Ahnadlass’s AchillesBlog

It’s hard to believe it was about one year ago that I had the big operation to put back together my achilles tendon. I have come a long way and I am pretty positive about the aftermath and rehab. I think my calf muscle on the injured side is still slowly increasing in strength. I do hope the year mark will not be the end of my rehab progress, and I am still hopeful that eventually I will be able to do a heel raise, even just half of one.

I wanted to give a progress update 11 months after my second AT surgery. Note that your progress will likely be much better than mine as you won’t have the complications that I have had (see other posts for more).

Function, calf muscle, heel raises
I would say that my injured leg is at about 70-75% compared to pre-injury. I have returned to all gym activities, swimming, cycling, running, skiing, and snowboarding. I have not gone back to soccer yet, but that’s the sport in which I was injured so I am still thinking if and how I will do that again. I generally tend to favor my good leg, which I am trying to change. The strength and endurance is slowly coming back, but I am still missing a good part of my interior calf muscle. I understand that takes a long time to rebuild so I am hoping it is just a question of time. My heel raises on the injured side still are very poor - I can lift my heel off the ground but only about a third of the height compared to my good side. The weakness is especially noticeable at the top of my heel raise - basically I get progressively weaker as I plantar flex.

Exercises
In terms of specific rehab exercises, at home I have a mini-trampoline (rebounder) on which I do jumping exercises. I also use my electrical muscle stimulator a couple times per week on my calf muscles when I am watching TV or doing heel raises. At the gym, I do various balancing exercises, such as on one-leg with the medicine ball, or on the bosu ball upside down, strength exercises such as heel raises (fast and slow, one and two-legged on a step), toe-walking, jumping (jump rope, agility drills), and stretching such as squats, rolling ankles while standing or calf stretches. I have minimised the dorsiflexion stretches so that the tendon does not get too stretched. However, that has limited my dorsiflexion on the injured side. My PT has suggested lunges which I have just started doing. I took Josué Diaz’s recommendation from myachillesrupture.com, and bought a pair of the Vibram fivefinger shoes. I really like them for the gym and short running sessions.

Scar, appearance, sensation
My scar has really improved. I have been using a CICA-care gel patch at night which was recommended by my PT. The scar is noticeably lighter, and the PT reports that the skin is softer as well. I still have a small lump of tendon/scar tissue where the graft was done. This is unfortunate as it rubs on most business shoes that I have. So I tend to minimize my time in any shoe with a hard heel cup. Surprisingly, nearly all sensation has returned in my heel area. It had been numb for months, but has slowly returned.

Latest PT and Dr visits
I saw my surgeon about a month ago, and she was generally pleased with the progress. I had a lot of muscle atrophy on my injured side which will slow down my recovery. However, she also noted that the graft came from my gastroc muscle which might cause permanent strength loss. It seems a majority of people after the surgery suffer a diminution of strength and have difficulty with heel raises. She urged me to continue with PT and the various exercises. She recommended coming to see her next year as she might suggest a clean-up operation to take care of the lump/ scar tissue on my heel. I am still seeing my PT every couple of weeks, and she gives me some pointers about my gait, exercises to work on, and gives me some ultrasound and a massage. Unfortunately my insurance will only pay for a few more sessions so that will be ending in about a month.

The skiing in the big mountains went quite well. I didn’t notice my tendon much unless I ran unexpectedly into a mogul or a bump with my skis which would cause a quick dorsiflexion in my ankle. If that happened at high speed, the sudden stretching could be painful, so I avoided bumps and moguls. There was some late season powder, and skiing powder was not a problem except once when I fell forward in some real cement-like snow, and got a bit of a stretch. My lower leg was very tired by the end of each day especially on the last run of the day back to the village, and an ice pack felt really good for apres-ski. Overall, it was clear that I need to work more on my flexibility (especially dorsiflexion) and my calf strength. The good news is that after the ski trip I have noticed my calf on the injured side is stronger as I can do better calf raises now.

I had a short warm-up ski today at the local indoor place.   It was a surprise how little I felt my tendon or my calf while skiing.  It’s a small indoor place, and I skied for 2 hours.  No pain or other problems to report .  Very excited now for the Alps.

AT Rehab has settled into a routine now - concentrating on walking without a limp, visiting the PT every week or two, regular trips to the gym and regular stretching/exercise sessions at home with the stimulator.  I am quite happy that I bought the stimulator now.  I do think it helps to work the muscle, especially in my case where I lost a lot of muscle because of my first failed surgery.  For example now I am using it when I do heel raises, and it tires out my calf muscle quickly.  I am also still stimulating parts of the gluteus muscle on my injured side while doing exercises, because that muscle had also atrophied.

I am walking, going up and down stairs, etc much better now than before.  There is a lot less stiffness and pain in the AT.  Still battling a bit of numbness in the heel region, and stiffness when I have been sitting at my desk for long periods.   I haven’t been jogging yet, but that is my next goal.

I have a Swiss ski trip planned for Easter so that is another incentive to keep working.  Can’t wait to get out on the snow.  All the best to everyone - it should get much better.

Like a lot of people, I have been lax on updating my blog.  I went to 2-shoes and then started thinking of other things.  In my case, I found a new job and moved.  When I first interviewed at my new employer, I arrived on clutches (PWB).  Of course, they were loath to ask me what was the problem but I explained that it was an ATR.

For the last few weeks because of the move, I have not been able to follow a rehab plan other than packing and un-packing boxes, taking the dog for a walk and doing a quick electrical stimulation program.  Recently I found a new physical therapist, and she is concerned about my limp.  I am really trying to work on that now with various exercises - thinking about rhythm and knee and toe position etc.  The general weakness and lack of flexibility in the injured leg makes it especially difficult to walk with any speed, and to descend stairs.  What I also notice at this stage is that after an hour or two of sitting, my tendon becomes quite stiff.  Another minor problem is the painful heel rubbing that I get in snug-fitting shoes.  I took J Diaz’s advice (from myachillesrupture.com) and bought some Vibram five fingers shoes.  They are great for working on the walking exercises but they do rub the back of my heel.

Hi all, I am progressing slowly but surely.  This week my PT suggested that I buy a electrical muscle stimulator to help along my calf muscle rehab at home.  He said that at first the EMS (during or after exercises) can reverse the atrophy that has set in and then later can help build strength for heel raises. It also may help in terms of pain and soreness in the muscle.  Because of my series of operations, I have lost considerable muscle mass in my calf.  My PT added that in my case I could easily use the EMS for several months.

Has anyone tried this?  If so was it useful and what type of programs on the machine did they use to rebuild muscle? It seems EMS’s benefits is not completely clear, but it is certainly used a lot in physical therapy.

I saw my surgeon today for a check-up (everything is going well so far) and I got a copy of some photos she took during my surgery 6 weeks ago.  I thought some of you might like to see what a heavy-duty re-op surgery looks like.  As a reminder, this was an operation to fix an earlier failed surgery where my tendon did not grow back together properly.  As you can see, it was necessary to open up the entire tendon.  The first photo is taken after she had cleaned the tendon having excising the scar tissue, and it shows just the viable parts of the tendon.  You can see that there is a big chunk missing at the top of the photo near my heal, where the tendon had not healed properly.

Here’s a photo showing the points where she harvested graft strips from where the tendon meets the gastrocnemius muscle.  She then used these grafts to reinforce the lower part of the tendon.

And finally here’s the finished product showing everything sewn back together.

This is the week (between 4 and 5 weeks) that I am transitioning to full weight bearing, while still in my Vacoped at 15 degrees.  My surgeon’s protocol has me using one crutch on the opposite side to the boot.  It is feeling quite good except that I don’t have any endurance.

Here is a photo of my scar 3 weeks after surgery.  As this is my second operation, the surgeon had to harvest some bits of tendon from higher up and that is why the scar is so long.   Luckily, some people seem to think that scars are attractive.

http://evolvify.com/male-physical-attractiveness-part-ii-chicks-dig-scars/