September 3, 2015 - Major Milestone Week! It gets better! (15 Weeks Post-Op)

September 3, 2015

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 .


August 10, 2015 - 3 Month Follow-up - Discharged! Shoe Guidance.

August 10, 2015

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 :)


August 5 2015 - Eleven Weeks Post-op

August 5, 2015

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.

Men's UA Valsetz RTS Side-Zip Tactical Boots

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.


July 22, 2015 - 9 weeks post-op update - Flying and Driving!

July 22, 2015

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!


July 15, 2015 - 8 Week Post-Op Surgeon Visit

July 15, 2015

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:


Week 7.5 - PT Progress And Weaning Out Of The Boot

July 10, 2015

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.


Sore from working out - at last!

July 4, 2015

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.