Severed Achilles Tendon - no pain and can still walk with a limp - can I just not treat ?

by Mac
(Park City, Utah, USA)

I severed my Achilles tendon 6 weeks ago. An MRI only just revealed a 2cm gap between the two ends of my Achilles tendon There is no sign of any fibrous material, just a totally clean break.

It hurt at the time, but generally I have received little pain, to none at all. I have been wearing a boot for about half of the latter period of the past six weeks.

I am male and 62 and I own my own business, quite simply being out of service for the time expected for surgery will mean I will have no business left at the end of it.

On which basis I am trying to find out, what happens if I do nothing ?

I have been told a boot is unlikely to help because the two ends are too far apart and a boot cannot achieve the angle required to get those to knit, plus it's been 6 weeks since the injury occurred.

So as it doesn't hurt and I can walk on it with only a slight limp, I am very tempted to just do nothing. Surely now it's torn, it's torn and the situation can't worsen or become more painful by just leaving it alone.?

In this economy one has to survive and if I proceed with Surgery, I will lose my business and then my home.

Please give me you honest and unbiased views on this.

Many thanks,
Mac



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Joshua Answers:

Hi Mac.

Tendonitis definitely isn't your immediate issue.

See: What Is Tendonitis

If you had not said that you "...can walk on it with just a limp...", this would be my response:

You have two options.

Achilles Tendon reattachment surgery, or The ARPwave System.

Surgery to reattach the achilles tendon, with a 6-12 month recovery.

The ARPwave System can very likely heal the separation with out surgery (you'd have to talk to the ARPwave guys to confirm your specific situation), and then jumping rope in 8ish weeks.

Or, post surgery, jumping rope in
8ish weeks.

Those are your two options.

--

But, you said you can walk on it with just a limp. That's a rare thing. That means associated connective tissue is holding you up.

Generally, if there is a complete Achilles Tendon Rupture, one can't stand or walk without collapsing, because there's literally nothing holding the foot/ankle in place in relation to the lower leg (plus the brain forces a collapse as an attempt to prevent more injury).

But you can stand and walk.

Can you get away without surgery and/or the ARPwave? Maybe. -Probably- not for very long though.

You'll either limp along, likely for the rest of your life, or you'll take a step one day and down you'll go and that'll be it. Back to square one of needing surgery for sure, and possibily the ARPwave to avoid surgery (depends).

Complete Achilles tears are bad news. One can generally get by with a torn ACL ligament, but rarely if ever a major tear to an Achilles tendon.

Plus there's the risk of blood poisoning/infection if those torn ends start to decay/rot. Admittedly I don't know much about that aspect.



If you want to have ARPwave give you a call, let me know here or on the form on the ARPwave System page the above link points to.



More questions, more answers.



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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
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Comments for Severed Achilles Tendon - no pain and can still walk with a limp - can I just not treat ?

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Jan 14, 2016
Rating
starstarstarstarstar 		Complete tear in Achilles tendon but I can still stand up
by: Charles

I had a MRI and orthopedic says I have a complete tear and there is a gap between the tendon.

But I am able to stand and walk with a limp.

But I cannot raise the heel of my foot while standing, but if i'm sitting down I can raise my heel off the ground.

This injury happened on 12-30-15 so it been about 2 weeks. It feels like its getting better and better.

My pain level is like a 1 or 2 and its the calf muscle that feels sore after walking on it and some soreness around the ankle and just above it.

So is my tendon really a complete tear? The Mri only shows my ankle a little bit above it,

Doctor says he cannot see tendon above ankle because of view and want me to just have surgery on 1-16-16. What do you think.

I can almost stand on on the 1 injured foot alone, but get pain from trying to balance it.


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Joshua Comments:

I think:

1. You can still stand on a complete tear, depending.

2. Other structures are still connected, that accounts for some available strength/stability/movement.

3. The MRI either shows a complete tear, or it doesn't. Or the MRI doesn't have a clear view of what needs to be visualized.

I haven't seen said MRI, so I don't know.

Get a second and/or third opinion from another doctor/surgeon. They'll at least let you know if the MRI has a good view of the tendon/ruptured tendon.

4. If there is a complete rupture, it's not going to reconnect itself by itself. Depending, maybe you can live/be movile with a ruptured tendon, but unless you're VERY sedentary, I wouldn't recommend it, as it sets you up for further damage in the future when you take a step and fall and/or rip something else.
Jan 17, 2017
Rating
starstarstarstarstar 		living without an achilles tendon
by: Anonymous82

I am a man 82 years old and my achilles tendon was initially severely strained when walking in Cornwall.

Subsequently a gung-ho osteopath ruptured it, without my realizing it.

I had to go abroad and then when I got back to England a physio told me that I should have an ultra sound scan which showed a total rupture.

It was decided that the ends of the tendon had healed and it would be difficult to do any thing about it.

So I have been living with this problem since the end of July last year- about six months.

I can now walk about a mile(rather slowly) on uneven ground(we have about 7 acres on the side of a hill).

I have no pain but get tired sooner than I used to.

There are two little muscles called: The petronius longus and the petronius brevis which are getting stronger and trying to take the place of my calf muscle.

So it is not too bad though I have to walk with one flat foot.


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Joshua Comments:

Hi Anony82.

That's great news you can still walk around on that ruptured achilles, stand on it/put weight on it, etc.

Did the ends of the achilles tendon heal back together? Or did they mean that the severed ends healed over?

If the latter, they would have had to cut the very ends off and then reattach the tendon.

All in all, you're in a pretty good position (compared to a lot of other people with ruptured achilles tendons).

Not much pain, avoided the trauma and risk of surgery, avoided a long painful recovery, post surgery your achilles and attached structures would be TOO SHORT and that would likely be painful for along time/rest of your life.
Feb 21, 2017
Rating
starstarstarstarstar 		follow up to my previous comments
by: Anonymous82

I have now been living without an achilles tendon for about 4 months and have had little sensible advice from health professionals.

I was advised to do 10 heel lifts twice a day. I felt that was not a serious excercise and began to increase the the number .

I can now do 350 heel lifts twice a day and am seeing a considerable increase in the size and strength of the two peronius muscles and am able to lift my left heel slightly when walking.

If I concentrate I can walk almost without a limp, but rather slowly.

I still have to put the instep of my left foot on the rungs of a ladder but am working on it. So, all is not lost.

Anonymous82


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Joshua Comments:

Well, all in all, that's incredibly good considering your achilles tendon is severed/completely ruptured.

Not ideal of course, but pretty dang good considering. 350 heel lifts is more than most 20 year olds can do these days.....
Jul 18, 2017
Rating
starstarstarstarstar 		Achilles debridement and mrsa infection
by: Mattmatt

I cut through my Achilles to the tibia(I think that what its called)also severing the tibia nerve in March.

I had surgery to reattach though caught mrsa and had a debridement 2weeks later.

Approx a month after that I contracted staph again and hence another debridement that was 8may.

I'm now in moonboot but have not been told if Achilles will reattach by itself or need surgery very vague(public system) what is estimated time of healing after debridement and will I get sensation back in my toes.

Thank you.


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Joshua Comments:

Hi Matt.

Ouch, that's a tough road!

How did that cut happen?


1. "have not been told if Achilles will reattach by itself "

What do you mean? If you had reattachment surgery, it's reconnected and will/should heal back together.


2. If the nerve was severed, it's unlikely that you'll get feeling back, much less any time soon.

What nerve(s) exactly were severed?

Did they attempt to reattach the nerves?


3. Can you wiggle your toes etc? Did you lose motor control when the nerve(s) were severed?
Or, how much motor control did you lose and where exactly?


4.Were you given any fluoroquinolone antibiotics like levaquin or cipro(floxacin)?
Oct 26, 2017
Rating
starstarstarstarstar 		Life with no tendons
by: Claire

Both of my Achilles’ tendons were surgically removed along with a piece of each calf muscle after I lost the flesh on both legs due to an invasive strep infection 11 years ago.

I’m now 40 and although learning to walk was a long and difficult process, I have never collapsed or fallen. I was told that I’d never run again and although I still can’t tip toe, I can run, just not uphill. So far I can run for 20 minutes without stopping. There is life and an active one to boot without Achilles’ tendons!


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Joshua Comments:

Really? Wow, that's awesome.

And aside from the terrible aspects of all that, REALLY interesting. The body is really amazing in many ways, and that you're able to walk and run one of those ways.

Tell us a little more about all that? What did the doctors predict pre-surgery? How do they explain your ability to walk and run? How did recovery and then rehab go?
Jan 20, 2018
Rating
starstarstarstarstar 		2 torn Achilles tendons
by: Milinda

I had two torn Achilles tendons in 2016 at the age of 56. One was completely ruptured.

I went to multiple doctors and told them I thought it was an Achilles tendon torn on the right.

However, they tested me for everything but tendon tear. One day I went down and there was no getting back up. Long story short(er), both tendons were ruptured. The left one with a gap. I had surgery on both tendons at the same time, which included donor tendons.

The right healed fine. After 6 surgeries for infection, with use of wound vac x 2, derma close x 3, and removal of donor tendon, scar tissue removal, etc., the wound closed. I can walk and stand on tip toes.

However, it is important to note, with no tendon, you have to stay motivated and work hard. My Dr. says I am a walking miracle. Never give up! Also, I think these were caused by antibiotics and statins.

Talk to your Dr. any prescriptions he gives you. It could save you from a year of inimaginable pain and suffering!


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Joshua Comments:

Hi Milinda.

Blargh, that sounds terrible!

1. Why did you have two achilles tendon tears?

2. Onset at the same time?

3. Did you take Fluoroquinolone antibiotics like cipro/ciprofloxacin, levaquin/levofloxacin, etc?

4. Statins absolutely have downsides, but aren't known to directly cause tendon damage. Having said that, if you'd been on Statins a while and took a Fluoroquinolone and experienced bilateral achilles tendon tear....that makes a lot of sense.

5. Are you without a functional achilles tendon on one side now?



Tell us more.
Apr 25, 2018
Rating
starstarstarstarstar 		Right Rupture
by: M

Hi,

I am going in for surgery on Monday after playing in a soccer game a week ago and hearing and feeling that lovely pop and promptly crumbling on the field. I knew what the loud "pop" meant instantly, left Achilles rupture, because I ruptured my plantar fascia playing soccer in college, about 15 years ago, and it was the same exact feeling and sound.

Prior to this incident, I was in physical therapy twice weekly for an undiagnosed severe pain in my right calf, which felt fine during the game. I guess I’m wondering if the two incidents could be related. The PT said my left leg was far looser than my right, so it doesn’t make sense to me that the rupture happened in the leg that hasn’t been an issue.

Not looking forward to the months of recovery but it is what it is. Good luck to everyone.

Thanks,
-M


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Joshua Comments:

Hi M.

1. Sorry to hear that. No fun.

2. It makes a lot of sense, as the 'good' leg has been doing a lot of extra work to make up for the 'bad' leg.

3. Severe pain is an indicator that something bad is happening. Or should I say, it's an indicator that there is something wrong with the mechanism, so even when you're playing without pain....there's still something wrong with the mechanism.

Admittedly one wouldn't necessarily expect a severe pain on the right to have a correlation with an impedning rupture on the left...but still it makes sense.

Yes absolutely there's a correlation. Maybe not a direct correlation as it's the opposite leg, but overall, the correlation is at minimum the clues of A. severe pain, B. previous significant injury (plantar fascia tear), C. the reality that the body compensates/adjusts to 'make up' for a structure(s) that aren't working correctly.

Right side wasn't absorbing force like it's supposed to due to the non-optimaly functioning mechanism, left side has to compensate and ends up trying to absorb more force, can't, something gives.
Sep 28, 2018
Rating
starstarstarstarstar 		ATR No pain, Asked to Walk and improve Calf Muscles
by: Siva62

Good to read the details provided by Mac. My Achilles tendon (right leg) got ruptured 12 weeks ago (June 25th, 2018).

An MRI, taken after a week, showed the gap as 12mm. Three days later, my leg was put in a fibre cast (conservative treatment) for two weeks.

At the end of two weeks, it was found, again by using MRI, that the gap had increased to 15mm.

The Ortho then checked if I could wiggle my toes (which I could) and said I could start walking and gave me some medication. Three weeks later, the Ortho did another review and said that things are improving and asked me to continue walking.

After another 4 weeks, and not happy with my progress, I consulted another Ortho. This Ortho too, told me to continue walking and that I should build my calf muscles. He said that we should focus on functional capability rather than the biological repair.

So, I am still in square one. I can walk a distance of 1 kilometer but with a limp. If I walk slowly, the limp is not visible. Am able to do plantar flexion.

Dorsi flexion, I have just started and can bring my foot to a horizontal level. Can do heel raises using both feet together (but not on my right foot alone). The Ortho feels that in a couple of months time I should be able to walk okay and subsequently be able to run short distances.

Just want to know if there are other people undergoing a treatment like mine.


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Joshua Comments:

Hi Siva62.

I am dumbfounded. You have a 1/2 inch tear in your achilles tendon and doctors etc are just having you walk it off? And then go for a run in a while??

That's....crazy. But hey, I'm not a doctor.

Why do they think the tear happened??
Oct 01, 2018
Rating
starstarstarstarstar 		In Continuation of my ATR problem
by: Siva62

Hullo Joshua,
My ATR happened while playing table tennis and when I lunged forward. This is a game that I have played
for many years while in school & in the University.

But not after that. Actually the first Ortho I met wanted me to have a surgery but I opted for another Doctor who said he would give me conservative treatment.

The current Ortho feels that once the calf muscles develop, I will be able to run and even play table tennis again. I have now increased my walking distance to 1.3 kms. Glad to hear of the other elderly (80 yrs) gentleman being able to walk over a mile.

I am also impressed with Claire's feedback that she can run. I would like to know more from her & the gentleman. Can I have their contact details as well as that of Mac.


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Joshua Comments:

Hi Siva.

I don't have their contact info, and if I did I couldn't/wouldn't give it to you for privacy reasons. Perhaps they'll get notice of your comment and reply.

So...how big/bad/severe is the rupture?

HOw exactly does the ortho think that 'your calf muscles developing' will fix the rupture? Weren't your muscles developed and working before the rupture?
Oct 09, 2018
Rating
starstarstarstarstar 		Further Continuation to my ATR problem
by: Anonymous

Hullo Joshua, The MRI scan report taken in Aug'18 said that I have a 15 mm tear. The Ortho feels that my calf muscle is weak and by strengthening the same, my walking will become easier.

So I am doing some exercises for the same. I am now walking a distance of 1.4 kms but recently got some slight pain just above the dent point. I have also started driving my car (auto) to the local shopping center. I understand your privacy need but pls post my email id: xxxxxx@xxxxxx.com. Others are welcome to contact me. I am keen to know how Claire, Mac & the 80 yr gentleman are managing. I am also willing to answer any question posted to me.


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Joshua Comments:

Sorry, just can't post emails publicly.

Question:

1. Does the ortho expect the .69 inch tear to just repair itself? Staying active on it is the answer?

2. How active were you before the tear?

3. Did the tear show up over time or was there a single event where 'oh I just tore something'?
Dec 07, 2018
Rating
starstarstarstarstar 		Now anonymous nearly 84
by: Anonymous82

I can still walk slowly but I have an unexpected problem. My subconscious brain still thinks that I have a tendon and corrects for balance before I can correct consciously. This means that I have occasionally tripped and a couple of times hurt myself. I have an appointment with a nerve specialist. I am hoping that my subconscious brain can be trained to use my Petronius instead of my calf.


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Joshua Comments:

That makes sense, there's definitely room for your brain to learn some new tricks/makes some adaptations.

Make sure your Vit D3 levels are between 60-80ng/ml because adequate Vit D does/will help your brain/body's ability to have 'balance' (both moving and when still).
Dec 09, 2018
Rating
starstarstarstarstar 		Continuation to my ATR problem
by: Siva62

Hullo Joshua,

My current status:
- Can walk a distance of 2.5 kms, on tar road but with a slight limp.
- Can drive my car (got the Doc's permission). - Can climb up and down stairs (as a normal person).
- The dent area (break area) has become fairly hard unlike the softness that I could feel earlier.

Your Question:

1. Does the ortho expect the .69 inch tear to just repair itself? Staying active on it is the answer?

The Doc feels that the body has the ability to make corrections and that I should keep my mind focused on the functionality. Hence, I should keep walking and do dorsi flexion exercises. He believes that strength will come back to my leg and that I will be able to walk normally and even run short distances.

2. How active were you before the tear?
I was fairly active. Used to go for walks, at least 5 times a week. Drive car on a regular basis and also go for long rides of around 800 kms. But games, I rarely participated.

3. Did the tear show up over time or was there a single event where 'oh I just tore something'?
I heard a sound while lunging forward while playing table tennis. A game I love and used to play a lot during my school & university days. But this event happened after a very long gap (over 20 years) of playing any game. I initially thought that my leg had hit something but my foot had changed direction and I had to go home dragging my foot.

Joshua, I would like to have some feedback from the Ortho's you know, who can share their thoughts, based on my inputs. They are welcome to ask any question. I also have the mri's & reports. I am deeply concerned as I want to be sure that I will get my strength back on my right leg.


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Joshua Comments:

1. Things weren't working correctly. That resulted in a sudden tear.

2. Those same things aren't working correctly, as your tissue is trying to heal from a tear.

3. It went from a soft dent to a gap filled with new connective tissue/scar tissue.

4. The doctor is hoping that that's the end of the problem and that using it like you did before will return to normal.

5. I'm sure you're get some amount of recovery. What bothers me is that all the things that weren't working correctly still aren't working correctly. So while you'll get some amount of recovery, you're at risk of a retear.

6. Sorry, I don't have ortho friends so can't show them your scenario. If I did, they'd say what ortho's say (what you've already heard from your doctor).

Some are better than others of course, and would send you to PT etc for SOME kind of rehab for a tear almost an inch big (.69 of an inch is a big tear).

7. Loss of strength comes from two directions: A. the tighter muscle is, the less work it can produce, thus less 'strength'. B. The brain can tell there's a tear/damage there and will not allow muscles to produce enough work to cause another tear. It's a way the brain protects the body from further injury, good news/bad news.

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