ericbabula’s AchillesBlog

Thanks for the support, everyone! Yeah, I don’t have PT, yet. I’m supposed to have my first session (probably just testing my ROM, strength, etc.,) on Thursday. But, I’m waiting to find out my out-of-pocket costs, before actually going.

It IS an uneven world out there!!! Concrete sidewalks and parking lots are easier, cuz you can see the unevenness. Grass is way more treacherous! Be careful out there!

Don’t stress over the 2 weeks thing. So what if it takes 3 weeks, or whatever! What’s an extra week, when you’re talking 6-12 months of recovery?! Nothing. In the end, it’s a week that you’ll never remember, once you’re done with this whole thing.

Happy Healing, everyone!

Congrats on a next milestone Eric. It is exciting and scary at the same time.

One thing my PT did for me at this stage was record my gate while I was walking in 2 shoes and review it with me in slow motion in order to eliminate the limp. It helped a lot. I did it few times at home as well to figure out what was not looking correctly. For instance I was not fully straightening my injured leg while walking. Comparing its movement to the uninjured leg helps visually.

And Shell, take your time, it is uneven world out there. The concrete walkways and parking lots are definitely not as straight as they seem when one has a weak leg and is scared of re-rupture.

Good luck to you guys with walking again!

Definitely don’t stress over the “2 weeks” Shell! My doc had me take 2 weeks FWB in a boot and then 3 weeks to transition to shoes. It will take as long as it takes and you know best what is right for you.

I’m still nervous with shoes on too. I wore them yesterday morning and then had to go out to run 2 quick errands, so I put the boot on. My husband commented that I was putting my boot on to go out and I said, yup, it’s an uneven world out there!! And it was only a few days ago I dared venture out without the security of a crutch. I won’t even attempt to walk across our lawn, which to the untrained eye looks like a nice flat lawn, but to me it’s some sort of wild mogul course!!
I’m trying to wear 2 shoes more and more, but if my ankle starts to ache I put the boot back on. I’m trying not to worry about how long it takes to feel like I stay out of it for good. My surgeon said 2 weeks, and it hasn’t even been one yet. If it’s a little longer than 2 weeks I don’t think the boot police are going to come after me!!

Thanks, shell and cserpent! I’m trying to get to two shoes, but am still nervous in less than ideal condition (e.g. my lumpy yard, or the HS graduation party I went to this weekend - too many people!).

Getting there, day by day. That’s all we all can do, right?!!! Take it day by day, and keep pushing forward!!!

Yes those exercises do help keep things progressing towards strength and flexibility Good luck with your progression in 2 shoes!

I just started my “you now have 2 weeks to get outta that boot” yesterday. Yup, it feels weird to be in shoes. Not sure I’ll actually be out of the boot in 2 weeks like my surgeon suggested, but my PT said, do what you can, try to be out of it a little more each day until you can go the whole day, however long that takes.

It does get really tired and sore really fast out of the boot right now. Good luck to you with bootless life!

Wishing you well for your first PT appointment next week. Good to hear you got a good report from the doc. Keep pushing forward.

Has anyone had problems with your incision and to doc not getting all of the stitches out? I have 2 small pieces of stitch sticking out of my skin and tender to touch. I am 6 weeks post op.

Thanks, agnes. Yeah, I’m ok with the non-op, so far! Actually, it’s moving along faster than I expected, so I’m happy.

No, I’m not using Evenup - I thought about it, but am hoping to only have a couple/few weeks left in the boot, so I’ll just suck it up.

I’m planning on starting with the stationary bike at home, before hopping on a real bike. You’re right - I don’t want to start all over again!!!

Looks like you are doing well and hope you are warming up to the non-op route. Same thing happened to me with walking in the boot. I was told to do PWB of about 50lbs for couple of weeks, but after 4-5 days of PWB I realized I was just carrying my crutches and walking FWB. I emailed my doc and he OK-ed earlier FWB as well.

Btw, are you using Evenup to have even gate while you are walking? It’s not the best for hips to have uneven limp for prolonged time.

Also, stationary bike might be a good idea at first. I started with it week 5, but while wearing a boot. When I started with no boot, I was just plantar flexing foot while riding with low resistance, but going at pretty fast speeds to get the heart rate pumping. Riding an outdoor bike at this stage might increase your risk of stepping on that foot when stopping. Just be careful, not worth re-rupturing and starting the whole process all over again!

molly - I never heard of release before. Just looked it up, here:
http://www.reboundmd.com/latest-news/what-is-tendon-release-used-to-treat/
Here’s to hoping that your ROM improves with exercises, rather than having to get this surgery.

Has anyone heard of or required an achilles tendon release following an achilles repair? I am 7 months post-op for full rupture. At a recent follow up, the surgeon mentioned if my range of motion did not improve in 2-3 months, they may need to release it…..

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Sounds great Eric! I started driving while I was using the boot to walk. Just put a tennis shoe in the car that’s what I did. Got in the car, switched to the tennis shoe, got to where I was going and put on the boot when getting out of the car.

My doc did NOT want me on a real bike until week 14. He said the chance of dorsiflexion too much is too great. So I’m just using the recumbent and stationary bikes at the gym. Not saying you shouldn’t use a bike since we have different injuries essentially - but just be careful! Starting on the stationary bike is good - it does take your foot a while to get used to the movement and the force. I can increase the resistance on the stationary bike without going “up a hill” which causes your foot to flex a lot more on a real bike. And on a recumbent bike I can increase the resistance even more since your foot angles are even less.

My doc doesn’t even want me walking up steep hills yet though I’m doing dorsiflexion exercises with the theraband.

I was doing the same ROM as you in weeks 3-6 - 30 reps, 3x/day (though I was also able to do dorsiflexion since my achilles was anch

Woohoo!! That’s great news! I’m so happy for you Eric! Continue to be a good boy, and don’t overdo it now! Good luck and have fun with all the new stuff you get to do now.

(As an aside….the anti-spam word for me at the bottom of your post was “optimism” - how very appropriate! Your optimism is always evident, and rubs off!).

Thanks, shell37! So far, things are looking ok. Of course, I know this is a long process, and I’m only 2 weeks in and I have to temper my excitement. But, I’m all for celebrating the little milestones and successes along the way! I think it helps me heal!

Every time I’m able to do a new thing, or get good news, I try to celebrate it and do a happy dance (even if only mentally, since I can’t actually step down on my bad foot, yet)!!! So, instead of dancing, maybe I go out to dinner with my wife! Or, just drink a glass of wine, or a beer, or something! Little celebrations!

I just have to keep reminding myself that this is a temporary injury. I will heal. I will rehab. I will get back to normal - it’s just a few months of inconvenience in the grand scheme of things.

Always try to stay positive! Happy Healing!

Sounds like you’re going in the right direction! That’s great news!

Yep, icing behind the knee helps (it’s a tip given to ppl in cast usually), but what also helped me was keeping my foot in the boot, place it on a pillow, so it’s secure, undo couple of straps and place ice bag inside of the boot on the top of the ankle.

As far as cleaning the foot/boot, I was told to always wear the boot in the shower with the cover on and after shower I was allowed to spot clean my foot. That way you are taking the foot out of the boot for few minutes in a controlled environment and can make sure the foot does not change the plantar flexion position. I was using adult wipes for the foot each morning, changing the sock and then applying a spray to the boot: Odor Eaters. That did the trick and the boot never got smelly and it was summer. Always wear sock in the boot. You can see all these on my ATR Equipment tab.

Eric - simple answer is you put up with it for 3 weeks. If you were in a cast it would be the same. The icing tip above is a good one. It is most important for non-ops to restrict movement in this phase. Sutures will give you some protection but without them, even a small movement can undo the healing which has already started and may increase the chance of healing long.

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The advantages of being in engineering - shorts are OK for a bit in case of injury.

Hi cserpent,

Thanks for the icing tip - I’ll try that today to see if that works!

I understand about the cast. When I had a cast 5 years ago, my pants (most of them) did fit over the cast. But, definitely not the boot.

As for the shorts - that doesn’t fly for me. I work at a professional office: dress pants and dress shirt required. Need to change every day.

Happy Healing!

And - regarding icing - put the ice behind your knee. It works well since the blood supply is running through the leg there. That is what they were doing to me when I came out of the surgery and what I did, often, until I was in the boot.

My foot was in a splint/cast for 3 weeks so it didn’t get washed that entire time It wasn’t doing much either since I put no weight on it so the only thing I had to deal with when I finally did get the boot and could wash it was major amounts of dead skin to scrub off - ick! LOL! I just wore shorts the whole time since my pants won’t fit over the cast. They don’t fit over the boot either so I’m still wearing shorts.

Or, take your pants off???

Hi Stuart,

How do you ice your ankle, or change your socks and wash your stinky foot (well, maybe yours don’t, but MINE get stinky! LOL!), if you don’t take it out of the boot for any reason?

Thanks for the info. I’ll try to read your page tonight!

Happy Healing!

Regarding tendon healing. If you go to my page (Xplora) and look under the tab ‘further reading’ I have a link to how tendons heal. It is a bit scientific but there is still some good info for lay people. Understanding the phases of healing will help you. The first phase is 3 weeks where a weak and disorganised form of collagen is laid down but that is what will join the tendon ends. The process is exactly the same with or without surgery. Sutures are used to position the tendon ends and hold them in place while your body does the rest. Without sutures the cast or boot will do the same. After 3 weeks, gentle Active ROM exercises can be started. This involves writing the alphabet with your foot while your leg is supported. Weight bearing can start whenever you are ready but should start before 6 weeks. I would not take the foot out of the boot until 3 weeks for any reason.

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Hi morcs,

I kinda understand how the tendon heals, now. I was mostly worried about being in a boot right from the beginning. I do take the boot off to ice the foot and to wash it and put new socks on, but try really hard not to move it. Although, I’m sure it moves slightly (maybe even more in plantar flexion than the boot/heel lifts). So, is that going to hinder the healing process? I don’t know. I’ll have to ask the doc when I see him on 04/21.

So, how long did it take you to:
* Partial weight-bearing
* Full weight-bearing
* Two shoes
* Driving (if right foot)
* Rehab
* Walking

Hi Eric, Re the “how can it heal” thing - it’s surprisingly hard to find info and it drove me crazy whilst I was in the cast wondering how it could possibly be joining back together.

There were two things I found out that gave me the lightbulb moment:

1. The tendon is housed in a sheath, so it’s not just two ends flopping about all over the place inside your leg that you’re relying on to miraculously sticking back together!

2. When it ruptures, it’s not a clean tear as if the tendon was sliced in half with a knife. It’s more like broken strands of spaghetti on either side - if you imagine bringing your hands together with the fingers interlocking - your fingers being the strands of tendon.

Boot vs Cast - as I understand it - the key thing is that your foot is being kept in plantar-flexion (toes pointing down) so that the strands of spaghetti are being kept close to each other where they can mesh and re-join. I think they usually still use the cast to prevent the temptation to take the boot off and move the ankle or weight-bear too soon.

I’m 4 months into non-op now after a complete rupture and I’m very happy with how

Eric, check out this paper on the tendon reattaching itself naturally: http://www.danmedj.dk/portal/pls/portal/!portal.wwpob_page.show?_docname=10547073.pdf

The initial stage when tendon reattaches itself takes about 2 weeks. It is a weak link initially as collagen type 3 mainly is created in that stage.

The range of motion exercises that are given after this stage are all in plantar flexion, with your toes pointing down and you always keep your foot in various degrees below neutral - depending which week you are in. This ensures that you are not stretching your tendon.

As far as deadlines for returning to activities, I would not really look at them as such strict ones. Your PT will be clearing you gradually for them as you progress. You will see some will come sooner and some later depending on your calf muscle regain and ankle strength.Here there is no template as everyone is so different. But I guess you know that from your first time around. Hope there is more of these “sooner” deadlines for you this time around!

Thanks, shell37! I’ll read it, for sure!

Happy Healing!

My surgeon is the one who came up with the protocol - nice to know I’m being treated by someone who knows what he’s doing!

Hey ericbabula, it’s actually the UWO protocol. I tried linking it for you, but the moderators didn’t allow my post. If you google Fowler Kennedy Sport Medicine Clinic in London, Ontario, then look up Patient Resourses, then Physiotherapy, you’ll see the Achilles protocol there. It’s a great Clinic, I feel very lucky that I’m being treated there.

Hi agnesatr. Thanks for your reply. I’ll have to look up the Canadian UWA protocol.

My doc said the cast isn’t necessary, and I can start weight bearing as soon as I’m comfortable doing so, as long as there is no pain. I see him at 2 weeks to see how it’s coming along. Exercises at home at 4 weeks. Driving at 4-6 weeks. Rehab at 6 weeks. Hiking at 4 months. Vball again at 4-6 months. Seems faster to get back to vball than my op recovery was, which is great!

I don’t know the science behind it. I would figure that I’m not going to heal if I’m weight-bearing right away. How do the ends meet and mend, if my ankle is moving around and getting pressure?

We’ll see, I guess!

Oh man, second time around! Sorry to hear that…. At least you know something about this injury this time around. I am non op, 10 months in 3 days since rupture and am pretty much recovered as far as the achilles goes. Still working on regaining some strength in the calf, but can do everything with that leg. You can check out the details of my nonop recovery on my blog (agesatr) and vlog (links to videos on the blog).

As far as protocols for nonop there is Canadaian UWA protocol, which is early weight bearing protocol and people have good success with it. I was on a Twaddle protocol, which is very similar, but starts weight bearing bit later. I was, however, putting pressure on my leg earlier than my protocol calls for. My protocol also called for early mobilization, which means I was doing range of motion exercises (all in plantar flexion) from 2 weeks onwards. I was to do it for 5 minutes once an hr or so. I can tell now, looking back, that it helped with my quick return to walking as my ankle was in alright shape.

Seems your doc might be going with the former protocol, which is good. The achilles heals better with applied

Thanks for the pdf, shell37! Maybe this is the protocol my doc is using. We’ll see.

http://achillesblog.com/files/2008/03/jbjsi01401v1.pdf

My surgeon led a very comprehensive study on surgical vs nonsurgical ATR recovery and found the re-rupture rate was virtually the same. The healing time is a little slower, but the outcomes very similar, and much fewer complications in the non- surgical group. Here’s the protocol my surgeon uses: http://fowlerkennedy.com/wp-content/uploads/2015/11/ACHILLES-TENDON-RUPTURE-ACCELERATED-REHAB-PROTOCOL.pdf
I’ll find you a link to his study as well.

Man, that’s too bad. Good luck on the early road to recovery, whichever route you take. I admire your positivity - I try to keep on the positive side, too, but this injury sure makes it tough sometimes. Looking forward to your updates!

Thanks, shell37! Just got a call from the Hospital. Surgery might be cancelled. They’re concerned about my heart, since I had my heart attack less than 6 months ago. I’m supposed to go there anyway, and have a talk with all the docs.

Good luck tomorrow! Waiting for surgery is torture, so having it done so quickly is great. Wishing you the best.

Jimminyc - we’ve decided to do a self-mapped Century, rather than a big group ride. Cheaper. Can go where you want. Can go when you want (if it rains - just push the date). Can stop when you want (e.g. if that park looks good, stop for 15 minutes, if that bar looks good, stop and have a beer!).

I’m a little nervous, cuz it’ll only be me and two other guys, and they’re both accomplished bike racers (both road and mountain)! They said they’d gladly go my pace, and make it fun. But, me being a competitive guy, I don’t want to make them feel like they’re having to slow down all the time, so I will be training hard (time permitting - family duties, you know!) to get my ave. speeds up higher, and my endurance higher.

Eric, Century ride sounds like a great idea, set yourself a pace and stick to it and I reckon you will ace it!!! Our timeline is similar and like you I am commuting at 16 to 17mph and I reckon it’s game on, just don’t get drawn into a pace that is too high (that is my normal mistake on long charity rises etc., I get competitive!!). Good luck!

I have no doubt you will do this. It sounds like there’s no quit in you!

Oh, Jenifer - I’m gonna do it! It’s on!!!

You can do this…..your leg is no fixed and the only thing holding you back is your mind. YOU CAN DO THIS……YOU CAN!!! Don’t psych yourself out. Come on…..go ride the Century Bike Ride One revolution at a time!!!!