Achilles Tendon rupture

While playing Pickleball on August 16th in Park City, UT I heard what I thought was a dropped racket or my partner hit me in the leg. Then I took one step and that ended the game and we were ahead !!! I went to Urgent Care and the doc said I pulled a tendon on the side of my foot and I should be ok in 5 to 10 days. Just ice it and treat it like a sprain. He did not take an xray or MRI. I did what he said and did not have much pain. After 2 weeks we returned to our home in Tucson and played golf a couple of times. Then went to Seattle and did a bunch of hiking from 2 to 3 miles a day for 4 days. Then off to Boston then home. I was a bit gimpy but not much pain and could not get up on my left toe. I still had some swelling so I went to a ankle doctor. He did an xray then said I should have an MRI. He suspected an ruptured Achilles. When the MRI came back it verified that I ruptured my Achilles and it had a .75 inch gap and should get it operated on ASAP. I wanted a second and third opinion so I went to another doctor, all foot surgeons, and he said I had a bad front foot and need reconstructive surgery before I had my Achilles fixed. He ordered a CT scan and by the time I had the scan and made another appointment it would of been 3 weeks. I went to another surgeon and he recommended that I go to PT for 5 weeks then come back for further evaluation. Now it is 2 and a half months since the rupture and it is getting to a point of no return. One of my friends suggested the Mayo Clinic in Phoenix so I booked an appointment and headed to Palm Desert for some golf for 4 days. Played golf twice then headed to Mayo. I saw the doctor and in 20 minutes he said you need Achilles surgery ASAP and we can do it Friday. This was Tuesday. He stated it was too late to do the nonsurgical way of fixing it. He said the front of the foot could wait since it has never hurt for 30 years and I could walk fine. So I got operated on Friday Oct 31st 3 days after my appointment. It has been a little over a week and I am doing ok. I have never had surgery or been in a hospital except to be born. Now I have to go up to the Mayo Clinic for 7 weeks to get my cast changed to start elevating my foot back to 90 degrees. It is going to be a long 6 months before I am able to play golf or go hiking or ? The Mayo Clinic is an amazing place ! Everyone there are super !!!! Even the food is good !!! So the morale of my first blog is get a second and maybe a 3rd or 4th opinion. If I waited I probably would of never walked again the right way. Stay tuned for the continuing saga and rehab !!! PS My rupture ended up being 2 inches instead of the .75 because of the length of time I waited.

13 Responses to “Achilles Tendon rupture”

  1. I can’t believe a doctor knowing you have ruptured your achilles has told you to just go to PT for 5 weeks. What you will find here is so much variation in the manner of treatment that it can become confusing. Look at what you have experienced already. That is confusing enough. In the end you will be playing golf again and pickleball. You are the second person I have heard rupture during pickleball. The other is retired65. I have never heard of it before then so I had to google it. The first image that came up on google was people playing it at a nudist resort. It is not a big sport down our way. Anyway, the Mayo certainly has a good reptutation world wide for being up to date but I am surprised they still multiple casting for this injury. The most modern protocols get people into walking boots early and have them weight bearing around 4 weeks. The method they are using still works but it is more of a pain for the patient. There is a recent post from ctcbusted about this that is worth reading. You seem very relaxed about this which is a great thing and will certainly help you through the recovery. Hope it goes well.

  2. What Stuart said! Those modern protocols — including 3 you can find at achillesblog.com/cecilia/protocols — generally get you FULL weight bearing at around 4 weeks, and PARTIALLY WB as early as 2 weeks in. And most of them use boots from the very start non-op, or after 2 weeks in a splint after surgery (to sop up the ooze).

    There are some patients in Belfast being successfully treated non-op with “chronic” (long ignored or misdiagnosed) ATRs, as you can see from the Wallace study (on Cecilia’s page). Wallace only sent a few for surgery, the ones whose torn AT ends wouldn’t meet (”approximate”) when he plantaflexed their foot. Until that study, most of us were convinced that chronic ATs needed surgery, period. Wallace also got excellent results with ALL his (few) REruptures, non-op. Overall, he got <3% rerupture rate, which is pretty good with or without surgery.
    His “secret” was to approximate the torn ends with plantarflexion, then to immobilize each ankle at exactly the angle that did the job. If the ends wouldn’t meet at any angle — true only for a few of his chronic ATRs, and none of the promptly treated ones or the reruptures — he operated on them.
    If you have trouble using Cecilia’s list, you can also see one of the good modern protocols at bit.ly/UWOProtocol .

  3. I am also amazed at the variation of OS diagnosis. I am 66 and a fellow pickleball victim. I had surgery 3 days after the injury but my OS casted me at 90 degrees from the get go so I was in 2 shoes at 6.5 weeks. That is a funny comment that Stuart made about pickleball at a nudist camp. It is a huge sport in Florida and spreading across the nation.

  4. Thanks for your comments. I am on a roller scooter and now can get around much better. I asked my Doc about the fast track and he stated that we take the conservative approach vs the liberal approach since the rerupture rate is higher with the liberal approach. I am 69 years old and do not want to do this again. I thought they played volley ball at nudist resorts. Now pickleball ! Right on ! You should see the Iphone holder that the caster built in to my cast. It must be the most expensive Iphone case ever !!!! I had to have surgery since I waited so long to find out what the problem was.

  5. Be careful on the scooter. go slow I just fell off of mineand put my foot down as a matter reaction and boy did it hurt now I’m worried of me and we ruptured I’m just glad I had my boot on.

  6. Sabre38, lots of Docs are still confused about the evidence, and believe that speed is scary in ATR rehab, because it’s true on the road in the car. Seems logical, so it’s easy to believe. The studies are there for you to read, linked from Cecilia’s page and the Protocols and studies page and my two studies pages too. Docs are humans, and busy ones, and most of them can still learn. If you can educate yours with facts and evidence, you’ll be saving yourself AND the next maybe 100 ATR patients from a brutal useless nuisance…
    And Wallace (see AchillesBlog.com/Cecilia/protocols) shocked us all by treating most of his neglected ATR patients successfully non-op. Most of us (including me, the non-op booster) thought that was impossible. But evidence beats “it seems logical”.

  7. A few scooter folks here have run over their “good” foot. Usually no lasting damage, but not a Good Thing.

  8. Hi Sabre38, I think the reruptures with the aggressive approach are probably a result of them not listening to their body. You can push yourself until your body tells you enough… if you don’t pay attention to that it can spell trouble. I think aggressive is the way to go for expedient, solid recovery as long as you listen to what you body tells you.

  9. Retired, lots of us — including me! — have gotten into trouble by straying from the best protocols WHILE listening to our bodies. In my case, I reluctantly followed the instructions of an ignorant PT who told me to do 1-legged heel raises long before they were appropriate, or prescribed in any of the successful protocols listed in AchillesBlog.com/Cecilia/protocols. I was pretty sure it was too soon, but only because I knew that I couldn’t do 8 “reps”, and that’s always been my definition of an exercise that’s too hard. BUT there was no pain at the time, so “listening to my body” wouldn’t have saved me.
    In fact, the pain didn’t start until hours later, and the pain persisted for a MONTH. Much more painful than the original ATR, and maybe roughly as painful as the pain immediately post-op — and scarier, because I knew what was causing THAT pain.
    So I’d say if you have a choice between following a schedule that has been proven to produce good results in a large group, OR exploring your own path while listening to your body, you’ll be much safer following the proven protocol.
    Mind you, if something hurts, don’t rush to do it either, even if you think your protocol calls for it. Get a second opinion first. But we’ve had lots of people here who hesitated to go NWB or FWB on time because it seemed scary. Then — often with the help of some psychological tricks from others here — they got over it and made the next step, and everything was fine. If their first principle was to listen to their bodies, they might have waited a long time.
    My theories about Sabre’s Doc’s extra reruptures from going fast, is that they don’t exist. Unlike the authors of the published studies, he’s never had to randomize his patients, or track their results carefully enough to survive peer review. So he probably sees with his heart, like most of us humans. Five reruptures among slow patients look like they happened DESPITE going slowly, but one rerupture in a faster group happened BECAUSE that patient went fast. That’s how we humans usually gather evidence when we do it informally. We discount evidence that doesn’t make sense or “doesn’t compute”, or doesn’t agree with our prior opinions. It’s called “confirmation bias”.
    My $0.02, of course, as always.

  10. I can’t believe you lasted 2.5 months with a rupture, what a trooper. Glad to hear you found your way to the Mayo Clinic and are on the recovery road (with an iphone holder!). I am an Aussie living in Canada so understand Stuart drawing a blank on pickleball- I thought it was a form of local slang at first!

  11. I understand Norm, but listinening to our body includes our brain after all, just sayin…

  12. As long as everybody understands that Listen To Your Body does NOT mean that you can’t get into trouble if you’re not doing something painful, because you definitely can.

  13. Good news ! I am going to be out of a cast in a total of 4 weeks, then a boot for a week then shoes. Then the fun begins !!!!

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