dfoss’s AchillesBlog

It has been several months since I last posted. I didn’t want to write anything unless it was positive and could possibly be of some use to someone else. I say this because thing were not going well in my recovery for a long time.
After debridement surgery for chronic Achilles tendonitis last November, I first moved out of the boot in late February ’13 believing that the trajectory of recovery would gradually go up. Unfortunately after a month of freedom the pain and swelling in my tendon had increased to the point that I was back in the boot. I stayed on a roller coaster like this until July moving out of the boot, slowly increasing activity only to get increased swelling and pain, diminished activity, then back into the boot. What was going on? It seemed that, while walking, each step without the boot tugged a little on the tendon causing a little more damage. I continued to look for answers and alternate treatment since what I was doing obviously wasn’t working. I seemed to be in a conundrum, I had to strengthen my muscles to walk without straining my tendon. However, every exercise or activity I knew of that strengthened the muscle also stressed the tendon. Until my muscle chain was long and strong I wouldn’t be able to walk freely. I had no strength in my calf so each step with my bad leg involved an exaggerated dorsiflexing. If I could push off at the end of each step while walking, as my good leg did, then this dorsiflexing would be minimized and tendon strain significantly reduced.
I eventually ran across something that I have not seen mentioned on this site or anywhere else, ARP Wave. I was skeptical at first and was not completely reassured by my initial investigation, but desperation is quite the motivator – I went through with it. ARP Wave is an electroshock therapy similar to a tens unit but that’s where the similarity ends. Muscles don’t work unless nerves tell them to and after months of atrophy my nerves had been asleep. Saying that ARP Wave stimulates the nerves is an understatement. It is quite painful and disturbing at first. Actually the treatment never quit hurting but the progress is so rapid that I looked forward to every session. After the initial sessions get the nervous system (and consequently the muscles) working properly, the following sessions train it to stay that way. All the while the muscles undergo rapid toning and conditioning. The important thing is that none of this strains the tendon, it reportedly accelerates healing of the actual wound in the tendon. I am not convinced of this claim but it at least increases blood flow to the wounded area. Having said that, I did experience a great deal of improvement in the wounded area during the 2 months of my treatment. Here’s some draw backs: It hurt a lot, you WILL hit your pain threshold, and some people just can’t take it. It requires daily commitment, I hour morning and night: more pain = more gain. You need to maintain a high protein diet (3 steaks a day- yea!) to feed the rapid muscle growth that’s happening. It costs at least $750 uninsured per month. Most people can get by with one month, I took two. There are few clinics offering this locally but it can be done long distance, via skype, from their home office. I started with a local technician and finished via skype.
This was by far the best 2 months of progress I have had since well before surgery. I am now walking up to 7 miles a day in moderate hills. The push off with my bad leg with each step is still much weaker than with my good leg but it is adequate, and improving. I have been doing heel drops (15 straight knee+ 15 bent knee x 3 sets x twice/day = 180/day) for a month now and experiencing the increased ROM and strength I thought this exercise would produce. Every time I started adding this exercise to my regiment before ARP Wave I would soon get the swelling and pain back and it wouldn’t go away without 3+ weeks in the boot. I have had no significant swelling or pain in the last month but there is still that dull, constant pain that lets me know I have a long way to go. However I continue to experience increased strength and ROM while experiencing less pain and swelling, not more.

It is week 9 and now starts the transition out of the boot. Tuesday I put on my left shoe and walk around the house, a real morale booster! Very unsteady at first but daily it seems my tendon is getting more used to stretching and the calf is waking up. I’ve added calf raises to my daily workout. I bought a range of motion (ROM) boot on ebay last week and believe this will help with this transition during the next few weeks. Tuesday I set it to 15 degrees planterflex and 0 dorsiflex but now have it set to P= 22.5 and D= 7.5 degrees. I can walk naturally with this boot set up with no strain while definitely feeling my calf pushing off with each step. I limp noticeably without the boot but this is decreasing a little each day. It finally feels like I have 2 feet rather than one foot and a club.

My PT sessions always start with 15 minutes on the exercise bike so I bought one on Craigslist. Now I start every day this way. It feels great to break a sweat. Yesterday I started biking without the boot.

So that’s the progress, I hadn’t managed everything the last few weeks as well. During week 6 things were progressing nicely so I predictably pushed things a little further, maybe too far. I took off the boot and walked around all evening this way with no apparent ill effect. This was satisfying. Two days later I walked 2 miles in the boot, a slight increase over the 1.75 miles I had been doing the previous few days. That night the pain, the types I hadn’t felt since before surgery, increased and I feared I had gone too far and done some damage. I went back to the crutches until my next doctor visit to be safe. Fortunately the doctor said everything looked fine and asked me “exactly which part of take it easy do you not understand”. I’ve been more careful since then.

Not much to report but somehow my blog messed up and the only way I know to fix it is to post something.
I am starting my sixth week and still seeing signs of improvement daily. I am FWB (in the boot) and going for a walk every morning and evening increasing the distance slightly as long as there is no suspicious pain. Went 2 miles this morning. My injury is a debridement, not a full rupture, and the tendon was not cut from the bone during surgery so my recovery may be quicker than most. However, the tendon was a real mess before surgery so how quick and how complete my recovery is are 2 different things. I have a lot of work to do. Stretching the tendon starts at PT this week for the first time. I’ve gotten more comfortable living in the boot than I expected to and am a little nervous about giving up the protection. I am considering buying a range of motion (ROM) boot before I go back to work in week 8.

I’m at 5 weeks now and am still on track. Started PT in week 4 but the first session was partially a waste of time as the ortho office didn’t send my PT the protocol as requested. I was annoyed to say the least but my PT said this is all too normal. He gave me the phone number of my ortho’s PT staff and suggested I call them, not the ortho’s office. He did the same and by the next session he had the protocol. Now I have a full regiment of daily foot ROM exercises and upper leg \ core strength exercises.

ADVISE - If you are not using your ortho’s in house PT staff then call them early and often to make sure they send the protocol to your PT on time.

As scheduled in week 4 I also started gingerly putting weight on my foot and by the end of the first day I was walking on both feet, with crutches and boot. The next day I ditched the crutches and 2 days later the dog and I went for a ¼ mile walk. The next day I walked a mile (in the boot), this was too far. I had swelling that night and could “feel” my Achilles tendon for the first time since surgery. This is a sensation I always had during the past year and was a constant reminder that something was wrong. I never “feel” my right, healthy tendon. It reminded me that this sensation will be a major criteria in measuring healing and activity allowance going forward. We must listen to our bodies but sometimes I need mine to say “don’t do that, stop now” but instead it says “earlier today you shouldn’t have done that, now you’ll pay”.

By early next week I need to choose a PT. I am really intrigued by Graston or ASTYM technique, my Ortho thinks it’s hog wash. Obviously it won’t be in protocol. I am an hour away from my Ortho and his PT’s and he didn’t give me an answer when I asked who he recommended in my town so it looks like it’s up to me to choose. There is only one PT in town that is certified in Graston or ASTYM but otherwise I’m not sure that clinic is my first choice. If this was part of your PT then I would like to know how important you thought it was.