Posted by: edhdez | August 10, 2015

Week 7 - Plantar Flexion concern, questions

My first PT at 7 weeks went really good, however, it raised some questions and left me a little nervous. My plantar flexion in my right foot, the good one is at 45º and my injured one is at 25%. I’ve been obsessing all day about the possibility of my tendon healing long, I’m still 5º on the boot and walking and I can’t get to 0º PF yet. Has anybody been thru this concerns?
These are the exercises I’m doing now, trying to strengthen the muscles. Walking about a mile a day and working out 3 times a day, upper body and both legs on boot.

Thank you all and have a happy healing day!

Responses

Ed - To my way of thinking your plantar flexion would not be a good indicator of you healing long particularly at this early stage. Remember you have this big ugly healing tendon and probably some scar tissue obstructing your flexion. Relax and give it some time. Continue with your mobilization exercises and note any changes. I would be more concerned at this stage if your dorsi flexion was excessive or greater than the unaffected limb. Another important thing is ensure whatever you do with the affected side you do with the other. Review this in another 8 months or more and until then there is nothing to be gained in worrying.

Hey Ed…just an FYI… I could be wrong and I’m willing to be corrected but I believe that healing long gives a reading for excessive dorsiflexion.

The reason most protocol call for limited dorsiflexion before 6 weeks (and some up to 12) is to avoid healing long, to avoid pulling on the healing tendon and stretching and stressing it unnecessarily.

Avg df range is 10 to 30 degrees according to my doc (different sources may have slightly different ranges) so that’s the measurement that would count. If I hear you correctly you are not at neutral and are not dorsiflexing so you can’t be healing long.

Also both your feet are in the range for pf which is 20-50 degrees which is great.

Also ROM can be increased over time so give it that time it needs…it goes to say that ROM should be measured using accepted standards.

Hope that helps.

Stuart and Donna! Thank you for your wisdom ;) this gives me peace of mind.

Looking good Ed! Glad to see you’re making forward progress. Regarding your PT research from an earlier post, I recommend taking the time to interview multiple PT’s and ask them lots of questions. At this point, you know a ton about the injury and recovery, so ask them questions you already know the answers to and filter them out as appropriate. A pretty good question to ask is simply “How many achilles tendon repairs (or non-op recoveries) have you worked with and have you had any re-tears?”. Best of luck moving forward my friend!

Hey Ed, you have made me paranoid now, I had not even thought of healing long before.

I have really good mobility so I am hoping that is a good sign.

Ed and Donna - Add the w’s and read this. ncbi.nlm.nih.gov/pmc/articles/PMC3178860/
End range plantar flexion strength is a key measure to determine if you have healed long but it does not mention plantar flex angle. This cannot be done for some time after the injury and I would suggest minimum one year and better two. Donna is correct about dorsi flexion and it measures 10mm longer for every 12 degrees more.

Thanks for the link Stuart, I do recall reading that at one point, it’s well worth the read for anyone having this injury.

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