I just passed the 10-week mark and my physical therapist gave me the thumbs up to go for a bike ride. The timing seems fortuitous because Lance Armstrong just fell and broke his collarbone. Not that I’m expecting a call from Team Astana, but it was good to get a vote of confidence from my therapist!

She’s had me doing a lot of balancing exercises lately. At first, it was tough just to balance on one foot for 30 seconds. Then I moved to a trampoline, then one of those inflatable rubber disks, then a balance board. Sometimes she has me close my eyes, sometimes she has me do lunges on to the disk. Calf raises, squats, warm ups on a treadmill walking forward and backward, side steps on to the disk, and more.

The scar is looking good, scar tissue is dissipating, range of motion still good, and strength is coming back. There are only 20 days left to perform my 90 day trick of walking a limp-free mile. I’m actually confident I’m going to make it. Shout out to Meghan Hamilton at Golden Physical Therapy. I thought she was taking it too slowly at first, but I can’t complain about where I’m at today!

I had my first physical therapy appointment today. The therapist said that my range of motion is nearly 100%, the supporting muscles in the injured leg are still strong, and I’m too impatient for my own good. She got two out of three!

The session started with a lot of questions about how I was feeling. She really wanted to know exactly how and where I was experiencing any pain or discomfort, even whether I was having trouble sleeping. In fact, I am having trouble sleeping - hadn’t even thought about it really, but she said it’s not surprising given that I was fairly active prior to the injury. You just don’t burn as much energy limping around and that can leave people feeling restless at night.

Anyway, I’m not feeling any pain or discomfort really, primarily because my surgeon prohibited me from anything other than simple range-of-motion exercises.

Next, she gave my calf a light massage to help loosen up the muscle and worked on the dime-sized lump of scar tissue near the bottom of the incision mark. Contrary to what I’ve read elsewhere, this wasn’t painful at all. Her touch was very light, maybe the deeper stuff comes later.

Next, two sets of 10 with an elastic band, in four different directions. Toes up and down, then down and up, then turning the foot from left to right, and finally right to left. Simple enough, told her I could do hundreds of these, but she gave me that same reprimanding look I got from the surgeon. I’m supposed to do these exercises twice a day.

Then she had me step on a box that was maybe 2″ high. She had me step off the box with the non-injured foot, leaving the injured foot flat on the box. Then I would roll the injured foot off the box, heel to toe. The idea here was to stretch the achilles and re-teach my foot to use a heel-to-toe rolling action, something that’s absent when you limp.

Then she had me walk very slowly, having me focus on heel-to-toe rolling action. Refreshingly, when I walked this slowly, my limp was nearly gone! She said this is good - it means my range of motion is fine, that we just need to focus on regaining strength.

She talked me through two stretching techniques. Basically, stretching the calf with a straight leg hits the gastrocnemius; stretching the calf with a bent knee hits the soleus.

And then we were done. Two times a week for six weeks. At the end, I’m sure I’ll be ready for a marathon. Seriously.

This picture was taken a few days ago and I’m just now getting around to posting. Roughly six weeks post-op and things are looking good. I’m pleasantly surprised with how nicely the scar is healing.
http://i491.photobucket.com/albums/rr272/blueingolden/Achilles%20Tendon%20Rupture/AchillesRepairDay40.jpg

My one concern at this point is the “lumpiness” of the scar. You can’t see it in the picture, but there’s a pea-sized lump at the bottom end of the scar. I’m guessing it is where the suture is located and therefore where scar tissue is building up on the tendon. It is just low enough to rub on the top edge of my shoes, so it’s a problem. Maybe this is the kind of thing that can be mitigated with massage?

I’m more or less out of the walking boot now. It’s still useful when I know I’m going to be in a crowd or some other place where my foot might get bumped or stepped on (e.g., the movie theater). Most of the time, however, I’m wearing a casual pair of shoes and limping along with a cane. Driving is a breeze.

I’m still reasonably good about ROM exercises every night. Thanks to Andy Metzger for the suggestion to do calf raises while at my desk. It was very difficult at first, but I can feel the strength coming back bit by bit. I’m still a couple of weeks from my next appointment with the surgeon. I’m determined to have him approve me for physical therapy at that time!

I’m four weeks post-op now and I had my second follow-up appointment with the surgeon yesterday. I was excited because I felt things were going very well and I was looking forward to hearing about how the repair was progressing ahead of schedule. The doc had other ideas.

Apparently, it doesn’t much matter that the scar is healing nicely or that I can walk in the boot without crutches or that I can actually pull my toes up past 90 degrees. Doc says the tendon takes 10 weeks to heal to the point where I can begin physical therapy regardless of how well I think I’m doing at the four week mark. Something about how there’s no blood circulating in the tendon so there’s no opportunity for even the most efficient body to heal an Achilles tendon any faster than 10 weeks. A torn muscle would be a different story, but this isn’t a muscle. Blah blah blah.

I asked if I could start swimming. He said maybe in week six. Sheesh. I asked if I could start neuromuscular therapy. He said week 10. Ugh. I asked why the tingling and numbness. He said I’m strapping my boot too tightly. Bull$#!%. I asked why my foot is still swollen even though I’m regularly elevating it. He said walking (not limping) provides the pumping action that keeps blood circulating through my foot, so it will remain slightly swollen for as long as I continue to walk on my heel. I guess that makes sense.

Despite the doctor’s irrefutable logic, I’m disappointed. If he won’t even let me begin physical therapy until day 70, my “90 Day Trick” will be a trick indeed!

Shrinkage, of course, became a household word because of an episode of Seinfeld in which George was complaining about the effect of swimming in cold water.

In this case, as I’m sure you’ve guessed, I’m talking about the atrophy of my calf muscles. Here is a pic three weeks after surgery. I’m in the walking boot and am pretty good about light range-of-motion exercises every night, so I’m hoping this is about as small as my calf is going to get.
http://i491.photobucket.com/albums/rr272/blueingolden/Achilles%20Tendon%20Rupture/AchillesRepairDay21.jpg

Surprised? Me too. My right leg is noticeably smaller than my left leg, but it’s not that bad! The circumference of my left calf is 15.75″; the right calf is 15.50″. I’m taking the measurement at the point where the circumference is at its max. I can live with a quarter inch of atrophy.

The circumference of my left ankle is 8.375″; the right ankle is 8.75″. I’m taking the measurement at the point where the circumference is at its min.¬†Right now, the difference is attributable to swelling.¬†Going forward, it could be due to the build-up of scar tissue, so I’ll be taking measurements regularly to monitor that. Hopefully, having read about how some have had to buy new shoes, this is something that can be managed by neuromuscular therapy.

By the way, those are steri-strips you see on my scar. Doc said to just let them fall off naturally, so I’m trying not to pick at them.

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