FHL Tendon Transfer - Rehab
STATUS
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. 
PRE-WEIGHT BEARING THINGS
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.
The IWALKFREE RULES
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.
DOCTOR VISITS
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.
NOW WHAT?
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.
HOW DID THIS HAPPEN?
(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.
Swimming
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.
Weights
2 days per weeks back and shoulders, 2 days per week arms and chest, 1 day per week legs
FINALLY
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.
CIRCULATION IS YOUR FRIEND.
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.
Filed under: Achilles Tendon Surgery - FHL Tendon Transfer and tagged FHL, ICE, IWALK, MASSAGE, POOL, REHABILITATION, SWIMMING, THERAPY, WEIGHTS
Your post made me smile - I like your fighting spirit and it sure is what will help ensure a speedy but safe recovery!
I don’t need to go over my story you can do that yourself on my blog, but my attitude was similar to yours and I can safely say that 19 months on ~ other than my calf still being very slightly smaller I or anyone else would never know what I had been through! I am back to all sport and outdoor adventures probably even more than before, have done some pretty tough challenges and the old Achilles has served me well. You def have to challenge the Achilles (safely) to make it all stronger, the stronger it gets the more you do.
I wish you and all other ATR’s well and a good recovery, it does take time but you will return to life as you knew it but with much more appreciation for your body and even more hunger to live a full and adventurous life!!!!
Take care all.
By mistake I posted a reply to you on Housemusic’s page… ah, but we are all the same community.
I love your spirit, and as a fellow 62 yr old who is aggressively recovering my freedom of movement, including dancing, I can only envy your having a pool and mountain trails to enjoy. Having returned to NYC 16 yrs ago, those activities are rare and prized events.
All I can say is just keep on having fun!
Manny
Manny. But you are in New York! You can walk everywhere! And there are places worth walking to!
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Pegleg. Thanks! A smile makes the whole journey worth while.
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True comment about places in NYC you can walk to, but then again, I miss my weekly visits to a mountain valley where I would relax, drink from the natural spring, pick an eat fruit, and use a machete to keep the trails open…
NYC is fine for walking, but I like the company of nature and wildlife when I need to relax.
On the other hand, I know I am not as brave and relilient as you are! LOL
Manny
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