Achilles Tendon Rupture, Non-surgical. 4 weeks after the ‘pop’ & have questions

Bones, joints and muscles
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39y/o active male. 5’-11” / 190lbs 

ATR on left leg happened playing coed softball on 8/2/18.  Started to chase a guy to tag him out, 3 steps into the chase on the ground. I immediately knew what happened so was at the ER being seen by a doc within 45 min.

First ER doc I saw said it was ruptured but wouldn’t need surgery(this was before x-Ray & ultrasounds) Second ER doc I saw who was privileged to my test results told me, “100% surgery kid” we can get you into see one of our OS tomorrow. I asked why the discrepancy between the two and he said the other doctor was mistaken, and I def needed the surgery. 

My mom is a nurse at another local hospital system(ranked higher than the one I went for ER if that matters) and friends with one daughters of the Orthos who worked out of there. Saw him the very next morning to get a third opinion. He confirmed the ATR and when reviewing my options he told me  “the only reason i would advise using surgery is if you were a professional athlete or trying to be one” “if you were my son, He’d be going the conservative, non-surgical route” “there’s only a 10% high change of rereputer compared to surgical using this method.” All these things made me feel great, I didn’t want to undergo the knife, no hard cast, no heavy pain meds and could go back to work in a coupe days...and only 10% re-rupture rate!? That was all I needed to hear. 

He gave me a boot with minor wedge inserts, told me to take it easy for a week then use my judgement for WB and come back to see him in 3 weeks. 

My job is pretty high paced, I averaged 18k steps a day before my injury so I was nerous about how being booted up and riding around a scooter would affect my productivity. My worries we’re valid, I had to take more breaks, work less hours when needed, and couldn’t make many of my out of office meetings. So I started falling behind, which my company has been great with accommodating my workload until this is over with. 

I love to play sports. At 29 I regularly play softball, basketball, football, sand volleyball, mountain bike, snowboard and water sports. The strengths

 of my game have always been my speed, acceleration and agility.  I’m worried that I’m never going to be close to those levels again even if I take PT very seriously. 

So, after 4 weeks of das boot and being the scooter guy at work. I’ve reading countless articles on this injury,  and I feel like I might have made the wrong choice by using  non surgical repair method. I feel like my doc should have made surgery seem like a better option for someone with my lifestyle. 

Does anyone agree? Or am I just being pessimistic? 

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FYI - I’m 29, not 39

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Hi, it’s easy to be pessimistic with this injury!! I was until my boot came off and I was sure it had healed...which of course it had. I am ahead of schedule with physio and although my foot aches my Achilles is very strong.  I think rehab is a little longer (and I’m 47) than surgical but I wouldn’t change my decision.  I’m in the uk and research shows rerupture nearly on a par between surgical and non.  I had a Vacoped boot which I could weight bear on from day one!! Which made a huge difference in mobility.  Stick with it, if you are young and fit I’m sure you’ll be back to normal soon 

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I popped mine and also went  non surgery as advised for the same reasons you state. From my research there’s a 80% chance of it not rerupturing as opposed to surgery which boasts a 90% chance of success. BUT non surgery gives you 0% chance of nerve damage/infections/scarring. So there’s the trade off. I did rerupture but I am well on the road to recovery now but my left calf is tiny compared to my right and I retired from playing football (soccer depending on where you live) as I don’t know why I ruptured, is it now a weakness?? Plus I can’t afford the risk of rupturing again.  If I could rewind time I would like to know what docs think about using a electrical machine to stimulate the calf muscle during recovery from as early as poss. The name of recovery is to regain mobility of the ankle as well as strength, so the earlier you can do this the better. I am 18months on from my rerupture and the injury doesn’t affect my home or work life anymore but I wouldn’t like to play football and pivot to much on that leg as I still don’t trust it as it broke so easily both times.

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Hi Mike,

I should first say I have not had any personal experience of Achilles surgery. I have had undiagnosed issues with both my ankles for a few years now. I am 38, and the lack of an explanation for my problems and the enforced lack of exercise is driving me crazy. Apparently I am not in sufficient pain for it to be tendonitis!

Anyway, my situation has lead me to do a lot of reading around online (probably too much!). And what I have seen quite a few times, is that if you have an Achilles rupture, and you want more from recovery than just to be able to walk, you probably need surgery. And it sounds very painful and slow, and obviously there is risk with any surgery of infection and other complications, but it seems surgery followed up by fairly extensive physio gives the best outcome for someone active.

What prognosis are you being given by your doctor/physio/whoever is supervising your recovery at the moment? I guess the need for surgery may be dependent on the extent of the rupture.

Obviously, I would not suggest making life-changing decisions based on googling. But I know it is so frustrating when you get mixed messages from the experts. At least you have contacts within the healthcare system which gives you more options by the sound of it. I am just stuck with whatever I can get from the NHS the referral system!

Best of luck with whatever you decide! Hopefully someone with experience of surgery will respond. There are some folks on the Cycling UK forum with experience of this, might be worth a post there as well.

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Oops, loads of people have responded!

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Hey Mike I also ruptured my Achilles and now 2 years post op. I'm glad I had surgery because it allowed me to become active again. Not as active as before(by choice) but I'm working out again. I will be honest and tell you that after the procedure I experienced a burning sensation and that's because the nerves were trying to reconnect in the foot. Also therapy is EXTREMELY IMPORTANT because you'll have to rebuild strength in that leg and calf muscle. I was off from work for about 5 months, but I am also alot older than you are...lol so it took me a little longer to heal and I was blessed to have enough time to cover my sick leave. If you decide to have surgery be sure to ask questions about anesthesia, type of procedures the pros and cons. My Achilles feels like new and stronger than ever.

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If you are on Facebook, I advise you to check out "Achilles Tendon Rupture Group". It is a private FB page, There are many stories and help to be found there. I recommend you check it out. I think you will find it very beneficial.

I went non-surgical route and very happy to have done so. Either way, the recovery time and process (other than healing of wound with surgical) is pretty much the same. Good luck.

 

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Hi Mike,

I don't think anyone knows whats the best solution for this dreadful injury. I'm 69 and , non op and happy with my progress at 15 weeks, still walking with a slight limp and can manage to walk an hour non stop and potter about all day. The thing is, that even when pro athletes have an operated achilles many dont reach the standard they were before. There is no conclusive evidence, as far as I know, that operated is better than non op at the year point. Current train of thought seems to be that non operated and early weight bearing is the way to go for quicker healing and less re rupture if going the non op route.

You are at an age now where you should be thinking about the longevity of your joints for older age use and maybe you should consider sports, like swimming, cycling and hill walking where you are less likely to re rupter

or break bones or get arthritis later in life.

It's like I told my son at age 34, consider stop playing english football/soccer before you end up with broken bones and tendions. He didn't totally listen but just plays occasional football, at age 37, but gets out on his bike a lot.

Sorry to be a kill joy but you can still get loads of enjoyment out of other less explosive and physical sports.

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Sorry this sentence is not correct

''Current train of thought seems to be that non operated and early weight bearing is the way to go for quicker healing and less re rupture if going the non op route.

It should read

''Current train of thought seems to be that early weight bearing when instructed, in boot , is the way to go for quicker healing and less re rupture if going the non op route.