Itching to run at 14 weeks

It’s 14 weeks for me today and I don’t have much to update since the last post.  Exercises continue as per my previous post and progression is slow but steady.  I’ll focus this post on the strange things that I’m experiencing that are different to previous weeks.

1) Itching! This is new for me.  It’s not just the scar which I would expect to itch and try to keep oiled and hydrated.  The itch is deeper and in the tissues.  Here’s a pic showing where it itches the most …

http://achillesblog.com/beanie/files/2015/12/achille-scar-14-weeks-itch-small.jpg

It also itches on the other side in the same area, and less frequently directly over the achilles along the bottom.  In the last few days I’ve been taking my knuckle and rubbing upward from the ankle on each side.  I’m pressing hard - it feels awesome and relieves the itch.  It’s very bumpy, especially on the inside of my leg, so hopefully I’m just pressing on swollen flesh and getting a bit of circulation like a physio would.  Hope I’m not doing any harm - it’s not painful to press, just helps to relieve the itch.

2) Dreaming of running!  So my leg is itching and my subconscious is itching to run :)  Throughout this injury I have had strange dreams.  Early days I’d dream of having to brake really hard to stop a car and wake up in a cold sweat that I’d actually pressed that hard in real life.  Once in the boot, I’d dream of things like putting the boot on the wrong leg and then walking off.  During this last week I keep dreaming of running in some form or another.  Mostly in the dreams I need to get somewhere fast or catch something, so I start running and then realise I shouldn’t be.  Last night I found myself analysing how I could prevent the sock rubbing on the scar while I ran and then realised (still in the dream) that the rubbing wasn’t the reason I couldn’t run yet.  Craziness!  But I guess it’s all a part of your mind and body coming to terms with where you’re at and trying to reinforce what you should and shouldn’t be doing.

3) Flip-flops (strops / thongs)!  These are not advised!  I understand why, they are unstable, don’t provide any support and if you misstep then you could twist the ankle with terrible results on your achilles.  But I’ve grown up in flops … I hike in them, I live in them, I love them.  And it’s hot in Australia right now, so wearing trainers all day is uncomfortable and irritating.  I usually toss the trainers and walk barefoot, but on a hard floor this got my heel a bit sore since my dorsiflexion is also quite bad. Soooooo, on the weekend I tried my croc flops which have a slight heel lift, and found that they are amazing to walk in!  I can’t decide whether it’s because when you wear flops you have to engage your toes to hold on and so that helps you to push off, or because I haven’t walked limping in my flops at all yet so my body just went on habit to walk normally when I put them on.  It’s probably more the 1st option, but whatever it is I can walk at a fast pace with absolutely no limp when I wear my croc flops!

Hope you’re all progressing out there and happy healing!

2m toe-walk at 13 weeks

I managed to walk on my toes unassisted and barefoot for 2m yesterday at exactly 13 weeks from surgery!  I was so ecstatic!  Walking on my toes again is something I only had pegged for 16 weeks or later.  I’ve been working at it fairly persistently and I succeeded in chest deep water at 12wks+3days.  Out of the water I’d progressed from holding with 2 hands, to holding with 1, to using my thumb and 2 fingers.  Last night I took the plunge, let go and wobbled along hands free.  What a feeling!  Holding yourself up on your toes seems like an excellent isometric calf exercise that is also practical which is why I’ve been so persistent at it.  I am paying for my exuberance a little today though.  My ankle is tighter and a bit more swollen and warm, I can’t walk quite as fast or stretch quite as far, and my calf is quite tired and a little muscle sore.  I’ll take it :)  I know I pushed a bit too much from the reaction, and I am not pushing at all today to compensate.  But I am still over the moon happy!

My report back for the week is that doing a lot of small sets of exercises as often as possible during the day is working!  At physio on Tuesday (12wks+6days) I managed to reach +1cm barefoot - in other words my toe was 1cm away from the wall and my knee managed to touch the wall with my heel on the ground.  Exactly 2 weeks before that I could only get -7cm, in other words my toe was touching the wall and my knee was 7cm away.  So 8cm in 2 weeks, and actually about 6cm in 1 week since in the first week I really didn’t get any better.  I only started improving when I made sure to balance, strengthen and dynamic stretch throughout the day.  I haven’t managed a +ve measure since physio, but I am hitting 0cm twice a day now and holding for 30sec.

For the most part the leg feels pretty good.  My walking pace has increased to about 4km/h outside (so some hills) but I am still wearing heel wedges to help my gait (thanks again Stuart!!).  I can feel the tendon almost all the way around, but I still have tight swollen flesh on each side just above the tendon.  The tendon itself rarely hurts, I can’t say that it hurts at all.  It feels like a steel cord!  The swollen sections above the tendon get uncomfortable and the muscles around the ankles and under the shin on the inside get pretty stiff and sore.  My calf is also starting to get a bit sore, which means … YES! there’s some calf muscle to get sore! :)

For anyone out there who’s interested to know what sort of exercises I’m doing for rehab:

Morning & Night:

  • 40 plantar slow back to neutral, 40 eversion, 40 inversion with a theraband
  • 3×20 seated heel raises, increasing weight on injured leg - I’m up to 12kg
  • 30 towel scrunches
  • 20 seated foot slides (stretch your bad foot out on the floor, then pull it back as far as possible to discomfort not pain, try to match your good foot - I’m far away)
  • 30 step forwards and then backwards on the injured leg, try get perfect form of heel-to-toe then toe-to-heel, keep hips aligned, don’t allow your ankle to roll inward (use mirror)
  • balancing on a pillow with perfect form (use mirror)
  • 30 marching steps with perfect form (use mirror)
  • 2 x 15 straight leg eccentric lowers (go up on good foot, shift weight to bad foot, come down really slowly on bad foot - I’m still supporting my weight with my hands on a table)
  • 2 x 15 bent leg eccentric lowers
  • 2 x 30 glute bridges
  • 1min straight leg calf stretch
  • 1min bent leg calf stretch
  • 1min toe flexor stretch (bend your toes up against the wall first then bend your knee over your toes)
  • 1min kneeling stretch (good knee on the ground, bad foot in front on the ground, lean forward into the bend on the bad foot)
  • knee-to-wall measure

Throughout the day (when I get up, I pick one and do 10 or so reps):

  • Squats (I like to squat to a chair and then stand up because my dorsiflexion is so bad at the moment)
  • Forward Lunges (I have to take tiny steps and can’t go deep, but these give me a bent stretch with weight on my toes as well as a straight calf stretch and are very dynamic as you move in and out)
  • Roll off my bad foot to tip-toe, my good foot in front, then back down slowly; repeat
  • Step onto my bad foot with a bent knee and weight on the ball of my foot, then push back onto the good foot; repeat
  • Standing straight leg calf raises
  • Standing bent leg calf raises
  • Standing straight leg calf raises with toes pointing outwards
  • Walking on my toes (supporting my weight along a counter with my arms)
  • Walking Lunges (basically just taking a step and pausing to stretch the back calf)
  • Standing with feet close together and just bending as far as I can and then standing back up
  • Balancing
  • Walking with balancing (stand for 5sec on each leg before stepping forward)

When I manage to get to the gym (about 4 times a week), then my options are:

  • Stationary Bike
  • Pool (swim and some rehab like eccentric lowers, walking on toes, walking, kicking; I hope to add hopping soon, physio ok’d it for me from week 14)
  • Treadmill Walking
  • Leg extensions
  • Calf raises on the leg extension machine
  • Hamstring, adduction and abduction machine
  • Anything upper body
  • Rowing - only one leg, I put my injured leg on a skater so it just rolls along for the ride
  • Recently added kettle bells swings and wall balls but very low weight and I can’t squat properly so the wall balls are more upper body than anything else
  • Tried the elliptical machine today … total fail!  will keep trying :)

That’s it.  My physio is away on holiday for a while now.  Before he left he told me that at 16 weeks we can start pushing more strength but for now I must just keep doing the exercises I’m doing and work hard on my flexibility.  He wanted me to try keep that +1cm and maybe get it to +2/3cm by 16 weeks.

Happy healing everyone!

12 week barefoot walk

The pain I had 2 days ago has disappeared as quickly as it arrived. I am so relieved! I really wasn’t keen to go back to the boot for an extended period.

My dorsi-flexion is still very far from normal and this is holding me back. Since I’m now at week 12, I have decided I can push my stretching a bit in order to try and get me back to normal. I’ve decided that instead of waiting for sessions of stretching or strengthening I will instead do a stretch / strength/ balance exercise every time I get up from the computer. This could be a calf stretch, squats, knee bends, heel raises, eccentric lowers, lunges, walking with a pause to stretch the calf, unilateral balancing .. basically anything that I can feel puts some stretch on the foot or does some balance or strengthening.

Not sure if it’s going to work, but what I’ve been doing so far hasn’t improved my dorsi-flexion at all, so at least this will be something different. I’m enjoying doing this today, and although my knee-to-wall measurement is not improving yet that I can tell, my walking has improved all through the day.

Here’s a video showing my barefoot walking today after doing these mini exercises all day…

12-week-barefoot-walking-small

Fast forward to rewind

I am 12 weeks post surgical repair of a full achilles rupture, the injury occurred 2 days prior to surgery.  Today is a day to celebrate as I have made it to the 12th week without re-rupture and all the information seems to indicate that your chance of re-rupture reduces radically after 12 weeks, so yay! :)

This last week of rehab has been really encouraging.  My surgeon discharged me last Wed, a week ago, and told me that I was free to do anything as long as I built it up slowly.  I was really busy with work for the next few days and did nothing other than the rehab exercises I have from physio, which are theraband, balancing, bridges, seated heal raises, towel scrunches, seated foot slides, walk throughs back and forward, and marching.  Usually I also do some extra walking and "couch" squats, but I didn’t have time.

On Sat I hit the gym.  I had decided that walking outside was counter-productive because the surface is uneven with many uphills.  What I wanted was to try and walk on an even surface at a pace at which I didn’t limp.  I can do this at home, pacing in the passage, but since I can now drive to the gym I thought that the treadmill was a much better idea, and I would get the added value of setting a pace, so I would know if I got tired and started to struggle and slow down or limp.

So on Sat I did 500m on the treadmill in 15min and managed a max pace of 2.1km/h without limping.  I also did a stationary cycle for 20min getting 69 avg watts and did some swimming with pool rehab that consists of pool walking, eccentric lowers on the injured side and tip-toe holds on both legs.  On Sun I managed 820m on the treadmill in 20min with a max of 2.6km/h.  On Sun I also noticed a marked improvement on my pool walking where my injured leg was rolling up off the heel before the good leg hit the ground, and additionally my other walking when I was just up and about in the house felt more relaxed and easier, much less of a hitch at each step.  On Mon I treadmill walked 1km in 22min hitting a max of 3km/h.  By Tues I got 1km in 20:30 with a max of 3.2km/h - so close to 1km in 20min! On Tues I also cycled 9.3km in 20min with 98 avg watts as well.

Everything felt good.  The treadmill walking seemed to be helping my other activities.  I was able to push a bit on the bike.  I could swim.  My pool rehab was getting better and giving me confidence.

On Tues night I did my usual physio rehab exercises.  Everything felt fine.  On the bare foot pillow balances I pushed a bit to hold the balance on the injured foot and then step forward onto my good foot.  The area around the outside ankle on the injured foot was sort of burning while I did this, but I thought the muscle were just working hard and the burn wasn’t near my achilles so I wasn’t concerned.  My final exercise was the knee to wall measure which I did in my shoes and I was almost there, like 1-1.5cm away, so I pushed harder than I would normally to try and reach the wall, but it wouldn’t go, so I stopped.  I sat down to do the scar massage and put some oil on.  The outside ankle was really burning, so I massaged just above the ankle bone but below the achilles as well.  When I stood up everything felt sore.  I went to bed.

During the night I woke up at least 12 times just from turning over because of the sharp pain from my ankle whenever my foot moved.  In the morning I very gingerly tried some ROM back and forwards and in circles and kept getting a really sharp bruising-like pain that I had never felt before.  It was like a short sharp ache.  It wasn’t tingly or stretchy.  It felt more like something was pressing on a bruise.  Deep, achy.  I don’t know, it’s very difficult to describe how different pains feel.  All I know is that it was new and it didn’t feel good.  Up to this point, ROM movements have never been painful, only tight.  I also couldn’t identify the exact point of pain.  Mostly it felt off my achilles and more towards the outside ankle, but every now and then that sharp pain felt directly on the achilles.  I pressed along the entire tendon and nothing.  I pressed around the ankle and nothing.  I did a Thompson test - my foot moved.  I did a pressure test and no problems.

So with no idea of what was going on, I thought that maybe I had overstretched in the knee to wall and caused some internal damage at the repair site pulling cells and fibers apart.  I didn’t want to make it worse, so I went back to the boot at 10 degrees.  Back to my 6 week status!  I tried walking in the boot like this and got no sharp pains although I was just generally aching after all the mornings testing.  So I left my foot back in the boot so I could continue with a normal day.  On Wed night I took the boot off before bed and tested ROM again.  I was still getting those sharp aches but they were less intense than they’d been in the morning.  I went to bed - no exercises.

This Thurs morning I noted through the night that things felt better and in the morning doing gentle ROM I had a stiffness pain that was more prominent on the outside ankle, but I had none of those sharp aching pains.  Encouraged I started my theraband exercises and that was ok.  I moved on to the towel scrunches but skipped the heel raises and stretches.  I put my shoes on and did the walk throughs.  My calf and achilles burned from the stretching this exercise requires but it was all stretching pain, the ankle was free of the sharp aches.  I did a small amount of balancing and then left it.

I saw my Physio and he said that there’s no way the stretches or balancing could have caused pain in the achilles.  He said that too much walking could cause the achilles to hurt, but I had not suddenly walked further or faster.  He tested all around the ankle and achilles and everything felt fine although my toe flexor muscle is extremely tight.  But there was nothing strange.  So .. who knows?!

I would love to know exactly what caused the pain so that I can avoid it or gradually work it away, but it doesn’t look like I’ll ever understand.  So I guess it’s a lesson learned that this injury is weird and sometimes it may hurt unexpectedly, so let it rest and then continue as planned?  This won’t be very helpful to anyone reading, but I searched the blogs to try and understand what was going on and I didn’t get any answers.  If you have this injury you may experience strange pains, so I guess try not not to freak out too much.

If anyone has had any common experiences or comments on this, I would love to hear them!

Happy healing all, and here’s wishing everyone pain-free weeks of rehab!

The bittersweet 11th week

I saw my surgeon on Wednesday.  I went to the appointment in 2 shoes, with crutches in hand in case I needed them which I didn’t.  He performed the Thompson test and then told me that I don’t need to see him anymore.  I am discharged! :)

I asked him about calf stretches and he told me that basically I can do anything, no restrictions, but I need to understand that my calf is extremely weak and therefore any stress I put through my leg will be taken up by the achilles until the calf gets stronger.  So there is no buffer, and if I put too much force on it, it may re-rupture.  He told me I can do anything, but I must build everything up slowly and incrementally, use my common sense and be careful.  Don’t run before you can walk was the message.

So happy days!  Now it’s up to me and my PT!

Today I am pretty sad though.  My hubby flew to Mt Gambier to do a crossover cave diving course that will allow him to dive any cave in Australia.  I should be doing it with him!  And worse than not doing it with him is that I can’t imagine at this point how I will ever be able to clamber over rocks while wearing and carrying heavy cave diving gear again!  I guess I have to trust that if you give this time you eventually get back to doing everything you did before.

So instead of dwelling on what I can’t do, let me end with something that I did today that I couldn’t do a week ago … I was able to drive my hubby to the airport! YES! :)

The path to 10 wks

Hi all,

I had a full rupture on 24 Aug 2015.  I was doing a crossfit wod which included heavy deadlifts, banded sprints and chest-to-bar pull-ups.  I had never done a banded sprint before, I actually thought we were supposed to do a banded bear crawl which I had done before.  So I picked out a green band which is the strongest band.  On the first round I did banded bear crawls and the instructor informed me that it’s supposed to be a sprint against the band, not a crawl.  I didn’t think the loading through and on the second round I sprinted against that really strong green band and it snapped - my achilles, not the band :(  It was so loud that I thought the band had snapped and smacked me in the ankle.  Once I realised that the band was fine, I knew what had happened because I’ve seen it happen before on TV.

It’s funny how we try to grasp for hope that the worst has not happened.  So after elevating and icing for 10min, the pain was pretty much gone and I poked at the achilles area and there was no pain, so I got a glimmer of hope.  Then I tried standing on the foot and my heel felt numb, like I was standing uphill or the ground wasn’t there.  There’s a clinic just up the road from our box, so I got my hubby to help me there (actually carry me - he’s so awesome!).  The Dr performed what I now know to be the Thompson test and showed me that there was nothing there, no movement.  Equipped with crutches I went to get an ultrasound.  They don’t like to tell you what they see, but the third time I asked the radiographer said "it’s completely torn".  The final nail in the coffin that whipped away any hope at all.  I managed to make it outside before bursting into tears!

It was a 5.5cm gap in the achilles 4.5cm away from the calcaneus.  The next two days were a whirlwind to organise medical aid and get me to surgery.  I know more now but I knew nothing then.  Although they told me I could choose, they lent towards surgery for someone my age (39) and with my activity levels, and since this is what I’d read that the pros had done, I was pretty convinced it’s what I wanted.  My first ever surgery and I hate hospitals and needles, but I wanted to get fixed.

My recovery has been pretty standard and has followed the same course as many of the people on this site.  I would like to thank Dennis and all the bloggers who contribute to the content in this site because it has been my go-to whenever I feel something that worries me or have a question.  This site is amazing, thank you!

I was in a front slab foot pointed down for 2 wks, then sutures removed and moved to a moon boot with 3 wedges and allowed PWB.  At 2.5 wks I bought my own Vacoped and moved into that at 20 degrees.  The Vacoped is fantastic.  I bought it because you can change and wash the liners which meant that I could exercise and sweat in it and then get clean again, and because you can swim with it on which meant I could start swimming as soon as my wound healed.  What I didn’t realise is that it is so much more comfortable than the moon boot.  I could immediately walk better with it on because the weight is evenly distributed and comfortable around your foot.  I also was interested in the hinge function, but I haven’t found it that useful until 1 wk after I started walking in 2 shoes.  Being able to adjust by 5 degrees is also great.  Highly recommended, as is an EvenUp to get both feet level.

At 3.5 wks I moved to 15 degrees in the boot because the Vacoped protocol showed 15 degrees from week 3.  I was also doing short stints of FWB in the boot at this stage.

At 4 wks I had a check up and everything was fine.  They had never seen the boot and were concerned (all interns so far, I had not seen my surgeon since before surgery).  They printed the surgeon’s protocol for me and told me to keep the boot at 20 degrees until wk 6.  I went home, pulled out a measuring tape and did the math - 3 wedges on my foot was 12 degrees, 2 wedges was 8 degrees and 1 wedge was 5.  So I left the boot at 15 degrees.  The Drs protocol also said that I should be sleeping in the boot until week 8.  But the intern I saw at week 2 had told me I could sleep without the boot.  So I continued sleeping without the boot.  I was concerned that I was impacting my rehab by not keeping the achilles stretched during the nights, but on this site I read that others had healed fine and not worn the boot at night, so I left it.  I would caution other readers that you are not safe when you are not wearing the boot!  I had two scares.  One night I woke myself up using my injured foot to turn me over in the bed.  Another night I was reaching for the crutches and my stabilising hand slipped and I put my injured foot down to catch myself.  Both of those incidents had me freaking out, checking my tendon, trying my own Thompson tests, etc.  If you’re in the boot you’re safe, so it’s probably better to be in the boot at least to week 6.

The Drs protocol said I could start physio at week 6, and my next appt at the hospital was wk 7, so I decided to organise physio on my own.  I found a physio just 1.3km away who had worked in a foot and ankle clinic for 10 years.  This has been a great choice.  He had a rehab protocol for me.  Everything was on track with what I’ve read.  He knew about the troubles with healing long.  He is very calm and reassuring.  And he’s active too and understands how badly I want to get up and running again.  I’ll post my daily activities which include the rehab he’s given me later on.

My 7 wk check up went fine.  I finally saw the surgeon for about 5min.  He told me to move the boot to 10, 5, 0 degrees over the next 3 weeks and work on ROM.  He also ok’d me to do hydrotherapy which the physio had told me to ask him.  This was great news.  My hydrotherapy exercises include walking in chest deep water, balancing, kicking, eccentric lowers on the injured foot, toe walking, side walking.  I went and started them the very next day after I’d seen the physio to confirm what I could try.

Wk 7-9 went fine.  The move to 0 degrees was tough.  Vacoped have a flat sole and a wedge sole.  0 degrees in the wedge sole was fine, but 0 degrees in the flat sole took me 3 days to master.  I felt like my leg always hyper-extended at the knee which hurt.  And the stretch in the achilles was also painful as my good foot stepped across if I took a normal stride.  I took this easy and swapped a lot between the two soles.  Even now, if I want to go fast I use the wedge sole.

Wk 9 I saw the Dr again and he said I could start wearing 2 shoes and slowly build my walking distance.  This was 1 wk earlier than his printed protocol, so I was over the moon.  I asked him what to avoid and he said just to increment everything slowly and use my common sense.  I specifically asked about inclines because I’ve read people have re-ruptured on stairs and inclines, but his answer was the same - just build slowly.  My first steps in 2 shoes were comical.  Worse than a toddler, pretty much just moving each foot inches forward at each step.  The next day at physio I showed my physio and he immediately gave me a step through exercise to help me gain confidence in allowing heel-to-toe and toe-to-heel rolling.  This worked a charm and 2 days later I could do a really slow walk.

At 10 wks I decided to try a very short walk outside, taking both crutches along to help over steep inclines.  I made 320m.  I’ve now built that up to almost 1km, but it takes forever and I can’t walk uphill at all, I end up peg-legging the uphills because my ankle range is stuck.  I can’t reach my knee to the wall when my toe is at the wall yet, I’m about 7cm off this.

I’m almost at 11 wks now.  I will see the Dr again tomorrow and report back.  For all of you just starting this, it gets better!  You may think that the world has ended, but the number of positive outcomes from an achilles rupture far out-way the negatives.  I can’t do it yet, but I believe that I will run and jump and triathlon and crossfit again.  I don’t just believe it, I have seen and read of others doing it.  We will get there eventually!