Posted on July 16th, 2014 by davidk
My recovery continues to go well and I’ve made more strides this past week. At my PT this week I graduated from the simulated “shuttle” jumping and began real, light (hands on a ballet bar) jumping on both feet–in-place, side-to-side, and diagonally (front-left to rear-right, and the reverse). I also did some gentle jumping on a small trampoline. This will eventually progress over time to free single-leg jumps. I also am focusing more now on my dorsiflexion via active balancing exercises (with bent knee) and passive stretching (with both straight and bent knee). It is my bent-knee dorsiflexion (soleus muscle) that was identified as a weakness via the Y-Balance Test (return to sport readiness) from last week. Although it still feels tight, I do feel like I’m making some improvement through this focused stretching. I’ve also increased my single-leg heel raises to reps of 15 at about 3/4 the height of my unaffected leg. I continue to bike regularly and yesterday took my longest bike ride since my ATR–30 miles–and my Achilles did not bother me at all. My swelling seems to be completely in-check and I’ve discontinued regular icing and will now only ice as-and-if needed. I next see my OS in 2 weeks (at Week 20) and am hoping for partial clearance to get back on the tennis court for non-competitive hitting. It’s been a long time coming, but there’s no doubt now that the light I see IS the end of the tunnel!
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Posted on July 10th, 2014 by davidk
[Week 17] Today at my PT appointment they gave me a Y-Balance Test. While I’d never heard of this or read about it on this blog site, I found it a very interesting test with potentially important diagnostic information, so I wanted to share. As background (most of which I picked-up on the internet after the fact), apparently this test has been used as a predictor of lower-extremity injury in sports. The original study (I think) was done on high school basketball players in their pre-season. They found that the results could identify those athletes that were more likely to have a lower extremity injury during the season–interesting! My PT said that they are incorporating this test for those patients that are interested in returning to sports to help gauge their readiness.
The actual test is pretty simple. You stand on one foot on a plastic block and extend your other foot in 3 directions: straight forward, backwards to your left, and backwards to your right (3 times in each direction, taking the best of three measures in each direction). Think of an upside-down capital “Y” with your foot at the intersection of the lines. There are plastic tubes emanating from the center block you’re balancing on (making that upside-down “Y”) that have the distance from the center block marked on them. As you’re balancing on one foot, you need to push a separate sliding block on each tube as far as you can and measure the distance moved. You can’t touch the ground as you move these blocks and you can’t place your foot on top of these sliding blocks either–you need to push the vertical surface of the block only with your foot just off the ground (no kicking). Then, you need to return that foot to center in a controlled fashion for the measurement to be good.
Before the test my PT measured the length of my legs–from hip bone to ankle bone. This measure is used to normalize the results. Then, you take the average measurements of the 3 directions (the best measure from each direction) and divide that number by the length of your leg to arrive at a composite score, doing this for each leg. On the test form at my PT’s office, they rate the difference between limbs as follows: 1-5% Excellent, 6-10% Good, 11-15% Fair, >15% Poor. In my later research of what I think was the original study, it was found that those players (both boys and girls) with a 4(+) cm right/left anterior reach difference were 2.5x more likely to have a lower extremity injury. Additionally, girls with a composite score (as described above) in the bottom-third of peers were 6x more likely to suffer a lower extremity injury.
My results: Before my test, my PT said that it was likely that, given my current status of recovering from an ATR, my injured leg would not score as well as my unaffected leg. What was interesting is that my injured leg scored better than my uninjured leg: 105.6% vs. 100.2%. On its face, it would seem as if I’m OK and ready to go back to sport. However, looking beneath the headline number, my injured leg scored much better on both anterior measures (about 10% better) while it scored much worse on the forward measure (about 10% worse). My PT seemed surprised at my results and speculated that the anterior comparisons were the result of extra balancing practice on my injured leg–more balanced (both legs) balancing is in order here. However, the forward measure shows that I still need to work on the active dorsiflexion of my injured foot (especially with my knee bent)–this was the key finding for me and now I have my marching orders to focus on this before heading back to the tennis court.
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Posted on July 8th, 2014 by davidk
This will be a brief update as I don’t have much news to report. My recovery continues to go well and life is getting back closer to normal. I’m still going to PT 2x week and the focus has shifted to strength building, active stretching, and light-impact exercises (e.g. skipping, shuttle jumping). Over the past week I’ve increased my biking and have biked 3 times: 13 miles, 6 miles, and 8.7 miles. On my last ride I went up a steep (but, relatively short) hill standing on my toes and felt pretty good strength in my injured leg. In between (every other day) I’ve walked–about 2.8 miles each time. I’ve had no negative repercussions from this increased activity. I’ve cut down my icing to once per day now as the swelling is much improved–and I may go to icing on an “as needed” basis. I continue to do 1 legged heel raises and can now do a set of 10 at about 2/3 the height of my good (uninjured) leg; this is improving each day, but I’m deliberately trying not to over-push here. On the negative side, I still have some tightness in my Achilles and calf each morning, but this usually goes away pretty quickly.
Here’s an updated picture of my recovering Achilles. Viewed from the side, I still have a visible “bulge” at the site of my rupture. Overall, still looks like a “fat tire”, but I see some improvement.
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Posted on July 1st, 2014 by davidk
At my PT appointment today, my PT said he had some “surprises” for me–new stuff. He then said at 16 weeks, the protocol they’re following for me called for an introduction to some more active and light-impact exercises. So, in addition to the stationary bike, both active and passive balancing exercises and calf stretching, today I did some light sideways hopping and some forward skipping. I also used for the first time the “shuttle” machine, which simulates jumping while lying on your back. You push-off of a vertical “backboard” and some kind of a spring mechanism brings you back–all without the weight of your body being pulled down by gravity. I did a number of different “jumps”: 2-footed and 1-footed, jumping in place and jumping and landing in a different place. He did tell me to let him know if I experienced any pain, but I did not–it felt good. He said he’ll increase the resistance over time and in a few weeks we’ll transition this jumping to the floor–real world!
My PT also took some measurements today on my range of motion and my calf girth. On my ROM, I have now 6 degrees of dorsiflexion and 49 degrees of plantarflexion–for a total of 55 degrees. Unfortunately, I don’t recall my previous measurements here, but I know they’ve improved. He did say my plantarflexion was “good” now, but he’d like to see my dorsiflexion move to 10+ degrees. On my calf girth, my right (good) calf increased 1/2 cm to 37 cm and my left (injured) calf has increased 1 cm to 35 cm–this increase has occurred over the past 5 weeks. I was most excited about my calf girth improvement and the 1/2 cm reduction in the difference between the two calves. I’ve been noticing improved muscle tone and I suspected some size increase, but it was nice to get official confirmation.
I continue to do my in-home PT, only once per day now, and couple that with a long walk (2.5 miles) with my wife in the afternoon or evening. My gait feels completely normal, with good push-off, and I generally feel no tightness or pain in my ankle/calf during/afterwards. I also continue to elevate as much as possible and ice twice a day. My swelling has noticeably improved over the past 2 weeks. After taking a few short bike rides last week, I haven’t been out riding again, but intend to do more biking. In all, I feel very good about my condition at 16 weeks and am looking forward to making more strides back to “normal”. In 4 weeks time I see my OS and hope to be given clearance for a “light’ return to the tennis court–that’s real motivation for me!
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Posted on June 27th, 2014 by davidk
After announcing my 2 new recovery milestones (single-leg heel raises and real bike rides) earlier this week, I don’t have much news to report. Sometimes, though, no news is good news. This week has been rather busy for me and I haven’t been as disciplined about doing my in-home PT. My single leg heel raises on my injured foot are still only a fraction of what I can do on my good leg. However, I have gotten a few bike rides and walks (< 3 miles each) in, so that’s good. For the last couple of days, I’ve also been working with my wife on distributing a 12-cubic yard pile of mulch on our gardens. We’d been waiting to do this project until I thought I was capable, and now’s the time. The one bit of new news I have is that I do think that my swelling has improved over this past week. Working for several hour stretches on the mulch pile, filling and dumping wheelbarrows and kneeling or crouching-down to spread it around, I anticipated my ankle would be quite swollen, but it wasn’t. I still rested and iced afterwards, for good measure, but I definitely notice an improvement here.
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Posted on June 22nd, 2014 by davidk
This is just a short inter-week (weeks 14-15) post. Today I experienced 2 new and significant (to me) milestones: 1) I took my first bike ride–just a short one (1.5 miles) around my neighborhood, to prove the concept (that I’m ready for this), and 2) I’ve begun doing single heel raises on my injured foot (not full height by any means, but still an accomplishment). These are two near-term goals I’ve had for a few weeks now, and today I felt confident enough to give them a try. My goal had been to reach these by week 16, so I’m slightly ahead of schedule. Patience and discipline does pay-off in this recovery process–happy healing everyone!
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Posted on June 18th, 2014 by davidk
This past week I took my first plane trip since my ATR. My family flew to Colorado and stayed in Boulder to visit relatives. While there we hiked the Flatirons (part of the foothills) and also went to Rocky Mountain National Park (RMNP) at Estes Park. For 3 consecutive days, I hiked 3+ miles on the “easy” trails. Given my condition, I’d probably categorize these trails as “challenging” given the obstacles (tree roots, rocks and boulders, and even some small creeks to cross over on wet stones) and elevation. We drove the just-recently-opened-for-the-season scenic Trail Ridge Road to the continental divide at Milner Pass–the views were fantastic. Along the way we took a mile-long hike at the Rock Cut turnout (12K+ feet). Despite the challenges, I felt great doing all of these. I was careful, but I also felt very confident in the status and condition of my still-healing Achilles’ tendon. I had no pain and not even any tightness in either my Achilles or calf. The only downside was increased swelling in my ankle–which, in addition to my heightened activity level, was probably exacerbated by both flying and being in higher altitudes than at home. At the end of every day my ankle looked like a tree trunk! I iced every evening in our hotel room and by morning the swelling was down. Returning home yesterday, on a day without a hike, my ankle was again monstrous so I’m certain that flying has an influence on swelling. I iced twice yesterday (afternoon and evening) and this morning my ankle looks normal (well, post-ATR normal, that is).
Here’s a funny story that occurred during our trip. One day while we were walking around Bear Lake in RMNP I noticed a man sitting on a bench wearing a “boot” on his left leg. While my family walked ahead, I just had to ask him–was it his Achilles? It was! He said it happened playing soccer and he was 6 weeks post ATR and was recovering non-op. He appeared to be FWB (I saw no crutches), but I could also see that he was at a low-point and very disappointed with his situation. I told him that things start to improve quite a bit around week 10, which was only a month away for him. I showed him my scar and told him I was at 13+ weeks and that my recovery was going great now–it is. As I left him to catch-up with my family, I forgot to ask if he’s using this blog–I hope so.
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Posted on June 11th, 2014 by davidk
I’ll try to keep this post relatively short. Sports are still a way off for me, but otherwise life is getting back closer to normal–which is good. My in-office PT has gotten much more aggressive with cycling to warm-up, dynamic walking exercises that emphasize balance in motion, heel raises, runner’s stretches, lunge walking, and partial squats–to name a few. My PTs try to mix it up with new stuff each week, which I appreciate. I try to replicate as much as possible my in-home PT with what I’m doing at my appointments each week–plus I still do some of my resistance-ROM exercises and I’ve added an evening walk with my wife around our neighborhood. I’m up to a 2-mile walk now and feel no pain, just some calf tightness and muscle fatigue towards the end of the walk. I feel that I’ve got a good push-off my toes on my injured foot–my gait is near-normal at this time, just my endurance is limited.
And, in the little-by-little category, I’ve just started to walk upstairs normally; for some reason I’m still not comfortable, however, going downstairs normally and use Norm’s trick of placing only the back-half of my foot on the step. Even though my overall activity level has picked-up, my ankle swelling has gone down considerably since achieving 2-shoes status, but not disappeared. I still elevate my leg as much as possible, and also ice twice a day. My Achilles is still top-of-mind for me, but not to the hyper-extent it has been. Looking backwards, life is much better today and I remain hopeful for a successful return to sports–primarily tennis and cycling.
Thank you to all of you who are ahead of me in this journey as your shared experiences have made mine easier. And a special thanks to Norm for his tireless guidance to all of us. To those of you behind me, be patient, read the blogs of others just ahead of you, and keep-up with your PT and recovery will come!
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Posted on June 3rd, 2014 by davidk
Today I had my 12-week post-op visit with my OS. He examined my Achilles’ tendon and said it was “rock solid“!, and given his intonation I took this to be a good thing. My recovery is going well, but not perfect and I had a number of questions for him and he answered them all without rushing. I am mainly concerned currently with new and increased swelling around my ankle–more than I’ve had my entire recovery. Given no redness or pain (which could have indicated an infection), he was not concerned and attributed this to my new and increased activity level and no more boot providing me with support. I also asked about my ROM at this stage–full plantar flexion, but only just beyond neutral dorsiflexion–and he said this was fine. I’ve just recently begun pushing dorsiflexion beyond neutral with my PT and he was confident it will improve with stretching.
Having obtained my operative report since my last visit, I had one new question about my surgery. There was a discussion about my paratenon (the paper-like sheath that covers the Achilles) being significantly disrupted, to the point where he was unable to fully repair. I wondered if there would be any long-term effects that I should be aware of/concerned with as a result. He said that it is quite common for the paratenon to be disrupted with an ATR and, given it’s thin and fragile structure, it is often difficult to fully repair, but that there should be no long-term adverse functional impact to my recovery. He then positioned my foot in plantar flexion position and showed me some very slight “bunching” of the skin above the Achilles, which he said was the result of the partial status of the paratenon–but that mine was very minimal and should get better over time. As I’ve already resigned myself to the fact that my prospective career as a foot model is over, I was not bothered by this news.
I also asked him what the danger of re-rupture was at this stage and I was somewhat surprised when he responded “high”. However, he clarified that at this stage patients may become overconfident in their Achilles’ tendon and companion muscles and overexert themselves. If restraint is observed and the PT protocol is followed, he then said the danger of re-rupture is actually “low”. Then, the best news of all: I am to come back in 2 months’ time (5-months post-op) and, if all is well, then he will give me partial clearance to resume sports activities–including getting back on the tennis court (hitting, but no competitive play). He then added that at that point my PT would progress to more aggressive sports-oriented situations and that he would see me again at the 6-month mark and, if all is well, he would then give me full clearance to resume all activities–with no restrictions! That’ll be the day! 
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Posted on May 28th, 2014 by davidk
My planned 2-week “weaning” period from boot to 2-shoes has been much easier and quicker than I thought it would be–I attribute this to being disciplined about doing my PT exercises ever since I got my cast removed. I am being careful, but since last week I’ve worn my boot only 4 times for select trips/events–the last time was 3 days ago. Today I went to my PT appointment for the 1st time in 2-shoes–not just bringing them with me. It’s a week early (relative to my OS’ plan), but now at 11 weeks post-op I’m declaring myself officially 2-shoes status! Next week I see my OS for my 12-week check-up and I feel confident about my ability to walk-in in 2-shoes with a (nearly?) normal stride.
For the past 3 days I’ve been taking walks around my neighborhood (~1/2 mile) in the late afternoon and my Achilles feels great. I plan to increase this distance up to a mile over the next week. My gait has improved a lot over the past week as well; I am still slower, but it’s getting closer to normal each day. I continue to do my twice daily exercise routine, which now includes a combination of silly walks (my term, a la Monty Python) of lifting each leg up in different ways and pausing before taking the next step–these have been great for my balance (but I do keep these indoors, or my neighbors might send me off to the loony bin). I still have to work on building back my muscle strength and endurance, but overall I feel great about my recovery at this stage–life is getting back much closer to “normal”. As I commented recently in someone else’s blog, if I must go through a (frustrating) plateau, this is not a bad stage for it–especially considering where I’ve been.
Today’s PT session continued the newer focus on balance in motion via different stances with upper body movements (some with medicine balls) and (silly) walks, but also added some partial squats and stationary lunges. My range of motion in plantar flexion is complete and I’ve been using resistance (green TheraBand) here for some time. However, my dorsiflexion ROM has not been similarly challenged and my PT said now was a good time to start. So, I’m going to modify my ankle pumps and circles to bring my foot beyond neutral in dorsiflexion without resistance and, then, once full ROM has been achieved I will add resistance via TheraBands. The squats and lunges help with this dorsiflexion ROM as well. I also asked for some kinesio tape on my Achilles after hearing about this from Sporti. My PT did not question me, but I don’t think it would’ve been offered unsolicited. Lastly, I had my PT measure my calves to give me a “baseline” of comparison for the future: my right leg is 36.5 cm, and my left leg is 34 cm.
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