Achilles surgery: long term expectations?

it will never be the same, but your prognosis to be able to run again is pretty good I am sure

you'll need probably a solid year to return, and hopefully you'll take it super easy on the recovery. The key I am told is lengthening your damaged achilles sufficiently to not immediately re-injure it again

I am 47 yrs. old and had mine repaired similarly in December 2017. I was dealing with the problem for some time before it partially tore & had a bone spur during a half marathon. I was optimistic about recovery and took the time to allow things to heal and I started training 6-7 months post surgery. Unfortunately I continue to struggle with this. It has altered my gait enough that I developed piriformis and low back issues. While the pain is chronic, I have continued training and racing. I am actively trying every palliative method I can find with the hope that I get some improvement.

Realize that every person will recover differently and you are younger and hopefully come through in better shape than I did.

Best Wishes on a speedy recovery

Long term wise, expect to be able to go back to some easy running but it may take up to a year or longer post-surgery. The procedure you mention is a little better prognosis-wise than say an Achilles repair after a rupture so that’s good. Just be patient and do the rehab. To be able to get to running and jumping you will gradually need to reintroduce those activities into the rehab process and really push it once you get normal ROM and average strength back but getting to that point is a long road unfortunately

Thanks everybody for the responses.

JluckDPT wrote:

Long term wise, expect to be able to go back to some easy running but it may take up to a year or longer post-surgery. The procedure you mention is a little better prognosis-wise than say an Achilles repair after a rupture so that’s good. Just be patient and do the rehab. To be able to get to running and jumping you will gradually need to reintroduce those activities into the rehab process and really push it once you get normal ROM and average strength back but getting to that point is a long road unfortunately

I'm 100% ok with it being a long and difficult process. I'm at the end of 3 years of increasing pain to where now I havent run in 6 months and it hurts a little when I walk more than about a mile in a day (not going for a walk, I just mean the little bits of walking here and there adding up to that, so the prospect of fixing that is great.

I'm completely ok with never seriously training again. I would love to jump into a 5k, pole vault occasionally with the kids I coach, etc. But if I can only do an easy paced 15 mpw, that's 15 mpw more than I can do now, so I'm stoked. I can get my main health and fitness in by biking and swimming.

I do know people who have had rupture surgeries, one of them returned to seriously training for the dec afterwards. So im not completely without examples, but was hoping I could hear from people on here. I appreciate all the comments.

Complete ruptures are bad -- you never return to pre-injury level. You see it all the time with football & basketball players. Too much scar tissue forms that doesn't have the same elasticity. Degenerative changes start occuring over the years. Then some athletes will restrain the tendon. Bad situation no matter how you slice it. ?

I developed Achilles problems running in college. I switched to marathons after graduation and managed 10 in the 2:2x-2:3x range before my Achilles degenerated to the point that I could no longer run. I had the exact same surgery on January 15th this year with an identical recovery forecast. I'm 28.

I was able to resume the stationary bike shortly after removing the boot at 2 months and by the 3 month mark I was able to really start increasing the resistance. So far so good but I'd be shocked if I was running anytime soon as the Achilles and calf are just so weak. I tried 5 minutes on the AlterG at 50% body weight and was noticeably favoring it and not generating any push off. My surgeon still claims that I'll be capable of running by the 5 month mark.

I had the surgery done last May. I was a 4:0x mile/14:0x 5k type of guy before I had it done. Even when I was in the best shape of my life, it was always nagging me. It took about 4-5 yrs to degenerate to the point of surgery, with the last 6 months really inconsistent and painful. The surgery wasn't exactly a gamble because I couldn't run prior, even after a massive amount of time off, so worst case scenario I could at least run a little bit again after surgery.

I am about 10 months out now and it has been a LONG road. I can run 35 mpw now pretty handily, but it's still weak and gets inflamed if I push it too hard. I have seen improvement from post-surgery, so that makes me happy. I would guess I still have about 8 months to go before I am totally recovered, but should be able to continue building my mileage slowly.

Had debride surgery in May 2012 due to calcification at the insertion. It was 6 weeks in cast, 6 weeks in a boot, then walking/pt. I began running again 6 months later. I ran Boston the following April.

I also dealt w/problem for 2 1/2 years combining all sorts of techniques to avoid surgery despite the fact that when I did run, every step hurt every run. I regret waiting so long now that it's in the past. Main difference is I was 56 at the time so the long decent into slower times was already well underway. I continue eccentric heel drops and calf/soleus flexibility but have not had further problems with Achilles or developed other injuries related to the surgery.

I made a decision at some point that I didn't want to use an excuse to stop running. If I can't run anymore, then I'll know. I wouldn't worry about 20 years from now, I'd worry about all the miles you won't log if you don't get well. Good luck.

Thanks for the additional posts. Great to hear from some people are various stages of recovery. Sounds like I can hope for at least somewhat if a return to normalcy.

I don't think I'll ever be willing to run high mileage (I never ran that much anyway, peak was about 70mpw in college) since I'll be afraid to hurt myself again. But at the very least, it sounds like some jogging is in my future, which I cant do now. Anything more is icing in the cake.

I'm fortunate that I've learned to not at all mind the stationary, it's all I can do now, so I've been watching Netflix on the stationary almost every day for the past year as I slowly gave up on running. Running is definitely preferred, though.

I like threads that come back around.

As an update, I got the surgery last Friday, the 7th.

My surgeon asked if he could video it to make into a training video for his surgical residents. He posted it to YouTube. Here it is, for anybody who wants to watch it:

https://youtu.be/a6nUCQWZh6A

This thread was a good reminder to not push my Achilles.

Don’t have any advice but I wish you a good recovery.

Best wishes in your recovery. It may be helpful for others if you give updates, particularly once you are weight bearing, in pt, and running again. I believe I made a mistake in waiting so long to have the surgery. Every step of every run hurt for 2 1/2 years along with hours and hours of attempts to mitigate the problem. You have a chance to give folks dealing with the question more real time information as they struggle to make their own decision. Good luck with the hard cast. Ugh!

Thanks. I also think I waited to long. My first recollection of first noticing "something," which I realize now was this problem was 5 years ago. I met with multiple podiatrists before meeting with the first surgeon 18 months ago and didnt believe her. I finally believed the third surgeon, who is the one who operated on me last week. I should have done it 18 months ago.

I'm actually in basically a ton of wrappings that hold on a hard rib of sorts on the back of my leg, its breathable and I can scratch my shin, so definitely better than a traditional hard cast.

I'll give updates in this thread, might be useful to people who find themselves in the same situation.

I'm finding this thread very informative and I hope for continued updates.

I, too, have a calcified insertional Achilles tendonosis. I've had this for almost four years. I've gone through stages of months of being unable to run at all or unable to run more than a few miles per week, but I've also gone through months of being able to run 70 mpw as long as I avoid sprinting, uneven footing and steep hills. In fact, three months ago I finished my first full marathon in 15 years. It was ugly, but not particularly because of the Achilles. For about the past year I've had no major setbacks and am beginning to think I can just live with this, but perhaps I'm fooling myself.

I'm 61 years old and I'm very worried that if I have to quit running for the better part of a year I'll never be able to run again. I'm strongly inclined to avoid surgery unless the condition becomes truly debilitating. Right now, I always have some pain when running but it's usually mild. When it becomes more than mild, I quit running for a few days and it gets better. I've also chopped out the backs of the heels of all my everyday shoes so there is zero pressure on the Achilles for 22-23 hours of each day. I can't run in chopped-out shoes as they slide around and fall off, but I choose my shoes carefully to be as soft in the heel as possible.

Hoping for further updates.

I'm dealing with achilles issues and am very curious whether there is normal achilles soreness that is part of tendon adaptation. My achilles get sore after certain types of workouts but within a few days the soreness is almost gone and in some cases completely gone; it takes a few days longer after a more intense workout. I've recently started doing sprint workouts on synthetic tracks, wearing spikes. After my first track workout I had tendinitis in both knees, the right hip and soreness in the soles of my feet and under the left patella (no doubt from running the curve.) All of that pain went completely away within 3 days - this is what I refer to as "adaptation." Subsequent workouts have not resulted in any of that pain and soreness even though I'm running progressively faster. My achilles are the exception, both have experienced increased soreness, the left worse. My last workout was alarming, on the first rep my calves and soleous were stiff and sore and the left achilles was very sore. After the first rep my achilles felt much better and I was able to run faster. The achilles soreness improves or goes away after warming up and working it. The tendinosis is not insertional, it is about halfway up in line with the ankles. If anyone has any thoughts about this I would greatly appreciate it. Obviously I would like to continue training but not if there is any chance of a rupture.

Some background - after many years away from running (stayed in very good physical condition) I started training again 4 years ago and almost immediately strained both achilles doing sprints on a synthetic track, wearing flats with an 8mm toe drop. I took 9 months off until the pain was gone then started training again. Since then training load has been well within my limits and have taken many days off between workouts to both recover and figure out what I was doing to create a program. Despite that caution, I've had the aforementioned achilles soreness the past three years. The soreness goes away fairly quickly, within a week or two and often within a few days. I also have the gene setting for reduced collagen production which is a red flag for tendon issues, though I've been extremely durable with no problems other than temporary soreness after some workouts and the achilles soreness. I ran many miles on the roads in my younger days with no issues. I'm thinking maybe the initial achilles strain 4 years ago didn't heal completely. Is a strain always a tear?

Any advice/insight greatly appreciated.

Was Achilles Greek or Cretin? wrote:

My achilles get sore after certain types of workouts but within a few days the soreness is almost gone and in some cases completely gone; it takes a few days longer after a more intense workout. .

I should point out that the Achilles issue we are referring to in this thread is insertional, this is where the calcification begins. Basically, you get a bit of minor damage and inflammation, maybe from overdoing the workouts, maybe just susceptible to it. The body tries to heal it but doesnt heal fast enough, so osteoplasts from the nearby achilles insertion into the calcaneus manage to get in their and do their job: deposit bone material. This causes you to be susceptible to irritation more easily, and it becomes a cycle. Over time the calcification grows upward into the Achilles and the inflammation causes the calcaneous to grow outwards.

In the video of my surgery, you can clearly see this bump before he begins and see how my bump is gone after surgery (because he literally grinded it away, half of the purpose of the surgery).

If you're having Achilles problems higher up, it's probably different. That doesnt mean you cant develop this problem I have, it is pretty common in runners, but it doesn't mean you will/are having this problem.

The first symptom I can remember from this 4 or 5 years ago was simply that my heel felt slightly bruised all the time. It never hurt while running, but accidentally bumping my heel against something while barefoot was like if somebody pressed hard into a bruise.

I totally get that. Im 34, so that factored into my decision, and the surgeon said it also factored into his decision to recommend I get the surgery. If I were older, he would have been less quick to recommend it. I would definitely consider your age when deciding. One of my fears if I accepted never running again was that it would continue to very slowly progress anyway and I'd be forced to get the surgery in 30 years just to walk.

You're describing me from 3 years ago to about 18 months ago, before it continued to progress to where those measures were no longer enough. 18 months ago, I tried 9 months off, then ran for 3 months with initially no pain, with it slowly returning over those three months to the point where I limped even when I walked. The past 6 months prior to surgery I took off, and it reached the point where walking was finally pain free again, usually.

I felt like stretching 5x a day was the biggest help. I always avoided it at the start, because I heard it could irritate an inflamed tendon more. However, one theory is that calf tightness is a risk factor for this. Maybe stretching should be avoided while resting an acute strain, but then i think it is important to reduce the risk of more chronic issues like this. It did seem to help a bit when I started religiously stretching, but I think it was too little, too late.

AchillesChallenged wrote:

I totally get that. Im 34, so that factored into my decision, and the surgeon said it also factored into his decision to recommend I get the surgery. If I were older, he would have been less quick to recommend it. I would definitely consider your age when deciding. One of my fears if I accepted never running again was that it would continue to very slowly progress anyway and I'd be forced to get the surgery in 30 years just to walk.

I don't know about that -- I know several middle-aged recreational athletes that had Achilles surgery, some even over 60! None of them even tried non-surgical rehab first.

Most surgeons want to do surgery to stay in business with little concern about patient outcome. If you ask many of these surgeons in a lot of these athletic-related musculoskeletal pathologies if surgical intervention will restore the patient to pre-injury level, they all say they can't promise that. However, in the same instance many times they discourage non-surgical rehab as an viable alternative:

Not Buying It wrote:

I don't know about that -- I know several middle-aged recreational athletes that had Achilles surgery, some even over 60! None of them even tried non-surgical rehab first.

Most surgeons want to do surgery to stay in business with little concern about patient outcome. If you ask many of these surgeons in a lot of these athletic-related musculoskeletal pathologies if surgical intervention will restore the patient to pre-injury level, they all say they can't promise that. However, in the same instance many times they discourage non-surgical rehab as an viable alternative.

I didnt have a rupture. All the studies you linked are about rupture. While there is probably some overlap, it isnt exactly the same.

Anyway, both articles you linked to conclude that surgery is slightly better, but comes with a risk of infection.

I think with a rupture, you have a bit of a clock. If you attempt non surgical intervention and it is in the small percentage of failures, the success of surgery is much lower. This might be why your friends were discouraged from avoiding surgery. But Im not a doctor, just making a guess.

Anyway, my surgeon did recommend surgery, but he definitely framed it as a choice, that no surgery was an option, but that any amount of rehab etc wouldn't fix the underlying problem and that I'd never be able to run consistently. Im inclined to believe him, I could see the bump from the growth of the bone in person and on the xray.

Speaking of which, I had my post OP follow up today. I took a picture of my pre and post OP xrays to share. Pt starts tomorrow. He said I would follow the "willits protocol."

I'll post links to photos later.