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Achilles tear no surgery

post #1 of 13
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 13
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 The doctor said my tendon was withdrawn well into the calf.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 13
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 13
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 13
I'd consult an additional orthopod or two about the need for surgery on the Achilles.
post #6 of 13
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 13
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 13
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 13

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 13
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 13

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 13
Another heel lift approach: Rise up on two, let down on the injured one.

Icing with elevation also helps swelling.
post #13 of 13
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.
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