6 Month Update

At almost 6 months, my range of motion (ROM) is 100% recovered and daily activities are no longer a huge chore. But, I still have strengthening to do.

Daily Activities
Daily activities have gotten much easier. I no longer think about my achilles on each and every step. Sometimes I struggle a little on uneven surfaces. Also, my body wants to limp and I sometimes have to force myself to walk with a normal gait. I have occasional pain on the bottom of my heel. Like many others, the heel pain was intense in earlier stages, but is much better now. I still do not have feeling on one side of my foot because of damage to nerves during surgery. As the feeling comes back, I get weird electrical shock types of feelings - but nothing unbearable.

I have continued going to PT twice per week. I do home exercises two or three times per day. My ROM is strangely a bit better than my healthy leg.

For the new members of this unfortunate club, here is the general progression of my therapy:
1. Flexibility. The initial focus was all on flexibility and ROM (basically, the exercises here: http://achillesblog.com/files/2008/03/achilles_tendon_rupture_mass_gen.pdf).

2. Balance: Once flexibility started to improve, the PT added exercises for balance (e.g., balance on one leg; balance on injured leg and tap my good foot in front, side and back of me; squats)

3. Strength: The last set of exercises has been strength. For example, seated heel raises -> standing, double leg heel raises -> single leg heel raises.

I also ride the stationary bike, use an elliptical machine, and walk on the treadmill. My PT wants me to be able to do a single leg heel raise before he clears me for running. A true single leg heel raise is taking some time to do. I have to put my hands on a table and push as hard as I can.

Lessons Learned
For the new posters, here are a few lessons as I reflect over the past 6 months. I also posted some reflections a few posts back if you are in a cast / NWB for a long time.

1. Be systematic: With whatever protocol you choose (or is chosen for you), be disciplined and systematic. Otherwise, you run the risk of a set back. If you need to be off your feet the first two weeks after surgery with your leg elevated, do it. If you are supposed to wear your boot, do it. If you have exercises to do, do them faithfully.

2. Be patient: This is a long term recovery and you need to be patient and look forward to incremental milestones.

3. Dealing with surgeons. This was my first surgery. In my experience, my surgeon was just focused on repairing the tendon and making sure everything was structurally sound. He was always in a hurry and had little to say about my ability to be functional on my leg. But, my PT was very focused on my functionality and quality of life. Once I realized this, I stopped fretting about the surgeon and it helped me stay sane.

Happy healing to all.

Here is my milestone update
• Injured: 9/13/14
• Surgery: 9/26/14
• Week 1 - 2: NWB (splint - foot at 25% angle
• Week 2 - 8: NWB (fiberglass cast - foot at 5% angle)
• Week 8 - 10: PWB (fiberglass cast - foot neutral). Added about 30 pounds of pressure every 4 days
• Week 10 - 14: FWB (fiberglass cast - foot neutral)
• Week 14 - 16: FWB (boot - one heel wedge)
• Week 15: Started PT
• Week 16: Started wearing 2 shoes indoors in safe environments
• Week 18: Reasonably comfortable with 2 shoes outside; can do a decent seated heel raise
• Week 20: Getting stronger. Able to perform double leg heel raises well; flexibility coming back - can do squats (body weight)
• Week 23: Range of motion is 100%; Working on single leg heel raise; Daily activities are not difficult anymore.

7 Responses to “6 Month Update”

  1. Great post ctcbusted! Thanks for sharing. I’m in a little different protocol with no casts. I’m 43 tho, so I can relate. The lessons learned are right on the mark and that’s how I feel this 4 weeks past have gone. I have my second PT today, I’m excited to show my PT the progress I’ve done so far. My ROM has improved a lot, but swelling has come back, think due to all the new exercises. I look forward to be 100% ROM like you and feel normal and not think about the Achilles 24/7 :)

  2. Edhdez: I forgot to mention swelling. I actually had more swelling when I started PT. For a short time, I took Ibuprofen to help. I also started wearing a long compression sock that goes up to my knee and that has helped a lot. I am still wearing the sock now.

  3. Thanks ctc, yah, the swelling is back after PT, guess it’s the norm :) it is jut annoying cause limits my ROM exercises. I’m also wearing a compression sock, I ordered a 30-40mmg I think online, but it came and it is sooo tight I had to go back to the one they gave me post surgery, not so tight, but I think it works, will ask PT today. Thanks again ctc goof to hear you have come a long way in your recovery, congrats!

  4. This is great CT…I want to make the point for everyone that even though I had a moderate to fast protocol and you had a slower protocol in terms of casting, FWB, when we got into boots, and finally two shoes yet we are both at around the same place in our recovery and daily life at 18 and 23 weeks. I can echo many of your notes on therapy and lessons learned.

    Great to hear from you!

  5. Thanks CT for your update. I totally agree with all you said here and your lessons learned are spot on.
    I am around the balancing part of PT and just got an ok to do some elliptical and treadmill (walk not running). My main concern is the swelling around my ankle (it’s almost a ballon in that area and was concerned it may get worse with increased walking/ellipltical. How bad was the swelling for you? I will try using the compression socks to see if that helps. Did you have it on all day? or just when working out?

  6. Donna: Yes, it is interesting to see that things are evening out between the two protocols. Hopefully, it puts some people at ease who are worried about protocols and speed of recovery.

    Squashedat: For a few weeks, my swelling was bad and balloon-like. I wear the compression sock all day. At this point, it may be mental as I like the feeling of the extra support. I also took a few high dosages of Ibuprofen and used ice once or twice per day to get it under control. For a few days, I scaled back my exercise to give my body a chance to recover. I was able to get my swelling under control before I starting the bike and elliptical. But, I would have had the same concern as you if I used the equipment already having a swelling issue.

  7. Wow, sounds like you’re progress is similar to mine (I hope not) because mine has been very slow. I also have nerve damage from surgery. I’m guessing the splint was too tight and swelling occurred that caused this. Something for newbies to take note on. This is a real risk that, if I knew, I would have not got the surgery.
    I would add a few things, I’m at a year and 3 months and my Achilles is still weak. I fatigue easy. I understand how you say surgeons are, they do their work and let PT’s take over for sure. I went through 3 months of PT..right around my 3rd month. My PT said I was strong and told me it would be a matter of tolerance from there on out. I play Ultimate Frisbee, age 44 so..let me say, after that, I was in pain and tolerated a lot!
    You would have to read my blog to get the whole story so..
    I will just add a few things as well..
    1. Pool therapy is awesome at your point. Walking on toes, leg lifts on ladders..anything you can do, feels great.
    2. Pick a good sports PT. PT’s are expensive so it’s important to get the right one.
    3. Even though im over a year of healing, I was told to still stay away from running until my heal is 100%. You over compensate when running, without even knowing it and you will just cause problems on your good leg. Not worth it.
    4. What I just learned from my PT was, do lots of reps of easy leg raises, leg press AND step Downs..forget about any weight, worry about reps and do them ALL the time. This has made me MUCH better.
    It has been very slow for me, it may not be for you but..i thought I would throw my experience in here which seems similar to yours.
    btw.. I have a heck of a time driving, my heal always tires out
    Good luck, great post

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