ejbvmi’s non-op AchillesBlog

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!

4 AUG 2015 - Rupture + 8 weeks

I had a nice surprise at PT yesterday. My therapist pointed at my cam walker boot and said “I think it is time to get rid of that.”

8 weeks post-injury, non-op, and very pleased to reach this milestone!

I will still use the boot if I need to get somewhere in a hurry, since I walk like a 110 year old man with a bum leg in two shoes… but it feels great to finally do it! (And drive my car again… so nice to be mobile again and I think the car missed me a bit.)

Even though I am thrilled to reach this transition, I am still very tentative with walking without the boot.  When I feel the tension in the AT as I walk, I waver between wondering if I am being a wuss for not allowing a bit more ‘pull’ on it and wondering if I am pulling on it too much.  I have not encountered any pain yet, and it seems to get easier to walk as the day goes on and it gets ‘warmed up’.  I’ll take it slow, and continue to revel in this new level of freedom.

For two weeks leading up to this milestone, I was on a vacation and walking 4-7 miles a day and removing a layer of my heel lift every 2 days or so.  While that was not always great for my heel, the AT was fine throughout and I had started to walk a little in our hotel rooms and stand in the shower.  The combination of lots of walking in the boot and a little indoor walking without it seems to have strengthened my injured leg a fair bit.  One might even accuse the calf of my injured leg of being somewhat “toned” (though it is still a chicken-leg compared to the opposite leg).

Probably worthy of mention: during week 8, I adjusted my boot so that it would allow up to 10 degrees of plantar flexion motion (range: up to 10 down, zero up).  After a couple days, I increased it to 20 degrees.  Has anyone else tried this technique?  I like the feeling of getting some motion in the ankle and calf instead of having it immobilized.  Clearly, I would not do this during the earlier weeks when the fixed angle facilitated healing the AT at the correct length.

Happy healing, everyone!

-Evan

21JUL15 - R+6 weeks, 3 days  (non-surgical, early WB protocol, FWB since the end of week 4)

1.  I hopped to the US and back to Germany this weekend.  I knew this would involve a lot of walking, but was surprised to see 6.5 miles on the watch at the end of one day.  While the AT was not bothered, I discovered that my boot is not really ideal for walking that far.  My heel was ready to call it a day by the time we finally boarded the return flight.

2.  At PT today, I stood bare and flat-footed for the first time since the injury.  It felt like a huge milestone… then we started working on putting tension on the AT and realized that there are many milestones still ahead.  Still, it was a satisfying step in the process.

3.  Also, we pulled out on of my 1cm heel lifts.  After that, it felt as though my heel had been plunged deeply into the depths of the boot.  Amazing what a difference 1 cm can make.  After walking a bit today, I am tempted to put 0.5 cm back in for a day or so.  Has anyone else run into a similar apprehension, or is 1 cm a ‘normal’ jump?

18JUL15 - R+6 weeks  (non-surgical, early WB protocol, FWB since the end of week 4)

I had my 6-week follow up with my OS this week, and he was very pleased with my progress.  The tendon is continuous, and everything looks like it is progressing well.  According to my watch I walked 5 miles that day, and though the foot was a bit swollen from being well below my heart all day and the tendon area was warm, I had no pain or discomfort.

The affected leg is getting much stronger, which is a welcome development considering that it was skin and bone only two weeks after the injury (atrophy happens FAST).  I’m not sure how much of this progress can be attributed to walking, the exercises or bike riding, but the combination seems to be working well.

My protocol calls for removing the heel lift in weeks 6-8.  My 2cm is comprised of two lifts of three layers each, so next week my PT will remove one of the layers, and we’ll see how that goes.  We are going on a vacation that will involve a fair amount of walking week after next, so I am in no rush to reduce the angle during a week when I will be walking a lot.

A friend asked about how to go about FWB, and posted a video of his PWB work with his boot set at 30 degrees plantar flexion.  For what it is worth, here are some initial thoughts that I shared with him, and I welcome any feedback from folks who have done WB in a boot set at an angle other than 0 degrees:

————-

“I watched your PWB video, and it was immediately obvious why you had the question of “how did you go about the transition to FWB?”  Key to the answer: Our boot setups are completely different.

My boot has been at a 90 degree angle (0 degrees on the setting… no plantar or dorsi) the entire time, and my plantar flexion is accomplished by means of 2 cm of heel lifts INSIDE the boot.  Therefore, the geometry of the boot (heel touches first, then rolls toward the toe) is “normal”.

Though my “Bledsoe EZ Set” boot can be set at any angle, the manual clearly says that weight bearing is not allowed at any fixed angle other than zero.  Your boot may not have this same prohibition, but at your current angle it seems like a real challenge to accomplish any WB that goes consistently into your heel where it belongs at this stage of the process.  You don’t want to be repeatedly stepping down on your toe, as that will place unwanted stress on your healing tendon.

I would recommend reading up on the manufacturer’s literature about your boot, to see what it says about weight bearing.  One thing to consider as an option is to set the boot to 0 degrees and accomplish the plantar flexion with heel lifts (not Dr. Scholls… the ones I have <“The Original ADJUSTaLIFT”> are much firmer and were installed by the OS office).  Walking with that setup has been relatively simple.  I walked 3-ish miles Monday and Tuesday, and 5 miles Thursday this week.  Though my pace is not all that fast, it was not uncomfortable and none of my other joints are bothered at all.”

Happy healing everyone!

-Evan