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Achilles tendon rupture - how much time between the injury and a surgery?

 Poster: A snowHead
Poster: A snowHead
I busted my Achilles completely last Saturday. Went to St Mary's A&E in Paddington and they put the leg in a cast. Came back there yesterday as the cast was a bit too tight. So this time they made it slightly lighter: cast on the calf, but not on the shin, so not so squashy. They told me that "soon" I would be contacted about follow-up appointment in fracture clinic.

So I got a text today confirming appointment scheduled for the next Monday. This is 9 days after the injury. I'm no expert, but this seems a bit long? A&E people described me as a fit bloke and I told them I'd prefer a surgery as I'm an active sporty person. But isn't all this waiting making things way worse? Should I quickly sort it out form my private funds. Does anyone know how much it could cost?
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
@wyspa, No idea about cost.

Replying because my friend last November had a 60% rupture at MK indoor ski dome. Today, late February he's still at the stage of slightly tearing it whilst stretching. He's seeing a highly respected physio and the consultant was very impressed with his Achilles tendon size/condition.

So, don't rush this tear or it's repair. It takes the time it takes to heal well.

Now, it could be a surgical procedure is EXACTLY whats necessary for you.

I've stuck my nose in just to say a good achilles repair may take longer than expected and it's critical that you give it as long as it takes...
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Well, the person's real but it's just a made up name, see?
@Tim Heeney, thanks for the input. I've basically written off this year (including summer) for anything more adventurous than a walk in a park. I understand it will be a lengthy and painful (both physically and mentally) process.

From what I managed to find out on the internet a surgery seems to be a slightly more preferred option for active people. So I'd like to go ahead with it. But my concern is that there may be a (short?) window of opportunity to do it after the injury actually happened. That's why I'm suspicious about that seemingly long waiting time I was given before I can see a consultant. Even if they schedule it a few days after the appointment it would be 2 weeks after the accident. Is it good? No good? Not much difference? Google doesn't seem to be so wise about it.
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If this helps from a few years ago . . . I had a full rupture in March . . . . strangely didn't know it was fully gone until April . . . . surgery mid April (plastic tendon put in) and did a cycling trip in Northern France in the September.

I took comfort from the plastic tendon as knew a further rupture was unlikely / impossible. Surgeon and Physio knew each other and agreed I could be pushed.

This was a few years ago now and have no lasting effect other than to have slightly different shaped calves . . . not that I can see !
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
I've busted both my achilles playing squash, they tend to elect for the cast over surgery as there are complications with surgery regarding infection in that area..... Both times was 4-6 weeks in a fibreglass cast then a star wars adjustable boot for the same again, then 3-6 months of physio/stretching, it's a bit of a drawn-out recovery tbh, but very straightforward......The idea being that when the tendon ruptures, it shreds like the end of a horses tail, so they point your toes so the ends of the tendon join again and let it heal like that, gradually bending the joint back to 90 degrees with the adjustable boot. both times (the first was 25 years ago) I was fit for skiing within the 9 month recovery, not a problem since........PITA though, so I no longer play squash Very Happy
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With regards to initial timing, it's really important if you go non-surgical, to get the leg in a cast asap, as otherwise the frayed ends start to heal, but separated............
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Then you can post your own questions or snow reports...
Did mine skiing - and got no choice in the matter - was repaired in a French hospital the next day by releasing another small tendon below the knee, pulling it down and whipping the Achilles together. Then about 7 weeks in 3 casts. The only pain I had was when they took the ski boot off and when they took the staples out of the op. site. If you are in pain then something is wrong with your treatment or you are trying to do too much on the leg. There are no nerves in the tendon itself.
I only learnt of the non surgical option when researching later - ain't the body a wonderful thing?

I assume that they have put the cast on "au equine" - pointed toe, shortened ankle position?


Last edited by Then you can post your own questions or snow reports... on Tue 28-02-17 23:41; edited 1 time in total
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alti - dude wrote:
If this helps from a few years ago . . . I had a full rupture in March . . . . strangely didn't know it was fully gone until April !

How could you not know? I could not put any weight on it at all - even in a ski boot!
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Mine was gone during squash game too. And this seems to be the main (along tennis) culprit from what I can see. It felt as if someone clubbed me just above my heel when I tried to reach a low ball. At first I thought my sparring partner hit me with his racket. Definitely not something I could have not noticed as I instantly fell down and started writhing for a couple of minutes. After calming down I was able to diagnose the thing myself. My tendons always had been very prominent so it was obvious that something snapped big style.

Now I have a second cast, but it was applied by A&E people. As lovely as they were they didn't look as confident experts in this type of injuries. And my foot is in almost neutral position which makes me think that there is a very slim chance the tendon could heal itself. I had a lot of pain in my lower calf, so I suspect that the upper end rolled up somewhere there and needs to be forcibly reattached with its lower counterpart. I think I'm going to splash out tomorrow and visit a private clinic, so they could at least tell me if this cast looks alright to them.
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Scrumpy wrote:


I assume that they have put the cast on "au equine" - pointed toe, shortened ankle position?


Exactly this, worst bit was when they took the cast off and forced my foot to around 45 degrees, I was convinced they'd snap it!
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wyspa wrote:
Mine was gone during squash game too. And this seems to be the main (along tennis) culprit from what I can see. It felt as if someone clubbed me just above my heel when I tried to reach a low ball. At first I thought my sparring partner hit me with his racket. Definitely not something I could have not noticed as I instantly fell down and started writhing for a couple of minutes. After calming down I was able to diagnose the thing myself. My tendons always had been very prominent so it was obvious that something snapped big style.

Now I have a second cast, but it was applied by A&E people. As lovely as they were they didn't look as confident experts in this type of injuries. And my foot is in almost neutral position which makes me think that there is a very slim chance the tendon could heal itself. I had a lot of pain in my lower calf, so I suspect that the upper end rolled up somewhere there and needs to be forcibly reattached with its lower counterpart. I think I'm going to splash out tomorrow and visit a private clinic, so they could at least tell me if this cast looks alright to them.


Bummer...... all the best for your diagnosis Very Happy
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And love to help out and answer questions and of course, read each other's snow reports.
@Scrumpy, thought it was a badly torn calf muscle and strangely was much better in a ski boot . . . .!
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So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
Hi, I snapped mine skiing about two years ago. It happened in Canada and I was put in a boot, toe down, for the rest of the week, and then went to A&E went I got back home. Mine needed surgery as the two ends were some distance apart also the tear was very clean so not much fraying. I had the surgery two weeks after it happened. Like you I was concerned about the wait, and contacted private clinics. As it turned out they couldn't have done it any quicker and I think the cost was about £7,000. The hospital did try and put it off for another week, but I argued strongly (crazily) that it had to go ahead. The consultant wasn't at all worried about the two week wait. He did suggest I got physio privately as the NHS provision was not enough. I did do that and followed all instructions faithfully. I was skiing again that December, 9 months later, and now do everything I did before, so there is light at the end of the tunnel. It is just quite a long tunnel.
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 You know it makes sense.
You know it makes sense.
@wyspa,

9 days ok

Jonathan Bell
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Otherwise you'll just go on seeing the one name:
Had the same experience as @KenX, did it in November and was back next season. That was about 25 years ago and I've had no problems since then. Good luck.
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 Poster: A snowHead
Poster: A snowHead
A quick follow-up, if anyone's interested.

So I arranged an appointment in one of the swanky clinics of Marylebone. The consultant confirmed my worries about the poor quality of my cast. He took it off and replaced it with a boot. Day and night difference compared to full-on plaster. I can at least get to the toilet without crutches.

I'm having a surgery tomorrow - 12 days after the accident. He said the best window of opportunity is about 2 weeks, before all tissues start to bind together on their own in random position. The op I'll have will be a percutaneous one. A several small incisions rather than a large butcher-like vertical cut. Less scars and post-op infection risks.

After that I'll be back in plaster cast for 2 weeks, followed by 4-6 weeks of a boot with varying degrees of foot-shin angles. Week 3-4 post-op will see me starting the rehab. Probably going on for about 6 months. So far I've spent £4000 (initial consultation, boot, some scans, medications and the surgery fee itself). I suspect there will be 2-3 follow-up consultation, so this will run up to £4500-£5000. That's excluding physio costs.

On the whole I'm of the positive state of mind. PITA and a lot of money I could spend on something nicer instead, but I'm sure, comes next winter, I'll be asking you for some advice about which resort to go to rather than which walking sticks are most fashionable at the moment.
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