Achilles rupture - some pain during healing

Hi Ian. From the research I did and what I was advised by 2 doctors and my physiotherapist - the long term results are the same with or without surgery.  I think surgery used to be the only option, but non-surgical route has gained in poplularity over the last few years. Eliminates chance of infection, I believe. Studies have shown that 12 months out, recovery is the same.

A scan would definitely show the details of your rupture, by my understanding is the Thompson test is a very good test. An xray will just show if any bones are broken.

I would try elevating your leg - lying down with leg elevated above your heart. For me, heat of the summer increases any swelling I do get.  But I sleep with my leg and foot under a pillow to elevate it, and my ankle appreciates the soft comfort.  Any swelling I may have had is gone by morning.

Light self massage can also help. To help stimulate the fluid to move.

And believe it or not I am advised that increased water intake is also good.

I am bad at drinking water. I have been advised to drink two glasses of water for every cup of coffee I drink. I am very good at drinking the coffee. Very bad at drinking the water.

Everyone is different in their injury and their recovery. As long as you are being monitored by a doctor or a physiotherapist you should be fine. You can try insisting on having a scan, but I tried that with my doctor when I wanted a second scan, but he felt it was not necessary, so I wasn't able to get one. I just wanted to see if 12 weeks on, if my rupture had healed properly. I was worried that it had not. I am now at 18 weeks and I always worry it has not healed properly.  But I am beginning to realize that this sort of injury just takes a long time to heal.

Hang in there. Good luck.

Sorry, I sleep with my leg and foot ON a pillow.  Not UNDER. lol.

Hi Ian, this sounds remarkably like my situation first time around. I did mine playing football too and I was given the option of surgery but never given the real details. I think it was easier for them to just put me on the cast.

Regarding swelling, I had a lot first time around when I went nine surgical. This time around with surgery I seem to have much less swelling. Not sure if this is normal, but certainly the case with me.

I would definitely ask for a scan. When I felt mine wasn't healed, it wasn't until it was scanned that they finally realised my Achilles was still detached. Your other muscles can sometimes give the impression that things are healed or not.

Hi ian can i just chip in if it helps im at 16 weeks complete

rupture non surgical , boot on for 8 weeks,5 wedges and have

had swelling from the start untill the last week when i started

to do More walking ,which caused it to diminish so take heart

maybeYours will also once you start getting a bit more

Active

best wishes

Hi Ian I also ruptured mine playing football and was non surgical now about 18 weeks post injury and even now being up on my feet at work most of the day it still swells up a little. Its to be expected. Think a lot of it early on is fluid so as you get out the boot and start walking again this gets the fluid to move away. I have also never had a scanand non surgical and have healed really well. Everyone is different but I would say be patient and before you know it life will be getting back to normal. All the best.

Hi Ian, I fully ruptured mine playing badminton 19 weeks ago and was in a cast for four weeks, then the boot for seven. I had a fair amount of swelling in the cast, then less so in the boot. However my bruising took a long time to completely disappear. I was lucky that I took a chunk of time off work and kept my leg elevated nearly all the time, and had it on a pillow in bed, so I think that really helped with that side of things. Also icing it helped a lot. I didn't have any scans or x-rays, just the Thompson test. I agree with Sandy from my own research that more and more are swaying towards the conservative route and that either way the end result is pretty much the same. Don't know of you saw in one of my earlier posts but I've been sharing my progress on Instagram - I'm jowoods11 if you want to have a look. There's some really great support on there. Anyway, keep us posted on your recovery - I hope it goes well for you.

I've just started following you on instagram JW. Great work. Good to see that you are pretty much there with your walking.

Gives lots of hope

Thanks Jonathan. Obviously my walking's not as good as that video clip all the time, I'm quite hobbly in the mornings or if I've sat still for a long time, but I'm getting there. My daily mile walk now takes me 20-ish mins where it was taking 30. I need to now try walking a bit further each day to continue to make progress.

I can walk a bit at the moment, but with a limp and then rest it when I get back. It's not my Achilles that hurts though, it is my heal after walking.

Did you have this?

No, not really. Possibly due to how my physio first got me moving - standing on the spot and moving my weight on injured leg as if walking, but concentrating on the full heel-sole-toe movement and really making sure I pushed off with my toes. I couldn't push off to start with, but practiced it every day (and still do). I think Sandy said she has had heel problems though, so I'm sure it's a common thing.

Quite a nice exercise to do when sitting down, is to roll your injured leg over a tennis ball.  Take your shoe off, and let the foot work a little. Gives a nice easy massage, and will help loosen the foot muscles.

Hi jonathan. LOL. Yes, I have heel pain. Some get it, others do not. Mine comes from walking on it for too long (more than 20 minutes).

Have talked to both my doctor and my PT.

Remedies:

- GEL cushions heel of shoes. They help some. I was using a gel heel insert. I have just bought a different one - Scholl's - for plantar faciitis. Will give that a try later when I try walking.  

- Icing.  I iced it last night for about 10 minutes and my heel stayed ice cold for about half an hour after.

- Accupuncture. My PT recommended I see her colleague. So far, I have said no. But if the other remedies don't work, then will give it a try.

Hi JW. I did not have an instagram account, but set one up to follow your progress. You are doing very well. Here's to continued success (albeit slow success) to us all.

Thanks Sandy, I guessed it was you who followed me :-) You'll all have to excuse my numerous sewing posts - it's a bit of an obsession! - but there will be more Achilles updates along the way.

Thanks Sandy. I did get gel heal cups from hospital. I have one in my bad shoe. I presumed this was fairly standard though. Yeah it's just if I'm on it for a while, heal starts to hurt.

It concerns me that Achilles doesn't it some ways.

That's just stiff and won't flex 

Got told yesterday that I should still be using my crutches at the moment even though I'm a week out of the boot. Physio said I need to use them as a means of making sure I plant my foot correctly as I walk.

Hi Jonathan.  I put one in each shoe, to keep my stance level, height wise. Otherwise, one shoe is a bit higher than the other and that can cause posture issues that I don't need.

Even before I came out of the boot, my PT kept pointing out that my foot was planted facing outward. It felt so natural, that I thought perhaps I always walked that way. But she insisted that I keep straightening out my foot and I am glad she did. Now I am back to walking normally again, I really appreciate her coaching me and my foot.

I didn't see a PT during the treatment, only now. Specialist said to ween of the crutches, but PT doesn't seem quite as keen. I guess PT is the one working with me more regularly. Had some twinges in Achilles the last few days since going back on crutches though.

Good that yours spotted you were walking this way though so it could be corrected. Are you walking without aid etc now?

Sunday was week 19 post injury. I am walking without aid for some time. Although I do see the benefit of having crutches handy if walking and my heel or achilles realy starts to hurt. If I had them handy at those times, would definitely have used them. But have not brought them along on any trips shopping or any walks. I do think that if I had brought them along when I started going for my 1 to 2 mile walks, that I might not be in heel pain situation I have found my self in. Note, I have not 'walked' for about a week now. Really trying to give my heel a chance to recover. And right now it feels fine. Only get pain when on my feet all day.

Between your Dr., your PT and your self - do what feels best. PTs have more experience with the rehab of achilles. But no one knows better what you are feeling than you. If using crutches increases discomfort or pain, try to watch yourself in the mirror to see why. Try crutches as possible support only. Not weight bearing. If that makes any sense.

Thanks Sandy. I have popped another heel cup in my other shoe to see if it makes some difference. But you are right, I need to do what I feel is best. I've got a holiday in 3 weeks which I'm hoping I can be walking a bit better for. Not expecting normality, but hopefully not a really prominent limp.

Damn, don't know why but my message got deleted.  

I have been working quite hard in the gym. Spending 30 minutes on bike, 15 minutes eliptical stepper and 20 minutes doing a super circuit (just stepping up with good leg, while having bad leg on step). I feel excellent. Zero pain, zero swelling, but some stiffness in calf/achilles area and  slight discomfort with a low profile cross trainer shoe digging into achilles.

Will definitely be playing tennis in 4 weeks time (ready for Summer here, and Winter has been mild).

Won't run after a ball but I am almost ready to hit some balls and serve !

How is your recovery coming on ?

How is the driving ?

All the best,

Neil.

Hi Neil

Sounds like you are doing brilliantly well. Such good progress.

My physio is being massively cautious with me this time, won't let me get rid of crutch yet still and isn't really giving me many exercises. I get it, but it just means really slow progress. I was on feet quite a lot at the weekend so heel and Achilles have been pretty stiff and sore the last day or two. 

Driving is ok. Leg gets a bit stiff on longer drives but other than that, it's ok.

At least you can drive..

One simple exercise that I found really helped is to stand on a step with your bad leg, and your good leg on the ground below it. You just step up with the good leg, keeping the bad leg still. Just easy up and down and repeat. If need be, hold onto something. Start easy and slowly. 3 sets of 10.  If you have any pain at all then stop immediately,

I understand your concern given the past rerupture, but at some stage you and the physio, are going to have to trust that things have healed. I am no physio but this should have been at week 6, so its time to start doing a few things to get going again.

With that step exercise you are not really doing anything to the achilles.  It is almost in a neutral position. You are just working the muscles around it, and bending the injured knee slightly when you step up with good leg.

Thanks Neil, I'll give it a try. Yeah that is my thought. I'm at 9 weeks now and want to try to get some strength back and as much as I get the caution, definitely need to get a bit of strength back. 

I would definitely do that exercise.

If you can get to the gym, do some stationary bike. Take boot off, and just wear a sock.

Injured leg heel right on the middle of the peddle (so forward from normal position), and just try and rotate the leg easily. No resistance to start with. So you peddle normally, but the injured leg is not really doing anything to the achilles area. It is again in a neutral position (not extended downwards or upwards).  The effect is extending your range of motion, and really working your thigh far more than the lower part of the leg. In a subtle way you are working your range of motion, and getting better blood flow through the injury. 

I was doing that on the stationary bike from week 4, so I reckon at week 9 you could try it.

Are you still wearing your boot  or walking around with a crutch for support ?

No been out of the boot for 2 and a half weeks now. But when I asked about the bike, they said not yet. Again, not sure whether it's just being over cautious on their part. 

I am massaging my Achilles daily with bio oil in order to get blood flowing to the area and doing tame if motion exercises as haven't got any other exercises from them as yet.

I would feel terrible if I said do something and you hurt yourself. But those two things are pretty minor and the achilles is not really doing anything (in a neutral position). You are probably doing more just walking around. Do you have a pool available, because maybe that is the easiest way to start things ?

But if you are out of the boot they should definitely be giving you physio exercises. These really should have started at week 4 or 5, definitely by week 6. I think you have to experiment a tiny bit. Cautious and slowly slowly is no problem, just listen to your body and don't overdo anything !  

I am having a rest weekend I think. I did quite a bit of walking on Tuesday and since then I've been having discomfort and yesterday it ballooned up. Achilles still feels intact, but just a bit achey so I think a couple of rest days might be wise.

Did you have any moments like this?

Yes, I definitely had swelling up to week 11. If I overdid it, I would see swelling around the ankle and lower part of the leg (ie. too many two footed calf raises). Now when I exercise I don't have this reaction. Your achilles will be intact but the surrounding muscles are just weak. If you scrunch your toes, while sitting you will see some life in the calf muscle.

I can feel my calf muscle building up, but I cannot get near a 1 footed calf raise. Gonna leave the tennis appearance tomorrow (why go looking for trouble). Hit the gym instead !

 

Hi Neil, still struggling with this a few days on. Swelling has gone, but got aching in the Achilles. As above, still feels intact, but more discomfort when walking than before and some pain. Pain seems to be towards the top of my scar into the lower calf.

Did you have this also??

No, I never had that at all.

But it is telling you to just take it easy for a few days. I could just be some damage from the incision.

I still have aching in my Achilles area. Went away for a few days and where I was they had a mineral pool. Took full advantage and worked out in it, which was great. Second day felt so good, I thought I could try running in the pool. Unfortunately, that was a big mistake. Had sudden, but not too intense, pain in the bottom of my heel. That was 5 days ago. This morning is first time I could walk without feeling pain in heel or a bump? on heel. It put me back because I have cut back on exercises and walking.  Seeing Dr. today, but I don't think I tore it. Week 21 since injury. Very frustrated at lack of progress. But this time I put it down to my mistake in the mineral pool.

I went to physio this morning. They put pain down to swelling a few days ago, which they think will have put pressure in the area and possible stress on Achilles. She thinks it's all still attached, just said to continue to take it slowly. 

Rest and keep going with light stretching.

Saw Dr. yesterday. He checked out my foot and the areas of pain. Advised that pain on bottom of heel was the plantar facius (sp?), not the Achilles. Since that pain has subsid

Oops, pressed wrong button. Since that pain has now subsided, nothing to worry about. Just don't run for now. The pain around the ankle/Achilles - Dr. advises that some people have that for months. Try to ignore it, but watch for increased pain and see him if it suddenly gets worse. Meanwhile, the best cure is stretching the calf muscles. Which I am back at full stretching routine.  I can see that backing off might ease the discomfort, but now I am two steps behind where I was before. So, going to put on my big girl panties and walk and work thru the discomfort.

Hard isn't it? That's how I feel at present. I feel like I'm further back than I was a week ago. So frustrating. But I think perseverance where possible is the key isn't it and trying to keep positive. Having done my acl before, and having been told that was the worst injury, I now disagree massively. This is the worst one I have ever had for getting back to normal.

Hi Jonathan,

DO you have access to a pool ?

I found the pool to be absolutely amazing when I was at your stage. It let me stretch and kick, and gain balance and strength very slowly. I was spending almost an hr a day in there, walking, balancing on bad leg, kicking etc etc.

 

I only have access to the local baths. But it's school holidays so it'll be absolutely rammed. The physio seemed reluctant on me going swimming yet. I am reaching a point where I will just start pushing things forward myself a little just because I feel that they are being over cautious. I do get the cautiousness, but I also need to make some progress.

Keeping you out of the pool, at this stage just seems wrong to me. Ok I am not a physio, but it lets you do everything you need without impact.

I would just sit on a floater and gently kick both legs just to warm up. It definitely works the muscles, stretches the ankle and achilles. No impact at all.

Then simple walking in the pool, hands behind back (ie. use your feet and not your arms).

Stand on injured foot and grip the pool floor with your toes, trying to keep your balance.

Walk backwards in the pool.

I was doing this at week 4, so they are definitely being overly over cautious. It is hampering your recovery. If you are already walking around out of the boot, you should definitely be exercising in the pool. Just take care getting in and out.

If you read any article on achilles op recovery, you should definitely be doing a lot more physio by week 14 .  I would hate to see you get injured, but exercising in the pool has to be one of your safest options for getting better. 

I agree with Neil. Walking in a pool, even gentle kicking, should not be an issue. Personally I would ask your PT or Dr to explain why they are being so cautious. If there is a unique reason, or an unusual risk, then they should explain this to you.

Saw PT today, advised her of Dr.'s feelings.  She concurred with him. Upon reflection, we think I have been placing too much weight on my heel and not enough on the ball of my foot. She gave me what she calls a "very specific protocol" to follow for the next two weeks. 

Calf raise on both feet, straight legged. Lift good foot and balance on injured foot for 45 seconds. Lower and wait 2 minutes. Repeat a total of 5 times. Do this in the morning and again in the afternoon. She said hang on to a ledge or countertop for balance.

So I did it this afternoon. Did not hang onto countertop for balance. Hung on for dear life. First time only managed 15 seconds. 2 minutes later, really pushed hard to stay up - managed about 20 seconds. And so on for five tries. Last try I managed 35 seconds, breathing strongly. Almost passed out.  Then rested and tried to go for a walk. Managed 1 mile. Really concentrated on rolling from heel to ball of foot. No pain in heel (Yay). Pain in back of ankle. Got home and iced - pain went away.

You are the best judge of your pain or discomfort level. Do what you can within your own tolerance. See how it goes.

Thanks for the advice Sandy and Neil.

I'm away this week, unfortunately my apartment doesn't have a pool, but friends does, so I may try and get in. If not, I will go when I get back.

Need to get things moving forward now.

Hi Neil I’ve been reading your advice and exercises I’m 71/2 weeks in but have done both can you surgery any exercises other than usual ones that I could try been in boots for 6 1/2 weeks

Cheers andi