Achilles Tendon Rupture Recovery Manual

Reading Time: 12 minutes, (but if you follow all the links an hour or so); Skimming highlights, 2-3 minutes.

Before we get into the very serious business of making sure you can heal your ruptured Achilles tendon in the best way possible, I think we can all agree that if that statue is a faithful representation of Achilles, then we can better understand why he was eager to live fast and die young. He certainly wasn’t going to be remembered for his penis size was he?

Secondly, let me add the standard disclaimers: I am not a doctor, the information provided here is for information purposes only, blah, blah, legal crap, blah. Bottom line: You take responsibility for your own outcomes. I present this information here because when my injury happened to me it was very hard to find any good information on how I could go about ensuring I didn’t remain a functional cripple for the rest of my life. The information relating to the recovery of full Achilles tendon ruptures on the net was so wide-ranging it seemed to be the work of a thousand monkeys. Recovery rates and times varied wildly and it was hard to understand why. I personally contacted other people who had this same injury and again, it seemed their recovery rates differed from mine quite drastically, but by speaking to them I could begin to understand why. Their recovery regimes differed from mine in several important ways and it is my personal view that this had a lot to do with it.

Type of injury: The type of injury you actually have will of course affect everything. Mine was a COMPLETE Achilles Tendon Rupture. That is, the tendon was fully snapped. There was about an inch gap of “empty” flesh where the tendon at the back of the leg, just above the heel should be. So these notes are mostly for those type of injuries, which is also the most severe kind. Important: If you have this type of injury it is imperative you receive surgery within 48 hours according to most good medical experts I have discussed this with. On a personal note, I was also strongly suggested by the doctors and nurses on duty at the hospital shortly after my injury, to NOT have surgery. Again, this is just my opinion, but I am sure that had a LOT to do with trying to save money for the NHS and nothing to do with what was best for me. I am a layman, not a doctor, but it is my considered opinion that if you ever want to be able to walk and use your leg normally again, the only way to do that with this type of injury is with surgery. And good surgery at that if you can get it. So don’t let the docs “persuade” you to do the cheaper and easier thing for the government.

Expected prognosis: Assuming you had surgery within 48 hours and assuming your surgeon was not trained in a sausage plant factory, you will generally be told that you should be “back to normal” within 6 to 9 months if you are fit, have no health problems and generally heal well, otherwise they will tell you 9 to 12 months but up to 18 months before you are “fully operational” again. This can all be a bit confusing, so here is my interpretation:

  • According to a search done on the rather extensive NHS database for physiotherapists and doctors that my physio did for me, the actual tendon, once ruptured will take on average about 6 months before it has healed to full strength. As with all things biological, this is just a guideline.
  • The main issue with proper healing of this injury is to have good blood-flow through the area. Blood pooling is common unless you keep the leg elevated, this is especially important for the first few weeks after surgery, but is a generally important point to keep in mind. Promoting ACTIVE blood-flow through the area and preventing the stagnation of blood in the area after surgery is important and probably the single most important point regarding healing of the actual tendon.
  • Even while healing, if you do not take APPROPRIATE action to manipulate, exercise and generally “activate” the area, the healing will not be ideal. The important point here is that you need to do enough to stimulate growth, healing, reacquisition of proprioception and so on, and not so much that you re-injure or impair healing through too much work on the injured area. This is the single most important point and it is really the crux of whether you will heal well or not. My personal experience was that everyone was telling me to take it easy, when instead I felt I had to do more work on the area. As it turns out, I was right, but it IS a fine balance, and it is EASY to make a mistake and re-injure yourself. I was EXTREMELY CAREFUL with all of my own invented little exercises, and I always used my own sensation of my own body as my guide. I cannot teach anyone else how to do this, you have to find your own way, but if you CAN do this, your healing of your injury will outperform most professional expectations. this at least, was my experience.

Actual Recovery Time: I snapped my tendon on the 22nd of June and had surgery on the 24th of June 2010. I am writing this on the 9th of March 2011, so about 8 and a half months after the surgery. My initial aim was to be able to walk properly 5 months after the injury as I was getting married at that time and would be in Brazil and I wanted to be able to swim in the sea, run around, train with Brazilian Ju-jitsu people and so on. I am happy to report that despite the fact I was repeatedly told these were unrealistic expectations, I hit all of my targets. After 9 months I wanted to be back to performing in training to the same level as before the injury. This was also considered wildly optimistic and unrealistic by many professionals I discussed it with. It is not quite 9 months yet, and I am not quite 100% as capable as I was before the injury (and I will give you details on that) but I would say that I am at least 90% of the way there. In some respects I am probably more than 95% of the way there, so I am still on track, and in the next two weeks or so I may well achieve my target or at least be very, very close to it. I also have no doubt that in time (however long) I will be as capable (or more, with further training improving my ability anyway overall) than I was before the injury.

Things I did that I think made the most difference

Immediately after surgery and for the next 3-4 weeks: Kept my leg elevated almost constantly. Did some self-hypnosis to improve circulation, if I lowered the leg, for a brief time it would feel “full” of blood at the bottom, so I would then also lift it again to ensure blood did not pool there. I spent most of my time with my leg elevated and not an inconsiderable time with it higher than chest level. This can (and did) cause me problems in the hip area later, but I am not sure how you could minimise this. I also slept with several pillows under the leg to try and keep it elevated during sleep. Getting good sleep made a LOT of difference and I would advise you to try to ensure you have good, deep sleep of long enough duration. I did not take many painkillers, but I did so for the first few days to ensure I slept as deeply as possible. In particular, a drug which helped me in this regard was the dihydrocodeine tablets (30mg), which I took only before sleep (1 tablet) and not even every day, but for the first 2-3 days after surgery I did. I also used a lot of self-hypnosis just before sleep and at various times throughout the recovery period to improve healing, relaxation and blood circulation.

After removal of the solid cast and use of the Air-boot: I was kind of lucky/unlucky with my casts, depending on your approach to things. My first cast was very heavy and solid and this caused me hip problems. I didn’t know when they put me in this cast that they had done so because they got the weird idea that being a sportsman I was a “dumb jock” and would probably try to run around my block or something, so they used plaster of paris and a heavy cast to help “immobilise” me. The result was an inflamed hip and knee joint due to the unrelenting weight which became pretty uncomfortable. I only found this out on my return to the hospital when the nurse on duty told me, as she was busy replacing my cast with the new, lighter (and colourful) fibreglass version. This was a godsent in terms of weight, but as it turned out, it had been put on a bit too tight and it blocked circulation a bit, causing me pretty impressive pain after about a week or so. So I had to go in before time and have it removed. At this point, though it was in contravention of what the doctors originally all told me, for some reason, they issued me with an air-boot. I suspect this was due to the fact that in their version of events it should have been solid cast, then fibreglass cast, then when that comes off air-boot, and that is what they did, but without checking the timeline. This was actually a GOOD thing from my point of view, because it allowed me access to the wound for the first time, and so I could also very gently begin some massage to help circulation as well as proprioception and healing. I had spent a total time of only 3 weeks in rigid casts as opposed to the minimum of 6 weeks I had been told would be mandatory. The down side of this is that at this point, your tendon is VERY fragile and if you screw up just once by falling, being careless, or somehow putting too much weight or pressure on it you have a very real risk of popping your tendon again. SO…if you ARE a “dumb jock” it’s safer to keep you in a rigid cast for another 3 weeks, but if instead you are more of a Batman, supercool, and supersmart jock, then this is the best way forward. You can even let your leg get a little sunshine (if you live in a country with sunshine) and let the leg “breathe” without any cast when you rest it carefully on pillows while you watch daytime TV and feel your brain cells dying even as your leg cells heal.

Important: If you live with animals, small children or careless adults, this is a dangerous option to take. A simple mistake of someone bumping your injured leg when it’s out of the cast can have some bad results. I was lucky in that I had Redhead Girl looking after me like only she can. Everyone should have a girlfriend as dedicated to nursing duties as she is!

In summary then, if you can get an air-cast sooner rather than later, do so as long as you can be careful. During this period, some exercises I think helped quite a bit, generally try to move your foot, do gentle resistance work and so on, always being careful to feel your limits and never push even just to these, but always hold a bit back.

The most important things I did here were:

1. Using the BEMER System. In fact I would advise you to use this immediately after surgery if you can. If I could do things again, I would use a BEMER mat right from the start for the first 4-6 weeks I think.

2. Swimming. You have to wait until your scar is healed to make sure there is no chance of any kind of infection, but swimming and walking in a pool was the single most useful exercise for the leg overall. After each session i could feel an improvement in proprioception and even range of movement, dorsiflextion etc. Sometimes when you have exercised the leg a bit too much, movement range decreases for a bit, but a couple of days later it suddenly makes a jump forward again.

3. Getting the right mental attitude. more than the swimming and the BEMER machines, has been my general attitude that I would do whatever it took to get back to 100% capability of use. Often that attitude resulted in me having to RELAX and take things easy and NOT stress instead of me being aggressively pro-active. Sometimes, the best thing I did was…nothing. just sat on my ass and read a book and took things easy. Also, the pretty constant self-hypnosis helped more than even would ever have guessed. Sometimes a dream or a self-induced trance allowed me to literally increase the movement range by almost an inch in a day without any effort or pain, just a shift of internal proprioception and muscular tension. This may sound like Voodoo, but it’s actually got a name: Psycho-cybernetics. Your mental attitude and self-identity really affects your body a LOT more than anyone believes.

4. Get a big shoe to match the height of your air-boot, so when you walk (assisted by crutches) you have the same height for your hips. this all goes to avoiding hip/knee inflammations which were the biggest problem for me. Besides, wearing platform/really thick flip-flops/stripper shoes for men is so much fun.


After the Air-boot:

1. Use your toes — do exercises to use your foot and move your ankle as much as you can. “Grab” the carpet with your feet, and “walk” your leg forward (from a sitting position) position by using your toes.

2. Do little “push-ups” with your foot. I found the best way to do this is to “stand on tip-toes” with my injured leg, BUT only from a sitting position at first. So at first I was only lifting the weight of my own lower leg, later I added weights on top of my knee (a box, a child, the girlfriend) as I got progressively stronger. I found that being in a rush to be able to stand on tiptoes or “spring” on your injured leg is NOT a good idea, instead focus more on getting full proprioception of your leg, that is, learn to use the whole foot again as much as possible. Play with it. Use a ball to increase its ability to “manipulate” (“pedipulate”?) objects and so on. this is key in my opinion for good recovery.

3. Massage. The way this was explained to me by a doctor is: Liquid accumulated in the injured area and other joints and eventually hardens and solidifies making movement difficult. By massaging the “liquid” up into the main body of the leg you promote better circulation and reduce swelling mechanically, which all helps your foot, ankle, and leg in general to stay “alive” and not get atrophied not just muscularly (which will happen anyway) but proprioceptively (proprioception is your ability to perceive, be aware of and use in fine detail, a specific part of your body)

4. Focus on proprioception more than strength. Don’t worry if you can support your body-weight well on the injured leg for a while, concentrate instead on making sure your MOVEMENT of the foot is correct. As soon as you begin to walk without an air-boot concentrate on ensuring the motions your foot goes through are correct. practice in a pool if you need to. I began to be able to do this about 7 weeks after surgery, which again was WAY ahead of schedule, (I should still have been in a solid cast according to them) but I must re-iterate, this new found mobility is probably THE MOST DANGEROUS TIME, and you should really take extra care. This is a critical period. A simple thing like a wrong step, tripping, or stepping inadvertently off a curb or onto some obstacle will break your tendon again, so TAKE CARE!)

5. Use a pool. Seriously, even if it means you have to get your crippled ass on a bus and then to a gym with a pool, do it. The use of water to be able to walk with a much lowered weight so you can make sure the foot is moving correctly when you walk in slow motion is very important. A LOT of problems are avoided by ensuring your motion and proprioception are correct. Exercising in the pool also lowers the “fear threshold” your injured leg will have. It is important you make your leg do the right movements, but you need to do so WITHOUT ANY WEIGHT at first. In fact, you can begin by manipulating your own foot with your hands, very gently before you begin trying to get your leg to do it by itself. Concentrate on getting the movements to be smooth and natural instead of jerky and sporadic. The smoother and more natural the movement, the easier you will be able to use your leg again when it has strength. Strength, of both the tendon and the surrounding muscle tissue, is easily increased once the tendon is FULLY healed, but recall this takes AT LEAST 6 months. So you need to make sure all your movements are correct and working well BEFORE you have the strength to do the movements with your full body weight. This point, the understanding of how important it is to make your leg move in the way it should move when it is healed or when it was normal before the injury, while at the same time understanding that your physical strength and structural strength to do so will not be available until MONTHS later, is probably the single most important point for correct healing of this type of injury.

After exactly 5 months:

This is how long it took me be able to walk like a normal person. Almost to the day, which was also the day I left for Brazil, it was 5 months before I could physically make my body walk in such a way that a bystander would not notice I had been injured.

There are a few corollaries to this though:

1.) I could make it look like I was normal but I could very well feel it wasn’t quite there yet, and I also had to walk slowly.

2.) The pain in my leg/ankle/foot throughout these 5 months was pretty constant. Every step I took was painful. Every day was painful, and the leg still swelled up if I walked for any length of time or was on my feet for more than an hour or so a day. I often was on my feet longer than this but I also massaged (or rather, my superhot girlfriend massaged) my leg every evening to move the fluid back up the leg. I mention the pain, because it was a constant and some people are afraid of this. Pain has never really troubled me in that I only used it as information. More relevant to me was if I felt the leg was “scared” of certain movements. Pain was a constant throughout. Literally every step I took was painful for the first 6 months at least, probably more like 7 months and a half at least actually, but the fact I was feeling pain was not important to me unless the pain was indicative of a warning. Because of my training and my being able to sense my body to a very refined degree, I could easily make this distinction even before the injury, between RELEVANT pain and just painful pain. If you do not know how to do this, then I suggest you really try to learn it over the course of this injury, because it is important. Pain tends to make us flinch and in a Pavlovian way we then stop using our limb as fully as we should. after months, if you don’t use it, you lose it, resulting in restricted movement that is going to be permanent or at least VERY difficult to fix later. So do not let pain stop you from increasing your proprioception. At the same time, do not ignore a fatigued limb, as this is the surest way to re-injure yourself and making this whole shitty situation a lot worse.

If you can keep these two things in mind, then you CAN walk like a human instead of a retarded zombie after only 5 months, but be careful.

You can now start on these activities:

1.) Walk on sand beaches if you can. Sand, sea and swimming is a great combination. I could do this for a couple of months, so it was great. I was walking normally and much better by month 6, and in fact I even took part in some (careful) wrestling with some great Ju-jitsu guys after about 5 and 1/2 months from surgery.

2.) Gentle jogging. Cycling in a gym, and trying to stand on tip-toes (this is still the hardest exercise for me and I did it with my other leg helping a lot to remove some of my body weight).

3.) Stretching. you should have been doing this pretty much throughout, very, very gently, but now you can begin to start doing so a bit more regularly and specifically.

4.) Re-building some of your calf strength, the best way to do this is by walking and even hiking in gentle hills an hour or so a day. I ended up going on a 6 hour hike in the jungles wearing flip-flops, which is absurdly stupid, so don’t do that, but do exercise your leg a bit, and consciously begin to not rely on the other leg for support as much. Begin to re-distribute weight evenly and make the injured leg carry its own load as much as possible without straining the leg.

After 8 months:

I can now run, jog, and walk normally. I still would be a bit scared of a sprain or sudden badly placed foot on odd or broken ground. Obviously this could cause an injury even on a normal leg, but I would be a lot more worried of that now than I used to be in the past.

Hip and knee problems are still niggling at me, but these are also due to my own previous over-exertions and damage from martial arts training of a decade and more ago, so it may not be as pronounced with you, but my left leg (uninjured) took strain and my knee joint is a little “impacted” as a result…BUT…I also moved home 3 times throughout my period of recovery (Once in September 2010, once in October 2010 and Once in January 2011. The lifting and moving of heavy objects in January certainly didn’t help, nor was it smart of me (it was just necessary, unfortunately), so don’t enter any weight-lifting competitions and you should be fine. I was overcompensating on the left leg and put it under too much strain. Despite this, I am recovering very well and although I can’t do full rolls from a run yet, I can roll to the floor from walking or standing without problems. I can also punch, kick and move around without any problems. Squats and duck-walking are painful on the knee/hip and will have to be entered into gradually, but I am not a million miles away from my pre-injured status in terms of ability on the gym floor at training. Once I am completely comfortable again with going to the ground as a result of wrestling, attacks, breakfalls etc. I will then be back to my old self, and I expect this will not take much longer. I also have had to cut back on training for reasons unrelated to the injury, so this obviously had an impact.

Final thoughts:

For a more detailed and blow-by blow account of the earlier periods with lots of detailed notes on the BEMER systems etc, see the ONLINE DIARY HERE




44 Responses to “Achilles Tendon Rupture Recovery Manual”

  1. Vicola says:

    My mum got her Achilles tendon sliced right through by a glass shelf when she worked as a Saturday girl in Boots in the 60s. She’s got a cracking scar, one ankle much bigger than the other and she limps when she gets tired. Clearly treatment has moved on a bit since then!

    • G says:

      Actually I don’t think treatment has changed much. The basic cure is:
      1) grab ends of tendon,
      2) stitch together in nice sausage-looking job mixed in with random bits of leg-meat,
      3) tell patient no reliable information is available regarding exact (or at least broadly accurate) results of healing

      Most of the healing/recovery is so badly explained (or rather not explained at all) which is why I wanted to give this small “manual” so people who need it can read up on it.

      The thing that has changed is the legal field. If your mom had that accident today you would never have to work again as she could keep you in limousines and pretty pool boys with the interest she would be earning from the payout from Boots.

  2. Luke says:

    Thanks for taking the time to document your recovery.

    I came out of my cast after 6 weeks was given the aircast boot which I only wore for a day or two, my thinking being that the more I use it the stronger it would get.

    Big mistake! Re-ruptured 8 weeks post op, I was so happy to have my mobility back I went crazy with doing things, I even started working (I am a freelance lighting cameraman) and broke it again when I went to sit on a low wall because I was tired from walking too far, the pushing up motion to sit on the wall snapped it, or rather it was the straw in the camels back.

    Well lesson learned all be it in a horrible way, this time round they are saying 8 weeks in a cast and then 6 weeks in a boot.

    My 2nd operation was on April 4th, I have been offered a job on August 1st, its in The Cook islands for 9 weeks, now clearly that is a job I want to say yes too specially as all I do right now is turn down work, being self employed its all a bit of a nightmare.

    It will be about 4 months in total f I do the job, I wonder if I will be able to?

    Do you think you could do it at the 4 month mark?

    I am relatively fit with my work and ride off road motorcycles (which people don’t realize its very hard work) and I am 40 years old and am very used to injuries being a motorcycle nut all my life, however I have never been struck down so hard.

    Well done with you recovery it is somewhat inspirational.

  3. G says:

    Hi Luke,
    I reply here so others can also benefit. As I say in point number 5, it takes AT LEAST 6 months for the tendon to heal, so at 4 months you will still be only 2/3 of the way there and mobility will definitely be an issue. I would suggest you absolutely ensure you keep your leg raised as much as you can and get yourself a BEMER mat if you have not done so already. The job out there will be a problem if it involves long days, lots of mobility etc. You may still be able to do it but if so I would be using the aircast while working. Also your flight will be a problem as you will get a swollen leg most likely so I advise if you do fly there to use a pressure sock that can be bought in some airports.
    All in all keep in mind I am not a doctor and you should always consult a professional, these are just my suggestions as layman.
    Also, you are “used” to being “banged up” you say and in my opinion this is a big part of the problem. If you do not take care to really FEEL and sense your own body’s limits the likelihood of re-injury even through a silly little movement is high.
    You almost have to become supernaturally aware of your body and what it’s telling you in order to make the healing proceed in the best way.
    I can’t really advise you on whether to take the job or not, that’s up to you, but if you do you will have to be extremely careful and hopefully have a good support structure. I had my gf (now wife) who is a saint basically help me throughout with everything.
    As for the frustration… I know very well what you mean. Try writing a book or doing stuff you can do sitting down.
    Good luck man, this injury is a bastard of a thing, to be sure, but if approached in the right way it can be a very important life lesson on very many levels.

  4. Anne O'Brien says:

    I ruptured my achilles tendon on Friday 13th May a day I’ll not forget in a hurry and had it operated on the following day.Reading your recovery manual has given me great insight into what to expect during recovery of this injury.I’m a very active person and love kettlebell training going 5 times a week which I’m going to miss terrible but by following your guidelines I hope to be back in the swing of things sooner rather than later.I am trying to keep my upper body mobility with some easy exercises from a sitting down position keeping leg elevated at same time ๐Ÿ™‚
    It is so good to read about real life experiences as it helps relate to what I’m going through.I wish you the best with your own recovery.

    • G says:

      Hi Anne, sorry to hear of your injury. It is a bastard of a thing to be sure, and no, there is no polite way of saying it :). BUT. If you are careful and sensible it can also be a great life lesson. I am recovering very well and if it were not for another niggling injury to my left knee, which was due to my trying to move my own apartment by myself while still compensating on my left leg, i would probably be back to 99% efficiency. I also suffered a further injury on the left leg at martial arts training so that has slowed things down a bit, BUT. My right foot has now healed to a level of functionality it did not even HAVE before the injury, so I have definitely learned a lot from this injury. It is after all a very expensive lesson, so you might as well get the most out of it.
      In terms of my physical ability, i am almost back to 100% ability with the injured leg, so I am happy of how it has healed. I will still be a couple of months before I am back to where I was overall, but on the plus side, i have gained a lot that I didn’t have before.
      My advice is to make really sure you do not re-injure yourself by doing too much to soon. Proprioception is more important than strength. For the first 6-7 months your main aim should be to retain proprioception (or rather, re-build it from scratch) and gradually increase mobility, but always with extreme care to not overdo the “testing” of the strength of the tendon. Remember it will take AT LEAST 6 months before the tendon is actually healed. So be very careful to not over-exert it. At the same time, mobility and proprioception will be lost if you do not CAREFULLY work towards retaining these.
      As with most “bad news” you can turn this around and make it a good thing in your life with the right attitude.
      I wish you a speedy recovery and look forward to your updates!

  5. tracy says:

    Thanks for the timeline-been 4 months and progress has seemed slow but helps to know this is normal. Just wanted to comment on surgery as being the best choice-I chose the nonsurgical route as a study completed last year in london, ontario compared surgical vs conservative(non-surgical) patients after following them for 2 years and found very little difference in the healing but the surgical group had infections and more blood clots which obviously affected these surgical patients outcomes-food for thought!

    • G says:

      I had a fully ruptured tendon. Without surgery Chances are good I would be permanently crippled. My opinion on this is really clear, but of course you must do what you think is best for you.

  6. Edwin says:

    I ruptured my achilles but this was missed in the diagnosis immediatley follwing the injury. so now I am 10 weeks later and going to an ortho. Anyone else have the same type of experience and describe how it turned out.

  7. Robert says:

    Sorry to blow up your comments but I just wanted to let you know that I know your not a doctor when I asked “will my ch tendn never be 100%” I just wanted your opinion.

    also I am a student, and have to walk to the bus, where you able to go on long walks (with crutches i assume) while in the boot?

  8. Victoria says:

    The first website I have seen which gives me some idea of what to expect now I’m finally out of a cast so thank you!!

    I also had a full rupture, from playing netball, but was not offered the surgical option. I have been in a cast for the past two and a half months (non-weight bearing) which seems to completely contradict everything that I have read about treating this type of injury successfully. As of this week I have been given a ridiculously huge boot to wear for three weeks to allow me to be more mobile (SERIOUSLY who designed these things!!!)

    I’m still optimistic and determined that I will return to netball sooner rather than never – being ‘crippled’ is not an option.

    Thanks again for the useful advice and insight you have provided.

  9. Andy says:

    Snapped my achilles on 27th May, Had op on 30th May. Splint on till 11th June and then had this changed for lightweight cast. This being changed for ‘boot’ on 27th June when phhysio will start.. Due to go on holiday to America on 3rd August. Will still be in boot and on crutches… Do you forsee any issues and have you any advice.
    I am fit (or was!) 59 year old, very active and am office worker.. (now back at work part time)..

    • G says:

      Basically read my whole diary and judge for yourself. I am not a doctor, and each situation is unique. i would certainly take it easy in your situation as it took me several months before I could even think of walking on it. Don’t overdo anything but read up on what I did in terms of regaining proprioception as this is key to an eventual full recovery and in my opinion you do need to start this very gently as soon as you get a chance.

  10. Julia says:

    Hi – this blog makes good and interesting reading – I completely reputured my achilles during a dance practice 2 weeks ago, seriously painful, I went to A&E, was put in a cast and sent home, I was told that I would be in a cast for 8 weeks and a special boot for 4 weeks and strong enough to dance after 6 months. But I am quite surprised that no scan has been done (how do they know how far apart the ends of the tendons are? can it really heal naturally if there is a great big gap?) Doctor said to me that they no longer repair achilles tendons with surgery as studies say there is no proof that surgical repair is stonger, I find this hard to believe. My dancing is so important to me, I need my achilles to be strong. Anyway, I’m paying for a second opinion from a private consultant on Monday and we’ll see what he says, I cant help but think the reason the NHS doc has told me surgery is not necessary is to save cost….

    • Alan says:

      Hi Julia
      This sounds very familier i was told the same(NHS) but pushed hard for surgery my op was on june 4th 2012 by the 15th june i was in a CAM boot (at my request).
      Have already gone down to just 2 wedges in the boot but still unable to walk without crutches,I have read lots of websites and can honestly say surgery is the only way forward.
      Hope all goes well for you.

      • G says:

        I agree. You are doing very well too, just be careful not to reinjure it by trying too much too soon.

    • G says:

      The NHS only cares about taking long lunches. I was forceful and unequivocal about wanting surgery immediately. I hope you got the name of that doctor and begin suing him personally as well as the hospital in question. I wish you the best but without surgery I am really not sure how things will go. Maybe research that online too.

      • Robert says:

        I’m not sure you can just sue in the situation here. There are always two options for ATr, surgical repair or non surgical repair.

        Non surgical repair is told to be just as strong as the surgical repair. I’m sure they have to have a reason for choosing non surgical repair for her, instead of the surgery. I think she could’ve went for second opinions…but I’m sure surgery isn’t the bet for everyone…though itd seem that way to us. I’m sure there’s reasons behind no surgery, like diabetes or other medical conditions that the surgery could put bigger risk on patient. Not saying she specifically has diabetes, but they ask you about 59 questions prior to surgery…those might’ve made a decision for the doctor. I’m not being an advocate, but just trying to put a different light on the subject here…maybe you guys are right and they’re trying to skimp out on high costs…but just thought I’d give a different possibility!

        • G says:

          Sorry but we will have to agree to disagree. The NHS staff are in my (very clear) opinion “trained” to save money and time and to give the least expensive “treatment” instead of the BEST treatment. Also, as far as I am concerned, with a full rupture there is no question in my mind that surgery is the only sensible option. There is a reason slaves were hobbled by having their achilles tendon cut in the past, and that is because it cripples you, and no, I don’t think it ever heals 100% without surgery! Even then, it’s a long slow haul.

  11. jan says:

    I had a achilles surgical decompression on wednesday 27th June in a cast to my knee. Was told to take paracetamol and 2 aspirins a day. 48 hrs later I am in agony can hardly put my foot down even though i have a shoe they put over my plaster cast adn crutches. Seems to be getting worse to walk on feels really sore at back of ankle. Any suggestions

    • G says:

      Go back to your doctor! Seriously…why are you wasting time asking some stranger on the internet?

  12. Alex Rodgers says:

    Male Aged 58. Totally ruptured my Achilles tendon on 23 May 12. Only a few minutes into a mountain bike ride – no crash, it just snapped. I knew immediately what I had done, but never thought it would happen to me. I was very upset.

    I have read with interest the article of Giuseppe and wanted to add my experiences.

    My background: high impact endurance and hard core adventure sports; Army PTI for over 40 years; personal trainer and sports therapist, including sports massage; coach and teach many adventurous activities and sports. Sports Science background.

    I have been involved in training and rehab of soldiers and injured soldiers and have seen the no-nonsense military approach to rehab: continue doing whatever you can, whilst carefully isolating the injured part of the limb. Expect no sympathy, it’s your life, so get on with it. Of interest, the US Army is taking a very dynamic approach to rehabilitating serious injured soldiers, reportedly with great success.

    I took the advice of the busy, bemused consultant, not too used to being asked informed questions (pinned him down and asked some searching questions). After I asked him to put himself in my place, he advised (because of my age and possible healing and infection problems), taking the non-surgical approach. Having done my homework and lots of reading of the literature, I agreed. Had a removable boot fitted (but told not to remove it), plantar flexed to allow the tendon to rejoin and repair.


    2 days after the injury, I was back on my indoor bike, working only my good leg, with the injured leg resting on on a bench. Uncomfortable, but determined to maintain my aerobic fitness. I think the loss of activity, fitness and losing all the benefits of fitness is probably the main reason some people take so long to recover from injuries. With a few limitations, also continued with my resistance (weight training) training programme as normal. Difficult, but I just cut out injured lower leg exerises and squats (for a few weeks anyway).

    Other things I did straight away: within the limitations of the boot, move the toes, feet and leg muscles. Did ‘static’ exercies (resist against the boot, even though movement is minimal or impossible – trying to move muscles has a similar effect to actually moving them). Did lots of ‘static quads’ exercises throughout the day. After one week, I removed the boot and started to gently (to begin with) massage the whole lower leg and concentrate on the tendon. within a few days, I was spending 20 minutes doing quite firm massage and frictioning, with my thumbs, the swollen areas and where I think the site of the severance was. All muscles of the lower leg were sore and I did a lot of sweating – effort and pain. I have progressed to very firm massage (now 6 weeks post injury) and am using ‘The Stick’ (google it), which I have found to be an excellent self-massage tool. I have also bought a Scholl electric home massage device, which I am using to reduce (sucessfully) the swelling in the leg and ankle. I massage up to 3 times a day and it works for me.

    3 weeks after the injury, I returned to the consultant. The orthotist decreased the plantar flextion (and therfore increased the dorsi flexion) of the boot, which was very uncomfortable for about and hour – sweating again! The consultant’s colleague asked me how it was going. I told him all of the above (thought I was in for a slapped wrist). He grinned, said ‘excellent’ and that he wished everyone would take such a proactive approach to their rehab. Emboldened, I asked him if I could now cycle indoors with BOTH legs – Yes, as long as I was wearing the boot and did nothing to stretch the tendon (which the boot prevents). Yes, start weight bearing, but using crutches. No need to tell me twice, Sir.

    I visited a former Army physio, who has worked with war injured soldiers for the last 4 years ( I intend to use him for additional rehab guidance when I am out of the boot). I confessed what I had been doing and he told me that he agreed with my approach. HE DID HOWEVER WARN ME THAT, UNLESS I WAS CAREFUL AND CAUTIOUS, I WAS IN DANGER OF GETTING TOO CONFIDENT, TOO SOON AND THAT HE THOUGHT IT WOULD TAKE ME ABOUT 18 MONTHS TO GET BACK TO ‘NORMAL’. I will heed his valuable advice.

    He showed me extra, useful strength exercises and confimed my thoughts that PROPRIOCEPTION (look it up) is crucial to a speedy recovery.

    I immediately went to the gym, strapped my booted left foot to the pedal and did a good aerobic trainig session (I have also been doing turbo interval training sessions and my upper left leg strength is improving very well). I incorporated Swiss Ball, back-against-the-wall squats, with a wedge under my good foot . No problem. Just a bit uneven and slightly scary to begin with. I also started weighted leg extensions on a machine (I do not normally advocate or do single joint resistance exercises, preferring narural, functional ones). However, beggars can’t be choosers. I need to strengthen my quads.

    5 Weeks after the injury, returned to consultant. Boot dorsi flexed to ‘netrual’ postion (90 degrees). Very uncomfortable for about an hour (brain and proprioceptors resetting to new angle) – more copious sweating. Consultant (different one again) happy with progress – continue with my approach. Do more weight bearing, but still on crutches. Doing very easy, sitting toe raises and scrunches barefoot.

    6 Weeks after injury. Have been doing (VERYcarefully) barefoot balancing exercises (alternate knee raises to chest and side steps) and slightly stretching the ankle and tendon (my physio friend warned me that one of the problems with ATR is stretching it too much and getting a permanently overstretched tendon). Started very gently walking a few minutes barefoot around the house (no obstacles). Leg stiff and strangely numb, but okay. Tried on shoes last night and walked for a few minutes, very slowly and carefully. I Can now balance, unaided, barefoot on injured leg for over 2 minutes. However, I am slightly worried that I am doing too much too soon. At work (did not miss any work days – now have an office job), I can walk around easily without crutches (in boot). I am having to force myself to use the crutches, but know it makes sense. I do not want to develop a lop-sided, habit limp.

    12 Jul 12: I will have an appointment with the consultant. I hope that, if he is happy with progress, the boot will be removed and I will return to shoes with wedges in the heels. I am under no illusions – when the boot is off, that is when the real danger and challenge begins. I will report on my progress (or otherwise).

  13. tracey says:

    Hi I had an Achilles rapture in 2009,and still to this day im having allot of pain ,especially when i walk,theirs like this sharp pain that just stops me in my tracks,you see i had an operation on my right Achilles ,was in a cast for 5 weeks, on the day i had the cast removed the hospital decided i go to physio that same day,so on the way down to the physio dept and still on crutches and not allowed to weight bear ,my crutches slide on water and i went flying yep you guest it right on my right foot ,the frigging pain was unbearably and my foot swelled up bigger then the previous Achilles injury,i was then sent back to the fracture clinic and a cast was re- applied ,they didn’t do an ex-ray or out like that ,just told me to come back to the hospital in 2 weeks time , so i did .i had all the physio after that but im now still in alot of pain and one my right leg in alot smaller than my left leg,and the muscles in my left leg are alot stronger than my right ,so do you think ive done more damage ?

    • G says:

      Again…I am not a doctor. you should definitely see a specialist, possibly get MRI scans first if you can so they can see what s going on. The shrunken leg will get back to normal size once you are fully healed and can exercise again, however you should not be in a lot of pain as far as I know. My pain threshold is pretty high, but I don’t recall it really ever being an issue. Definitely get checked out from someone who is specialised in this though.

  14. Alex Hochhausl says:

    For what it’s worth, I thank you deeply for your informative write-up.

    The funny part is I ruptured (complete) my achilles on June 22 (this year). Last year I had surery on my birthday June 27 (unrelated to this), and guess what I did this year on my birthday – have to stop this cycle!

    This injury, besides the obvious physical impact, caused just as much emontional damage for the first week. I am by no means a professional athlete, although I guess I would put myself at above amateur level. 4 years ago (at 40) I made the change from a “meat-head body builder” to “triathlete”. It was a huge change, but I’ve never felt better – getting faster every year. I went from bearly being able to run 1/4 mile to regulary running half marathons, and have placed as high a 4th in triathlon in my division. I note this not to brag, but to give credit to the positive impact that the inspiration of others can have (mine was others who let neither age nor disability stop them from incredible achievement).

    This spring I ran a personal best 13.2 @ 7:50 avg pace and was just getting into high-gear training for my fall Tri race schedule when a really dumb diving board accident (june 22) took me out of the game for the rest of this year. Game over.

    The surgeon I went with came highly recommended, and is putting me on an accelerated recovery schedule, although I know I’m done for the year. Seems I have been following good practice based on his and your recommendations.

    Reading your experience, and those of (professional) athletes, who have come back 100%, offers tremendous emotional support, and I am truely grateful to you and others for that. As they say, and I have experienced, racing is just as much (if not moreso) mental as physical, especially long distance events; Recovery from injury is just the same.

    I thank you and your contributors for taking the time to offer such valuable information, and hope.


    Alex H.

  15. Rob Hold says:

    Great manual, very educational.

    I completely ruptured my achilles tendon on the 3 May 12 after stepping up on to a kerb. I went to A&E on 4 May 12. Doctor at A&E did a cursory investigation, felt up the back of the leg and said it was a bad sprain and that I had two options – immobilise it or leave it. Obviously I went for immolising it. It was put in a half cast and I was given an appointment for the fracture in two weeks.

    Two weeks later and saw an Ortho Consultant who after investigation, Thompson test and an ultrasound the next day confirmed it as a complete rupture. Told surgery was not an option as the healing process had already started. He said I would be in a cast for 12 weeks and then walking boot for 4 weeks with physiotherapy. Knowing the seriousness of a re-rupture I accepted my fate.

    After a couple of replacement casts, I was seen by another Ortho Consultant and finally had the cast removed after 11 (10 Jul 12) weeks. I was given no boot nor offered any physiotherapy as Consultant said physio entertains re-rupture. Another appointment has been booked for 3 weeks time. I’m a little concerned and slightly confused about the mixed course of treatments mentioned by two Ortho Consultants – is this another NHS cost saving exercise?? Have written to my GP for his comments.

    In the meantime I will use gentle exercises to gain leg strength. I can walk with a hobble and my heel kills me. Walking on the beach is great as is the cold sea water. I work for the NHS so not in a hurry to get back to work.

    • G says:

      Sounds like rank incompetence to me. I am no doctor but my own full rupture was obvious to me. I am however not surprised, the level of medical experitse in the UK is, in my opinion, little improved since about the year of our Lord 1440 or so. I would not have been too surprised if they had placed leeches on me to heal the leg. I think part of the reaosn I had surgery was that I was so clear and forceful about it. Most people in that state expect that the doctor would know best. Given you work for the NHS, I would seriously consider suing them if I were you.

  16. Jeanette says:

    Thanks for posting your experiences. I found your site after my upteenth search on the internet looking for some guidance on my situation. Apologies in advance for the length of my post.

    On June 11 2012, I ruptured both of my achilles tendons whilst on holiday. I didn’t know that that is what I had done – I thought it was a sprain and continued walking around on them, albeit painfully, until I got home a week later. I immediately went to the GP on 18th June who agreed it was a sprain and told me to take ibuprofen and use the RICE principle.

    A couple of days later I sought a second opinion from a private GP who sent me for tests at a South London hospital. The hospital carried out a number of tests, including two scans. Notwithstanding the fact that the nurse who initially saw me told me she suspected an achilles tendon rupture, the doctors who saw me, including an orthopaedic consultant, concluded nothing was wrong. The consultant in fact told me to exercise my ankles, including by hanging my heel off a stair. She may as well have asked to me start doing back flips!

    I went back to the private GP a couple of days later, this time looking for a physio referral. However, he sent me to a specialist sports doctor who in turn sent me for an MRI scan. The results came back a day later and I was told at that time that I had two completely torn achilles. He said he would refer me to a surgeon, but after 2 further days of hearing nothing, I picked up a phone and made the appointment to see the surgeon myself.

    The surgeon told me that the left achillies tendon was completely ruptured – 6 cms, the right tendon was partially ruptured. Apparently, missed diagnosis is pretty common. I had my operation on Monday 9 July (about a month after the initial injury) but only on the completely torn left tendon. I was given a walking boot for the other leg. I was told that I only needed the walking boot when putting weight down on the leg (which I have to do from time to time as it is the only way for me to get around – e.g. to the bathroom and back).

    Since that time, I have been at home with feet elevated. However, I am very worried about my recovery. My main concern is that, given the length of time it took to get diagnosed and treated, I won’t recover fully. In particular, there is something going on in the right leg – a kind of hardish lump has formed where I think the tear is. I have no idea whether it is a good / bad / temporary development. I have an appointment on Monday so hopefully can use that to get some specific advice.

    I appreciate you are not a doctor, but any thoughts you have would be welcome. If anyone has any (hopefully positive) stories about recovery after delayed diagnosis, or treatment received for a partially ruptured tendon, I would be happy to hear them!

    • G says:

      Hi Jeanette, sorry for the delay in replying but I am tragically busy at the moment. Your comment really made me feel for you. My advice would be as follows:
      1. By threat, cajoling, bribery or whatever, get a full MRI scan on your legs, particularly the right one.
      2. Consult with a specialist that deals with this type of injury regularly and preferably one that is also a surgeon. This may be harder in the UK than it is overseas but it should still be possible.
      The above two points are necessary more in order to give you a mental reference point which is important in order to heal (I think so anyway) than to fix things by surgery, which may still be a possibility but it would probably be related to reducing the “lump” and streamlining it, which might not be a good idea to do now anyway. The lump is in all likelihood a neuroma, I have one in my wrist where I went through a window at 16 at school and it slashed my wrist (long story). It does not necessarily cause a problem unless it compresses other tendons/areas, which depends on the size. To some extent a neuroma is necessary in order for the tendon to heal. When tendons re-attach they form a ball of fibers that interlink, that is essentially what a neuroma in this case is.
      3. WHATEVER the doctors say relating to your expected recovery rate you can (again, in my non-doctor opinion) ALWAYS do better than they tell you. My best advice is to follow my own diary closely and pay particular attention to increasing and improving proprioception as soon as possible but without putting any unnecessary strain on the healing legs. Proprioception is in my opinion the key. Increase of motility, strenght etc, all come with time, but if you let the proprioception fall away, you are going to have real problems later. In any case, a certain amount of fluid/calcification buildup is probably going to happen but you should be able to deal with this well later as long as you are consistent in working on the problem in many ways and in a multi-pronged approach.
      4. GET A BEMER MAT AND USE IT AS MUCH AS POSSIBLE. This thing helped me heal an underlying injury I had had for almost 2 decades, the sooner you get one and use one, the better. If you need the number of someone who hires them PM me as I have it somewhere, her name is Kathy, you don’t need to listen to her ideas, unless you want to but the mats work.
      Let me know how it goes.

      • Jeanette says:

        Thank you so much for taking the time to reply. I really appreciate it! Its good to get a different perspective. At my appointment with the surgeon last Monday he insisted that the damage to the right leg will get better over time on its own. However, for peace of mind I will definately head back to the hospital to get, yet another, opinion / scan on the right leg … sigh.

        I will take a look at look at your suggestions regarding Proprioception and the Bemer Mat. If there is one thing this experience has taught me, it is that you really need to take control of your own healing and listen to your body because doctors can and often do make mistakes.

        Thanks again

  17. Julia says:

    I posted a comment further up this chain on 22nd June, so thought I would come back and give you an update

    After my last post and feeling pretty let down by the NHS, I went to see a private consultant and it was the best thing I did, after seeing him it all seemed to make sense โ€“ so I thought I would share what I have learned:

    The reason there is so much controversy as to whether to stitch a ruptured Achilles or not, is because, basically no one really knows the answer โ€“ it would takes years of study and hundreds of patients to be able to accurately say if stitching a ruptured Achilles makes it stronger than one left to heal naturally and this has never been done, so ultimately we rely on the personal judgement of the doctor we end up seeing.

    One thing my doc stressed is โ€“ it isnโ€™t so much about whether you stitch an Achilles that determines how strong it is afterwards. It comes down to how much hard work and commitment the patient puts into the rehabilitation and the physio, that makes it strong in the future. If a patient is complacent, lazy or in too much of a hurry, then there is a much higher chance of re-rupture.

    The private consultant I saw immediately sent me for an ultrasound scan โ€“ this is essential to know the extent of the damage and to decide on the necessary treatment. Now, I am no doctor and have no medical experience, but once I could actually see my injury inside my body, the decision made sense.
    My scan showed the two ends touching with no gap โ€“ I was 2 weeks post injury and the healing process had started so the doc decided it wasnโ€™t necessary to op. I could buy this, it made sense. (if there was a gap then he would have operated, it isnt rocket science!)

    I was 5 weeks in a cast (changed 3 times in that time, to alter the foot angle), I have been in a black boot for 2 weeks, with dials to limit movement. I go back for another ultrasound next week to check on the healing process, then after another one week in the boot, hopefully I move into in a trainer, then the physio and hard work will start.

    I am determined to be dancing again by Christmas!

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