bobfv’s AchillesBlog

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.

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 .

So I am at 6.5 weeks post-surgery on an aggressive protocol. I recently added new exercises at PT prefatory to getting back in to two shoes, which should be in about a week and a half. Since yesterday was a holiday Friday and my wife had yoga class at our gym, I hitched a ride with her and did a workout based on my PT, here is what I did (all with boot on):

Exercise bike: 40 minutes level 3 80 RPM
Leg lifts - 20 with each leg in all four planes of motion (boot on)
standing balance with 8# ball - 30 seconds on each leg
Leg presses - 2 sets of 10 with the bar and 2 10 pound weights
Squats “sit to stand” - 2 sets of 10
Step ups - 10 with each leg.

In the evening I took the Metro train into Washington DC for dinner with my boys so I walked about 4 blocks FWB with no crutch or cane.

Well, this morning I am sore, but “good sore” - both glutes and hips really feel the work I put in yesterday, which is great. I am looking forward to continuing with PT and with these workouts on my own! Can’t wait for the boot to come off so I can do even more. OS said strengthening with my legs and feet pushing away from my body is what I need to concentrate on.

Oh - also last week at PT, with the consent of my therapist, I had my wife come in while they were doing “scar tissue mobilization” massage and she learned how to do it, so now I am taking the boot off once a day for her to give me a massage and rub vitamin E on my scar. I also still take the boot off once or twice a day to use the vaso pumps (still a chance of blood clots until I am out of the boot) and I also take it off to shower, and to walk between the bathroom and my bedroom (very carefully!) after I shower and before I dress.

My Physical Therapist gave me a copy of my Post-Op protocol, which I am following now 4 1/2 weeks after surgery, and I thought I would post it for you.  I am glad I chose my surgeon, with an aggressive protocol.

• 2 WEEKS Post-Op

Begin PT

Partial WB in boot with heel lift

No dorsiflexion past neutral

Edema control

Ankle AROM all directions

Ankle mobility/joint mobilizations

Foot intrinsic strengthening

Scar tissue mobilization, STM along gastroc/soleus complex

Quadricep/Hamstring/Hip strengthening and stretching

• 2-4 Weeks Post-Op

Progress WB

Stationary bike in boot

Seated BAPS

Begin resisted plantarflexion (seated heel raises, theraband plantarflexion)

• 4-6 Weeks Post-Op

Wean off crutches (2 crutches to 1 crutch to FWB)

Begin closed chain lower extremity strengthening in three planes of motion when FWB (Mini-squats, wall squats, leg press)

• 6 Weeks Post-Op

Wean out of boot at home (with heel lift in shoe)

Progress to no boot over next two weeks

Ankle brace if prescribed by doctor

Single leg proprioceptive exercises

In the previous post I recounted how an innocent stumble resulted in the full-thickness rupture of my already torn right Achilles’ tendon.  It was a beautiful Springtime Sunday at about noon, just outside the ball park (Nationals Park in DC - to see the nationals play the Braves).  I immediately tried to get up but my right leg just didn’t work, I knew immediately that I had ruptured the tendon.  I did not hear a pop or snap, but then again, with a moderate tear already diagnosed, my tendon was probably just hanging on by a thread.  I rolled around, my sons were concerned, and I looked up to see a Good Samaritan, and older lady in a Washington Nationals jersey, hand me a paper wipe to clean my bleeding right knee.  Out of nowhere a lady in scrubs was next to me, telling me she was a nurse and I appeared to be seriously injured.  I told her I had an injured Achilles and I was sure I had ruptured it and she told me to remain still while she called EMS and got me an ambulance.  At the same time, uniformed Nationals Park workers showed up and told me to stay still while they called medical.

My leg hurt bad, and I could not move my right foot up or down. A large hematoma was forming under the skin, and my leg felt as if it was full of fluid.  I thought about my predicament - Washington DC’s Fire and EMS is notoriously incompetent, and hospitals in DC are full of people with gunshot and stab wounds.  There are actual recent cases in the press about DC Fire not responding and leaving people to die. I was not going to risk my care to these clowns.  My two sons, both over 6 feet tall, picked me up and we got over to my car parked just outside the park.  I told the boys to enjoy the game, and I got in my car to head to my neighborhood hospital in Reston, VA, about 2o miles away.  I promised my sons that I would pull over and call 911 if I couldn’t drive.

My advice is that if you rupture your right Achilles, do NOT try to drive.  Post-rupture, your right foot is just a big block at the end of your leg that you cannot flex up or down.  My foot was getting numb and my calf was swollen and filled with fluid.  It was stupid, but I managed to slowly drive out to the Virginia suburbs, about 20 miles.  It hurt like  hell, I called my wife at home and asked her to meet me at the ER with my Vicodin prescription.  I parked outside the ER and drug my bad leg in and stumbled into a wheelchair.  My wife arrived and I chomped down two Vicodin while the intake nurse put a cold pack on my leg.  After a short wait I went in to treatment, the ER doc gave me the Thompson Test and diagnosed the complete rupture.  He started an IV and gave me 1mg of Dilaudid IV and sent me to X-ray.  No bone issues on the X-ray, so I got another mg of Dilaudid (that stuff is fantastic - 8 times stronger than morphine) and he put me in the boot and sent me home.

When I entered the treatment room at the ER the baseball game that I had just left was playing on the TV and it was just starting.  I was in the ER for about 3 hours, so I watched the entire game - our hometown Nationals beat the Braves 5-4!