Achilles Rupture February 26 2008

Hey all…hard to believe I just wrote that title to this post.   Time flies when you’re having fun :)   I’ve been keeping up with most everyone’s posts…although I did just read about Fordtough’s bilateral experience…and wow..I think that takes the cake.   I was so fearful of rupturing my good AT hobbling around on crutches for those first 8 weeks, but in hindsight, I would have gotten through it.  

On to the status report.   The limp is pretty much gone, phew..that just seemed to not go away.   Reminded me of those mosquitoes at Boy Scout camp buzzing around outside my bug netting at night.   The ankle feels extremely solid in shoes, and better and better in bare feet.   I took my first big mis-step in recovery about a week ago.  Was not looking were I was walking and stepped up on to a curb and the heel dropped to the ground, full weight on the repaired AT.   My heart dropped…but she held solid.   I’ve been visualizing the repair site inside, and I’m pretty convinced that by now, it’s solid in there.  I’ve actually been treating the first  6 months as time to let it heal.   I’ve been doing very little strength training over the past month, just stretching and walking.   I ride my bike daily with daughter in tow on the trail-a-bike…it’s a 10 mile commute round trip.  

This morning, I put the clipless pedals back on the bike.   I took a ride for the first time on the route that I rode a few days before tearing back in February.  There are two good hills that put me to the test when I’m 100%.   I almost bonked on the first hill (more due to a few too many beers this Labor Day weekend), but managed to grind through it and was so damn proud of myself at the top…I also gave a quiet shoot out to my surgeon and my PT.   The second hill is shorter, but steeper….I started up it behind another guy.   I keep it out of the granny gear and really pushed hard with my recovering leg….I cruised past the other biker.   The AT felt good and altough winded at the top, I could do nothing but smile.   Of course I got passed easily on the downhill by the same guy..but I’m a brake rider when it comes to the downhill…always enjoyed climbing more.   Sooo..long story short, biking is good…and getting better.   I’m going to keep the slicks on and stay on the road through the fall/winter.   I’ll hit the trails again next spring.

So now it is on the strength training.   I just recently got started, lots of calf raises (eccentric) and balancing.   I never was a big runner, but hope to do a little of that as well.   I actually am teaching my 3 year old daughter to ride her bike w/out training wheels and that’s a lot of running while bending over.  The AT feels good through that.  

The only thing that bugs me is when I’m doing a heel raise and at the very top of the raise, the AT feels like it’s bunching up at the bottom, towards where it connects to the heel.  Other than that, my range of motion is close to 100%.   I’ve been doing weight bearing stretches for quite some time, and will continue on with that.   I can hit one, maybe two, single heel raises, but that’s it.   I do them with assistance now regularly, so we’ll see how that pays off this next month.  

Here’s a pic:

Just a slight improvement in size and definition of the calf from the last month.   We’ll see how this next month goes with the increased strength training.   I’m really pleased with the profile of the AT though…I assumed it was going to be super fat for the rest of my life, and although a little bigger than the good one, it’s much better than I would have expected.  

Here’s the scar:

One legged calf raise (that’s as far as I can get off the ground):

Well, until next month, keep up the good work all!   I’m excited to see how many folks are taking advantage of this community that Dennis has created.  

Cheers!

Brendan

Hey all -

Been keeping up with most folks progress still…just not much to add, as everyone seems to have their necessary support structures and “go-to” people on their site. It’s good to see no recent re-rups…I hope that trend continues. Thanks again for the T-shirt Dennis…the kids are napping upstairs, but afterwards I’ll get it on for a pic.

It’s been a month since the last update. Progress is slow at this point….if I think about where I was last week, I don’t see any improvement. If I think about the 4th of July though (a month ago), I start to see where I’ve come this month. Still bike riding is my primary form of exercise/rehab at this point. My commute is 10 miles roundtrip, and I do this 3-4 times/week with my older daughter in tow. She has moved up from a trailer to a tag-a-long bike, which definitely puts some more torque on my bike as I ride…I think it’s good for the AT. The real fun is having the Burley bike trailer with my 16 month old towed behind the tag along…it’s a real train…around 100 lbs total. I took a 20 mile ride this morning…and really pushed it for the first time. Midway, I was pretty bushed, thought I might lose my breakfast, but powered through it. I got up out of the saddle as well and pushed my recovering leg pretty hard, it felt good.

My limp is hit or miss….pretty typical at this point from the comments of Jim, Dennis, Tom, and Doc. I’ve been doing as much walking as I can with my knees bent and on my toes as possible…it really isolates the gastric and feels pretty good….sure looks like a chimp though! On that same note, my single leg calf raise is pretty weak…but getting better. I can’t even come close with my knee locked and straight, but when it’s bent, I can get the heel of the ground an inch or so. On the double calf raise…I still feel like the tendon is bunching up at the bottom, towards the heel. I’m massaging it regularly, and don’t feel any adhesions. Guess it’s just due to the scar tissue and inflammation still

I’ve tested the running a little…more chasing my kids than anything…and that feels good. I threw the disc a bit last week…and I won’t be playing ultimate any time soon…but it feels great to get around.

Here’s some pics:

Happy Heelin’ All!

Hey all…been a few weeks since I checked in. It was a bummer to read about the 2 re-rups…interesting though that both happened above the original repair site.

I had my last ortho appt a week and a half ago….he was very pleased with where I was at. He mentioned that I’ve really taken the time to research and be active in my recovery, and he thinks it’s paid off. I definitely had less limp in my step as I walked out of there….definitely a good feeling!

I’m walking around comfortably, not much limp left at all. At the end of the day, it sometimes returns, but after a good night sleep it’s good to go the next morning. I’ve been commuting (10 miles) to work on the bike daily. I’m getting ready to put the clipless pedals back on. I’m still tire pretty easily…I’m definitely not where I was aerobically before the injury. I plan on really working on endurance over the next 2 months. As a note to bikers, I talked to a guy in a local shop and he recommended shimano pedal/shoe systems as it’s still the only system that allows for tension adjustments. I was asking about egg-beaters or others…but I think I’ll stick with my shimanos for now and loosen them up a bit.

I was just walking down the stairs (in shoes) and got the bottom and realized I wasn’t doing the hop step…so that felt like a milestone too! Barefeet is feeling better and better…although still a limp. I’ve been trying my Chaco sandals from time to time, and those are working too…now I can work on my Chaco tan!

Here’s some pics of the progress…calf is still noticeably smaller, but I’m happy with the definition that is coming back:

I’m still a few weeks away from a single calf raise…but working on it as much as I can remember. I find that really concentrating on getting up on the toes during normal walking has been more helpful than the actual calf raises. I’m sure I could be working it more, but I’m into slow and steady for now.

Here’s a close up of the chicken legs (I mean heels):

I’m happy with the definition and lack of swelling.

Oh..and I just noticed, you can see that picnic table in the background…my 3 1/2 year old daughter and I built that a few weekends ago…my first project since the injury.

Hope this finds everyone in good spirits…it’s a good day to be alive today!

-B

I went to my final PT appt today.   I worked pretty hard for 30 minutes on the shuttle machine and was doing some two leg jumps on it.   The newest batch of exercises consists of balancing on just my injured leg and I have a bungee attached to my good ankle.  The other end of the bungee is afixed to something.   I balance on the bad leg and pull my good leg against the bungee…i rotate my body 90 degrees each time so that I am pulling the bungee in a different direction with my leg.   I have ski poles in hand at first for balance, but ideally after a few reps of this, you can balance on your own.   This is really helping build balance and ankle stability.  

During my US, massage, and ice/stim…my PT mentioned that over the past 19 years, he has seen any where from 2-10 ATR’s a year, and mine was one of the nicest looking at this point of recovery (3.5 months).   That was a super nice comment to hear heading out of there.   Now, it’s up to me to continue the strength training.   Kind of a strange feeling to be out on your own.   I do have one more ortho appt next week..but I think that may be the last too.    I did tell the PT office that I’d be back in with a case of beer once I could dunk again!   Which is even funnier, because I’ve never been able to dunk anything other than a tennis ball and that was back in high school!  (I’m 5′9″).   I am suppose to work it pretty hard and take notice of any tendonitis…if that becomes an issue, the PT said we can work some US, massage, ice/stim to help with that.  

I’ve got no swelling, the limp is close to being gone, and I’m still doing the handrail walk/jump down the stairs as putting the good foot down to the next step still puts too much strain on the tendon.   ROM is almost 100%.   Here’s to thousands of calf/heel raises in the next 3 months!  

Just as a reminder of where I was just a few months ago:

I can remember that day, it was cold/wintery out and I was worried about getting the vegetable garden in for the year…..well, as my dad said, it’s incredible what a handicapped person is capable of:

Started tomatoes inside while I was laid up after surgery.   Got the early season stuff (peas, lettuce, spinach, radishes) etc in by crutching out and laying on the ground.   Potatoes went in during first few days of FWB in the boot.   Transplanted tomotoes/peppers in a shoe.    What a spring!

Happy Heelin’

Just got back from my first extended ride…and although just 10 miles, it felt great.    I think I’ll be ready to start my cycle commute to work starting on Monday, tt’s 5 miles each way.   I’ve got to pull my daughter in a trailer..so it will be a little extra work, but luckily we live in flatville…so it shouldn’t be to bad.   Here’s a pic of the mtn bike converted to ATR cycle:

Slick tires put on, clipless pedals replaced with flats, and seat lowered so that heels can hit ground in case of quick stop.  

Gosh…I just am reading some posts of folks that are just in their first days after surgery and it seems just like yesterday to me.   I’m telling you it goes slow at first and then before you know it you’ll be back on your feet (or cycle) and doing the things you love to do.   In retrospect, when I was laid up in bed for those first 2 weeks, leg elevated, in pain…it was one of the only times in the last 10 years that I’ve really slowed down.   I got to think about things and catch up with old friends…things we just don’t get to do in today’s busy society.   So in some sort of wierd way, I enjoyed those first few weeks, not really while I was experiencing them, but after the fact…the memory is not bad, it’s actually a little refreshing.   I’m not saying I want to go through this thing again, but I can remember writing a post 2 months ago about being scared of returning to the activities that come with risk of injury…but now just a few months later, I say bring ‘em on.   

I just feel thankful (and a bit embaressed/spoiled) to have access to such good health care.   I saw an image on the Yahoo home page a few days ago of some tribe in South America that was being photographed from a helicoptor…they are apparently one of the last truly indigenious tribes that have not had contact with the modern world (aside from seeing metal flying in the sky!).   My first thought was, wow…if one of them tears an AT while hunting…there is a good chance they would be crippled for the rest of their life…however long or short that may be.    Hence..the thankful feeling on my part…

So, Brendan, what are you getting at really.   I guess I’m just a little overwhelmed with good feelings today and I just think I’ve grown a lot through this experience, so I’m kind of glad it happened…no, glad really isn’t the right word….maybe fortunate.   Heck, IMO, we get one shot at life here…and why not experience as much as we can.   We are members of an elite group of folks who have sustained one of the worst sports injuries…and we are all living to talk about it.    

OK…back to the heel…it’s still looking good, I haven’t iced outside of the PT office in a week:

Been walking in two shoes for about two weeks now, and if I really concentrate and roll up on my toes, I walk without much limp.   But if I need some speed, I stay on heels and limp along.   Working the calf eccentrically with some body weight, and cocentrically with the therabands still.   Did some jumps on the leg press shuttle machine at PT which my therapist said would be scary…but I didn’t find it so.   Stretching the AT for one minute intervals with some body weight.   I’m going to make a slant board as well to help keep the stretching up.   A family friend said that that really helped her in the 3-6 month time period after she had ruptured hers.  

As eriedutchgirl says…keep your chins up.    We’ll all get this thing licked!

Cheers!

Today marks 13 weeks from my injury, and it’s time to start talking in months instead of weeks…figure that’s a milestone in itself!

I can honestly say “Where’s my boot?” now, and not have a solid answer…I’ve got some leads, but wouldn’t bet on any of them being right! I can remember this feeling with my crutches about 5 weeks ago too….although they are both strategically placed in the house in different locations so that I can see them every day as a reminder of where I have come in the past few months…which is a long way! They also remind me to continue to go slow in my rehab, because I don’t want to be back on those things anytime soon.

So been in two shoes all day for the past three days…I may put the boot on to mow the lawn this coming week, but other than that, I think I’m done with it. Walking is getting better by the day, still a noticeable limp, but no real pain. I just have to limp with my leg gets to the point when I feel the tendon get tight and I can not get up on to the ball of my foot. Going upstairs is fine, coming down is still a bit awkward, but I’m getting the hang of rolling my toes off the front of the tread so as to not put excess strain on the AT. I messed around with some different shoes, and my hiking boots offer the most support and therefore the least limp, but they are heavy and I tire quickly. Running shoes seem to be the best all-around bet, I limp a little more, but they are light and I think the extra flexing that I do during walking is helping to stretch the AT.

For PT - I’m continuing with Theraband work with dorsiflex active stretching, inversion/eversion, and plantar flex. The strength in these areas has come back very quick. New to the regime is some active stretching…leaning foward with feet flat on the ground until the tendon feels tight and holding for 5 seconds and then rocking back up to neutral. This is done on a slant board at the PT office, and I’m considering building one as it looks pretty easy (piece of plywood, 2 x 4, and some grip tape). I’m also working the calf muscle eccentrically. This is done by holding on to a rail/support, getting up onto toes on both feet, transferring as much weight the bad leg as possible and slowly returning the heel to the ground over the course of 5 seconds, trying to isolate the calf as much as possible. This was a bit of a strain on the tendon at first which was uncomfortable, but after some practice, I have learned how to isolate the calf muscle and avoid the tendon pain. Here is a pic showing the difference in calf size…not to bad:

I’m riding the stationary bike and just put some slicks on my mountain bike so that I can start getting around town a little easier. I also ditched the clip-in pedals and lowered the seat so that my heel can touch the ground in case of a quick stop. I’ve taken my daughter to day care via bike trailer and rode to work every day for the past few years, so having to drive for the past few months has been a big change, and I’m looking forward to getting back to the bike commute.

At the PT office, I’m continuing with Ultrasound, Cold-Laser, and Ice/E-stim as well. I massage the AT religiously a few times a day…starting to work much deeper now around the back of the AT. Still get some small “cracklies” which are minor adhesions, but nothing serious. The AT is sliding nicely in the sheath. Here’s a closer shot of the AT…starting to see some better shape in the heel.

All in all, I’m super excited about where I am at…definitely on a slower than average track…but as I’ve mentioned before, I think one of the most important things that I learned in this process is to embrace your recovery protocol (whatever that may be) and it makes the healing seem to be more effective.

One other thing to note is that my injured leg is still consistently more red than my good leg. I’m chalking that up to continued increased blood supply to the injured side as my body tries to heal itself more…but any other feedback would be appreciated.

Keep up the good work everyone…lot’s of positive energy on this site. Thanks!

As many of you know I live in Northern Colorado……

During a lunch appointment yesterday, the weather turns south pretty quick.   It gets so loud in the restaurant from the hail, that we can’t have a conversation.   The weather eventually blows over and we make our way back to work.   My office is on the second floor of a large manufacturing building.   I hop on the computer and start hearing stories about tornadoes that have touched down, and fairly close to where we are.   My first thoughts are for my family….call my wife to check on our youngest at her in-home day care…and I call my older daughters day care center and they are practicing tornado drills with the kids, but have a basement and are aware of the situation.    My next thought, I better get my boot on!   I’m OK in a shoe, but if running for cover is on the agenda, the boot is the preferred mode of transportation.   Plus, I forgot to tell you, that at any given time, the manufacturing building I am in is loaded with 30K empty and full bottles of beer…or in the case of a tornado, pieces of shrapnel.    Cell service is fading in and out, and it’s difficult to keep up with the news….some tense moments for about 30 minutes.

The tornado passed by our location about 3-4 miles to the east.   A couple of the guys I work with were towing a camping trailer back to the brewery and ran right into the sucker.  The trailer was ripped from the back of the truck and they sat it out in the pickup.   Reports on the radio were for more touchdowns, so they were able to 4 wheel it out of the ditch they landed in and make it back safely.

Phew…glad that is over!   Back to recovery…but with just a hint of perspective.

Happy Heelin’

Not a whole lot to report…my doc gave me the official green light to start weening out of the boot and back into two shoes.    I told him that I had been wearing two shoes around the house for the past few days, so I’m a little ahead of his recommended protocol, but I have been about 2 weeks ahead this whole recovery.   Two shoes feels great, my heel spur rubs something fierce on the frame of the walking boot, so I can’t take it for too long.  

Did I say how good two shoes feels?   Only problem is my shoe that hasn’t seen any action for 10 weeks looks brand new compared to his partner in crime…or really grime!    So going up stairs, I point my toe out to make sure my whole foot contacts the stair tread.   I can head up normally though.   Going down, I have to lead with my injured foot..then catch up with my good foot.   It doesn’t feel ready to put the good foot first down a tread.    On flat ground, I’m trying to walk as normally as possible….at least going through the heel toe motion.   My AT is tight in the morning and I give it a stretch and after a few minutes of walking in shoes it loosens up pretty good.   I actual have the sensation sometimes when I’m walking that it is too loose, cause I can’t feel the tightness.   But when I flex my knee/calf forward a little with my foot flat on the floor, I feel it again and am reassured.   I guess I’m just a little surprised by how good it feels!

 Have I mentioned that two shoes feels GREAT!!!   I got a script for more PT (have had 4 appts to date over the past 2 weeks).  I will start strength training…I have the option of going 2x/week, but with a $30 copay/visit, I’m just going to stick to one/week.  I’ll see my ortho again in 4 weeks, and he wants me to be in a shoe fulltime by then.   I still get around faster and more confidently with the boot, so I’ll use it for huffing around work and mowing the lawn, but when I’m in the house, I’m in a shoe.   He also mentioned that the boot should be used if the leg is fatigued at all, which I have experienced during these first few days of walking in the shoe.   It’s a strange feeling having your knee buckle and some extra weight on the tendon.

 It was 12 weeks ago that I ruptured this thing…it was snowy and winter, now it’s 90 degrees today and I’ve come so far.   I can honestly say that this site has provided more information and support than I could have imagined.     I sound like a broken record, but thanks Dennis for setting this up….and thanks to everyone else for sharing your experiences, you have helped me through this in more ways than I can mention.  

 Happy Heelin’

Today marks 11 weeks from my injury and 10 weeks from Surgery.   I’m getting around well in the boot..it’s definitely loosening up, the straps keep hanging off more and more.   You can also see the tip of the “Superfeet” insole.

Here you can see the boot is really starting to fall apart from the velcro ripping at it.   I’ve been it in for 6 weeks now.

Here’s the calf…didn’t have a lot to start with, but still looking forward to building it back up again.

Here’s a pic of the incision site.  (Sorry Dennis…not trying to rub it in…keep up that Arnica Oil!)

Here’s the heels…they is a healin’  Swelling is way down, I’m very happy after just 2 PT sessions and really keeping up with the massage.

For comparison..here is 3 weeks ago:

Here’s a look side by side….my tear was right in the middle of the tendon and you can still see a little indentation where it is healing.   The AT is still swollen a little above and below the actual tear site.

Here’s a final close up…just messing around with my camera…pretty cool!

Happy Heelin’

To recap my protocol to date:

Splint (NWB) - 2 weeks

Cast (NWB) - 2 weeks

Boot (NWB/ROM) - 2 weeks

Boot (PWB - FWB) - 2 weeks

Boot (FWB - 2 wedges in heel) - 1 week

Boot (FWB - 1 wedge in heel) - to date.

Had my first few PT appointments this week.  First off, really clicked with my therapist…he’s an avid outdoorsman, and although has only worked on a few AT’s in the past year, he did work with a competitive male cheerleader (one of those big guys who holds those 95 lb girls up with one arm) and was very successful.   I told him that I was a little concerned about a re-rup in PT, and he said that he likes to take AT’s pretty slow at first, so I should have no worries.

He was very impressed with my low level of swelling and ROM.   I told him about talking my ortho into a boot at 4 weeks and he thought that was a good idea.   He took some initial measurements.   My calf on my injured side was 4 cm smaller (in circumference through the thickest part) than my good side.   Doc Ross mentioned an average muscle loss per week of inactivity..wonder if this is in line?

Next was some massage, primarily around the tendon and scar, but also quite a bit on the talus as my plantarflexion is currently a lot worse than my dorsiflexion.   The tendon was fairly sore during, but it was a good sore, like any deeper massage.

He moved on to ultrasound and cold laser.   The ultrasound was also a bit painful as it rubbed around the tendon and scar, but the cold laser was completely pain free.    We finished with E-stim and ice for 15 minutes.

He mentioned Superfeet again, and I knew it was finally time to get a pair.   Boy what a difference.   I got the green version, and put them in my boot.  I am supposed to return to my next ortho appt in 1.5 weeks with no wedges in by boot.   When I moved from 2 wedges to 1,  my heel was really irritated.   Once the superfeet insole was in the boot, there was no discomfort with 1 wedge.   I plan to go a few more days with 1 wedge, and then remove that one as well.

In leaving the appt, he wanted me to start some light theraband work (planterflex).   We had to go with the lightest band, in my case that is yellow.   It is funny how my ankle/calf/tendon just wouldn’t fire with any resistance on it.   I could planterflex fine with no resistance, but with just a little resistance, it wouldn’t work.   I kept at it for the first few days, and I think it was more of my muscles needing to “relearn” that motion with resistance, because I am doing it fairly easy now.

My second PT appt was yesterday, after one day in between appts, and there was a noticeable improvement in my dorsiflex and  the swelling level in the upper tendon area.   He said the tendon is sliding nicely in the sheeth, and to keep massaging the tendon upwards towards the calf to get any of the swelling gunk out of the sheeth and into the limbic system.  Along with ROM, and the planterflex with the theraband, I am to start using the theraband to pull a little dorsiflex to stretch the tendon a little more, no weight bearing stretches yet.

I have a couple more PT appts scheduled next week before my next ortho appt.   I have a copay for each PT visit, so I’ll just have to gauge when I feel like I’ve gotten all I can from the modalities and information they provide on exercises.   I don’t think I’ll be able to go for too long though, as it gets expensive quick.  But I figure now it’s an investment in my long term health and activity level, so it’s money well spent.

Happy Heelin’