Achilles surgery: long term expectations?

I think you have a great attitude towards it and the outcomes you would be happy with. Good luck with your rehab.

AchillesChallenged wrote:

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

No....surgery isn't slightly better when accelerated functional rehabilitation with early range of motion is preformed:

Just as an update. I'm not 5 weeks post surgery. Basically here is the summary of the recovery so far from the day of the surgery:

- first 36 hours: foot remained entirely numb, no pain.

- around 48 hours: hurt a lot for a few hours, but then it went away

-2 week mark: visited surgeon, he removed the cast and put on a walking boot. Told me I could walk with up to 50% of my weight on the foot, along with crutches. Began PT, which was basically sitting down and wiggling your ankle around gently. It hurt to put very much weight on the foot at this point, couldn't really do 50%. Required to wear the boot all the time, except when doing PT or washing my foot. Absolutely no weight on the foot without the boot on.

- 4 week mark: Allowed to put up to my full weight while wearing the boot. Hurt too much initially, but after 3 or 4 days, was able to slowly progress to full weight on the foot and ditch the crutches. Still wearing boot at all times except when doing my PT or washing up. Not allowed to put any weight onto the foot without the boot on.

Next step is my 6 week appointment with the surgeon and PT. I expect them to remove the heel lift in the boot, so it will be more normal to walk in the boot.

I still have some "bruising" sensation in the heel. It basically feels the same as it did pre-surgery. I figure this makes sense, he cut and scraped away bone and achilles, so it would make sense for it to still feel a little tender. Some of the incision and where the stitches were is visible. But there is no raised scar, I can't feel the scar with my fingers, so I take that as a good sign for the future when I'm allowed to wear shoes again. The main swelling is basically gone, but the Achilles isn't quite as defined as on the other leg. I chalk that up to lack of muscle tone in my right calf, its significantly atrophied compared to the left leg. Obviously that will take some PT and use before it returns to normal, not really anything I shouldn't have expected.

At this point, walking in the boot feels great, so I'm anxious to move forward and have to remind myself the schedule is important. I'm optimistic that I'll be able to run again in a few months. Without the surgery, I wouldn't have been able to.

Here is a picture of the before and after XRAY. In the before picture, you can clearly see what my surgeon described as "a huge heel spur." In the after picture, you can see the bone anchor used to reattached the achilles in the surgery. It is attached using a non-absorbing thread. My surgeon said it would hold the achilles in place during the healing process, then would be just sitting there after the achilles reaches full strength. Unfortunately, I took pictures of my xray from opposite angles, but you can kind of see how the calcaneous is shaved down slightly.

https://ibb.co/Lx7mkHF

A quick update. Im at 12 weeks today from the surgery.

I can walk slowly with no limp. Walking fast I cant do without limping. The pain at the bottom of my heel got really bad weeks 9 and 10, but now that I'm 12 weeks past the surgery, its pretty much gone.

Pain at the location where the Achilles inserts to the calcaneus is definitely what is limiting me at this point. I cant do single leg raises, it is just way too painful when I try. Double leg raises are possible, although it hurts. If I put my other leg forward onto something and partly assist, I can do calf raises with about 80% of my body weight on the operated leg. It hurts, but it is a bearable amount of pain. This is part of my rehab.

I tried running yesterday, but due to the pain when trying to push off, I could only manage a slow old man shuffle, I went about 600meters or so. My 12 week appointment with the surgeon is later today.

Biking is now mostly pain free. I can push pretty hard on the bike with only a little Achilles discomfort. I've been using platform pedals to keep pressure off of the incision area, but I think I'm ready to switch to my cycling shoes and clipless.

The scar is nice and soft, I dont have any irritation from that. Its definitely visible, but no problems with it.

Im at 15 and a half weeks.

This weekend, on Saturday, I ran 3 miles at about 9:00 pace. I had a few spots that I felt good and picked up to around I minute pace. It is a little painful running, still, I definitely have to focus on running with good form to avoid favoring my right left. After my run, I did my PT. I felt like I definitely could have run farther for the first time, but decided not to push it. There were a few times during the run that I could feel my form actually returning to pretty much normal, with a midfoot strike rather than heel strike.

I can now hold my full weight in a raised calf position for about 5 to 10 seconds. However, it hurts a little too much to do a calf raise from flat footed. I can do about 90% of my weight with minimal pain.

I can do "quick steps" on a box now, I can do a speed ladder while maintaining a heel raised position.

On Sunday I did a 6 mile hike carrying my toddler. The uphills I have to walk weird because it is a little too painful to push off of that leg.

Today (monday) I feel good enough that I'm tempted to run again, but I'm going to wait until tomorrow.

In the past 2 weeks, I feel like the pain at the heel has decreased a lot. I can now walk pretty fast with only minimal pain and walk slowly with no pain. I expect I'll be able to do heel raises with my full weight in a week or two.

Update, now at 18 weeks. I continue to feel better. Definitely still not 100%. I can run every other day now somewhat comfortably. Had a 6 mile run this week where I averaged in the 7:45 per mile range, running with the baby jogger.

The pain level has decreased enough now that my running pace is no longer limited by the pain. It still is a little uncomfortable on some steps if I land awkwardly or step on a bump in the path. But overall, running an easy pace like that is finally enjoyable again.

I've been doing long vigorous walks on my non running days along with a stationary bike "ride."

Overall feeling pretty good. On non running days, the pain decreases enough that I can squeak out a few single leg calf raises. If I do it after running it's a little too painful.

I've been continuing ice and advil.

At this point, I'm running more than I could pre-surgery. My surgeon told me I should continue to improve for 6 to 12 months after surgery and it's only been 4, so I'm feeling pretty solid about it.

Since lrc has their stupid new method of tracking who is using an anonymous name and I've changed devices, I can't use my same name...

I'm at about 17 months post surgery.

I'm still not at 100%. However, it is significantly better than pre surgery. I can run 4 or 5 miles every day. If I overdo it, I still have some inflammation and discomfort. Pre surgery, one run would leave me unable to walk. Now I can run a week straight and just have some soreness. It has continuously gotten (very slowly) better. The past month or two i continue to notice very gradual improvements, even as I'm able to do much more than pre surgery.

Congratulations. I remember posting on this when it came out. I still do eccentrics but not as often (surgery May 2012). I never think about my AT. Good luck with your progression. For me it's always been more important to get a run in than anything else.

Given the number of people who face this issue, good job keeping folks posted.

Hi! I just got this surgery last Friday and really appreciated reading about your recovery. Not sure if you'll see this but if you do, I'm interested in whether you ever got back to 100% running. I'm at that point where I see a very very long road ahead and hoping to remind myself that in the long term this is worth it!

Curious to hear your further long-term update, if you ever revisit this thread. It is very informative to others going through this. I plan to share my own experience once I am further out.

I am now 3 weeks post op from “mini open” insertional Achilles debridement.

My pain and “bruising” sensation to palpation was at the far medial third of my insertion. I ran through it for about 5 years until decided to start trying progressively more invasive things… spent the past 3 years trying these: shockwave, prolotherapy injection, percutaneous scraping, Tenex tenotomy, PRP injection, endoscopic calcaneoplasty/retrocalcaneal bursectomy, Tenex targeting the subcutaneous bursa, and lastly mini open debridement and reattachment with a single anchor. If this doesn’t work, I just give up… Will become a cyclist full time, as I have for the past 1.5 years.

Now 3 weeks out I can bear full weight in walking boot with heel lifts. I still have the bruised tenderness to palpation feeling as before surgery. Was hoping that would be gone, but I guess the OP also had that for several weeks/months postop.

I think my rehab may progress quicker since only 20-30% of my tendon had to be detached. On the flip side, I am very anxious that the surgeon did not “get it all” because of too much emphasis on minimally invasive technique. I also had amniotic membrane applied to my tendon (under the paratenon) at the site of debridement, which is supposed to speed healing (evidence mixed but my surgeon is a believer).

Now 5 weeks postop. I am walking slowly and carefully in Dansko clogs (open back, 2 inch heel). Burning pain when after walking subsides with rest. Bruised sensation when palpating the area. Incision healing well. Using silicone sheets to minimize scar.
Have been riding stationary bike a lot with flat pedals and wearing a short ankle boot. I made mistake of cycling with the silicone sheet on a few times which led to some skin maceration.

I would advise anyone else using these silicone sheet to remove them before exercise.

Will post updates periodically over the next several months.

So I’m 11 weeks postop now and sadly feel zero improvement. My symptoms returned after week 5. I looked at the insertion with ultrasound (I am a radiologist) and was floored when I saw the same intratendinous calcification and bone spurs that I assumed would be removed. I’m beyond pissed at the surgeon, but can’t dwell on it. Searching for someone else to operate on me and actually fix this…

The orthopod I went to is reputable (operated on several pros, so I flew across the country to have 2 surgeries with him), but at the end of the day he was just too reluctant to detach the tendon and debride. Just wish he was more clear about that plan before surgery.

Haven’t run for going on 2 years now. This is just demoralizing when I think of the time lost.
Thankfully this does not prevent me from riding my bike. Don’t know what I’d do without Zwift.

Thanks to all for sharing. I have a similar lingering injury but not bad enough to need surgery yet. So sad to hear the surgery was for nothing, I hope you overcome this.

Update: I am now 5 months out from the mini-open intratendinous spur excision surgery, and feel fully recovered from it, but sadly the same symptoms of tenderness, pain in dorsiflexion, and pain at end range plantarflexion persist exactly as they did pre-surgery... and imaging shows many of the same abnormalities (distal intratendinous dengeration and enthesophytes) that were not addressed by that surgery.
I saw another orthopedic surgeon today at a big university hospital. He is willing to operate on it but wants to completed detach the tendon, debride, smooth bone, reattach. I have no symptoms from the lateral half insertion and it looks normal on imaging, so the plan gives me some pause... the whole cutting through asymptomatic portion of tendon to reattach it. I understand why he has this approach... because I'm damaged good now having had 2 failed less invasive surgeries. I will get 1 or 2 other opinions before deciding what to do, but I definitely am going to have another surgery. Not giving up on running yet.

University orthopod said he’s be happy if I can run a 5k or 10k in 1.5 yrs postop but not a marathon. Didn’t really make sense to me—it was like a “tell me you’re not a runner without telling me” moment. I just nodded and didn’t press the issue, but was thinking “dude, racing short distance means faster speeds and so more demand on the tendon, both in training and in the race.” I’m not totally autistic so knew it wasn’t worth getting into that.

If any of you regular posters are podiatrists or foot/ankle orthopods, please feel free to weigh-in on the issue of full detachment vs. partial in this situation. My symptoms and imaging abnormality correlate with only the medial half of the insertion. No Haglund deformity (although now maybe there is some heterotopic ossification from the endoscopic calcaneoplasty that I tried initially, almost 2 years ago now). Advice appreciated.