Dr. E called mid-afternoon with preliminary results, mostly to make sure I was in the boot already and to make sure I stayed there. I have a partial "intrasubstance rupture" of the achilles tendon involving about 10% of the cross-section of the tendon. Translation: it's where the tendon attaches to the bone, not the muscle, and this is good because it's much easier to treat.
The options are
-get back in the boot for 4-6 weeks, more rigorously than before. IOW: don't get out of bed without it (though she didn't say I needed to sleep in it), and I can still take it off to drive.
-get a cast to limit movement even more. Dr. E was not enthusiastic about this one, as she said "I have more patients injure themselves using crutches..." I'd be unable to drive.
-surgery, option a: full repair of tendon, then would be in a cast while it healed.
-surgery, option b: "oblation" of the area (making micro-cuts, I gather), which is less invasive, the goal being to stimulate blood flow and promote healing. Poor blood flow to this area is a big problem with this type of injury, making things slow to heal. Oblation would be done outpatient, but would still mean no driving for the first 2 weeks after surgery.
I'm starting out in the boot, and will see Dr. E next Thursday to see how things are going and to go over all this in person (and based on the final radiologist's report). I'm leaning towards trying the boot alone, and if it's not progressing, consider the oblation surgery. Must coordinate this with various work activities (trip to Denver in early June, short trip to Washington DC in late June) and the schedule of the folks next door, whom I would need to lean on if I end up with a period when I can't drive.