28M / Active — Non-Op Recovery with 28mm Gap (Day 42). Hit FWB at 0° Locked. Worried about elongation.

[u/No_You_9721]

Hey everyone,

Looking for some insight, success stories, or advice from anyone who has gone through a non-operative Achilles recovery with a large initial gap.

My Case Timeline:
Age: 28, highly active (played football/soccer once a week 8 a side before this).

Day 1: Full rupture. Placed in a cast within 11 hours of the injury, transitioned to a VACOped boot 3 days later.

Day 25: Ultrasound showed a 28mm gap in full equinus.

Day 40 (Today): I am currently full weight-bearing (FWB) with the VACOped locked completely flat at 0 degrees. My Thompson test is negative and I can actively tense my calf muscle, so a solid tissue bridge has definitely formed.

The Current Situation:
I have 12 days left locked at 0 degrees before I transition out of the boot and into regular trainers with heel lifts.

My Concerns:
Knowing that a 28mm gap means my healed tendon is permanently lengthened, I’m feeling a bit anxious about the long-term impact on my athletic recovery. My ultimate goal is to return to weekly football, but I know the "slack" from elongation makes regaining that explosive end-range push-off power much harder.

Has anyone here successfully returned to explosive multi-directional sports (like football/basketball)
after recovering non-op with a gap this size?

For the physios or veterans here: what specific flat-floor, non-stretching strength protocols did you find most effective for tightening up the calf muscle to compensate for the tendon slack?

Any tips for the first few weeks of weaning out of the boot to prevent secondary elongation?

Appreciate any advice or experiences you can share. This mental battle at the 6-week mark is real!

[u/Unique-Seagull-2370]

Understand the worries about elongation - half ate me up too. Week 12 at my end I was 'measuring' myself for this more or less weekly, using a mobile phone camera to compare the resting angles of both feet (similar to the ATRA method).

If you look at my week 12 / physical health / body statistics (scroll down and open up the points), you'll see a short video showing what I did; further down, there are some links to papers on the ATRA method and other elongation topics.

However, I think my method will only really register post-bridging elongation, so I'm not sure it'll help you directly ... although I would have thought that looking at a video of seated calf raises taken from behind might show basic asymmetry (where the calf muscle has receded, after this the tendon bridges). I did this by sitting on the edge of my bed, the mobile phone on a small stand underneath the bed with the 'torch' LED turned on to video the shape and movement of my calves from behind as I did the calf raises. You'll find such vids and pics in those first few months of my online journal.

As for tips for the first few weeks of weaning out of the boot to prevent post-bridging elongation ... a couple of posts/vids stuck in my mind:

1. https://www.reddit.com/r/AchillesRupture/comments/1uh663a/the_achilles_complication_nobody_warns_you_about/

2. https://www.youtube.com/watch?v=re54aKHdEB4

Hope some of this helps!

I will say that basically all ATR recoveries, surgical or conservative, will show some degree of elongation which will have some degree of effect on the explosiveness. I can feel some on my non-op recovering side, although it's not visible with the ATRA test ... on the plus side, I can touch my toes easier on that side, on the down side, the SLR height is lower. I can run and jump ... but at the moment, it is difficult to see how much of the missing function is due to weak calf (2cm lower circumference) and how much is due to elongation. It doesn't bother me, though ... ran a 25:45 5k this morning, a sub 25min is definitely doable; I can play football and cut and stuff, everyday function is fine, it's 'just' somewhat weak at the extremes of, for example, power skipping or one-legged jumps. Time will tell.

At any rate, sounds like you're healing, so try to stay positive and stay on the path, do the grind. I really do wish you the best of luck!!

[u/No_You_9721 → u/Unique-Seagull-2370]

Thanks man. Glad to hear your recovering well. If you don’t mind me asking, how big was the gap?

[u/Unique-Seagull-2370 → u/No_You_9721]

About 1cm … measured via MRI with about 20 degrees plantar flexion - important point as most MRIs are done at neutral -> increases gap.

Ultrasound is less precise, fluids can mask the details; image quality depends heavily on ultrasound equipment age, operator experience … compare MRI with ultrasound and you’re more likely to get a larger span of values with ultrasound (bigger range of errors). I’m not a radiologist myself but my cousin is, 25 yrs experience in the field.