ElSurfer’s AchillesBlog

Hey all, some comments on my YouTube videos chronicling my progress a few years ago prompted me to post again. I was 40 when I ruptured it playing basketball. Here’s where I am today 3 years later - Still doing a fair amount of athletic things, 4-6 hours of Martial Arts per week (Brazilian Jiu Jitsu, Muay Thai and Karate), Surfing and Mountain Biking and trail running sprinkled in between. Other than being half a step slower (due to age) and sucking wind because cardio has always been a challenge for me, I’m doing pretty good. I’ll have to admit that my right calf is about 85-90% where it was before the injury, and that it is probably 1.5″ in circumference smaller than before (I’m stocky and have thick calves anyways, so 1.5″ isn’t all that noticeable) but I can tell because it’s my own body. Perhaps, I healed slightly long or the 6-8 weeks of atrophy caused some muscle loss, I’m not sure.

Now I don’t notice the drop off in strength during endurance type sports, like running or mountain biking - even sprints and jump ropes aren’t noticeably different either. I’ve done some 10k runs and longer mountain bike rides with lots of elevation gain without any struggle with the ATRd leg. The only time I notice the weakness is when I’m doing martial arts and I’m kicking off the leg many, many times. I notice it when it starts to fatigue because it affects my balance and technique as you have to balance and pivot off the ball of your foot which relies a lot on calf strength.

I suppose I could really work hard and start doing calf specific strength exercises like I did in the first few weeks of PT to get it stronger, but I think the point is, I really don’t need to to enjoy the things I’m doing in my daily routines. These days, my calf is one of the last things on my mind. At my age and my activities, it’s more about being flexible and recovering from other injuries, like strained backs and neck or tendinitis in my elbow. Martial arts is rough on my body, but good for the soul.

(NOTE: this was supposed to be posted back in May 2011 - I forgot to publish back then and my how time flies…. I can’t believe it now Feb 2012. I’ll have a 1.5 year post surgery update shortly - lol ) For those that are new, you can watch my progress videos in my past posts.

Hi Team,

Been a while since my last update, I believe it was about 3 months ago. Let me start off with the (very few) negatives.

Right ATR’d Calf size is still about an inch in circumference smaller than the left.
Strength is about approx 80% than that of the left. (rough measurement by comparing the amount of raises each leg can do).
When I’m sore or stiff the day after a run, you can notice me favoring one side when walking.

But these are really minor, let’s talk about what I *can* do now at 10 months w/o hesitation. (I was doing a lot at 5-6 months, but it’s been no holds barred since then) -

* Played my first game of basketball as a sub in a couple weeks ago. (This was more of a mental hurdle as this is how I got hurt) scored a couple points and grabbed some rebounds in 20 minutes of play.

*4 to 7 mile trail runs, with up to about 1000′ elevations gain, 2 to 3 x a week. (getting ready for a 10k mud run in 2 weeks.

* Hard contact Karate and Jiu Jitsu Sparring once a week.

* 100 mile, motocross enduro rides across deserts and mountains.

*Sprinkle in 10-15 mile mountain bike rides when I get the chance.

*Cut out red meat and Soda since February and last 12 lbs - oh wait, that’s not related to my ATR!.

No video this time around, when I figure out this GoPro helmet cam, I’ll have some interesting 1 year perspective to show.

I still think and look at my ATR every day. I don’t think I’ll be 100% until I get through one day without thinking about it. I’ll let you know when it happens.

Hi Team,

Glad to see the site back up. Since my last post back in mid December, I’ve managed to slack off my therapeutic specific exercises over the last 1.5 months and I’m paying the price. Holidays and more specifically-WORK- have kept me both physically and emotionally too drained to work on my leg. My single leg calf raises aren’t incrementally that much better than they were 1.5 months ago. I’ll post a video and you can be the judge. I *have* been consistent in my martial art workouts, fast walking at least once or twice a week, but there is still a slightly noticeable difference in calf size. The last negative I’ll mention about this 6 month anniversary is that I still get a lot of stiffness in the AT area when it’s idle (ie. sitting at a desk, getting out of bed) and it takes a few moments to stretch it and get walking again. There is no more heel pain, just stiffness.

However the last two weeks I’ve worked on changing that - hit the gym even when traveling, starting to hike on uneven terrain more often and mountain biking as hard as I did before the injury. I got to go surfing about 3 weeks ago (in cold 55 degree water with no stiffness!). Even more encouraging - This morning I did a 5 mile trail run (about 65% of that was running, the other 35% walking steeper uphill) and to my surprise, there was no calf weakness that would have caused my stride to be uneven like back in November. No favoring of the AT’d leg. This was true even at the end of the run.

My goal is to make the Camp Pendleton Mud Run in April (10k) and maybe play 1 full court game of basketball in the upcoming weeks.

The scarring has flattened out quite a bit, I’m happy about that, no weird rubbing or irritation from any of my shoes. AT is still thick, but I can live with it. There is zero swelling even after vigorous exercise.

Anyways aside from the stiffness, I’m feeling a lot more confident and comfortable and taking a few more risks.

Life is pretty much back to normal activity wise. I can confidently say you should be able to do 100% of the things you did before injury at 6 months post op. How hard you are able do them, well… YMMV. 4 weeks ago if someone asked me how I was, I would have said my calf strength was 60%. Today, I’d say about 70-75%. I really think it’ll be a 1 year gig for me.

Videos of stuff 6 to 6.5 months - you’ll get there!

weird way to post a picture but here goes. this is for Kaston’s reference about AT thickness and the “bump” on the back of the heel.

15 minutes til 9a.m. my meeting reminder goes off and I rush over to the Dr.’s office for my follow up appointment at 9. Sit around for a while, Dr. comes in, asks a few questions about pain, exercises I’m doing etc. I tell him it’s all pretty good, except for some calcaneous pain behind the heel, stiffness after sitting for a while, and thickness. He says it’s all typical and I’m on track. Full recovery at about 1 year for calf strength. I’m optimistic about getting full strength sooner, but know that reality is he’s right and that it’s a really slow process. We shake hands and I’m not to come back unless I have any issue or questions.

It was bittersweet to pay my last $25 co-pay, hey it’s $25 bucks, but it’s my last one. (all my other Dr.visits that weren’t PT were covered under the entire “procedure”).

More on the thickness and pain behind the heel which I asked about. Apparently after surgery, everything heels in a big glob/ball of scar tissue, which of course is what the thickness is all about. The heel pain he says, is caused by the stretching and molding of the AT and sheath at work. The thickness will go down “a little” as things stretch and work themselves out.

The “bump” on the back of the heel won’t go away. (I’ll post a pic or two of my scar and thickness to this post shortly).

I haven’t been able to follow much as of late because work has really been kicking my rear and life has been steadily getting back to normal.

I’ve been going to the gym about 1 or 2 times a week when I can’t do my regular routine of trail running and mountain biking after work (due to rain or getting home really late). Gym time for me means some where between 10pm to midnight, but I try to do all of the rehab exercises. At 4.5 months and with current calf weakness, they are still very relevant. On top of the PT exercises, I’ve added machine single leg presses, squats, some weight. I find the Bosu Ball very important for proprioception. I then throw in about 20 minutes of shoot around time on the basketball court (weights are boring to me not any competitive full or even half court, just shoot around and easy post moves.

My calf measurements have been the same as they were a month ago - 18.5″ on my left non ATR’d and still 18″ on the injured but dominant leg. I think there’s more definition in ATRd calf however.

Activities are getting back to normal - I feel I’m about 50 to 65% on my endurance cardio and am hitting it pretty hard on the trails. Over longer distances of running and towards the end, the calf weakness becomes apparent. I do firmly believe that running inclines is going to be a huge factor in continuing to build up calf strength.

I’ve been able to go almost full contact on my martial arts workouts. In my last sparring and grappling matches I didn’t have to think about favoring my leg at all. I was more cognizant of my crappy conditioning.

If I had to rate my calf strength, I’d say I’m about 50-60% back normal. Swelling on a scale of 1 to 10 is like 1.5. I haven’t iced or raised in about a month.

Difficulties for me at point?
Disappointed at how thick the AT is (like 2.5x thicker than non ATR’d), but such is life and I’ve had to give up my aspirations to become a male shoe sandal model.
It’s winter and the air is dry, but the ATR’d leg tends to be dryer and itchier.
I need to stretch more (like daily), I don’t believe I’ve healed long nor have the potential to heal long at this stage.

Anyways, here’s my 18.5 week video. I ran about 6 miles up some really steeper trail miles yesterday so I’m really stiff and my calves are fatigued. Heel lifts were difficult. Hard to come up with something different showing progression but here goes -

I’m an intermediate level Adventure Racer where the primary disciplines are Kayak, Trail Run, Mountain Biking. A typical day race for me is like 5-10 miles on Kayak, 15-20 trail running/hiking and maybe 25-40 miles on a bike all while orienteering to a dozen to two dozen checkpoints out in sticks with a map and compass within 8 to 12 hours. I must admit I’m not at my racing weight, but I decided to give the trails a “GO” this weekend after my boss at work laid down a challenge for a group hike coming in December.

Anyways I took some video and debated about posting it because of how LAME and GIMPY I look and the stride is freaking AWFUL. But hey, we all gotta start running sometime. The takeaway here is that I’m able to push the calf and Achilles a lot harder now. This was a 3.5 mile run up and back. 600 ft elevation gain in 1.75 miles. The terrain was really uneven and bumpy from the rains so it exaggerates (read: exposes) my calf weakness BIG TIME. You can see me hopping ruts, bumps and off camber trailage. I ran about half of it. The AT did not hurt after wards nor was it any stiffer than usual. I have to look back and really laugh at this video, but mostly at my own girth and how badly I suck. Anyways, it’s motivation and I predict that over the next 2 or 3 weeks, the stride will even out a lot more. Anyways, it’s good for a laugh.

I only had a little bit to update here the last 2 weeks as not really much changed during week 12. I started feeling the frustrating plateau. (the clip is below if you want to skip my rant

I met with the OS last Thursday and all is well. He looked at my foot and basically said to come back in 6-8 weeks. He confirmed that I didn’t need to see the PT any longer and I finished up my last PT appointment the Friday after. Of concern to me was the “thickness” of my AT. He said that I’d always have thickness, however it would go down and also smooth out with time, but would never be normal like before (any other 1 or 2 year post-opers care to comment on your thickness? has it gone down? any problem with shoes rubbing?). Also asked about the sutures that were used to sew up the tendon and they were off the semi-permanent type which would take years to dissolve as opposed to several weeks I will continue to lotion, work and mold the AT area in order to get it to thin and smooth out a bit more.

So the last two weeks (weeks 11 and 12 post-op) I hadn’t seen huge leaps in progress. It’s not like I’m all of a sudden now doing 10 full single heel raises effortlessly. Admittedly, I’d been taking it way too easy from therapy isolated exercises that are meant to build strength. I believe the tendency to slack off was due to the fact that I’m walking 90% normally and have spent more time doing my regular exercise routines (mtn. biking, Motocross and Martial arts) without too much need of a strong calf on the ATR’d leg. I realize I need to change this and plan on doing some more exercises that I will show on my week 13 vid.

My PT trainer pointed out the fact that there is exercising and that there are therapeutic exercises meant to get the leg back to normal. Just going about day to day activities isn’t enough - even over time, as other parts of the body tend to compensate for the weak calf leaving the calf weak.

Here is where I stand now at 12.5 weeks:
Good:
Able to do about 12-15 single heel raises at the bottom range (2-3″ off the ground)..
I’m wearing dress shoes now.
I haven’t iced or raised in about 1.5 weeks (don’t know if this is good or bad).
Confidence in day to day activities. I don’t really think about missteps on even ground.
Calf/AT tightness on a scale of 1 to 10 is about 1.5, It just feels more weak as opposed to tight.
Heel pain is gone as I start to shift weight to the ball of the foot naturally when standing.

Bad:
I still get a little stiffness (in the calcaneous area / back of the heal) in the morning or when the leg has been immobile too long.
Upper range single heel lifts are non existent. (4-6″ off the ground)
Still a little swelling, but not too bad.

Ugly:
AT thickness.
Getting calf strength back is going to be a concentrated effort, it won’t come back naturally.

-edit-
I wrote the above about 5 days ago, but as of this clip (week 13), some things have been incrementally improving and I’m a bit happier about my progress. I went to the gym last night (for the first time since the injury) and started blasting away at my exercises including leg presses and weights. Surprisingly it’s wasn’t stiff the day after the gym. Going to try to stay religious at it, because there’s no PT there to push me.

Here’s the week 13 clip.

One more week of PT to go, 2 more sessions and I get the boot from the PTs or is it called graduation?!. My ROM is there and they’ve given me all the exercises they can, now it’s just a matter of building strength. They’re done with me! I meet with the Doc next week (12 weeks post op) and we’ll see where I go from there. Supposedly the tendon should be 100% healed by then and I can probably start really stressing it. My journey with the docs and PTs is almost done and I’ll be on my own.

My 10 week video. Still in physical therapy and adding exercises every session. I had to travel this week and didn’t get much chance to do these exercises on my own. However, I did a lot of hurried walking at the airports trying to keep my gait straight and concentrating on heel-toeing.

I did Karate last night for 1.5 hours (first time in 3 months since the injury), which consisted of lots of stretching, falls, warm up bouncing, Kata (forms), all on a mat. I also did some careful kicking (front, roundhouse) on a kicking pad, but had to take it real easy as pivoting to kick on my ATR’d foot was mentally and physically near impossible. Walking/bouncing barefoot on a mat was definitely more challenging than I thought as the mat kinda counter-sinks creating a bit more stress on the calf. It was definitely a hard work out, probably harder than I should have done, but I was never in any pain or strain. My Doc and PT would have a serious fit had they seen what I was doing out there.

Here’s the vid. It was done the day after my workout and PT session so I was a bit sore and stiff doing this video, some movements are a bit jerky. I had to also hurriedly put it together. 10 weeks post-op, two maybe three things in there I shouldn’t be doing but attempted and did - I think you’ll find it interesting.

Again, it’s my right that’s ATR’d.