Achilles Rupture Recovery

< last edited 23rd Nov – work-in-progress >

The next immediate steps for me to take care of were:

• General Practitioner (GP): to get me signed off on sick leave as well as get various bits of paperwork and prescriptions (see Week 1 for details);
• Magnetic Resonance Imagery (MRI): this ‘magical camera’ will get a decent set of pictures of your internal ‘soft tissues’ without anyone having to get physical; this enables the medical staff (hopefully a foot / ankle specialist!) to get an accurate idea of how badly and where exactly you ruptured your Achilles (see also Week 1 for how it went with me) … this, together with other factors, forms a basis for that crucial decision: op or non-op treatment?

Now, I’ve seen fairly frequently in some threads in the meantime that some surgeons will say, kind of, “Naah, don’t need an MRI … we’ll see what’s up when we slice you open!”. I personally would not be happy with this approach, regardless of how experienced the surgeon might be (quite independent of the fact that I would absolutely INSIST on a minimum of two opinions before ‘going under the knife’!) – it just sounds way too much like ‘winging it’ to me … not something that gels well for me in connection with an operation, rather, this (subjectively) feels like the approach one would take, when one said: “I’m an excellent, no, brilliant surgeon; I can take whatever the world (read ‘your body’) throws at me!”.

In fact, the first ortho doc I saw actually went one step further, and said that an MRI was a “waste of time” 🫣 ; all other 5 docs I saw happily insisted on it to be able to diagnose properly and decide op / non-op. I just think: why would I want to not use this ‘tool’ from the toolbox if it’s there and available? Because I like the ‘thrill’ of being on the edge … ?!? My mind can simply not get round the thinking that must be involved in this kind of approach … although I do appreciate that I am lucky enough to live in Bavaria, Germany where this technology is a) readily available even in many small towns, and b) paid for by health insurance

In other words, I do recognise that it may simply not be an option for many in this world, depending upon where one lives and what kind, if any, of health insurance is applicable, to have an MRI scan. If good insurance is not available but a good doc with plenty of experience operating on Achilles tendons is on hand (these will be a rarety outside of foot / ankle divisions or clinics!), then they may well be able to make an educated guess. If not, I guess a much larger incision than necessary might be the result (as I’ve seen on Reddit 🥴 ) – scars don’t bother me at all, unnecessary slicing and big gaping wounds that can get infected or lead to other complications … yeah, they kinda do. Either way, if you’re injured and reading this: it’s your injury, your choice … and I’m not a doctor – do your best to educate yourself and then make a decision.

At any rate, one has (a little) time to go do some research once a cast or boot is on (nevertheless, if an operation is necessary, it’s generally accepted the sooner it happens the better, so don’t take too long!); in a different country, I would go educate myself, see what the possibilities are in the region, with whatever health system / insurance is active and get AT LEAST TWO medical opinions! If these differ, I would ALWAYS go get myself at least one more until I had two doctors (mostly) agreeing independently; I ask questions – as the patient, it’s my body and it’s my right to know what they know (and DON’T know!) so that I can make the best decision for me. Additionally, I write down the questions before I go to an appointment so I don’t forget and, if possible, I like to take someone (with a clear head and no injury – as an injured person, I AM under stress!) who can make sure nothing is forgotten or misunderstood. Remember: the medical staff you talk to, regardless of which ‘level’ … they’re ALL human.

I don’t consider any of this to be medical advice, rather, common sense that most people would (should!) already use when dealing with a tradesman but often don’t when dealing with a doctor … because doctors are professionals and, of course, always know what they’re talking about and don’t make mistakes … right?!? (he wrote with a degree of sarcasm 😅 )

That concludes this attempt of mine to give you, possibly an injured person, an insight into (non-medical) aspects which I would have GLADLY known about in the first couple of days after my accident – and that, despite the fact that I live close to Munich and have a large network of doctors, also specialists, relatively close to hand plus a good national health system (despite what some Germans may say!).

What follows on this page are some resources which may, hopefully, educate you a little further with regards to the pressing and, for many people, key decision: does one go for an operation? Or a ‘conservative’ treatment, with all the advantages and disadvantages (compared to the surgical treatment) this represents? My personal decision (to go the ‘non-op’ way) is one I made over the course of two weeks, although I was 95% decided already on the 3rd day post-injury; the final opinion I received on the first day of the third week, from an accident orthopedic specialist at the hospital with the ER department that fitted me with the VACOped boot, ramped that up to 100% decided … and as I walked out of that last consulation (from the sixth doctor I’d seen in 2 weeks), I was finally at peace with my decision as I took the train home.

The general consensus (my interpretation of it, at any rate) is that the _average_ healing time is approximately the same, regardless of operation or not (although timelines will vary); functionality can and should also be more or less restored the same, seeming to largely depend upon how good surgery was or wasn’t plus physio support and exercise consistency; some will argue that having surgery is key to getting back 100% instead of ‘just’ 99% functionality … but there are some who would disagree and say that, so long as nothing was generally screwed up in the initial 8-12 weeks, physio and consistency will play the biggest role. Genetics, age, fitness, nutrition and many other factors will also surely play their part … and everyone is different.

There is a HUUUGE amount of information on this subject with lots of different, to some degree very contradictory, statistics and opinions; it is also a decision which one usually needs to take fairly quickly (if you’re going to opt for an operation – if not, things don’t change, you ‘just’ follow the route cast + boot or, like me, just boot from the start). Hence I’ve collected some infos and white papers on the subject..

P.S. As with any of the other pages in this ‘collection’: if you think I’ve forgotten anything, misrepresented something, made a mistake in any way shape or form, gone over the borderline between non-medical information and medical advice, or whatever else, PLEASE do get in touch with me either via the comments below or send me an email direct (sols_achilles_stuff@icloud.com).