Cecilia’s AchillesBlog

It has now been five months since my rupture. In the past month life has returned almost entirely to normal with one big exception: I still haven’t returned to running. Originally I hoped I would be able to do this after five months but the strength just isn’t there yet. Maybe next month! Here’s what has been going on:

• I am walking completely limp free and don’t run into any distance problems in my day to day life.
• I danced for nearly three hours at a wedding last weekend. I didn’t do any excessive jumping up and down but I held my own on the dance floor.
• My main cardio workouts right now are yoga and spin biking. Neither seem to bother my achilles as all.
• I can do the tiniest heel raise ever on my injured side.
• My toughest physio exercise, which I just sort of invented one evenings, is walking around the house on my tip toes. It makes me feel a burn deep in my calf.
• The swelling in my injured foot has almost completely subsided. I still have a thick tendon (and will for a long time, I suspect) but from the front by ankles are the same size again.

Thanks for checking in. I hope that everyone is doing well on their recovery journey!

Today is the four month anniversary of the day I ruptured my Achilles. There are certain dates that are forever etched in my memory (anniversaries, graduations, etc. ) and March 7, 2014 is now on that list. So in honour of my Achilleversary here’s an update on my current status.

• I have been released from regular physio appointments. My instructions at my last appointment were to keep doing heel raises and come back if I plateau or if something goes amiss.
• I am pretty much walking limp free which means I can do a good impression of a push off my injured foot but I can tell the strength of my stride is uneven on the two sides. A limp becomes visible later in the day, when I’m walking uphill, or when my ankle is stiff (either first thing in the morning or after a long period of inactivity).
• I can do heel raises with a 50-50 distribution of weight across my legs. I can even do a few with more than half my weight on my injured side. I’m also working bearing weight on my tip toes.
• I’m trying to take a walk every evening and using my fitbit to track my steps. I don’t get to 10,000 everyday but I think there’s been a slight increasing trend of the past month.
• I still have residual swelling in my injured ankle. There are still certain shoes (mostly adorable ballet flats) that I can not wear because they are too tight on my injured foot so I’m living in adjustable sandals (not flip flops) and running shoes. I haven’t worked up the nerve to wear high heels and I think it will be a long time before I want to go there.
• My heel soreness seems to have pretty much subsided. A few weeks ago I would get a lot of soreness towards the end of the day but it’s pretty much a non issue now.
• My Achilles is still extremely thick and there is still a discernible notch possibly at the injury point. I’ve been trying to do some self massage to help breakdown the scar tissue.
• My calf size imbalance is quite noticeable but I don’t care. I feel like I’ve come so far in the past four months that I wear that imbalance with pride.
• I am back to doing regular difficulty yoga classes. I still have to do some modifications and I don’t do dangerous poses (like handstands or anything I might fall out of) but I don’t feel otherwise limited by my foot. I can detect that my balance and flexibility on my injured side has been compromised.

I feel like I made a lot of progress during the last month even if some of it is subtle changes only I can detect. During the next month I plan to increase my walking and focus on working on stability and flexibility through yoga. I feel like everything is on track for a full recovery and I hope to be doing some gentle running before the end of the summer.

At this point my boot and my cane are almost certainly fully retired. I haven’t used either in a week but I haven’t quite had the nerve to banish them to the basement yet. The last time I wore the boot was on Saturday on a trip to the dump to pick-up compost. I was planning on wearing it while planting my garden but decided I felt good enough to do that task in shoes. Then it started getting quite hot so I decided I was ready to try wearing sandals again. I’m only wearing sandals that are firmly attached to my feet (no flip flops) so they still feel very secure for walking.

I went to my first yoga class since the injury this week. It was a “rest and renew” class so all the poses were seated and I had no problem keeping up with the class. I did a few slight modifications mostly involving having a foam pad under my injured foot to make up for a lack of flexibility. Next week I’m going to move up to a low level open class which I expect will be more challenging.

My rehab focus is on heel raises and walking. I’m averaging about 6,500 steps a day. By the end of the day I usually have some soreness in my achilles. It’s just enough to keep me from overdoing it. I’m also working on challenging myself by going up stairs with only the ball on my foot on the step. That really fires up the Achilles. One of my friends who is a physiotherapist (not the physio who is actually treating me) was over for dinner this weekend and she told me that I should be able to do 30 single leg heel raises before I start running again. As soon as she said that I wanted to cry. Then again, I can’t even do that on my good leg (at least not without a countertop for some support) so I’m not sure where she got that number from.

It feels really good to have gotten to the 12 week mark. Even though there is still a long road to recovery ahead I feel much less “injured” than I did just a few weeks ago.

I’m all about the heel raises these days. I’m doing about 100 heel raises split into three sets each evening. One thing that I find interesting is the calf on my injured side doesn’t really fatigue during heel raises. I’m trying to put as much weight on my injured side as I can bear but it’s my good right side that gets tired first. My physio explained that my achilles still isn’t strong enough to actually challenge my left calf muscle enough to get it to exhaustion. After watching me do some raises he was pretty happy with my technique and weight distribution though. He suggested that I focus on shifting weight to my bad side at the top of the heel raise (I can not put 100% of my weight on my toes up there) and then bear more weight going downwards than I did going upwards.

My shoed walking is steadily improving. My stride length is back to normal and I can nearly walk at a normal strolling pace. However, I’m focusing on slowing my pace down a bit to force my left foot though a toe push even if there’s not much strength there. That way when the strength comes back I don’t have to correct a flat footed gait.

I feel like I’m close to loosing the boot for good but I did wear it for three days this week while I was at a work conference. There was a lot of walking to be done and some of it on uneven ground. On the first day of the conference I did >11,000 steps in the boot which I’m fairly certain is the most walking I’ve done since my injury. By the end of the day my heel and shin were throbbing. I decided to skip a few social events at the conference just to keep off my feet but all in all I was pleased with what I was able to do. Also I’ve gotten very good at answering the “What did you do to your foot?” question in under 20 seconds.

I’m slowly starting to reintroduce cardio exercise into my life. In the first two months after my injury I didn’t have a burning desire to try and modify my exercise routine. Other than brief periods of injury I’ve basically been in training for something since I started playing competitive basketball at age 12. I figured a few months off wouldn’t kill me. Besides, it took all the energy I had to get myself to work and home during the week. Trying to bus and then crutch over to the gym or yoga studio just was not happening. However, I’m starting to feel the itch to do more so I’m adding the stationary bike to my routine. I might try a gentle yoga class next week too!

There were lots of small improvements during week 10. I’ve been doing my double calf raises (and other exercises) diligently and ever so slowly I’m able to put more weight over to my injured leg. According to my bathroom scale I’m now putting about 25lb of weight on my inured side at the peak of the raise. So I’m roughly one third of the way to an equal distribution of weight. My stride length in 2 shoes is nearly normal although I have no push off my injured foot. My 2 shoed walking speed has improved from snail to tortoise. I’m still hyper aware of my surroundings but my confidence and trust in my foot is slowly starting to increase. I just keep telling myself that slow and steady wins the race.

My physio seems quite satisfied with my progress although he noted that he can still detect the location where my tear was. It has healed over but isn’t fully filled in with solid tissue yet. It’s nothing out of the ordinary but was a good reminder that the risk of rerupture is very very real. He also noted that I have a lot of scar tissue above the injury location which is something that will just have to work itself out with time.

Other than my slow speed and limp my biggest functional limitation is going down stairs. I can’t step down with my good leg because I don’t have enough dorsiflexion and it puts too much strain on my injured leg. It’s something to work towards. I’ve also decided to start wearing my fitbit (I had to dig it out of the gym bag I had with me the day I hurt myself) so I can track my walking distance. I’ll be working on slowly and steadily increasing that over the next few weeks.

I’m happy to report that I’m still going strong with 2 Shoes. Right now I’m using my boot for the bus commute, crowded places, and anytime I need to walk a long distance or get somewhere quickly. My shoes of choice are running shoes which I have to admit look a little strange at work but are quite comfy. I suspect it will be a long time before I return to some of my dressier work shoes. I’m also finding a cane to be immensely helpful in my return to shoed walking. It’s great to have for balance, it clearly tells strangers that I’m slow and should not be bumped in to, and it’s turquoise blue which is just fun. It’s a Hugo Folding Cane and I can’t say enough good things about it.

I still haven’t completely solved the mystery of my suddenly ill-fitting boot. Ever since it went to neutral it has not been fun to wear. I suspect that once the last wedge came out my former boot walking gait no longer worked and that put a lot of stress on the rest of my body. I’m still relearning how to FWB in the boot. It also dawned on me that perhaps I should start inflating my boot. Previously I was told not to inflate it because the wedges were in the way of the air pockets. However I’m finding some inflation is helping to hold my heel in place which is good because the boot seems incredible wide compared to my narrow heel. This makes me wonder why boots aren’t sized by width like shoes. I’d never wear a men’s width shoe so why aren’t there women’s width boots? Well maybe there are but I certainly don’t have one!

My daily exercise routine is ROM, stretching, theraband resistance exercises, seated calf raises and standing calf raises (~10% weight on my injured side). I usually do about 3×30 standing double calf raises in the morning and then another set in the evening. Unless I’ve done a lot of walking during the day and my calf/ankle feel fatigued in which case I adjust accordingly. Today at physio we added some balancing exercises to my routine. I did 10×10 seconds of one legged standing on a small trampoline with a grab bar for stability. I could feel every small muscle in my foot start to fire when I did that! I also started step-up exercises - slowly raising and lowering up and down a step to work on balance and strength.

My goals for this week are to just keep walking as much as possible (in safe, controlled settings, of course). I can now stride with the heel of my good foot even with the toe of my injured foot. I’m really trying to focus on good walking form and rolling off the ball of my injured foot even though I presently have no discernible push-off strength. That will come in time!

Last week I started the progression from FWB to 2 Shoes. Wednesday the last wedge came out and I slept without the boot for the first time. Thursday I wore the boot to work and in the evening took my first outdoor walk (350m) in shoes using a cane. Friday, I did a lot of walking in the boot during the day and then spent the evening either barefoot or in shoes. I actually had a lot of trouble on Friday walking in the boot without any wedges. I’ve lost the nice roll through stride and my gait was choppy and uneven. For the first time, my booted shin and heel and both knees were sore by mid-afternoon. This morning (Saturday) we left the house to run a few minor errands and actually returned home after one stop so I could swap my boot for a shoe and pick-up my cane. At this point I feel as though my body is rejecting the boot.

I’ve decided to, at least temporarily, put my last wedge back into the boot. This seems like a step backwards but I just can’t walk in the thing in neutral. I’m pretty sure if I use the boot in neutral I will hurt my knees and that just doesn’t seem worth it. It’s not a stretching/ROM issue - I’m in neutral when I walk in bare feet and the running shoes I’ve been wearing only have a 4mm rise from toe toe to heel. In fact my AT was about the only thing that wasn’t sore after a day of neutral boot walking.

So while I can’t take a neutral boot I did go out and about in shoes and a cane today so I’m officially updating my status to 2 Shoes!

Last week was all about double calf raises. Initially my physio wanted me doing them standing up but I was putting almost no weight on my injured leg so I also started doing them while seated. Since I don’t have to worry about balance while seated I’m able to really focus on getting my calf muscles to fire. After 7+ weeks of immobility I have to retrain my brain to use those muscles. I’m definitely making progress with the calf raises although I’m still a far far way away from a 50/50 weight distribution.

At today’s physio appointment we took the last wedge out of my boot and I was told to start the transition to 2 shoes! This is good since for the past few days I’ve actually been doing a little bit of bare foot walking around the house. I’m currently doing a choppy a half walk - where my good foot steps to even with my injured foot. I don’t really have the dorsiflexion to step very far forward with my good foot and of course I have zero push off from my injured foot but that’s OK for now. I just need to keep up with the calf raises and stretching and I’ll get there eventually. Also I’ve been cleared to start sleeping without the boot!

My physio thinks that given the condition of my ankle and tendon the transition to 2 should should take me about 2 weeks. I’m mentally prepared for a 4 week transition so we’ll see how things go. I think that this week I will focus on walking around the house and maybe try to do a short walk around the block over the weekend. My physio didn’t say anything about putting wedges into my shoes but I bought some gel heel inserts a few weeks ago so I’ll probably put those in a pair of running shoes to start.

I can’t believe that I’m going to say this but the last 8 weeks of being in the boot full time have actually flown by. Time for 2 shoes!

It’s been steady state around here over the last week. About the only change is that I started doing resistance exercises at home with a theraband. I had a pretty active weekend considering I’m wearing a boot: household chores, shopping and a dinner out. I even spent some time outside helping install a rain barrel and build a frame for a raised garden bed we’re putting in to the backyard this year. I was maybe at 25% of my usual capacity for helpfulness but it felt great to actually be doing something.

My physiotherapist took out my second (of three) wedges today. I was sore for about 48 hours after the first wedge came out so I anticipate that happening again. Apparently this temporary soreness is a good thing as it means I’ve healed tight but not too tight. My ROM is improving (dorsiflexion and inversion are the most limited) and I can rest my unbooted foot on the ground (no weight) in neutral without it really feeling like too much of a stretch.

I’ve been instructed to start doing double calf raises at home. Like so many steps in the ATR recovery this is both thrilling and terrifying at the same time but I feel like I’m ready for it. I’m supposed to put the extra heel wedges from my boot on the ground under my heels (so I’m not actually going down to neutral) and put as much weight as necessary on my good foot so that I can complete a full calf raise. In other words sacrifice weight bearing for completing the full calf raise motion. I’m going to try this out tonight and tomorrow and then my physio will see how things are going on Friday.

I’m excited to share all the progress I’ve made over the last week. Within a day or two of my last post I was able to achieve FWB status. On Friday afternoon I even went for a 0.9km walk around the block. On Saturday I went to the grocery store and left the crutches in the car. I am happy beyond words to be able to get out and about without my crutches. On Sunday I navigated an Easter get together (including a buffet dinner) and when I walked into the lunch room on Monday without my crutches my colleagues gave me a round of applause. FWB feels so so good.

I’m diligently doing my ROM exercises and gentle stretching several times a day. I can now bring my foot to neutral. I had another physio appointment today and everything seems to be healing on track. My physiotherapist did some “more aggressive” stretching of my ankle. I can’t say I really enjoyed this - it wasn’t painful, just really really tight. Apparently the stretching is good to get the scar tissue to align (or something like that). We also removed the first of three wedges from my boot today. As much as I enjoyed being 6′2″ in the boot I’m happy to be getting shorter! So far I haven’t noticed much of a difference without the wedge.

I feel like I’m in a really good place in my recovery right now. I’m pretty much entirely self sufficient around the house (carrying laundry into the basement isn’t happening though) and I’ve conquered riding the bus so I feel like I’m getting my independence back. I haven’t done any solo shopping or errands yet but that doesn’t really bother me. Post dinner walks around the neighbourhood and yoga are keeping me from going stir crazy. I actually think I’m going to savour the next two weeks of FWB before weaning off the boot slows me down and/or puts me back on crutches!