1 week post-op Achilles Tendon Tear repair, pain increasing

by Patrice

I am Patrice, a healthy and active 40 year old. I tore my achilles tendon at work on 12/12/10. I had surgery to repair the tendon on 1/19/11. The surgery was performed under general anesthesia, and surgeon described outcome of surgery as "excellent."


I went home the same day as surgery, and experienced little pain until the next day. That pain was just what I had expected- soreness around calf and ankle, and a pressure like pain when injured foot was not elevated. Spent next week on couch, only getting up to answer the call of nature. Stopped taking pain meds (norco) after 4th day.

Over the last 2 nights, I've been experiencing a different and more uncomfortable kind of pain.

The pain is in my heel, and is best described as an intense burning. It seems to intensify in the evenings and pain medications do nothing to alleviate it. I keep the injured foot elevated while in bed, so there is no difference in positioning.

I wake up at least 4 times a night as a result of the intense pain, and have to just wait until it eventually lessens enough for me to go back to sleep. Each episode lasts from 10 to 20 minutes, and the pain is simply remarkable.

The doctor said pain is to be expected, and offered a different kind of medication, but the level and reoccurance of the pain is surprising to me. I am just curious if anyone else who has had this surgery has had a similar experience and can sympathise or offer a solution. thank you



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Joshua Answers:

Hi Patrice.

Part of the Tendonitis dynamic is long term muscle and connective tissue tightness.

Specific to Achilles Tendonitis, the calf muscles and the Soleus muscle underneath, and the connective tissue tightly wrapping it all, pull on the Achilles tendon.

Your muscle(s) could no longer absorb the force of the load, and the tendon gave way (which effectively created more length.

You had surgery which (assumably) pulled that tear back together. This effectively got rid of the new length.

So surgery reconnected the tendon itself.

But in no way shape or form does it reverse the Pain Causing Dynamic that has been feeding on itself to create more and more tightness.

So forces are still pulling. Even more so after the insult of surgery.

The Achilles tendon attaches to your heel, basically. It makes sense that that heel connection is now getting pulled on more than usual. This irritates the tissue. Thus pain.

Two thoughts, other than getting my Reversing Achilles Tendonitis program, is:

Magnesium for Tendonitis

and Self massage. Just get in there and start squeezing gently. Squeeze harder/deeper only if it doesn't hurt, but over time work your way down, lengthening too tight tissue, and creating circulation (old stuff out, new stuff in).

More questions, more answers.



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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
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Comments for 1 week post-op Achilles Tendon Tear repair, pain increasing

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Sep 15, 2017
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Mag and Vit D - Joshua
by: Pip

Morning Joshua,

My Vitamin D3 levels 88.
Magnesium 1.22.

I have been fortunate to see a temporary doctor at our surgery who seems to be taking note of the rash and pain on my ankle. He is going to request the report of the MRI I had done early August. Really praying he can help.


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Joshua COmments:

Hi Pip.

88ng//ml is slightly high but you can be up to 100ng/ml, no problem (there's just no increased benefits once you get over 80ngml).

So that's great.

Magnesium blood serum level of 1.2 is low...and means your intracellular levels are LOW.

Keep me updated on the old MRI results.



Sep 03, 2017
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Vit D/ Magnesium
by: Pip

Morning Joshua,

I will have to request the Vit D and Magnesium levels when I see my GP. will update after the 13th Sept '17.

Thank you for your replies.




Sep 02, 2017
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Vitamin D
by: Pip

Hi Joshua,

My Vitamin D3 is 1,000 unit, one tablet daily. when my bloods were last checked both Magnesium and Vitamin D were good. My Vitamin D deficiency was first picked up over 10 years ago which was bit of shock as I am a person who spends a lot of time outside. I did start taking Magnesium but a blood test early this year found my levels to be good.
[I have B12 injection every 3 months and have to take iron supplements]


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Joshua Comments:

1. No need for B12 injections. Sublingual B12 methylcobalamin is as effective as injections.

2. Magnesium blood level tests will always come back in range. Your body is designed to keep the blood levels in range no matter how much magnesium you actually have available.

What was the actual level?

3. What was your Vit D level?



Sep 02, 2017
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MRI follow up, to Joshua
by: Pip

Hi Joshua,
Many thanks for your time and knowledge. I have found this to be a great support over the last few months.

It is funny you mention Vitamin D, over the years I have had problems absorbing Vitamin D so take a daily supplement.

I will be speaking to a doctor soon re the follow up on the MRI, so will keep you updated.

Thank you!


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Joshua Comments:

Hi Pip.

Fun fact: You don't have a Vit D absorption problem, you just weren't taking enough Vit D (and magnesium).

Well, technically if you don't have enough magnesium in you you can't absorb the vit D your do get...but generally people think they have an 'absorption problem' because that's what they're told by their doctors....but that's wrong.

People just aren't getting/taking enough so their levels stay low.

What's your Vit D level? How much D are you taking now?

And yes please keep us updated on the MRI results.



Aug 31, 2017
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Update/MRI response to Joshua
by: Pip

Saw my consultant today following an MRI scan done 4 weeks ago, as I was still having pain under the heel bone, plus below the outside ankle bone.

I also have the rash around this ankle which started at 5 weeks post surgery.

I was shown the scan which was of the side view of the inside of my foot.

Again he pointed to the muscle of the big toe tendon, which has been used to build up what was left of the diseased tendon. The image of this muscle was very marbled/white which I was told are tears. I was told one wouldn't expect to see this much white on the muscle.

This is not the area where I have the most pain, it's the area they keep referring to, so again I feel I am being ignored.

When I pointed out I still had this itchy rash and wondered if it could be a reaction to the metal screws, I was told he has never heard of anyone being allergic to metal implants. I was told to see a doctor!

I'm left wondering why a badly torn muscle has been used to replace a diseased tendon.
Will stretching exercises help ease the pain on the heel bone with these tears. When walking there is a lot tightness on the back of this leg.

Still have a mystery rash which I didn't have before surgery.

There is still a lot of swelling around the ankle and the warmth isn't as bad since I have started a mild dose of antibiotics for another condition.


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Joshua Comments:

Hi Pip.

I'm not saying they're right, but most of the time where you feel the pain isn't where the problem is.

For instance you feel heel pain because of lack of function elsewhere in the lower leg.

Even if you have a 'tear' there at the heel, the CAUSE (which to me is the real problem) is not at the point of injury, it's in the structures above the heel.


"I was told he has never heard of anyone being allergic to metal implants."

Then he should spend 5 minutes researching the topic in professional journals etc.

Having said that, I don't know much it, so don't have any opinions on the correlation between your rash and the implants. It could be any number of things.


"I'm left wondering why a badly torn muscle has been used to replace a diseased tendon."

They don't really care, they just needed some tendon and that's where they took it from.


"When walking there is a lot tightness on the back of this leg."

There was tightness before, and now there's more. That's more the original cause of your problems, and some/much of your current.

That muscle with the tears/scar tissue is too tight and not working well. Other muscles are too tight and not working well. That leads to, for instance, heel pain. That tightness is ignore before and after surgery, but that's where the focus needs to be.


"There is still a lot of swelling around the ankle and the warmth isn't as bad "

Maybe you have a little infection in there. What you definitely do have is metal drilled/pounded into bone, and the body doesn't like that. And if your ability to heal isn't up to snuff because of a variety of reasons like low nutrition...

For instance, what's your vitamin D level?




Aug 27, 2017
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Update from 6/9/17 Surgery
by: Danielle

Thank you for responding Joshua!


I'm now at 11 weeks post- op and have been out of my boot for 3 weeks. I started back at work bartending at the beginning of August but was forced back onto disability because of the pain. My doctor AND my physical therapist gave me the okay to go back to work which I was very eager to do. The heel pain and swelling was so overwhelming that I was having to take breaks every hour. Now I feel like I am back at square one.

The original incision site (from the door laceration) burns constantly and my scar tissue is extremely inflamed. I haven't been able to find a lot of information online of people's progress this far out... which worries me because I think my pain is really extreme for being this far into my recovery.

I attend physical therapy three times a week and take vitamins but I have a defined limp that has kept me from doing much walking and exercise. I'm waking up multiple times a night from stinging up and down my achilles. Icing helps for a bit, heat does nothing and my physical therapist just keeps telling me to try and push off of my toes.

This has been the most exhausting summer of my life. I just want to walk without pain and get back to a normal state of existence.

If anyone has any info on pain management for this far out from my surgery, I'd appreciate it.


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What vitamins are you taking?

How are you icing?



Aug 15, 2017
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Complex regional pain syndrome
by: Pip

October 2016, I had a tendon transfer from the 3rd digit to my thumb, as a tiny tumour on the nerve made the muscle waste away.

Surgery went ok and I have better movement of the thumb.

BUT.. I developed Complex regional pain syndrome. It was day 3 when I woke to a very cold hand, then the burning and shooting pains started. The treatment for this was medical chilli patches. This has helped reduce the overall pain and itch. When the temperature drops outside my hand will feel the cold more than my other hand.



Aug 10, 2017
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Reguarding everyone's burning complaint.
by: Anonymous

Im on surgery #2 on my foot.

This time bone spur removal (again) lengthening tendon and all other crazy crud.

2 weeks out of surgery and the pain starts....which is normal. Now the burning everyone is curious about....did your doctor not tell you they do a nerve block in you foot before surgery starts....that burning is your nerve regenerating....firing back up!

YES ITS VERY NORMAL! My first surgery I woke up feeling like acid was being poured on my foot.

This time not as bad. The only issues I'm having is the most extreme pain in my heel (which has 4 anchors now) when I'm elevating my foot.



Aug 07, 2017
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Respond to Joshua
by: Pip

Hi Joshua
Still in much pain with swelling.[surgery March '17]

The Achilles tendon removed and replaced with 4 grub screws. The FHL tendon muscle was used to repair what was left of the diseased Achilles tendon[FHL tendon pulled through heel bone.]

Have not been told or checked if the swelling and warmth is an infection. Still have rash.

Waiting to hear results of second MRI scan.

Pain is very much under heel bone.

Didn't think there would be this much pain!


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Joshua Comments:

If there's worry about infection, they should/better rule it out. For multiple very important reasons.

Keep us updated!



Aug 01, 2017
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Help
by: Anonymous

Had Achilles Tendon surgery, 6/26/17 Surgery was very successful, had the pain block which last more than twenty four hours, my first post op surgery my surgeon said the wound is healing nicely, place a hard cast on.

Second visit another cast was placed on. I am experiencing excruciating pain more now then ever before.

Third visit i was given a cam boot with weight bearing as tolerated.

Very very painful to the point im in tears.

Any suggestions anyone???


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Joshua Comments:

Hi Anonymous.

1. Why do you call it a 'very successful surgery'?

2. What exactly is hurting? Who what why how where when?





Jul 22, 2017
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Achilles Tendon Transfer
by: Pip

Four months ago I had a Achilles tendon transfer and the swelling to the back of heel removed. The surgery was done as the Achilles had become very diseased which eventually left me with a very painful swelling at the back of the heel.

Since week 3 I have been suffering pain to the bottom of my radiating to the back of my heel bone.

It was very painful every day wearing the air boot [10 wks]I was nearly everyday trying to pad the heel part to cushion my heel. I am still suffering bad swelling more round the ankle bones, bad pain and the heel is always warm to touch. The swelling round the ankle bone has been very itchy with a slight raised rash on the skin. I am on strong pain killers which at times does not touch the pain.

At 6 weeks, after 2 weeks non weight bearing and 4 weeks part weight bearing I ended up back in a back slab as the pain across the heel bone was to much to walk on. A scan showed a tear on the out side of the heel bone, which is still where most of the pain comes from.

When I came out of the cast the grey boot was pushed onto my foot with force. I had 3 wedges in the that boot. I don't know whether this caused the tear or to do with the on going swelling and daily pain I am still suffering. I'm starting to not be able to cope with it now.

Is the swelling, warmth, rash and pain on the heel bone normal at 4 months?


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Joshua Comments:

Hi Pip.

Depending on the scenario, all of that at 4 months isn't surprising. I don't know if it's 'normal', but it's not surprising.

Hurting etc for 4 months is entirely common. Yours sounds a bit more than that.

Lots of pain is not surprising. You've had major trauma to big structures.


Rash is not good, depending on how long you've been out of the cast and boot.

If you confirm it's not an infection, I'll be happy.


1. Did they remove bone?

2. The achilles was completely removed from it's attachement, and reattached?

3. With additional tendon taken from where, exactly?

4. What exactly have you been doing for self-care/rehab?





Jul 17, 2017
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2 Days Post Op After Completely Ruptured Tendon
by: Danielle

I'm a 28 year old extremely physically active female. I box, run and bartend so I spend most of my time on my feet. I've never had any pain associated with my Achilles area.

On May 16, 2017 I was hit in the ankle with an extremely heavy metal door at work, which lacerated an inch wide and deep tear into the ankle. The ER misdiagnosed it as merely a cut, no imaging and tests done to determine Achilles' tendon damage other than some pressure applied to the foot by the "Doctor" (he turned out to be a psychiatrist!).

A week later I awoke to the most intense pain and cramping spreading from my calf down to my ankle. The next day my doctor scheduled an MRI as he was sure I had ruptured my Tendon at least partially.

I finally got my surgery on June 9. By then the tendon had fully ruptured and spread further up my calf and down my ankle. When I woke up from surgery I was met by a cranky nurse and very little post op instructions other than, elevate and don't bear weight.

Now my issue is that I'm in a hard cast that is so tight I feel like my leg is being squeezed off. I have no idea how many sutures are in my ankle or where they are located.

The most intense pressure is right where my Tendon was ruptured and where I believe my sutures are.

It feels wet, not from the outside but the inside and I'm scared the pressure from my cast and general movement of my foot in my sleep has torn an incision.

Is this a possibility or am I imagining it?? I feel lost, like i was just sent off into the world with little understanding of my surgery (the first one I've ever had!).

I'm trying to ice it to numb the discomfort but no amount of ice can penetrate this suffocatingly tight cast.

Any recommendations would be so appreciated!! I'm miserable and confused.


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Joshua Comments:

Hi Danielle.

Ouch, sorry to hear that.

1. "he turned out to be a psychiatrist!" I'm no lawyer...but that's gotta close to the realm of malpractice.

ER's miss stuff, but a psychiatrist evaluating your injury??


2. "When I woke up from surgery I was met by a cranky nurse and very little post op instructions other than, elevate and don't bear weight."

Yeah...... :(


3. "in a hard cast that is so tight"

This response is likely to late to help, and I suspect you ended up going to the doctor and discovering the cast was in fact too tight (whether you were swollen or not).

But if you (or anybody reading this) has those concerns....go see your doctor asap. Have them cut the cast off (even if they don't want to, ESPECIALLY if they don't want to) and evaluate the surgery site/wound.

Could be sweat in there, but if you're A. uncomfortable and B. have more than 'normal' worry about it, go see the doc and force the issue if necessary.



So.

Still in the cast?

What are you doing for rehab (because you're going to need to do some good/effective rehab, don't leave it to 'time' and 'rest' and some PT stretching and strengthening (or at least, I wouldn't).






Jun 12, 2017
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Achilles tendon rupture - burning pain
by: Katalin

Hi,
I had a full Achilles tendon rupture. I had an operation a week ago. Until now i had no pain, but this afternoon the burning pain in my heel started and when it comes it is pretty bad, it actually makes me cry. My doctor did not mention anything about this pain. I still have a hard cast.

I read the previous comments, but there was not mentioned how long we can expect this pain to be this bad.

Please give me some info about it. Thanks.


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Joshua Comments:

Hi Katalin.

That's great you had a week post-surgery without pain! Lucky you. (Not joking).

But, your doctor didn't mention anything about bad pain. They often/usually don't.

But, your achilles tore in half. Then a surgeon cut through your skin, probably cut your tendon (to clean up both sides), pulled the ends together and stapled (?) them back together.

That is a MAJOR injury.

So it's probably going to hurt, and bad, for a while. How long, I don't know...it depends.

- How overstretched are your lower leg muscles now? (the reattachment process essentially shortens the tendon so it's pulling on the muscles and connective tissue).

- How bad is your inflammation process?

- How fast can your body dial down the inflammation process and clean out the pain enhancing chemical it releases?

- What's your nutritional status? Meaning, how sufficient are you in the nutritents needed to relax muscles, recover from the stress of pain/trauma/injury/etc?


It's unlikely your doctor gave you any self care short of rest, staying off it, elevating, and painkillers and anti-inflammatory drugs.....and you're stuck in a hard cast so you can't ice dip.

So at this point, pain killers, anti-inflammatories, elevation and positive thoughts.

Your body is severely injured and trying to heal.


More questions, more answers.



Jun 09, 2017
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Response to Joshua
by: Shsnnon

Hi!

Yes, I am in a half cast with fluffy stuff on top and ace wraps. My first post op appt in this Monday. I would really love to get in a boot!


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Joshua Comments:

As soon as the hard cast comes off, get to ice dipping A LOT for a while.



Jun 08, 2017
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Burning/pain almost 2 weeks PO
by: Shannon

I, too am having all night burning pain. I will be 2 weeks PO tomorrow. The last 2 nights have been pretty bad.


(I googled the symptoms and found your blog!)


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Joshua Comments:

Hi Shannon.

Are you (still) in a hard cast?




Feb 06, 2017
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Burning pain
by: Annette

I too am having the horrible burning pain in the back of my heal. Sometimes enough to cry and bring me down like a hot iron.

I am 7mo. out its driving me crazy. I do have horrible RA so I thought that may be why. I see doctor next week.


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Joshua Comments:

Hi Annette.

We need more details.

By RA do you mean Rheumatoid Arthritis? Why exactly do you think you have RA?

You've had achilles tendon rupture and/or surgery?

Etc.





Aug 26, 2016
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post-op achilolesàhaglands deformity surgery
by: barb

I have had 2 operations for this prob, been in 4 casts I have severe pain while in cast

Burning aching causing crying during first surgery all went well no post-op pain at all site was super glued it was still draining was sent home with a dressing and told could could return to work.

I am a floor nurse no sitting wound reopened again to surgery this time after 10day post-op cast # 4 was applied I am having severe pain with castup (L) side of leg around to back oh leg with some burning.

Dr said repair was more extensive moved wound from one side of ankle to other pulling skin formimg a huge bulge what can I do for the pain.


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Joshua Comments:

Hi Barb.

The doctor returned you to full duty to an on-your-feet job?? While the surgery wound was still open and draining? That's crazy!

In the short term, it's painkillers to deal with the pain to get you through the day.

When the cast comes off I'd jump into the Reversing Achilles Tenonitis program.

You're going to need to do some work to rehab what's going on in there.

And the second the cast comes off you'll want to go heavy with the ice dipping you're learn in the How To Reduce Inflammation page.


In the mean time:

- keep your toes and ankle moving a little tiny bit in the confines of the cast. Keep things moving.

- increase your protein and good fat intake

- natural anti-inflammatories like turmeric

- read this entire thread and follow the links/read those pages too.





May 07, 2014
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topaz surgery on june 26 2013 and its not looking good
by: Kim

I am a 42 yr old 230lb black female.I started having pain in my left heel early may while working. I work in a warehouse walking 9 hrs at a fast pace.

So with my heel pain I couldnt work. I went to the podiatrist and he took a X ray which should that I have a hugh bone spur. So before he could give me a cortisone shot he orderd a mri.

The mri showed a small interstitial tear at the lateral aspect is what the report says along with showing mild to moderate plantar fascitis and plantar calcneal spur with stress reaction also mildly hypertrophic PB and PL tendinopathy and peritendinitis ATFL sprain and last low grade PT tendinopathy. Deltoid ligament sprain.

So I dont know what any of this means but he suggested I wear a boot and threapy did that from may 16 till june 16 and no relief also taken off wk.

So he suggested the topaz surgery with will focus only on the tear because he said that he didnt think the bone spur was the cause of the pain. It was from the tear. So mins before they put me to sleep the dr asked me exactly where my pain is so he can mark off where he will perform the procedure I told him where and 2 days layer when I can take the bandage off I noticed he didnt do it where we discussed.

As day go by 3 day exact I have a hugh knot where he did the surgery. So now on top of my old pain I also have new pain. The site of the surgery hurts along with my WHOLE foot and angle. So my check up visit was july 5 2013. First I wanted to know if the site should look like it does.

The nurse was obviously concerned with the look before the dr came in its dark spots above the site and the knot. So the dr comes in and he looks at it looking concerned as well.So he says that the knot is my bone and I can see it better so thats a bunch of mess.

I asked was he sure it wasnt a cyst and he says o no its not a cyst. So I asked why he did it where I told him it didnt hurt and he first says that's the focal point then he said I told him it hurt right there and I told him I've never had pain there till now so he says I want to keep u close to me. Come back in 3 weeks and to stay off it which I have pretty much and he also said that since I was stretching like I was advised to that maybe ive strecth to much and to stop but he wants me to go back to therapy which focuses on stretching.

I think I have made a big mistake with this dr.

Still in alot of pain and extra pain.


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Joshua Comments:

Hi Kim.

A doctor asking where he's doing surgery moments before actually doing that surgery is not a sign of a good doctor.

Nor did he ask or inquire or consider WHY you were having pain/problem in the first place. An MRI is just a picture of current events. Doctors SHOULD wonder WHY the MRI looks like it looks.

Pain and tear etc doesn't just show up for no reason. And those reasons are still in place after surgery.

It's been a good long while since you posted. Give us an update and we'll go from there.





Mar 23, 2014
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Burning sensation from Achilles surgery
by: Anonymous

My husband is 4 days post surgery and also having same intense burning sensation that worsens at night. Pain meds do not help the burning.

Does he need to be on a different type of medication ?


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Joshua Comments:

Hi Anonymous.

I don't know if he needs meds or not. You'll have to hope your doctor has something to offer there.

Surgery cuts into flesh and causes injury (which causes a lot of inflammation side effects, etc). There's going to be pain, etc. If any little nerve was bruised/damaged/cut, there will be issue from that too.



Aug 15, 2011
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Post Achilles Tendon surgery question
by: James Guy

Hi. I injured my Achilles tendon about 3 months ago playing basketball. It started as a high grade tear and started to scar but last Sunday it popped and I had to have surgery. So on 8/8/2011, my surgeon repaired it and gave me meds and im in a splint. Now the last couple of days, my calf muscle has a pain similar to like a Charlie horse pain. When my leg is elevated it doesn't hurt but when I get up, and of course im using crutches, it hurts.

My surgeon's nurse said its normal. What is wrong?? Can anyone help?? Thanks


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Joshua Comments:

Hi James.

Unfortunately, it is common.

Your tendon ruptured. You had surgery to reconnect it, which effectively shortens the structure. Plus all the trauma of surgery (cutting, torn flesh, punctures and cuts etc.

So now when you're upright, even the pressure of blood and gravity is going to cause it to hurt. You have a crazy unhappy Process of Inflammation.

And if you put any weight on it (I assume you're in a cast) the tension on all that unhappy tissue makes it hurt.

The charlie horse is likely from your traumatized muscles now being pulled apart 24/7 from the new tension of a shorter structure.

I highly suggest you get an ARPwave unit (see The ARPwave System). Not only for the fast pain relief results (neurologically setting short muscles to length) but for the 4-8 week full recovery it can help provide.

Magnesium for Tendonitis would also be highly suggested.

More questions, more answers.




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