An Overdue Update

28 Weeks 6 Days Post Op

It’s been awhile since my last post, as seems to be typical at this stage of recovery.  I am now around 6.5 months post-op from the second surgery, and while I try to put this injury to the back of my mind, it still remains a top priority.  I guess I just haven’t felt a need to post much lately as my recovery is still moving along slowly.  The tendon is still a bit tender when it’s stretch to the extents and during some lateral movements, but it is better than the last time I posted.  My calf is a bit stronger, but still far from normal.

I just started receiving the Graston massage treatment when I last posted .  I ended up having a total of about eight Graston sessions.  I noticed some improvements during the first three or four sessions, but then the results started to plateau.  My PT decided to switch to ultrasound to help break down and even out the scar tissue.  The ultrasound may be helping as my tendon feels a bit more pliable than it did a few weeks ago, although it’s difficult at this stage to determine how much of a factor time is to my healing.

In addition to the manual therapy, I continue to work on an endless array of exercises to improve my strength and balance.  It feels like I could spend 2 hours at the gym and still not get through all the exercises.  So, I do my best to attain a good, daily balance of strengthening, balance, and cardio exercises.  I have recently advanced to some plyometric exercises which should help build some explosive power back into my leg.

I also started to ease back into running.  Over the last couple of weeks I’ve progressed from two minute intervals of running up to about five minute intervals, with a couple minutes of walking in between the intervals.  There is definitely a fair amount of fatigue in my leg, so I’m cautious not to progress to quickly.

While I occasionally get discouraged about my calf strength progress, I remind myself that my current recovery is a bit different than a standard ATR recovery.  I went into the second surgery with a calf that was probably at half its normal strength, so I’m trying to overcome a fair amount of atrophy.  My surgeon told me prior to surgery that it could take a year and a half to get back to full strength.  If that’s the case, I can’t be too upset with my current status.  Hopefully the tenderness will continue to subside and I’ll be able to get a bit more aggressive with the strengthening exercises.


33 Responses to “An Overdue Update”

  1. Hi, Tom. How’s the recovery going? I saw another doctor (a foot and ankle orthopedist) this week, and, well, it wasn’t very helpful. He agreed that my tendon had lengthened during the recovery, but he didn’t think that surgery was a good option. He suggested I start seeing a personal trainer. I feel a little like Alice in Wonderland, in that no one seems to believe that there’s a problem with the tendon — rather, it must be me not doing enough exercises, or not doing the right ones. I’m seeing another doctor on Tuesday; we’ll see how it goes. Anyway, the doctor I saw this week said that the surgery would involve grafting part of another tendon onto the achilles, or something like that. Is that what you had? I can’t tell if when people say my tendon has stretched, that means it’s intact but just longer (like a rubber band) or that the stitches didn’t hold for some reason so that I have tendon/scar tissue/tendon, rather than all tendon. If it’s the second, why can’t they just remove the scar tissue and reattach the tendon? I just read some of the older comments from your blog, and it sounds like you did have the tendon graft surgery. It also sounds like a lengthening of the tendon after an ATR repair is more common than I had thought. Another question — how far off the ground were you able to get with the one-legged heel raise? I can lift the left heel about an inch, maybe an inch and a half; the doctor made it sound like that wasn’t too bad. The thing is, I can’t walk properly because I can’t push off on the left foot. Did you have that problem too? As awful as a second surgery sounds, never being able to walk properly, let alone run, is a lot harder to swallow. Ugh.

  2. Tom — So I saw in one of the posts that you did not need the tendon transfer. that’s good to hear. I guess the surgeon didn’t know until he got in there, though, right? I wish I lived anywhere near Minnesota, as I would make an appt with your surgeon, just because I know he’s done it at least once! Although perhaps it would be good to wait a few months … :)

  3. I’ve been poking around online and found this article — sounds like what I have (and you had):

  4. Jolie - I was just wondering the other day if you were able to meet with any doctors. Sorry to hear the foot & ankle specialist wasn’t very helpful. Hopefully Tuesday will bring more news. You’ve asked a lot of good questions and I’ll try to help as best as I can. As you mentioned in your second comment, I didn’t need a tendon transfer. My surgeon prepped me for the possibility, but during the surgery he decided that my tendon was in good condition and would heal strong enough without the transfer. That is something that probably varies by surgeon.

    The lengthening, from what I know, may be the result of a couple factors. First, the ends of the tendons may not line up correctly. This is rare for the surgical option, but the surgery involves approximates the tendon tension, usually based on your uninjured leg, and unfortunately, it is not an exact science. So it’s possible that the tendon can end up too long, or too short. Second, a gap can form between the tendon ends during the healing process in which scar tissue will fill. This may result in excess length in the tendon. A gap could form if the sutures don’t hold properly or if the tendon is stressed too much, too soon. Third, this is pure speculation, but I wonder if simple biology doesn’t play a small role as well. As a side note, I read a study that compared two recovery protocols and the results showed that an average lengthening of 5 mm occurs, regardless of the treatment protocol.

    I never measured my single leg heel raise after recovery, but you probably couldn’t pass more than a sheet of paper under my heel. Maybe I got about a half inch off the ground?? I struggled with walking for quite awhile, because of the lack of strength. Eventually I felt like I was moving pretty normal, but I think I just got used to compensating for my weak calf. I probably had a very slight limp all along.

    If you’re interested, I can try and contact my surgeon to see if he knows any colleagues in your area that may have experience with the shortening surgery. Sorry that you’re having to go through this. I know all to well that it’s not fun. Hopefully you’ll get more answers on Tuesday.

  5. Jolie, the various surgical tendon grafts are usually used to bridge a big gap in a tendon that’s basically become too short for the surgeon to pull the two ends together (even with the foot plantar-flexed “in equinus”). You and Tom seem to have had the opposite problem, so I don’t see why a graft would be appropriate, unless large parts of your tendons were badly damaged, etc.

    Even with damage, since many of us have recovered from good-size gaps without surgery — i.e., our bodies made new tendon to close the gap — I’d be surprised if a graft made sense. (Just a surgical opinion from a REAL non-surgeon, FWIW!)

  6. Norm - As you mentioned, a tendon transfer can be used to bridge a gap, usually after a misdiagnosed ATR or if the original ATR resulted in a large gap. That’s probably the most frequent situation for a tendon transfer. But, it can also be used to augment the achilles and make a stronger repair, in cases where there is significant deterioration of the tendon. FWIW, my surgeon has done the same shortening procedure on college athletes and has included the tendon transfer to strengthen the repair. Perhaps it isn’t always necessary, but it probably provides some reinforcement. I believe the tendon transfer can also help improve the blood flow/circulation to the tendon to aid in healing.

    In my situation, my surgeon determined that my achilles was healthy enough and he felt the reconstruction procedure went well that the tendon transfer wasn’t necessary.

  7. Yup, thanks, Tom, good info. I had read some of that stuff, but I think I’m starting to repress the stuff I read about the surgical cure, now that I’m a card-carrying member of the other side!

  8. Hi, Tom and Norm. Thanks for the responses! If I do have a gap, which I think I do, I’m hoping it’s not too big. The whole tendon transfer idea sounds very unappealing to me. I really don’t like idea of messing with an otherwise healthy part of my leg! I think the most likely cause for me would be something during the recovery, but I guess that’s a bit secondary. While I’m waiting to see if I can get it accurately diagnosed, and in case I’m wrong, I’m continuing to do lots of exercise. I even met yesterday and today with two different personal trainers. The one today was actually quite good and had himself ruptured his achilles tendon 4 years ago (while training for rugby). His (now healed) injured tendon looks quite normal — vs. mine that is quite thick and has a rather large bump at the bottom. At the same time, his calf, while quite muscular, is noticeably smaller on that leg.

    Now that I’m looking again at your photos, Tom, I think your injured leg (pre-second surgery) looks a lot like mine. Not everyone has that massive thickness. I can’t help feeling that is another indicator of a problem. My doctor of course has said it’s normal. Ugh!!

  9. Tom — If it’s not too much trouble, maybe you could ask your doctor if he knows of a good foot and ankle specialist (preferably someone who would have that experience) in the DC/Baltimore area. It can’t hurt to have another recommendation.

    Oh, and another thing re: biology/genetic factors. I have very flexible joints, and always have. The orthopedist who is a friend of my friend thought that might be why I ended up with a stretched tendon (if in fact that’s what I have). I don’t know if that applies to you too, but it’s an interesting theory. I guess that could be a factor with the recovery with any second surgery.

  10. Jolie, I’m not sure you can judge much about the state (or length) of your AT by the bumps and thickness. The best guide to tendon length is how far you can dorsiflex before you hit the limit of your tendon length (and that suggests that yours is long, as Tom’s was).

    My AT down near my ankle bones is way wide, with hardly a sign of the normal “indentations” on either side, behind the bones. And it is a little fatter in the back (i.e., my whole foot is a bit longer) than it used to be, too.

    Mind you, my OTHER ankle was a lot like this 8 years ago, after I tore THAT AT and had it repaired surgically! (I skipped the surgery this time, as you may recall.) It took it a while to “thin out” and resume its previous shape, or at least very close. (Now I’m wishing I’d obsessed about my two ankles shortly BEFORE I tore the second AT, but I was in a happy and busy place, living a more normal life than we all are now!!)

    Also, this time, the back of my lower leg — the back of the AT — showed a good-sized lump several inches above the location of the tear! Nobody gave me a clear answer on what that was. One theory (developed from one of my ultrasounds) is that I had suffered multiple tears, at least some of them partial. I don’t know, but that bump has vanished almost completely after 11 weeks, so I’m starting not to care.

    One simple diagnostic question is this: Do you now pass the Thompson test? I.e., does giving your calf a good squeeze (while you’re lying on your front , hanging over the end of a bed) cause your foot to move in the plantar-flex direction?

    And a related question: If you put your “bad” foot a bit behind you, and shift your weight toward that foot, how hard can you push down? Hard enough to lift most of your weight? (One trick I’ve been using is to put a scale under that foot, a bit behind me, while I do this “test”, and read the force off the dial.)

    If your foot moves in the Thompson test, and you can push anything more than maybe 30 pounds or more with the ball of your “bad” foot, then it’s clear (to me, FWIW!) that you have a continuous, healed, intact AT — no “gaps”, it’s just too long.

    Only if the answer is “NO!” to either question is it conceivable that you may be facing “gaps” in your AT.

  11. Jolie - My surgeon gave me the name of a specialist in Baltimore. I’ve sent you an email with the contact information. Let me know if you don’t receive the messge.

    As for the thicknes, I agree with Norm. I’m not sure that is really an indicator of any problems. The thickening is just part of the healing process. Some people just heal with more than others, but I think eveyone will tell you that the repaired tendon is thicker than it was prior to injury. It may thin out some with time, but the thickness shouldn’t significantly impact the funciton of the tendon.

    The gap question is one you should be speaking to your doctors about. It sounds like you’re dealing with a lengthening problem rather than a chronic rupture condition. But, it’s possible that you may have suffered a partial re-rupture at some point during rehab.

  12. Norm - As an interesting side note, while digging up contact information for my surgeon, I realized that he did a fellowship at Western Ontario. If I ever have to go in for another follow-up appointment, I’ll ask him what he knows about the UWO study and get his thoughts. I’m guessing he did his fellowship awhile ago, but maybe he knows some of the doctors running the study.

  13. Thanks to both of you. Tom, I did get the email, thanks! Norm, as to your two tests, I’m not sure about the Thompson test, will have to try that later. But the second test I passed without a problem. I can push off the bad leg and stand on it (lifting my other leg off the ground). …. Anyway, will update as I have more info. Thanks again for all of the thoughts/advice/etc.!

  14. Tom, that’s funny that your Doc did a fellowship at Western Ontario! The University is in a fairly small city (London, ON), so he may well have crossed paths with the docs that did the study. I forget the name of the Sports Med. Clinic at the University, but I think that’s where they hang out. I’m sure there’s also a hospital or two there. . . Small world!

    Jolie, we have another tendon (or two?) that can push our toes down gently, even without an AT. After my first ATR (right leg), driving home from the gym where I tore it, I found I could push the gas pedal on my car with the front of my foot, but I couldn’t hit the brake hard without putting my heel on it. Pointing my toe in the air was OK, but walking up stairs normally made my life flash past my eyes!

    If you can do a single-leg heel raise on your “bad” foot, there is absolutely no doubt in my mind that you’ve got a continuous, and sound, Achilles Tendon. Forget the Thompson test. (You’ve also got way more calf strength than I do at 11 weeks!)

    So I think your only problem is the length. Unfortunately, that does look (to me) like a problem, and probably one that will send you to surgery if you decide to fix it.

  15. Actually, I cannot do a single-leg heel raise on the injured leg; not more than about an inch anyway. I went to another doctor this week, and here is the gist of what he said: my tendon lengthened during the initial recovery so that it is now too long; when the tendon is too long, you cannot effectively work the calf muscle, which is why mine is weak; the bulkiness and lumpiness are related to the lengthened tendon; surgery can fix it, but it is a much longer recovery; he believes my tendon is intact; a gap is unlikely unless my tendon had suffered some trauma during the initial recovery (which I don’t believe it did). He wants me to try electro-stimulus therapy first, to see if it can wake up my calf muscle. If not, I’m almost certainly going to have the tendon shortening surgery, as a long recovery would be better than no recovery. By the way, I have no problem with stairs. Thankfully, as I have stairs in my house! :)

  16. Your doc’s prediction of a long recovery seems consistent with Tom’s experience too, Jolie, though I wouldn’t have expected it otherwise.

    If you really want to try to strengthen your calf while your tendon is too long, there should be straightforward exercise ways to do that, even though walking isn’t one of them. Similar to straight-legged and bent-knee heel lifts (or presses against a machine, etc.), but with a shifted Range Of Motion, to accommodate your long AT.

    Here’s a couple offhand, from “my collection”:

    1) Stand at the bottom of a flight of stairs, holding the banister. Put your good foot half on (half off) the first step and shift your weight to it. Place your “bad” foot beside it, half on/off. Let your “bad” heel drop as low as is comfortable, and go from there to your maximum heel lift, knee straight, with a small fraction of your weight. Gradually shift more weight, as strength and comfort allow. If your whole body weight isn’t enough for a good workout, then (a) your calf isn’t very weak! and (b) you could add weights, or use gym equipment instead.

    2) Sit on a reasonably high chair with the front of your “bad” foot on a board or a brick — something thick enough that it’s a dorsiflexion stretch for your heel to reach the floor. Your knee should be flexed near 90 degrees. With an appropriate weight resting on your knee — I’m currently using a 3-gallon pail pretty full of water, with padding underneath it, or 20-odd pounds — do a series of heel lifts, from one extreme to the other.

    My physio tells me there are two “heads” to the calf muscle (Gastroc Nemius and soleus) where it attaches to two “strands’ of the AT — and that the straight-leg lift works the GN, and the bent-knee one works the soleus. And they’re both important.

    He also says that the last little bit of lift (high onto the ball of the foot) is important, and that it’s better to include that with less weight, than to skip it with more weight. (This may be especially so for you, since that’s the part of your ROM that is limited.) He’s suggested numbers like 12 reps per set, 3-4 sets at a time, 3 sessions a day.

    If you work at exercises like these, I’m sure your calf would get a workout, and develop more strength. On the other hand, I can’t see a way for exercise to make your long tendon any shorter. But starting with a strong calf muscle before surgery might well make your recovery quicker. (I’ve been trying to “wake up” my atrophied calf muscle for 3 weeks or more already, and I’ve had a pretty quick rehab, with no complications!)

    FWIW, my physio gave me electro-stimulus therapy (”interference current” — supposedly more effective than TENS?) for my first few visits, then he stopped because he told me it wouldn’t be effective for me any more. I got the idea that it was mostly useful as a substitute for “real” exercise, when the tendon was very delicate and the muscle very Jello-like. But I’d expect you to be able to do real exercises, if you (or your Physio) are creative enough.

  17. Norm - Good suggestions on the exercises, although if Jolie’s (and others?) elongation experience is anything like mine, then they might not help a whole lot. It definitely doesn’t hurt to give them a try, but my problem wasn’t getting from the dorsiflexion position back to neutral, as when hanging your heel off a step, but rather getting from neutral to a plantarflexed position, especially the end of range plantarflexion. I spent over a year doing an endless number of seated and standing calf raises, in many different settings, with different weights, high reps, low reps, etc. and it just never made much of a difference. My calf muscle just couldn’t contract enough slack out of the achilles to put enough tension into the tendon, allowing the heel to properly lift off the ground. It came down to simple anatomy for me.

    You are right, though, that any calf strength that can be gained now would likely help if a second surgery is needed. And, it is definitely a good idea to work both the gastroc and soleus.

  18. I agree with every word, Tom. I think Jolie has two problems:
    (1) an over-long AT and
    (2) an under-developed calf muscle.

    #1 can only be solved surgically.

    #2 can be addressed with targeted exercises, even while #1 is still un-solved.

    Whether it’s worth taking time and effort to address #2 now, while waiting for (or thinking and deciding about) the surgery to solve #1 is a good question, and one that jolie herself ultimately has to make.

    As for me, I’m trying to go full-speed on my physio’s new calf-strength (and AT-strength) exercises — but I’m only going half-heartedly on my physio’s new stretches to maximize my dorsiflexion (and maybe my AT length)!!

  19. Norm - I think we’re coming from the same place, just looking at it slightly different. I actually would fully encourage Jolie to keep trying to develop the calf muscle through exercises like those you previously mentioned. It certainly doesn’t hurt to try. I guess the point of my last comment was that, in my situation, #2 was directly related to #1 and target exercises didn’t do much to address #2. My calf muscle remained un-developed no matter how many hours I spent on strengthening exercises. For me, #1 had to be addressed to help with #2. But, my situation may have been more extreme than Jolie’s and that is why I would encourge her to continue trying strengthening exercises for a bit longer before deciding on another surgery.

    BTW, it’s great to hear that your recovery is coming along well (aside from the recent plateau). I know it is very helpful for people choosing the non-surgical route to hear that you have progressed very nicely. It’s also helpful to hear your story given that you’ve able to give a direct account on both surgical and non-surgical recoveries. Keep up the good work!

  20. Tom/Norm, Thanks for the comments/suggestions. My experience has been similar to Tom’s in that no exercise works the calf muscle in any significant way. I can do reps until I’m exhausted, and the muscle never even gets sore. The soleus is actually not in bad shape, but the gastroc is very weak. From what my doctor told me, given the too long tendon, exercise is pretty much futile. I haven’t stopped though, just in case he’s wrong and/or there’s some incremental benefit. …. I hope you both continue to heal/recover strength, and quickly!!

  21. Testing testing, can’t seem to comment and would love to talk to you about the 2nd surgery.
    Can you email me if you get this:

  22. Hi Tom,
    Darn, I wrote you this elaborate comment and it wouldn’t post and I lost it.
    I’ll keep this brief now, but I just wanted to chat with you about your thoughts on your 2nd surgery.
    I’m facing the same possible scenario. I’m 5 months post-op, still limping, have way too much dorsi-flexion, can only get off the ground on a single leg raise about 1/2 inch, and had a new surgeon (I fired the one that did my surgery) immediately tell me that I had a bad repair and it’s pulled apart and will most likely need a 2nd surgery.
    I had an MRI yesterday and follow-up tomorrow.
    I know you waited a year and a half for your 2nd. Looking back, would you have done it as soon as you suspected it was too long? I’m just wondering if I should wait at least a year to see if it gets any more livable the way it is.
    How are you now since your last post?

  23. Hi Betsy,

    I’m very sorry to hear things are not going so well for you.

    There was a discussion, on this blog somewhere, about too-long tendons after surgery, and whether that is “our” fault or is caused by the surgeon tying things up too long in the operating room. I think it might have been Smish who said her doctor believed the latter was the case for most.

    Does your new doctor think the repair was too long in the first place, or that it got pulled too long sometime during the rehab? Or will the MRI give some idea?

    Best wishes,


  24. Hi Doug,
    Thanks for remembering me! Yeah, things are not good and the MRI showed that I had “longitudinal intrasubstance tearing”. The doc said about 1/3 of the tendon didn’t heal. He thinks that the main problem was the surgeon doing a poor job. Had that not been the case, then my early mobility plan wouldn’t have exacerbated the problem. He also said that he likes to do the FHL transfer/graft on his repairs because they are so much stronger. I believe Beckham had that done with his ATR for extra strength. I’m now looking at a cadaver tendon allograft for the reconstruction. The MRI does not show the length of the tendon, just if it’s intact. The too long question is based on one’s inability to not push off in end-range plantar. Which I also have. So, I have tearing and lengthening.
    It’s weird because I can do a lot of activities fairly well, like biking and swimming, but it’s the slight limp that makes walking for any distance uncomfortable. I thought it was getting better, even the end range plantar strength seemed to be getting better.
    I’m going to get one more opinion by a foot and ankle specialist, then decide about when I get the surgery, unless he thinks I can avoid it, but I doubt it.
    Talk to you soon!

  25. Betsy, do you know you’re using two different Login IDs, betsy and betsy22?? (I just noticed!)

  26. Hello,
    I’m new to this blog but would really liked to have known about it (if it even existed) back when I ruptured my achilles tendon in 2001. I can appreciate all your posts and think it’s great that everyone shares so much useful information. That’s what I’m looking for. As I mentioned I ruptured my tendon in 2001 when I was 23. I had it surgically repaired, it healed long and then I had it shorted by another surgeon in 2003. The 2nd surgery did not shorten it enough. For many reasons, but mainly because of a loss of faith and few options (my FHL was used in the 1st surgery and my 2nd surgeon said I could consider a transplant from a cadaver were I to opt for another graft) I have not had any surgical work done since 2003. Considering the permanent weakness and compensatory issues that I’m anticipating as I age (knee, ankle, toe issues etc) I’m once again looking around for a surgeon for potential options. I’m specifically looking for doctors that have a good track record for revisions (ideally some who’ve done revisions of a revision). I live in New York City. My 1st surgery was done here, and my 2nd was done in Baltimore. I’ve just started making phone calls and appointments in the city to find doctors that might have or know surgeons with the experience I am looking for. I’m hoping some of you here might be able to send me information for doctors who have helped you. I would really appreciate any names you could pass on.
    Thanks in advance for your help.

  27. I’ve got a puzzlement about this whole thing, JB, and maybe you — or Doug53 or one of the other Docs — can help solve it.

    I don’t see why a “revision” of a too-long healed AT should necessitate a graft, any more than on original “normal” ATR. Assuming the tendon has healed too long, but otherwise normally (just an assumption), I’d think that having it surgically cut (essentially “re-ruptured”) and simply reattached at the right length (essentially “surgically repaired”) would (a) solve the too-long problem and also kick-start the massive inflammation-and-healing process that a “normal” ATR triggers.

    My recollection of the studies on “normal” ATRs is that grafts DON’T produce better results (pace Beckham and his famous surgeon), on average.

    If anybody can see what I’m missing here, I’d appreciate it.

  28. Norm,

    I don’t see the logic, either, so I’m as puzzled as you are. Just like the question of surgery for reruptures, it is a relatively rare problem that would be hard to study in a good randomized trial.


  29. BTW, on re-reading my post just above, I’m reminded of a funny cartoon from New Yorker mag (a LONG time ago): Sophisticated-looking couple leaving a party, she says to him, “Dear, you should never do those ‘a and b’ things, because you never do get around to ‘b’!” The good news is that I DID get around to “(b)” — but I forgot to label it!

    Now if only I could ensure that this is my biggest boo-boo of the week. . .

  30. Norm,
    My original surgeon used my FHL tendon to reinforce the repair. I ruptured my AT while jumping (landing out of the air) I was a professional ballet dancer. The tendon frayed at both ends and retracted up my leg. The repair used had been performed on other dancers and was meant to return me to dancing. For the 2nd surgery, we opted for the z plasty so the tendon could be partially cut in two spots and “tucked” up to not sacrifice its integrity and risk re rupture. Both surgeons were dance specialists. The suggestion for a cadaver’s tendon was really a suggestion for a full transplant. The work I’d had done by that time meant there was not enough ‘untouched’ tendon to work with. Between the fraying, the fhl suture and the z plasty most of the area between my heal and calf has been re constructed resulting in extra thickness and stiffness. It’s like the difference between a small tree branch and a twig. In effect, the repaired tendon is really strong but the length tension ratio is off so mechanically it doesn’t work properly. Had the tension been restored it would have been strong enough for me to dance again.

    As you said, having it surgically cut (essentially “re-ruptured”) and simply reattached at the right length (essentially “surgically repaired”) might solve the too-long problem. That is where I am looking for some expertise/specialty because it would require cutting through the previous work and hitting that length tension ratio which was missed the last 2 times.

  31. JB - Sorry to hear you’re still dealing with a tendon length issue. I don’t know any orthos in NYC, but I’ve been in touch with another individual who’s gone through the shortening procedure, and who I believe has been in touch with an ortho in NYC. If I can get any information I will pass it along to you.

    As for Norm’s question, from the information I’ve received/gathered, a tendon augmentation/graft may not necessarily be used as a way to make the AT stronger than normal, but more as a way to maximize the chance that the AT will get back to normal strength. If the AT is relatively healthy, an augmentation/graft may not provide any additional strength. However, if there is significant degradation or scarring from a previous injury, the augmentation/graft may help with the healing process. In other words, you might not be trying to heal to 110%, but just improving your odds at getting back to 100%.

    As Doug mentioned, AT reconstruction is relatively rare so there probably aren’t a lot of good, reliable clinical studies. Therefore we’re left with a surgeon’s prior experience and best judgment when determining if an augmentation/graft is necessary.

  32. For sure it’s all professional judgment here, especially for second-time repairs on the same tendon. But if I’m remembering correctly the studies on grafts vs. no grafts, those results seem to undermine the “logical” conclusion that grafting on an extra bunch of stuff creates a stronger finished product.

    Science is full of logical hypotheses that don’t pan out, and this little sub-discipline of “ours” seems to have even more than its share!

    Just speculating here, but. . . There are probably some people — especially those with compromised ability to heal and re-build “new” tendon — who might need a graft to get near 100%, and wwho ould also benefit from one — at least if it successfully healed well enough to stay alive and get nourished properly.

    But the more I learn about ATR recovery, the LESS it seems like what auto mechanics do for a living, and the MORE it seems like what God-or-Mother-Nature does with all healing. The key question with a graft isn’t whether or not it has, or initially adds, some strength. The key question is how it changes the final, fully healed, tendon. If (as I recall those studies), it doesn’t add any extra strength at 6 months or 1 year post-op — when most patients are still NOT back to 100% original strength — then maybe it’s another surgical intrusion without benefit, except maybe in very rare cases.

  33. Tom
    I would be interested in information on ALL orthos you or anyone on this blog have that have experience with shortening procedures. That seems to be the hardest part of researching - finding Dr.s anywhere that have performed this procedure with success.

    Most foot/ankle surgeons do AT reconstruction but beyond calling and asking their staff if they do revisions (or revisions on revisions) there is not much to go on. And obviously Dr.’s don’t publicly disclose their surgical successes and failures so recommendations are the best way to go.

    I am of course looking at docs in NYC but not opposed to calling or visiting docs anywhere.

    My email is I would be very grateful for information from anyone.


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