Walking in my shoes within four weeks

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.”
http://www.youtube.com/watch?v=IqhlQfXUk7w
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.

51 Responses to “Walking in my shoes within four weeks”

  1. Okay, so I’m tooting my horn a bit loudly here. Guilty as charged. I have had a nice recovery and wanted to share it, especially with those who are interested in a shorter rehab. I wasn’t doing exercises all day long to do this. It was very much a part-time effort.

  2. Doug,
    I read your blog a couple of days ago and thought, ‘this is my kinda guy.’
    I’m also 53, I am very active and in excellent shape. I will be working with a physical therapist who knows me well and will probably be a good cheerleader if I’m ‘ahead of schedule.’
    My blog is going to be a detailed record of all I do.

  3. Hi Bill,

    I moved my story over to this blog, hoping for a better chance to reach others. I hope I’m able to pass on some tips or inspiration that some might find useful. Watching your blog, it sounds like you’re doing a great job of doing what you can do to move things along without being reckless. With your good fitness and obvious work ethic, you’ll be on your feet in no time, I’m sure.

    Good luck!

  4. Doug,

    Was this an approach your doctor was open to? Did you come up with it or did he? I’m wondering since I am going to my doctor on Wednesday and I hope that he might be open to it.

    I have the standard cast on now (2 weeks out).

    Matt

  5. Hi Matt,

    Let’s just say he was open to it after the fact. It was my doing. I’m a doctor myself, though, if that’s any excuse. (I spend my days, and many nights, for that matter, taking care of critically ill premature babies, though, and that’s pretty far removed from adult orthopedics.)

    My approach was to not stress the tendon any more than it was stressed with what he told me to do, but to do some extra things within that limitation. That included working on the calf’s strength early, (mainly trying to limit muscle atrophy), bearing weight on the heel early on, and walking without crutches as soon as I had enough flexibility in the ankle to do that “silly walk.”

    You were put in the dreaded (in my mind, anyway) cast, but at least two weeks is less than many have to deal with. When the cast comes off, you’ll be able to see how much muscle atrophy has happened to this point. I hope it’s not too much.

    There are dangers to long immobilization that don’t get mentioned much. Severe muscle atrophy makes the period of time when one misstep could lead to rerupture longer, I suspect. I’ve gotten a little lazy since four weeks or so, but by my six week visit I wasn’t really worried about slipping and hurting myself anymore. I remember catching myself one morning, between five and six weeks postop, standing and balancing on my injured foot while I pulled on my other pants leg. This just “happened,” without my thinking about it. That was a good indication of how stable I felt.

    Another medical danger of long immobilization is blood clotting in the leg veins, especially if you have a genetic predisposition to that sort of thing.

    I’m rambling now, aren’t I? (I got into teach-the-residents mode there for a moment.) Anyway, good luck with your rehab. If I can be any help, please let me know. I’m being a pest on this site for that very reason, to help others have a quick return to relative normalcy, like I had.

  6. Hey Doug,
    nah, that’s not rambling. Good information. I speculate/hypothesize right along with you. You have been a valuable incentive in my own short recovery. Seeing as most of the rerupture reports I read are 100% below (distal) to the surgically repaired tear it seems logical to look at other causes. You have done a good job of pointing out the sequelae of the surgery. Since the management of this injury is all over the board, and the debate still rages in the literature, why not be proactive when you feel that conservative management is not cutting it?
    Whereas you are an MD and have some instant credibility, many of the injured here could be facing the heavy opposition of professional ‘experience’ and ego.
    I am very glad you are pestering us all.
    :-)

  7. Doug,
    Do you have any suggestions as to why some people experience very little pain with this injury and some people are in the worst pain of their life?
    Did you have long term Achilles pain (tendonosis) before your rupture or did it happen as kind of a surprise?

  8. Smish,

    I don’t have a good answer for your first question. My tendon hardly hurt at all when it popped, but it hurt quite a lot the night after the surgery. It was a surprise injury. One second I was fine, the next I was on the floor. I remember getting a little Achilles inflammation when I used to go loaded bicycle touring in mountainous terrain, but that was 25-30 years ago.

  9. Doug,

    I have a theory about the pain levels that was confirmed again just yesterday. I think sometimes it has to do with past use of pain killers. At first I thought it was only due to having had chronic pain (tendonosis) where the nerves are miss firing. But then I have since learned that after you have had any significant amount of narcotic painkillers, you “rewrite” how your pain messengers work.
    I am a classic example of this possibility. I had to take some pain killers when I basically “broke my face” and with a severe low back problem. It really wasn’t that much but I think it was enough that I altered things a bit. My achilles pain has been off the charts.
    What do you think???

  10. Doug,

    Thanks for the information. Don’t ever feel like you are rambling. Don’t know how well my doctor is going to receive the suggestion to go early with the boot. He wants to put on another cast for two more weeks. Right now, I’m focusing on moving as many muscles as possible (toes, limited ankle and upper leg) as to keep them from atrophy. I have a PT friend who said similar things to you. He said the biggest hurdle is muscle weakness, not the injury itself. I’ll keep you posted as to what happens tomorrow.

    Smish - As far as your pain comment, I had one day of serious pain after the surgery, but has since subsided to almost nothing (i was off ibuprofen 3 days out). What i found was the medication made me irritable, amplifying the pain. Seems like if I could have dealt with it with a clear mind, I would have been much better off… Interesting theory though, I haven’t had much history with narcotic painkillers.

  11. Hi Matt,

    Don’t be afraid to be insistent. If he gives you a hard time, tell him about all these other people you have read about who have had successful early rehabs, and ask if there is any reason you are different from them. Is the surgical repair weaker than most for some reason? (That may get him in the ego a little bit.)

    If you really want to push it to the max, you could flat-out refuse to let him put a cast on. He may be the doctor, but he can’t force you to wear one. I would hope, if you were to do that, he would give you a boot, or at least a splint to ace wrap on. I imagine you could find a boot somewhere else, if need be.

    Good luck!

  12. Hi Smish,

    I’m not aware of any effect like that, narcotic pain relief making you more susceptible to pain later, but then the medical libraries are full of stuff I don’t know. You can see the reverse, where insufficiently treated pain makes you more sensitive to pain later.

  13. matt,

    I was in a similar situation, my doc originally wanted to cast me for 6 weeks. After I did my research on this site I went prepared at my first visit to discuss with him the possibility of a brace. That was 2 weeks post op and he was very open to a brace even though he said he had never used one before. I left and he made some calls and got me set up with the VACO brace, he left me a message yesterday that he got it covered by my insurance and that we would put on next week. I advised my doc not that I did a lot of research on the net (they hate that) but rather spoke to other friends that have had the same injury. I also made it very clear to him that I did not want to risk a re-rupture and that I would wear the boot religiously. I am calling him today to set the appt to have this cast cut off and put that boot on. I also have been very diligent about exercises with toes, flexing foot both ways etc..and going to the gym 2-3x a week. A friend of mine who is a bodybuilder advised me that when bodybuilders tear a muscle or tendon they keep working out the un-injured side and the body get can fooled that only one side is working out. He advised when the tear a pec muscle they work the healthy side out like crazy and when they get the cast off the atrophy is not as bad. Don’t know it there is any truth but I am willing to try anything. I also take vitamin c and zinc and have been eating pineapple like crazy. Heard these might help in healing. Go be honest with your doctor, it’s your foot, your life and you should have a say in your treatment.

  14. Doug et al,

    I’m looking at my robin’s egg blue cast - begrudgingly. I went to my appointment and they took the cast off. The technician began to prepare me a boot and I’m thinking, great… I don’t even need to ask. The doctor comes in, comments on the scar, says it looks good (and it did) and says, ok, we’re going to put you in another cast. At that point, I said, “are there other options to the cast?” at that point he went off….. its like I hit a nerve! He started bantering on about how if he didn’t like the cast I’d have to find another doctor, he underlined the name on his coat with his finger (as if to say I’m the boss here) and said he told me that this is the way he treated it and that I had agreed to this long before the surgery. Geez………. I just asked a question. I didn’t see any of this before… probably because I was a good, submitting patient up until now.

    Needless to say, the cast is driving me crazy. I think the psychological belittlement is affecting my mental ability to deal with it. I’m frustrated. Any suggestions? Nothing against the man, but there’s something about the way he responded that ticked me off. He didn’t even answer the question. It seems idiotic to go to another doctor at this point (he mentioned that other doctors don’t like to add patients mid treatment). Any suggestions?

    Matt

  15. Hi Matt,

    I’m sorry your doctor is so inflexible. Maybe he needs some range of motion exercises. Your story reminds me of a very funny medical journal article (rare, but it happens):
    http://www.bmj.com/cgi/pdf_extract/319/7225/1618
    I think he has a combination of alternatives number 1,2,7, and quite possibly 6.

    What now? You have to decide whether or not to “fire” your doctor and find another one. It’s not that uncommon, and not idiotic at all. It’s your call.

    Good luck!

  16. Thanks for the bit of humor Doug. I think 1 and 2 definitely fit! I think I’m going to learn my lesson and stick it out.

    I work for lawyers (I’m not one :) and I find that much of their methodical ways of dealing with problems creates most of their stress (and lack of enjoyment) in their job. Sometimes I wish doctors would treat the whole patient (physical and spiritual), rather than just the injury. I think they would find much more enjoyment in their work.

    Thanks for your help and encouragement!

  17. Hey Doug,

    Question for you as the resident expert on quick recovery. I am 5 days post op, and am thinking it is time to start doing SOMETHING to help my cause. I have been trying to flex my calf a bit, but often that action catches the achilles too and that isn’t pleasant. Any tips at this stage? thanks.

  18. Hi Pete,

    All I can say is do what you can without sharp pains. When I first started “working” my calf, I was barely, and I mean barely, making it twitch.

    In case you didn’t see it, I revised this note and posted it on 4/29. That version is more complete. You also might want to check my later note on 8/6 about vibrating massage and how that might have helped me out.

    Best wishes,

    Doug

  19. Doug, I “met” you when you responded to my new blog, but I’ve finally found your own story, and it’s great!
    What you don’t say, though (I think), is (1) What were you doing when you tore the thing, and (2) are you doing that activity (or similar) by now?
    Or (maybe 2a) how close to 100% of pre-injury do you feel now?

  20. Oops! Full-court basketball is the answer to my first question! And maybe you’re not back to it yet, right?

  21. Hi Norm,

    No, I’m not back playing basketball, although my tendon is fine. I can jump up and down about 20 times in a row on my “bad” leg, heel never touching the ground, before it starts to ache a little. Maybe it’s not perfect, but it’s plenty close enough to play again. Call it 99% recovered.

    Unfortunately, my teenage daughter has pretty severe autism and behavior problems, and can physically dominate my 58 year old wife. That’s a problem if I’m not home. Between caring for her and my job, I don’t have much time for anything else. When she is doing okay at home, which happens at least some on most days, I can “play” on the computer, with a TV next to me that monitors her room. So I’m overweight, underexercised, overworked, underslept, etc. I suspect anyone who has taken on full-time caregiving knows the story. I have a stairclimbing gadget in the basement now that I hope will help some. It’s pretty effective, but rather boring. I would sure rather be out on my bike or XC skis than on that thing.

    My daughter tends to do better in the summer, so I’m hoping to get enough exercise in this summer to make a comeback on the basketball court in the fall. But then, we make lots of plans that never happen.

    Keep us posted on your progress,

    Doug

  22. Doug,

    You must ne an amazing person. I have no idea where you get the strength to do everything you do. I have two kids - 18 and 22. They are reasonably healthy and successful people, still I find it difficult at times to deal with their moods. I can not imagine haw hard it has to be for you. Good luck with everything!!!

    Marina

  23. Dear Doug,
    I can’t help myself, I put on my Speech Pathologist hat as soon as I read your post. It happens I specialize in working with students with complex communication needs and challenging behaviors, including students with Autism. My heart goes out to you, this lousy ATR thing has thrown a monkey wrench into our already complicated lives. Any chance you could get respite services from your state developmental disability agency?

  24. Thanks, Marina, but I don’t know that there is anything amazing about doing what must be done. We sure didn’t volunteer for this! Those who adopt or foster care kids with serious problems, now they’re amazing.

    MaryK, I’m afraid respite care isn’t an option here. My daughter is too difficult (and strong) at unpredictable times, especially if her routine is changed, even in very small ways, for someone else to care for her. It was so hard to see her behavior deteriorate three years ago, so soon after several years of discrete trial work had gotten her to where she could learn new language on her own when she was 12. We will never forget that incredible day when she said, while goofing around with some “dress up” clothes, that she was “making a fashion statement.” We looked at each other, “Did you teach her that?” Nope, she had learned it on her own, probably from some TV program, and used it appropriately! She worked so hard to get to that happy moment, a girl who had virtually no language until she was four. We couldn’t have been prouder of her if she had won a Nobel Prize.

    Best wishes,

    Doug

  25. Doug, you are a kindred spirit. My wife and I have a 16 year old daughter with fairly significant cognitive and physical disabilities, including some autistic tendencies. People always say what great parents we are and my reaction is exactly the same as yours; unless you’re some kind of sociopath, it’s not like you have a choice. Plus, spending time hanging around childrens’ hospitals quickly opens your eyes to the fact that there are always plenty of people worse off than you.

  26. Doug,

    I was just re-reading your story for clues…did you really never have a “boot.” In other words, you went from surgery splint to 2 shoes for your shuffling that turned back into walking? I just got the boot at 10 days post-op and was told I can weight bear right away. I am having a hard time so far putting much weight on the foot in the boot and am wondering if the boot is actually hindering my progress.

  27. Hi Pete,

    That’s correct, I never had a boot. From five days to about two and a half weeks postop, I would take off the splint a few times a day and stretch the tendon. At 2 1/2 weeks, I had enough flexibility to do that bad-foot-out-front shuffle in my shoes. (In retrospect, I might have been able to shuffle a little sooner with a heel wedge in my shoe, but I didn’t do that.) Over the next week, the tendon gradually stretched out, so that by 3 1/2 weeks I had a fairly decent walk going.

    Does the boot hold one back? It certainly could, as it limits your dorsiflexion. That is, of course, by design, to protect the tendon from too much stretch. The trick is to balance stretching/walking with being careful.

    There is nothing that says the boot must be on either 0% or 100% of the time. As I described in a later note on 7/10, wearing the boot part-time for protection, while doing some shuffling/walking regularly in a safe situation and with your full attention, may be a useful compromise.

    What is limiting your walking with the boot? Is it too much tendon stretch, or is it something else?

    I hope this helps,

    Doug

  28. I think I am just being impatient, this is day 11 post-op…but it really threw me when the doc said I could walk out of his office if I wanted to (in the boot). The fact that I can’t is what is getting me, not even close really. I tried today to put as much weight as possible with the crutches and felt like I was hurting myself. (rerupture would be very painful and cause mass swelling again, right?) With the boot off, my range of motion sucks…though I don’t really know what is good or bad right now. The only “exercises” I was given was to push down on the front of my foot inside the boot to tense my calf and the work my foot gently upwards (no resistance) with no boot. Maybe I will take it slow and get impatient if I don’t see progress by next week. I was just thinking that it might be easier to try putting weight on the foot in a shoe since the boot is so elevated…feels like you are forced to put too much weight on the boot foot to take a step.

  29. It sounds like your heel needs to keep from going down too far when weighted, if I’m reading you correctly. Could wedges be put inside the boot, under your heel? That might let you put more weight on it.

    I didn’t have much range of motion at 11 days, either. It was another week before I got almost to 90 degrees, which allowed the shuffling to begin. I guess it’s just a matter of continuing to work at it. I wouldn’t worry too much about not getting much weight on your foot this early.

    It is nice that your doc is encouraging some calf strength work, as hardly any docs do this early.

    Good luck,

    Doug

  30. I have wedges in the boot…same as before surgery, when I could actually shuffle around pretty well with or without the boot.

    I don’t know how much pushing down on the foot is doing for my calf…it is definitely smaller than the other one and super flabbly already. I wish I had gotten more direction at the appointment, since I don’t go back for 3 weeks…maybe that is by design? But if so, wouldn’t he have stressed to go at my own pace and say that things would come along very slowly?

    How did you measure 90 degress…just the ability to stand up straight barefoot or a guesstimate looking at it?

  31. Hi Pete,

    Things do come along slowly, so I would just keep working at the strength and flexibility as your leg allows. That’s basically all I did, (along with the vibrating massage, that might have helped more than I knew at the time). If you can work the upper part of your injured leg, (like that “lift the butt off the mattress” exercise I described), that helps for later on, too.

    Until I could stand with my injured foot out front, I just estimated the angle by looking at it, as you guessed.

    Remember, this is a season-ending injury even for a professional athlete with expert care, so don’t expect too much too fast. You have a good plan; just keep plugging away at it. You have the great advantage of being able to start your rehab early. Barring complications, you will be back on your feet soon.

    Best wishes,

    Doug

  32. Thanks for the advice and well wishes, Doug.

    I still find myself spending the majority of my time in bed with my foot elevated…do think that will help or hinder recovery? In other words, should I try to operate as normal (sit at my desk - work from home) in order to have to try to walk more often? Just trying to strike the right balance between rest and muscle building activity, I guess.

    And I am sure everyone has gone through this, but I tripped the other day and got a sharp pain at the injury site…is there any way to reassure myself that I didn’t re-rerupture? There is no extra swelling, but the injury sure hurts when I try to put weight on the foot (kind of in the same way it did before surgery)…but that is to be expected, right?

  33. Hi Pete,

    The balance of work versus rest is one only you can answer, but I might suggest a couple of guidelines. One, don’t worry much about swelling as an indicator of having overdone it. Swelling happens, just control it with compression. I used compression way more than elevation for swelling, especially after the stitches were out, which gave me a lot more mobility. Second, being a little tired, sore, or stiff the day after a good workout is okay, too. If you are still that way for another day or two, however, you might want to ease up a little.

    As to the question of rerupture, lie down with your good leg’s knee fully bent/up in the air, put your bad ankle on that knee, and try pushing the ball of your foot against your hand. If you can generate more than a tiny amount of force, you should be okay.

    Good luck,

    Doug

  34. Well, I haven’t had much additional swelling at all. I still get the “full” feeling and pain when I go from elevated to non, but not much swelling so far…maybe I am not doing enough? Trying to walk I can’t tell if my pain is the achilles inside or the wound outside with the steri-strips.

    Do you mean push forward/down with the foot? Is that the achilles working? I seem to have decent strength doing that, so if that is a good measure, I am happy.

    I have horrid red bumps all over my bad leg where it was in the splint and is now in the boot. And itching them is still heavenly…any concerns there? Is there some kind of lotion I ought to apply? I assume this is just irritation and not some sort of creeping doom…?

  35. Those bumps are the hair folicles I think. I had the same thing and nobody could tell me what it was. It looked like a red rush, was hot, and eatched horribly. Then my doc took one look at it and told me what it was. He turned out to be right.

  36. That sounds like what I have…nasty. Any harm in letting my wife apply various lotions? I don’t know if they work but the act of rubbing them in feels quite nice. Sleeping in the boot can’t help. I really only take my foot out for a few hours at night before bed.

    Doc said I could shower now too…any concerns or stories there? Wound is at 12 days, stitches out.

  37. I tried different things and the only one that helped me was the Aloe gel and keeping my leg open to the air.

  38. Gel on, leg exposed…hoping for the best. I feel so vulnerable without the boot though.

  39. Hi Pete,

    I can’t help you much with that rash, other than to guess it’s due to lack of airing out or some kind of allergic contact rash. What is on your skin when you wear your boot? That material could be a problem for you. Or, the excess moisture from being sealed up in a boot could be a problem. Check with your doctor if it’s bugging you enough, or if it might be affecting your recently-healed incision.

    Yes, the Achilles tendon’s main job is to transmit the force of the contracting calf muscle to the heel, which results in the ankle moving as it does when jumping (plantar flexion). There is a common misconception that the Achilles is involved in toe movement, but other muscles and tendons handle toe movements. That’s why I suggested putting your hand on the ball of your foot, not your toes, in my last note.

    You have “decent strength” in your calf, so you can try to maintain that strength, and minimize calf muscle atrophy, it by working it as often as you can. Getting calf strength back is the last and longest part of the rehab, and this head start can greatly shorten that process, as I think my experience demonstrated.

    Good luck,

    Doug

  40. I think the rash must be an allergic reaction. I had the leg exposed a ton more today than at any time in the last 13 days, and my wife put aloe on it several times. Fortunately, the rash isn’t around the wound itself (because I haven’t let myself scratch there probably) but if it doesn’t get better soon, I will call the doc.

    I swear it doesn’t feel like the achilles is involved when I push down with the ball of my foot on my hand as you suggested. But I will take your word for it. I was able to do the shuffle today without crutches and in the boot. That is either a good sign of healing or a sign that there is no tendon in there…

  41. Rash no better…maybe worse. Talked with a nurse and she said to wash it off in the shower, which, admittedly, I have still been too scared to do despite the OK I was given back on Monday. She said I could take Benadryl and insisted NO SCRATCHING! She said it was probably an allergic reaction to the fiberglass in the splint? Well…she is about 4 days late on the scratching front…feels so good. She said not to put any lotions on it, but that if washing it off didn’t make it feel better she would bug the doctor (in surgery today) and see if he had any cream recommendations.

  42. FWIW, my barefoot showering technique is as follows:
    Line up your crutches, and put them within reach of the inside of your shower. Have a stool of some kind in the shower, of course. I have a slab of ensolite camping-pad foam on top of mine, for comfort. Start with a dry shower stall if you can, and have a stool outside the shower, too, with a cloth or towel over it.
    I walk into the shower stall with boot on, sit in the chair, and remove the boot. Then I lean over (or stand carefully) and put the boot outside the shower.
    I shower, alternating among sitting, standing carefully, and kneeling on my bad-side knee. Avoid pulling your toes up (hard) while washing your bad foot.
    Eventually, everything is washed and rinsed!
    Squeegee the shower door (if it’s a stall), open it outward, stand carefully, grab the crutches, and crutch NWB out of the shower. DON’T SLIP!
    Close the shower door, put the boot near your outside stool, crutch to the stool and sit with your bad foot out in front. The rest is pretty straightforward — but avoid pulling your toes up (hard) while drying your bad foot.
    If you can put a clean sock on your bad foot — carefully ,without hurting yourself, of course! — it may help with the rash.
    (If you’re showering in a bathtub, some of this will have to change!)

  43. I’m have graduated to regular shoes! It’s been five weeks post op and I can’t be any happier. Thanks Doug! I followed your treatment method, which was against my surgeons advice… If I did I’d be still in NWB for two more weeks! I’ll try to drive around my block this weekend. It’s good to have my life back.

  44. Hi Christian,

    That’s great to hear! I wrote this blog hoping to help people recover more quickly and uneventfully. I hope you can take some time to document for us what you have done and what you have learned in the process, to benefit the next “generation” of fellow sufferers.

    Good luck with the strength work,

    Doug

  45. Christian, your progress sounds great! I’m going a bit slower than you and Doug (without surgery). At 11 weeks post-immobilization, I’ve been at Doug’s “frustrating plateau” — ALMOST strong enough to walk barefoot without a limp, but NOT QUITE! — for what feels like weeks and weeks.

    I’ve started theorizing that the folks who make it to “slight limp in 2 shoes” more quickly than most have to spend a few weeks waiting for the slow-pokes to catch up a bit, before we can get rid of that little dip in our stride!

  46. Hi Doug,
    I think getting into a removable cast or boot as early as possible is the crucial component. I got mine roughly weeks n a half post op. Once, I was in a boot, I started stetching the tendon and PWB right away. (I let pain be my guide) I was FWB within a week and was able to try on a pair of regular shoes (without attempting to walk on them… I just missed wearing shoes!) I took a few steps in regular shoes a couple of days later and at five weeks post op, I was able to walk a block unassisted in regular shoes. The only pain I had was on my heel… I think it’s because of my current walking mechanics. The pain went away a few minutes after I got home n rested the foot. I was able to drive to the store yesterday without any problems. This was great because I don’t have or use taxis to get to my appointment anymore (the round trips were about $90 per!!). I’ll be starting PT in two weeks. Good Luck to all of us!

  47. Christian, you have done very well for one who had to start out in a cast! I hope the strength part of your rehab goes quickly, too, which should help your walking mechanics.

    Best wishes,

    Doug

  48. Christian, you wrote “I got mine roughly __ weeks n a half post op.” Is the missing word (where I put a “__”) “two”? That seems consistent with the other things you said.

    Me, I’ve found the strength thing much slower and more frustrating than the FWB and ROM things. Well over two weeks after I went into 2 shoes (and FOUR weeks after I started in a hinged walking boot), I still can’t “push off” properly at the end of a walking stride, or do a 1-legged heel lift. So there’s this ever-so-subtle “dip” at the end of my stride that turns it into a subtle limp. Everything else about the leg now seems remarkably normal — balance, comfort, stability, ROM, etc. I’ve been working it a fair amount, too. . .

  49. Hey
    the missing word is “two.” I was in a splint for a week and a hard cast for ten days. I haven’t started heel raises yet… I’m still apprehensive about going too fast. My doctor wanted me to be still in NWB until 3/10/10. I might try double raises later this week. I need to work on getting stronger right now. Any positive progress is good for me.

  50. Our ADHD. boy who in addition has Aspergers Syndrome does very well academically during classes nonetheless he does not have virtually any buddies. He would prefer to devote a long time on the computer as opposed to meeting with some other kid his age. When he will be required to get among boys and girls his own age group, he complains a lot and also looks extremely anxious. He says other kids hate him and even call him creepy. My own heart breaks for him. While i see our kid relating to other kids, he does not seem to possess the required social skills.

  51. Hi Doug,

    I found your journey inspiring. Just wondering, did you sleep with the splint on? And what was the initial angle of your splint? Did they ever change the splint angle?

    Thanks
    Peter

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