Progressing nicely around 15 weeks

I guess it is good that i dont precisely know my weeks post op which means This is not foremost in my mind. I did visit doc a couple weeks ago with the ok to proceed to do anything i am able. The question was posed by PT when could we do plyometrics? But I am not physically able yet. This past week able to do single heel raises in the pool. Doc said usually sees good breakthrugh around four months which will be a couple more weeks. I think i aat about same progression as my first tear on the other side which took me to 100% at five months. I am nearly without limp at this point but last week my good leg was giving me knee problems so who could tell? That is improved thanks to some love from the PT who put the pads and stimulation on the knee. Getting old sucks. PT measurements at 14 weeks showed dorsiflexion at 6% as opposed to 15% on good leg. Plantar flexion was equal and has been for a while. The side to side of the heel, while foot is flat on the floor, is where i feel inflexible as well. Dr also said this was the reason i still have pain in my inside ankle area and as that flexibility improves the pain will diminish, as it has already started to.

I did try spinning a couple times at a little over 3 months postop. As I suspected i could only stand for about 10 seconds at a time and the tendon did feel ‘very well used’ though not painful. the calf was very tight for a couple days after and it could have been over compensation that messed with the knee. So back to that in a couple weeks and continuing with the swimming, pilates, ellipticle, weights and stretching. And love the PT massages!

We went away to caribbean over xmas and it was wonderful, however walking in the sand proved fairly difficult. Heels sinking and unable to push off makes for inelegant exits from the water! A couple times it proved painful. I did slip off very low wedged sandals one night and that was extremely painful. Put them away after that.

Will go back to Doc at about 5 or 6 month mark just for a final visit. It is nice to be at the point where there is no real impairment of any sort. Cant run or jump yet but no big deal for my lifestyle.

PT update

Felt like I have finally had my first “real” PT sessions as there had been communication with Doc. Spent about 8 minutes using an ‘iso-stepper’ which is really a recumbent elliptical, on little to ‘no’ resistance. However, very hard to get started and there was a bit of pain in inside ankly muscle, which is where I recall the most irritation the last time I went through it. Not sure why but consistent. Once the stepping was started it went fine, the flexing was tight and pushing off slow from bad leg but workable.  Then did some balance (1 foot in front of the other and then switching after 1 minute or so, closing eyes when balancing well which makes it harder). Did some ‘windshield wiper’ action and toe lifts while holding on (not much help from the injured side, but a start). Then some massage and sono-therapy. Wouldn’t say I was very sore after but it felt well-used.

Went to see the Dr for 8 week visit and he was very non-chalant about everything. Said my Physio Therapist was “freaking out” about what to do. Well, actually she was just trying to get something difinitive from him as I was pushing her and the envelope in her eyes. He basically said ‘You know your body, just be careful and don’t do anything stupid.”  He mentioned he likes people to wear the boot until 10 weeks, though sometimes has let people out at 8 (I had not  worn the boot in of course as I haven’t worn for 4 weeks).  He just smiled when I told him my boot ‘just wouldn’t stay on. Kept coming off!’  So we have an understanding that I am doing whatever I think is right for me.

The limp is still there, of course, but am seeing slow improvements.  Keep on Truckin’!

Nearly 8 Weeks Post-Op

Second time to type this as it seems to have been lost (aaaarrrgghh!). I have been having issues with being able to update my blog lately…  It will be 8 weeks on Dec 7th and I have been off crutches and out of boot since November 15th appt (not with doc permission - he thinks I am still in a boot). Have been in shoes with lift, though not sure they are all that necessary - mostly raises my scar above the edge of shoe to avoid irritation.  I will go see him on Dec 8th and walk in with no boot and plan to be honest about whatever he asks. As he said last time, “Better to be lucky than smart.”  Certainly applies this time around too.

Started PT at nearly 6 weeks and was very honest about what I have been doing (with and without permission). However, she did not get direct communication from Dr. so first 3 sessions were really just massage, mobility manipulation and slight resistance. I felt like it was a waste of money by 3rd but now they have apparently spoken so I will see what progress can be made next week. I have continued resistance bands, tracing alphabet with toes (forgot about that one), and ROM exercises on my own at home. PT did measure ROM and it was -2% flexing (I would have thought 0% but I guess you don’t have to be 0% to stand! who knew?). I forget the other direction but comparison wise to other I think it feels and looks just the same when pointing - all that driving and pushing off on pool wall, I guess. Still going down the stairs flat-footed and foot pointed out perpendicular.

With exception of limits on exercise, life is essentially back to normal - carpools, cooking, errands etc.. just at a slower pace.  Have been swimming about 6 miles a week and Pilates 3 times a week. Getting a little bored however. I did try elliptical at about 7 weeks and it was do-able but for other reasons haven’t gotten back on it. Tried the stationary bike too, but ankle really did feel too wobbly at that point, even pedaling ‘flat footed.’  I do see the necessity of the boot - I have had a couple of missteps, though fortunately nothing major. A couple days ago I was in the grocery store as they were stocking up. Most boxes were stacks and obvious but there was one lone box of heavy cans that I managed to kick (sideways somehow) with my bad foot and really felt that! I had to stop and catch my breath (and spoke to the manager - had I been old and frail it could have been much worse).  Also a couple times on uneven ground and slopes where the toe lands higher than the heel unexpectedly. Managed to react fast enough so no real damage but reading the Brit who just re-ruptured on the curb at 4 months certainly does put a worry in the back of one’s mind.

One piece of advice for all - get a copy of your PT records at the end! I failed to do so on my other side and never anticipated I would need them but sure would like to have a reference now of when I did what for comparison and moving forward. My former therapist (who was more aggressive than this one) left the old place so I have no way to track him down either.

Happy Holidays to all and I will add more when there is some measurable progress.

4 Weeks Post-Op

Here is where I am. I would truly like thoughtful feedback (no mindless reprimands please).  Brief history is this is my first rupture of my RIGHT AT but I did my left one 16 months ago and had a very good recovery. I am feeling like this one is going even better. The (same) ortho decided to only keep me in cast 2 weeks and then put me in boot (as opposed to another 2 weeks in 2nd cast last time). Immediately started swimming and pilates (adjusted for NWB). So 3rd week post-op dedicated to staying in boot except for sleep and exercise. Then 4th week started leaving boot off around the house. I decided yesterday to stop with the crutches and am in 2 shoes (with heel lift). Mind you, I am walking peg-leg and not pushing off at all - just a flat footed walk with a big limp.  I have had essentially zero swelling since week 3. Looking at my feet you could not say which one had surgery 4 weeks ago. Even the scar looks ‘beautiful’. Doc felt it today and commented “not at all hot or swollen.”   He recommended staying on crutches 2 more weeks (no I didn’t say I went without them day prior) and get to FWB in 10 more days, but stay in boot. However, have done the 75% FWB for a couple days now.

The thing is, I feel no issues around this, no pain at all, it is very strong  and I am being very careful. I don’t have the fear of shoes that some have mentioned and having been through this before (very recently) I think I have a good benchmark to compare.  I cannot deal much more with crutches as they provide nothing but a hassle - I truly feel they are more dangerous, slipping on wet floors, getting knocked by passersby etc..   I do still scoot around on the scooter at home and not trying to bear weight at all times, just getting on with life. Though crutches are faster at this point so I haven’t thrown them out entirely when I am out of the house.

I am not trying to be a hero in this and I am not pushing forward with PT before Doc says but I do plan to listen to my body on this. Also, just read Parissky’s post which is not far off from what I am doing so that made me feel less like I am a lone ranger. Anyway, that is where I am, being ‘carefully aggressive’ with my own treatment. Thoughts?

And, just for the record, having done this twice, the difference of having a cast for only 2 weeks is huge, in the sense that all those little muscles get to move much sooner with ROM excercises and band exercises and the atrophy of calf is much less. I think this is the way to go to get people back on the road - much greater ‘prevention’ and much less ‘recovery’ of collateral damage.  I predict that within 3-5 year the recommendations will be much more aggressive. Considering they used to have people in casts with no activity for months it seems.  We shall see I suppose!

2 weeks in for 2nd AT rupture

Got my cast off at the 13 day post-surgery and stitches out. Attendant said “I have never had anyone so still and quiet while I took stitches out - and there were a lot of them!” I think they had loosened up a good bit and I had made conscious decision to wait the full 2 weeks for cast off rather than go at 9 or 10 days. Partly because of waiting I was able to get foot to neutral so doc let me go into boot, no second cast this time. The leg and foot actually looked very good. A stripe of black and blue under ankle area and stitches nice and straight. Not much swelling and no real discoloration apart from surgical bruising. This time around both for first week and continuing every night pretty much all night, I have kept foot propped up. This has seemed to help a great deal to reduce swelling. Also use icepack on and off when sitting still.

I am eager to see if I don’t have as much problem with all my little feet muscles (of which there are MANY) atrophying this time. That was the first thing I noticed with PT first time around - I was surprised by the soreness of lots of little places. I think because I can now move and do ROM exercises 2 weeks out rather than 5 weeks I will progress (or at least not regress) faster.

Got clearance for anything non-weight bearing. Which meant I went for a 1 mile swim the next day followed by an hour of Pilates, which I had done once before with cast and some on my own. The swim felt very good to have freedom in the foot. I strongly feel like swimming last time really helped recovery and flexibility. I did not consciously ‘kick’ with my foot, more from my knee on the bad side but it did get flutter and movement going and felt it loosen up a bit about 10 laps into it. The pilates I just didn’t do any weightbearing and all was well. Nice to get back to gym and I came back the following day for a longer swim.

Also tried for a short drive around the block without boot. The automatic cars are so easy. Accelerating no problem at all and can rest heal on floor. Braking was fine but had to keep foot off floor, which meant pointing it and got tired pretty quickly. I will not be going on any significant drives soon but it does mean I can transport kids short distances and allow enough time not to be rushed - a good general rule when on crutches or injured.

The other side

OK - here I am 15 months after my left AT rupture, great rehab fully funcitional on left leg as of 5 months post surgery though stiffness still occurred a few months after that. Very active at everything, running, swimming, tennis, elliptical, weights, pilates (which includes lots of tendon strenght and stretching). So on October 10th 2010 I decide to go play soccer for the first time since I ruptured left. And 20 minutes into the game, I rupture my RIGHT AT. Could not believe it. I fell to the ground and screamed, not in pain but in anticipation of what was ahead. I knew right away what happened. Having been here before, I skipped the whole ER thing and just waited until Monday to see the same Ortho (Before he could speak I said ‘You said this would not happen’….”You tore the OTHER one?” Dr asked? “Well, lightning does strike twice sometimes but it is really rare.” Well, hey thanks. Surgery 24 hours later, in at 7:30 on Tuesday home by noon. Essentially same drill (except nurse suggested I should put some weight on it. I told her to go check the post-op instructions again - OH!). Again, little to no pain and being good about keeping it propped up. The reall kicker this time,of course, is I can’t drive. So while I was extremely active last time I will be more dependent on getting rides for several weeks.

I haven’t yet searched the site for bi-lateral ruptures, but I am thinking I am in a small, albeit unlucky, club of few. Plan to start up pilates again this week and then do swimming after first post-op stitches removed on 25th.

Would love to hear from any other bi-lateral ruptures out there! Still cannot believe it.

For Posterity I am keeping this record of Left AT in 2009 as I need to update for new one:

Achilles Injury Date: 06/13/2009
Surgery Date/(Cast Date for non-operative treatment): 06/16/2009
Partial Weight Bearing Start Date: 07/11/2009
Full Weight Bearing Start Date: 07/24/2009
2 Shoes Start Date:
(while also Full Weight Bearing and not using crutches.)
Physical Therapy Start Date: 07/14/2009
Injury Activity: SOCCER
City: Washington DC
Which Leg: Left
Birth date: 05/25/1966
Gender: Female

On Vacation making progress

It has been 3 or 4 weeks since my first post. In that time I have a few things to report. Had my 3rd post-op (at 5.5 weeks since going away on vacation the next day)- doc told me I needed to stay on crutches until 6 weeks. I gave him the look and he said “You have been walking around without crutches?”    Yes.  “Just be careful with it. It does seem that the more you use it the quicker the recovery.”  Well, OK then.  When asked about weight bearing he said “Weight Bearing as tolerated.” (That was for PT info).  He also told me four more weeks of boot.  I asked him what the purpose of the boot is and he said it is just to protect yourself.  I guess I have been full weight bearing since about 5 weeks since I gave up crutches earlier than recommended by him.

I haven’t used crutches since exiting the Docs office.  Honestly, given a couple of good falls, I think crutches are as dangerouse as not using them. And, it really put stress on my right forearm due to overcompensation and gripping the cructh.   Anyway, next day off for a roadtrip (10 hour drive) - no problems at all beyond usual driving stiffness.  I drove mostly without the boot (left AT) and was able to do some ROM things while driving.  I packed the crutches but never touched them the whole vacation -just took up car space.

First part of vacation was in my hometown of Oak Ridge, TN which has the most fabulous public pool in the country. It is TWO football fields in size and the lap swim lane is 100 yards which means one mile is only 16 (long) links. It is like a glorious open water swim under the sky with spring-fed 74degree water. This is heaven for a swimmer.  I swam every day and did lots of toe raises in the water as well. (I had started that around 4 weeks gingerly).  Now doing toe raises on land (only with both feet at this point but seeing progress).   The other big thing, against medical advice, is I have basically given up the boot too. It just slows me down.  I do use it in unknown terrain (visited a construction site and glad to have it on) but in the house and pavement I just walk. Had to buy a pair of flip flops as I only brought one shoe from each pair since I thought I was going to stay in the boot. I did bring a pair of sneakers but the back of shoe cuts into scar too much.

I did appreciate Walter’s PT info post/advice.  Because I went away on vacation I haven’t had PT for weight bearing and have been doing my own thing (with info from here and elsewhere). Pool calf raises and on land holding on to furniture etc..  Still doing Pilates as well as swim.  My big excitement at the 6.5 post-surgery was pushing off the pool wall with both feet, full force, no pain. Swam that with a big grin on my face.

2ndweek of vacation we are in Kiawah (with Joe Biden on the island now). This is a great biking place and I got tired of walking to the beach so I hopped on my son’s bike (because it was smaller, I had no problem reaching the ground when I had to stop) to try it out. It is VERY flat here and I took it very slowly and pedalled flat-footed and it went great.  I didn’t even attempt the really small hill in one place since it was the first go round.  I will take it easy and force myself not to bike everywhere now, though it would be faster. My husbandis very fearful of something happening on vacation.  I feel like I know my body and am very careful. Not sure if he is more worried about me or the inconvenience factor!

I have found that giving my scar a massage really makes the walking easier, albeit temporary. No limp for a few minutes after a self-massage. Try to do a couple times a day.

It really doesn’t feel as if I am pushing myself too hard (a little swelling but nothing at all painful and swelling subsides quickly).  I am ‘ahead of the game’ it seems and I don’t want to be afraid to try things while being sensible.

I have had a black cloud over my head this summer. In addition to the AT rupture, the garage door came crashing down on my SUV windsheild 48 hours before leaving on vacation, shattering it. Managed to get it fixed in time (alongwith $1000 of needed servicing!).  And,  a few days ago at the beach I ran into a Jellyfish and got a nice sting on my “good leg”.   Still have nice tentacle markings. So, I am looking at my AT progress as the bright spot.

Will post again after returnto DC and some PT sessions.

First entry, 34 days post surgery

I have appreciated everyone else’s information so hopefully mine will help some others in the future. I fully ruptured my left AT on June 13 playing in a soccer tournament. It was the second game I had played of the day having had no issues prior. I stepped back and planted my left foot to strike the ball with my right. I literally heard a POP (and an uh-oh crossed my mind), as I fell to the ground. But I really had no pain so was looking for a hole I stepped in and inspected my cleat to see if I ripped it or cracked the sole since I hear a pop. Saw nothing, so I stood back up, it felt weird, put more weight on left leg and fell down again. I looked at my heal and saw a big indentation where my tendon used to be and pretty much knew what happened.  I ended up going to a nearby ER since it was a tourney and the first aid people insisted. I would have gone anyway since it had never happened to me before, but if I knew then what I know now, I would just skip it.  They had no need to do MRI as it was evident the problem and they put  a splint, sent me home with crutches and I made a Monday morning appt with a highly recommended Ortho group in DC.  Again, the strangest (but a blessing) thing in all this was I really had little to no pain throughout.

The appointment was fine, pretty quick (confirmed the issue, talked about surgery and recovery, though I didn’t absorb a lot at that time). Scheduled surgery for Tuesday 8:30 AM and was home by noon with a cast. The worst part for the first two weeks was the crutches. I ended up getting a kneewalker after 2 weeks and wished I had done it MUCH sooner. It is extremely useful and allows you to carry items and get around the house without the crutch pain/knots etc.. Don’t hesitate to get one - well worth the rental fee. And the kids have fun on it too.

I really felt good from the get-go and 4 days after surgery I decided to try pilates at home. I take 2-3 classes a week so knew what to do and it went great. So, from then on I was going to the gym and taking classes. Yes, the left leg/cast was heavy but it just added to the workout. There were very few things I could not do, all of them weight bearing and a good instructor can modify what you need. If you have done pilates before, keep it up. No reason not too (My doc said “no restrictions as long as no weight bearing. I took it to heart.


First post-op follow up was 11 days after surgery. When they put this cast on they changed the angle to something less than 90 degrees. I requested and got a Gore-tex cast so that I could swim in it. That was another great decision. So I added swimming to my pilates and really was able to keep up my activity. The drag on the leg was something (took me an additional 10 minutes to swim a mile) but of course no real stress since you are in the water.  Again, I was back in the gym five days a week either swimming a mile or swimming 1/2 mile with an hour of Pilates.

Second post-op was July 13, 2009, 25 days after surgery. The weekend before, knowing I was going to be in a boot, I began putting some weight on the leg. This caused me no pain (the angle was a bit weird) and it wasn’t a lot or any great length of time (from bed to bathroom for example). However, when I went in for appt the Doc said “You haven’t been walking on it have you?”  Well, a little for the last two days. “Don’t do that (didn’t explain why).”  Got fitted with a boot and told two more weeks of crutches.  I have been in the boot for 5 days now and again have been putting some weight on it.

I had my first Physical Therapy appt one day into the boot. All Range-of-motion stuff which was stiff but felt good to really start something. I had also gone swimming that morning without boot (of course) and it REALLY felt good to have it move. Swimming freestyle was a gentle flexing of the ankle. No pushing off, but otherwise felt very natural and got much of my speed back without cast. I do think that the swimming for the last week without any restrictions has made a big difference in flexibility, along with my two PT sessions to date.  
The second PT session got a ’scar massage’ which didn’t hurt nearly what I expected. It was more like a muscle soreness and tenderness. I have been doing some on my own as well since then, as well as daily repititions of recommended exercises. Pilates adds some of its own flexibility so that seems to be helping as well. Even in one week my flexibility has increased dramatically. The first session he measured Neutral (zero degree) on flexing and %35 on pointing. My good leg was -15% on flexing and 65% on pointing. I am going to ask him to measure again next appt.

 My advice is, if you were active before, do everything you can to be active again, even if it is something different. I could be doing weights of course, but then I would have to haul myself up the stairs at the gym, and there is only so much time to dedicate with kids home etc..

The real life-saver in all this has been that our area has grocery delivery service. Don’t know what I would do without it! If you have it, take full advantage. One upside is that the kids now know they have to help more and don’t even say a word when I tell them it is time to put away dishes or take out garbage. Small miracles.

And, lest those of you think I am crazy for not listening to my doctor about weight bearing, I provide the information below. My leg seems to have no problem bearing some weight and again I am careful about it (not too far, too often and careful not to bend my ankle yet, so it is more hobbling than walking). But, from this website and other searches it just seems there is such a wide range of when walking begins, and more importantly, I haven’t been able to get an answer for why NOT walking sooner, once cast is off? So, I will discuss again with Doc in a few days, but am making a bit of my own decisions on this. Would love to hear comments either way on this!

From (

There were some treatments used many years ago that relied upon a leg cast. This led to tremendous weakness and atrophy of muscle that was often permanent. Approximately fifteen years ago, with a treatment pioneered by Dr. Myerson, the recovery after surgery for repairing the Achilles tendon changed dramatically, leading to maximum restoration of tendon healing and rapid return of strength. Instead of a cast, a removable boot is worn and instead of using crutches, walking is commenced very rapidly after surgery. Therapy and exercises are begun soon after surgery. This therapy process is critical in the recovery after tendon rupture, and without a carefully monitored program, full recovery is never possible. This treatment has made a huge difference in the recovery process for both recreational and professional athletes.

I will report back regularly!

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