I sustained a full rupture of my Achilles tendon last week and am trying to decide between surgical and non-surgical options (accelerated PT). I really don’t want surgery and neither option sounds good.
Any thoughts? Anyone been through this?
9 Likes
@knowsstuff is the guy who really did this type of work in his career and maybe he will weigh in. My friend had hers surgically repaired. Hers was due to taking a type of antibiotics that now have a black box warning, especially as we get older (Avelox & Cipro are in that family).
3 Likes
Here’s an article about the connection between antibiotic and tendon rupture. I did notice my tendons were very sensitive and sore when I took Avelox (which is in that family of antibiotics), but fortunately I didn’t have any ruptures.
1 Like
So sorry to hear this. There are many clinical articles proving both casting vs surgery are the correct answer. Also the actual location of the tear matters but let’s just say it’s the watershed area of the tendon and NOT an avulsion with bone coming off the heel.
If an athlete once the swelling is down, then I would surgically repair. Depending on the mri also. If not one then casting. Some will advocate for casting first then surgery. I have had patients that we casted first and when taking them out it was apparent enough healing had occurred. I also used PT a lot.
My favorite case was someone that another doctor just told her to walk on it. By the time she was referred to me she was limping away with just a stub of the tendon. I used a cadaver Achilles tendon and had her walking in no time. Even did a marathon.
But here’s the advice. If you don’t want the surgery. Don’t have it. Understand the good and bad also. If it doesn’t heal well enough even with PT you might need surgery down the road. Then you’re doing PT twice.
I had a Sports medicine lower injury office. I was “extremely “picky on who my PT was. I pretty much hand picked them. When you would visit them they would text me with questions etc while you were there. I did lots of lectures to PT groups also. Not all PT do lower extremity well. Just a note.
Good luck. You can DM me with questions. Everyone’s experience is different
There are also new techniques out there but also make sure whoever is doing it has done them before.
6 Likes
Having been down this road (some time ago), I would first ask what the odds of a successful outcome are with and without surgery. At the time, my orthopedist put the odds of a “fix” with surgery at 50% and the odds of “same or worse” at 50%, after 6 months of recovery and PT. Perhaps a doc like @Knowsstuff could have had better insights and options up front. Mine didn’t inspire confidence! A top-notch PT got me put together again without surgery. Yet a young colleague 's DH ruptured his Achilles playing basketball, had surgery, and was 100%. Not all injuries are the same. Getting a clear understanding of what you are dealing with may also help in the decision-making.
Having been to PT for a number of things over the years, there is a HUGE range of ability in that field. The good ones are fabulous. Others offer little more than what you’d get by googling your condition. So if you go that route, try to get a rec for a PT from others who have been successful.
I’m sorry you’re going through this.
He was giving you the medical /legal answer. If I did surgeries that only had a 50%chance maybe it’s me,I would have that doctor ask himself that question first. There is tons of clinical articles on the subject. I never had an Achilles tendon rupture not get back to the sport /activity they wanted to. But I tell every patient my first goal is to get you walking. Anything after that is extra. I can’t guarantee that they can play basketball like Michael Jordan but walking and hopefully without a limp is the first stage. As I stated I am picky on PTs for the things you mentioned. They need to have vast experience in lower extremity and biomechanics. No surgery is ever guaranteed.
Also on second and third and 5th opinions. Lol. When I have a patient asking for another opinion that had several I would just ask what they want to hear. Lol. If it wasn’t a serious infection or something like that it’s elective surgery. This isn’t emergency heart surgery. Then I would go along with what they wanted BUT give them enough knowledge to make a logical choice. When deciding a treatment plan it should “ALWAYS “be both the patient and doctor /surgeon together. The problem is when you get a patient that doesn’t want to partake and just says “You’re the doctor, do whatever “. I won’t move forward on a patient that won’t take responsibility for their treatment plan. I have learned a few things over 38 year’s and taught our surgical residents the same.
I know it sounds corny but I look at it if she was my daughter or wife. What would I suggest but as stated not all ruptures are the same. I had patients come in with supposed ruptures and in my office they could bear down against my hand. Very weak though and I would tell them. “Seems like your fixed”… lol. With a complete tear you can’t move the foot down at all. It’s kinda limp. There is usually a Dell (indent) where the tendon ruptures…. These don’t have to hurt. Many people keep walking on them with a limp. Which I don’t suggest.
Usually a sports medicine doctor either Podiatric Surgeon or Ortho but make sure they do these on a regular type basis. There are new micro procedures that have lots of promise also. Small incisions to repair so less of a scar.
2 Likes
Thank you SO MUCH for this information. I just sent you a DM.
Ouch!
Response sent awhile ago
Thank you!!
A friend’s husband had a ruptured Achilles tendon a few years ago. He had surgery to repair it. It got infected, needed a 2nd surgery to deal with that. He also had to wear a compression sock that went up to lower part of his knee for quite awhile after that. He’s totally fine now.
I’d go with @Knowsstuff’s advice on this topic! 
3 Likes
That sounds awful — so glad he is fine now!
And 100 percent about @Knowsstuff — I am so grateful for his knowledge and advice!
1 Like
Yes, I think my friend is glad she opted for the surgical repair, followed by good PT. She fully recovered but did warn me about that class of antibiotics (which I had taken whenever per my lung doc’s orders I had an infection 1-6x/yr for about 16 years). Stopped taking that class of antibiotics after that.
In 2004 I tore my achilles while playing softball. Our first baseman at the time was the trainer for a local Big Ten baseball team and saw it happen. He’s a funny guy, just stood at first and yelled “Drag him off the field, we’ll look after the inning” with a vague gesture towards the foul line. He got me the name of their ortho and when they looked at my leg they suggested a non-surgical casting, which I guess was fairly new to them. I got a new cast every week, moving from pointed toe to 90 degree over the course of the summer. Worked great, no pain during or after, no reinjury, not much PT needed. But I tell you missing a summer of activity at 39 meant that muscle mass never came back. My calves are visibly different to this day.
1 Like
I am very sorry to hear about the rupture. I too had a full rupture 2 1/2 years ago that required surgery. The surgery wasn’t the problem. It’s the slow and very long recovery because tendons require slow growth and loading over time. PT was an absolute must, 6 months, initially. The 2nd year I did another 3 months. I have always have been an active person and I really hated how it changed my life the first year. I am finally feeling like myself and doing almost everything I did pre injury, except playing pickleball. H said no more pickleball because he and I can’t handle another achilles rupture ever again lol.
Both calves are the same size now. Initially the injured leg’s calf was much smaller than the other when it was in a cast for a month. Finding the right surgeon is the key. Wishing you a speedier recovery than mine.
1 Like