Walking in my shoes within four weeks

Doug,

Your posts about aggressive rehab got me inspired at week 4 post op for my torn Achilles. I’ve done some research now, and it seems you are not a bad patient at all. The American Academy of Orthopedic Surgeons appears to “moderately” recommended <2 week supported weight bearing and early mobilization 2-4 post op. Here is the reference doc:
http://www.aaos.org/research/guidelines/atrguideline.pdf

Ryan you betcha YMMV… Congrats on your fast recovery! I’ll be very happy going at half your pace…and back to jogging eventually. Soccer, we’ll see…
I’m looking at early options other than traditional casting to minimize atrophy and return to basic functioning early but safely. Best,

Hi Doug, thank you for the reference and for sharing your experience. I will keep it in mind for whenever the time comes. I’m in a cast 11 days post op. Please kindly let me know if you have suggestions for now and the next couple of weeks. Best,

Hi Gabe,

I’m glad to hear my old blog is actually being read by someone! If an exercise doesn’t feel right, it’s probably right to not press your luck.

Regarding working your hip extensor muscles, perhaps the same exercise could be done with something (firm but not too hard) under the knee, so you are pushing on the back of your knee, and not on your heel. Of course, if you could find a fancy weight machine that does the same thing, that would be great.

There is another way to work the knee extensor muscles (quadriceps), which I wrote about a couple of years ago. Go to this site, and scroll down to near the bottom:

achillesblog.com/doug53/2009/08/08/six-months-on-calf-at-full-strength

I hope this helps,

Doug

YMMV of course… The first 2 weeks I was limited to upper body weightlifting. As soon as I got to PWB (19 days post surgery) I added walking, up to 2 miles. Kayak, and spin bike were added after 3 weeks. Swimming after 4 weeks. I’ve kept a daily blow-by-blow record of my rehab schedule here.

Thank you Ryan. These start at 4 weeks or so if I understood correctly. I guess not much before then.

Gabe-
Here’s a post I wrote up on early exercises:

AchillesBlog.com/ryanb/2011/09/27/73/

Hi Doug, thank you for posting on your experience. I am now 10 days post - op on a cast. Surgeon proposed 4 weeks but is willing to cut it open or switch to a hinged cam walker earlier. I think I will go for having it open to allow some passive therapy and then going for the booth. For now I was looking at your ‘butt-lift’ exercise but even that you suggest it’s just pressure on the heel, it didn’t feel right to me at this point. Perhaps since this was some time ago you have some new insight and perhaps others could comment as well on early exercises and choices. Thanks again,

Doug - I read this a couple of times but was not sure which you were talking about. Thought either way I would get a confirmation. Glad to hear all went well.

Hi Stuart,

Most of what you say is true, but I think you missed the key point that I was talking about a tendon in my finger healing a little long, not my Achilles. My Achilles is fine.

Doug

Doug - It may be in years to come a version of your rehab becomes the norm but you have said that you ‘healed long’ and I wonder whether the things you did earlier than others had some bearing on that. I can fully understand your need to get things happening early. Your reasons were not trivial or selfish and I have an idea you understood the risks. For some people, the need to get back to their formal ‘full on’ life will push them to look for any glimmer of hope and without sufficient medical understanding things could go horribly wrong. I know from my own experience that in the early days I was convinced I could do this faster than everyone at the hospital told me and any evidence to the contrary I discarded. In the end I found a good balance and a good physio and my progress is going well. There are so many ideas on how this injury should be treated but surgically there are also so many methods still used and this can have an impact on how fast we can get things moving. The suture method, type of sutures, the skill of the surgeon, the location of the rupture and the extent of damage or degeneration of the tendon, whether a

Hi Doug

I agree a rehab can be done faster and it can also be done quite safely. What sticks out to me though is that the increased risk to rehab faster is far greater than the increase in time to get back to fully functional.

What I mean by fully functional is doing what you could normally do before so break into a run if you want when crossing the road, reaching up high on your toes to get something off a shelf, or just to play a sport. All this without thinking “if I do this, what are my chances of re-rupturing”.

I think for those of us that are new our focus is on healing as quickly as possible and “2 shoes” seems to be the beginning of the end of the rehab. What you find out personally is that its not even close.

For example, if your goal is to be mobile on 2 feet (which in both of our situations is what we needed, in my case my wife is disabled so needs lifting etc) then wearing a boot resolves that. I didn’t even need a boot really, a walking cast would have been fine as I managed it in my non-walking cast.

When taking this into account the length of time from “2 shoes” to “fully functional” is a long tim

Sorry to hear that, Doug. I tore my right ring-finger’s last-joint (phalangeal?) extensor in a volleyball match, in-between my two ATRs. I casted it for the standard period (6 weeks? 8?), first time without any noticeable benefit. Then my Sports-med Doc sent me to a hand specialist, who was 100% NOT amused that I’d continued playing volleyball in the splint the whole time. He put me on a different splint (aluminum, foam, and adhesive tape) — it was quite secure once it was on, but putting it on my right (dominant) hand was VERY scary for that tendon! He also prescribed “NO SPORTS” (which I took to exclude bicycling and sailing, but to include volleyball).

After another 6 or 8 weeks, it was functional, though with a slight “crane’s neck” deformation. I was afraid that the slight pre-bend of that joint would pre-dispose me to re-rupture it while blocking a spike, but that didn’t happen up until my second ATR, and I’m still waiting to return to volleyball. Hopefully this Fall, if things continue to go well with my cardiac rehab.

BTW, after I tore my finger’s extensor tendon early in an evening of competitive volleyball, I did NO

Just joined, Im 2.5 years out, i have ripped both, recently i been waking up barely able to walk after playing bball last night.

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.

Great to hear from you, Doug, and great to hear that you’re still having some fun! I’ve gotten back to skiing after my recent heart surgery, and I’d be bicycling if the roads here weren’t full of frozen-slush “death cookies”.

Newbies here should review Doug’s earlier posts — maybe especially around April 2009 — for his fascinating bad-boy rehab story and a bunch of sensible tips and tricks, too.

Doug, I’ve still heard nothing back from Mayo about changing their online advice on ATR repairs and such. Mind you, I haven’t checked for a long time to see if anything has quietly changed. . .

I second doug53 comments hang in there it gets better. I also had the ultrasound done at 10months post op and it showed the tendon looked great and fully healed according to person administering it. I could see it on the screen and the tendon looked similar to my “good side” on the screen. At three months the tendon looked disorganized with squiggly lines and now it looks like the good one only wider. Played in my alum soccer game at nine months, softball twice a week since and felt good and even played in our annual turkey bowl football on thanksgiving. Haven’t really noticed a difference in speed or jumping ability but I notice some calf fatigue after playing sports for while, kind of like I’ve done a good bicep workout in my calf. Start indoor soccer this weekend and that will be another stepping stone. The injury does play with your head a little but you forget about when you start playing and after you start doing the things you used to without hesitation your confidence grows. Good luck everyone

Another happy basketball update!

I’m working days for a few weeks, which is when the less competitive games I went to twice happen. Sunday night, I tried my luck with the young folks. I thought, going in, that I would see how much catching up I have to do to play at my old level of competition.

Happily, it went much better than I expected, scoring often, playing pretty good defense, getting some rebounds, even blocking a few shots. I smiled after making another basket when one of my teammates said simply, “Doug is back!” Well, my aerobic fitness certainly needs some work before it’s all the way back, but it sure felt great being back and doing well.

Hang in there folks, it eventually gets better.

Doug

The verses of that song are cute, too. By Malvina Reynolds, the brilliant author of “Little Boxes” and a few other gems? I was introduced to it by Pete Seeger — LONG before it seemed to apply to me!

There’s a great song that goes like this:

How do I know my youth is all spent?
My get-up-and-go just got up and went.
But in spite of it all, I’m able to grin,
and think of the places my get-up has been.

Doug

Fantastic news!

Personally, I don’t plan on ever “Playing” basketball again… I’ll shoot around and goof off… but no more ball for me, thanks.

It’s not only this AT that’s helped me make this decision… My right knee is pretty much garbage anyway… I figured I was playing with fire when I hit the courts almost 2 weeks ago, but I thought it would be my knee that would require surgery and rehab.

So, rather than risk a re-rupture AND/OR a destroyed knee, I’m just gonna be happy with my memories
Lots of good sports memories so I should be fine… Besides, my kids are getting to the age where I can live vicariously through them

Doug, I missed your response to my post! Sorry about the neck, glad about the weight!

I’m not sure that volleyball is exactly contra-indicated after Aortic Valve replacement, it’s more like the vast majority of the post-op “zipper crowd” talk about the “life-changing event”, and generally seem to maintain a more moderate approach to exercise than I ever did. Mind you, so do most guys my age with normal hearts and no surgery. . .

There is a group at cardiacathletes.org that’s doing marathons and such, though I haven’t noticed any volleyball players yet — and a lot of them are young sprouts.

In any case, there seems to be a several-month period of cardiac rehab, not to mention the time for the sternum to heal back together. If I dare to ride a bike in March, or ski Whistler at the end of March, I’ll count it a success. And I’m hoping to be more-or-less unimpaired in early May when the dinghy racing season starts.

But if there are no guarantees in ATR recovery, and “everybody is different”, it sounds like all of that SQUARED for this rehab! The crowd at ValveReplacement.org speaks of “bumps” along the post-op recovery “roa

There was a lot of chatter here a while back about barefoot running, including wearing the weird-looking Vibram 5-finger “shoes”. A lot of that discussion was about forefoot running.

Me, I’m no runner, but I’m sure most of the fast moving I’ve done one the volleyball court is forefoot running, with no heel strike. The other “move” that gives a great workout to many body parts including the calf and AT is running backwards — also a pretty big part of volleyball and most other court sports, including all the racquet sports. Basketball, too, on defense?. Me, I’d be doing a lot more of it if it were easier to see where I was going! (And also if I weren’t headed in for heart surgery so soon!!)

I should pass on something I discovered recently, in case it helps someone else.

There is a lot of chatter in the running world about “forefoot running.” This is a style of running in which the ball of the foot, not the heel, strikes the ground first. It is a natural way to sprint, but some people run more slowly that way, too, as I did for much of my younger life. Then a runner friend of mine got me running with a heel strike.

Fast forward many years, and I have significant arthritis in my knees, which limits my running. I tried going back to forefoot running recently, and found I could run much more before my knees started to bother me.

Forefoot running might also be good for that not-quite-fully-recovered stage after an Achilles rupture, as it works the calf at the plantar flexed end of its range, the hardest part to recover. Does anyone want to give this theory a try and report back?

Doug

Hi Norm,

The “life” component of it was finding a game that occurs during my daughter’s 2 1/2 hours at school. Getting back to the more competitive evening game may not be so easy. I also found that I’m a little helpless under the basket, as my neck injury doesn’t allow me to look straight up!

Another thing I did to protect myself from any further Achilles injuries was to get my weight back down to where it was before my neck injuries and my daughter’s behavior change. The extra weight I was carrying probably helped pop my Achilles last year.

I hope your valve replacement surgery goes beautifully. What exactly is the bad thing that can happen playing volleyball with a new valve? Blood clots getting loose, maybe?

Best wishes,

Doug

That’s great, Doug, I’m tickled for you — happy that your leg AND your life both let you get back to basketball. Now do watch out for that OTHER leg!!

Me, I’m getting much more mixed messages from the online “zipper club” folks (open-heart surgery survivors) than from the ATR bloggers, about my returning to volleyball after my upcoming valve replacement. The good news is that I’ve now gone without for almost a year, with no more sign of complete insanity than you’ve all witnessed. The bad news is that my retirement from v-ball may finally have arrived, at 65, and part of me will miss it.

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.

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. . .

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

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!

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!

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

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.

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 –

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.

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…

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 demonstr

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

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

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.

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.

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…?

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

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?

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