Do Achilles Tendon Tears Require Surgery?
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- เผยแพร่เมื่อ 13 มิ.ย. 2024
- Do all achilles tears need surgery? For many of you the answer is no. How do we go about deciding who might benefit from Achilles tendon surgery? What are the risks of Achilles surgery?
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Use this as a stepping stone to improve your discussion with your surgeon. Research is changing every month. The views expressed here may not be relevant in the coming years. This video is for your education only... This is NOT meant as medical advice.
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Thank you for your time and information Drs it's always good to get a second or third Drs advice from the professionals themselves
Very interesting discussion, thanks for sharing! I'm surprised non-surgery is so successful. I would've expected the tendon to retract too far for them to heal with appropriate length (not too long).
Ruptured my R achillies 14 weeks ago and chose to have surgery. Lucky I did, because it was torn from the bone.
Heel anchors used and the scar is almost unnoticeable. Had Clexane injections to prevent DVT, was in a post-op cast for 2 weeks, fibreglass cast for 4, then moon boot for 6. Into week 3 of being in normal shoes and start rehab end of next week. Suffered some really noticeable muscle atrophy but positive this will sort itself with some gym work.
Good luck everyone - worst injury I've ever been unlucky enough to suffer with. Stay strong.
Justin I have a tear tendon injury I can move my foot very good I can not walk with out horrible pain, some move with pain. I have steroids shot, I did like, my body did no like it. I have also some therapy nothing works, it hurt so bad. My question is the doctor of the video said that he did not recommend the surgery. What do you mean with Suffered some really noticeable muscle atrophy but positive this will sort itself with some gym work. This feeling was after the surgery. I am scare
@@marklorge8055 did u ever have the surgery,I'm in waiting room to get MRI on ankle, I been living with Achilles Tendonitis for 6 yrs now,at this point can't do it no more,I did physical therapy for 1month got a little better but still in pain
@@danielnargiso2614 Most painful surgery that I've ever had. I had my Achilles tendon repaired with a "saddle strap". Some veins removed, bone spurs removed. In 3 weeks it will be 1year since my surgery. I still have pain when I walk, and I cannot Walk barefoot, as it still hurts. I am still recovering. I can not spend excessive time on my feet as of yet. Hope this information helps!
@@marklorge8055 sorry to hear that,are u overweight?I am 5'7 320lbs
@@danielnargiso2614 l am 5'9" 200LBS.
I had a torn Achilles a number of years ago; went to the doctor the very next day… Two or three days later, the decision was made to not do surgery and I was advised that it would heal on its own. I was in a boot for about six weeks and then slowly began to get my way around again. However,… My injured leg is pretty much worthless, the calf is 20% atrophied, and my leg is hyper extending at the knee. I have developed a noticeable limp in my injured leg and now it’s too late to do surgery. I definitely regret not having surgery to fix my Achilles properly.
I had the op and the calf atrophy is not good. 30% what it was. Never comes back to normal,
Doctors, my Doctor laid out the following protocol for non-operative rehab. So 6 weeks in a cast, then transition into a boot with wedges. I am reading a lot of medical studies that show major improvement with patients that began applying weight on the affected leg at week 4. Would this something you recommend or 6 weeks of healing with no movement maybe a better option?
Not sure if you will see this, but I was told there was no concern but got an MRI because I felt something was wrong. Came back with degenerative tearing since 2013 - Achilles Tendinosis, as well as Bone Spurs, Calcification of the Heel, Bursitis, and intermittent Plantar Fasciitis. (Apparently I had broken my big toe and it healed - though I never knew). I wore a boot for almost a year and sometimes it helped the pain, sometimes not. It will swell up in the night sometimes and hurts to walk, but sometimes not. I walk up stairs no problem (except for the torn meniscus on the other knee (and possible same knee...again)). Sometimes it throbs and whew.
I told the doctor I was thinking of surgery. Do you recommend it and how long is the recovery. I'd like to be back to normal by November at least.
I blew mine out when I was 57 just taking a step. I'd been an active athlete all my life having played D1 college football and then continued playing basketball frequently until I was 47 and developed heel spurs. I was told then to watch for an Achilles injury.
I went the conservative route when it ruptured as I had significant swelling. To this day it does not feel normal at all. No pain but it feels that about mid way up my Achilles it's stuck to some undelying tissue. I can feel the exact spot of reaattachment when I flex my foot.
After being in a cast for months I developed a DVT which caused me to be hospitalized. My dr. examined me after taking off the cast but never said anything about my foot being bluish or the swelling. My internist caught it a week later and sent me for an ultrasound. Another surgeon told me I should have been given a blood thinner after casting.
Wow,sort to hear your story . I hope you recovered well from Achilles’ tendon & DVT .
My husband sadly jumped on an box in our garage in 2008 & ruptured his left Achilles’ tendon and I drove him to hospital where he had an operation & had his in plaster I thing at least 6 weeks . He had an clot injection for 2 weeks but after 4 weeks he had an Pulmonary embolism ( clots to both lungs) he nearly died .
It was an long recovery in 2008.
But last week he was on small wall looking in our bird box & bees came out and fell on grass he felt pop in his right leg .
He ruptured right Achilles’ tendon this time !
Luckily this time we brought an boot & orthopaedic surgeon said ok just need insoles do his foot held in down wood position . Plus this time he got 8 weeks fragman ( clotting injections ) to reduce risk of clots .
What risk of rupturing both Achilles’ tendons !
Did you get surgery?
Aspirin
Hi. I am curious to know how your leg is now... How long did it take to feel normal? I'm 4 months since the rupture age 57. Non surgical. Doing physio but dealing with pain and fatigue. Glad my specialist prescribed aspirin.
I had a total rupture 2 monthts ago did surgery after a week i had an infection, then i had another surgery to take out infected tissue now its been two weeks after surgery and I am in antibiotics since and waiting for wound to close between the stitches its a nightmare
Any thoughts on flouroquinolone induced ruptures or tendinitis? I still have severe tendon damage almost 10 years after taking this class of antibiotics.
Omg NO!!! I just finished that class of antibiotics and think both mine are torn or something bc one/and now the other hurt really bad.
i tore my achilles on aug 30th and scheduled for surgery on the 16th in a couple of days. i don't know if i should do the surgery or not do the surgery
Im a 42 year old thats very active and had a complete tear playing basketball. My tendon went all the way into my calf muscle. I elected surgery and its been great for me thankfully. Took about 9 to 12 months for a complete recovery.
Im surprised to see people going non surgery but doing weight bearing and walking after a month. It took at least 3 months bf i able to put weight on da foot. To me, the best thing that contributed to my healing is taking physical therapy serious and doing exactly what they say do.
Great discussion, I just had a complete tear in my left Achilles and doing a lot of research into this topic. I would consider myself a very active individual, it happened during a soccer match.
I just got diagnosed with a full tear in my left Achilles as well. Did you opt for non surgical route??? I’m hoping I’m able to do so
@@erickperezvaliente1668 Yes. I'm 4 weeks postop now.
@@lepoldbuttersstotch How are you feeling 4 weeks post op? Are you weight bearing yet?
@@erickperezvaliente1668 I'm not. Non weight bearing until 6 weeks. 2 weeks post op in a splint. 4 weeks in a hard cast. Then into a CAM boot for another 4-6 weeks of progressive weight bearing and physio.
Feeling good though. The first few weeks post op were very unpleasant due to random shooting pains and swelling into the splint creating pressure points and being unable to sleep more than an hour a night... things finally started to normalize and I'm following a stretching regime vigorously everyday.
As for op vs non op, it depends what you are comfortable with. Everyone's lifestyle is different and you have to weigh the pros and cons yourself. I'm very athletic and compete in multiple men's leagues weekly so I wanted to do surgery because of the potential upside of a stronger repair, less chance of rerupture, faster recovery and I'm willing to risk the consequences, which are rare but very real wound healing issues, nerve damage, scarring. I've seen botched surgeries that end up costing the person their ability to walk...
Now for non-op treatment, the rate of complication is much less and it also depends on your rupture, everyone is different. There is also a chance that non-op won't reattach properly after 8-10 weeks and you have to do surgery anyways.
Most younger athletes do surgery but that's a generalization and some don't and still get back to their former levels of sport fitness.
@PeenutButterJelly when did this happened and how are you feeling now?
I am 2 weeks post op and it happened playing soccer as well.
Hello to all my question is what about a tear in the achilles aroud a santimeter so not so mutch is it a good idea to do a not sergial recovery
I tore the same tendon twice about 15 years apart. I had 2 different doctors each time, neither one did an xray or a scan. The back of my leg was purple...So I think I was given a short shrift both times, since they didn't do any xray, scan. They just sent me home with a clumsy boot that didn't fit and there was no follow-up either time. The leg where the tendon tore twice is about a inch smaller in diameter than the other leg....It could happen again. I walk a LOT and I am not a couch potato Bad medicine imo TWICE, which seems to follow me around.
What do you think about using BPC 157 to help with the healing process of the ruptured Tendon?
That’s what I’m trying to take
Super helpfull, thanks for sharing!!!
Torn mine 10/12/22 playing basketball. Age 37. Play often. Sucks. Had surgery. Been 3weeks
How are you doing now? Any rereuptures or issues?
Hello recently I tore my Achilles tendon it is about 2.5 upon 5-6 cm high. My podiatry wanted surgery but my primary doc recommended no surgery. I ignored my podiatry and not get surgery. However my tear created an hour shape glass, will this heal on its own?
Hi how is your recovery going? also what was your original gap size?
Interesting. I opted for surgery -- about 15 years ago -- because I was told it was the best option given my young age and athletic background.
I tore mine yesterday :( friday I can decide if I want surgery, I am very active train 5-6 day a week, I dont understand :( i have huge muscular calves. I wanted to go do Alpinism Mountaineering next year. Imagine tearing shit alone in the mountains.
@@maktiki The orthopedist told me when I tore mine that surgery was my best option to get explosive power back. The worst thing about the whole ordeal wasn't the surgery but rather the recovery. A month in a hard cast and another month in a walking booth, but that was back then. Don't know if protocols have changed since then. They hooked me up to a pain pump hanging around my neck post surgery with catheter in my leg for a couple of days. I looked like rapper Flavor Flav did back in the day with that massive clock pendant :)
thank you... you give me hope... I ruptured my achilles tendon.. thou the MRI shows a 38mm gap, but initial clinical examination by the doctor suggested only a partial rupture.. quite in conflict with the mri.. However they suggest surgery... which im personally not in favour of. So its been a month (without surgery) and i can stand , walk slowly... and hoping it will heal in time. can easily flex my toes. The thompson test which was not showing any movement earlier has now started to show some movement. Just not sure if its time to start some exercises to strengthen it.
how did your injury turn out? are you walking ok
I think the Thompson test is bullshit because if you actually ruptured your tendon up top instead of new your heel of your foot of course your rupture is not going to make the calf flex your foot clean and simple it's not rocket science
How it turn out for you
How did it turn out?
how it turn out please reply
thank U
I ruptured mine as well, I am not interested in surgery at all, I rather do therapy and change my diet for healing purposes. I done with basketball 🏀 for good I’ll shoot around but that’s as far as it goes, I’ll do my HIIT training after I heal but that’s it.
Mikey Mike how you doing with it now? I tore mine last week playing ball and thinking the same as you stated above for healing
Rehabbing a torn Achilles is a year process... it takes a very long time to get back your strength.
These are tough injuries for athletes... only 37% of professional basketball players return after a torn Achilles, and they're never back to normal. Many of those who do return are not back for a second season.
I hope your recovery is going well
@@cameroncarlton9601 how you doing bro?
@@Lu-qc9kp it was tough but I recovered to about 85%. Would be even better but I got lazy on the rehabbing
@@cameroncarlton9601 i got a tore tendon in my knee but rejected surgery u think i can heal back🙏
Hi,i have recently partial achilies tendon rupture playing basketball ,i am 39 years old ,the doctor said that i have a 80 percent rupture a suggested non surgical procedure,I am interested in your oppinion about that ,because i still have some of my achilies connection
yes i have the same issue did not torn it completly but a little bit aroud 1 sm i wonder what is the best way to heal this problem can it heal without sergery
@@vasilasenov-om4dh Hi,i recover from the first rupture about 6 months non surgical,but last year in 14 July i have another rupture about 5 cm above first rupture i can believe it happened on regular walk ,just snaps like first time,i was so desperate about second rupture and recovery was all the same like first time non surgical,it past a year since second rupture and i recover great second time, everything is ok i feel ok ,the recovery was better this time,i can walk normal,faster but i am not trying to run so far i am not sure that i am capable,i practice every day my calves ,and feeling stronger tendon ,i hope i will soon trying to run slowly....
Does the treatment change according to site of rupture? Mine snapped close to heel insertion unfortunately. Initial surgeon said conservative treatment and didn’t even do a USS! Btw I am 43 and extremely active, ruptured mine playing basketball (been playing for many years).
Looked for second opinion and had surgery 10 days after injury. Surgeon managed to fix it with bone anchors. So far post-op day 14.
How long do the post surgery pain last?
Blake Moore can you give me about your experience. I am in your situation now. Thanks
.
@@saeedmaleki45 Hello, sorry I just realised I did not reply to you. I am now 1 year post surgery and overall I am very satisfied, although I am not back to my normal self and doubt I ever will. I am back doing all standard activities but not back to sport yet. Can walk/hike for 15km or more, stand for several hours and not limited in my work. No pain.
First few weeks were terrible. Had lot of pain when my leg was not raised and for 10 days I was almost bed bound. Had lots of issues with swelling for at least 5-6 months. Could not stand for more than 2 hours or so which was an issue for my job.
However things got steadily better. I have been doing rehab (mostly on my own, guided by a surgeon protocol and under physio supervision once a week) every day since the cast was off. Get up at 6am before work to put in 30 mins of static exercises (heel raises, stretching, rolling board, squats) and then try to put in some jogging or biking in the evening. 2-3 times a week do plyometrics (double leg and single leg jumping). Range of motion even after 1 year is not exactly back to normal, especially stretching of calf with knee bent. My surgeon says is on purpose as did not want tendon to be elongated. I am scared to go back to sports as don't want to go through this again. I feel healthy now but as said not back how I was before. After all I am 44 and although it saddens me, I can live without playing basketball. Should be able to go back and play some tennis though. I now can do single heel raises with 15kg 20 reps 5-6 sets but I can say my repaired achilles is probably at 90% strenght. Calf circumference is now very similar, there is only 1 cm difference which is pretty good. Keep in mind however that I have been very dedicated to rehab and done a lot of strenghtening exercises (more than stretching). If you want to know something more specific let me know.
Hello Blake. I was just wanting to know if you could update your progress at this point.
Back in 2017 I tore my Achilles went the non surgical way and I’m back to normal just the process took a little longer
Hey man I'm literally one month in to my tear currently in a boot wen the non op way as well it was more or less recommended by my surgeon but he was willing to operate on me I just decided on non op, how long did it take you to get off the boot?
@@SabaYNWA i got off the boot at 3 and a half close to 4 months.
Do you know the size of the gap between your torn achilles tendon? Mine looks like between 20 - 30 mm
@@SabaYNWA Have you had surgery?
How old were you when you tore your tendon?
I have treated patients with neglected total Achilles tendon rupture. They had significant disability. Much improved after surgery
I’m. I’m week 3 wearing a cast they said next step maybe boot. I choose non surgical
@@harajly23do you regret not getting surgery? Did you have a big gap between each end of the tendon?
@@mikinos822 no I’m walking fine no problem. I was one of the lucky ones I guess. Thank god 🙏
I have shredded my Achilles due to Bone Spurs. The Ortho Surgeon wants to remove the damaged portion of my Achilles, remove the back part of my heel bone drill holes in it and reattach. I am a 60 year old very overweight female and I am scared to death of this. I am in some pain every day but not intense pain. The recovery scares me so much
I had the same case too. The surgery was painful. But, there was no other option. Doc put some screws too
Goodevening sir. I have question if you don't mind. I rupture my Achilles' tendon 5days ago and my doctor only suggest me to take surgery . But we don't have enough money to pay for that operation. Can my Achilles' tendon still heal without doing surgery?
A year too late sorry and to clarify I am no doctor but I tore my achilles 4.5 months ago and I didnt have surgery on it. I was put into 3 inch heal lift and did physio and the body did all the healing. I'm back to walking about 10,000 steps a day already. Always consult a doctor but having no surgery is a viable method nowadays.
Josh A Can you give me more information about the heel lift and the direction that you took, exact steps with nonsurgical healing of your Achilles? I’m in a similar situation as you.
@@ResultOriented Well the day it happend I was put into a cast with my foot in a plantar flexion position, I was like that for 7 days and then put into a walking boot with 3 1 inch heal lifts in it. After about 4 weeks since the day of injury I started partial weight bearing and some small movements of the foot. After about 6 weeks I was doing full weight bearing and increased ROM stretches, then about 7 weeks in I was walking on the boot around my house. Then in week 8 I removed 1 of the 3 heal lifts and then every 7 days took out another and another, so by week 11 I was at neutral in the boot. Then by week 12 I moved into shoes and since then its just been continuing to regain flexibility and strength. I do 1 hour of isolated physio on my leg each day, minimum of 7000 steps a day and 1 hour of general excercise. In your journey all I can say is consult a doctor, dont push yourself to hard and listen to your body, everyone's path will vary slightly so dont be stressed if you feel a bit behind. Remember it's a 1 years full recovery so dont feel like you aren't progressing it takes awhile to even walk with speed. Hope your recovery goes well !
@@josha5266 so you never got surgery? i just broke mine went to the specialist told me i need surgery but im very scared never had a surgery in my life im wondering if i can heal it withput it i dont take how long it takes
@@rayrodriguez9893 I would always follow what your doctor says but it is 100% viable to do it without surgery. I NEVER had surgery on it and it's been healing great and I am walking like normal now. I'm from Canada and we have very good medical care and here we can do it without surgery because our doctors are used to doing that method and actaully prefer doing no surgery. But idk where your from but they may not be as aware and familiar with the non surgical route so it may be more beneficial for you to do what they are best at.
If you've a partial tear, and the ability to generate significant force through the ball of your foot, presumably the "two ends" problem doesn't arise.
hello i have a partial tear around 1 santimeter will i recover without surgery
I have preformed over 5 thousand foot and ankle surgeries. With proper patient selection and surgical techniques out comes are very predictable
Hello my question is what about a tear in the achilles aroud a santimeter so not so mutch is it a good idea to do a not sergial recovery
Definitely why I’m watching 😭😭😭😂🤦🏾♂️😂
Hello doctor. I had rupture and went through non op route and reruptured at 5 months. I am offered surgery. Do u agree with that?
How did you re rupture it
@@nftluis665 thanks for the reply. During rehab, isometric loading on one leg, it gave away again. I ended up having surgery and now at 23 weeks post surgery. Walking and doing rehab, but at a very slow pace
@@kosalabandaranayaka8333 what your condition right now?
Doctors, I have a quick question, Im pretty sure I tore my achilles but I am able to put my foot down and push down on my cast with my foot. Could this mean that this is a partial tear, I will be getting an MRI very soon but just wanted to see what your opinion maybe on this. I have not tried to go up on my toes and making sure my foot is in its natural state in a partial cast as per instructions from ER. All Doctors are pointing me to surgery which is fine but I will be looking for a second opinion.
HI Alex ... You can still push your foot down after the Achilles is torn. There are other muscles that assist you in doing this.
Good luck
@@HowardLuksMD if surgery is needed should it be done within the first two weeks of the injury? My MRI is taking a really long time to get approved.
Howard Luks Do you have a video about nonsurgical treatments of the Achilles?
I have a 3.5 cm chevron tear where the tendon attached to the heel bone . How long will it take to heal with a boot and PT .
Did you have surgery?
@@joeyandowenthebreamslayers9059 no , I have had 5 spinal fusion from neck to sacrum so I do not want anymore surgery’s . I go to pt and use anti inflammatory lotion and wear a brace with a lift to take the stretch off the heal .
Hey Doc,
So my achilles ruptured about 3 weeks ago. It states a complete rupture with a retraction and 4cm proximal to the calcaneus. I went to urgent care(probably my worst mistake) and they shrugged it off as a sprain. Went to 2-3 other doctors and my PCP, however, I had a gut feeling that something was definitely off. Decided to get an MRI out of pocket since my doctor wouldn't write me for an MRI and found out I had the tear. So being that it's 3 weeks, I went to an orthopedic surgeon and they mentioned that he wants to perform surgery on it. We did the thompson test and it came out positive. I was walking on it for about two weeks thinking it was just a sprain. How badly did I get screwed and would you recommend going through with the surgery?
5cm retraction*, sorry.
Did you ever get an answer to your question? I'm having similar issues!
@@sherryjellison I had to get surgery done. It retracted too far. The first 24 hours are critical to keeping your foot in a plantarflexed position. I'm having complications at the moment since my wound is still open.
Whatever happened with this ? Going thru the same thing now. Been 3 weeks because of how my appointments were scheduled but now doctor is saying no surgery because it’s been too long
@@OverDriveDriven If the doctor is saying "no surgery because it's been too long" you need to get a second opinion. That doesn't sound right.
I have a vertical tear of 6 cms. My podiatric surgeon is flexing his scalpel at me.
I do not want surgery. Do you have any way i can heal back without surgery?
im going thru the same my doctor i saying i have to get surgery but i dont want to did u get it?
@@rayrodriguez9893 I ruptured mine complete tear 11 cm. I went to Stanford and they gave me the option for surgery but the ortho said if it were him, he’d choose non op. I thought that was a bug deal coming from a surgeon!! I’m trusting the process but it is a stressful!
@@baileym7189 non surgery is very long and you still have some pain sometimes at least I did
What happens if you don't tear it but it's still sore af? I haven't been to the gym for a week. I woke up and my left Achilles throbbing.
Usually that is due to achilles tendinosis or achilles tendinitis. Both are fairly common. Usually respond to relative, not absolute rest and stretching.
I found an EXACT diagnosis for my problem online. www.livestrong.com/article/552549-my-left-achilles-tendon-hurts-right-after-i-wake-up/ It started to feel better as the week progressed. I was even able to skip for 9 minutes. Still a bit sore though. I'm just alarmed that it occurred so randomly.
I have a mild tear but I also have bone spurs. So I was told I needed to have my spurs shaved because it’s affecting the tears in the achilles. I have this in both of my feet. Do you recommend I have this surgery?
If some one ruptures or completely tears their achilles you most definitely need surgery or it will never be the same. I tore mines and i definitely needed surgery
Research says otherwise plus with surgery you aren’t the same neither
@@Ajspecial1000 wrong
@@antlive3761 so you completely the same after an Achilles’ tendon rupture you don’t know what you on about and yes depending on the size of the gap and rehab non surgery can be good at surgery the only reason you americans love cutting things open is cause your surgeons are all private
@@antlive3761 you wrong
@@Ajspecial1000 listen if you completely rupture or tear your Achilles you probly can let it heal if your not active but if your playing sports like I do then u definitely need surgery. I needed surgery and you got dam right im an american
Surgery isnt mandatory but may be a better option. Dealing with scar tissue is more of a topic than actually surgery itself. Chances of re rupture is higher not having surgery in my opinion.
Studies have shown that non surgical is better, that's why I didn't have the surgery on my ruptured Achilles tendon.
@@roneducator actually studies show no difference. The biggest issue is that when complications arise after surgery they can be a very big problem. The skin is very thin in that area around our achilles and it doesn't like being operated on.
Re-rupture will only happen if you make fast darting movements... if you're very active running exercise basketball football ECT, just walking or driving is not going to re-rupture it very highly unlikely
Finally..fuck
ive heard of people not have surgery and letting it heal by its self lol
Seriously
I broke mine 4 days ago, i really didnt want surgery but doctors have been advising against it, saying it wont fully recover & will be weak, not allowing me to walk long durations & distances. Is this true?
update: i've consulted 3 doctors from 3 diff hospitals. 2 govt. They advised against non surgical, saying it wont fully heal esp if the tear is 2cm or more. & the chance of rerupture is big.it will be weak the fibers wont grow back to stick togther w/o surgery. I am really confused now. Anybody pls share real insight on what i should do.
Hello I am Charlie I broke mine 5 days ago and I don’t want to have the surgery. Can I use your information? Thanks
Hey Charlie, how did your recovery go? I have just recently torn mine. As far as the ultrasound imaging goes, my tear is about 1.2cm apart. I've purchased a moon boot and have elevated my heal to increase the chance of reattachment but I'm genuinely concerned about a bad attachment and lower function in the future. What did you ultimately decide and did it help?
I had surgery. It isnt fully recovered yet now after a year coz I havent been diligent in doing my self rehab. But it wont tear again, the only fear is the other ankle, which feels tender, with tHat, I have ultimately retored from any rigorous physical sport. Hope it helps.
@@helloiamcharlie5801 hey how are you doing now ?
What did you end up going with?
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Hello to all my question is what about a tear in the achilles aroud a santimeter so not so mutch is it a good idea to do a not sergial recovery