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Achilles tear no surgery

post #1 of 38
Thread Starter 
In May I had a complete tear of my left Achilles tendon. Surgeon decided non-operative therapy was best course. So I endured a week in a cast and 10 weeks in a walking cast with wedges under the heal. Then 2 more weeks in boot gradually taking wedges out. I have had boot off for 3 weeks now with physio and exercises. I have gain most of my leg muscles back but ankle is still very weak. Surgeon said to keep raising myself onto my toes and work towards walking on my toes. There is no way I can even raise myself. I try daily and there is zero lift. There is still a lot of swelling at the end of the day and lots of pain after any exercises.

Has anyone out there been through the non-operative treatment and if so is my recovery or lack thereof normal? Is this what you went through?
post #2 of 38
I've heard of nonsurgical treatment of partially torn tendons taking many months to years. Never heard of nonsurgical method resulting in reattachment.

When I blew out my Achilles (detached about 1.5 inches above its anchor at the heel), I had the surgical repair. The doctor said my tendon was withdrawn well into the calf. My recovery took almost six months of casts and boot and a couple months of PT, with almost a year of daily stretches standing on a ramp for five or more minutes to get back to almost normal. If I don't stand on my 35-degree ramp regularly now, a dozen years later, the tendon loses flexibility.

I cannot understand how a nonsurgical approach to a complete severing of the tendon would even work, let alone be as fast as you describe.
post #3 of 38
What does your PT think? Lately I've learned they can be smarter than some doctors.

I just googled "can a detached achilles tendon heal itself" and got a lot of hits, if you want some recreational reading. Remember, though, stuff you read on the Innertubz may or may not be true.
post #4 of 38
Thread Starter 
GP says no PT yet as ankle is not healing and needs surgery. orthopedic surgeon says it will take time and just walk on it. The OS has a great reputation and he did my knee surgery (quadricep tendon) 5 years ago and did a great job. But OS says PT won't help any more than walking. With knee, my PT was fantastic and primary reason I got better. So I am confused. Which Dr do I listen too? There is a big gap in the back of my ankle and a golf ball size lump at the top of the tear.
post #5 of 38
I'd consult an additional orthopod or two about the need for surgery on the Achilles.
post #6 of 38
I ripped my tendon completely a few years back. Many of my relatives are doctors and they arranged a phone council regarding my treatment smile.gif The verdict was surgery. It was about a year before I could run again, but since then I had zero problems. I know a completely ripped tendon can heal without surgery. My relatives told me without surgery it
may rip again, but with surgery it is extremely rare.

These are just a few thoughts from a layman and you have to use your own judgement. Another factor is that I am from Sweden where health-care is for free. Not sure if economic arguments play a role for your (and your doctor's) decisions.

Good luck with your recovery!
post #7 of 38
Thread Starter 
Thanks for the advice. I live in Canada and health care is also free. First opinion I easy. Second opinion can take a long time as health care system has to approve the 2nd opinion first. I'm waiting on approval for 2nd opinion now.
post #8 of 38
Quote:
Originally Posted by ankhsign View Post

Thanks for the advice. I live in Canada and health care is also free. First opinion I easy. Second opinion can take a long time as health care system has to approve the 2nd opinion first. I'm waiting on approval for 2nd opinion now.

Sounds as bad as obtaining a second opinion when dealing with worker compensation injuries here.
post #9 of 38

I ruptured my Achilles in August of 2010 (softball, rounding first with visions a double)

 

It was torn but did NOT roll up to the calf muscle

 

I did not want to go with surgery - infection risk, scars, adhesions, etc

 

At U Mich Foot / Ankle they have a protocol for who does or does not qualify for

a non-surgical treatment.

 

I had two ultrasounds taken, with one my foot at 90 degrees (torn ends farther apart)

and the other with my toes pointing down (torn ends closer)

 

I dont know the cutoffs but my "gaps" were 15 mm and 7 mm respectively, which

was close enough for them to admit me as a non-surgical patient.

 

Hard cast with foot down (28 degrees), then aircast (removable) with heel wedges,

then back the heel wedges down over several weeks for each wedge.

 

I skied December 2010 and ran marathons in 2011, so i could not be happier

with my decision.

 

HIGHLY HIGHLY recommend www.achillesblog.com

 

tons of support, information and advice

 

good luck

PM me if you care to discuss.

 

Brad

 

ps - tendons do grow back together; the Achilles tendon is the largest one in our body.  Even with surgery,

what the stitches do is hold the opposing ends in close proximity, then our body does the rest. One of the proponents

of non-surgical is at U Western Ontario - London.

post #10 of 38
OP describes a "big gap" where the tendon is missing, not a 7 to 15 mm gap, and a knot at the calf muscle. Maybe when the gap is small, the sheathing surrounding the tendon remains intact and promotes reattachment.
post #11 of 38

Hi Kneale,

 I didn't see the part with a big gap and a knot at the calf (from the OP)  (I see it now in the second post from ankhsign)

 

Independent of that, the distance between the ends is key, which is why the ultrasound may

disqualfy that treatment option if the gap is "too big".   If his doc recommended / allowed non-surgical

I would hope they would have checked the proximity of the two ends.

 

If it rolls up into the calf then surgery is the only option...not sure what happened with the OP

 

Most re-ruptures take place in the first 12 weeks after initial.

 

I had a "void" where the rupture was took place but no lump.

In my case the top and bottom of the tear were essentially the same.

 

I did find the full strength takes a LONG time to get back

Even today (two years later) i cant do the same one-legged heel raise

on my left as i can on my right.

 

@ankhsign:  have you tried assisted heel raises? (ie both feet, or one foot with an assist from your hands (hands on a countertop))

 

if you have swelling at the end of the day then elevation is a good thing to do.    it does get better :)

post #12 of 38
Another heel lift approach: Rise up on two, let down on the injured one.

Icing with elevation also helps swelling.
post #13 of 38
Thread Starter 
Thanks for the comments and feedback. Hearing the experiences of others I very helpful. I was in a hard cast for a week and the had a walking cast with heal wedges for 8 weeks. Then removed a wedge per week for three weeks before removing the walking boot. Not 4 weeks without boot. Stil a lot of pain especially after any exercises. OP said to stand ald the walk on toes. There ain't no chanc this is going to happen. When I try to stand on toes there is absolutely no movement whatsoever. Good leg no problem. Torn tendon leg, absolutely nothing happens. Try raising on toes while sitting and I can raise the bad foot but it is more lifting from the leg muscles that the ankle action. Leg muscles have come back pretty well since losing he cast. Massage therapist had been working on the lump and it is getting smaller. Ice feet and ankle every night and elevate the leg to reduce swelling. MT says lots of gentle massage after ice to get the swelling down and the fluid moving. How long was it before you could rise on you toes?

Another problem I have is stairs especially going up. My toes tend to drop causing me to trip on edge of stairs. I have being trying to build up muscles. Muscles are cooperating but tended isn't.

Thanks again for your comments and suggestions. Going to achillesblog.com right now.
post #14 of 38

I tore my right achilles this July, and my recovery approach has been what the industry refers to as "the neglected achilles rupture", which means I am doing nothing special to it (no surgery, no boot, no immobilization, etc.); I am just basically walking it off.  Yes, it's a long walk, and there seems to be a long walk ahead of me.  Need to understand that when the achilles pops, there is a perimeter sheath around it that remains intact.  My tear was about 4-5 inches up from the ground, and it left about a 3/4 inch gap/dent between the two ends.  What happens over the subsequent weeks is that gap gets filled with fluids that will eventually reform the tendon.  The entire process obviously takes up to a year.  At just over three months now, the dent I had is just starting to get solid again, which is part of the reforming process that comes before the tendon gets fibrous again.  So instead of having my tendon stitched back together tight, or having my heel immobilized at a flexed angle to allow it to reform tightly together, I am allowing the extra length for the recovery.  I believe this will prevent the possibility of re-rupture, as extra temporary length is more forgiving.  Eventually, the tendon will shorten again to optimal length.  The industry says I will never regain full strength back this way, but I don't believe that.  I just think the body knows more what to do than the surgeons who have a profession to maintain.  I also didn't like the idea of having the sheath cut or poked into, which allows outer and inner fluids to mix, which is unnatural. We shall see in the end how much approach fares, and what excuses the industry come up with for proving the body smarter than the industry.  Although my right calf still show signs of a failed Thompson test due to the extra interim length, I have seen no muscle atrophy, as my total body training has continued despite the tear.  I believe my Planteris muscles (other smaller muscle group in the lower leg) have bulked to carry the load on that side during the recovery.  I am thinking, in the long run, my right leg may actually become stronger as a result of the tear with this approach.  If interested you can follow my progress at youtube channel "61 Custom Rebuild".  

post #15 of 38
Quote:
Originally Posted by Pete Wagner View Post
 

 The industry says I will never regain full strength back this way, but I don't believe that.  I just think the body knows more what to do than the surgeons who have a profession to maintain.  I also didn't like the idea of having the sheath cut or poked into, which allows outer and inner fluids to mix, which is unnatural. We shall see in the end how much approach fares, and what excuses the industry come up with for proving the body smarter than the industry. 

 

It's true, the body heals itself (or at least tries to). Surgeons simply optimize the conditions for your body to do its thing.

 

I sense your disdain for the medical profession, and fortunately for you no one will force you to seek medical care. You're not alone in that sentiment; I've read of others who don't want to go see doctors, which is fine by me -- I haven't seen a doctor in over five years. It's always seemed to me though that if a person wanted to really live by those convictions and avoid hypocrisy he should remove himself from ALL medical care. If he were to find himself with a bone poking through the skin, he would have to put it back in there himself. If he were to look down to discover that his intestines were visible then he would have to tuck them back in there himself. If he were to develop a raging sepsis then he would have to manage it himself. If he were to discover a melanoma then he would have to either cut it out himself or let it run its course. Regardless, the medical industry won't shut its doors to you even if you shut your doors to it (just in case you chicken out and decide you want help).

 

I'll follow along to see how your Achilles rupture fares. I hope you keep updating us on your progress, good or bad. Good luck!

post #16 of 38

Thanks, no I don't necessarily see science as a bad thing, and yes I have a comprehensive medical insurance plan that I would use when I think it could help.  But I believe the body knows best how to handle soft tissue issues, and I do have extensive experience with that.  Further, clean diet (not easy these days), good exercise regimen is the best medicine.  I went to see the orthopedic specialist for a consultation to get a better idea of what was going on down there, this was about 5 weeks after the rupture.  First off, they kept asking me if I needed pain medicine; I had to say no a few times.  Then, after waiting a good hour, the specialist finally came in, performed a Thompson test, and said there was still a small window of time to perform surgery (on my "neglected achilles injury"), and that without surgery I would never be fully functional again.  I told him I didn't come in for surgery, but just wanted to understand the body's natural processes and what to expect going forward.  He threw out some long latin medical terms and was done in describing it in 20 seconds.  I asked him if he would be interested in following my progress for purposes of broadening the medical documentation on "neglected" cases.  He wasn't.  Then you hear about all the complications and multiple surgeries for what doesn't even need to be operated on.  Pretty much clear to me, it's at least half money racket, if it's half good.  You can follow along my youtube channel (61 custom rebuild) if interested.  We shall see, but I'm feeling very good about my recovery.  

post #17 of 38

Just a tip: I tried to watch your most recent video from 6 days ago but it's really long and I lost interest after about a minute. Updates of 60 seconds or less would keep peoples' attention better.

post #18 of 38
Quote:
Originally Posted by Pete Wagner View Post
 

Thanks, no I don't necessarily see science as a bad thing, and yes I have a comprehensive medical insurance plan that I would use when I think it could help.  But I believe the body knows best how to handle soft tissue issues, and I do have extensive experience with that.  Further, clean diet (not easy these days), good exercise regimen is the best medicine.  I went to see the orthopedic specialist for a consultation to get a better idea of what was going on down there, this was about 5 weeks after the rupture.  First off, they kept asking me if I needed pain medicine; I had to say no a few times.  Then, after waiting a good hour, the specialist finally came in, performed a Thompson test, and said there was still a small window of time to perform surgery (on my "neglected achilles injury"), and that without surgery I would never be fully functional again.  I told him I didn't come in for surgery, but just wanted to understand the body's natural processes and what to expect going forward.  He threw out some long latin medical terms and was done in describing it in 20 seconds.  I asked him if he would be interested in following my progress for purposes of broadening the medical documentation on "neglected" cases.  He wasn't.  Then you hear about all the complications and multiple surgeries for what doesn't even need to be operated on.  Pretty much clear to me, it's at least half money racket, if it's half good.  You can follow along my youtube channel (61 custom rebuild) if interested.  We shall see, but I'm feeling very good about my recovery.  


Just curious, Pete...

 

Have you done very much research on untreated full tears of an Achilles?  I don't have a lot of experience with that injury but the experience that I do have (a couple of athletic friends) would lead me to seriously doubt that a fully-torn Achilles would heal itself.  

 

Since I was present on the baseball field when one of those friends' tendons went and I could hear it from across the infield, I have pretty vivid memories of the injury.  He    could    not   walk   afterward.  

 

It's a real stretch (pun couldn't be avoided) for me to believe that would ever have healed itself.

 

Good luck with your recovery.

post #19 of 38

Yes, Bob, read my earlier post.  It definitely will heal itself without surgery, but they want you to believe that the lengthening of the tendon is a permanently bad thing.  From what I have read, there are no "documented" cases of neglected achilles returning to full function.  But as I have discussed in my vids, the body of evidence seems to be filtered.  The study on "neglected achilles" injuries has average age of the person like around 70.  So it seems to me, that they are studying patients who come into their doctors with issues resulting from torn achilles that were untreated.  You would not go to your doctor for an untreated torn achilles that healed up nicely, as mine is doing.  It needs to be studied, but the industry, at least the specialist I saw, was not interested.

post #20 of 38
Quote:
Originally Posted by Pete Wagner View Post
 

Yes, Bob, read my earlier post.  It definitely will heal itself without surgery, but they want you to believe that the lengthening of the tendon is a permanently bad thing.  From what I have read, there are no "documented" cases of neglected achilles returning to full function.  But as I have discussed in my vids, the body of evidence seems to be filtered.  The study on "neglected achilles" injuries has average age of the person like around 70.  So it seems to me, that they are studying patients who come into their doctors with issues resulting from torn achilles that were untreated.  You would not go to your doctor for an untreated torn achilles that healed up nicely, as mine is doing.  It needs to be studied, but the industry, at least the specialist I saw, was not interested.

 

when I "popped" mine the treating hospital said:   Surgery OR Ultrasound to see the "gap" between the ends. The gap was assessed with toes down (relaxing the Achilles and bringing the ends closer) and also with ankle at the typical 90 degrees if one were standing.  I think the big gap was < 7mm, and smaller around 4mm.  These two numbers were small enough that they would treat me as 'non-surgical'      So that's what I did

 

But they had me in a solid cast with toes down (3 weeks) then a "boot" with heel lift over the next 9-12 weeks, with the heel lift being lowered over time.

Surgery or no surgery, the recovery plan is identical: cast --> boot --> walking.

 

*my suspicion* would be that a "lengthened tendon" would mean you would lose some of your explosiveness/pop,

sort of like a delay in a cars transmission when you hit the guess.  pure suspicion, no data.

 

My (unsolicited) advice would be to focus on one legged exercises that specifically target the calf on that leg.

Mine was five years ago (and 10 marathons ago) and my affected calf is still weaker and smaller than the other

 

Good luck with it.

post #21 of 38
Quote:
Originally Posted by docbrad66 View Post
 

 

when I "popped" mine the treating hospital said:   Surgery OR Ultrasound to see the "gap" between the ends. The gap was assessed with toes down (relaxing the Achilles and bringing the ends closer) and also with ankle at the typical 90 degrees if one were standing.  I think the big gap was < 7mm, and smaller around 4mm.  These two numbers were small enough that they would treat me as 'non-surgical'      So that's what I did

 

But they had me in a solid cast with toes down (3 weeks) then a "boot" with heel lift over the next 9-12 weeks, with the heel lift being lowered over time.

Surgery or no surgery, the recovery plan is identical: cast --> boot --> walking.

 

*my suspicion* would be that a "lengthened tendon" would mean you would lose some of your explosiveness/pop,

sort of like a delay in a cars transmission when you hit the guess.  pure suspicion, no data.

 

My (unsolicited) advice would be to focus on one legged exercises that specifically target the calf on that leg.

Mine was five years ago (and 10 marathons ago) and my affected calf is still weaker and smaller than the other

 

Good luck with it.

 
My gap, more like a dent, seemed about 3/4 inch when standing.  It never closed, but has gotten solid as part of the remodeling phase.  That side still gets no response to the Thompson test (at 14/15 weeks), so the extra length is now there for me to deal with going forward.  No muscle atrophy at all.  My gut tells me it's the way to go, no or little chance of rerupture (although I am not pushing it), and no issues with stiffness and flexibility.  When we sleep, our toes more point like a dancers, and I assume over time the tendon will shorten naturally.  I'm not expecting a world record recovery at this point, but a full one, and maybe even coming back stronger.  But this will take it's time, probably a year if not more.  We'll see.  I'm sort of playing guinea pig with myself on this.  So far so good.  Thanks!

post #22 of 38


Is it too late for me to reply to your post?

I would like to tell you about my experience with a "neglected tendon rupture".

post #23 of 38
Quote:
Originally Posted by katehanley View Post
 


Is it too late for me to reply to your post?

I would like to tell you about my experience with a "neglected tendon rupture".


Welcome to EpicSki!  Probably too late for the OP (Opening Poster) since Post #1 is from 2012.  However, others in similar situations would undoubtedly like to hear about your experience if you would like to share.

post #24 of 38

I would like to hear your experience.  My "neglected" achilles has come back so nicely, I plan to play semi-pro football starting next month.  The ruptured side actually now feels better than the other side.  I'm now at 14 months.  Age 55!

post #25 of 38

My experience:

I had a bad fall  UP some stairs after maybe turning my foot wrongly.

Could not get an appointment with my family doctor for four days.

When he eventually saw me he did the Thompson test which he said was OK and therefore  not a rupture.  Said maybe only partial rupture but he did not advise me to immobilize it.

He did not even suggest an x-ray or ultra sound.

I went for another opinion at a walk-in clinic which doctor sent me for an x-ray - negative - no bones broken- whereupon he booked me for an ultra sound,  It took over four weeks to get this ultra sound (British Columbia in Canada!) and five weeks by the time I got the result:  an 80% achilles tendon rupture.

The walk-in clinic doctor suggested I get some advice from an ortho surgeon.

He saw me within two days.  Did the Thomson test on BOTH legs.  Showed only little movement in my injured leg.  Therefore he said he could do surgery the day after.  This was apparently still in the good timeframe to do so.  Also said had I been 85 years of age and not 77 as I am - he would have not advised surgery. I elected to do research on pros and cons and decided against it.  He phoned my family doctor (the one who did nothing about it)

and said he advocated surgery. He also must have balled him out about having done the thompson test only on one leg and having not immobilized it.  (The ortho guy had a student in his office at the time I went for consultation and he stressed to her that the test should have absolutely been done on both legs) I went and consulted with both family doctor and the walkin clinic doctor and came to a mutual decision to go the "conservative" route.

Although this was rather weird as I had been walking around on it for over five weeks! and should have been immobilized. 

Had to wait another couple of weeks to begin physio.  Have been doing some exercises given by the physiotherapist who said it was too late for immobilization - this has been for r the last three weeks.  So I am now at week 12.

I am very worried as I have never heard of anyone else (except you) who has had a so-called "neglected" achilles tendon rupture.  I do not know what to expect as I have heard horror stories.  I have always been very active including lots of ballroom dancing but now am only hobbling around and go for walks with a cane but not for more than 20 minutes at a time.

But you seem to have done OK.  I congratulate you and would appreciate any hints or advice.

Thank you,

post #26 of 38

My advice:  If you feel like it is getting a little better, a little stronger, a little less swollen, a little more comfortable doing things, then you are in natural recovery, and you should not want any procedure that interferes or sets this backward.  Your sheath is almost certainly intact, which keeps all the body's remodelling fluids where they need to be.  Don't want to cut into that and mess things up or run risks.  I would say keep on it, keep moving so long as there is no pain, as this helps the recovery process.  You might want to google DMSO and try it; I use it and believe in it.  Give yourself 16 months of recovery time to hit top potential; it is not a quick recovery.  You'll lose calf size but will add strength in some other smaller muscles.  You may have to adjust your gait as a result of the adjustments to your mechanical structure.  Movement emanates from the core, so focus closely on your hips when walking, always moving in the most comfortable way, even though it might be different than before.  The goal is not to return to your old form, but to regain full healthy function as you want.  Good luck. 

post #27 of 38

Hi Peter, 

I am so glad I found this thread- thank you (and all) for contributing! :) 

 

I have recently had achilles repair surgery on my right foot.  Tomorrow at my 6 week follow up, I should get clearance to start walking on it again.  However, I have over-exerted on my left ankle, and now it feels like I might have done something to it.  It's definitely sensitive, weaker and sore, but definitely did not have the traumatic explosion that brought me to the UR with my right one.  My left leg has just been getting gradually more and more sore over the last few days.  Then a couple of days ago I was hoisting myself up my stairs at home when I felt a little discomfort in my ankle.  Nothing major, but now I'm taking it easy.  I feel a bit flat-footed and weak, can still lift up on my toes, but all in all, not bad.  

 

SO- my question for you Peter is what did your "neglect remedy" or whatever you called it, look like?  Did you wrap your ankle?  What type of rehab did you do?  I think I'd like to follow something like this, considering I JUST had surgery and I need my left leg right now.

post #28 of 38

Rachel, my approach says there's no one rote way that will work for everyone.  But I believe DSMO helps the fluids circulate and do what they need to do to support the recovery.  Beyond that, movement in therapeutic ways is necessary.  How to move should be determined by you.  Gravitate to what feels best and strongest for you.  Tendon injuries may require a mechanical adjustment in your movements.  The Achilles structure if formed when we are children, and thus becomes tight as we grow and age.  Rupture may loosen it up, create extra length, and so your mechanics on that side must also change.  This is not a bad thing.  Stitching up a rupture can marginalize its functioning in various ways, so that's another factor.  My advice would be to walk in small circles (10-15 ft diameter) and focus intensely on how your lower body feel from hips down.  Go slowly, and make adjustments in your gait to improve the strength and feel of your movement.  Clockwise and counterclockwise.  If one way feels better, do that way, but switch up every now and then.  I find clockwise feels better.  Go longer and faster and gradually incorporate a skip into it.  Only wrap if it doesn't feel good without the wrap.  Otherwise just work the feel in a raw way.  Try it and let me know.  Do to the interest I'll be doing a new video on my "61 Custom Rebuild" youtube channel on this, within a few days.

post #29 of 38

Kate and Rachel, for you:  https://www.youtube.com/watch?v=3P5kBjIFjEk

post #30 of 38


hi, i ruptured achilles 80% and due to  a wrong diagnosis i walked on it from day one.  OS wanted to operate when we diagnosed it at 5 weeks - i refused surgery - it is now 13 weeks and i have been walking on it continually.  have some PT but he says walking is the best thing for it.  plus a bit of theraband exercises.  

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