Achilles Rupture Recovery

Just to repeat one of the key points regarding this injury of ours: every injury is different. Thus it shouldn’t be surprising to know that there is no ‘one size fits all’ solution. This starts with the big question: am I going to need an operation? It may surprise you to find out that there is even a choice, nay, a tendency in the modern world to perhaps not move away from surgery as such, but to recognise that a non-surgical (non-op) treatment path not only exists, but can be the preferred way to a return to normal life in a growing number of cases. Whatever that ‘normal’ means for you.

There are many factors which will play a role in this decision (which is, ultimately, your decision … whether the doctors act like it or not). The following is just a small extract:

• Where did the rupture occur? Very roughly speaking this can be narrowed down to 3 different areas: down near the heel (tendon-to-bone), somewhere around the middle of the tendon (tendon-to-tendon) and higher up (tendon-to-muscle)
• How big is ‘The Gap’? (and what do the tendons look like – even a rupture in the central area often results in ‘mop ends’ rather than a clean cut … these exist too, but are more the exception than the rule)
• How old are you? Older patients will tend to be handled conservatively due to the risk of complications connected with surgery
• How fit you are? Are there any ‘comorbidities’ (other health issues) and risk factors tending to point towards a conservative treatment? Whether you are a smoker or not will also play a role.
• What are your long term targets? Professional sports people will frequently opt for surgery hoping for a faster and more successful return to their career; the same motivation may apply to non-professional but ambitious sports enthusiasts. Others (myself included) may be sports enthusiasts and determined to get back to a fully active sports-oriented life, but at the same time not be set upon achieving that ‘100%’ pre-injury status (I, at 55, will be satisfied, even happy, with a return to 95-99%). Yet others still might solely be interested in being able to walk again, with zero interest in jogging, let alone any other forms of sport.

At any rate, the first thing to realise is that you will most likely have a choice … nay, you will always have a choice. Whether you decide to exercise the right to educate yourself and choose your path, or whether you essentially leave the choice up to the medical personnel … that is up to you. Here you can read the beginnings of my own row of decisions as well as find a host of links to external resources digging and diving into this complex and very personal decision.

Remember my GP was really unhappy about the potential waiting list of several weeks for an MRI? That she asked her assistant to telephone around and that got me onto an ‘acute list’ for cancellation replacement at a local MRI practice? Well, lo and behold, this morning I got a call from a lady offering me an appointment for tomorrow (Wednesday) at 10:30. Excellent, I thought – I’ll take it 🙏 !

The next bit of good news: when I got up, I found a pot of coffee waiting for me, made by my 15 yr old son before he set off for the train to school – this kind of injury always affects more than just the injured and I’m really proud of how he is being so independent and helpful 😍.

The most important thing on the morning’s schedule was the appointment at the clinic in Munich. As I was unable to drive myself, of course, my partner took me there – she is so good to me, really lucked out there!

Finding a parking place nearby in Munich was, however, impossible – the search simply consumed lots of time … so although we thought we’d left home in plenty of time, it ended up being a bit tight; the end result was me taking a short cut around the back of the hospital via piles of damp leaves in an unprotected boot 😬.

Note: A VACOped liner is essentially a giant sponge. Walking through wet leaves on Day Two was my first lesson in the ‘new physics’ of my life. If you have to go out, wrap it in a plastic bag before you leave the house; long term: buy a cover, details below.

Nevertheless, it was a great visit – the doc really took her time to do a VERY thorough ultrasound scan (saw what might be a few overstretched but complete tendon fibres – hope!) and exam as well as assuring me that a non-operative treatment may well be an option and answering lots of questions; at any rate an MRI was definitely indicated in order to get a clearer picture of the tendons, she assured me, absolutely not a waste of time; I should come back the next day as soon as I had the MRI results. That was encouraging!

Getting around on crutches: ?

Protecting your cast or boot: ?

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< I’m going to come back and do a better job on the collation of prioritised lists later, but for the moment, have a look at this ‘gear’ page I wrote early on > … it’s not great, not complete, and there are some more lists on Reddit, but perhaps better than nothing.

Rome wasn’t built in a day. Your tendon’s healing will also take a long time – as mentioned, typically one should consider this to be a 12+ month injury, with 2-3+ years not being uncommon to return to (more or less) pre-injury health. Additionally, one cannot simply ignore the aging that takes place parallel to the recovery … none of us are getting any younger. Nevertheless, you will almost certainly read of cases here or there where people seem to make an astoundingly fast recovery. These are the exceptions, not the rule. Tendons heal sloooowly.

One generally well-accepted fact is that the decision to opt for surgery, or go for a conservative treatment, will not, in itself, be the most decisive factor in regards to your recovery time and the outcome. There are people who have surgery which is botched, or they suffer a re-rupture despite a good operative procedure, thus taking longer than average to heal; likewise there are people who, other than during the original ER visit and initial consults, have virtually no contact with medical personnel and come out of the injury fitter than they went into it. These are also the exceptions, rather than the rule.

In fact, in many (perhaps even most) cases, how good your physiotherapy support is and how consistent you are in performing the required exercises will outweigh this seemingly be-all decision. And nevertheless, physiotherapy is a long way down the road from where you are today; opting for surgery, or not … that decision is, currently, way more relevant. So let’s take a dive into a variety of posts, videos and white papers going into this topic.