boris1’s AchillesBlog

the issue with walking is that you compensate with the good leg, without really noticing. You take a longer stride, which means that you put down the good leg before pushing off properly with the injured one.

One way to counter this, if your calf is strong enough, is to walk stairs. Make sure you place the heel on your injured leg off the step - so it’s hanging freely. Do this slowly, and feel it. If it doesn’t feel safe, don’t do it!

Another thing you can do is to use forearm crutches, and walk hills with your injured leg only. The higher pace you manage, the more you will use the calf on your injured leg to kick youself upwards. However, this doesn’t work in flat terrain, you need a somewhat steep hill to have any effect.

I would also consider balance exercises. I particularily like the following exercise: Stand on your injured leg - bend down and touch your toes (bend knee as much or as little you want) - raise up and stretch your hands above your head. Repeat 10-30 times.

Good luck with your walking, and happy healing!

I found walking very frustrating. It seems like I limped forever–even when I thought I kicked it, my kids would tell me that I still limp. Your physio sounds like mine–she suggested slowing it down and exaggerating the motion. It sounds obvious but walking is the best thing for retraining that leg. Throw in some heel raises and work the eccentric movement too.

It takes time for the muscles in your foot to come back–I can do everything I did pre-rupture but I can tell that my injured foot is not as strong (evidenced by my weak tippy toeing.) Be incremental–6 weeks is still early days. good luck!

I think it’s probably easier to be moderate anc controlled with DF stretches if you use a towel or such in both hands. That eliminates the FWB part, which could lead to overdoing. You can still use the wall to measure your progress (ROM).

Boris, all the DF stretches pull on the AT, which pulls on the calf muscles: mostly the soleus if your knee is bent, mostly the Gastroc if it’s straight. It’s kind of an AT-calf system, hard to isolate the parts.

Thanks for the wisdom guys.

I’ve been doing the wall stretches for two days now, taking extra care on the dorsiflexion portion where you slightly bend the knee. Upon reading all the healing long info I’ve decided to stop them altogether, perhaps until 8 weeks.

Does the calf wall stretch also stretch the AT or can I do this one safely at this point?

I wasn’t satisfied with my PT’s answer.

My main question is: when can I start these dorsiflexion stretches safely? 8 weeks, 12 weeks?

Boris - it is quick to be in shoes but I wouldn’t say it was too quick. I was there in 7 weeks and I know many others here the same. Like Norm said, the boot can go with you even if you don’t wear it. I didn’t go barefoot around the house, prefering to wear shoes with wedges to take the strain off the tendon. It means you can walk without a limp easier. You will need to be more careful and aware of your surroundings. In particular you will have to watch out for others around you as you are not carrying your obvious signs of a disability like crutches or the boot.

Unusual to see the medical community being so aggressive on the rehab. As you can see from most postings here, most victims feel things move too slowly. It’s refreshing to see the opposite though my experience tells me that 6-7 weeks is a bit early to be out of boot except for exercise and ROM. Use your head and stay informed.

I’m with you, Boris! And remember that most of the transitions from boot to shoe say “WEAN off boot”, so there’s no shame in keeping the boot handy for scary outings or when your leg feels tired or sore.
You’re at the stage where I love a hinged boot, but the AirCast produced great results in a number of studies, so just use your head and Watch Your Step!

Interesting. I got someone to do the Thompson test and it looks good. Another question I have is regarding where the original tear was. When I run my finger up my tendon from the heel I can feel a slight divot where I believe the rupture occurred and where it was sutured together, like not a full gap but obviously my tendon is not fully healed circumferentially. I’m five weeks post op, how normal is this and can you guys feel the exact spot where the rip occurred?

Boris, there are ATRs all the way from the heel bone — including “avulsions” that tear off a chip of bone — up to the calf muscle(s). I’m guessing that there’s a kind of flat “normal distribution” (a flat “bell curve”) of frequency vs. location.

Both of mine were maybe 3-4″ above the top of the heel bone, which I think is the most common spot. There used to be a dominant theory that this spot was rupture-prone because it was the “watershed” between two different blood-supply regions, where the flow stagnated. So that part of the tendon didn’t get its share of flow, oxygen, and “food”, so it weakened then tore. I’m sure lots of out-of-touch experts still tell that story, but I believe some recent studies have disproved it. I don’t recall any of the details, sorry.
And there seem to be two “heads” of the calf muscle (the Gastroc or Gastrocnemius and the soleus), each with its own connection to the AT.

Hi Norm, thanks for the reply.

On another note, I know the the tendon is thinner by the heel and tapers out as it goes up and connects to the calf. My thinking is the smallest cross sectional area would be the most vulnerable to rupture but I could be wrong.

Wondering if anyone has any info regarding of where an ATR typically occurs? I mean is it closer to the heel or higher up the calf?

Unfortunately it’s not trivial to decide - though I think they should have done a Thomson Test! Post-op patients often have bad adhesions - scar tissue that glues together adjacent layers of tissue that should slide past each other - and slips and falls can break them up. Most false alarms are of that sort, and yours might be.
Good luck!

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