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 JosuĂ© 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.

One Response to “11-month post surgery update”

  1. normofthenorth Says:

    I think everybody gets weaker as they lift their heel higher and higher off the floor. Even your uninjured leg, though you don’t notice it if you can easily lift your body weight to full height. The “leverage” of the ankle joint gets tougher and tougher as the foot moves more parallel to the leg. I’ve been left with a strength deficit that sounds fairly similar to yours on my left side (ATR #2, non-op), and I’ve returned to all my pre-injury activities including 4-on-4 competitive court volleyball, the one that tore the tendon. And I’ve been shocked that my diminished calf strength doesn’t seem to show up as diminished floor-defense agility or speed, or diminished vertical height at the net.

    That ankle does occasionally “feel funny” when I load it heavily, though not in the calf muscle or the AT area, more along the outside above the ankle bone. Nothing that slows down or shortens my volleyball marathons or my aggressive bicycling, but I do notice when I load it close to its diminished strength limit, usually while making some awkward misstep, and probably more often when I’m bushed. (It generally does NOT bother me at all when I jump or land or lunge or dive for the ball. Nor when I push hard to accelerate on my bike, though mounting my bike with my toes on the pedal can make it feel funny.)

    I’m still shocked how irrelevant to my fave activities that last bit of calf strength has been, at least for me. Obviously there’s a limit — and I think my soleus strength may be much better than my gastroc strength — but for me, a straining half-height 1-leg heel raise seems to be enough strength to “do the job” pretty well.