My Achilles Tendon Rupture — Success with no Surgery and no Physical Therapy!

Below is my diary regarding my:

  1. Initial achilles tendon rupture in October 2013 followed by weeks in a splint, cast and long boot.
  2. A likely unfortunate re-rupture in December 2013 after walking normally in two shoes for just one week:-(  Back to long boot.
  3. Subsequent long-term recovery after getting back into two shoes in January 2014.

I will try to update this page every year.  To view other people’s diaries or start your own, you can join the achilles tendon rupture forum on this site.

October 5, 2013 — As an at-the-time 35 year old male (this injury is most common in 30-50 year old male weekend warriors, and I was a prime candidate), I was playing high level indoor doubles badminton after a 1.5 year or so break from my favorite sport.  Until the age of 32 or so, I would describe myself as being fairly athletic and pretty good at a number of sports.  However, from the age of 32-35 I stopped playing sports (barring some recreational beach volleyball and a few dispersed badminton sessions), and slowly gained weight and went from around 185 lbs to 200 lbs.  I feel that that this extra weight on my 5 feet 11 inch frame combined with several years of very limited exercise probably increased my likelihood of suffering an achilles injury.  No-one in my family has ever had his or her achilles tendon rupture before, although no-one in my family ever played sports as intensively as I have done throughout most of my life.

I have played indoor badminton on and off since my early teens, including having participated in around 20 tournaments.  In recent years, I have primarily focused on doubles (much less running than in singles and much more skill and reflexes involved).  On October 5, when I went to play at my local club, I was paired in the top doubles group as most of the other players who showed up on that day were of intermediate or beginner level ability.  My partner and both my opponents were all in their 20s and definitely looked fitter than me.  I would never have matched their level in singles anymore, but in doubles I was more than holding my own close to one hour***(see footnote) into our three game match.  Each team had won a game, and in the middle of the deciding third game, I ran forward to return a drop shot and then rapidly ran backwards to return another shot.  While running backwards, I saw my partner to my right coming leftwards in my direction in order to return the same shot, but I was getting to the shuttle first…and then I suddenly collapsed.  I felt like I was shot in my right leg calf area and my partner must have stepped on my right calf muscle while we were both attempting to reach the same shuttle.  After I fell down, I looked at him accusingly, but he was adamant that he did nothing!  FYI  — later on I learnt that both this kind of “accusing-the-partner” scenario and “being-shot-in-the-calf” sensation are quite typical feelings when people rupture their achilles tendons.  In fact it seems like a majority of people who rupture their achilles tendons while playing a sport initially think that they have been shot in their calf muscle region.  After my sudden collapse, all the other players were staring at me in disbelief since no-one had even touched me!

I limped off the court and was quite confused.  At the time, I did not realize what kind of injury I had just succumbed too.  In fact, this would be the first truly major injury of my life despite my having played so many sports in the past and having done a number of reckless things in my younger years.

Later that night, despite continuously dragging my injured right foot or limping slightly, I went out with friends (and I drove), including to a hookah bar!  I continued to drive and walk with a limp for another week despite persistent swelling of my right foot, as well as purple discoloration near the heel area.

***Based on anecdotal evidence, it seems to me that a majority of these injuries happen after a person has been playing a sport for an hour or so, rather than in the first 10 mins of activity — perhaps indicating that prolonged stress to the tendon/legs and dehydration are also partly to blame?  It also seems like warming up extensively prior to playing a sport in order to prevent such an injury is not effective (yet many medical professionals continue to believe this myth).  Kobe Bryant and David Beckham are examples of superstar athletes who ruptured their achilles tendons when in their mid-30s, and I really doubt that those guys do not warm up properly.  Unfortunately, for most people, their achilles tendons are not as strong in their 30s as they were in their 20s and warming up will not make much if any difference in your risk of suffering a rupture.

October 14, 2013 — I finally went to see a foot doctor after doing some online research and suspecting an achilles tendon rupture.   She did not think it was guaranteed to be a full rupture even though I had a positive Thompson test which would indicate a full rupture. To confirm the diagnosis, the doctor scheduled an MRI for the next day. She also gave me a tall boot to put my right leg into in order to stabilize the lower leg and area around my achilles when I walked — so as to limit any further tendon gap widening. The boot had 3-4 wedges in there under the heel, as this allows my foot to point downwards and the torn achilles edges to theoretically connect as long as the gap is not longer than the height of the wedges being inserted.

October 15, 2013 — Despite my still weak right leg, I drove 20 minutes to the imaging center where I had an MRI early in the morning.  My foot doctor then called me in the late afternoon and said it was a full rupture and I felt upset and relieved at the same time.  However, my doctor said that she was getting married soon (!) so I should see her medical practice partner the next day.  She said I could get surgery with that partner right away if I wanted to.

For more on my rupture images, see my achilles tendon rupture MRI.

I spent a restless night researching on achilles tendon ruptures and especially on surgery versus no surgery debates.  I hoped that my 8 days of walking, driving and even climbing stairs to a friend’s second floor condo had not made the rupture too large for the non-surgery conservative treatment option to be impractical (Note: according to some research, even very large gaps in the tendon after a full rupture can be successfully treated non-surgically, but I remain somewhat skeptical).

October 16, 2013 — Saw the new foot doctor who seemed excellent.  She said my full rupture was small (1.2 centimeter gap per the MRI, equivalent to less than half an inch) and I could choose the no surgery option even though she generally preferred surgery.  As is the case with most American foot doctors, my intuition told me that she had not read up on the latest studies favoring non-surgical treatment as well as on the newer rapid mobilization protocols. This proved to be correct when I followed/went through her slow and conservative treatment protocol (see further updates below).

After I had decided on the non-surgical treatment option, I was immediately given a scrub to put on, and then my right foot was put into a splint and I was given crutches.  I could no  longer drive my own car since my right foot was in the splint, so I had to call a friend to come and pick me up.  I have no family living near me and I hope to change that in the near future after going through this ordeal alone!

Later that night, I went to the grocery store with another friend so as to buy a rolling stool to move around more easily in my apartment (turned out the stool was ineffective and never rolled over the carpet well); a protective plastic bag to put over the splint for showering purposes; and a few more essential items.  See achilles tendon rupture equipment for more information on things you might need.

October 19, 2013 — After just two days, I was going crazy staying in my apartment all day.  Because of the frequent rain in Seattle combined with the hilly area near where I resided, plus three wide steps right outside my apartment, it was hard for me to go far out of my apartment on crutches.  Even going to the Walgreen’s across my apartment complex was close to impossible due to the crazy and unpredictable traffic while jaywalking (or to be more accurate, “jaycrutching”).  I did not feel like crutching my way to the nearby intersection down a slope and than going back up a slope on the other side in order to get to the precious Walgreens.

I then started to look online for any kind of electric cart that I could rent (even though I was skeptical that I could store it outside my apartment in the rain, and I was a bit concerned on how to get it up and down the three steps right outside my apartment).

Instead, I discovered something that turned out to be miraculous called a knee scooter, and found a local company that could deliver it to my home.  You have to read my testimonial on why the knee scooter beats crutches.  I was also very lucky that the bus system around my city is stellar.  The buses are very modern, and they lean towards the sidewalk and out flips a ramp so that people like myself on scooters can come up and down very easily and fast (without needing the slow ramps or lifts that people on wheelchairs require). I started using the bus daily once I had the knee scooter.  Without either of those two amenities, it would have been torturous for me to recover from my injury by spending most of my time indoors in an apartment during the rainy winter Seattle months.

October 26, 2013 — I went to the doctor’s office as scheduled, in order to replace the splint with a fiberglass cast.  This was much better and sturdier than the splint.  No wool, cloth and other material coming out anymore as was the case with the splint in the second week.   Also much more compact and little movement within the new cast. The doctor recommended keeping this on for 4-6 weeks.  I am not sure why I was ever put into the splint in the first place as the cast is definitely superior.  It seems like some people prefer the splint, but I would not recommend it.

Early-December 2013 — the doctor allowed me to get out of the cast and into the boot (same boot that I was given on  October 14, which I had only used for a day prior to getting into the splint).  She said that I was getting into the boot faster than most people.  I was in the splint for 2 weeks and the fiberglass cast for 6 weeks prior to getting into the boot.  According to most modern accelerated protocols, 8 weeks before getting into a boot is slow, but in the USA, accelerated non-surgical protocols are not as commonly followed as in Europe.  The doctor did the Thompson test and said there was some mild movement in my right foot after she pressed on the right calf.  So we were both very pleased at the recovery.

The doctor gave me three wedges to put in the long boot, and asked me to remove one after every week if I remember correctly.

Early-to-Mid-December 2013 — Against my doctor’s advice, I decided to get into two regular shoes just a few days after I got into the long boot!  Based on all my online research, it seemed like by week 9 I was already late in getting into two shoes.  I was not willing to wait till week 12 to get into two shoes as advised by my doctor. Although she was great, I felt like she was not well versed in the non-surgical treatment option and modern rapid mobilization treatment protocols (as is the case with most American doctors).

I was walking for around a week in my regular shoes (with at first 3 and then 2 and then 1 heel wedge inserted in there if I recall correctly).  My limp was completely gone!  I was very happy that I did my online research and decided to follow my gut instinct.

Then disaster struck……. in the most unlikely of events that one can not even fathom in a million years!  One night I went to Applebee’s restaurant with two friends and we sat at the bar.  After 2-3 drinks, I had to go to the restroom.  I jumped off the stool (my tendon had healed very well and made me very confident), went to the restroom and used the regular toilet rather than urinal in order to discharge my beer.  Once that task was completed,  I pressed/kicked down the flush lever on the right side of the toilet with my right leg.  I didn’t press it with sufficient force, and after a second and third attempt, the fourth attempt was finally successful.  However, during this fourth attempt, I felt a strange sensation in my right leg of a carpet being pulled and slowly ripped off the floor.  I immediately realized that I  may have re-injured my right achilles tendon.  All because I have an OCD type habit of not using my hands to ever touch a  flush lever! Below is a photo of the flush where it all happened:

Achilles Tendon Re-Rupture Toilet Accident

I talked to my friends about what I may have done and we all left the bar with me limping again.  I was praying that even if I had re-ruptured, it was just a partial re-rupture.

When I got back home and was putting on my pajamas, my bad right leg just collapsed when I was putting my left leg into the pajama (i.e, when my right leg was the only support/connection to the ground since I was standing on one leg).  I had been doing this comfortably every day since I got into two shoes a week ago, so I was now certain that I had re-ruptured my achilles tendon.  I had a miserable and depressing night of anxiety-ridden sleep.

Mid-December 2013 — A few days after my re-injury, I went to the doctor and told her that I got into my regular shoes over two weeks prior to when she would have recommended that, and now I may have re-ruptured by kicking down on the flush lever!  I felt a bit embarrassed about all this of course.  She did the Thompson test and it was positive yet again, and then she had me walk a short distance and felt like I had re-ruptured.  Since I did not get a second MRI due to its high cost the first time around, I will never know for certain whether I had a full re-rupture of partial re-rupture.

The doctor had me get back into the boot, with four wedges in there.

December 31, 2013 — Went to the foot doctor for a check-up, largely because she had recommended it and because this was the last day of the year and my bill would be largely covered by insurance due to my having met most of my annual deductible for 2013.  She said there was definitely an improvement in my walking.

January 8, 2014 — Four weeks after my re-rupture and three weeks after getting back in the boot, I reduced the wedges in my boot from four to two.  A week or so later, I removed the remaining two wedges too.

January 27, 2014 —  Almost six weeks after getting back in the boot, I moved into my regular two shoes and started walking and driving again.  Since my new health insurance plan would make me pay 100 percent of my doctor visits till I met my high deductible, I decided not to visit my doctor anymore unless I had another setback.

February and March 2014 — My walking improved quite rapidly in February, and my limp went away very fast just like the first time around.  Walking up steps also became straightforward, but I was still hesitant and slow when walking down stairs.  I think it was primarily fear of another re-rupture if I mis-stepped or stepped on the edge of a step my mistake.   Perhaps my tendon could have healed long and that made walking down steps slightly less natural? I am not sure as yet.

In any event, I rejoined a local gym in mid-February (I had been a member at the same gym for a year before, but rarely went there and wasted my membership fee).  In late March, I decided to sign up with a trainer for the first time in my life.  My goal was to rebuild my atrophied right calf muscle, lose 20 lbs of weight and force myself to go to the gym regularly as I now had two half-hour appointments with the trainer every week.

April and May 2014 — Walking down steps has become easier, but my gait is still slightly awkward and hesitant.  Even though my gym trainer has refrained from making me do any targeted exercises to rebuild my right calf muscle, I think it has gained back at least half of what was lost.  Probably still 10 percent smaller than my left calf muscle in circumference.  I will buy a measuring tape and measure each calf muscle in June.  Update: It turned out that the right calf muscle circumference at the thickest point was just under 1 inch smaller than the left calf muscle circumference at the thickest point (15 inches versus 14 inches).  This situation did not change through 2015, although I was lazy and did not do calf raises and other calf exercises more than several times a week.  Make sure to read my page on calf muscle atrophy after an achilles tendon rupture.

Interestingly enough, I never went to physical therapy throughout this whole recovery process.  Every single person on the blogs I read seemed to go to a physical therapist.  Within several months after walking in two shoes again, I seemed to be walking absolutely normally, running as fast as before on the treadmill and I am sure I will be able to do one heel raises on my right leg fairly soon.  In fact I could already do those in the swimming pool in April 2014.

The only thing that concerns me is that my right achilles is very thick. It seems like this does not change for many people for several years, and in some instances, it can be permanent.  Perhaps physical therapy would help in thinning the right achilles in case there is still scar tissue in there that they can reduce via massage and heat therapy?

October 2014 — At this point I can say for certain that my decision on not to have surgery was a good decision.  I never think about my right achilles any more except when changing trousers and seeing that it is still thick down there.  I can easily run 3 miles on a treadmill at my gym, I can jump, walk 10 miles in a day and more.  Although I can do a one heel raise on my right leg now, I can not hold it anywhere near as long as my left leg.  My right calf muscle circumference is still about an inch smaller than my left calf muscle.

I have not dared to play badminton again because I play at a very high level and do not feel like its worth knowing if I can do that again without risk of a re-rupture.  Perhaps I will try to play again next year if my financial and personal life are more set in stone, but at present, I cannot risk another rupture and 2-3 month confinement in an apartment and knee scooter yet again!

2015 — I went the whole year with no issues with my leg and almost never think about my injury anymore.  I finally did sign up for 4-5 physical therapy sessions, primarily to see if my atrophied right calf muscle could be regrown, and if my thickened right tendon could be shrunken.  While the calf muscle did not grow during my therapy sessions (note that I did not do the exercises anywhere near as frequently as recommended by my therapist), the tendon definitely shrank.  The therapist was superb at massaging the tendon vigorously, using the graston technique on it, and reducing the underlying scar tissue.  I did not realize that a large portion of the thickness was scar tissue and not the actual regrown tendon.  Moral of the story:  do not skip on physical therapy like I did.

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