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Tuesday, May 3, 2011

Achilles Tendon Ruptures: Don't Forget about Non-Surgical Options

I want to thank Dr Carl DiRaimondo for pointing out that Achilles Tendon Ruptures can be treated non-surgically. I have rehabed about 100 complete achilles tendon ruptures without surgery and another 50 or so surgically repaired. Both have there pros and cons, but both types of repair can be rehabed to 100%+ strength. Both groups seem to start running between 6 and 9 months. Both groups can have failures requiring further surgery. The failures in the surgical group are much more dramatic due to surgical complications. The main complications in the nonsurgical group are re-rupture and inadequate reattachment. Both can be fixed with the surgery in the future.

There is quite a bias in the world  when achilles are ruptured to fix them surgically. They are sent to surgeons from the primary care docs or from the ERs. Only the articles like these can make someone stop and say maybe I could treat this injury without surgery. After one year, whether the tendon was surgically or nonsurgerically fixed, there really is no difference in function. If you are surgically averse like me, and unfortunately you have a problem like this, consider a non-surgical approach. I would be happy to send our protocol to anyone on the non surgical rehab of achilles injuries.


  1. Thanks for your insight into non-surgical treatment. I had a partial tear (~80%) of my achilles four months ago, and following the protocol of my orthopedic surgeon, did not have surgery (6 weeks of walking cast, physio, etc.) While I can walk now (with a slight limp), I feel that my progress has levelled off. Daily swelling is a regular occurence. I have a few quick questions:

    1. Do I just need to be more patient?
    2. Would you recommend any kind of orthotic to cushion my heal?
    3. Can you send me the protocol you mentioned above?

    I realize that your time is very valuable, but would appreciate any feedback you can give me.

    Neil Maltin

  2. Neil, Thanks for the email. I will send my article over the next week to you and will try to post it soon also. Casting less than 3 months for partial tears is iffy unfortunately. Usually, 3 months cast and 1 and 1/2 half month of carefully weaning off the cast completely. I always prefer a very stable orthotic device as you begin walking. Swelling and a slight limp is normal at this stage so the ability to progress first from two sided to one sided toe raises, and then gradually increasing your one sided toe raises each evening to 25 straight knee, and 13 bent knee is crucial in seeing if the rehab is going well and since I am doing this great run on sentence I might as well continue.... So, the two questions I have for you, is there pain, and where are you in your toe raises? Rich

  3. Please, can you send me the protocol?

    Thanks in advance

    Gerardo Amilivia

  4. Dear Gerardo, I just sent Neil the protocol on PDF but need your email address. You can sent it privately to Thanks Rich

  5. Ruptured achilles tendon and was put in a cam walker at 90 deg. I Opted for non surgical since I am in decent shape. I actually can flex the foot after 1 week slightly. Dr was mad and offered zero rehab. What type of excersises should I do and is it too soon, I feel no pain in the inflatable cam walker and can walk on heal easily with some flexability...


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.