Achilles Tendon Rupture - surgery repair with Xenograft

If you had surgery to repair your Achilles Tendon Rupture and want a fast rehab, click here to see the AAOS only 2 highest agreements to be in support of early (≤ 2 weeks) post-operative protected weight bearing and the use of a protective device that allows mobilization by 2- 4 weeks post operatively.


On December 4, 2011 I finished a 90 minute bike ride and then met up with some friends to play fag football at the local park.  We tossed the pigskin for another 90 minutes and I was feeling great but my calves and sprinting muscles were a little surprised to be doing all those short burst efforts (I haven't played a field sport in years).  With a normal acceleration to provide pass coverage on Ronimal Shevock, I heard a loud pop and instantly collapsed.  I thought somebody had stepped on my leg or kicked me, but really my Achilles tendon had completely ruptured.  Spontaneous combustion, no warning, no impact, no contact, etc.  A doctor friend came to the field to check me out and confirmed the tendon had snapped.  It did not roll up my calf and create a large ball; it didn't really hurt that bad either.  I was not able to walk, nor did I try to...

That night I confirmed the diagnosis with my own Simmonds-Thompson test by laying face down on my bed.  Here is a picture of the ruptured Achilles tendon (left foot).  You can see how the foot hangs at a different angle and there is no definition around the tendon:

Since the injury occurred on a Sunday, I couldn't get seen by a specialist until I made an appointment with my Primary Care Family Physician on Monday.  Luckily I got both of those appointments taken care of and by Tuesday we were waiting for insurance approval to perform surgery with xenograft on Wednesday (3 days later).

The surgeon, Dr Cedric Wong said the operation went well and he did use the pig's intestine (xenograft jacket).

The first day or two after surgery was quite easy because of the heavy medication.  They must put a block in your leg because the first day was very painless.  I did not continue to take the Norco prescription after the 2nd day so I was fairly uncomfortable until Monday (5 days later) when I went back to work at my desk job.  Sitting in the La-Z-Boy and watching TV for six days straight makes me bonkers.

I used a Knee Walker to transport myself instead of crutches. The walker is more like a knee scooter and allows you to carry things and open doors which is impossible with crutches.  Its sort of fun to ride I guess, which helps for an active person like myself.  Crutches are the worst, they should be outlawed.

After about 12 days I unwrapped the ace bandage and plaster half cast to take a sneak peak at the incision.  It is about 4-5 inches long on the inside of my leg, not straight up the back as expected.

At my 2 week follow up appointment the doctor gave me an air cast which can be removed for bathing and dressing.  My doc instructed me not to walk or do any weight bearing activities for 4 more weeks (6 weeks since surgery).  However there is quite a bit of research that says supported weight bearing and movement can occur at 2 weeks post op.

At 3 weeks you can see the improvement in the incision.  Its amazing how well the skin can heal an open wound. 

However, what isn't as exciting is the muscle atrophy of my calf...

5 weeks post-op I am now bearing weight in my air cast with a heel wedge and doing range of motion (ROM) exercises despite my doctors orders of immobility up to 6 weeks.  My tendon feels good, just tight in dorsiflexion so I don't push that much.  My day to day life is very sedentary.  I have a desk job and a nice family to take care of me at (our single story) home.  There is slight risk of re-rupture with early mobility but that would probably be a result of a fall or blatant behavior (bar fight:).   The other large risk with early mobility is gapping or tendon stretching.  

6 weeks post-op my ortho doc told me to continue the same path for 6 more weeks: Air cast full weight bearing, no weight bearing ROM.  That doesn't sound like my cup of tea so I am going to find some agressive rehab PT.  I cant let my leg sit in a cast for 3 months.  Obviously I am not going to ignore that I am injured but I also believe in aggressive rehab. Hopefully this mentality goes well for me! 

7 weeks post op, I am working out at the gym with the air cast on at least twice a week.   I do core exercises, upper body weights, stationary bike (10-15 min), and quad work.  I wear 2 shoes with heel insert around the office and the house and my air cast if I am going out and about.  My ROM is good and I've been pushing (gently) on dorsalflexion (the only direction thats limited).  I am going to start driving stick and using the clutch (injured foot plantarflexion).

8 weeks post op - I have completely stopped wearing the air cast.  Doc wanted me to stay with it for 12 weeks.  Keep in mind I have a desk job and a quiet life (right now).  If I were active on my feet and at risk of slipping, falling, etc then wearing the cast for another month would make sense.  Instead, I am using this time to gain flexibility, ROM, and strength in my injured leg.  

• Driving a standard transmission with clutch is going well; feels like a nice therapy at every shift.  
• I also quit wearing the heel lift shims.  
• Physical therapy prescription is just ultra-sound, massage and some gentle stretching.  The best treatment I have found is using the pool.  In the pool, I use the kick-board for some laps, then do egg-beater tread water for a minute or two, then I walk through the water at chest level to really stretch the dorsiflexion with less body weight.
• I am also using the eliptical trainer and bicycle.

10 weeks post op - I am pleased with my self prescribed aggressive rehab.  I go to the gym 4 days a week.   I am also doing about 1 hour on my road bike 2-3 days a week.  Riding hurts quite a bit and I cant go very fast or very far.  I mostly sit and spin, but can do a tiny bit out of the saddle.  I am trying to shake the limp in my walk, hope to be done with that by 12 weeks.  Some doctor friends have advised me not to worry about pushing that very much because it is the eccentric contraction: the motion that broke the tendon to begin with.  Pushing off from dorsilflexion.  General dorsiflexion is quite good, but still not 100%.  I can touch my knee to the wall when my toes are 4" from the wall.

you can really see and feel my Xenograft jacket (pig's intestine)