ejbvmi’s non-op AchillesBlog

23JAN16- R+33 weeks, non-op, early weight bearing protocol

I have not posted in quite some time, largely because my injury no longer plays a central role in daily life (acknowledging that feels even better than I thought it would).  The insights found in these blogs and the support from the community were vital to my progress (especially in the early days) and I am truly thankful for it.  I am also grateful that all of that patience and effort paid off and that I now find myself “nearly normal” again.  I still avoid tennis and other activities that would require an explosive push off, but I am active again in all of the other activities I enjoy (biking, swimming, running, hiking)… and it is so satisfying.

As with other phases of my recovery, the past couple months have involved a dose of judgement and moderation.  I was thrilled when I regained the strength to run again (typically 1.5-2 miles)… but discovered that a normal stride would result in some post-run AT soreness for a day or two. It seemed that I was flirting with possibly damaging tissues that I wanted to be as strong as possible over the long haul, so I prescribed a break from the impact of running (since a poorly executed stint of barefoot running seems to have contributed to my AT rupture, I may be a bit paranoid).  I decided at around R+26 weeks to stop running for awhile to allow things to heal further.

My next run was at R+32 weeks.  I found myself in a scenic town and decided to jog to a historic area… it turned into a 5.5 mile round trip, and everything felt fine afterward.  I did opt for a higher than normal cadence and minimized push off (e.g. more of a shuffle than my normal running stride), but that hardly seemed like a big sacrifice.  It is so satisfying to be able to get back out and enjoy an activity that has been a big part of my life since my teens (a long time ago).  I went out for a 2-mile run yesterday at just over 9 min/mile pace, and was very pleased at how the AT felt during and afterward.   I will continue with the high-cadence, minimal push-off stride for now, and slowly transition toward a normal running stride over time.

Progress in other activities:

Walking-essentially normal looking, but I do have to focus at times to pull that off because my right (injured side) calf is not yet as strong as my left.  The bottom of my heel was sensitive for a long time after my transition to two-shoes.  While that sensitivity is much less than it once was, if I stand in one place for too long I do feel it.

Swimming-In flip turns, I used to push off mostly with my un-injured leg.  Now I use both legs equally and never give it a second thought.

Cycling-The AT is probably ready for anything at this stage, but I do not accelerate as aggressively as I once did.  This is probably more of a psychological limitation than a physical one.  I’m not racing anyone, so don’t feel rushed to push it just yet.

My biggest remaining hurdle is to regain strength in my right calf.  Although I have functional strength back, that calf still is only capable of a comparatively wimpy single-leg heel raise and is still visibly smaller than the left.  It has been too easy to lose discipline and not exercise it as I should, and my focus over the coming months is to bring it as close to its original strength level as possible.

Lessons learned worth sharing:

-Be diligent with your PT.  Progress won’t happen without your deliberate effort.  At every phase, you should actively seek out the activities that will escort you to the next level of progress.  E.g., in the first few weeks those small movements when out of the boot keep things from seizing up, so that you will have less stiffness to combat when real exercises begin.  Every week or two, you will probably be ready to introduce new exercises and activities.

-Listen to your body.  Every Doc and therapist has to guess a little about where your body is and what you can do.  The line between harmless discomfort you should work with and pain that means “stop!” is one that is not obvious in the early days, but that you need to figure out.  Doing exercises with some discomfort is just part of the program, but ignoring pain can cause real trouble.

Best of luck to everyone on our own path to recovery.

https://youtu.be/s2iwr32nIj0

Happy healing, everyone.

-E

25OCT15- R+20 weeks, non-op, early weight bearing protocol

I admittedly have slacked a bit regarding deliberate exercising lately (no gym time in three weeks), but I have been doing tons of heel raises on stairs and walking.  The strength has been steadily returning to the calf on my injured leg, and I am finally getting a decent bit of push-off when I walk.  My stride is finally nearly back to normal.

Today, my daughter and I did a 2K fun run to support the local Girl Scouts, and it felt great to get out and jog a bit.  This was my first run of any significant distance since the injury, and even at my super-slow pace it felt phenomenal to be out there again.  My plan for the next month is to jog 2-3 times a week, continue with heel raises and squats, with the goal of running two miles in 16 minutes by the end of that month.

Best to all in their own recoveries!

17OCT15- R+19 weeks, non-op, early weight bearing protocol

Full disclosure: My gait still isn’t quite back to “normal”.  After walking a few miles, my heel still starts to hurt and I develop a more noticeable limp.  When walking down stairs, I still roll my injured/trailing foot off the step a bit, so I am still not symmetrical there.  The calf still needs work, and I still can’t do a single-leg heel raise.

Having said all that: life is really good right now.  We just took a week long vacation that saw me log an average of 12,000 steps per day, including one day of 19,000 steps… and the AT was good to go.  It was never sore at all, which seems like a spectacular statement considering where I was just a few months ago.

By the end of the vacation week, my calf was noticeably stronger and I was getting more push off from it.  This was a reminder that I have been neglecting my exercises lately.  I was super-diligent about exercises during the first 8 weeks, but once I started driving again and returned to work and travel, I allowed life to get in the way.  The result of that neglect is that I have probably progressed slower than I could have.  I live on the second floor of our building, so now I make a habit of doing 50 heel raises on the stairs each time I go up or down.  My calf is on fire… but that is a good thing, since the AT is still solid and pain-free.

Happy healing, everyone!

5OCT15- R+17 weeks, non-op, early weight bearing protocol

The good: my AT seems to be doing great.  I walked >24,000 steps {~9 miles?) on a long day that included a 6+ mile hike this weekend with son’s Boy Scout troop, and the AT was not even sore.

The bad: my joy at how well the AT was doing was somewhat overshadowed by the prominent pain in the heel and ankle of the “bad” foot.  I have come to realize that the foot and ankle are not quite ready for prime time yet, and I need to pace myself to prevent damaging anything in there. The heel pain has been a byproduct of my heel-centric weight distribution in the boot and early two-shoes walking, but has lessened lately  as my weight distribution has evened out.  However, this was by far my most ambitious day of walking since the injury and “rang the bell”.   I took it a bit easier Sunday and today to recover.  Starting this Saturday, we are taking a week long vacation that will involve a lot of walking… I will have to try to behave myself so that I can enjoy the entire trip!

Best to all.

16SEP15 - R+14 1/2 weeks, non-op, early weight bearing protocol

My Doc suggested working on the treadmill and setting a goal of running two miles at an easy pace around the 16 week mark.  Today, I jogged for the first time since injury, stopping after 1/2 mile and feeling pretty good.  I am still not pushing off normally on the injured leg yet, but just the fact that I could jog at all felt like remarkable progress.

Today was my third trip to the gym in the past couple weeks.  While I was at there, I did a few sets of squats, leg presses, toe extensions, etc..  The strength is returning to the injured leg.  Life is good.

For those earlier in their journey: be patient, push yourself but don’t hurt yourself.  You will be back in the game before you know it.

Oh, yeah… and it appears that every day at the gym is now a leg day.

10 SEP 2015: Rupture+13 weeks, non-op, early weight bearing

13 1/2 weeks after the “POP!” and my heel dropped bizarrely to the floor when I attempted to push off while playing tennis, my Ortho told me today that I am doing great and that he won’t need to see me again.  I still have a lot of work to do regarding calf strength, but this still feels like a huge milestone.

On a related note: I returned to the gym a few days ago, and it felt great to regain that bit of normalcy!  30 minutes on the bike to get the heart rate up, and then a few rounds of single-leg leg presses, toe extensions, leg curls, etc..  I can hardly remember feeling so satisfied by any workout.  The muscle soreness I encountered over the next couple days actually felt great after three months without it!

This week was the first time since the injury that I have been able to walk “with impunity”.  What I mean is that, although my walk still isn’t entirely normal yet, I no longer fear walking too much and ending up with a sore AT or insane swelling by day’s end.  I walked just over five miles today, and everything feels ok.  Marvelous!

For anyone early in their own journey reading this: have faith, be patient, do your physical therapy and exercises, and you will be here before you know it.

A few reflections, looking back on my experience so far:

1.  Early weight bearing works.

2.  Physical therapy works.  I started PT during week 2 with massage and manipulation, and progressed through various phases as appropriate to where I am now.  Using PT to define what is appropriate at each stage, and doing enough of those exercises on my own time have been key to my recovery.  (I’m not done, of course… but I am where I am because of those activities.)

3.  The right gear is important.  The Elasto-Gel ankle wrap was suggested by a comment early in my recovery, but I was cheap and delayed buying it.  I wish I had bought it sooner, because it is a more efficient and comfortable way to control swelling than my old-school ice pack.  On a similar note, I took a trans-Atlantic flight two weeks after injury without a compression sock… not my smartest moment ever.  Definitely should have acquired a compression sock for that trip.  I used one extensively over the rest of my first couple months.

4.  Activity is important for recovery, but so is caution.  I’ve had at least a half-dozen “oh no” moments, and feel fortunate to not have had a serious setback.  I once stepped on a cobblestone wrong and mildly sprained the outside of my weakened ankle, once did an exercise too aggressively at PT… the list goes on.  Bottom line: it is important to remember that things are more vulnerable than we want to believe while we are recovering.  One would expect a snapped Achilles to make that point pretty well, but stubbornness runs deep in my family.

Happy healing, everyone!

-Evan

22AUG15, R+11 weeks, Non-op, early weight bearing protocol

The past two weeks have produced a lot of progress.  I took it easy for a few days after walking too much early in week 10, but this past week (week 11) my AT felt solid and I was able to really focus on exercises and trying to make progress toward a normal walking stride length and rolling motion for my injured foot.  I still do not have enough strength in the calf to push the heel up from the ground normally while walking, but I am giving it max effort and the calf is getting stronger each day.

Many things, such as the way I use my foot while driving, are starting to feel “normal” again, which feels great.  I still get a fair amount of swelling by the end of the work day, so I elevate at the office when I can and still ice every evening.  My “Elasto Gel” flexible foot ice wrap arrived this week, and that turned out to be $31 well spent.  Using the old school ice pack, I would ice for 15 minutes, then reposition the pack to another part of my ankle for another 15, then another.  With this new wrap, the whole foot and ankle get the cryo benefit at once.

My Physical Therapist has been giving me a lot of new exercises to help improve my balance, stability, strength and walking motion.  I tried to post photos the blog, but seem to lack the Wordpress mojo to make that happen.  Instead, I posted them to the ART Facebook page in an album.  Hopefully anyone interested in them can view them at this link: https://www.facebook.com/media/set/?set=oa.10153583687629485&type=1 .

A  buddy asked for a video to explain the exercises, as the photos were not quite enough to explain the walking motions.  Here ya go: https://youtu.be/rUaLCe1xIfc .

My Therapist often tells me to relax and trust my AT, saying that it has healed (yes, past tense).  Has anyone else heard the same at this stage of recovery?

Happy healing, everyone!

-Evan

In case anyone wants to see what the beginnings of my two-shoes phase looks like:

https://youtu.be/_6AIX7nppWM?list=PLu1nHtWBBf8YfYz6JCH4z_vrVBF592gHI

All the best to everyone in their own recovery!

-Evan

R+9 weeks, 8AUG15

I have been walking in two shoes for almost a week now, and I am pretty happy with the state of things.  My first steps were very tentative, but thanks to my PT’s help and daily work I am beginning to roll my heel up a bit more each day.  It still takes me awhile to get where I am going, but I just allow for a little extra time and the satisfaction is worth the extra time.

The tendon and calf are a bit stiff in the morning, so my morning routine now includes some work on the exercise ball.  My wife bought the thing years ago, and I rarely did anything with it.  It is my new best friend.  I sit in my lounge chair with my foot on the ball, and roll it in a variety of directions to loosen up my AT/calf and strengthen the muscles along the back and sides of my lower leg.

In addition to the work on the exercise ball, I also do two-leg heel raises on a couple of thick books, as well as alternating single heel raises (not full weight on a single leg… sort of a PWB heel raise).

The combination of these two activities is a good warm-up for my injured leg, and I can walk a bit close to ‘normal’ after doing it.  My calf is still super-weak and I can’t push my heel up with it as one normally would in stride, but things are improving daily.

The swelling at the end of a work day is far less than it was a few weeks ago.  At this point, it does not cause any really “puffiness” in the ankle and foot… just enough to stiffen the ankle and limit my ROM a little.  Evening elevation and ice normally clear that up within an hour or two.

Happy healing, everyone!