FHL Tendon Transfer - Status 28 Weeks Post-op

Quick summary. I’m 63 years old. I had an FHL tendon transfer to replace my left Achilles Tendon, which I shredded beyond repair. I continued to exercise and climb for the seven months prior to having my surgery on November 20, 2015.  My recovery was extremely fast, which I attribute to my great surgeon and the fact that I had already learned to stabilize my foot with the very tendon which was used as my replacement AT.  I got instructions from the PT’s and did the rehab on my own, twice a day, seven days a week. Basically I trained the shit out of it. I was walking in 7 weeks and out of the boot in 8.

I used the IWalk, instead of the stupid scooter. The IWalk  is advertised on the front page of this blog.  The IWALKFREE Rocks! Other than the inconvenience of having to put the thing on, it was like walking. I could pretty much do anything. And, an added bonus, it was the ultimate attention getting device. 

And here I am, 7 months post-op. The war is over. Now it’s time to win the peace.

I’m back to training full time (hiking with weight, weight lifting) and climbing without restrictions. I am continuing to wear a lace up brace when I climb to avoid any kind of impact injury due to a fall. After climbing for seven months without an AT it is a real pleasure to have one again. I am much faster.

I can handle full body weight while on the ball of my left foot. And … I can run again. Whee!

The residual pain I was getting in my heel from the screw (used to anchor my FHL tendon) is gone. I have a little remaining swelling, which I treat with ice when it gets obvious. My replacement Achilles gets quite sore following calf specific strength exercises. My calf strength measured by doing calf raises seems equal with my right foot.

Perfection?  Not exactly. The diameter of my left calf has continued to shrink and now it’s down to about 1 full inch less than the right. Meaning it’s ugly and I’m losing style points. This gradual reduction in size is probably the result of muscle atrophy that occurred during the seven months the Achilles was ruptured combined with the muscle contracting. The degree of calf muscle shrinkage didn’t become obvious until it began to stretch out after it was reconnected. As my strength seems good, I’m equating the smaller size with probably less muscle endurance and a reduced margin for error.

I’ll give the training 5 months reacquire my original calf size and then declare victory.

I nailed the route. If you are thinking of doing an AT repair and have any questions or problems, email me.  amountainclimber@hotmail.com

FHL Tendon Transfer - Status 18 Weeks Post-op


I am 63 years old.  I climb mountains.  Yes, I am insane.

I wrote off my AT (a total loss) a year ago, March 2015.  Got my surgery on November 20, 2015. As I had no AT left to fix, my surgery was an FHL tendon transfer.

I was out of the cast in two weeks and walking in 10 weeks. I did a ton of research, did some work with PT’s but I have rehabbed this mostly on my own.  I have detailed the rehab program I used in my previous posts.

How did a 63 year old guy progress so quickly?  Yes, I worked at it, but I also cheated.

By continuing to climb after rupturing my AT, I learned to adapt my FHL muscle and tendon (the ones that works your big toe) to stabilize my foot in absence of having an AT.  The FHL tendon goes down the tibia, does a 90 degree turn and attaches to a tendon bundle near the arch.  For a FHL tendon transfer, the doctor snips the tendon above the bundle, drills a hole in your heal, and then anchors the tendon there with a screw. Then he attaches the calf muscles (and what’s left of the AT) to the transferred tendon.  For me, because I had already adapted this tendon and muscle to stabilize my foot, the operation had the wonderful effect of improving the lever arm.

The ultimate result was, after 9 months of strengthening my FHL tendon and muscle prior to the surgery,  my ability to control my foot post-op was abnormally advanced.


It was time to do something stupid and take my new AT out for a serious road test. Well, maybe more that a test, we would climb an actual mountain.

Mt. Gould is directly west of Lone Pine, CA in the eastern Sierras. It is a 13,000 foot peak directly north of Kearsarge pass.  Most of the route would be on snow, so we brought Ice Axes, Crampons and Snow Shoes.

I decided to wear my Salewa Mountain Trainer mid-height gore-tex boots. To add additional protection for my repaired AT,  under the boot I wore my McDavid Classic Lightweight Laced Ankle Brace, which holds the ankle in a slightly extended position and would restrict the movement of my ankle if I messed up.  The brace is THE BEST, extending from 6 inches above the heal to mid-foot, with laces the full length so you can adjust the fit easily. I wear it over my thick climbing socks. It’s $30 on Amazon.

I also brought along a large zip lock plastic bag, so that I could take my boot off, fill the bag with snow, and ice my ankle if I had any issues with pain or swelling.   With all my winter gear my backpack weighted about 3o lbs.


The good news about walking on snow, is that it is mostly soft, which is easier on the feet in general, and was easier on my new AT. No rocks or pounding.

The bad news about walking on snow, is that latter in the day, on the way down, the snow gets soft, which means eventually doing something called a “post hole” where you step on snow which seems firm, and then, suddenly, the firm surface breaks, and your foot and leg drop painfully, so you end up with one leg thigh deep in snow.  This can do all sorts of horrible things to your ankle, even if it is at full strength. But that is something to worry about on the trip down…


The trip up was great.  The highlight was climbing to the top of a 1000 foot snow gully with about a 40 degree pitch by kicking steps in the snow with our crampons.  I had full control of my left foot and my left calf was sufficiently strong enough (supported by the boot and the brace).  In general, traveling uphill was good.  My ankle flexibility had improved enough so that I only felt mild stretching in my new AT and my calf didn’t cramp like it had done two weeks previously.


Downhill, well, that was pretty interesting.  Pick the problem you want to have.  To avoid doing the post hole, we wore snow shoes. I hate snow shoes. Big, flat, long things attached loosely to your feet.  Talk about tripping over your own foot…

Now, if you have been doing PT, you might be familiar with a stability exercise where you stand on one foot (controlled by your new AT)  on a rubber disk, and then you bend over and extend your hand out in front, while your leg wobbles around.  Twenty on each side right?  Walking downhill using snow shoes is EXACTLY like doing that, for, like, three hours.


During the climb I felt some mild tightness in the AT but no pain.  It was a remarkable improvement over climbing without an AT (which I did all last year).

The following day I had mild tingling around my heal and mild soreness in my calf.

There is only one conclusion to be drawn…


I am back.

If you have any questions you can reach me on twitter @aMtnClimber

FHL Tendon Transfer - Rehab 3

Well, I forgot to log my last visit to the doctor on February 6 at 10 weeks post-op.  The doctor spent about 10 minutes testing the strength of my new Achilles.  Then he had to confirm my surgery date because he couldn’t believe I was only at 11 weeks.  In summary he said I was months ahead of schedule and that I didn’t need any further follow ups.  His comment was “Don’t do anything crazy.” We scheduled a visit with his office’s PT staff to do an evaluation.

On Sunday, February 7 I did my first hike, 7 miles round trip, 2,200 ft vertical gain, with no problems, but it is mostly just a dirt road.

During my visit to PT they had me walk to check my gate and couldn’t figure out which foot had been operated on… so no problem there.  I received a combination of massage and electro-stym therapy in order to reduce the remaining swelling, which was due to hematoma related to the surgery which had hardened in place.

I continued my twice a day home physical therapy, with some balance work suggested by the PT’s, and visited the PT’s office three times a week for a two week period while they helped to resolve the residual swelling.  I added twice a week hikes.

On Sunday, February 27, at 13 weeks post-op, I climbed Strawberry Peak, an 11 mile round trip with 2 short class 3 rock sections and about 3,500 feet of vertical.

On Sunday, March 20, at 16 weeks post-op, I did my first trip back to the Sierras, a snow climb up the Tuttle Creek drainage just west of Lone Pine, CA.  We turned around at the 6 hour mark as I was experiencing some tingling and mild pain. The snow started to get soft and post holing with my left foot really sucked.  Following the “Don’t do anything stupid” rule.  I wore a full height boot with a lace up brace to guard against rolling the ankle or a rapid flexion, the typical result from post holing.

So, where am I?

My left calf is about 1 inch smaller than the right calf.  I can elevate onto my toes with both feet. I can’t elevate using just my left foot, but I can support my weight on the ball of my left foot, which makes climbing possible.  The process of getting my left calf back to full strength is going to take quite a while.  As I ruptured my AT in March of 2015, and only began using my left calf normally 10 months later, the general rule of thumb is that it takes as long to get it back as it did to lose it.  Which means 10 months.  But I can rehab it by climbing, and that works for me.

As far as advise I can offer, here’s a list of what worked for me.

  1. Get in the pool.  I did 3-4 days a week. Half and half, swimming and kicking with a kick board. Circulation is good for healing.
  2. Do the rehab yourself, every fucking day, assuming you see a PT get a protocol from them. When you have your ass parked on the couch watching TV, that is a good time to do the boring elastic band work.
  3. Have your PT teach you how to massage it yourself.  It reduces swelling, which is something you want.
  4. Ice is fucking magic.  I got 3 large blue gel packs and iced my Achilles before and after any exercise, at least 4 times a day. If it starts to hurt, ice it.
  5. When you are out of the boot and ready to walk, then WALK.  Get some high top boots, a set of walking poles and take up hiking.
  6. To strengthen your calf muscle don’t rely on just the rehab exercises, do your hiking with a backpack and gradually, over time, add weight.  I use bags of cat litter.
  7. Accept the reality that it is going to hurt.
  8. DO NOT USE OPIATE pain killers.  I got my doctor to prescribe Celebrex. It is way easier on the gut than alieve or ibuprofren.

FHL Tendon Transfer - Rehab 2


It has been exactly ten weeks since my surgery.  I’m done with the boot two weeks ahead of schedule.

Recap> As you may recall, I am 62 years old, I wrote-off my Achilles tendon, so I had an FHL Tendon transfer to repair the rupture.  The FHL tendon connects your big toe to the FHL muscle in the calf.  The doctor snips the tendon, drills a hole in your heal bone,  stuffs the tendon in there, and uses a screw to anchor it.  I climbed for six months with the rupture and adapted my FHL tendon and muscle to stabilize my foot. Since I was already using it, the tendon relocation simply gave me a better lever arm and the use of the rest of my calf muscle.

The doctor said 2 weeks in the boot progressing from 20% to 100% weight bearing.  Then 2 weeks no boot, progressing from 20% to 100% weight bearing.  My flexibility and strength were excellent so he said not to bother with a heal wedge.

I was full weight bearing in the boot in a day.  All too easy.  Then I experimented with no boot. Also easy, no problem, but limited stability, so I went for a hybrid. No boot in the house and a boot out in the world where there was more risk.  After a week of that, walking without the boot was easier that walking with the boot, so I parked the boot.

I am still on twice a day rehab.  Bands, massage and ice.  I’ve added partial weight bearing raise on toes, and then full weight bearing isometric foot extensions, holding my body weight up on my toes.  I’ve had some muscle soreness in my calf and some mild tingling on the surface of my inner heal.  While walking I feel tightness in my calf just below the knee when I try to extend my stride.  I’m still avoiding doing any direct stretching of my new AT/FHL hybrid. I’ve had no problems with my gate, other than a slightly shorter stride length. I’m quickly re-adapting to having use of my calf muscle again and can roll forward onto the ball of my left foot as I walk.

Anything involving putting full body weight on the ball of my left foot it still totally out of the question. The strength and stability isn’t there.  But its just been 10 weeks and I am way, way ahead of schedule.

How does my foot look?  Almost normal. Swelling is almost gone. My AT/FHL hybrid is fatter that the original and I still have a slight indentation where the original AT resided.  My scar is almost invisible.  Swelling during extended periods of sitting has subsided dramatically.  Its all good.

I’ll do my next post after the doctor takes a look in two weeks.  I plan on asking for a PT appointment so I can have my progress evaluated.

FHL Tendon Transfer - Rehab


It has been exactly eight weeks since my surgery.  I have been in the boot for four weeks.

As you may recall, I am 62 years old, I wrote-off my Achilles tendon, so I had an FHL Tendon transfer to repair the rupture.  The FHL tendon connects your big toe to the FHL muscle in the calf.  The doctor snips the tendon, drills a hole in your heal bone,  stuffs the tendon in there, and uses a screw to anchor it.  Exactly, I’ll never dance point again. :)


I tried out the scooter and hated it.  Stairs and cars blow. And little bumps.  Those little wafer front tires, I almost went over the handle bars when I hit the transition from tile to wood going from the living room to the kitchen.


To work, home, stairs, in and out of the car, plus there is one amazing bonus.  The IWalk is a world class attention getting device. Wear it to a party and you’ll see.

Because I’m insane, I looked at the IWALK and said, “Is there something stupid I can do on this?”   I did two long hikes using the IWALK. Four hours is about the max for a hike. After that, shin and knee chafe on the platform got pretty intolerable.

Both hikes covered about 10 miles round trip and about 2000 vertical feet.  I got video and which I will post on the IWalk Facebook page when they get over the fact that I used my hiking poles.  They are afraid people will think that poles are always needed.  THEY ARE NOT, OKAY.  I use poles when I hike with two perfectly good legs.  I have lousy balance. Without them I tip over. For normal walking around on the IWalk, not even 62 year old me with crappy balance needed any help.

My big IWalk hiking discovery was that in order to walk uphill using the IWalk, you need to loosen the top thigh strap so you can articulate the leg. You also need to adjust the leg length. Often.  On hikes the surface will tilt to one side or the other, and you you need to adjust the leg accordingly. I made the leg really short for steep downhills to avoid doing a face plant.


I visited the doctor at 1, 2, 4 and 7 weeks post-op. In summary that looked like this.

(1) Look at the wound. New cast. Change dressing.

(2) Cast to boot, remove stitches, meet with in-house physical therapist. Begin passive physical therapy. Toe and ankle movement.

(4) Evaluate strength, range of motion and healing of wound. Begin active physical therapy. No weight bearing. Strengthen calf.

Doctor said my rate of healing and acquisition of strength was very advanced.

(7) Evaluate strength, range of motion and healing of wound. Weight bearing in boot, 2 weeks, weight bearing no boot, 2 weeks.

Doctor tested the strength in my calf and his comment was something like, “I’ve never seen anything like this. Your range of motion, strength and level of healing, are amazing.”  Then he tested it again to be sure.

He said to walk in the boot for two weeks, gradually transitioning from 20% to full weight bearing. Then ditch the boot, and transition from 20% to full weight bearing. He said not to over do it.  I asked if I needed a heel wedge and he said not to bother.


So I went home, transitioned to full weight bearing in my boot in about three days, then did the same thing without the boot.  Now, when I’m home, I walk without the boot, When I leave the house, I walk with the boot.

I am pain free.  Almost.

Walking is weird. Not walking for six week makes a difference. The bottom of my foot isn’t flat, it’s round, so I feel like I’m walking on a squishy gel pad.  The only thing that hurts is my heal, where he drilled the hole. (they drill all the way through, when you watch a video, you can see the spinning drill bit come out the heal.)

My replacement AT is still tight, I intentionally avoided working the range of motion to avoid stretch the tendon.

In summary, I am walking, totally pain free, at 8 weeks post-op, and I am 62 years old.


(1) First, and most important, I cheated.

My rupture was in March, the surgery in November and in the interim I continued to climb.  In the process I was strengthening the FHL muscle and substituting my FHL tendon for my missing Achilles tendon.  When he relocated the FHL tendon, positioning it where the Achilles attaches, he simply improved the lever arm for the tendon and muscle I was already using.  When he attached what remained of my Achilles tendon to my FHL tendon, I regained use of my other calf muscles.

(2) Then there was the rehab.

I didn’t use a physical therapist.  Since I did it myself, instead of some sort of 2 or 3 day a week schedule, I did the rehab twice a day, seven days a week. This is what my rehab looked like:

Bands, ankle plantar flexion (extensions), 3 sets of 30 (gradually increasing the number of bands and the number of reps)

Seated, ankle plantar flexion (extensions) with a 1/4 inch heal lift, 3 sets of 30 , (adding pressure by leaning forward onto the knee)

Mixed bag of toe crunches, (grab something with your toes and drag it), ankle adduction and abduction (rotating your foot) against a band.

Scar tissue mobilization massage. About 10 minutes. I put my scar ointment on, then I do friction massage with my thumb along either side of the new AT, upward, in the direction of blood flow.  I also do friction massage, in the direction of blood flow, of any areas of my foot where there is swelling. If you can find someone to do it for you, GREAT.  My wife has weak thumbs.  It is her only weakness. I can live with that.

At the end I iced my entire ankle. Twenty minutes exactly. Not more, you’ll get fucking frostbite. I used a large blue gel pad, maybe 6×8 inches, with an ace bandage to hold it on.  The first few times you do this IT HURTS.  Suck it up. You get used to it.  ICE IS YOUR FRIEND.

(3) General Conditioning

I am swimming and lifting weights 5 days per week.


I don’t swim with the boot.  I do a little walking in the pool then I swim about 1000 yards, about a quarter of it is kicking.  The first four weeks were awful, not because of my foot, but because it’s been 20 years since I swam. My mind thinks I’m still a good swimmer but my body keeps saying, “you suck.”  Then, magically, about two weeks ago, it started to feel like swimming again.  I was actually able to do an interval set, 10 x 100’s @ 1:30.


2 days per weeks back and shoulders, 2 days per week arms and chest, 1 day per week legs


ICE IS YOUR FRIEND.  ICE, ICE AND MORE ICE.  I am repeating this for a reason.

4 time a day, at least, 20 minutes max

Opiates are procrastination. Pain sucks but when they wear off you haven’t moved the ball down the field.  Ice should be the first option. Then elevate your leg.

When I drive, I slap the ice pad on before I start the car.


Get in the fucking pool. 5 days a week if you can.  If you can’t swim, do both kicking and walking on the bottom with a foam float.

Unless, of course, you like suffering and an extended recovery.  Different things for different people.

I see the doctor in a month.  Next post then.

FHL Tendon Transfer

I ruptured my Achilles Tendon in March of 2015 while mountain climbing and had the surgery eight months later.  The rupture wasn’t anything interesting. I rolled my ankle at the bottom of a hill, twenty feet from my car, heard a gunshot and found myself laying on the ground.  Well, it wasn’t a gun shot, it was my Achilles snapping.  I am not some young stud. I’m 62 years old.  Mountain climbing is not “rock climbing,” as it involves high altitude hiking, boulder hopping, glacier travel, ice climbing, mixed climbing  (with crampons and ice ax) and some occasional rock climbing, all while attempting to get to the top of a big scary mountain.

Denial is an amazing thing.  I somehow ignored the gunshot and convinced myself that I had a bad ankle sprain, which I rehabilitated with ice and strengthening exercises.  I kept climbing, in the process discovering that I couldn’t extend my foot. I resolved this by wearing my high top mountaineering boots, with a pads around my left ankle so my foot was locked in a permanent L.

The swelling finally went down and at that time I noticed a big dent where my Achilles used to be.  This motivated me to visit the doctor and my denial was at an end. It was an interesting appointment. He did the Thompson test to confirm the rupture, but when he watched the range of motion I still had, and my ability to walk, his comment was, “How the hell are you doing that?”  He messed with it for a while and we concluded that I had learned to substitute the muscles and tendons used to plantar flex my foot for my missing Achilles.  At that point the question was, did I really need to get it fixed, being a man of my advanced years. Denial is an amazing thing. I want to do what I want to do, so I told him I wanted it all back.  I continued climbing while I went to war with my insurance company.  The surgery was finally performed on November 20, 2015 by Dr. Bob Baravarian, who is the head of Podiatric surgery at UCLA.

It turns out that I had damaged my Achilles tendon a number of times prior to the rupture. He said a normal tendon rupture looks like a box of spaghetti that has been snapped in half, my tendon looked like a box of spaghetti where none of the pieces were longer that a half inch. In other words, my Achilles tendon was a full write off.  He snipped my FHL tendon (it goes to the big toe) , drilled a hole in my heal bone, and anchored the tendon there with a screw. He then attached what was left of my Achilles tendon to my newly relocated FHL tendon.

Prior to the surgery, I found myself unable to accept that I wouldn’t be walking or hiking for six months. So I got on line, found this blog and on the front page was an advertisement for an iWalkFree, the hands free crutch, which I purchased before the surgery.

To give you a clear idea of how stubborn I can be. I did a three mile hike, using the iWalk, the day after my surgery.  At that time I discovered a couple of things.  My shin did not like resting on the edge of the cast while sitting on a platform, and the dam thing sucks at walking up hills.  I resolved both problems, but more about that later.

THE IWALKFREE IS FUCKING AWESOME!!!    I could go anywhere and do anything. The only downside is putting the thing on and taking it off. But, give it a few days. You get better at it. You will also acquire a huge appreciation for the process a person with a prosthetic goes through.  Do you need a crutch for balance?  NO.  Trust me, my balance SUCKS.  I carried a crutch around with me, as a crutch, but after three days I abandoned it.

IWALK TRICKS,  (1) make it slightly shorter that normal so you don’t trip over the toe,  (2) get a sheepskin pad for the base, (3) crank down the strap behind the knee, (4) make the top (thigh) strap loose when you need to go uphill, (5) stairs up - use the hand rail and pull, lead with the good leg, go two steps at a time.  (5) Down stairs - if you have two hand rails, use one leg hold the IWALK out of the way, No hand rails, Lead with the peg leg.

POST-OP PAIN. Well, my ankle was really painful before the operation.  So everything after the operation was an improvement.  I was handed a big bottle of Norco. None of which I needed.  Well, maybe recreationally…

I really couldn’t get much out of hiking, but Dr. Baravarian had provided me with a dry bag so I could take showers, so I decided to start swimming again.  I had been a swimmer in a previous life.  As in, twenty years ago.  Swimming  sucked! Twenty years is a really long time not to do something, but what the hell else was I going to do? Sit on the couch?

A week after the operation I went in for my first post-op appointment, got a new cast and was told to see a physical therapist.  I got on-line, researched the rehab protocols and decided I would rehab it myself.  A week later I cut the cast off, redressed the wound, replaced all the lumpy bandaging with a couple of thick climbing socks, which I split lengthwise so they would fit over my supersized foot, and put the cast back on using large ace bandages to hold it on.  This allowed me to start icing my foot.  A week later I went back, had the stitches taken out and got my cast exchanged for a boot.  They were very impressed by how rapidly my foot had recovered.

So, why the rapid recovery?  I’m old.  I’d guess it has something to do with what I did.

Ice, 4 times per day, 20 minutes per session. (way better than opiates)

Swimming - just the thing to maximize circulation

Anti-Inflammation - Celebrix (generic:celecoxib 200 mg), much easier on the gut than ibuprofen or aleve, 1 to 2 per day, as needed

Supplements, which I’m not a big believer in, unless the circumstances are unusual, which relocating your FHL tendon is, so…

Brand: Metagenics - Collagenics 2 pills twice per day, Inflavonoid Intensive Care,  1 pill twice per day, OmegaGenics SPM Active, 2 pills, twice per day.

Now it was time, LET THE REHAB BEGIN.