Week 8 Post-op

I hit week 8 postop yesterday.  Feb 11th was surgery.  Right achilles.   I’m out of the walking boot and only need to wear it if I’m going out and have to be somewhat more mobile than usual.  I never wear it indoors anymore.  I just make sure I’m very careful when I’m moving.  I’m still not cleared to drive but have my monthly Dr. follow up next week and I will be cleared to drive.  I am trying to walk without much of a limp on solid ground but that is difficult.  If I focus and take short steps, I look normal.  I have a natural long stride and can’t turn over on my toes without pain in my lower achilles - at the calcaneus bone. I am sort of doing bi-lateral heel raises on solid ground- with a lot of support from my good leg!  So I guess I’m not really doing bilateral yet.   I can feel by touch there is a lot of scar tissue built up also.  I’m also still getting a considerable (in my opinion) amount of swelling after spending a few hours without elevating and walking around.  I’m not sure what is the swelling and what is scar tissue at this point.  I hope all of that (the pain and swelling and scar tissue) are going to go away in the next few weeks.  My PTs are OK - not great.  I’m on workman’s comp so the place I’m going is packed and understaffed.  It’s like a 1 to 5 ratio.  The PT is running around and I feel bad for her, but after they give me a quick scar tissue massage, I’m basically on my own for 45 minutes.  I do more on my own at my gym with a pool.  When I’m on my own, I start off with biking about 10 miles in 25-30mins.  Then a lot of core exercises and the ankle/foot mobility exercises I was told to do - then I get into the pool.   I have a 25 meter pool that goes from 4′ to 10′ and a smaller rehab pool that goes from 3′6" to 4′6".  The pool is a godsend for me.  I can actually walk normally in 4-4′6" of water and I’m starting to move lower.  I’ll walk a couple of laps -but I don’t overdo it.  At the slightest feel of pain - I back off - which is not normal for me!!   I keep telling myself that I’m only at 8 weeks and the tendon is still not repaired yet.  I’m also able to do some water running without any strain or pain.  Once I’m comfortable kicking I’ll try to swim.   The realization of just now long it will take to get back to normal has hit me.  This is a long term project here.  I’m very thankful to have PT and my gym to keep me sane and able to workout.

https://www.youtube.com/watch?v=9KUpqilpNx4

11 Responses to “Week 8 Post-op”

  1. hi Kevin,

    we are one or two weeks apart. i find very similar experiences to yours. my ankle is quite swollen too and the scarring is significant. seeing PT this week and will get back with their opinion.

    pool is the way to go for me, i want to stay cautious for the 12 weeks of high risk re-rupture before i push myself again. between week 9 and now (almost week 11 for me) the improvements have been great. my walking is very similar to yours, and definitely the shorter the stride the better i walk.

    what does it feel to cycle on the stationary bike? do you do proper cycling or you are pushing down with heel only?

    today was the first day i tried some breast stroke in the pool (I normally do front crawl with my legs locked around a floatie), it was a very strange sensation but overall positive and it did not hurt, just activated some muscles that i hadn’t felt before

    suerte

  2. Kevin,

    Just came across your blog and it’s a great read. I’m 4 weeks post op tomorrow and still on crutches and NWB in a fiberglass cast. I expect 2 more weeks until the boot. Looking forward to the pool exercises you mention.

    Best of luck,

    Kevin

  3. Hey Kevin,

    We are just about on the same timeline - I had my surgery on February 9. I’m also having nearly identical pain and swelling that you describe. I don’t really use my boot unless I’m going to be walking far distances on uneven ground. I wear sneakers EVERYWHERE and I keep them by my bed so I can throw them on as soon as I wake up.

    Fortunately, I have a great PT and he is taking me through an aggressive rehab protocol.

    Going back to the pain and swelling - I’ve recently been feeling pain in my lower Achilles, right above the heal bone (I believe this is where my rupture occurred, but I’m not positive). I didn’t really notice it before I started walking more and I really only feel it when I’m really concentrating on stepping with my injured leg the same way I’m stepping with my non-injured leg. Basically, whenever I try to push off my toes when stepping. Maybe I’m sick, but it almost feels like the pain means I’m walking correctly, so I try keep doing it… I’m going to talk to my PT about it today.

    I also get the swelling after a few hours of not having it elevated above my heart - and I was told that continues for a while.

    I just got my pool resurfaced at my house, so once the chemical “charge-up” is done, I’m going to be spending a lot of time there.

    My favorite exercise to do now is the one-leg balance. My PT pointed out to me that with younger and/or more athletic people, you use your ankle to stabilize yourself, and in older or less athletic and, in our cases, injured people, you use your hips to try to stabilize yourself. I notice my good leg uses ankle stabilization and my bad leg uses my hips.. never knew this before and gives you a goal for the exercise.

    Let’s keep it going! Keep me posted!

    Kevin

  4. Hey guys,

    I’m in the same boat just hit 4 weeks post op. After surgery, I was put in a splint for 2 weeks then had my sutures taken out after which the doc told me I would be in a cast for 4 weeks. I have another appointment in two weeks, at which I’m guessing I’ll get a boot and will demand one if they don’t.

    Is this a pretty conservative approach to recovery? There seem to be quite a few people who were in the boot and readjusting to walking within 2 or 3 weeks of their surgery which makes me a bit envious tbh.

    Now of course I understand not every case is the same but I’m just curious if I should be pushing my doc’s buttons. I live in South Korea so I’m guessing they would probably err towards the consertative side.

    Joined the ATR club playing basketball but looking forward to the day I cancel my membership.

    Wishing everyone a speedy recovery!

  5. The literature/opinion is split in the medical community. Some prefer early mobility, others are more conservative. It also depends how bad the rupture was, and how effectively they were able to complete the repair.

    Complete immobilization (via a cast) for 6 weeks is definitely on the conservative side. I was immobilized for 2 weeks in a splint and then placed in an aircast with instructions to not weight bear for 6 weeks total.

    I started walking on the boot a few days earlier than I was supposed to.

    The first 4 weeks in the aircast I was also doing ROM activities in bed.

    Being able to partial weight bear within 4 weeks is more on the “progressive” side of treatment.

    Based on all the literature I’ve seen, 6 weeks is the general point in which full weight bearing is encouraged with the boot, but also many times without the boot.

  6. Yes, the medical community is split to a degree. However, A LOT has to do with age, pre-rupture condition, post surgery goals, other contraindications, etc. The post ATR data is pretty conclusive in that outcomes are better the sooner WB and mobility occurs (how quickly that happens differs from case to case). In my case (ATR surgery on 2/24/16), I was out of the cast and 50% WB 10 days after surgery. I was taken out of the boot completely on 4/1/16 (5 weeks post-op). My PT does not even want me to work on ROM because i’m already at 13 degrees dorsi-flexion (no overstretching). I’m purely working on bilateral heel raises, band work, walking 1/2 mile daily (strengthening). I also only had 5mm atrophy comparing calfs. I’m walking with only a slight limp, and I literally feel stronger everyday. My mindset the day after my injury is/was I’m going to beat this and get back to where I was, pre-injury.

    The bottom line is that if you want to have world class outcomes, you need to work at it like a world class athlete.

    I told my surgeon & PT out of the gate what my expectations are and told them to treat me like an athlete, because that is who I’ve been and how I see myself.

  7. to pozaicer - I am on a standard stationary bike and i’m able to pedal with some light resistance - not standing up at all obviously. I’m consistently biking about 10mls - every stationary bike is different so that probably doesn’t mean anything. I just go until I break a sweat and then go on to core, ROM and then the pool. Good luck. Thanks for your comments.

    kpeters - keep me posted on that heel bone pain. I have the same pain in that (I believe the calcaneus bone) when I attempt to walk normally off my toes. Don’t push through pain at this point though. Your Dr will have the final say on that but from what everyone has told me - sharp pain at this early in the game is not good. It’s not a ‘no pain, no gain’ injury. Let me know what the Doc says. Thanks. Good luck.

    reyrey - I have the same mentality. I’ll stay in a gym for several hours and be up everyday at 5am if I knew it would help me improve faster - but - I was told the tendon is still healing at this point and to not push it too much until we get further down the road (when that is exactly I’m not sure ). Just be careful! I wouldn’t push through any pain at this point. I can’t wait to get the green light though! Sounds like you are doing great - and have an awesome attitude. Keep that up! Good luck.

    Thanks for all your comments.

  8. reyrey,

    Good stuff. You’re lucky with how little you atrophied. Might I ask what your exercise regimen is aside from heel raises, bandwork, and walking 1/2 mile a day? You doing anything in the pool? Stationary bike?

    I had surgery 2/2 and am of the same mindset. Play in lacrosse and basketball leagues all year.

    I am 10 weeks post-op and am almost able to do heel raises on solid ground, but not quite. I started in the pool a couple weeks ago and am into the shallowest point and comfortably doing raises (3′ - I can’t imagine this depth of water is even taking much weight off).

    Otherwise I ride the stationary for 35min + daily now, and do several sets of heel raises in the pool every other day.

    Thanks

  9. Kevin,
    You are absolutely correct. Can’t risk a re-rupture loading too quickly…it’s a fine line and you need to listen to your body. You are an athlete, so you know the difference between sore and pain. The 3 month mark is really when the tendon ready to be pushed, and until then, slow and steady progressions. Just to give you a sense of my background, I’m a strength and conditioning coach (NSCA, CSCS), and work with high school, collegiate/amateur and professional athletes. My PT is a friend who consults with NFL, NBA, NHL teams and has worked with EVERY big time athlete on one level or another (he’s been featured on 60 Minutes twice). My surgeon is a team doctor for various US Olympic teams and other national teams. I’m very luck to have this kind of treatment and access to such pros. Feel tap into my resources as you move forward. I’ll do my best get you info if you want it.

  10. mibball,

    I’be been in the gym doing everything not involving my left leg. Exercise is good for the circulation of injury, overall health, well being, and mental state. As far as rehab, I haven’t gotten in the the pool yet, but I will this week. Right now, in addition to the things I mentioned above, I’m doing hip extension work on the ground, proprioception (balance), light squatting to a chair (just a bar), assisted lunges (TRX), and a ton of core work.

  11. thanks Kevin. today i had another PT appointment and i’ve been cleared for stationary bike (with an almost identical objective as yours).

    the PT was surprised by the flexibility and progress, so recommended i continue with my regime (theraband exercises, ROM, raises and extensions in the pool) plus start swimming involving the affected leg (gently) and using some weight lifting for the quads and the harmstring as i did have almost 2inch lose of calf muscle and the rest of the leg is weak.

    the PT reckons that the swelling will be months before it goes to normal and that the stiffness when cold or resting the tendon may never go away, so i was recommended to keep moving the foot/curling toes when working or resting in order to aid recovery.

    thanks for your answers and good luck too!

    suerte

    i was told to stay vigilant till the 12 week to give the tendon extra time to recover and i was told not to engage in any salsa dancing for longer than a few minutes till further notice! which is a shame, but there is no point in pushing myself stupidly.

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