I've ruptured my achilllies 2.6cm gap, do I go for surgery or conservative treatment?

Hi Vietzy101

First of all I'm really sorry you;ve done this, it's a really nasty injury. I had a similar gap in mine which I did in mid December last year playing squash. I was initially told I needed surgery but then when I met with the consultant he advised against surgery due to my age (53) and due to it being a little higher than usual and close to the calf muscle where the tendon is more like muscle fibres. Said it would be like stitching cooked spaghetti!

I remember not being able to imagine how it would heal with a gap if I didn't have surgery but was reassured it would. Now, 10 months down the line I can say it was probably the right decision and I'm happy with the outcome. The key thing is to have the aircast type boot with the heel wedges and follow an accelerated rehab programme. You need to be careful obviously for the first few weeks but my advice is listen to your body and try to keep the ankle moving when you have the boot off and push the boundaries bit by bit, just small movements in the ankle, rotating and toes back and forward. The thing that made my life bearable in the NWB phase was a knee scooter which was absolutely brilliant and allowed time for my hands and arms to recover from crutches.

For info, I'm a sport lover as well and now have no ill effects on runs of up to 3 miles, don't go much further then that anyway due to knee pain on long runs. I also cycle quite a bit, up to 50 mile rides with no ill effects now. The tendon feels strong now but it's really thick compared to the other one.

Anyway, good luck and best wishes for a good recovery, I won't say speedy because it won't be speedy! I just had a flashback, sleeping in that bloody boot *shudder*.

All the best

Chris

Hi sorry to hear about your injury.

I'm not sure your tendon will repair conservatively with a 2.6mm gap.

I had 1.5mm gap and was not given the option of an operation despite me pushing for one.

I was 5 weeks in a cast and boot before my complaining got through and they offered me another US scan. The US scan then showed the gap had got wider and wouldn't repair without an operation and a tendon transfer from my big toe.

Yes the operation is painful, I couldn't lower my leg for 9 days after and am only 4 weeks into my recovery and still in cast.

My surgeon has said I will be 12 weeks in a combination of cast and then boot and that would be the same with or without an operation.

Also when they were trying to sell the conservative treatment they said the rerupture rate was very similar if operated on or not, however after the operation they confirmed the percentage of rerupture after is around 3-5% after surgery as opposed to 15-20% without surgery.

I'm sorry to say whichever route you take it is a long slow recovery and is just as tough mentally as it is physically.

For me this will basically mean very little sporting activity for my future, however a lot of people do go back to a decent level of sporting activity but you're probably looking at 6-9 months minimum recovery.

Good luck with whichever route you go and please lee us posted.

Id say go for surgery if you plan on being active the reoccurrence rate w/o surgery is about 50%. I had my surgery 10 weeks today. Had splint for 17 days when I had sutures removed. Started therapy 9/12 boot till 10/6 resumed driving then as it was my right Achilles. Won't say it's all peachy but other than swelling I really had no pain. I occasionally limp but therapy helps and my foot is stronger with each passing day. I had thumb sized gap when I ruptured mine if I had partial tear I'd have elected to do therapy. Good luck on whatever you decide each surgery is different and each surgeon is different hopefully this eases your mind.

Vietzy,

SO sorry to hear about your ruptured tendon! I went for the surgical option. There are quite a few different approaches to the surgery depending on the surgeon, the exact nature of the rupture and other risk factors--these are best discussed with the surgeon. I think it is a good idea to get a second opinion and do some research about outcomes online.

My experience so far: Ruptured achilles on 29 July, consulted with surgeon on 1 August and opted for surgery which took place on 2 August this year. The srugery is called "minimally invasive" in that it does not require opening up the leg behind the tendon with a large incision. Instead, there is a small incision just above the rupture and a tool is inserted and most of the suturing and repair is done through the skin. Surgeon used a system called Arthrex Percutaneous Achilles Repair System (PARS).  You can google it and actually see the animations of the procedure. I got through the surgery fine and so far have had no significant problems; you can see the kinds of issues people have in this by following this blog. I am now about 12 weeks post op and can do most things I was doing before, except I still have weakness in the calf and the foot muscles so I am not back to single heel raises yet. I also am not running. But I am confident I will recover my pre-rupture function and strength, although it will take WAY longer than I thought at first.

I still have a slight limp, I think because of the weakness in my foot and calf--amazing how fast those things atrophied during the few weeks they were immobilized! Also, physical therapy seems to be really helping to get me doing things that are appropriate for the recovery stage and progress.

I opted for surgery because I am still quite active (at 67) and like to bike, hike, and ski and wanted to minimize my chances of re-injuring the achilles--this was discussed at length with my surgeon. So far, I have been pleased with the outcome, but you will also find plenty of folks on this site who have had some serious issues during recovery.

Chris (below) has had a good outcome without the surgery. Tough decision.

Wishing you all the best for a complete recovery, whatever you decide.

I ruptured my Achilles on August 8 and opted for surgery on August 12. I am 53 years old and active. I did it playing tennis. He said it was the best way to go to assure that I wouldn't rupture it again. There is the risk of course of falling and infection, but I've done well 8 weeks in a booth. Currently in my 5th week of PT, down to one crutch and getting stronger every day. Unfortunately, whatever route you choose it's a long, slow process.

Hi Vietzy

Sorry to hear about the injury. I fully ruptured my tendon on the 17th August. I'm 33, very active and decided against the operation. I wasn't keen on the risks with infection, nerve damage or scarring. I have been able to FWB in the boot for about 7 weeks, I can now point my foot and I'm actually on a plane to japan as I write this. I have had no regrets with my decision. I think its all about adapting to the injury and trying to keep yourself positive.

All the best

Matthew

Hi, I am sorry to hear about your rupture. Mine happened on 16th June, non op, the gap was 6cm, I tried to push for surgical option but they said the same thing about recovery and healing period. Now I have full movement, no pain, according to PT all going well. I sill walk with a limp, get pins and needles (slightly lack of senssation) on the heel, very sore calf muscle though. I had to change my car to an Auto one, didn't do much but it gave me some indendency. It's been 1 month that I am back to work full time. I think for both surgical and non options, the recovery process is very slow, the only thing as you said is the risk of re rupturing. Don't be disappointed nor frustrated, you will get there before you know it. Best of luck  

So sorry to leatn of this rupture...

A tendon is the thick fibrous termination of the muscle. 2nd opinion is a greay idea.

I have completely ruptured as well as incompletely ruptured...either way, it takes time.

The keu to a successful recovery is to relax and follow the advise of both your doc and physical therapist.

Generally speaking, after 6 weeks you are able to go fot it. I found s heating pad helpful for warming the repair up before exercise and using ice with elevation after exercise.

May you rapidly and fully recover,

judith