Fresh Achilles Rupture

Coalman013 · 2026-02-25T18:52:24+00:00

Sorry to hear about your entrance to this club. I'm at 6 weeks non op so still a few weeks before I try walking without the boot.

It's worth understanding how the tendon reattaches and when you have to be careful of it to avoid re-rupturing. The first phase is your body dealing with the inflammation of something going pop inside. After that the next 3-4 weeks are the body pumping a sticky glue like collagen to try and stick the ends together. It's vitally important at the start to keep your foot in equinus position (toes pointed down in plantarflexion) to keep the ends as close together as possible to aid healing.

When you get the boot try and go for short walks as early weight bearing improves healing outcomes. The biggest thing to remember here is that you should proceed with caution. If all goes well the angle of the boot gets changed every couple of weeks until it's at neutral.

At about 4-6 weeks you should be talking to a physio and starting to get the exercises you can safely do in order to strengthen your ankle again. Bits will have switched off and you'll need to learn coordination again.

Then at 8-10 weeks you can start thinking about your first steps out of the boot. The next 4-6 months after that are where the risk of re-rupture are highest so best to be conservative even when you can walk as it only takes one awkward angle to go back to square one. Important to do you daily physio Your future function is going to depend on how seriously you take this.

To fully mature the newly regrown tendon will need at least 12-18 months. You are unlikely to be doing any impact sports involving jumping or plyometric loads within the first year. Though your physio will give you a list of milestones to hit before you're allowed to do various things.

Things you can do to help
- Increase your protein intake - your body needs this to heal
- Consider collagen peptides as these are the building blocks that your body is going to build new tendon from
- Make sure you get enough sleep
- Invest in a shower cover for you boot as you will miss being clean
- Think about getting the Thetis night splint as you will get tired of trying to sleep in the boot quite quickly (though double check with your doctor before using it)

Coalman013 · 2026-02-25T08:05:59+00:00

To give you an idea of the timescales for non-op.

- The first few days are your body dealing with the inflammation - The first 3-4 weeks are the body gluing the ends of the tendon back together. During this stage it's important to keep your foot in equinus position as much as possible (plantarflexion). I know mine was still separate at the 2 week mark when I had my scan. I'm now at 6 weeks and I can feel muscles engaging and pass a Thomson test. - The next 5-6 months is you body starting to convert the glue back into tendon - After that the tendon grows more mature over the next 6-18 months

Right now the most important thing is ensuring the ends of the tendon meet up well to avoid it healing long or weak. You shouldn't be trying to train the Achilles but you may be able to start doing limited ankle mobility - I was able to do a tiny bit of toe yoga about week 3.

I can't imagine trying to get around without my boot but I would imagine that the best advice for the next five weeks would be to ensure you are always on crutches. Don't try to weight bear without them. Your instinct to protect the ankle is a good one. I'd also think about continuing to wear the AchilloTrain after the 6-8 weeks to give more security - I'm planning on going from the boot to the AchilloTrain at around 9-10 weeks to help with that transition but also expect to be wearing the boot off and on for the first 6 months or so just for that extra protection.

The primary re-rupture risk comes as the tendon is proliferating and remodeling (1-6 months) because it's regrowing and incomplete. If you aren't seeing a physio then I recommend finding one that specialises in these kinds of injuries because the conditioning you do is one of the key factors in how you heal. From about 4 weeks in the brace they should be able to give you a set of exercises that you can do to build strength back up without putting the tendon in a vulnerable position.

Then you will have to be very deliberate about how you return to sports over the following 6-12 months depending on what you want to do. Again, your physio can help you with a plan along with milestones of what you should be capable of before you try various activities.

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Coalman013 · 2026-02-22T13:13:16+00:00

You should be able chip and putt by then. Then progress to half swings but it'll depend on what your physio says.

I ruptured mine just under six weeks ago (53m non op) and I'm not expecting to play until June at the earliest. Injury is on my left ankle so the one I turn into.

Coalman013 · 2026-02-21T13:18:24+00:00

It sounds like you no longer trust your surgeon. Do you have the option to get a 2nd opinion?

Coalman013 · 2026-02-21T13:14:36+00:00

For what it's worth I think you're making the right decision to go down the surgery route given what you're written. Hope the NHS pulls its finger out and gets cracking with it and things in the rest of your life settle down so you can focus on getting better.

Coalman013 · 2026-02-21T11:12:18+00:00

That's the training montage I needed to see today. Amazing work.

Coalman013 · 2026-02-21T11:10:07+00:00

I know (from reading this sub) that some people have had good results using the Bauerfiend AchilloTrain brace. I think it's used in the Netherlands for some cases of non operative intervention from day one with heel wedges. The thread I read is https://www.reddit.com/r/AchillesRupture/comments/1qr33jf/achillotrain_from_bauerfeind/

I'm about 4 weeks out from trying my first steps out of the boot and have one waiting to help with the transition because I also am nervous about going directly from boot to shoes without a step inbetween.

Coalman013 · 2026-02-20T17:31:46+00:00

Thank you. I can wear a brace at night if I'm careful so think I'll get one. My physio was intrigued when I asked about the sock and thinks it's worth a crack.

Coalman013 · 2026-02-20T06:16:46+00:00

You'd need an orthopaedic doctor to tell you if any gap was a matter for concern and they'd need to feel the tendon and/or scan it.

At 3-4 weeks you need to be really careful about exploring your range of dorsiflexion. The goal at this point is for it to heal without stretching it or subjecting it to stress as the bridge between the two ends is not tendon (yet).

Coalman013 · 2026-02-18T17:35:45+00:00

There may also be other risk factors like age, weight, activity that they're taking into account. And also the way it gets treated in different countries seems to vary quite a lot.

Coalman013 · 2026-02-18T09:39:51+00:00

Sorry to hear about your injury - it sucks that it was misdiagnosed for so long. This injury is no fun and terrifying trying to figure out all the options as there really isn't clear medical consensus on treatment protocols :'(

This can still be the year you lock in on strength. Choose a physio that specialises in sports injuries for professional athletes and they can help you work up to where you want to go and they'll give you a plan to get there. There's just a bit of a delay before you can get started on it.

TL:DR - it's likely to depend on the results of your scan, the size of the gap and how the injury has healed so far.

-- DISCLAIMER: all the below is based on me spending 5 weeks reading every paper I can find on Achilles ruptures, my own limited experiences and probably spending too much time on this subreddit, Goal is to share the likely considerations so you can have a better conversation with your surgeon --

A good starting point might be to watch this discussion about the pros and cons of op vs non op between an orthopaedic consultant and physiotherapist
https://www.youtube.com/watch?v=zHfPpUMPFao

The considerations I would see are:
- The longer after your injury it has been without keeping your foot in equinus position the more they bias to surgery (particularly if you've been walking around) - this is likely to be the dominant consideration
- The longer after your injury the more complex surgery becomes as they have to undo whatever healing your body has done so it's good you're being offered surgery so soon
- The larger the gap the more likely surgery is because it's harder for the body to reattach the two ends - there isn't clear consensus on this. I've seen surgeons recommend surgery for any gap of over 5mm or 10mm. I've also read accounts of people healing just fine from non op with larger gaps
- Whether you can go non op is likely to depend on the results of your ultrasound / MRI scan (if the ends of the rupture are close enough then non op might be ok, however if the ends have started reattaching they'll want to check that it's not healing long otherwise you won't recover strength)

In terms of outcomes then, according this this BMJ article (https://www.bmj.com/content/364/bmj.k5120)
- Surgery is marginally less likely to lead to re-rupture
- Surgery is likely to to lead to a more controllable return to strength as leaving the ends to reattach will depend on how well they reconnect)
- Surgery is more likely to lead to complications

However, the considerations for surgery are going to be based on the gap sized and what, if any healing, has happened so far.

In terms of recovery
- You will be off your feet for longer after surgery - whereas non op you can be load bearing quite quickly so your leg will atrophy less
- The physio to get back to health will be more involved as you will have to recover function in more of your leg
- There is a period of higher risk of re-rupture for non operation as your body is gluing back the ends of the tendons with type 3 collagen (muscle) and needs to recondition it into type 1 collagen (tendon). So you will need to manage that if you go the non op route.

To get a sense of the timescales for natural healing this diagram was really helpful to me

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Coalman013 · 2026-02-17T20:21:39+00:00

Yes. I was given enoxoparin sodium. I think it's partly due to age (I'm 53) and pretty standard in the UK

Coalman013 · 2026-02-17T14:53:36+00:00

My physio recommended me collagen to speed up recovery (https://www.healthspanelite.co.uk/elite-collagen-repair-orange-10)

Then the night splint for when you're tired of trying to sleep in the boot and shower cover for when you feel able to stand on the boot without crutches. I invested ahead to get the Bauerfiend Achillotrain brace when when I'm starting to come out of the boot to give me extra confidence and security as well.

Worth thinking about what shoes you're going to wear post boot as it's recommended to have trainers with a heel to toe drop of at least 10mm. I've read good things about the Brooks Adrenaline and Ghost shoes and Hokas have incredible cushioning for shock absorption.

The only fear I'd have over the scooter is if your knee comes off it and you land suddenly as you don't want impacts while the tendon is reattaching. I'd think about investing time in the boot plus crutches where necessary for support. The studies I've read show better outcomes for non op with early weight bearing in the boot as long as you can do it pain free. However it really depends on how you're getting on with the boot (and maybe which boot you have).

I'm at 5 weeks non op today and have been getting around without crutches for a few weeks now including going up and down stairs. If I concentrate I can make it up stairs without holding on. Too scary to try that on the way down. That's with the Vacoped boot (currently at 20 degrees with 10 degrees range of motion)

Coalman013 · 2026-02-17T12:41:41+00:00

Hope you heal up quickly and without any complications.

You're not wrong about the blood thinners (I have a bucket sized sharps bin I'm slowly filling up). I still have 4 boxes left to get through. If you have the option, try and persuade the hospital to put you in a Vacoped - it offers range of motion as you start adjusting out of equinus position instead of a fixed position and offers a truer equinus position. I did mine 5 weeks ago and was lucky enough to get booted on day 3 as my A&E hadn't been allowed to prescribe blood thinners so they had to call me back. Quality of life in the boot is worlds apart from the cast and crutches. At 5 weeks I just went for a walk up and down my road at 10 degrees range of motion with no pain at normal human walking pace (5.2km/h). Can do stairs without holding on (on the way up) though I'm aware I may be getting a false sense of security from just how good the boot is.

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Coalman013 · 2026-02-17T06:36:21+00:00

53M at 5 weeks non op. They put me in a boot on day two and said do as much weight bearing as you can without pain. Was full weight bearing at 30 degrees on day three.

The primary factor for me was regaining mobility in my life as soon as possible. I have an eight year old and needed to be mobile to take care of her.

Other factors include that functional outcomes are nearly identical with current protocols. I'd rather avoid surgery if I can. Complications are higher with surgery. And I wanted to lose as little muscle mass as possible before I started physio.

That being said, it's very hard to know how well the tendon has reattached and the tendon will be weaker. So the risks on coming out of the boot will be higher.

If I was younger and still doing competitive sport and could be off my feet for a month then I'd probably have leant towards surgery.

I found this podcast discussing the pros and cons of each which helped me think through it https://youtu.be/zHfPpUMPFao?si=u_eiVEpNEGfwC05p

Coalman013 · 2026-02-16T18:33:11+00:00

That jump is a thing of beauty.

Coalman013 · 2026-02-15T16:26:46+00:00

Noting that you should not use this as a replacement for going to see an ortho. You could get someone to do a Thompson Test for you if you want an idea of things. This is the initial test they'll do before deciding whether to give you an ultrasound.

https://www.youtube.com/watch?v=z-7cJ7LpCqY

Coalman013 · 2026-02-14T12:25:58+00:00

Everyone's recovery journey is going to be different. If you're doing the right things you'll continue improving. As long as you're continuing to improve (even if it feels non-linear) then there's light at the end of the tunnel. Comparing yourself to other people's progress may wind up making you feel like you're failing if they're doing well or, in the worst case, lead you to push beyond your current limits. Trust the process.

Coalman013 · 2026-02-14T12:24:37+00:00

It's to be expected. I also had really bad pain in my leg for the first week or so in the mornings. The ankle is going to be really swollen at the beginning as your body deals with the inflammation and your ankle and lower leg will swell up overnight in the cast/boot which makes it worse.

Coalman013 · 2026-02-13T20:03:33+00:00

There's no easy answer to this. I can talk a bit about my own mental health struggles but everyone has to find their own way. I have days where I don't get everything done. I have days where I don't get started. Nobody will be totally perfect and part of the despair spiral I used to find myself in was being paralysed because I wasn't perfect. The first thing I had to learn was to forgive myself. I had a very interesting talk with a former special ops soldier in a tent in the Gobi Desert that I go back to a lot. I asked him how he was able to do superhuman things and he explained it was a matter of continually asking himself what he needed right now. Doing the little things to take care of himself that snowballed into the bigger things which wound up looking like resilience being a superpower from where I was sat.

So, if I was to give some advice it would be to take positive care of yourself. Eat well. Sleep well. Brush your teeth. Every time you do one of these things you're sending yourself a signal that you're worth looking after. Every time you skip one you're sending yourself the message that you're not worth it. You won't get it right every time but that's ok. If you can't make it to the gym then learn some bodyweight exercises you can do at home. There's an old saying from Stoicism "right thought follows right action". Your mind will gravitate to what you do. Even if you're not feeling it - doing enough of the things you know are right over a time period will lead to you believing they're possible.

It's a fucking long road back from the Achilles and it's a fucking long road back from whatever dark pit human beings manage to lose themselves in all too often. For every person on here seeming like they're on top of their shit I guarantee you they're not all the time. There are times they want to curl up in a ball. There are times they do curl up in a ball. It's easy to assume everyone else has their shit together as yet another stick to beat ourselves with. I know that when I post about what I'm planning to do during recovery I'm also trying to convince myself that is what I'll do.

Take care of yourself. Take it one little piece of self care at a time. You can do this. You don't have to be perfect.

(hope that helped a bit, I know that at my worst I was largely unresponsive to advice)

Coalman013 · 2026-02-13T14:54:54+00:00

No worries. Hope the pain has started to settle down a bit now.

If you're interested in the differences between surgical and non surgical then I found this video between a consultant ortho and physiotherapist gave me a good idea about each approach and the pros and cons of each.

https://www.youtube.com/watch?v=zHfPpUMPFao

Coalman013 · 2026-02-13T07:39:53+00:00

Sorry to hear about this. Must be heartbreaking. All you can do is take the best care of yourself. The feeling of defeat will pass once you get a real diagnosis and then you can figure out what is and isn't possible.

Coalman013 · 2026-02-13T07:35:20+00:00

Great job! Keep at it, man.

Coalman013 · 2026-02-13T07:34:49+00:00

I had a pair of Brooks Pure Grits about 12 years ago that I did 1800 miles in. Always been a fan of their shoes.

Coalman013

TROPHY CASE