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.

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

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:

I am in the middle of my 7th week post-op and I have progressed in my PT protocol to a new set of exercises designed to get me back in two shoes and regaining my strength and balance. The protocol now includes:

• Normalize gait
• Progress calf strengthening
• Seated heel raise>>>standing heel raise>>>single leg heel raise
• NMES prn  (neuromuscular electrical stimulation as needed)
• Gradually progress dorsiflexion past neutral in stretching and strengthening
• Progress to equal ROM bilaterally
• Eccentric plantarflexion strengthening

I am enjoying these new exercises, for the most part, and continuing to do many of the exercises I learned in the past four weeks of PT.  I have stopped wearing the boot to bed at night and I take very short walks without the boot in the house, very carefully.  In PT I use my street shoes with a heel lift.  I am still doing seated heel raises and have not started the stimulation yet.  My range of motion is very good - I practically have the same ROM in both ankles, but I am not about to push it on dorsiflexion.  I am doing plantarflextion on the Total Gym in shoes which is kind of scary, because I have the balls of my feet on the machine and my heels off of it - the idea is to press down with my toes, but I am scared of slipping and going in to a big, unintended dorsiflexion.  I am also enjoying working on single leg balance - I alternate lifting one foot off the ground and standing on one leg for ten seconds at a time.

I have an appointment with the OS this coming Wednesday, and I am hoping to get his blessing to lose the boot and to start driving.  That will be exactly 8 weeks post-op.  Other than that I feel great, no pain whatsoever.  I bought a pair tactical boots which are lightweight and have a side-zipper entry and I plan to wear these in the first weeks out of my Aircast boot to provide extra support and protection. I have worn them around the house and they don’t seem to put any pressure on my scar, which has healed almost completely.

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.

Today I visited the Orthopedic Surgeon 6 weeks to the day after my surgery.  I have been FWB in the boot for over a week and I am now walking without any crutches or cane.  The doc did the Thompson Test on both sides, noted proper function. He also noted atrophy in my right calf, fairly normal.  I have well-developed, muscular legs so the atrophy in the calf muscles is pretty apparent.

I told the doctor I have been showering out of the boot, standing on my bare feet in the shower and carefully walking from the shower to the bedroom to dress.  He looked a bit alarmed and told me to be careful. He also told me to continue physical therapy, and per protocol to begin to wean out of the boot.  He took one of the three lifts out of my boot which feels much better, and we set our next appointment for two weeks from today.  He still doesn’t want me driving for at least a couple of weeks.  He also warned me not to do any dorsiflexion past neutral in PT, and to continue strengthening through resisted plantarflexion, leg presses, and to start balance exercises.

I feel really good.  I have no pain at all.  My wound is healed and dry except for one little spot that continues to ooze just a little bit.  I have no problem putting more than my full body weight on my right leg wearing the boot - I stand up and put all my weight in that leg and it doesn’t hurt at all.

So, fingers crossed - I will wean out of the boot and continue physical therapy over the next two weeks.  I am extremely anxious to start driving again and hope to be cleared to drive in two weeks - I have a very expensive German paperweight sitting in my garage waiting for me to get behind the wheel!

That’s it for now - here are two pictures that my wife snapped during the exam - you can see the significant thickening in my right calf comparing it to my left one.

Normal Post-Op on June 19 visit four weeks to the day after my surgery.  Dr. Kartelian performed the Thompson test, everything looked good.  Wound site looked fine, the surgi-strips hadn’t fallen off yet, no problem with that.  I showed off my range of motion, rotating my ankle and lifting my toes up to neutral.  He performed a strength test with me pushing against his hands.  Everything was great!  He told me to continue to wear the boot, keep the heel lifts in the boot, continue physical therapy, continue with the vaso pumps, and over the next two weeks go to full weight bearing (FWB) as long as there was no pain.

Great!  I was so happy I put my boot back on, picked up my crutches, and walked right out of his office on my own two feet.  To be honest, I had been "cheating" a little throughout the week, putting full weight on my right foot while still on the crutches - no pain at all, everything felt fine.  At home I used one crutch a little but mostly no crutches and that night I walked up the full flight of stairs to my bedroom without crutches!  What a relief to be able to use my hands to carry things while I walked, and to be able to bear my full weight for personal hygiene activities in the bathroom!  Taking showers is still a little tricky, taking my boot off while sitting in a shower chair.  I actually started kneeling with one knee on the shower chair which makes showering much easier.

Looking forward to the next two weeks of physical therapy in which I will begin "mini-squats" and other exercises to begin lengthening the Achilles and increasing my range of motion.  By protocol weeks 4-6 will see me wean down form 2 crutches to FWB, but I am already there!  No pain whatsoever, and no pain meds since the surgery.  I still elevate, ice, and use compression pumps in the evening for a few hours, and I strongly recommend that regimen to eliminate pain.  Still sleeping in the boot, I hardly notice it now.  Yesterday my wife told me I "look good" in the boot, and with the full beard that I started growing on the day of my surgery.  Walking with this boot I guess I sort of look like a pirate - the beard stays until a client meeting or other exigency dictates that I shave it off!

I have mentioned the vaso pumps a few times - here is a photo of one on my right leg - I love these things.