This worked well for me, your mileage may vary. I’m 53 years old, in fair but not great shape, so if I can do this, I suspect many other younger or more fit people can do the same or better. Here is how things progressed:
First, my completely torn Achilles tendon was surgically fixed five days after the injury. My ortho doctor described my tendon ends as very frayed, “like spaghetti,” and seemed concerned that the stitches might not hold well in that frayed tendon tissue. At the end of the surgery, a splint was put on the front of my shin and the top of my foot, keeping the foot plantar flexed (toes pointed down). The splint was held on my leg with an ace wrap. If you are stuck in a cast, your rehab options are more limited than mine were.
That night, pain relief was the big issue. I took my last narcotic pain pill 15 hours after the surgery. After that, I just used Aleve. I rested and kept my leg up as much as possible.
Five days later, my doctor took a quick look at the surgical wound and redressed it. In the five days between the surgery and redressing, the splint and ace wrap were in place the whole time. During those five days, I started the very beginning of my rehab, using the calf muscle just enough to make it twitch a little. This is about the lightest imaginable stress on the calf, but I did a LOT of it, to music, most of the time. I continued to keep the leg elevated as much as I could, but that was limited by my returning to work a week after surgery.
At that five day doctor visit, my doctor’s instructions were to remove the splint occasionally and to stretch the tendon, but only by using the tibialis anterior muscle. The tibialis anterior muscle is the one on the front of your shin that pulls your toes upward toward your knee. I did this stretch several times a day, and I did it as hard as I could. While the splint was off, I also started making circles (in both directions) with my toes, to work on my coordination, and also gain some confidence. A few days later, I began to work the calf against a tiny amount of extra resistance, by placing my index and middle fingers on the ball of my foot, pressing just a little as I pushed my foot downward. As time went by, I increased that finger resistance, (and increased the number of fingers I was pushing against). When doing this, I was careful not to put any more stress on the tendon than my doctor-approved stretches did.
I should point out that I never did anything that hurt during this entire rehab process. I was also quite a chicken sh*t until I started walking, going up and down stairs at home on my butt.
I started another exercise after that five day visit, to keep my upper leg in some kind of shape. I would lay on my back, with my knee bent about 90 degrees, keep my “good” leg in the air (holding that knee with my hands), dig my “bad” heel into the bed, and lift my butt off the mattress. This works the muscles on the front and on the back of the thigh, and the butt muscles, too. I did this often, every day, until I was walking again. The weight is on the heel, so the toes bear no weight, and there is no stress on the tendon.
Twelve days after surgery, my stitches were removed. (My doctor told me to stay on the crutches, keep doing those same stretches, and he would see me in five more weeks. I wonder if he suspected, by my surprised look, that I wasn’t planning on waiting that long.) I continued the same exercises as before. Just a few days later, though, I could get my toes up to the point that allowed an odd form of walking. I could keep my bad foot out in front, bear weight on that heel (only) for a moment, while I moved by good foot forward a little. Then I would move the front foot forward a little, and repeat. This shuffling walk reminded me (and many others) of the old Monty Python skit about the “Ministry of Silly Walks.”
This was a slow and awkward way to get around, but it was an important beginning. Once I started walking, everything slowly but surely loosened up. I still used the crutches for covering longer distances.
Once the stitches were out, I often used two compression tubes, a little homemade pillow (placed around the back of the tendon, from the inside ankle bone to the outside ankle bone, to keep the swelling down in those little hollows between the tendon and the ankle bones), and an ace wrap over it all, to control swelling in the leg.
Between roughly 2 1/2 and 3 1/2 weeks, that awkward walking gradually improved. I could bring the good foot forward more and more each day, until the good foot’s heel was just in front of the bad foot’s toes when the good foot stepped forward. During this important process, I continued to never stretch the tendon any harder than those doctor-approved stretches, (which I continued to do, along with the finger resistance calf exercises). During this time, I also made a point of planting the bad foot’s heel rather firmly and bending the knee a little while doing so, to work the bad leg’s upper leg muscles. At the end of this period, I was walking well enough to put away the crutches for good.
At that point, (3 1/2 weeks), I was pretty pleased with my progress, so I “coasted” for awhile. I mostly just used walking for exercise, moved the good foot more forward, and began to, very gently, push off a little with my bad calf as I walked. I concentrated on walking as smoothly as I could. At about four weeks, many people didn’t notice the little bit of limp that remained in my walk, (that the bad heel stayed on the ground a little longer than normal, until the good heel took some of my weight out in front). Still, I didn’t stress that tendon any more than did the doctor-approved stretches.
At five weeks, I finally started stressing that tendon a little harder than than the approved stretches, both in stretching and in calf strength exercises.
At my six week postop visit last Monday, my ortho didn’t mind that I had been walking for weeks against his advice. He looked a little nervous when I told him that I had put my toes on a bathroom scale to test my strength and pushed down 140 pounds, but no harm, no foul. He said the tendon felt great. The physical therapist thanked me for making him look so good. They both said I didn’t need to come back to see them again, as I was pretty clearly well on my way to getting my strength back. There are some health care dollars saved!
I never used any fancy devices such as walking boots or rehab gadgets. I really wonder if those boots, while they do protect us from accidental injury, actually hold us back in regaining flexibility. (And don’t get me started on those casts so many are stuck in for weeks.) I did this with crutches (a necessary evil), my splint, an ace wrap, two compression tubes, and my little homemade “pillow” that hugged my tendon to keep the swelling down in those little hollows between the tendon and the two ankle bones. I started riding my bike at 3-4 weeks postop, so maybe that counts as rehab equipment, too. Mostly, though, it has been just walking and some simple no-equipment exercises.
I strongly suspect that most doctors are way too cautious, leaving many of us with withered calf muscles that take months to regain their strength. My atrophy was at its worst about two weeks ago, when the maximum circumference of my good calf measured 17 inches, while the injured calf measured 16 inches (with no swelling). You had to look pretty hard to notice the difference.
I’m left wondering how this rehab plan would work for others. Was I just lucky somehow, and this plan would be too dangerous for general use, or is this a basic plan lots of people could use? I’m hoping some folks wanting a faster rehab will give this a try, likely with some of their own ideas thrown in, and let me know how it goes.
It may not make any difference after a year or more if one’s rehab is slow or aggressive, but I think the first months after my injury have been and will be a lot more pleasant, (and less expensive, with less work time lost, and less hassle for our families and friends), than the experience of most people who go through this nasty little detour in life.
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