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Here is my vlog from month 8 and 9:



9 MONTH DOCTOR’S VISIT
I just came back from 9 month doctor check up. Actually, today exactly is my 9 month rupture anniversary, btw. :)

The doctor said that the achilles looks good and that I healed ahead of the usual surgical estimates. Thompson test returned almost same movement in my injured leg as in my non-injured leg. Ultrasound of the achilles showed much more organized tissue than last time, so that’s good to see. It was interesting to see the site of the rupture, which had more unorganized collagen than the surrounding areas. My doc mentioned before that it might take couple of years for the collagen to be organized. It would be interesting to see the ultrasound of the rupture site in couple of years to compare. :) So, as far as the achilles goes, I am discharged from the doctor! Most of the appointment was dedicated to my hamstring, which might now be actually sciatica pain. More about it below.


AGILITY: p90×3 and JUMPING ROPE
And here is my return to my pre-injury workouts.

Before this injury I worked out about 6 times a week doing P90x and Insanity programs. Some of them require quite a lot of agility. I was wondering at the beginning of this injury how long would it take me to get back to doing it again. I have been working out regularly from day 7 after rupture, but I started doing some of the workouts from my programs in month 5. Initially only the ones that did not require jumping, so things like yoga, upper body, lower body static strength, etc. At the end of month 7, however, I was cleared by my PT to do any jumping exercises as well, so I “jumped” right back to more explosive workouts form my programs. During first explosive workout, I remember, after 15 minutes my achilles was letting me know that it was feeling it. I managed full 30 minutes, but could feel my ankles and achilles until the next day. It was not a bad pain, but soreness you have, like you have not used bunch of parts of your ankles and achilles in a very long time. It felt sort of good, lol. Now that I have been at it for over a month, it is much better. Still feel it after the dynamic workouts, but not with the same intensity.


I also started jumping rope, as I mentioned in the last post. That has been great for ankles and calves! Once I forgot to set the timer and just kept going at it happily listening to the music. Well, I could not walk for the next 3 days, my calves were so sore. So, here is the proof, jumping rope really works calves!!! Now I monitor the time I jump though!


Here is a compilation of some explosive moves, just to show that we can get back to agility. My injured leg is still a bit weaker on push off (I do not notice it that much on two legs jumps), but it absorbs the landing pretty well. During single leg jumps I still feel weaker. They are getting better though.



PHYSICAL THERAPY
I have been going to PT once a week in the last 2 months. My physical therapist was splitting the time between my achilles and hamstring. For achilles, it was mostly working on regaining flexibility. I get Graston tool work done and some ankle mobilization. We stretch it with added resistance and then utilize the new, stretched out range of motion to do some calf work outs. Rest of the calf work is done by me at home at this point. I still do PT 6 times a week at home. It is pretty much same exercises as in my last post, but modified here and there. Still lots of calf raises, but all on an incline. Still lots of balancing and squats. Rest is taken care of by my regular workouts. On top of that hamstring rehab work…

I still get massage therapy done once a week as well.

Few changes since last time:

1) All soleus and gastroc stretches now done on a platform. DIY platform = styrofoam block + old shelf + wobbly cushion.

2) Added resistance to to stretches. I am using pull up assist that I attached to my bench. This stretch has worked pretty well in returning dorsi flexion thus far.

3) Stretches in lunges on incline with knee over toes. Just doing calf raises in the lunge position, moving whole body up and down. This works dynamically on dorsi flexion and also works nicely on calfs (and quads ;) ).

4) This is really good stretch for arch in the foot. Doing many calf raises, I always felt pain in the arch. This helps a lot with it. Being on the incline sideways and balancing works well in straightening the arch and also the inside part of the achilles. Initially I was getting spasms in my foot after 30 seconds of doing it, it was so bad. Now that’s passed and I do it couple of times 1 minute each time. I recommend this one to everyone. I was really grateful for my PT after he gave me this one!



CALF STRENGHT AND FLEXIBILITY
I hit a true plato in my dorsiflexion at 9cm. For the longest time, every time I came in for my PT, I was at this dreaded 9cm in knee to wall test (toe to wall measurement). With help of my PT and with stretching we were able to get it to 10.5cm-11cm, but it was always going back to 9. Finally, I think it was mid month 8, I was 10cm at the beginning of the session. That was exciting. haha The little things! :) This one actually is not worrying me anymore, I will get there. Stretching feels good now, so I do not mind doing it few times a day. It does not take much time, so I am ok with it.


Now, as far as strength, that is hard to truly measure. I know that single calf raises are used as one measuring statistics, but so many other muscles are used in calf raises and I think after doing 1000s of calf raises my body learned a bit how to compromise with other muscles, so that measure is not exact. But anyways, in month 6 I was able to do 60 single calf raises on the injured leg. In mid month 8 I did 120 single calf raises with healthy leg and then whipped up 120 with the injured one as well. I could do more with each leg, but decided to stop there. Saying that, they are not as easy in my injured leg as in the healthy leg. They require MUCH more effort. I actually was drenched doing the test on my injured leg.

I now do all (including bent leg) calf raises on incline and they are much harder. Still a lot more weakness raising from below neutral than from neutral. I feel a big difference in incline calf raises in my injured and non-injured leg. My numbers are also fraction of the ones going from neutral, so this is something that is still very much work in progress.

You can see above how puny my injured (right calf) looks in comparison to my uninjured one, lol. Where is my gastroc? ;) I do not really worry about it. I just want the strength back. :)



WINTER SPORTS UPDATE
I have been doing quite a bit of downhill skiing this winter and the achilles is holding up nicely. It gets sore after couple of hours and I need to massage it during lunch time, but then it is back to normal for the afternoon runs. So, still not 100% back, but it is not slowing me down, which is great! I have the next 2 weekends full of of skiing, so am eager to see how the achilles will do in consecutive days of skiing on longer trails!

Snowshoeing had the same effect as skiing. I feel the achilles after couple of hours, but it is not to the extent that I have to stop.



HAMSTRING UPDATE and RUNNING
I mentioned in few previous posts that I injured my hamstring at the end of November while running. Well, I am still struggling with this thing… I tried a run in month 8 to test it and my hamstring flared up again. I vowed not to run again until I feel absolutely nothing in my hamstring. Lets see how that goes… My PT has been rehabbing my hamstring more than my achilles, it seems, and now I have a separate referral just for hamstring rehab.

On a positive note, during my trial run my achilles did really well. No pain, no after effects, ran with complete flat shoes for the first time and it was ALL GOOD! It was also so good to run, but what to do, got to wait a bit longer… Again, patience, patience…. If there was a pill for patience…

And today at my doctor’s appointment for achilles check up, my doc evaluated my hamstring problem as well and he thinks that it might be sciatica pain, so it will be treated as such in PT at the moment. Doctor has a plan of action for it, so I am hoping to be finally pain free in coming months! Crossing fingers…



LIFE AT MONTH 9
I still think about achilles every day, but that’s because I do PT every day. Because of PT it gets sore, calf gets sore, so it’s hard to forget it completely yet. A lot of time otherwise I do not think about it now. I had a bad slip on our floor in month 8 and I did not even think about the achilles, so I guess that’s a positive mental progress. ;) Now I think about my hamstring instead, since I have to give some feedback to my PT in our weekly sessions, haha. That’s my unfortunate side effect of this achilles injury.

Once more wishing everyone happy healing, lots of patience with this ordeal and as little setbacks as possible! :)

Just a quick update this month since I managed getting back to few things. I also have not updated my video blogs for a while, so I recorded one since last month with the update and recordings of PT exercises. Here is the 7 months vlog:



CROSS COUNTRY SKIING
In December I went back to cross country skiing. Achilles was more or less fine. I could feel it when my injured leg was in the back and going from dorsiflexion into plantar flexion. It was not very bothersome, but I definitely felt it. The achilles was totally fine afterwards though, so that was promising! Here is a short clip from that day:



DOWNHILL SKIING
This is something I was curious about since my rupture day and something I was looking forward to getting back to the most. I really love downhill skiing and I could not wait to do it again. The achilles was fine most of the time. I could feel similar bothersome feeling like in cross country now and then, but no pain really. There were some runs where I felt nothing, which was a nice surprise. I managed 5.5 hrs of skiing, which feels good for the first time after this injury. After skiing, when I took off the boot, my achilles screamed a bit, but that was very temporary, thankfully. I am grateful for the hours of physical therapy and working on my legs, hips and glutes, ’cause my legs felt strong while skiing and definitely helped with the still lacking strength in my injured calf. When I got home, the foam roller was a big help.

Btw, skiing boots do feel VERY similar to the boot worn for this injury, haha. I had a deja vu moment. Here is a clip from my return to skiing day:



SNOWSHOEING
At 7 months and 1 week I went snowshoeing. Once more I could feel the achilles a bit, but much less than with skiing. No discomfort afterwards.



PHYSICAL THERAPY (PT)
PT is pretty much as in the video above plus hamstring rehab exercises (good leg’s hamstring gave up when I returned to running). Stretching became much more intense and I am seeing good results with it. My physical therapist is using Graston tool on the achilles. He is also taping my foot, ankle and calf and stretches it. Then we usually use weights and bands for stretching both soleus and gastroc . Once stretched out, I do calf raises on incline and squats in order to utilize the larger range of motion and get the body and brain used to it. We were able to bring my dorsiflexion to 11cm at one point (knee to wall test). It does not last, I usually go back to 9cm or so. It’s work in progress, but getting there. Still some time until I get to 16cm. :)

I also started jump rope workouts yesterday. No update on it yet, as it’s been only two days. Hoping it will help with my calf and ankle strength as well as improve my cardio. I am hoping to add it as a variation to stationary bike.


WALKING BAREFOOT
This is another achievement this month. Since my last update I started walking barefoot at home. Up until then I needed to wear some kind of heel insert or a heel. Now I am finally able to wear flat shoes and walk barefoot at home! For me that has been amazing as I prefer to wear no shoes at home. :) I am also able to walk hills with no heel inserts in my hiking boots, so pleased about it too. I do not think people that have not gone through this injury understand how significant these “small” milestones can be!!!


So that’s it for month 7. Just wanted to give some hope to those that are earlier in the journey. We can get back to sports that we love after this injury!

Also, for those that are good candidates, non-op with protocol that includes:
- early mobilization in plantar flexion position AND
- early weight bearing AND
- delayed stretching AND
- systematic work on calf strength
seems to be working out well thus far.

Crossing fingers for everyone’s successful come backs to sports or activities you love! It can be done! :)



Yay! I made it to month 6. It’s official - it’s been 1/2 a year since my rupture. I cannot believe that I survived and doing pretty well. Here is what’s been happening in the last month.


RUNNING
So, in the last month I continued progressing in “Back to Running Program”. I am now in stage 5, which is 48 minutes of intervals of 2 minutes running and 1 minute fast walking. I managed to clock 7K in that time. The stage before that was 36 minutes and I was doing 5K intervals in that time. The achilles definitely gets a workout as far as stretch and my calf gets super tense. It actually feels really good after, meaning, I finally feel that calf is alive again and stretching it after running feels good. :) With all the good feeling comes some pain as well. The ankle is definitely still stiff and towards the end of the run I can feel the achilles more and need to force the foot more into plantar flexion with each step to relieve the pain. All was more or less good with 5K intervals. When I started 7K however, the hamstring in my good leg started giving me problems. This is probably due to compensating for the lack of strength and dorsiflexion in my bad leg. I am taking a break from running to heal that and will resume when my glute/hamstring feel better. I miss the every other day running already, but there is enough of other work to be done on the body, so it’s fine. :)

Here is a pic from my run during our trip to TX. Such nice weather there in comparison to Seattle at the moment!



5K UGLY SWEATER RUN
To celebrate my 6 months, I signed up for 5K Ugly Sweater Run. I knew I can do it when I hit stage 4 of the running program and could do 5K intervals with no problem. It was an exciting goal to work towards to. The run was great. I actually managed to run the whole thing with no stops. Took me 29min 33sec, which is average pace of 9.5min/mile. Worse than before injury for sure, but who cares, I can run! My pace initially was good, the last 1.5km suffered a bit. I felt amazing after knowing that the achilles held up well! The hamstring in my good leg was another story, lol. I am now working on healing it.



PHYSICAL THERAPY
The biggest part of the last month was the physical therapy (PT). I still have been going to the clinic 2x week and the rest of the days I do about 1.5- 2 hours of PT exercises at home. I take one day a week as a break from any lower body workouts to rest up a bit. I get massage therapy 1x week and I try to take a rest-day the day after that. Massage therapy is really painful, but seems to be helping out with loosening up the muscles. I have been sore here and there below waist almost daily, so there is lots of knots and tightness. My glutes/hips/hamstrings are really getting some workouts on top of calfs.

As far as the exercises, my physical therapist keeps adapting them based on how my body responds to different things and based on my achilles pain level. He makes me try different types of calf raises, some on flat, some on incline, some on decline. I also have been working on jumps and ankle mobilization. I am doing single leg jumps now, but they are still bit hard. I continue with glutes/hips/hamstings exercises and doing lots of balancing. My physical therapist makes me use BOSU ball at the clinic and I finally decided to get it for home as well. I can see using it in the future as part of my workouts. I really enjoy doing balance exercises on it. Lots of different options. I also got the wobbly cushion. That one is hard!

Here are some exercises I have been doing in the last month:
- Double calf raises - continuing these with weights. Doing them on flat and occasionally on the stairs. It all depends on achilles tendon pain. If I aggravate it by stretching it too much my physical therapist told me to go back to the floor until the pain is gone. (pic in last month post)

- Single calf raises (with straight leg and bent leg) - doing them with weights. So far have been doing 3 sets of 20 with 15lbs. Just this week though I increased the weight to 30lbs and doing 3 sets of 10 to work more on strength. Will be increasing weight gradually.

- Eccentric calf raises - still doing them daily, 3 sets with straight and 3 sets with bent leg. Have been doing them with weights on floor. When doing them on stairs, it was aggravating my achilles too much. NOTE: I am doing them for my healthy leg as well. Just being paranoid about rupturing my good leg now or in the future. Time to start working on it as well! :) (pic in last month post)

- Single leg bridges on ball and double leg double bridges on ball - still a daily routine and it still works these glutes and hamstrings! (pic in last month post)

- Balance on BOSU ball (squats/single leg squats/skaters). Using both sides of BOSU.

- Balance with bands (pic in last month post)

- Side walks with bands

- Lunges and squats (pic in last month post)

- Foot tapping - that’s a new one and really works on my injured ankle, which gets so stiff! This seems simple, but it is actually hard! I do it now 3 sets of 45 seconds.

- Stretching (pic in last month post)


CALF STRENGTH
Last week my physical therapist ran a strength test on my calf. I first did max number of single calf raises I could do on my injured leg. I managed 60. Then I did the same on healthy leg and managed 100 or so. So it looks like my injured calf is about 60% strength of my healthy one. Still lots of work to be done here. In normal daily activities I do not feel too much lack of strength, but when I need to do anything on my injured leg alone, I definitely still feel weakness.


DORSIFLEXION
As I wrote last month, we started working on my dorsiflexion flexibility. I am now comfortably at 7-7.5cm when not warmed up. My physical therapist started doing some more manual work on my tendon to increase the flexibility. He has been working on my calf throughout my PT sessions, but now does more tendon and ankle specific work as well including using tube tape, foam roller and more specific tendon massages. This week he started Graston tool and massaging stick. Ouch, these were really painful. Thankfully, the pain was only during the session and did not linger afterwards. In the couple of sessions I was doing also more intense stretching with weights and bands and on incline. We were able to get me from 7cm to 9.5cm in last session. Not bad. I know it will not stay there, but it’s a work in progress. I am also doing stretches at home. Initially 3x day standing stretches, as shown in last month’s post. Now, also added stretch using foam roller on tendon itself. This one is little painful, but the pain does not stay long. Still long way to go to 16cm…


ACHES AND PAINS
Last month was full of aches and pains.

Achilles tendon pain: At the beginning of last month, I had a week when I overdid it again. I had to take extra day of break and also move my calf raises to floor instead of step. That helped and pain disappeared after few days. When I came back to the step again, the achilles pain came back, so I went back to the floor once more. This time the pain lasted 6 days. I had to lay off running at that time as well. Now as per advise of my physical therapist, I do double calf raises on step and all other calf raises on the floor. So far that seems to be balanced enough and lets me keep the achilles pain away.

Healthy leg knee pain: my physio thinks that this is due to me compensating with healthy leg while squatting. That makes sense. I reduced number of squats for the time being. I am also doing lunges with my injured leg forward only. The knee pain is getting better.

Healthy leg upper hamstring/lower glute pain: this one is definitely from running and due to compensation for the injured leg’s lack of strength/flexibility. I am giving hamstring in healthy leg a rest and doing only some isometric hamstring/glute exercises on a ball as per physical therapist advise. Massage therapy on glute/hamstring almost threw me off the bed last week it was so painful, but it made it feel a bit better afterwards. Lets see how painful it is tomorrow. I am dreading it already…

Injured calf soreness: now this is a welcomed pain! Nothing better than waking up, moving my injured leg and actually feeling your calf! On days after running, that’s the best! I so missed this feeling! One does not realize how precious something is until you loose it. Well, we all loose our calfs in the process of this injury and it surely is nice to start getting it back! :)


GETTING MY LIFE BACK
So, last month was pretty much more of the same with some modifications. Lots and lots of lower body work, managing and working around the pain and seeing good progress in strength and flexibility. Life is definitely pretty much coming back to normal. I am getting back to more or less similar social life as well.

Below, I am back to climbing ladder, here, putting Christmas lights on our house. I have to admit, I did not think about my achilles. I was more concerned about staying on the ladder. :)

Ah, and a funny thing: I have been wearing heels a lot. Achilles just feels so much better and my heel inserts do not fit in all my boots (we have winter here in Seattle already). Now, whoever I meet always exclaims that I am all recovered ’cause I am wearing heels. I have to then explain that I am still unable to walk properly in flat shoes (or bare foot), but wearing heels removes pressure from the achilles and I can walk pain free with more ease this way. I understand that, when one does not think about it, it is counter intuitive and it’s a natural reaction, but I have been doing a lot of explaining lately! lol :)



ENTERING SECOND HALF OF RECOVERY YEAR

One big thing I realized this month; and if you are reading it very early in your recovery, here is some food for thought for ya. At the beginning of my journey, once my doctor confirmed a full achilles tendon rupture, I just accepted it. I literally said: “Oh well, s#!t happens. I guess if you do things, sometimes things will happen to you. I still would rather do things and have things happen than do nothing.” Then I accepted the fact that this injury is no joke and that recovery time is about a year. I did not hold hope for anything faster, I just took it for what it was and decided to dedicate myself to recovery. I also decided not to look far ahead. Yes, I kept reading blogs and medical papers to see what’s coming, but I was concentrating on short term goals for myself. Because of my early acceptance, anything that came ahead of schedule was a bonus and was welcomed happily. However, I was really not depressed about any stage of recovery, because I knew that that’s part of it and there is absolutely no way around it. So, when I was NWB, it was what it was, when I was fighting limp or heel pain, it was part of the process for me. Now, I am trying to gain flexibility and strength and fight all the pains and I know that’s part of the process. It will pass as well.

So, for everyone that is starting out, or having hard time, try to accept this injury for what it is and understand that it is a serious one. Work hard, concentrate on short term goals and know that the stage you are in will pass and new one will start.

Happy healing to all and onto the next stage, whichever it might be for you at the moment! :)


I cannot believe it’s been 5 months already! Time definitely passes by so much faster now than in the first weeks. I guess there is less uncertainty now and much more work on muscles to get back to normal. This injury is for sure a true test of patience, as it takes such a long time to fully recover. It still seems like a long road ahead before I can be back to pre-injury level, but the physical therapy now is more or less like workouts, so it’s fun.


CALF AND TENDON
I saw my doc at the end of October and he did ultrasound of my tendon. The doc was really happy with how the collagen production looks like. Thompson test showed movement, but the notes state that it was not symmetrical with my healthy foot yet. Overall doc was really happy with my progress and said that he is confident to release me to all sports by month 6. I was bit skeptical about it because of the continuous risk of re-rupture and still not fully functional calf strength, so he said lets wait for month 9 for a full release. The risk should be smaller at 9 months than 6 months. I also know that by then PT should show bigger improvements in strength. I was told I can go skiing after month 6! This was the best news I’ve heard. I will probably wait until January (month 7), but lets see what snow do we get east of Seattle in December! Might be tempting…

As far as calf strength, it is improving for sure, but the injured calf is still much weaker than the healthy one. I can do single calf raises with no problem. I keep doing bunch of double calf raises and the eccentric calf raises. The problem is trying to isolate that calf and getting its engagement without involving other muscles in the leg. It’s crazy how the body just cheats and uses other parts to compromise for the weak ones.



STRETCHING
My PT started me on stretching from week 19. I read many blogs and protocols others have been put on and I always saw stretching introduced much earlier. My PT is not rushing this part and I really like his logic. He had me working pretty hard on strength from the beginning, but kept stating that there is no need for stretching initially, that stretch can be done at any point, but if I overstretch early on I could heal long and he will not be able to help me with that. I was totally on board with this thinking and so far it has worked out great. The lack of dorsi flexion has not hampered my progress of my other activities. The increasing strength allows me to progress nicely into sports already. Daily activities are becoming more normal. It is still hard to walk barefoot because of lack of dorsiflexion, so I wear my funky Skechers with higher heels and inserts, or put inserts in other shoes and I am fine. Leg is still crazy stiff in the mornings and I still walk like a robot when I get up, but few sets of pumps/inversion/eversion work with Thera Band and calf raises after I get out of bed tend to fix that. :)

I also found out that apparently I am rather on a flexible side in dorsi flexion in my healthy leg. I am about 16cm (when not warmed up) toe to wall in a “Knee to Wall Test”. When my PT tested my injured foot I was at 1.5cm. That’s 14.5cm of stretching to go! It seemed almost impossible in my head at this point, but I got measured this week and I am now at 7.5cm. Yay, getting there. My PT is happy that it is not stretching at alarmingly fast rate. It has been progressing nicely and steadily.




I can say one thing: working on my calf raises on the floor (not stairs) did not stretch my calf muscles. I got no dorsi flexion flexibility from it. Doing active stretching into dorsiflexion (from week 19) had immediate effect of 2cm stretch after first 5 days of stretching!

The stretches were so uncomfortable at the beginning. I cannot even explain the feeling of it, but it was weird uncomfortable pain even when stretching gently. Initially I was really scared of re-rupturing. My PT kept assuring me that this is normal feeling and I am not risking rupturing from gentle stretch at this point. My doc confirmed the same saying that explosive movements are more dangerous at my stage not the stretches. After a month of doing each of these stretches daily (3 sets of 30 seconds/3 times a day) the stretches are feeling better, but still a bit uncomfortable. I noticed that applying hot water bottle and/or doing calf raises before the stretch helps as it pumps some blood to the leg and warms it up some.



After I got cleared for stretching I tried to do yoga. I use p90X3 program and use yoga from that. The first couple of times I did yoga, the difference in calf flexibility was totally messing with my alignment. My hips felt out of synch and downward dog and symmetrical stretches were wacky. Now it is a little bit better. The improvements came with the increased dorsi flexion ability.


HILL WALKING / RUNNING / HIKING
Once I started stretching I started doing hill walking with max speed I could manage (with the permission from my PT). I am fortunate to live in a very hilly neighborhood, so I really can just come out of the house and can either climb up or down hill. I designed myself program of progression starting with 1 mile, then 2 miles until I got to 4 miles of continuous up/down hill walking. I use mapMyRun app to make sure I only walk on hills while training. I guess this is one way to get to know all the roads and paths in my neighborhood. ;)


Once I got to 4 miles I decided to go on a proper hike into the woods. I searched for a short 4 mile hike, packed up my cameras and tripods and went for it. I wanted to do it alone to pay attention to my tendon and just enjoy the nature. Oh my! What a pleasure to get back to what you love! I so missed hiking this summer. My heart still beats faster remembering the feeling of being back in the woods for the first time. I honestly thought I would not be able to hike this year, so being able to do that in less than 5 months after rupture was amazing to me! Let me just say, the joy of being out there and being able to use both legs justified all the daily sweat put into PT!
As far as tendon, it was tight, similarly to when I walk hills, but manageable. No pain as such. I had to stop few times to roll my ankle to loosen it, as it gets stiff with fast walking. Achilles was feeling fine after the hike, so that’s encouraging.



In week 20 I got cleared to slowly start running!!! I so did not expect it when I showed up for my PT appointment that day. My PT told me to get on a treadmill and I was like “what?!”. The test run went well enough that I got cleared for “Return to Running Program”. It is a program with progress stages that involve intervals of running and walking. I do each stage 3 times before moving on to the next one. I am now on stage 3. It feels amazing to run again. I never liked treadmill running, I prefer running outdoors. I do not call myself a runner as I do not do many long distance runs, but I do like to clock few miles as a warm up before my workouts. Being able to feel the speed and wind on my face was great. My pace is not the same as pre-injury pace yet, but I am averaging 8.5 min/mi on my run intervals. Some intervals are faster, some slower. I honestly care more that my achilles is feeling alright after runs. The difference in dorsiflexion does show while running. My hips are not in synch for sure. On couple of the first runs outside I felt like the lower body was someone else’s. It felt so strange and foreign. That is getting better now, but I still feel difference in my stride. I try to do 3 runs a week, which means I had to give up my hill walking for the time being not to overload the tendon.


PICKLEBALL!!!
Return to the crime scene - lol. I signed up my hubby for our meetup pickleball event and said I would tag along to see everyone and watch the games from the sidelines. My PT did not want me to play yet because of all the sudden moves and side movements. I was a good patient and did not play, but I did hit the ball by the net with hubby. Just some volleys. It was really nice. I got some frustration out while I was at it, lol. I also got to talk to a player who was across the net from me when my rupture happened in June. Apparently I was returning a ball from him when my tendon snapped. I could not remember that bit. He said though that he can remember it well though. I can imagine, as I collapsed right after! Was probably quite a site. The positive from that outing: I do not think I have mental block to come back to playing racquet sports. As I was hitting I was fine mentally. I just knew my limitations now, so tried not to run, but if I was cleared for it, I would go for it. That’s good to see. I was not sure how I would feel.





PHYSICAL THERAPY
Best for last. :) My PT appointments are still 2 times a week, but I have home PT to do every day. Now I do about 2 hours of PT a day. It is crazy how much time it takes. I can see improvements, however, so I keep going. My PT involves pretty much all lower body muscles, so it is like doing your leg day every day. Because of that I realized I need 1 day of rest a week. I saw that I was burning out with the addition of running/hill walking on top of all the PT exercises, so now, I schedule massage therapy at the end of the week and take the next day off. This seems to work best for my calf/hips/hamstrings/gluts muscles. Without that day off my gluts and hamstrings were hurting all the time. It is more manageable now. So again, balance. This one is not easy for me…, but I am learning.

As far as exercises, they are not so much different from previous month, but variations are added.
- Single calf raises (straight and bent legs) - messing around with different styles and started doing them on stairs. Backing off to floor when tendon is hurting after.
- Double calf raises (straight and bent legs) - doing them with weights on stairs and backing off to floor when tendon is hurting after. Doing some with my toes placed inwards and outwards as well.
- Eccentric calf raises (straight and bent legs) - doing them with weights on stairs and backing off to floor when tendon is hurting after.
- Balance exercises - bunch of different types of standing on one leg with skaters, or bands, or kicks, or yoga balances
- Ball bridges (double and single leg)
- Lunges - doing straight, angle, back - basically any types I knew before with additions of leg raises. Also doing lunge to calf raises.
- Squats to calf raises
- Side bridge clams
- Side walking with bands
- Double leg jumps (single are still hard and do them only during PT appointments)

I am now daily massaging my calf with a tennis ball to get some of the knots out. The calf is getting pretty stiff from all the work and I sometimes feel it in tendon. Massaging out the calf muscles really helps with it. I do foot rolling on tennis ball as well as foot gets sore from so many calf raises. Rest of the muscles - using foam roller.

A NOTE: I feel it is so important to have a PT one trusts. I am fortunate to have a really good one on my side. He pushes me most of the time, slows me down when I overdo it and is up to date on anything new that comes out there as far as exercises go. I like it that he reads up on new things and is interested in research that is out there. I am curious about new studies myself and keep reading up whenever I get a chance too, so knowing my PT is into it is really assuring. Just a note to all, find someone you trust. With this injury requiring such a long recovery, it is important to find someone that you trust!




So, month 5 was cool. I got to run, I got to hike, I got to hill walk, I got to do yoga, I got to hit some balls in pickleball. I am so grateful this leg is healing and that I am able to do more and more. It just shows that a lot of hard work and help from physical therapy pays off. Step by step getting better. Still long way to go, but now I definitely see the light at the end of tunnel!!! Set backs happen. I overdid it one week and we had to slow down the following week, for instance. That’s part of the process to learn to listen to your body as well.


Hope it serves as encouragement to some that either chose non-op route, or are recovering from surgery and are just starting PT. Keep at it, listen to your doc and therapist, work hard, learn to listen to your body and the results will come with time! Happy healing all! :)





This has been really cool month as far as strength of the calf, but it was not without challenges.


WALKING
Walking is becoming easier. Most of the time I do not have a limp anymore. I still wake up with a very stiff leg and cannot walk normally until I warm it up, so I do foot pumps in plantar flexion and inversion/eversion, all with black TheraBand. I will show this in my vlog from this month. That seems to do for a quick fix and lets me walk more normally.

Doing my physical therapy first thing in the morning has also proven to be the best warm up for walking during the day. Sitting for extended time brings back stiffness in the leg and I have to warm up to walk normally again. Nothing like in the morning though.


DRIVING
I have been doing TheraBand pumps daily for many weeks in preparation for driving. I was cleared to drive in week 15. It was so amazing to get my freedom back! My physical therapist (PT) was mostly concerned with my leg’s ability to do emergency stop, so I went to a parking lot and practiced slamming the breaks. Leg seemed fine with that, so I ventured on the road and have been driving ever since. Nothing compares to getting that freedom back… I shed some happy tears on my first solo drive. Being dependent is one of the hard parts of this injury, so step by step getting my life back and this was a BIG step! :)



ACHILLES TENDON PAIN
This month I have been struggling with tendon pain. It was a weird pain right on the tendon and not around it like in the past. It was concerning me quite a bit. My PT keeps repeating that we heal while recovering from the work we put in, so I finally listened to him and reduced my exercises to a single, long session a day. That seemed to help, but the pain did not disappear completely.

Then my PT suggested self massaging my calf with a tennis ball to get the knots out. That helped for sure and was spot on, but the relief was temporary. The pain was still coming back. I started applying hot water bottle to my tendon nightly and that feels so good and helps temporarily.

So my PT’s next suggestion was to wear higher heel during the day to remove some of the tension from the tendon. Bingo! Well, I am sure the combination of all three of the above is the best and I follow all three, but the elevated heel shoe is the winner. I work out with very slightly elevated shoe like before, but then immediately switch to a higher heel shoe with a heel insert for extra elevation. My achilles pain is not there, or if I have it after workout, it disappears after shoe change. I was really relieved and kudos to my PT for all the suggestions and solving it. :)

I bought these funny Skechers with raised heels, lol. They are actually pretty comfortable, have memory foam inserts and will be used for everything but workouts. This style would definitely not be on my shopping list if not for this injury, but hey, this color was on sale and these are the highest heel raise sports shoes I could find! ;) More info and pics on my ATR Equipment page.



MEDICAL MASSAGE THERAPY
The tendon pain this month made me think of massage therapy for the injured calf. I asked my doctor for a referral. My insurance covers some session, so this was good time to use it. I was skeptical as I do not trust strangers touching my achilles. I was pretty tense and my first session was not the best. It took me 2 weeks to book with someone different and oh my, I found a massage god. The calf massage was so painful, but it was so thorough and gave me such a relief! I am not going to anyone else from now on. It was good to have my hip rotator, calf and knee/ankle/foot loosened up. I definitely think that this is very beneficial with all the work the injured leg is put through in this recovery process! I will try to have it done weekly, but only with this specific massage therapist. I think it is so important to find someone that knows what they are doing with this injury!


CALF RAISES
I have been doing a lot of double leg calf raises with straight and bent leg as well as eccentric calf raises, also with straight and bent legs. In week 17 when I was able to comfortably go down on the single injured leg from calf raise, my PT asked me to do single calf raise and I was able to lift off! Yay! :) Quite a change from a previous try in PT, when leg would not move even a bit. I was told to try to do a single calf raise and hold it for 30 seconds. I managed with a lot of effort. Then I was asked to do it again. Managed it somehow. It was not pretty, but who cares. I was able to start working on single calf raises. :)



PHYSICAL THERAPY
Physical therapy is still a big part of daily life. Every morning about 1 hour (2 hours if I include some extra workouts). I see my PT 2 times a week, so on those days I just do a leg warm up at home and try to do upper body workout. I actually really like going to my sessions. My physical therapist varies the exercises and always tries to make them challenging. The quick massage at the end helps to loosen the calf.

I really like my PT’s approach to stretching, or rather to no specific stretching. Basically, thus far I have not been doing dedicated stretches. This is to make sure the tendon does not get long. I do get into dorsi flexion during some calf strengthening exercises and balancing, but that’s it. I am instead working pretty hard on calf/hip/ankle muscles and it seems to give great results so far. I’m told stretches will come. I am good with that being delayed as I definitely do not want to heal long.

This week also I started running on my tip toes! It’s nothing like running yet truly, but it’s a start. During sessions with my PT I also started balancing on tips toes while walking in different patterns. That is hard and shows how much weaker my injured leg is, but I love the challenge.


Some of the leg exercises in month 4:
1. Double calf raises- doing more pumps than holds this month. Started doing them with weights 22 lbs in the backpack.

2. Eccentric calf raises with weights - doing single leg descent became easier this month, so started doing them with 22 lbs weights in the backpack.

3. Single calf raises with straight and bend leg - still pretty hard for me, but managing 3 sets of at least 20

4. Squats with calf raises - started doing them with 22 lbs weights in the backpack. In my sessions doing squats on either half foam roller or BOSU ball. These are fun, but challenging.

5. Single leg balance skaters - doing now 3 sets, 2 minutes each in each leg. These are gluts killers.

6. Running in place on tip toes - doing short sets of 30-40 seconds now. This one really shows how weak the injured leg is!

7. Double leg double bridges with curls - this one was killing my legs initially, but now it’s a consistent hamstrings/gluts/calfs workout.

8. Single leg bridges with curls - this one is new at the end of month 4 and it really showed me how much weaker my injured leg is. It is pretty challenging, but I somehow love it at the same time.


Still doing stationary bike and my regular body workouts outside of the PT.


Month 4 of my recovery has passed quickly, since I am slowly getting back to more things from my normal life. The calf is a complete center of attention. Between working on it, going to physical therapy, massage therapy and constant soreness in my whole legs and gluts muscles it’s hard to forget about it. Thankfully, tendon soreness is under control now!


Once more, I feel that daily physical therapy is a key to quicker recovery. Listening to your body is another important thing. Balancing the work and recovery is not something that is easy when one wants to get back to normal, but that’s another lesson to take from this experience. I am not the best at this, but am trying to listen to my body more and slow down when needed. I recommend it to everyone. ;)


I will be seeing my doctor again in 2 weeks.


Happy healing all and keep at it, whichever stage of recovery you happened to be at! It does not feel like it in the beginning, but time passes by very fast in month 4 of recovery. :)








2016-09-26 Update: Vlog from week 12 and 13:





The last 2 weeks were mostly about trying to walk as normally as possible and about lots and lots of physical therapy (PT).


DOCTOR’S 14 WEEK FOLLOW UP
I had a follow up with my doctor today. Doc examined my tendon and was really happy with its healing progress. He assessed the tendon as firm and strong. The thickening of it is there, but I was told it is normal at this stage. Doc mentioned that it is not as thick as seen with post-op patients at this point in recovery. Doc performed Thompson test and he saw plantar flexion movement of the foot. Then I got ultrasound, which showed thickened intact appearing tendon with disorganized collagen architecture. Doc did ultrasound of my healthy tendon as well to show me the difference. I was told that the injured tendon collagen might never get back to the same state as before the injury, but that this would not have impact on tendon’s strength and capability. I was told that the next ultrasound will be in 3 months to check the difference. I asked for a referral to massage therapy, since my insurance covers few of these and my calf could really use some massaging after all the work it is put through daily.

I was also cleared to start some dorsi flexion stretching. My PT measured me yesterday and I am now equal in both feet in plantar flexion (thank you toega!) and am at 18 degrees dorsi flexing my healthy leg and 5 degrees dorsi flexing my injured leg. I was told that this is good indication of healing normally and not long. I was also cleared to do stationary biking with natural leg movement (until now I have been biking with toes pointing down to avoid dorsi flexion of the foot). I also was told no running, jumping, or cutting/pivoting exercises for 3 more months. That means I am not going back to my insanity or p90x workouts for a while.

Below is the thickness difference in my tendons at this point.



And here is the thickness difference in my calves. My calf is growing! It does not look like much, because my right injured calf was 1 inch thicker than my left calf, so I might just end up symmetrical after I am done with this injury.



I also asked about skiing. Given the fact that my summer was pretty much gone as far as sports and hiking, I am now looking into winter season. I was told that given my recovery status and if all goes well from now on, I should be able to ski at the beginning of 2017. I was so thrilled with the news! I cannot even drive myself at this point, so thinking of skiing in Jan/Feb really is something that I am looking forward to!!! :) Now I just need to be careful until then to not re-rupture and stay on track…


HELLO CALF/ACHILLES STIFFNESS
I read a lot of people writing about leg stiffness and the last 2 weeks I found out why. I was fortunate enough to not have a lot of it until week 10 or 11. Now, however, every morning immediately when I get up I walk pretty much like a broken robot. I figured out that if I do my PT right after getting up, the stiffness disappears and I am good to go. Warm shower helps with it as well. Nothing is better for me than seated heel raises and calf raises for calf and achilles stiffness; balancing for ankle stiffness; and squats for sheen muscles stiffness. Sitting at the computer for extended periods of time also brings stiffness back and I need to do few exercises to get rid of it in order to walk more normally.


WALKING
It’s been almost a month of walking with no boot. My walking in shoes has been work in progress. I am slowly getting hang of it. I still have to think about almost every step, but only to try to avoid limping. When I am not tired or stiff and think about it, I can walk with almost no limp. I can see, however, that at the end of the day, or when I need to walk faster, or when I am immobile for a while, my walk is choppy. Also, I do not know if it is only mental, or not, but it is easier to walk when I wear my compression sock. Somehow, I am able to walk smoother and more easily when wearing it. I was told that some of the limp is due to lack of dorsi flexion at this point, so this should get improved with stretching from this point onwards. I still do not walk bare foot. I wear gel inserts in my shoes for little elevation and comfort. My shoes came with memory foam inserts, so double softness definitely helps and I feel heel pain only at the end of day if on my feet a lot.


BOOT
I almost booted the boot completely. I wore it only couple of times in the last 2 weeks to mow the lawn and when we went to a crowded place. I will continue doing so when I need to be on uneven surfaces or in uncertain situations. Otherwise, I am doing everything in 2 shoes now. Yay!


PHYSICAL THERAPY
That has been the biggest part of the last 2 weeks (along side of working on proper walking). It takes up a LOT of time, but I feel it is worth it as my leg is feeling stronger. No more floppy, loose meat on my injured leg! :) I am told by my physical therapists that there is not that much scar tissue around my rupture site. I got some Graston tool massage done on it in week 12 and 13 and it hurt quite a bit, but it was good pain. Also, now that my calf is working so much more I do get little bit of muscle soreness. It is so welcomed, because that means my muscles are coming back! Again, yay! The PT massages are feeling so good now as they massage the knots out!

As far as PT exercises, I moved from shorter 3 x day sessions to 2 x day, longer sessions. In the middle of the day I do some seated heel raises and calf raises to warm up the leg when needed. The exercises are as I showed in last post with the following changes.


1) Calf raises pumps were substituted with eccentric calf raises. This is in preparation for single calf raises. I go up on both legs and come down 90% on injured leg. These were hard in the first week, but I am now doing 3 sets of 20 at a time. I do these at least 2 times a day. After my research of tendon and eccentric exercises, this is definitely the way to go. I still put towel under my heels to not put too much pressure on achilles and do not stretch it too much.

My PT wanted to check my ability to do a single calf raise, since the above are going so well and that was a flop, haha. I stood there on one leg, was willing it with my brain to go up, but nothing was moving. Such a weird feeling. No pain, no strain, just nothing. Just imaging looking at your finger and telling it to bend and nothing happens. We tried horizontal leg press machine and I was able to do single calf raises on it with 20 lbs (It was really hard!) and single leg bent knee calf raises with 40 lbs. I will be working on these in coming weeks to get to single calf raise.


2) Seated heel raises: I do them now with 45lbs weigh on my knee. I tried 50lbs and my calf was fine, but my knee was not appreciating the weigh on it, so I told my PT that this is my knee’s limit and I would stick to 45lbs. We replaced seated heel raises in PT with horizontal leg presses. With that I can do more weight while in PT room, but at home, I still do seated heel raises with 45lbs few times a day. Seated heel raises seem to fix my sore from walking calfs. After days where I am on my feet the whole day, there is nothing better than couple of sets of seated heel raises. Somehow all my muscles in my ankle and calf relax after it. Tendon also feels better.


3) Heel raises in wall sitting position: This one is new. I basically do a wall sit and do heel raises. I started with each foot separately and now do both at the same time.


4) Toes raises in wall sitting position: This one is new as well. Again, I do a wall sit and do toes raises one foot at the time.



5) Balancing with bands: balancing on one leg was not challenging anymore, so now I use bands on my ankles and do the below. I also am trying to get to 2 minutes of balancing on injured leg with closed eyes.



6) Horizontal leg presses: As mentioned above my physical therapist was experimenting with me with leg presses in preparation for single calf raises. It is nice, cause we can isolate each calf and compare its ability. I am now up to 20 lbs in single calf raise and 40 lbs with bend knee heel raise while using the machine.


7) Lunges: I asked for it, we tried it and I was cleared to do lunges. Finally! For now when injured leg is behind, I put it on a bench behind me and lunge with my good leg. When injured leg is in front I can do regular or bench lunges, I just need to be conscious of not too much dorsi flexion on the front leg.


Rest of the exercises remain the same as in the previous week. Still doing a lot of stationary biking and increasing resistance. That has been really good for hips.


The fun part this week was that my hubby tried one session of exercises together with me. I keep nagging him to take care of his calfs to reduce the chances of rupture happening to him. I was glad to hear he was sore the next day. That should convince him to do the exercises with me more often and strengthen these calfs and hips! :)


So, that’s my week 12 and 13 in non-op (conservative) route. Regardless of your status in recovery, wishing you happy healing and lots of mental strength to get through it. Hard work definitely pays off in this stage, but it also needs to be balanced based on how the tendon feels. So, definitely listen to your body. Also, another point is that no two bodies are the same and we all heal differently. Some stages are faster for some, some are slower. As long as one follows good protocol and works hard when needed, it will get better! :)




2016-09-22 UPDATE:

VIDEO REVIEW OF WEEK 10 and 11:






The last 2 weeks have been the most exciting so far! Sorry for the long post, but a lot happened. It was definitely a period full of changes.


DOCTOR’S 2 MONTH FOLLOW UP:

I saw my orthopedic doctor at the end of week 9. My progress was good, achilles tendon looked well and I was cleared to start weaning out of the boot. This transition was estimated to last about a month. I was given a new boot since the straps of my old boot were completely worn out and the new boot was much lighter and was making walking easier. It’s Aircast boot and I wish I got this one much earlier! I really like this one better than my black boot.

At the appointment my husband and I asked the doctor a lot of questions, since we have not seen him for a month and my condition changed quite a bit since then. TIP for everyone going for a doctor’s appointment: keep compiling a list of questions for your doctor and bring that list to the appointment. Then at the doctor’s office refer to that list and make sure that all your questions get answered. It is so easy to forget things we wanted to ask. I almost felt bad asking so many questions, but hey, I am injured and my doc is an expert, so I got to use him as the resource. He was really good and patient answering everything. I feel bad for the next patient, who probably needed to wait longer that day! Sorry…


STANDING ON 2 LEGS WITH NO BOOT

The day after my doctor’s visit in my physical therapy (PT) I was told to stand up for the first time with no shoes on. That happened with my heels on half foam roller and toes on the ground not to put too much pressure on the injured achilles. I learnt to really trust my physical therapist, as he is really good/experienced at what he does and seems very logical in his approach of therapy. So, I just got up without thinking and followed his instructions only seconds later to realize what happened - I AM STANDING on 2 legs with no boot on for the first time AFTER 2 months and 1 week. I sort of freaked out inside with happiness. It was really exciting moment for me. My injured leg did not pop again, it did not hurt and it seemed to hold me in whatever limited capacity it could! Major moment!


STANDING FOR THE FIRST TIME WITH BOTH FEET



LEARNING TO WALK AGAIN

I was given few calf exercises to be performed at home (see below for details). My physical therapist told me to always have something under my heels to not over stretch the tendon. I was told to go home and try to walk in the house in 2 shoes and do my PT exercises daily. I was to wear inserts under my heels in order to have a bit of plantar flexion position and provide some relief for the tendon. After my second PT that week I was told to get more adventurous in the house out of the boot. That day and over the weekend with everything I did I was thinking: am I adventurous enough? At the same time I was really cautious not to step weirdly on my foot as re-rupture was on my mind constantly.

So, I started with simple tasks at home in 2 shoes, like slowly walking around the counter for 5 minutes, then I would put the boot back on. Emptying dishwasher in 2 shoes, or doing light cleaning then putting the boot back on. I was not able to do any serious tasks outside of the boot yet, so whenever there was something easy on the horizon I would take my boot off and try to do it in the shoe. When working at the computer, I would keep the boot off and just move my foot around in plantar flexion position.

The boot was still main part of my routine. That week I was putting tile floors in one of the rooms as well as putting cabinets together. Needles to say I needed to wear boot for these tasks and was forced to take breaks to walk around in the shoes only. These breaks were needed anyways, as my heel still was hurting when walking in the boot for a while. Somehow, getting out of the boot and walking (read: limping) in the shoes was providing relief for the heel.


BOOT IS STILL VERY MUCH NEEDED

At the end of week 10 I ventured outside in 2 shoes. It was slow and cautious. The trips were short at the beginning and to safe destinations. At the end of week 12 I am now trying to go to most places in 2 shoes only. On straight road I try to walk normally. Uphill, however, I walk sideways, or avoid it if possible. Stairs are easy, but I am very cautious on them and use railing.


BRAVING OUT THE WORLD IN 2 SHOES

I started my walking out of the boot in a robotic way. I was basically walking in a shoe, like I was walking in a boot. That meant big limp. I thought I was not supposed to bring my foot in dorsi flexion position. That was basically looking like a robot walk. At the beginning on week 11 I went to physio with both shoes on and got schooled about walking in 2 shoes. Apparently, I was supposed to start with the heel, roll through the foot, end up at the heel, get on toes and lift the heel. I was asking if this will not make me heal long and was told that walking alone will not do that, especially that my heel is raised in the shoes. Running, stretching and dorsi flexion exercises at this point could cause it. Well then, now I am trying to walk like a human being! It is going well. I just feel little weakness in the injured leg, which causes slight limp. When I really concentrate there is no limp, when I am tired or talking while walking, limp is back. It is going to be a loooong way to normal walking with no thinking.

My physical therapist took a video of my walk and we analyzed it in slow motion. That was great as I saw what to improve on. It was good to see the motion of my healthy and injured leg and compare these. I realized, I use my knee too soon in the injured leg. I was able to improve on that already. The video of the walk from the side and its analysis is something worth doing for everyone starting to walk again!

Now I use boot for physical things I am afraid to do in shoes and also outside when going on soft surfaces, or to unpredictable place, or when I need to walk faster.




SLEEP WITH NO BOOT

I decided during that week that I would sleep with no boot on on the weekend. I was scared of tightness in the morning, hence I was postponing booting the boot at night. My doc told me to get night splint if I get tightness after sleeping with no boot. So, I decided to put my compression sock on and sleep in it, just so that I have some kind of reminder that this leg is still very fragile. My night went well for the foot, but I kept waking up many times checking if the leg was fine. In the morning, however, I was very surprised that I had no tightness and that I could put my boot on with no problem and walk in it. That was very encouraging. I slept another night in compression sock, that went well as well. The following few nights I slept in fuzzy sock only on the injured foot to serve as a reminder. A week after my first bootless night I slept with 2 naked feet and I was totally fine. Today, at the end of week 11 I am completely comfortable sleeping with no boot. It took me longer to be fine with sleeping with no boot, but I got there in my time and am now minimally thinking about it at night. Just being slightly more cautious with the covers.





SHOWER WITH NO BOOT

The same weekend I also took my first shower with no boot. That event was not overly exciting, as I have been washing my foot in the shower while sitting on a chair and showers generally were not challenging with the boot cover and the seat. But I did that and I was more cautious on wet surfaces and when getting in and out of the shower. The PT exercise of balancing while standing on the injured foot definitely helped with that. I was not supposed to walk bare feet, so I was wearing my sneakers or a boot with heel inserts right up to the shower and putting them back right after. Have not showered in the boot since. Shower still is a place I am very careful at and try not to relax too much. Wet floor plus weak achilles tendon combo can become disastrous pretty quickly!


PT PROGRESS IN LAST 2 WEEKS:

1) Seated heel raises: Started them with 0 lbs and am now doing them with 35 lbs dumbbell on my knee (towels needed for cushion). I started with 3 sets of 20 reps each held for 10 seconds. Now I am doing 3x day 3 sets of 20 reps each held for 10 seconds while adding some pulsating to engage calf more.

2) Laying down prone plantar flexion: we retired it as it became too easy after 2 weeks even with pressure applied by PT while doing the exercises


LAYING DOWN PRONE FLEXION

3) Weight shifts with raised heels - these were retired after week one, as I was able to stand on one leg with raised heel pretty quickly. I can now stand at least 2 minutes on the injured leg while unassisted balancing. I do it at least 2 times a day. Started doing yoga tree pose as well, but with raised heel.

4) Standing on one bent leg with raised heel — we started this in week 11 and this one is still hard. I manage doing it for a minute, but end up sweating while doing it. This is something I currently am working on improving.

5) Squats with raised heels: These are pretty easy, as they mostly work upper legs and I have been working them out daily throughout the injury. It’s just fun doing them out of the boot now. Working on equal weight distribution as the body naturally moves to the good side to compensate for the weak side. Started doing sumo squats too making sure injured foot is in plantar flexion. Inner thighs are appreciating it.

6) Calf raises: Started them with 75% good leg / 25% bad leg weight distribution and with something under my heels. Am now working on equal weight distribution. I am now 50/50, but the injured leg is weak and need to concentrate on it’s engagement. Doing 1 set of 20 3 times a day, each rep held of 10 seconds. My raise is equal in both legs, but the injured leg needs lot of work to be comfortable before going into single calf raises.

7) Calf raises - pulses: This week my physio therapist made me do calf raises pulses. Doing 20 of them 2-3 times a day. Working on equal weight distribution.

8 ) Stationary bike: I was cleared to bike with no boot on in week 10. Have been doing 30-40 minute rides every other day gradually increasing resistance. Shorter, warm up rides on the other days. Injured foot does not go past neutral while biking (toes pointing down).


CLEARED FOR STATIONARY BIKE WITH NO BOOT

9) Pool: Ventured out to the swimming pool as was encouraged by my physical therapist. Walking in the pool was so much easier than outside. That was fun. Then I swam with a pull buoy, thus not using legs, but upper body only. My upper body really enjoyed variation in the workout and it was so relaxing. The most challenging part was walking bare feet to get to the pool and taking shower. The floors were so uneven and wet! I brought my boot all the way to the edge of the pool, but we walked between the pools and I needed help with that. It was a fun experience and I cannot wait to go back again.

10) Stability ball bridge with leg curls: Have been doing 3 sets of 20 daily. This is great workout for hamstrings and glutes, but also activates some calf muscles that wrap around the knee. I keep my feet in plantar flexion position doing them.

11) Side plank with clam shell: These work outer thighs, core. I do 3 sets of 20 on each side a day. I need to add resistance bands to these, as I gained confidence with my injured leg outside of the boot

12) Regular workouts: doing more weight bearing workouts as long as they do not stretch my injured calf and my foot does not go past neutral.


And now the good part: I gained 0.5 inch in my injured calf over the last 2.5 weeks! Now I am up to a whooping 12 inches. I lost total of 2 inches. The good news was that my right (injured) calf was always bigger than my left calf, so I have 0.5 inch of gain left to match my healthy calf. :) The calf does not feel like hanging meat anymore and when I squeeze it nothing loose moves around anymore when pushed from the side. Yay! Progress!


KT TAPE

I asked my doc and physical therapist about KT tape. They both said that this will not protect my leg from going too far into dorsi flexion position and will not prevent re-rupture, BUT it can serve as a reminder if I bend too far while walking, or moving around. We got some tape on amazon and my physio therapist showed us how to apply it. We recorded it, so I will include it in my video update. I will update in the next blog how well it worked out for me. Btw, I got really bright color, so that people see it clearly when I walk slowly when I do not wear my compression sock. Not having a boot on my leg makes me feel vulnerable especially that there is no longer any indication for strangers that I am injured. I still wear compression sock daily. I got second pair of MOJO socks as I really like them. See more on it on my ATR EQUIPMENT page.



That’s it for my long update. It was a lot of firsts and a lot of work over the last 2.5 weeks. Because of the extensive PT, constant practicing of walking and concentrating on/analyzing the leg, time passes by really quickly at this stage. If you are reading it and are at earlier stage in your healing, there is something to look forward. This is a fun stage, but also stage you really get to work hard. If you put effort into it, you will love it! :)


Happy healing all!





The last 2 weeks were pretty much all about walking in the boot full weight bearing (FWB), doing physical therapy (PT) for ankle/toes/little bit of calf and trying to manage heel pain.


HEEL PAIN MANAGEMENT

As mentioned in previous post, I started FWB in the boot with one wedge at the end of week 6. The Evenup platform made that pretty easy for me. In week 7 (week 6 in my protocol) I was to remove the wedge and go to 0 degrees (neutral). Couple of days after I did that my heel started to hurt after being on my feet for 2-3 hours. It was hurting right under the heel. No other pain anywhere else, but this annoying strong pain that pretty much stopped me from walking. Resting, elevating and icing were the only remedies when I got to that point. I was forced to take the crutches wherever I went and use them when the pain got bad. In the evenings I pretty much needed them.


I started researching heel pain and I read everywhere that that’s normal at this stage and that this would pass. I bought gel inserts. That seemed to let me avoid the pain for a bit longer, but not stop it. I also had some old gel pads for the heel, so I added them on top of the gel insert. That felt even better, but the pain was still coming back in the evenings. My PT mentioned that it might be good to put the wedge back in. I tried that, placed the gel insert on top of it and the heel gel insert on top of that. That was like walking in a wedge shoe. That combination was the most successful, but the end of the day always brought heel pain with it. I iced and elevated a lot in the last 2 weeks.


I posted the gels I used on my ATR EQUIPMENT page.

THERE WAS A LOT OF RIDING AT THE BACK OF THE CAR WITH FOOT UP TO REST HEEL PAIN AFTER WALKING



I am grateful, however, that this is the only pain I am having. Frankly speaking I did not feel any pain since day 3 or 4 from the rupture, so in spite of this onset of the heel pain after walking in week 7, I feel pretty happy with my recovery so far. Cannot complain.


AIR TRAVEL

We had a family function to attend that was out of town. I was cleared by my doctor for it since it was not too long of a flight. I called the airlines in advance and reserved a wheelchair. I knew I need my crutches as well, since I had no idea how my foot would react to flying. At the check-ins I asked for seats with more leg room and we were moved to the front of the cabin both times. I think the wheelchair really helped out. I felt funny to be pushed around the airport, but at the same time I did not want to use my leg before the flight. At both airports it was my husband pushing me. At our airport they had these cool wheelchairs, where you can place your hand baggage under the seat. At our destination airport they had the traditional wheelchairs, but we were shown how to load the bag on one of the foot rests. It worked out well. We also had priority boarding, which was helpful. On one flight the attendants stored my crutches in the coat closet and on our way back we stored them in the overhead compartment.


I took aspirin the day before the flights and on the day of flights as a precaution against blood clots. I also took a ice bag with me to the cabin to ice my leg. One tip is to actually load your ice bag at one of the cafes close to the gate before boarding as they can run short on ice on the flight. I was also told by my doctor to remove my boot on the flight and do my range of motion exercises. I did that once in every 45 minutes or so.


After the flights the foot was definitely swollen, but I had no pain, just tightness from swelling. When we came back, the swelling was more significant, but I had my PT the next day and my physio used massages and tight tape with which he pumped the liquid up. That was pretty cool actually. He also told me to definitely ice above my heart that week to reduce the swelling from the flights.



As a side note, ladies are at advantage as far as wearing heels on the good foot while wearing the boot. I managed wearing my formal footwear on my good leg to the family function and even dance a little in the boot (that was a new one for me for sure :) ).

At least the shoe color matches. ;)


COMPRESSION SOCK

My PT also recommended knee high compression sock. I wish I was told about that before I flew, lol. I ordered MOJO compression socks and so far am pretty happy with them. I will be ordering another pair of them as I can see myself using them for a while. I wear the sock throughout the day taking it off for my daily PT exercises. I take it off during the night and replace it with my fluffy sock. And yep, I still sleep in my boot. I am chicken and even though my protocol allows me to sleep without the boot, my doc said that it is fine to keep it on at night. My problem is that when I keep the boot off for a while and keep my foot in plantar flexion position my achilles area gets really stiff and it takes some time before I am comfortable in neutral again. I just cannot imagine how stiff I would be after 7 hours of sleep in plantar flexion…


I posted the compression socks I used on my ATR EQUIPMENT page.


PHYSICAL THERAPY, TOEGA, ROM, EXERCISES
I got couple of new moves for my daily PT in addition to the exercises from last post. I have also been doing something called toega: yoga for toes. After my PT in week 6 I noticed how stiff my toes were and I was just researching for something to help me with it. I came across TOEGA. I laughed at first, but once I tried it, I saw how hard it was to do these things with my injured foot and how easy with the healthy foot. I asked my PTs and they all knew about it and said that is a good idea. I do these exercises when I wake up and before going to sleep. I think they really helped my toes a lot since. The injured foot toes flexibility is starting to look similar to my healthy foot flexibility. My toes and muscles around them do get sore though when doing these exercises. One important point, I was doing all these in sitting position and in plantar flexion to make sure my leg does not go and stretch past neutral.
I am still doing my range of motion (ROM) exercises 5-6 times a day. All in plantar flexion position. I also still work out while wearing the boot almost daily. I always start with stationary bike or rowing machine and then do my strength training with body weight and weights.



8 WEEK DOCTOR CHECK UP

On Monday, August 15th, I had my 8 week protocol doctor’s check up (9 weeks since rupture). I was told that the tendon looks really good and it is healing well. It is little thicker around rupture site, which I was told was good. The swelling level apparently was looking goos as well. I was cleared to start weaning out of the boot into regular shoes, asked the doctor, what it seemed like, 100 questions and was told that right now it is time to concentrate on my PT and calf. I am to come back for another doctor’s visit in 4 weeks. Hearing good news from the doctor is always re-assuring and pumps you up for the next stage of healing.


So, overall the last 2 weeks were definitely new experiences for the leg. There was more PT, more walking in the boot and more brainstorming on how to manage my heel pain. One thing I can say is that I am more comfortable with my leg, I can keep it out of the boot longer while sitting and am not as finicky about it. With that said, I am very cautious with it as the re-rupture is very much on my mind. I still shower in the boot with the cover on it, sleep with the boot on, but am definitely feeling that the leg is stronger and healing. A final pic of some of my boot adventures:



Happy healing everyone - in whichever stage you are in now. Looks like every stage has its challenges, but we can get through it one day at the time! :)

2016-09-01 UPDATE - finally got to uploading video of progress during these 2 weeks (see below post)




Lots of changes in week 6 and 7! I went to the doctor NWB, left PWB in the boot and a week later I was FWB in the boot. That’s a lot of progress in comparison to previous weeks.


PARTIAL WEIGHT BEARING (PWB)
My boot was adjusted to neutral position with one wedge inserted, making it about 10 degrees plantar flexion position. First couple of days after my doctor’s appointment I could not stop walking in a boot with crutches. It was so exciting to use both of my legs, even if it was not full weight yet. I was supposed to put about 45-50lbs on the injured foot in the boot. A good way to gauge the actual pressure applied is to place the booted foot on the scale and check the weight while pressing it down:

CHECKING HOW MUCH PRESSURE TO APPLY WHILE WALKING



After 2 days I received Evenup platform, which you place on your healthy foot’s shoe. This way your healthy leg and the booted leg are at the same height and that makes walking so much easier. I think because of Evenup I got very comfortable walking so quickly. You can check out more on EvenUp on my
ATR Equipment Page.
I felt no pain in the achilles or ankle. My doctor mentioned, however, that I should not expect any pain. During that week I was really eager to get out in the evenings and weekend. It was just fun to walk after being at the computer the whole day.


FULL WEIGHT BEARING (FWB)
Towards the end of week 6 I noticed that I am walking and am just carrying the crutches without using them. I contacted my doctor to see if it is OK to do FWB in the boot earlier and he said that it is OK. So, week 7 I am on my two legs with no crutches. I still sometimes use my crutches when going outside for support only. These uneven surfaces are no joke. It’s funny how flat looking concrete is not always so flat! As far as achilles and ankle, these were still good, no pain. I will have the each stage of walking in my week 6-7 video.



RANGE OF MOTION EXERCISES (ROM)
I was to continue my ROM exercises as in previous weeks. I continued doing them about 7-8 times a day for about 5 minutes. I noticed that my foot actually lets me know that it’s time for ROMs. I guess the foot gets stiff in the boot and I can feel when I need to move it again. ROM exercises do not look like much, but they definitely are helping.


WORKING OUT
I was cleared at the last doctor’s appointment to exercise on a stationary bike and rowing machine while wearing a boot. That was a wonderful addition to my daily workouts. Rowing machine is a good warm up before strength exercises, but with stationary bike I was finally able to raise my heart rate and really break some sweat! I just push with my hill of my boot. Stationary bike rocks! I kept doing rest of my strength exercises as normal, one-legged push ups, array of NWB legs exercises, bunch of NWB abs and back workouts, and upper body weight training.



GETTING OUT
I will not be able to drive for a while still, so need drivers everywhere. I have been trying to get out normally, just assessing the situation. Still avoiding overly crowded places, but other than that I have been trying to participate in as much of outdoor activities as one can do with crutches. Trips to the lake, meeting with friends, outdoor movies, outdoor reading, chores, etc.



PHYSICAL THERAPY (PT)
I also had my first PT session at the beginning of week 7. It was a consultation session that took a bit longer than normal sessions will from now on. My therapist took my range of motion measurements of both of my feet, massaged the tissue in my calf manually and with a stainless steel instrument (IASTM CFM: instrument assisted soft tissue mobilization, cross fiber massage). That felt good. My husband also was told to massage my foot for 5 minutes a day to massage the accumulating liquid up. I wish the therapist specified 15 minutes instead. ;) Other than that I was given few exercises for ankle strengthening: isometric angle inversion/eversion, toe towel scrunches and toe presses. Additionally, I got couple of exercises for hips and back of legs/back with the ball. I was scheduled for 1 session a week for the next 2 weeks and then 2 sessions per week for the 4 weeks after that.



So, week 6 and 7 were definitely eventful as far as recovery. The next 2 weeks should not bring that much new as I am supposed to stay FWB in the boot and do similar PT. My next doctor’s appointment is 2 weeks from now. I will update the progress then.


The guys that are already ahead in the recovery are not joking. Things do speed up after the initial few weeks, so patience is definitely a key!


Hope everyone’s recovery is going well!


HERE IS VIDEO REVIEW OF THESE 2 WEEKS:



These past 2 weeks have been pretty good. In week 2 and 3 I got used to crutches and iWalk2.0. I also gained confidence in going out on both of them.


Week 4 started with the 4th of July weekend - Independence weekend in USA. I decided not to hold back that weekend. I mowed part of our lawn wearing iWalk2.0, ran some errands with my hubby and brother (I will need drivers for a while), hung out few times with friends from out of town, and went to a 4th of July party. The reason for writing about all of these is that if you are going through ATR and are in early weeks - things do get easier pretty quickly. I am still in the beginning of my treatment, but life is already becoming more normal.

MOWING LAWN ON IWALK 2.0 :)



I was still non weight bearing (NWB), however I started applying pressure on my injured hill while wearing the boot. I was still wearing the boot at all times even in the shower (using a bag over the boot). My boot was set at about 25 degrees plantar flexion. I also noticed that my leg did not swell as quickly as in previous weeks. I could keep it down much longer during the day. On busy days when I did not get a chance to elevate much, it swelled quite a bit, but some icing and elevation in the evenings helped with that. Another thing is the bruising I have on my heel. It is not from the impact of the injury, but it’s a blood that dripped from the rupture site to the heel. It is definitely getting smaller.

4 AND 6 WEEK HEEL COMPARISON



I was told to do range of motion (ROM) exercises for 5 minutes every hour. This has been the best part of the last 2 weeks. I did these exercises about 8-9 times a day. By the end of week 5, while doing ROM exercises and holding my tendon I can feel it being pulled and its thickness feels closer to the healthy one. Hubby suggested to remove sock while doing ROM exercises and it does makes it more enjoyable for the foot. The leg is cooked up in the boot for 24 hrs, so any freedom feels good. :) I started feeling tingly in my toes and on top of my foot in the last couple of weeks. I am not sure if that’s because the foot is in the boot for such extended period of time. Massaging with some lotion helps with that, however.


ROM EXERCISES



I am continuing with my NWB workouts almost daily, which is helping me stay in the same shape as before the injury. It definitely lifts my spirit and gives me more energy for everything else during the day. That’s something I would recommend to everyone. I just make sure to tighten my boot more, so that my injured foot does not move as I lift it. I think I got most of the strengthening exercises down, but having issues bringing my heart rate up with only one leg to use. Some yoga balance exercises help with that. I also have been attempting one legged burpees and one legged jumps and that gets me out of breath quickly, but I cannot do many yet with one leg only. Will be working on these to break down some sweat.


Today I had my 5 week doctor’s check up and it went great! I am in a week 4 in my protocol. The doctor liked how my tendon feels and looks. He was really happy with the healing progress. There is not gap. Thompson Test yielded some movement in my foot, but I was told that this test will be more conclusive at the 3 month mark. I was told ultrasound or MRI will not show much at this point as collagen does not show up that well on these. My boot was moved to neutral position and 1 wedge was added (equivalent to 10 degrees). I was moved to partial weight bearing (PWB) in a boot (yay!!!). I am supposed to start with 45lbs of pressure while using crutches. In 2 weeks I am supposed to remove the wedge, moving me into neutral, and start weight bearing as tolerated. I am supposed to continue with my ROM exercises. I was cleared to do stationary biking while wearing a boot as well. I will update in couple of weeks on my progress of PWB! My right calf, on the other hand, is definitely missing some muscles!

WEEK 5 CALF ATROPHY



For everyone just starting out, I can say from my weeks 4 and 5 that it did get easier for sure. I feel as a lot of it is in the mind. Once you get used to the new situation and have systems in place, the rest sort of happens and time passed by faster. So, be patient and happy healing! :)



HERE IS MY VLOG FROM WEEK 4 AND 5:






It’s been 3 weeks since my rupture and 2 weeks since my non-operative treatment began. The last 2 weeks have been pretty much an adjustment period and I have to say I am now getting used to this one legged situation. Everything now seems easier and I do not really have any complaints (well, except that I am short of one leg!).


LEG’S STATE

I don’t have any pain and have not been taking any meds. I do feel swelling after some time of being on crutches, or on my iWalk, or even sitting with my leg down, but elevation of the leg always helps. I basically always have to plan: after some period of activity I needed to elevate for a bit. I am also icing in the evenings. I was not supposed to remove my boot at all except for spot cleaning my foot, so I was icing inside of my boot. I was unstrapping couple of boot straps and placing the ice bag inside of the boot. This way I complied with doctor’s orders and got some swelling down. :)


SLEEPING

The sleeping has became easier as well. Try sleeping in a boot that resembles a ski boot with covers on top of it! I remember in week one I did not sleep soundly even one night with the weight of the covers on the boot waking me up constantly. I solved the problem. Since my injured leg is on the right, hubby and I swapped places where we sleep. Now I sleep with the injured leg on the outside of the bed. That way I can cover myself with covers completely except the injured leg. That helped me a lot with sleeping. No more waking up with the boot tangled in the covers!


WORKING OUT

I also have been working out quite a bit. Since week 1 I was exploring all the exercises I know, picking out the ones that do not use both legs and trying to adapt them to non-weight bearing on one leg. It has been so good to move. It gives me more energy and I do not feel as tired from all this hopping around on one leg. It also feels amazing to move my upper body, since there is so much sitting/elevating involved in the first 2 weeks. Another thing I am still a bit worried about is muscles atrophy. My calf muscles in my injured leg will disappear. I cannot help it, but I am trying to work on my injured upper leg muscles. That way when I start walking again I do not have to worry about my upper leg muscles as well as my calf rehab. Below are few examples of my NWB workouts.


GETTING OUT

At the end of week 2 I ventured out a little. A friend of mine had a baby shower and it was with females only and no kids, so I decided to make it my social debut on crutches/iWalk. I am glad I brought both of my “toys” with me as the house the baby shower was held at had a steep staircase. iWalk was amazing help with that! It is so easy to use it on the stairs. Also, going down the stairs, it is so easy to go backwards on iWalk! It was a tip in their manual that I ignored initially, but it came in handy on a narrow stairway. Now I only go backwards when going downstairs. It also is much easier to stand on iWalk in social situations. I could actually hold my plate and stand with free hands. I still had friends helping me with this and that, since I am slower, but I did not feel too handicapped on it! :) It was definitely good to finally dress in something else than shorts/t-shirt. That’s good for mind’s healing. ;)

Also, last weekend we did some yard work. Yep, I said we! My hubby picked up my yard mowing, but I managed giving it a go as well. It was actually not bad on the iWalk. Holding the lawn mower for support definitely helped. I also did a little bit of weeding and flower trimming. When walking on iWalk on uneven grass you definitely need to be careful, but I was able to do it slowly.


CRUTCHES

As far as crutches go, I got some crutches covers in week 2. These were very helpful to me. After week one on the original crutch handles I felt bruised on my upper ribs and my thumbs were hurting. Since I used the padding all is good and crutches became my better friends. I would recommend everyone to get some covers in your week one before the pain sets in. I also became more handy at carrying some things with crutches. Nothing though beats iWalk for carrying things around! I love that thing, can’t you tell. ;)


2 WEEK DOCTOR’S CHECKUP

And on a final note, I saw my orthopedic doctor today. 2 week check up (3 weeks since rupture). It went well. My foot is now more comfortably moving up and down in plantar flexion. My boot has been adjusted from 35 degrees to 25 degrees plantar flexion. I was also told to do range of motion (ROM) exercises. My protocol states 5 minutes of exercises outside of the boot every hour, but the doctor stated few times a day is fine. I will have it in my next update how did my schedule look like with the foot ROM exercises. I am really excited to move my foot even a bit. I am still NWB for the next couple of weeks. I can set my foot on the floor in a boot though and put a bit of pressure on it. Not quite PWB yet. I was told ROM is the most important at the moment to help with the healing of the tendon. My next check up is in 2 weeks.


CALF ATROPHY

Below is my calf comparison to show the atrophy that happened just in 3 weeks. My calf shrunk 1 inch! My right calf has always been about 0.5 inch thicker than my left one and now my left calf is 0.5 inch thicker than the right one! That was fast…

RIGHT CALF ATROPHY:  1 INCH SMALLER!!!


So here we go, on to the next part of healing! :)

Hope everyone’s calves are healing well!!!




HERE IS MY VLOG FROM WEEK 2 AND 3:






Well, what a week it has been! I think everyone that had something new and major happen to their body knows what I mean. The worst part for me during week 1 was the stress of the decision whether to operate or go with the non-operative route.


Thursday and Friday after my Wednesday night rupture were interesting to say the least. I found out that crutches are VERY limiting. You cannot carry anything!!! That means you hobble to whatever place you are at and you do things there if you need to use hands. Kitchen counters help as you can slide things to different parts of the kitchen and hop on one leg around. This is very limiting though…. I will write up few tips on using crutches that worked for me and also some equipment recommendations for first few weeks soon.


So, my first 2 days were basically spent in bed with my leg elevated. Eating had to happen at the kitchen counter, since I was not able to move anything while on crutches. Hubby’s help in the evenings was well needed and appreciated after all the hopping around during the day. I felt so tired not knowing what I did to be so tired!


On Saturday I finally received iWalk 2.0 - a pretty awesome invention I now call My Leg! I cried happy tears when I put it on and could walk and use my arms. I felt like a free person again! :) I cannot believe I was excited to do the dishes… Something…

FIRST STEPS IN IWALK2.0 WHILE EATING FRUIT!!!

I’M WALKING (sort of)! :)

Now, that I figured out how to move, there was a bigger issue on hand: the decision of surgery or not.


I saw a first orthopedic doctor on Friday (2 days post rupture). Doc#1 examined me, did Thompson test and confirmed ATR. She explained surgical and non-surgical options with the standard answers that active, healthy people usually get surgery. Surgery has its risks. Non-surgical option was also available, if I wanted, but that re-rupture rates are higher with it. My husband did a little research on ATR by then and asked about the latest studies on non-surgical treatments and their success rates. She acknowledged these, but stated that these are not conclusive yet to be a standard. We then saw a surgeon that works with Doc#1 and he confirmed everything Doc#1 said. I was not pushed by them to go one way or the other. They basically laid down all the facts and said to take couple of days to think about it and let them know what we choose. They spent a lot of time with us, answered all the questions we had and said that we cannot make a wrong choice. Both options can be applied successfully. Doc#1 changed my cast for a boot with a 20 degree toe decline. I felt so much more comfortable in it than in the cast. I was allowed to remove the boot for the shower and icing only. I was ordered to be non weigh bearing (NWB).

MY BOOT AFTER CAST REMOVAL (20 DEGREES TOES DECLINE)

We spent the next 3 days researching everything we could find on surgical and non surgical options. We read a lot of medical studies, websites and blogs. I joined ATR facebook group and got some good perspectives there too. AchillesBlog.com was so helpful as well with all the resources! I think I will provide a separate tab on my blog for resources I used, since there are so many. My head was spinning from all the information. At the end of it I saw quite a few success stories with non-surgical approach in athletic persons that I was very interested in that option.


We had a Tuesday appointment (6 days post rupture) with a second orthopedic surgeon, recommended to us by Emergency Room. We were hoping that something gets clarified in our heads during that visit. Well, we were wrong… Doc#2 was not interested in anything other than surgery with 6 weeks of no movement and a very conservative PT. I asked about early weight bearing and non-surgical studies that show success and he dismissed these. According to Doc#2 there is consensus in medical community that active young people get surgery. I asked what did he think about the risks of the surgery and he dismissed them saying that I should not worry about that if he does the surgery. Well, we felt pretty informed after our research and I knew that what Doc#2 was saying was not wholly representing the facts out there. The risks of surgery are real and the studies are real as well. I knew in my heart right then that this is not a doctor for me, as we were not even able to have an educated conversation with him. I am sure he is a great surgeon and has a high success rate, but I did not like the approach of “my way or a highway”. Doc#2 did spend quite a lot of time with us, we did not feel rushed, but all the conversations were about the surgery he performed and questions about any other approach were shut down. Doc#2 basically stated if I want non-op, or different post surgery protocol, to go somewhere else. He scheduled us for a surgery 3 days from then, just in case and said to call and cancel if we change our mind.


Third opinion. We got a recommendations from my husband’s work contact about another orthopedic doctor. We were trying to get an appointment with him for a week and finally managed it for Thursday (8 days post rupture). When we saw Doc#3, we felt at ease immediately. He seemed informed in different treatment strategies around the world, did not dismiss anything and himself stated facts from the latest studies. We felt like we could exchange information we read and get his opinions on them. Doc#3 stated that they had surgeon from New Zealand in the past and he was treating athletes in non-operative way, because that was the direction he knew from New Zealand. He stated that if I was back in Europe than I would probably not have a surgery with my case, but even that depended on a country. He also admitted that in the USA the current approach is still to cut if you are healthy and active. On the other hand he confirmed that the new studies show that there is similar recovery rate with non-operative treatment for active persons. Doc#3 treated athletes this way as well in the past. Ok, we finally felt like we met a doctor that knew both sides. I asked about recommendation on imaging for non-op (something I read in one of the no-op studies). He stated he can do an ultrasound right now regardless of our the choice. Before I knew it, I was on my belly and my hubby was seeing my rupture on the screen. It confirmed full rupture with minimal gap and all looked good for healing either way. I was comforted by it. Doc#3 also looked at my foot’s natural bend and stated that maybe bigger angle of the boot was needed. I confirmed that current boot angle feels like it pushes my toes up a bit. My boot was reset to about 35 degrees (somewhere between 30 and 45 degrees - hard to read). Basically the doc asked the person adjusting to align the angle with my foot’s natural hanging angle.

35 DEGREE PLANTAR FLEXION - FIRST 2 WEEKS OF TREATMENT (WEEK 2/3 POST RUPTURE)


At the end of the visit we spoke about the treatment protocol and I was told that in the next 4 weeks the angle of my toes pointing down is the most important. In the non-surgical treatment connective tissue will need to grow to connect the ends of the tendon. The downward toes angle is there for the ruptured parts to be as close to each other as possible, thus preventing creation of too much connective tissue. More connective tissue = weaker tendon and possibly too long tendon after healing. I was also told not to take off my boot at all except for spot cleaning my foot and changing the sock. I was instructed to not take the boot off for the shower, but just use bag over my boot. This made sense to me, as during the previous week, I felt the most vulnerable during the shower with my foot hanging and in risk of being injured further. Remember, that if you do not have surgery, any movement of toes up risks rupturing whatever healed already.


We were so happy after the visit. I immediately cancelled the scheduled surgery and appointments with Doc#2. I felt like the stress of last week drained all my energy I was supposed to use for healing! I was not stressing about the surgery itself - if I was told I need one, I would do it immediately, no problem. What was keeping me awake at night was the decision about the best approach for me and my case. If the latest studies show that there is not much difference in recovery with the non-operative approach for athletic people, I just do not see the need to risk the complications from surgery. I have it in my head that if I re-rupture, I will probably decide to go for surgery then, but I decided to worry about it only if I have to. For now, I am fully concentrating on the non-op approach.


I have appointment with Doc#3 in 2 weeks. I am supposed to be NWB for 2 weeks and to elevate my foot as much as possible. Btw, Doc#3 was also the only one who knew about iWalk 2.0, which made me see that even in this aspect he was aware of the latest things available out there.


So here it is, the beginning of my non-operative journey to recovery! :)


My advise to all new ATR patients would be to not be afraid of seeing multiple doctors and getting few opinions. There is no one right way that fits all, because every person and injury is different. What matters is to do solid research to know YOUR options and not only the options that the particular physician practices. Choose a doctor and treatment track YOU are comfortable with. It’s not easy. I do not know about other medical fields, but unfortunately ATR medical community does not have a unified view on treatment plan. What one doctor practices and swears by, another will not think about and will even criticize. I found it strange and confusing, but I am glad my decision is made and I feel good about it!


Now, back to healing that leg! :)




HERE IS MY VLOG FROM WEEK 1:






Wednesday, June 8th, 2015 - it was my last day of blissful ignorance about achilles tendon rupture (ATR)….

MY EMERGENCY ROOM CAST

MY EMERGENCY ROOM CAST - AFTER REMOVAL

I am in the middle of house construction projects and that day I was painting our laundry room. I knew I had to work fast, because I had pickleball meetup in the evening. Not a biggie. I primed and painted the room, including acrobatic acts of doing so behind the water heater and furnace. I cleaned up in time for our pickleball.


It was my second time playing pickleball and my hubby and I just got new paddles, so it was exciting. For those that never heard of pickleball, it is a fast growing sport that is a combination of tennis, badminton and table tennis. It does not require as much running as tennis, but it is still very fast and requires sudden movements and quick changes of direction. So even though I was not running much, there was a lot of pushing off happening, just like in tennis. I never gave it a second thought while playing, however. I have played a lot of tennis and racquetball, so pickleball was no different. That is until I was either receiving a serve, or serving (cannot even remember now) and pushed off my right foot. It was not even anything very quick, or dynamic.


I suddenly heard this loud pop and felt as if someone hit me with a bat on the back of my lower right calf. I collapsed on the court and was in a really bad pain. I was really confused with what happened and was waiting in agony for the pain to stop. The sharp pain stopped a little bit after couple of minutes, but I had this weird numb feeling in my foot that I never felt before. I could not walk as my foot felt like jello. My playing teammates helped me hop off the court and later to the car.


My hubby drove me straight to the emergency room, where the doctor performed Thompson test, which is basically squeezing of the calf muscles and observing if the foot moves. Well, my injured foot was not moving, which I was told, is consistent with achilles tendon rupture. I was referred to orthopedic surgeon and informed that I probably need a surgery. My leg was placed in a half cast (hardened cast in the back of my foot and bandaged to my leg for stability). I was given Hydrocodone pill and prescriptions for crutches and more drugs. I was told to see the surgeon in the next 5-7 days. In the meantime I was ordered to place no weight on the injured foot.


I was in a little bit of a shock, but I hanged on to the word “PROBABLY” in: “you will probably need a surgery” and decided to worry about it when I get to the surgeon. For the moment I just wanted my crutches and bed! We went to 24hr pharmacy and my hubby got my drugs and crutches. While waiting in the car I found out that there is this crutch that looks like a leg and your life would not be so bad with it. That made me more relaxed to see that I am not doomed to be stuck in bed. Yep, that was the first thing that I was worried about after my injury. Being very active, bed rest for few weeks sounded like a death sentence at that moment.


I went to sleep having no idea about what my next year would be like….