, tight one?
Thanks Lou. What does that translate into for you? How often do you play tennis, for instance?
Hi Gunner
I play 2 hrs doubles tennis every Tuesday, hard court. That’s my most strenuous activity for my AT, even though I don’t now go after drop shots or lobs. I also play 2 hours softball, twice a week. The league game is Sunday, with a pickup informal game Weds. I take it real easy in the Weds game, its more of a practice session.
I also do a daily 1 hr 1+ mile walk (with toe presses) & PT exercises at the beach with my dog.
When I ATR’d I was doing softball Sunday, tennis Tuesday, and badminton Wednesday, 2 hrs of each. I now think I was not giving my AT enough time to recover between tennis and badminton.
Again, Gunner, when the result of careful controlled studies contradicts what seems reasonable or logical, I go with the studies. For a while, the only studies on stretching were done on members of the Australian Army (and they showed no benefit and maybe a bit of harm).
Now I think there are finally some other studies, and I think it’s those others that found that pre-sports stretching lowered performance (like strength and speed and “vertical”, etc.). I don’t know if they also showed the risk of injury maybe increased. If it’s illogical, maybe it’s no more so than relativity or String Theory or other things that seem to be true. . .
looks like it was a shift in sports about stretching in past 5 - 10 years.
My PT guides me to warm up than exercise and only than do stretching and those stretching are static - it could be due to post ATR recovery.
Yes, I was trained to stretch before exercise, but after warm up - light jogging or etc. And stretching was more dynamic than static - could be due to age
Thanks Lou: My biggest concern is my drive and competitiveness. It will be hard for me to play tennis once a week at a moderate level. I guess I’ll start there and see if I can live with it. Otherwise I might have to go back to golf entirely.
Since I’ve enjoyed swimming so much, I’m thinking about exploring what they call “masters” swim events and “team triathlons” where I could do the swim leg.
Hi again. I will get around to getting a blog created but just have a quick question for now. I decided to go against my dr wishes last wednesday when he suggested another two weeks in the split cast. He said “normal” people don’t need the extra two weeks but because he didn’t trust me to watch my activity he wanted me to continue as is. He is concerned because I have three small children and I teach jr high boys, so I’m on my feet a lot. I decided that I feel great and was actually having more trouble then the cast was worth due to the pain caused by walking unbalanced. At one point my good foot hurt so much I couldn’t walk on it. And as I expected the pain was gone two days after I stopped using the cast.
Ok, so here’s the question and I know others have had this same problem but I can’t find any good suggestions. My heel hurts. Really bad after a long day. What’s causing this and what can I do. Almost like a heel spur feels. I can’t really pad my shoes because it’s also when I’m inside. And I tend to live in Keens so there also really hard to put any padding in.
Anyway any advice would be good.
Heather
Sorry, Heather, but it’s just like the old joke:
“Doctor, it hurts whenever I do THIS!”
“So don’t do THIS!”
What you have (and what many or most of us had when getting to FWB and 2-shoes) is very similar to a heel spur (plantar fasciitis, aka PF) and may even be a version of it. The more you load it, the more you walk around on hard surfaces with flimsy shoes/soles. . . the more you’re doing “THIS”.
Most of us have gotten relief from a combo of less “THIS” — i.e., get off that heel more — and padding the heel so it’s not getting the heavy loading and the high shock loading.
There may be other things that help, like maybe drugs or ice. My theory is that your heel is just tender from the NWB, and it has to get used to carrying your full body weight (and even more, in the moment when you clomp it down hard). I don’t know whether abusing it now can lead to full-blown PF or not, but I wouldn’t run the experiment.
I spent as much time as I could in Crocs when I first got out of my walking boot. They’re amazingly squishy-soft underfoot, so it was like carpeting the whole house in gel!
BTW, the solution to keep your GOOD foot from hurting (and your knees and hips and spine) is to build up your OTHER shoe so it’s the same height as your cast or boot. Then you’re only at risk of twisting your (good!) ankle on that “elevator shoe”!
Nope, the problem was the high heel I was wearing to balance the cast. I’m not a high heel kind of girl and wearing them every day was causing big pain on my good foot. As soon as I became two shoes on both feet that pain went away. Took your advice on the crocs today when I was gardening and it helped some but sure leaves dirty feet.
However, in regards to the don’t do this problem I don’t have a choice. Like I said three young kids and a job where I’m on my feet all day. Even if I could take time off work, can’t really do anything about the kids. The cast made the pain even worse. And now that you mention the PF it seems I’ve had the problem before in my foot, just can’t remember which one. Will have to ask the dr.
Ice, ibuprophene and crocs! Hope it works
thanks again for your advice and support.
Elevator shoes, not high heels!!
Good luck and (continued) good healing!
Arelhope.com is the rehabilitation treatment center of alcohol and drug addiction. AREL HOPE approach is holistic - addressing the physical, mental, emotional, interpersonal and spiritual. Drug Abuse Treatment, Drug Treatment, Alcohol Abuse Treatment, Alcohol Detox. http://www.arelhope.com
I had a clean tear of my Achilles & had surgery to repair it. I have been in a cast for 4.5 weeks now (got another cast 2 weeks after surgery) & will be getting the cast off in 1.5 more weeks, so 6 weeks total in cast after surgery. I am supposed to get a boot next but I am wondering how long it will take till I can walk without the crutches once I get the boot? I have not put any weight on the casted leg other then to just balance myself. Once I get the boot will I be able to try putting weight on it & start walking within the first week?
Thanks for any advise!
Mitch - many of us here got into a boot much earlier and were partial weight bearing around 3 weeks and full weight bearing a couple of weeks after that (give or take). Some doctors will try to keep you off it for a longer period but studies and personal experience shows that early weight bearing aids healing. This does not mean that you will not have a good result. The danger period for re-rupture is up to 12 weeks then it declines. Old school doctors prefer to keep you safe until then. You can get plenty of good advice from this site but I suggest you discuss everything with your doc if you are unclear and before you take it upon yourself to change your doctors protocol. Having said that, there are many doctors who will not listen or change their pratise. If you think it is not working for you then you can be your own advocate if you have enough understanding. Go to my blog site - Xplora - and look under ‘further reading’ for some helpful links. There are also some links on the sites main page.
Thank you so much Stuart….. I will check out your blog as well.
Rehab question: when you first start PWB is your AT sore? I started putting some light weight on it (just resting it on the floor, etc.) and it’s really sore. It’s also coinciding with a 5 degree stretch from 15 to 10 degrees on Friday night, which my AT seems to be protesting. I’m at 3.5 weeks. TIA, Kim
I think you’ve already figured this out yourself Kim; they key is to make lots of small incremental changes. Try not to make multiple changes at the same time. You’re trying to go to PWB at the same time as a reduction in angle. My suggestion is to do one or the other… but not both at the same time. Wait to go PWB until you’re comfortable at the new angle. Or… go back to the old angle (if you can, in a boot), temporary, while working on PWB.
Thanks, Ryan. I’ll back off a day or two on the PWB. This is the first angle redux that’s bothered me more than a day. It’s probably just too much at once.
I’m 3 days post-op and started my home resting 2 days ago.as you can imagine,it’s very hard to do stuff in cast with crutches(I also live alone which makes things extremely difficult).I know I’m supposed to just lay and rest but sometimes I just need to get up to use the restroom or get something from the kitchen.my main problem is lack of sleep at night.even I elevate my injured foot,it still hurts.any recommendations for me,please?I’ll get my stitches removed in 10 days.how long will it take for me to start walking bit by bit after the stitches removed?like a month?thank you in advance.glad you are around
burak29
Even if you don’t get much sleep, I’ve heard resting is almost as good. I went non-op so I don’t have much to help you with as far as pain management goes outside of don’t try to be a hero, take your pain meds. I managed to attach some canvas bags to my crutches and that helped me carry stuff around. Hopefully you’ll go from a cast to a boot in 4 weeks and that will make a world of difference.
starshep
thank a lot friend.I think I’ll have less pain once the stitches removed…one other question;by boot,you mean those ‘robocop’ style boots?
burak29
Yes I do mean a robocop boot. Also more properly known as a CAM (Controlled Ankle Movement) boot. Although most any will do the job, the Vacocast seems to be the best. so push for it if you can. Some people even go to 2 shoes right after the cast but that seems risky to me. Unfortunately it seems like a few orthopedic surgeons are are not up on the latest protocols and want patient in casts even longer than 4 weeks. Unless your surgeon has a really good reason, you should do everything you can to convince him to get you in a boot after 4 weeks. Normofthenorth has a lot of info on his blogs about the most modern and effective recovery protocols. You might want to make a print out of them and be prepared to discuss them with your doctor.
I honestly don’t wanna take any risks so I’ll skip moving into shoes I guess…for the last 2 days,I feel a bit of a pain on my calf area.is that normal?
burak,
I’m not sure what to say about your pain. I’d recommend you give your doctor a call on that one. I might be nothing or it might be a symptom of a blood clot which could be very serious.
ok,it’s been more than a week and I have some questions for you folks.I went to my first post surgery meeting.doctor told me that the wound is healing up pretty fine and he put me on a new cast(plastic this time).I asked him about these boots aircast walker- type of boots and he said it’s not the procedure that he is following.does that make sense at all?I mean are there people out here who’ve been told by their doctors the same?anyways,he told me that I’ll spend another 4 weeks in this new cast.then, he’ll put me on ‘walking cast’ for another 2 weeks.now,I live in prague and doctors don’t speak very good english.what did he mean by ‘walking cast’? does this timeline of recovery sound fast or slow?please give me some hope as I’m really low on morale support.
I live in the us and my plan sounds similiar to yours. In a cast four weeks and then a boot for four weeks. Now walking everywhere in shoes. I wonder if by walking case he means a removable boot. I also did not have the aircast and am doing fine. I started pt at eight weeks and i go two or three times a week. Hang in there, it gets better. Hope you are enjoying prague, such a beautiful city.
my comments were for burak29, i thought i was on your page.
thank you baezlyons.I’m just waiting for the day that I can walk freely without any crutches.I hope I’ll be able to do it in 1,5 months
Hey all,
I suffered a partial tear in my right Achilles and went with the non-surgical method. It’s been three weeks to the day since I injured my AT, and the process has been something. I sustained the injury two days prior to relocating for a new job (where I have no nearby friends or family to help get me around), so going about the day-to-day activities has been challenging.
I was just curious as to where the rest of you non-surgical folks were at at this point in the recovery process in terms of cast, boot, any weight bearing, etc…oh, and how you managed to say sane!
I see my doc this week, so fingers are crossed!
hello everyone!
today it’s been 10 weeks since my surgery and for a few days now i’m wearing shoes!! it’s like i’m learning to walk again but day by day i can feel a small improvement. Had a talk with my doc and my physio therapist and pretty much they both suggested the same exercises…however, i need to be quite careful and watch how i walk…i got a turbo trainer for my road bike and yesterday i rode for about 15 min after a long time…felt nice…doc also said that if im able i should walk on the beach..so im really happy that i live in a tiny greek island!! :-)…my aim is to be able to windsurf by june and hopefuly i’ll make it if i feel confident and strong…its great to be mobile again and its great to be able to drive!! good luck to everyone with their recovery!!
Hello, My name is Tim.
I ruptured my achilles playing basketball by simply just jumping up for a rebound. I would consider myself as a explosive athlete I played college football at Cal U of PA and now I been in many basketball leagues before i had this injury. The doc said it was a very rare tear/ rupture from what they have normally seen. He said that the tear was really close to my heel and when in surgery he found that the achilles itself had tears in it. So he had to repair that first and then attach the tendon back together. He also said he put in 2 anchors to hold it there in my heel also with sewing it. The question that i have been asking myself is: Since this is rare from other ATR injuries does this mean that my recovery process will be extended?? Why and how so? I also want to get back as soon as possible to activity, i feel poopy about myself being only 8days post op and not being able to do anything. Considering i would be active in many activities at least 5 times a week. I do understand that I have to be very patient as well but i am just wodering if there are any secrets or things that helped others out to speed up their recovery.
As of now i am in a soft half cast and see the doc in a couple days for my first check up. I am wondering what goes on during that and what gets done. I have been elevating and iceing the back of my knee. Taking ibprophen to reduce swelling and aspirin for blood clots. I do have knee scooter and i really suggest that rather than crutches. The scooter is heaven compared to crutches.
ACCIDENT- i was getting out of my friends car and as i was trying to balance myself on one leg i was beginning to fall and quickly with out even thinking caught myself with the bad leg. i didnt feel instant pain but just a very very uncomfortable feeling through my entire leg going up to my calf. It was a sore and a little painful that night but went away the nxt day. Does this mean i am all good? Or might i have done something to myself?
I am new to blogs and everything so if this isnt the correct way, my bad. I am really curious and would love to know more information on my situation
Hi tim if you look at the side of the blog left side you will see lots of subjects you can then hopefully make contact with specific people
I had my first post op visit 10 days after surgery. Stitches were self absorbing so no removal necessary. A little oozing hut, all looked well with some black and blue around the incision. Physical therapy starts in 1 week with no weight bearing. Back of heel o
Is still quite tender. Calf muscle is like jello. I assume it will be several months before I am back on my bike and golfing.
Hi wanted to share my story and path to recovery.
I am 26 years old and I ruptured my achilles by playing basketball on slippery pavement with bad shoes. I generally am quite fit and go to the gym, but switching to fast stop and go motions was a bad mistake without a proper warm up, also wearing shoes with bad heel support.
I had a clean tear but the tendon stayed in place because I also ruptured a part of the muscle. They put me in a cast without surgery, it turns out you don’t really need it and the complications are not worth it. It is recommended if you are young to avoid the surgery.
It takes about 3 months before you are walking again. And even then your calf/achilles are not strong enough to lift your entire body so you will be limping (I am limping about 3.5 months in). It is a shitty injury but you just have to accept it and try to learn something.
Tips:
- elevate your leg as much as possible, this will drain it and will let fresh blood flow in (recommendation given to me by a dancer who has had many terrible injuries). There is not much blood flow to that region anyhow so do what you can.
- First 6-8 weeks you’ll be on crutches non-weight bearing. It is hard and annoying, and best to have someone close to help you (I moved back in with my parents). Do not be lazy and go down the stairs 2 crutches at a time, I fell pretty badly and could have made things much worse. Either sit on your bum or put both crutches under one arm and use the rail.
- Eat lots of pineapple, vitamin C, drink water. After about 6 weeks you can start flexing your leg (check with doctor). Also shower with your cast on (you will be moved to an aircast about 1-2 weeks. Don’t risk putting weight on your leg (just bag the damn thing and seal with tape).
- Once you can partial weight bear, go for walks and work the leg out. Dont’ overdo it if there is pain. Stretch it out when possible, and clean out dead skin.
- About 10 weeks in you will likely be able to full weight bare. Start slowly, using 1 crutch even, and gradually go for longer walks. It will be sore at first and then will get better. But then it will get worse again once you strengthen your leg and start putting more strain on it. Don’t be alarmed, this is a natural part of the process.
- Follow your doctors orders about the inserts to elevate the heel. Don’t rush to take them out. Also sleep with your cast on. The key is to keep the leg int he right position and if you don’t do it overnight it might be extra stiff in the morning and you’ll end up hurting yourself when you slam it into your boot and start walking.
- Once you transition to walking shoes (~12 weeks). Use inserts into shoes for heel elevation (both legs so you don’t screw up your back). Get shoes with good heel support. I also recommend getting some exercise bands (~$20) to work flexing your calf (check amazon). The best way is to sit on a bed and wrap them around your foot and put tension on them with your hands. Then flex at the calf as though going on your tippy toes. Expect that if you are walking around, recovery will be up and down pain and swelling wise, as you put more and more strain on your leg (your calf will be getting stronger). You’ll struggle for another few weeks until things normalize. You’ll just limp but there will be little pain (some swelling). You can do tippy toe exercises carefully on both legs, don’t overdo it (also balance ona wall).
Overall this is a crappy injury and it will likely affect you for 6months - 1 year (especially if you play sports). 3.5 months in I kinda don’t mind it anymore, I limp and can’t run at the gym, but I’m over it. With a bit more time things will transition back to normalcy.
Anyway, I hope these tips are useful. Best of luck with the recovery, and don’t worry, you’ll be writing a positive recovery story much like my own in no time.
Cheers
Hi basketballnoob,
Sounds like you followed one of the older protocols. The newer ones have you at pwb around 2 weeks and fwb soon after that. I was fwb at 13 days and haven’t needed crutches since.
Then I think they want you in 2 shoes around 8 weeks (which is what ill be at hopefully this week!)
I do think the tips about walking to strengthen and vitamin c are good ones. I’ve been religious with both of those as well as all my pt exercises (squats, calf raises, band work, balancing on one leg). I think those things have all helped my recovery.
Best of luck with the rest of the recovery!
Hey basketballnoob!
In addition to learning a bunch of tricks to survive on crutches WAY too long, I hope this experience teaches you that medical experts - like you and me and the rest - didn’t get 100% in school, and agent getting 100% on the job either. Mags was really gentle with your Doctor!
I wish you’d looked at the 3 best new ATR studies at AchillesBlog.com/Cecilia/protocols 3.5 months ago, and worked hard as your own Medical Advocate. Not only are the newer faster protocols way less of a pain, they also give better clinical results - especially for those of us who went non-op. It’s true that non-op works as well as surgery, but ONLY with the new fast protocols. The old slow ones like yours don’t work any better today than they did 50 years ago.
The good news is that most of the proven harm from slow non-op care is high rerupture rates, and your risk of that should be history now. With luck, your calf and AT strength will continue to rebuild as good as new. I hope so.
Unless you were on Cipro-type antibiotics soon before your rupture, there maybe something about your body that makes you prone to ATRs. if so and this happens again, dont give up in non-op, but DO give up on old style Conservative Casting!
Finally, don’t blame yourself! Most of us tore our ATs after a LOT of stretching and warming up, so that doesn’t prevent ATRs. The science says the same. Stretching pre-sports seems to increase injuries (& DEcrease speed and performance!), and warming up is only neutral.
Agent –> aren’t! Autocorrect!
Hi everyone,
I would be grateful if someone could tell me how long before they were able yo start running. It’s been 3.5 months nice the surgery and I have only been walking in shoes four about 4 weeks. I am making good progress but would live to know how long before I can resume running. My physio and I are aiming to start gentle running by the end of October and back to normal running by Christmas. What have others experienced with the surgery protocol?
Thanks
Michael who is missing running like crazy
Had ATR Aug 2014. Self treatment, non-surgery. Walk with brace after 3 weeks. Back to gym after 3 mths. Back to badminton after 4 mths. Abt 80% recovery now. Did not see any doc or PT. Total amt spent : less than $100 for braces, crutches (did not even use) etc. Thank God for internet !!!
badmintonplayer I am impressed. Thanks for sharing. Whether by choice, because you know you can, or need due to financial constraints, I think it’s good for others to know you can treat this on your own. I think it would take a certain personality to do that, not everyone would be confident enough in their own ability to take care of it. YAY for you. Best of luck getting to 100%!
donna thanks. The thing is when you feel helpless in the midst of a hurting, unknown, panicky situation, most people would go along with the “norm”, which is surgery. I think as more and more anecdotal evidence surfaced about the amazing self-healing power of our body, many may choose for non-surgery. Surgery, in, my opinion, only adds to the misery and prolongs the healing. I’m taking the financial issue out of the equation so as to be medically/scientifically objective.
I completely ruptured my AT on April 26th playing soccer. Prior to the injury I was doing 200lb calf lifts. Due to my financial constraints I couldn’t afford the surgery. My doctor chose to go a conservative route and was going to have me in a cast for (6) weeks. At about 3 1/2 weeks in I started to have extreme pain and swelling in the calf. It turned out to be a blood clot. The 1st (4) weeks of my injury consisted of lots of pain and swelling as I had to work and could not properly elevate my leg. Once out of the cast to monitor the clot, I was put into my boot and to remain non weight bearing for the remaining time. June 15th I started slow re-stretching of my tendon. Each week I was to remove a lift from my boot and increase the amount of weight I would apply to it. I am finally at the week where I am putting full weight on the leg and have been able to walk up and down stairs (very slowly but still doing it). I am at the point where I am excited and very nervous. I am at 12 weeks from time of injury, is it easy to rerupture? Are there any signs I can look for to prevent it. The tendon is very tight still and the muscle is coming back very slowly.
mariwinter - Re-ruptures occur when you put more stress on the tendon than it can take at the point of healing you are at and is usually instantaneous. This could be from a slip, misstep or fall and also the type of exercise you are doing so looking for signs is not of much help. I need to be honest but I do not want to scare you. The way you have been managed without surgery is quite old fashioned and does put you in the higher risk category for re-rupture. This risk dose slide away after 12 weeks but it does not go away entirely for a bit longer and in your case I would stretch that out because you have been locked up so long. What I am saying is you need to be careful when you walk and watch your step. What has been found is tendons need some loading to heal well. This encourages the strong collagen type I to form and replace the weak and disorganised type III which is laid down during the initial healing phase. Early weight bearing and movement has been shown to be beneficial to this process particularly in non- surgical cases and it produces a low re-rupture rate. That is behind you now so to move forward the best thing would be to walk and do so without a limp. If you limp then slow down and take shorter steps. Stay on even ground or use a treadmill. Wear good supportive shoes with a higher heal than toe. Brooks or ASICS motion control shoes are good but I find Nike are more fashion than function. You also need to strengthen the other muscles which are used for walking and do some balance exercises. If you push too hard then you could do damage but your tendon does need the exercise to heal well. A good PT will also help but if money is the issue it can be done on your own. Keep everything incremental and start small. Eccentric loading is better but for now I would concentrate on getting things moving again after this lengthy period of being locked up.
I’m 13 weeks post op from Achilles Injury that resulted from landing after a box jump. I heard the pop and felt like someone “hit me in the back of the leg”. My surgeon did the “thompson test” and an xray but never did an MRI. My surgeon said it was a clean tear and repaired. I was casted for 6 weeks, then in the boot for 6 weeks. 9 of the weeks I was NWB, progressed to FWB as of last week.
Today, I went for my 13 week followup and was given the “ok” for two shoes. Mind you, I’ve only been FWB in the boot for a week. I have an extreme limp, but am able to balance in the boot without assistance of a crutch or cane. My question is when I was put in 2 shoes, my injured foot felt “like I had no arch” anymore as if my foot was completely flat to the floor compared to the other. I have heel lifts in my shoes, but I feel much lower in my arch on my injured leg. I’m not sure if its because my calf muscle has wasted away and atrophied but in the back of my mind I’m scared I tore my tibial tendon or something that has gone missed. Did anyone else have this feeling of “flat foot” when first putting on shoes? Thanks!
Jax, what’s gone missing is likely your midfoot muscles. Don’t worry, with rehab, they should eventually get back to normal.
jax3231,
I am experiencing the same thing that you are. When I try to walk on my injured foot, it feels like I am walking on rocks. I was in enormous pain when I attempted to transition from the boot to shoes. My foot was swollen 2 sizes bigger than the good foot. I bought this crappy shoe at Wal-Mart that strapped because it was the only thing I could find at the time. I never had the chance to FWB in the boot with no crutches. Doc said get out of boot in Week 11 and transition. So I attempted. Could not walk without severe foot pain. So PT put me back into boot until I could walk without crutches in boot. PT said that the foot muscles and tendons were atrophied and needed to be strengthened and the foot pain would go away. PT also started working on stretching my back which is causing foot pain. I got a new pair of Sketchers on Wed. They are gel infused with memory foam. They feel excellent on my feet. I can finally feel the swelling subsiding which is making the foot pain much more bearable. I am now in an 8 1/2 shoe which is 1/2 bigger than normal. I am at Week 14 and ditched the boot on Tuesday. IMHO, the boot is good for the early stages but not making matters any better in the long term. I found that the only way to get strength back in that foot is to use it and work through the pain. I will use the crutches to take some of the stress off when it hurts a lot but by next week, I have my mind made up that I am done with crutches, scooters, wheel chairs, boots, heel lifts, ankle braces…..I want my foot back which will then give me my ankle back which will give me my calf back (to some degree) which will give me my quad back, which will give me my back back!
Sketchers was the ticket and exercising and moving it through the pain. I hope this helps you.
I am now 4 weeks post surgery. I had a plaster cast for 2 weeks and then they took out the stitches and put me in a walking cast with 4 wedges. Today I took out my first wedge.
I expected to feel a stretch or something….but nothing. I am pretty paranoid that maybe my tendon is not healing properly.
Anyone else have experience with this?
Hello, I had a question for anyone can answer for me please. I’m 5 weeks post surgery for achilles surgery. I have had three PT sessions already. but just range of motion. Since my Dr. is on vacation and the therapist won’t let me really do anything until the dr gets back to them. My question is that if I sit up on the edge of a chair the heal of my foot doesn’t touch the ground. I should state if I sit normal my heal will touch but if I bring my foot backwards it’s a few inches of the ground. Is this normal I would ask my Dr. but as I said before he isn’t in the country. If I asked this question in the wrong section sorry.
Jon