Busted Up 42 Year Old

Today is the one year anniversary of my rupture while playing soccer. I ran a 5K today with my children! I thank God, doctors, and family that I met this personal goal.

I ran this race last year in 29 minutes and today was about 35 minutes. My legs felt good and I only had to fight through asthma, my old nemesis. I think it will take another year to be at full pre-injury strength because of how I am healing. But, I am certainly well-recovered enough to jog safely. The only lingering problems I have are numbness in part of my foot from nerve damage and stiffness / small twinges at random times. I am content with my progress and will continue to exercise to get stronger. I am finished with “court and field sports” (i.e., soccer and basketball). I am 43 and have too many people depending on me to take the risk.

Like others, I have offered advice along the way in my posts. Looking back over this year, I will offer this suggestion - control your emotions. ATRs are difficult because of the gravity of the injury, the many possible protocols that can cause anxiety (”am I moving fast enough?”), and the length of recovery. Your outcome will be better if you control your emotions and anxiety, educate yourself, and commit yourself to following your protocol and doctor’s/therapist’s instructions.

Here is a summary of my year
• Injured: 9/13/14
• Surgery: 9/26/14
• Week 1 - 2: NWB (splint - foot at 25% angle
• Week 2 - 8: NWB (fiberglass cast - foot at 5% angle)
• Week 8 - 10: PWB (fiberglass cast - foot neutral). Added about 30 pounds of pressure every 4 days
• Week 10 - 14: FWB (fiberglass cast - foot neutral)
• Week 14 - 16: FWB (boot - one heel wedge)
• Week 15: Started PT
• Week 16: Started wearing 2 shoes indoors in safe environments
• Week 18: Reasonably comfortable with 2 shoes outside; can do a decent seated heel raise
• Week 20: Getting stronger. Able to perform double leg heel raises well; flexibility coming back - can do squats (body weight)
• Week 23: Range of motion is 100%; Working on single leg heel raise; Daily activities are not difficult anymore.
• Week 28: Can do a partial single leg heel raise; working on doing a fully stable one leg heel raise before trying to run again
• Week 32: Stopped going to PT after he said there were no more exercises he could show me. Continued the work on my own
• Week 36: Jogging on treadmill at about 4 miles per hour; 30 to 40 seconds at a time.
• Week 45: Can run a single mile in about 10.5 minutes. Ran 4 miles at a 12 minute per mile pace
• Week 52: Ran a 5K on one year anniversary of rupture

At 11 months, I am making good progress with getting back into athletic shape and only have a few annoyances in everyday life.

I have been able to run 4 miles on a treadmill at about a 12 minute per mile pace. After being released from PT, I continued the exercises on my own until they got easy. I still do a lot of stretching, heel raises, and squats. When I started running, I was very cautious and followed this pattern:
* Alternated walking and running for 30 seconds at a time - for a total of 5 minutes. I did this until I felt strong.
* Ran for five minutes straight and continued until I felt confident.
* Ran for half a mile and continued until confident
* Ran a mile and worked on getting my time down to under 11 minutes (pre-injury I was around a 8.5 minute single mile)
* After that, I started adding distance instead of speed (speed still makes me nervous)
My next hurdle will be running outside.

For everyday activities, all is well. Sometimes I limp out of habit, when I get tired, or if I am around someone else limping. It is strange. I have to stop and tell myself to walk normally. The bottom of my foot also gets sore at times.

I would be interested if anyone else can share what they did to get themselves back into running shape at my stage.

For everyone in the early stages, I will state the oft-repeated advice of patience. Also, be systematic and diligent in following whatever protocol or doctor’s orders that you have. As you see in my list below, my doctor’s orders were pretty difficult to follow. But, eventually, you will be out of the woods.

Here is my milestone update
• Injured: 9/13/14
• Surgery: 9/26/14
• Week 1 - 2: NWB (splint - foot at 25% angle
• Week 2 - 8: NWB (fiberglass cast - foot at 5% angle)
• Week 8 - 10: PWB (fiberglass cast - foot neutral). Added about 30 pounds of pressure every 4 days
• Week 10 - 14: FWB (fiberglass cast - foot neutral)
• Week 14 - 16: FWB (boot - one heel wedge)
• Week 15: Started PT
• Week 16: Started wearing 2 shoes indoors in safe environments
• Week 18: Reasonably comfortable with 2 shoes outside; can do a decent seated heel raise
• Week 20: Getting stronger. Able to perform double leg heel raises well; flexibility coming back - can do squats (body weight)
• Week 23: Range of motion is 100%; Working on single leg heel raise; Daily activities are not difficult anymore.
• Week 28: Can do a partial single leg heel raise; working on doing a fully stable one leg heel raise before trying to run again
• Week 32: Stopped going to PT after he said there were no more exercises he could show me. Continued the work on my own
• Week 36: Jogging on treadmill at about 4 miles per hour; 30 to 40 seconds at a time.
• Week 45: Can run a single mile in about 10.5 minutes. Ran 4 miles at a 12 minute per mile pace

I stopped going to PT at 8 months post surgery. I am still working hard at recovery and started jogging at about 9 months.

I am making good progress in my long recovery journey. At about 8 months, my PT gave me the choice of continuing to see him or to go on my own with the exercises for the rest of the way. I chose to go it on my own to save the time and money from going in. He instructed me to wait until I can do a decent single leg heel raise before running.

Everyday activities are absolutely fine with occasional sensitivity on the bottom of my foot and heel. My scar is sort of ugly and the area behind the achilles sticks out a bit.

Strengthening my calf muscle is the last and most difficult thing to do. Just this week, I can do a mostly unassisted single leg heel raise. I have started jogging on the treadmill and have been alternating between walking and jogging at about 4 MPH so far.

I see, unfortunately, lots of new bloggers on this site. I hope you are encouraged by my update. As you can see at the bottom, I was on a slow, very inconvenient protocol. But, I am feeling good now that I did not have setbacks and can start to feel strong again.

Here are highlights of my exercise routine at this stage
1. Warm up on elliptical, bike, row machine
2. Single leg heel raises
3. Sumo squat, heel raises (put back against wall, squat down to seated position, do heel raises)
4. Windmill (put two objects on ground, balance on injured leg, and pick them up with opposite hand)
5. Bosu ball squats. (turn it over on the soft part, stand on hard plastic, and do squats)
6. Bosu ball balancing (balance on the soft squishy part of the ball)
7. Walking lunges (holding weights)
8. Toe walks
9. Step up/down on a box — add more weights over time
10. Leg press
11. Goblet squat (hold a weight in your hands and do squats)

Here is my milestone update
• Injured: 9/13/14
• Surgery: 9/26/14
• Week 1 - 2: NWB (splint - foot at 25% angle
• Week 2 - 8: NWB (fiberglass cast - foot at 5% angle)
• Week 8 - 10: PWB (fiberglass cast - foot neutral). Added about 30 pounds of pressure every 4 days
• Week 10 - 14: FWB (fiberglass cast - foot neutral)
• Week 14 - 16: FWB (boot - one heel wedge)
• Week 15: Started PT
• Week 16: Started wearing 2 shoes indoors in safe environments
• Week 18: Reasonably comfortable with 2 shoes outside; can do a decent seated heel raise
• Week 20: Getting stronger. Able to perform double leg heel raises well; flexibility coming back - can do squats (body weight)
• Week 23: Range of motion is 100%; Working on single leg heel raise; Daily activities are not difficult anymore.
• Week 28: Can do a partial single leg heel raise; working on doing a fully stable one leg heel raise before trying to run again
• Week 32: Stopped going to PT after he said there were no more exercises he could show me. Continued the work on my own
• Week 36: Jogging on treadmill at about 4 miles per hour; 30 to 40 seconds at a time.

I am making incremental progress on single leg heel raises on my way to running again. PT and rehab is getting monotonous - but, I am still doing the work.

Daily Activities, Flexibility, Pain
As I mentioned in my prior post, my flexibility is all the way back and I am not experiencing pain. I can do everyday activities without a problem. I have been out with my children doing a lot of city walking (in DC and NYC) and enjoying the spring weather. Swelling is under control and I certainly have a larger achilles heel area now where the repair was done.

Running and Athletic Capability
I am still not running yet. I am focusing on maintaining a good attitude in this stage as the rehab is very much in the monotonous stage. I assumed I would be all the way back at 6 months. But, it is not in the cards for me to be on the shorter end of the recovery guidelines. So, I will keep posting for the benefit of others who have a similar timeline.

I am still going to PT (once per week now) and doing exercises every day. The next goal is to do a full and stable one-leg heel raise before running again. Right now, I can only do a partial one leg heel raise. I tried 30 seconds of a very slow jog on a treadmill - I could do it, but I want to have a stronger push off before doing that again.

Current Exercise Focus
My exercises now are focused on strengthening the calf muscle. Here are the highlights. (Remember that these exercises are for the later recovery stages. If you are in the first several weeks, the focus is on range of motion and balance).

1. Electro-stim calf raises: The PT puts the electro-stimulation pads on my calf muscle. He cranks it up until the stimulation makes my muscles contract. Then, I do heel raises for 7 or 8 minutes.
2. Squats while standing on one of those blue Bosu balls (the ball is flipped over onto the soft blue portion)
3. Windmills: balance on the injured leg with two cones in front of me. Pick up the left cone with my right hand and stand up with arm raised (repeat with opposite side of body).
4. Get a hand weight (on the same side as injured leg). Balance on injured leg. Put hand straight up in the air. Do a squat and cross hand to opposite foot.
5. Wall sits: sit on the wall (with back against wall). Do heel raises.
6. Toe walks: get up on toes. Walk a short distance while doing my best to stay on my toes with injured leg.
7. Use leg press machine and do heel raises
8. Bike, elliptical, and treadmill walking. I have been cranking up the incline on the treadmill.

Here is my milestone update
• Injured: 9/13/14
• Surgery: 9/26/14
• Week 1 - 2: NWB (splint - foot at 25% angle
• Week 2 - 8: NWB (fiberglass cast - foot at 5% angle)
• Week 8 - 10: PWB (fiberglass cast - foot neutral). Added about 30 pounds of pressure every 4 days
• Week 10 - 14: FWB (fiberglass cast - foot neutral)
• Week 14 - 16: FWB (boot - one heel wedge)
• Week 15: Started PT
• Week 16: Started wearing 2 shoes indoors in safe environments
• Week 18: Reasonably comfortable with 2 shoes outside; can do a decent seated heel raise
• Week 20: Getting stronger. Able to perform double leg heel raises well; flexibility coming back - can do squats (body weight)
• Week 23: Range of motion is 100%; Working on single leg heel raise; Daily activities are not difficult anymore.
• Week 28: Can do a partial single leg heel raise; working on doing a fully stable one leg heel raise before trying to run again

Happy healing to all

At almost 6 months, my range of motion (ROM) is 100% recovered and daily activities are no longer a huge chore. But, I still have strengthening to do.

Daily Activities
Daily activities have gotten much easier. I no longer think about my achilles on each and every step. Sometimes I struggle a little on uneven surfaces. Also, my body wants to limp and I sometimes have to force myself to walk with a normal gait. I have occasional pain on the bottom of my heel. Like many others, the heel pain was intense in earlier stages, but is much better now. I still do not have feeling on one side of my foot because of damage to nerves during surgery. As the feeling comes back, I get weird electrical shock types of feelings - but nothing unbearable.

Therapy
I have continued going to PT twice per week. I do home exercises two or three times per day. My ROM is strangely a bit better than my healthy leg.

For the new members of this unfortunate club, here is the general progression of my therapy:
1. Flexibility. The initial focus was all on flexibility and ROM (basically, the exercises here: http://achillesblog.com/files/2008/03/achilles_tendon_rupture_mass_gen.pdf).

2. Balance: Once flexibility started to improve, the PT added exercises for balance (e.g., balance on one leg; balance on injured leg and tap my good foot in front, side and back of me; squats)

3. Strength: The last set of exercises has been strength. For example, seated heel raises -> standing, double leg heel raises -> single leg heel raises.

I also ride the stationary bike, use an elliptical machine, and walk on the treadmill. My PT wants me to be able to do a single leg heel raise before he clears me for running. A true single leg heel raise is taking some time to do. I have to put my hands on a table and push as hard as I can.

Lessons Learned
For the new posters, here are a few lessons as I reflect over the past 6 months. I also posted some reflections a few posts back if you are in a cast / NWB for a long time.

1. Be systematic: With whatever protocol you choose (or is chosen for you), be disciplined and systematic. Otherwise, you run the risk of a set back. If you need to be off your feet the first two weeks after surgery with your leg elevated, do it. If you are supposed to wear your boot, do it. If you have exercises to do, do them faithfully.

2. Be patient: This is a long term recovery and you need to be patient and look forward to incremental milestones.

3. Dealing with surgeons. This was my first surgery. In my experience, my surgeon was just focused on repairing the tendon and making sure everything was structurally sound. He was always in a hurry and had little to say about my ability to be functional on my leg. But, my PT was very focused on my functionality and quality of life. Once I realized this, I stopped fretting about the surgeon and it helped me stay sane.

Happy healing to all.

Here is my milestone update
• Injured: 9/13/14
• Surgery: 9/26/14
• Week 1 - 2: NWB (splint - foot at 25% angle
• Week 2 - 8: NWB (fiberglass cast - foot at 5% angle)
• Week 8 - 10: PWB (fiberglass cast - foot neutral). Added about 30 pounds of pressure every 4 days
• Week 10 - 14: FWB (fiberglass cast - foot neutral)
• Week 14 - 16: FWB (boot - one heel wedge)
• Week 15: Started PT
• Week 16: Started wearing 2 shoes indoors in safe environments
• Week 18: Reasonably comfortable with 2 shoes outside; can do a decent seated heel raise
• Week 20: Getting stronger. Able to perform double leg heel raises well; flexibility coming back - can do squats (body weight)
• Week 23: Range of motion is 100%; Working on single leg heel raise; Daily activities are not difficult anymore.

I am making good progress at 20 weeks and am telling myself to be patient.

I have been working hard in PT and getting more flexibility and strength. I can do double leg heel raises and body weight squats. As my calf gets stronger and able to push, I am starting to get past the stage where I feel like my heel is “stuck” on the ground as I walk. The only mild setback I have had is aggravating an old lower back injury because of all the overcompensating.

I have accepted that I won’t be one of the people who is running and back to athletic activity at 6 months. I think it is the way I have healed and my long immobilization. However, I am content and thankful that I have put the crutches and other hardware away and have moments when I am not thinking about my injury. I am keeping my goal of running the same 5K with my son that I ran in September a week before the injury.

Here is my milestone update
• Injured: 9/13/14
• Surgery: 9/26/14
• Week 1 - 2: NWB (splint - foot at 25% angle
• Week 2 - 8: NWB (fiberglass cast - foot at 5% angle)
• Week 8 - 10: PWB (fiberglass cast - foot neutral). Added about 30 pounds of pressure every 4 days
• Week 10 - 14: FWB (fiberglass cast - foot neutral)
• Week 14 - 16: FWB (boot - one heel wedge)
• Week 15: Started PT
• Week 16: Started wearing 2 shoes indoors in safe environments
• Week 18: Reasonably comfortable with 2 shoes outside; can do a decent seated heel raise
• Week 20: Getting stronger. Able to perform double leg heel raises well; flexibility coming back - can do squats (body weight)

I am wearing 2 shoes in most situations, slowly getting stronger, and realizing that more judgement is needed than my prior stages.

PT and exercise are helping me slowly loosen up and gain strength. At PT, the therapist is adding some strength exercises in addition to therapeutic stretching. I am doing lots of seated heel raises, stretching my calf with my foot hanging off a stair, squats with a medicine ball, etc. I am feeling stronger and more confident when I walk, but still not ready for more athletic movements.

I had my first incident of serious swelling and hotness after my first day indoors and outdoors in two shoes. It felt pretty bad and shut me down for the evening. This was a new experience for me because I had no real judgement calls to make about my activity level when I was in a cast for three months. So, I have been learning when to rest and back off, when to use ice, and when to take a little Ibuprofen. Towards the end of a long day at work, I also walk with crutches to give myself a break. I learned that it was not good to approach the pain and swelling line too closely because it prevented me from exercising and making real progress.

Here is my milestone update
• Injured: 9/13/14
• Surgery: 9/26/14
• Week 1 - 2: NWB (splint - foot at 25% angle
• Week 2 - 8: NWB (fiberglass cast - foot at 5% angle)
• Week 8 - 10: PWB (fiberglass cast - foot neutral). Added about 30 pounds of pressure every 4 days
• Week 10 - 14: FWB (fiberglass cast - foot neutral)
• Week 14 - 16: FWB (boot - one heel wedge)
• Week 15: Started PT
• Week 16: Started wearing 2 shoes indoors in safe environments
• Week 18: Reasonably comfortable with 2 shoes outside; can do a decent seated heal raise

I am in two shoes now (in safe indoor environments).

After one week of PT, I am now cleared for wearing two shoes at home and other safe, indoor environments. Indeed, it is simultaneously exciting and terrifying! I am acutely aware of the environment when walking - even at home (especially my 9 and 6 year old children running around).

For others in earlier stages, be encouraged! You will see in my history below that I spent a long time (3 months) locked up in a cast. But, I have made progress. My incision is all healed and I was able to get into shoes after a week of PT. I have been able to walk with a pretty good gait and heal-to-toe motion.

Here is my PT status
1. Still doing all the therapeutic stretching stuff (see my previous post and others’).

2. Added exercises include:
• Balancing on my injured leg
• Balance on injured leg and tap healthy leg in front, side, and behind me
• Step throughs
• “Obstacle course” - walking through flat ladder on the floor
• “Obstacle course - stepping over small hurdles

Milestone Update
Here is an update to my milestone list.
• Injured: 9/13/14
• Surgery: 9/26/14
• Week 1 - 2: NWB (splint - foot at 25% angle
• Week 2 - 8: NWB (fiberglass cast - foot at 5% angle)
• Week 8 - 10: PWB (fiberglass cast - foot neutral). Added about 30 pounds of pressure every 4 days
• Week 10 - 14: FWB (fiberglass cast - foot neutral)
• Week 14 - 16: FWB (boot - one heel wedge)
• Week 15: Started PT
• Week 16: Started wearing 2 shoes indoors in safe environments

I have two things in this post: (1) PT update; and (2) a recap of my personal milestones.

PT
After 15 weeks PostOp, I started PT!! I am comfortable with my physio’s personality and the facility. My range of motion was decent considering being immobilized for three months in a cast. After overcoming the mental hurdle, it feels good to move again. However, I am trying to restrain myself from getting too intense too fast since my athletic side has been reactivated. I have read with keen interest (and empathy) the experience of others and want to avoid setbacks. I am still wearing the boot and looking forward to weaning off as I get stronger. I am going to PT three times per week with these activities to date:

• Massage of the injured area
• Calf stretch against wall
• Seated calf stretch (gentle pull with rope around ball of foot)
• Ankle alphabet
• Ankle pumps
• Seated calf raises
• Marble pick up with bare feet
• Seated toe flex on towel
• Weight bearing buildup (shifting weight on both legs, barefooted)
• Electro-stimulation and ice treatment

I am doing the stretches at home 2 or 3 times per day.

Personal Milestones
I also liked Donna’s simple summary for the benefit of other unfortunates who will join our club.

• Injured: 9/13/14
• Surgery: 9/26/14
• NWB (splint - foot at 25% angle): Week 1 and 2
• NWB (fiberglass cast - foot at 5% angle): Week 2 through 8
• PWB (fiberglass cast - foot neutral): Week 8 - Week 10. Added about 30 pounds of pressure every 4 days
• FWB (fiberglass cast - foot neutral): Week 10 - Week 14
• FWB (boot - one heel wedge): Week 14 - Week 16
• Started PT: Week 15

It was very difficult to be NWB and in a cast for so long. I can’t say I would choose a cast for so long again. But, one advantage was having very little anxiety about re-repturing during the first 12 weeks since I was locked up in the cast. Now, I am on the long road to get strong again.

Happy healing to all.

I have termed myself the “outlier” since I seem to be on the slowest recovery path of current posters. I had 8 weeks NWB (2 in a splint and 6 weeks in a cast) and then 6 weeks in a weight bearing fiberglass cast.

Anyway, I had the cast removed, am in a boot, and have an appointment for my first PT appointment. My surgeon is finished with me and does not need to see me anymore. The boot is certainly lighter and easier to walk in than a cast. But, strangely, I experience more heel pain in the boot than the cast.

It was a joyful experience to move my ankle around and take a bath after 3 months. I am stiff - but have a decent range of motion in my ankle. I can walk very well in the boot. But, I am waiting for the physio’s instructions before trying two shoes. I am very excited about PT as I found the organization that does the rehab work for the local professional hockey team. Surely, they have seen a lot of ATRs in their time.

I’ll keep posting and will hopefully be encouraging to others on a long recovery protocol.