bobfv’s AchillesBlog

Today is May 14, 2016. I ruptured on May 10, 2015 and had surgery on May 20, 2015 so it is my one year anniversary. I went back to see the surgeon for a one year check about 2 weeks ago - everything looked fine to him.

So - one year later I have progressed to the point that I can pretty much do anything I could do before the rupture. I am jogging every day. I jog at 5 mph for about 30 minutes. Before the injury my daily run was at 6 mph, but I am still working out of the loss of endurance and gain of weight that came with my recovery over the past year. I plan to run the Army Ten Miler in Washington in the Fall and will continue training. My running training is basically completely normal. My ankle is not sore afterwards, I do just fine.

Daily activities are not affected at all by the ankle. It is sometimes a little bit stiff in the morning (the first thing I do is walk down stairs) but that goes away with my normal activity. I started doing one legged calf raises just about 2-3 weeks ago. It is still hard for me to get up on my toe using only the repaired ankle, but I can hold my body weight on the injured side without any problem. I continue to do calf raises and stretches in addition to my running.

My calves are totally symmetrical - no sign of the atrophy which was so pronounced just a couple of weeks after the injury. I have absolutely no fear of putting any strain or force on the repaired ankle.

It was a tough injury and I was so lucky to have great support from my family, flexibility at work, access to a great surgeon and physical therapists, and generally good health. The exercise and therapy are what have gotten me through this. I wish everyone the best of luck in dealing with their injuries - and I encourage you to read back in my blog if you want advice on any stage of your first year of recovery.

Peace out.

Not a lot to report except for a major milestone - six months post-op today!

Everything is going well and I pretty much have forgotten about the injury.  I wear regular shoes with Superfeet insoles and I walk without a limp. I am in the gym 6-7 days a week. The only thing I still can’t do is run, ie, have both feet off the ground at the same time.  I can walk fast (1 hour 5 kilometer pace) at a high incline.  Truth be told, I am pretty sure I could jog right now, but I am holding off until I build up more strength.

I am doing calf raises, resisted duck-walking using Therabands, eccentric strengthening on the leg press machine, one-legged balance exercises, and a few other  exercises every other day.  My daily cardio is a 40-60 minute fast walk on the treadmill or a 30 minute bike ride or elliptical machine workout.

The last resisted exercise I cannot do is a one-legged calf raise on the bad leg.  I am working towards it, but just don’t quite have the strength. I have gained full symmetry back in both calves, but I notice that on the repaired leg, the development in my calf muscle is "shorter" than in my uninjured leg - I think as I continue to exercise it, more of the calf muscles will regain strength and tone.

My scar looks good. A couple of nights a week I apply a silicone patch to lighten it up a bit, and when I don’t have the silicone on I rub some Bio-Oil into it.

So that’s it, I am pleased with the progress. Also very happy that I went surgical and got into an early weight-bearing protocol and in to PT early.

Hard to believe it but I got out the calendar (as I do every Wednesday) and ticked off the number of weeks since my surgery on Wednesday, May 20, and today marks 20 weeks!  At this point, I really don’t remember that I ruptured my Achilles unless I think about it. My gait is completely normal, but I feel a very slight “hitch” in my right ankle when walking in flat shoes. I am wearing either well-supported shoes with “Superfeet” arch supports or specialty shoes like Skechers Shape-Ups on a daily basis.

What I CAN do: I can walk normally up and down stairs, as I have a full range of motion.  I am unlimited in terms of cardio work on a bicycle, elliptical trainer, or Stairmaster. 3-4 times a week I do specific strength and balance exercises in the gym, these include leg presses focused on eccentric strength, stability pad work, one-legged yoga poses on my “bad” leg, two legged calf raises, and plyometric hopping exercises. On the treadmill I walk at a 5km per hour (3.1 mph) pace for 30-60 minutes.  I have absolutely no fear of rerupturing at this point and I work hard to put stress on my calf muscles as I seek to rebuild them.

What I cannot do is run - and I define running as leaving both feet at the same time in a forward motion.  I feel like I could if I wanted to, but I am waiting at least another month while I continue to strengthen myself.  I feel like I could probably do a one legged calf raise on my “bad” leg, but I am going to wait on that as well - in the mean time, I do about 100 2-legged calf raises a day and focus more and more of my weight on the “bad” foot.  My biggest issue is eccentric strength.  For example, when walking down stairs, I put the ball of my ATR foot down first and it is still very hard to prevent the heel from just plonking down - I just don’t have that eccentric strength (strength as the calf muscles lengthen) yet, but I recognize it and I am working on it every day.

The scar looks okay - I rub Bio-Oil on it a couple of times a day. It is small and even, the surgeon did a great job on it.  I have lost 15 pounds of the 20 that I gained since the injury, and I am going to try to keep the momentum up and lose a little more.

That’s it!  Very pleased with going the surgical route, with my early weight-bearing protocol and with getting in to physical therapy early (3-weeks post-op.)  I am going to “walk” a couple of 5K’s this Fall - whereas my pre-injury 5K time was around half an hour, I just want to do the distance in an hour (I have been doing this on my own, but It will be fun to join an organized 5K event.)

Best of luck to you all in your continued recoveries.

Every Wednesday since the day of my surgery on May 20, I think about how another week has passed.  I am really doing great and can honestly say that I am better than I was before the rupture (bearing in mind that I had a diagnosed moderate tear for a few months before the rupture.)  In the past two weeks I traveled on business from my home outside Washington DC to New Delhi, India and back again and I am happy to report that I experienced no swelling or discomfort in the repaired ankle at all.  I have not been icing or elevating just because I don’t need to.

What I have been doing is exercising.  I am back on the elliptical trainer for 30 minute pain-free cardio workouts and when I have time I follow that with a 30 minute walk at 3.1 mph on the treadmill.  I pick 3.1 mph because that is the distance of a 5K run.  Before my injury my standard 5K time was around 30 minutes, so I feel that now I could easily complete (although not RUN) a 5K with an hour or greater limit, so I am starting to look for one here in the area.  I have also been keeping up with the strength and balance training that I learned before I was discharged from PT.  For example, I just got back from the gym where I did 50 2-leg calf raises, 3 sets of 15 balance exercises where I stand on the bad leg and bend down and touch a yoga block with my opposite hand, plus the most important exercise for me now - eccentric strengthening.  Eccentric strength is strength in your muscle as you are extending it, so if you imagine yourself standing on your forefoot - you use eccentric strength when you lower yourself on to your heel.  As recently as 2 weeks ago all I could manage was to drop my heel, but with continued work I am finally getting some control over the process.  Besides walking, I use a leg press machine with 90 pounds (the amount is not important as long as you have some resistance) - then I do basically a 2-legged toe raise on the machine, and I just use my bad ankle to lower myself back to a little past neutral - then back up on two toes, down on one as before.  This eccentric strengthening has really been helping me and I have noticed that my heel soreness has almost disappeared, since I am no longer dropping my heel when I walk.  Going down stairs, I also practice eccentric strengthening by going down to the next step on my toe and lowering the heel.

I have completely normal range of motion, very little pain, and my gait is almost back to normal.  I don’t think I have a limp but my wife tells me I still have a little bit of one.  Oh well - keep doing strength and balance exercises!

For workouts I am using my old running shoes - Asics Gel-Kayano 20’s, with green Superfeet insoles.  I am mostly using the Skechers Shape-up Comfort Walkers for everyday use and have even taken my dogs on a couple of 2-3 mile weekend walks on fairly smooth terrain.  I would like to get back to hiking the trails around my house more regularly now that the weather is nice, which I should be able to do.

My scar looks fine - I rub Bio-Oil on it several times a day mostly because I like how the Bio-Oil smells.

That’s it for now - my advice to everyone starting out with the injury is that the time actually passes quickly - get in to PT as soon as you can and start to reclaim your life from his nasty injury.  I am very pleased I went the surgical route - but of course my perspective is that I did not have any surgical complications, so I guess that is easy for me to say.  It gets better - hang in there!

Hi everyone - I have had quite a bit of progress and passed several milestones since my last post and I wanted to share that information with you!

First off, physical therapy is invaluable - get yourself a therapist you are comfortable with and go and work hard! My therapist Chris is fantastic. He showed me how to ensure I was getting muscle activation when doing my exercises. As my strength has increased he has had me up on my toes, and on the leg press machine doing eccentric strengthening. I have been doing daily cardio at the gym and repeating the leg exercises every other day.

The first milestone of the week came Monday, August 31. I went to the gym and got on to the elliptical trainer and I had a great, 30 minute workout with no pain or swelling in my ankle. Up until Monday I had only been doing the exercise bike for cardio, but adding the elliptical is already making me feel better. I was sore in the evening just because my hips and quads have not been worked out like that in some time, but I will take it slow and get back in to it, alternating bike and elliptical days.

The second milestone came on Tuesday, September 1 - my temporary disabled parking permit expired! I am sad and happy at the same time - much more happy than sad because I don’t need it any more. Obviously - the convenience factor was nice, but thank God I can walk again and I hope I never need one of those passes again.

The third milestone was on Wednesday, September 2 - 15 weeks to the day since my Achilles Tendon Repair surgery! Feeling better every day - no pain and little soreness!

The fourth milestone, like the second, is also bittersweet. Today September 3 I had my last PT session and was officially discharged from PT. It was a great session, about an hour and 15 minutes and I did all my exercises. At the end, my therapist Chris gave me lots of advice for what to do going forward. He had me do some little plyometric hops on both feet which I should continue to do as I can tolerate it, and he showed me how to do planks and lunges on my toes without stressing or hyperextending the Achilles tendon.

I am so pleased with the progress, with the progressive, early weight bearing approach by my surgeon, with the support of my family (especially my sweet wife who drove me around for 2 months!), and the fantastic care I received at physical therapy and Town Center Orthopeadics in Reston, Virginia. I realize I still need to continue to work on healing and to watch myself, but I have a big goal to run the Army Ten Miler road race here in DC a year from now, just as I did a year ago, and several years previously.

Another thing I want to call out are Skechers Shape-up Comfort Walker shoes. These shoes are magic - when I wear them I do not limp and I took my dogs for 3 and 4 mile walks in them this past weekend. Buy them on Amazon or from the Skechers web site - about a hundred dollars very well spent!

Best of luck to you all on your recovery journeys. If you want to discuss any aspect of my recovery journey I am happy to help if I can - Email me at BobFV@aol.com .

My ATR surgery was on May 20, 2015, so technically I will be at 12 weeks post-op this Wednesday (it is Monday, so that is two days from now). Today was the first follow-up with my Orthopedic Surgeon in about a month, due to both of our vacation schedules.

As I mentioned in the last post, I am doing great, walking in two shoes and driving. When I saw my OS today he did the Thompson Test, checked my strength, and said that while he was there for me if I needed anything else, he is done with me, I am discharged! I told him that I have dropped down to one PT session a week and they are scheduled out for about the next month and he told me that should suffice as well, if I continue to work on the exercises I learn in PT on my own, which I have been doing all along.

In PT I have progressed to two footed calf raises with no support (30 a day), eccentric strengthening on a leg press machine, resisted toe walking back and forth. heel walking, calf stretches against the wall, heel to toe balance walking, stability work on a blue Theraband stability trainer, and practice stepping over a step, as opposed to just step-ups for strengthening.

My gait is getting better by the day. The slower I walk, the easier it is to have a normal gait. I concentrate on working my repaired leg through the entire normal range of motion from heel strike to toe push off. I still have just a little pain walking down stairs but I am doing my best to concentrate and work through that and come down stairs the "normal" way rather than one foot at a time.

The OS gave me an instruction sheet which is very helpful. I told him I was starting to develop a little heel pain from the asymmetry of having a heel lift in one shoe and not the other, and he told me to go to "Superfeet" or custom insoles for both feet so that the pressure will be equal. He gave me the following instruction sheet for shoes which I think is extremely helpful:

1. Arch Supports: Custom or over-the-counter "Superfeet"
2. Motion Control Shoes: For example Brooks Beast, New Balance 1012 (and I add Asics Gel-Kayano to that list)
3. Danskos
4. Birkenstocks
5. Skechers Shape-Ups
6. NO barefoot, flip flops, slippers, high-heeled shoes, Uggs or Crocs!
7. To ensure proper support make sure that your shoes DO NOT "bend or fold" excessively.

So I consider it a great day. Still taking things one day at a time, but steadily improving with every passing day

Well the time really does pass quickly.  We returned on Monday from 2 weeks of vacation out West, and today marks 11 weeks to the day since my ATR surgery.

While we were gone I did not go to PT, but I did go to the gym each day the first week and I progressed through most of my PT exercises.  I did standing balance on each leg, leg raises in four planes of motion, massage and Theraband resistance with the assistance of my wife, toe presses on a leg press machine, and eccentric strengthening on a leg press machine - pressing down with both toes and then back to neutral under resistance with just my repaired leg.  Also, I did at least 3 sets of 10 of two footed calf raises every day.

Most all of my activities were fine.  I wore mid-height hiking boots with a heel lift for extra support.  My gait is pretty normal but I walk pretty slow, some steps feel perfectly fine, others make my repair site feel like someone is squeezing it with pliers.  Range of motion is the same in both ankles, which is great.  The biggest problem I have had is with walking down stairs, but we are starting to work on that specifically in PT.

I went back to PT on Tuesday morning, the morning after my flight home.  I was excited to show my therapist how strong I had gotten and how I could do two legged calf raises with ease.  That was a mistake - never gloat to your physical therapist.  He proceeded to kick my butt for an hour, even having me walk around on my tiptoes with resistance bands, which really hurt a lot.  It helped to have him work with me on my stepping and I think before long I will be fine walking down stairs much better.

I continue to drive with absolutely no problem.  I got another set of boots - side zip lightweight mid-height black boots from Under Armour, they work great!  I added a 1 cm heel lift to my right boot. They are “Men’s UA Valsetz RTS Side-Zip Tactical Boots.” Extremely comfortable, lightweight, and supportive.

My scar is healed and gives me very little trouble.  Around the house I still don’t go barefoot, I use light shoes with a heel lift to remove some of the stress from my Achilles.  I took walks up to about a mile on vacation and plan to continue walking as much as I can.   Being out of the boot, I feel my strength and muscle tone returning.  The hardest thing for me now is my balance, it is taking a while to come back.  I bought a stability pad to help me work on my balance at home, and will be doing some one-legged exercises in my spare time too.

Next appointment with the OS is next week - looking forward to that.  Will concentrate on improving strength and balance before my next OS visit.

Today marks 9 weeks to the day since my ATR surgery. In my last post I wrote about my outing to the ball game in shoes (boots) over the weekend. The following day I had a great PT session, working on standing calf raises and gait normalization, then yesterday my wife and I flew from Washington DC to LA. I wore my Aircast boot and had no problem at the airport, went right through “TSA Pre” without any extra scrutiny, and had no problem boarding. We sat in first class so I had enough leg room, and I took my Aircast off and replaced it with a comfortable street shoe with a heel lift as soon as I was seated. It worked out fine, I used two shoes to walk from my seat to the lavatory. A couple of hours in to the 5+ hour flight I put my vaso-pumps on my calves and let them run  for about 90 minutes, a hedge against blood clots. When we landed I put the Aircast back on.

At LAX we picked up our bags and took the shuttle to the car rental place. I am an LA native and learned to drive here, my wife is a little nervous about jumping on to the LA freeways, so I took off my Aircast, put on my tactical boots (see previous post) fired up the rental car and jumped on to the San Diego Freeway at rush hour. I had not driven in about 2.5 months, but I had absolutely no problem. No pain, no issues whatsoever. My heel just rests on the floor of the car and I plantarflex to operate the throttle and brake. Piece of cake! I am so happy to be driving again!

When we got to our destination in LA my ankle felt fine but it was swollen from the flying and driving, and I iced it down. I had not had any swelling in weeks but all those hours with the leg down on the ground took their toll. The swelling went away after icing and I didn’t even need to take a Motrin or Tylenol.

Today, celebrating my 9 week anniversary, I got up early and went to the gym. I went in two shoes - I picked up a pair of Hoka One trail running high-tops to give me support in the gym and they worked great. I rode the exercise bike for 45 minutes, then I did most of my PT exercises including one leg balancing, step ups, basic proprioception, and 2-legged calf raises. I recommend these great shoes for transition workout shoes. I put a 1cm heel lift in the heel of the right shoe.

That’s where I am at week 9. I feel like I am making great progress now and getting my old life back!

I had tickets to yesterday’s baseball game, Washington Nationals vs LA Dodgers, and I just had to go. The Washington Nationals are my adopted team, and the LA Dodgers are the team that I grew up with in Los Angeles so this was a must see. Since my injury I have attended two games, both when I was PWB in the boot with crutches, and I switched out my seats for ADA “handicapped” seats and everything worked out okay. Yesterday I decided to use my regular seats, which are all the way down right on the field in the 3B corner, meaning I have a loooong set of concrete stairs to go down and up to get to the seats. To top it off, yesterday was a heat warning day in Washington DC - high heat and extreme humidity with heat index values in the 100’s. If you have never been to the Washington DC area in the dog days of summer, the place is absolutely miserable. It is built in a swamp and it just swelters, and yesterday was predicted to be the hottest day of the year so far.

So with that background, I decided that it just was not practical to wear my walking boot - it would get uncomfortable, be difficult on the stairs, and also be difficult in terms of people stepping over me to get in and out of the row. I wanted to sit in my seats, not in the ADA section. Since I am at 8.5 weeks post-op and doing well in PT I decided to give it a go in two shoes.

I bought a special pair of shoes just for this purpose. My background is military and law enforcement and I am kind of a nut for tactical gear. A company out in California called 5.11 Tactical makes great equipment and gives me a veterans discount, so I chose them in selecting a protective boot to wean in to out of my Aircast boot. After looking through their selection I decided that I wanted the following qualities in my boot:

- 8 inch height for ankle protection
- lightweight and breathable
- stiff shank to prevent excessive dorsi-flexion
- ability to accommodate a 10mm heel wedge
- comfortable enough fit around my scar
- side zip for easy on and off

I selected the ATAC Sage 8 Inch CST Boot because it had all of those qualities in addition to a composite safety toe (CST) to protect my foot if someone stepped on me. The boots are very comfortable and I took them to my OS appointment and my surgeon really liked them and thought they would be a fine boot to transition into as I moved to two shoes, providing lots of ankle protection and support.

So I am still not driving, my friend picked me up and off we drove to Nationals Park in Washington DC, just south of the US Capitol. We had a parking space right next to the park and I had no problem whatsoever walking in my new boots! I walked a little bit slowly just out of caution, and I was very careful to avoid situations like curbs which would potentially put me into excessive dorsiflexion, but I did just fine. Once inside the concourse I walked all the way to the far side to get to my favorite sandwich stand, over to my seats, down the stairs - no problems at all. Sitting in the seats I was very glad I didn’t have the Aircast boot on as people stepped over me to get to their seats.

After the game I came home and iced my ankle but I really did not have any pain or swelling - I was very pleased as I had worried about both of those issues but neither materialized.

I consider the whole outing a great success, except for the fact that my adopted hometown team lost to my boyhood hometown team I hope this info is useful for anyone transitioning to two shoes. I am going to stay in the Aircast boot for most day to day activity for a couple of more weeks, as my OS had ordered, but it is nice to know I have this option and I am going to use the boots as I start driving again next week.

I had my 8 week post-op appointment with the surgeon today. The good news, everything looks fine. The bad news - OS wants me to continue conservatively over the next 3-4 weeks, wearing the boot most of the time, continuing with strengthening, and walking in two shoes with a heel lift at home. He also did not clear me to drive, which is a disappointment but one that I can work around (I have a very expensive, luxury paperweight form Germany in my garage!). He said that in a year I will not even remember if I was in the boot 2 months or 3 months, but just to be on the safe side to keep wearing the boot with one lift, and to wear my shoes with a lift when I do PT and around the house. It doesn’t really bother me - I have good ROM, I am getting my strength back, and I would rather not risk future problems, so I will stick with the status quo for now.

In physical therapy I am progressing to leg strengthening exercises now that I am healed and have a relatively normal range of motion, so I will continue to work hard to strengthen it up.

Here is a photo taken this morning - my 8 week post-op anniversary photo: