eastcoastrunner’s AchillesBlog

Today marks one year since my debridement and repair surgery. In some ways it went really quickly. Before the surgery it was a gradual decline of running "a-lot" to not being able to run "at-all". Then there were the months of recovery post surgery.  But once I was able to start running again post-op, I think I made really quick progress! I ran a 50K just 6 months after the surgery (slow, but I still did it.) I’ve run several more since, and have built my weekly mileage back up to where it was before the injury took hold.

I’ve been training through a snowy winter for a 100 mile trail race coming up in June. Winter running has proven to be a challenge for me as running (or even snow shoeing) on snow has been the one thing that really makes my foot hurt more than anything. That being said, I ran a 6 hour trail race on trails covered in snow and mud 2 weeks ago. It was the same race that I ran last year when I realized I COULDN’T run on my Achilles any more. I HAD to run it this year! I was happy enough with my finish at the race this year–not as many miles as I would have liked, but considering that the trails were really slippery, I did well.

I would not say that I am 100% recovered. My dorsi flexion is still terrible in my AT foot. My foot still hurts for a few minutes each morning until I work the "kinks" out. My scar still itches sometimes–and it now has a big, purple "slug" where I once had the pretty little inscision line. There is still an adhesion at the very bottom of the scar that I doubt will ever "let go".  My ankle bone on the inside hurts for no reason. My soleus muscle is still skinny and very tight (which I believe is pulling at that medial anklebone) Perhaps most scary of all– I can feel the boney growth building up on my OTHER Achilles insertion. I suppose it is just a matter of time until the left side will have to be done as well. (although it doesn’t hurt and has not affected my running.) I don’t think any of these things are preventing me from participating in my sport, they are just a reminder that I still have a ways to go.

I hope that other runners who are going through AT recovery right now might benefit from knowing that you CAN get back to running! It’s not easy going through the recovery process, and there will be days where it feels like you will never be "whole" again. But then there will be days when you make a huge jump in progress. Once you start to progress, it builds from there and you will feel stronger and more confident with each passing week.

It’s been a little while since I updated my blog. Like most of us this far into healing, I’m mostly back to normal. (of course, “normal” is a subjective term! )

Just a quick re-cap: I’m a woman in my mid-forties who is a trail and ultra runner. I work as a Spinning and Fitness Instructor, and High School Track Coach. I had Debridement and Repair Surgery with Bone Removal (with the tendon reattached to the calcaneal bone with a nice, big titanium screw) in my right foot back in April. I feel the surgery was a success and worth the few months of “down time” to heal from it. I have run two 50K trail races since surgery, one of them in snowy/icy conditions. I am currently training for a huge goal race in June. This training cycle is different for me as I am learning to NOT ignore pain in my foot. I had AT issues for 3 years prior to finally having the surgery– It’s been a bit of a challenge to pay attention to the sensations in my foot instead of ignoring them.

This brings me to “Running in Snow”. Here on the coast of MA we have had a bit of snow. Not deep enough to be useful–can’t snowshoe in it. It IS just enough to be slippery and make for challenging conditions for running (heck–even for walking! I slipped on black ice just walking into work last week and hit my tail-bone. OUCH!) There was less snow and a bit more ice a couple weeks ago when I ran my last 50K. It was actually easier to run inthe crunchy icy-snow than it is the 4″ or so we have right now. I have found that the constant lateral sliding and slipping in this snow on the trails is the one thing that will make my AT hurt and my foot swell. Even the old pain in my forefoot and toe comes back after an hour or more running in the snow. I can feel the weakness in my right foot and how I favor that side a bit… and am so much more cautious with running things I never gave a second thought to in the past. I actually think this is good in a way. It’s helping me to know what to focus on to get stronger again. I’m back to being “good” with my PT exercises!

Since the trail running on the snow is proving to be a bit of a challenge for me right now, I’ve added some road running back into my weekly mileage. The roads are quite clear. This is helping me to even out my stride and I’m regaining something sort of resembling speed. Yesterday was a long run on a hilly road course, and I was able to run up the steep hills on the balls of my toes for the first time since surgery! (honestly, it was the first time since before surgery I was able to run like that) That feels like a major accomplishment to me! (and yes, my calves did feel it–in a good way!)

Today was back on the slippery trails. I shortened my run to about half of what I planned to do because I could feel my AT and my calcaneal screw in a way that I will pay attention to. Maybe I’m learning…..

~karen

Well, I haven’t been checking in very regularly lately. At close to 7 months post-op for Achilles Debridement and Repair, I am pretty much back to “normal”.  Today I am home with my youngest awaiting the arrival of Storm Sandy.

I wanted to share my race report from Saturday. When I had my achilles surgery  in April, I had to miss out on a whole bunch of races throughout the summer. I volunteered at a lot of races and stayed active in my trail running community, but of  course this isn’t the same as running them! The race I ran on Saturday was the last one I had registered for before the surgery. It was supposed to be my first 100 mile trail run and my biggest Goal Race. My Ortho and I decided I could still aim for this race as a goal, but to shorten the distance to the somewhat more reasonable 30 mile option :)

The race is called Ghost Train Rail Trail Race. It was run on an old railroad converted to trail and the surrounding trails and roads. It was a 15 mile out-and-back…mostly flat and very runnable, with only one real hill in each direction. It had a very woodsy feeling to it as it ran through forest and past lakes and streams and ponds, and there were enough roots and old railroad ties on the trail to make sure you had to pay attention! There was a 30 hour time limit for the people who were running 100 (or more!!) miles.

I had to start the race later in the afternoon as my high school Cross Country Team had our League Championship meet that morning. (girls won the conference championship, boys came in third!) I had cleared it with the Race Director in advance and he welcomed me to start late to keep the 100 Milers company for a while once it got dark. So after running around at the meet for 4 hours, I drove from MA to NH and started my race about 2:00 in the afternoon. I knew I had time to run my first out-and-back in the daylight and the second would be run in the dark with headlamp. The out-and-back set up is a lot of fun. You pass EVERY other runner in each direction, so you can greet and cheer them along, or exchange information, etc. This came in a bit handy later on…

My first 15 miles were pretty uneventful. I ran every bit of the terrain, cheered on the other runners, and was quite happy with my time. My tendon was a non-issue and I really felt fantastic. When I got back to the start/finish, I grabbed my headlamp and a snack and headed back out with a 65 year old “Legend” of the sport who was running 100 miles. I enjoyed his stories and company, but since I was still fresh and running strong, he wished me well after a couple of miles as he couldn’t keep up with me.  About dusk I was trotting along alone, feeling strong and so happy to be back to my sport, when I heard a crunching in the woods to my left. I was expecting to see a deer, when a short black shape came ambling toward me. My brain said “Not a deer. Dog? BEAR!!” I was so surprised to see a bear (and so excited! I’ve always wanted to see a black bear!) I exclaimed “OH!”  The bear stopped short, stared at me for a second in the bear equivilent of “OH!” then turned around and tromped quickly back up the way she came down. Seeing that bear made the next several miles zip by as I was so in awe. The out-and-back set up of the race was good because I was able to let the other runners coming toward me know about the bear, and they in turn could let the runners behind me know about the bear. Soon everyone along the trail was asking about the black bear. Some were worried about it, some hoped to see it, and a couple other runners did get to see her as well.

It got very dark shortly after my bear siting, and I had to put on my headlamp. The darkness slowed me down a lot–and I was being very careful not to fall and do anything stupid to my tendon! I didn’t mind the slowing, and I actually like running in the dark. It was fun to see the other runners headlamps coming along toward me for the remainder of the race. We could only identify each other by height, gender and voice in the pitch dark. Someone had placed jack o lanterns along the trail in various places, along with ghosts and the Grim Reaper. Coming up to one of those ghosts hanging in the pitch dark where there hadn’t been anything hanging during the light was…scary! And fun! I was sad when I finished my 30 miles. I felt like I could have gone another lap, but decided that I would be smart and stick to the plan. Today my quads, hipflexors and calves are quite sore…but in a “good” way. My tendon is just a little bit tender. It didn’t even swell much! I am walking with just a bit of a limp today though, but not from pain–perhaps fatigue? The incision scar is a little tender. It is right on my calcaneal bone and does rub on the back of my shoe–but I put enough Body Glide on it that it was just a  friction rub and not too bad.(before the surgery the huge bump on my achilles insertion would bleed from the friction) My finish time was by no means a PR, but I am thrilled with how much I ran, how good I felt while running and after the run, and I am even happy with my time as it was faster than I expected.

Thanks for reading! ~karen

PS– lost power during the storm for several hours after starting to write this post. Looks like a lull in the storm now, but expecting it ot hit hard again soon.

Our local Woods has a free weekly trail running series from May till September. I have been running these races for years. This year I was the “designated volunteer” working the timing at the finish line. (volunteering can be very rewarding, too, and I was happy to “give back” to my sport while I couldn’t participate this year) I haven’t been able to make the races for the last month as I coach Cross Country and our meets have conflicted with the races.

Last night was the last trail race in the series…and we didn’t have a xc meet, so I ran my first race since surgery! It was a 4 miler and I felt fantastic! Uh, my time was much slower than ever, but I was so happy to be out there running, and I felt like a rock star with all the cheering I got throughout the race This race makes my Goal Race next month feel more like a reality now. I know it will be slow, but I don’t care too much about that.

 I have been running regularly for about 5 weeks–up to 2.5 hours on the trails for my long runs this past weekend–but I haven’t done any speed work yet, and I have still been adding walking breaks into my running. This informal little race felt so good to open my stride–felt like I was flying (even if the pace more closely resembled the Tortiose) Hey, I didn’t even come in last!

Last night and this morning my foot felt tender at the insertion (where the screw is–wonder if that will go away at some point?) but my tendon felt petty good. Progress!

This week I had to go to a “Very Important Meeting”. I just felt so silly wearing my nice skirt with my frumpy old Grandma shoes (the backless sneaker things that are the same style as my 72 year old Mom wears–ugh) I took courage in hand and strapped on a pair of 3″ wedge sandels. Now, I never had to wear wedges in my boot (and I never had casts…went right from my surgery into a boot) But I assume those shoes did what wedges in a  boot or shoes do–and they were surprisingly VERY comfortable! I’d been worried about walking around in them, but it wasn’t a problem at all. My AT and heel felt really good all day. I’m still glad that I don’t have to wear dress clothes every day, but it was nice for that one day.

Yesterday I did a 4.5 hour hike up and down  Mount Monadnock in NH with 3 other personal trainers and a yoga instuctor. We all work together and this was a “team building/fun” outing . One of the trainers is my boss, who had knee surgery just after I had my AT surgery, and the same Ortho did both of our surgeries. We got a photo to send to the Ortho of the two of us standing at the top of the mountian. Ha, getting UP the mountain was a little challenging. Getting back DOWN was the hard part! Today my upper body is sore, especially my triceps from sitting on the edges of the large rocks and lowering myself with my arms instead of leaping down. My AT is just a little tender, but not really painful.

I’ve hiked in Colorado and the Grand Canyon…I found this little rocky mountian way harder than either of those. I’m sure it’s from being out of shape and being so protective of my AT (and thinking about the OTHER AT the whole time!) I had fun and I am glad to have tested the foot like this. It didn’t really hurt much during the hike and didn’t swell until I got my shoes off. If I can figure out how to get the photos off my phone and onto my blog, I’ll post some later! Next up: hiking the White Mountains in NH!

Today is exactly 5 months since my Debridement and Tendon Repair Surgery.

I’m getting back to my active self, although far from 100%. I am still having pain at the spot where the screw is on the back of my heel–and I have a pretty good sized Bump there again. I find that Bump very distresssing for several reasons: I had a huge Bump pre-surgery which was the boney growth that had to be taken off the insertion (some form of Haglunds). It also rubs against the back of my shoes causing pain in the incision/screw area. But this bump seems to be softer than the boney bump pre-AT was, so I think it’s just swelling. I hope. If it’s not better in a couple weeks I’ll check in with the Ortho again. He did tell me that as I got active again, it would feel like I “did something” to it for a while and that was normal. (that comment seems odd until you realize that my Ortho had exactly the same surgery and is speaking from his own personal experience) I have found Skutr’s suggestion of pre-wrap and Kinesio tape to pad the incision/screw area to help. (Thanks, Skutr!) My whole foot still aches every night while I “try” to sleep. It doesn’t bother me much during the day while I am active, but at night when I stop it hurts enough to keep me awake. Does this happen to anyone else?

Road biking: Once or twice a week @ about 15mph (not fast but comfortable) and now I’m able to ride even big hills. Longest I’ve rode post AT so far is 25 miles, although I’m thinking about doing an organized 50 miler in a few weeks.

Indoor Cycling: back to teaching my Spinning classes once a week as normal with all positions. Feels so good to sweat!

Running: I am running every other day as I build my endurance back up. My gait is  “off” a bit as I’m still lacking the flexibility in my AT ankle both front and back. On the roads I’m running 2-3 times a week about  3 miles with just a bit of walking  if needed. (my usual route is mostly flat with 2 hills). I’m running on the Trails 5-6 miles usually 2 times a week. I hike all the more difficult trails and run the smoother and flatter trails. I am up to about 50% running/50% walking  mixed single track and fire road. I am able to run up the smaller, smoother hills now. I’ve started running the downhill trails at a faster clip, too I’m an assistant coach to a very talented high school Cross Country team. I can’t run with the kids (haha, couldn’t pre-AT either! They are fast!), but I’ve been able to run around during practices every day to coach them. We are very lucky to have groomed forest trails 1 mile from the school and grassy horse trails as our Home Course.

PT: I’m down to once every 3 weeks. I do my exercises at home pretty regularly. I still can’t do a “pretty” single leg standing calf raise, but I can get my heel about 1″ off the floor most days– and higher after PT massage.

So, I am trying to be patient with easing back to “normal”. But like most of us, patience isn’t my strong suit.

I did a lot more running during my hike on the trails yesterday! I purposely left the trekking poles home (they get in the way for the running part!) I did a route that was moderatly hilly and about 2/3% single track trail and 1/3% fire roads. The route I chose was about 5.5 miles. I went alone so I could concentrate and do exactly what I wanted to do. (yes, I always tell someone my planned route  and when I am expected back home= safety first!)

I was experimenting on what I can do and can’t quite do yet. I didn’t bother to time how much I was running–I just went by feel and what I wanted to try running. This is what I found so far: gentle downhills  and flats w/o too many roots or rolling rocks or acorns to slip on were easy and fun. Steep downhills were hard and scary and I felt more secure walking those. (huh, I was good at running those pre-op. Hopefully that will come back soon) Gentle uphills don’t hurt as much as pre-op! I could feel the stretch in my AT, but the pain in the insertion and tendon was much less! Steep uphills still require walking (and some I wished I had the trekking poles) Part of this was also was that I’m out of shape and got winded easily. Enforced walking!

Tricky single track with lots of roots and rocks was too challenging as I still lack the strength to “dance” through those areas on my forefeet/toes like I used to.  I had a hard time picking my feet up enough not to trip, so walking is still the rule for those trails for now. I also am not ready to leap over streams and fallen trees…I didn’t even try.

My whole foot did hurt after the run/walk. I think it’s just so weak and the muscles are not used to moving in the way the trail forces the foot to move. I soaked in epsome salts, then used ice and elevation. The swelling and pain was down a lot by evening. Today my AT foot hurts behind the lateral ankle bone, but nothing too bad.

2 questions for anyone with advice or opinions: #1– a lot of the pain comes from my shoes touching my incision and maybe I’m feeling the screw under the skin a bit as well. (my scar runs from just above the sole of my foot to where the AT flexes at the back of the foot–about 2″ scar) I put band-aids over the scar and a piece of Kinesio Tape over that, but it still stings and tingles from the back of the shoes. Any ideas how to make that area less sensitive? #2- What about running/walking  in sand? I am wondering if this could both work the foot in all directions like trail running, and help to make the skin less sensitive…but is that too much stress on the AT and calf?

I’m at 19+ weeks post Debridement and Repair Surgery (not ATR, but the recovery is close to the same).  I have started to ease back into running and jump back into biking this week.

I’ll start with the Run. I suppose it’s hard for me to call it a true run. It sure wasn’t like “going for a run”.  I’m used to running distance.  My running of choice is trail Ultras. This, uh, wasn’t that!  My Training Partner (who, BTW, is a true saint for not ditching me during this l-o-n-g recovery!!) and I met at the Common yesterday to begin this back-to-running process. I don’t know if other parts of the country or other countries have Commons. In New England Commons are flat open grassy areas that were used during the Colonial times through Revolutionary War and beyond to hold Military Musters and Trainings as well as a place for the cattle to have a common grazing area. Now it’s used as recreation area and an open space  to hold large gatherings. Our Common is 1/2 mile around and has a finely crushed cinder gravel walking path around it. We walked one lap around to warm up. Then we ran 1/8 lap, walked 1/8 lap a full time aound, then we added more running and less walking each time we completed a loop around. The whole walk/run ended up  about 3.5 miles and included not quite 2 miles of non-continuous running. It felt good! The only pain I noted during the run was to my Pride!  This was slow and hard and my strides were short. That 2 miles of run felt like 10. But my Training Partner said that I looked pretty smooth and wasn’t limping or lurching. I understand it will be a gradual process and I keep telling myself I am getting stronger with each new step– and I can get back to running trail ultras next year. I have the opportunity to start all over again and build a strong base then add speed when I’m strong enough and I’ll be a better runner in 2013 and beyond.

The Bike Ride was today. I had planned to start biking last week, and EVERY time we planned to go out, it began to thunderstorm. Today was beautiful and a perfect day to ride. I met a friend at the Y. My Husband liked that I was going with this friend as he is someone that we both used to ride with and he is a good, safe cyclist (who happened to rupture his AT 20 years ago and knows what it’s like!) We agreed on a route that wasn’t too hilly and that we estimated to be about 15-18 miles long. We decided that he would go ahead of me to watch out for hazzards (crazy drivers, etc) and to keep the pace consistant. The ride was WONDERFUL! It felt easy! I haven’t been on my road bike in over a year, but it was very natural again. I’ve been teaching Spinning classes for 12 years, and Spinning has been a huge part of my recovery, once my Ortho gave me the OK–around the 3 month mark I was allowed to use both feet on the pedals and no standing climbs. We did encounter 2 hills on the ride that felt like hills…but I stayed in the saddle and even though they winded me, I got up them pain free. We underestimated our route, the ride ended up being just over 21 miles (oops!) We averaged 14 mph (slow, but “just right” for starting back) I’m looking forward to going out again next week!

Yes, this afternoon I needed to ice my foot. I think that we went a bit too far, but I’m not regretting it.

My PT seems to have “gotten down to business” since I was discharged by my Ortho last week! After the usual massage, stretch and balance exercises, today we did seated double and single heel raises, Standing double and single heel raises, then—we did hops and bounds. That-was-scary! I would stand on AT foot, then hop off it and land on both feet. After reading some of the posts around here this week, I was quite scared to try it. But it wasn’t bad after taking the first literal “leap of faith”. The bounds were gentle exaggerated running motions accentuating the push-off.

Best of all?? I got to RUN a teeny, tiny bit! Just back and forth across the room 5 or 6 times, but my foot remembers how to run!

I will fully admit that my foot hurts now several hours later. My scar is stinging. My heel bone feels buised. My AT is achey. My ankle is swollen. My calf  just remembered that there is muscle in there and it needs to get back to work.  My PT thankfully told me to expect this, and to do these execises “as tolerated” this week. Hmmm, now that I’m thinking about it, my big toe joint and fore foot feel really good though!

I RAN a little! This felt like a very real step toward getting back to my distance running!

Today was my 17 weeks post-op for Achilles Debridement and Repair surgery (not ATR) with my Ortho. I won’t need to go back now unless I have an unexpected problem, or when it’s time to have the left AT done (sigh… we’re hoping that won’t be for years! I am in NO hurry to go through this again!) At the end of the appointment, the Ortho showed me some photos of  Ultra races he completed after having the same surgery.

So, everything is looking really good and healing well.  I had gotten a bit behind healing schedule when I had trouble getting to FWB a while back, but now he said I am actually ahead of where I was expected to be.

I have been given the OK to begin RUNNING in the next couple of weeks!!! :)  I will start first on the track by jogging the straights and walking the curves. Once I get running steady, I can move to the rail trail and roads, and finally to my hilly singletrack trails.  In the mean time, I can build up with the elliptical trainer which feels like running a bit. (I started on that with the PT yesteday.) I can now add standing climbs on the Spinning bike. I can start riding my road bike now on flat roads, being extra careful with clipping out of the pedals and adding hills gradually. I can carry on with hiking trails adding distance and more difficult terrian.

Yesterday at PT I was able to do single leg heel raises for the first time! I could do double leg heel raises for a while, but the right leg wouldn’t lift w/o the left.  My PT has said that I can’t start running until I can do them, so I had been trying for a week unsuccessfully. Yesterday he tried different ways to get the muscles to remember how to fire…and then suddenly I COULD do it! I did 5 sets of 4 single leg lifts, which was enough for the first day. It was nice that the other PT’s were cheering  me on, too–very encouraging atmosphere.

So, I am feeling very optimistic about things this week. My forefoot is still my biggest issue, and the Ortho and PT are both confident that will work itself out over time. It was caused by being immobile in the boot for so long. I feel it’s a pain that is mostly tolerable and doesn’t get worse unless I do too much, and  it’s getting better with PT.