frustratedcoach’s AchillesBlog

I didn’t really do PT. My doc simply told me “you know what to do”, no need to pay for it. I did go in to get joint manipulation done to start working the metatarsal stiffness out, which helped a ton even never being in a cast.

That said, at about 11 months out I measured my calves and there was AN INCH difference between the two. Over the last month I’ve got that down to less than half an inch, but still.

One great exercise the doc told me was standing on the stairs, heel raise up on both legs, come down just on the weak leg.

Granted I’d had other ankle problems before so I did know what to do. Whether he was just saying it or actually believed it he said I was the fastest healing Achilles he had ever seen.

I think PT offers a few different things:
1) Guidance on exercises to do. They had me work a few different things (balance stuff) that I would likely have neglected on my own. But, a little research could probably yield a pretty good set of guidelines on standard rehab exercises for an ATR.
2) Equipment. My PT facility had a few specialized pieces of equipment that weren’t available at my regular gym. But, I think I could have managed using the gym equipment, and maybe spending $50 on some home gear (wobble boards and such).
3) Motivation. For some, a good therapist is helpful in pushing through painful exercises, and staying motivated to do the various exercises. In my case, their job was probably to keep me from pushing too hard, too early. Motivation was not an issue for me. YMMV.
4) Therapies. Ultrasound, heat, scar manipulation, etc. Some of this I could do on my own- but things like ultrasound could only be done at the PT facility. It’s hard to quantify how much they helped. I think some of the most effective therapies (massage) can be done at home.
5) Consult. Surgeons are very busy.

Do the physio!!! I swear on my life that if I had not started physio at the end of 2 weeks as per my doctor I wouldn’t be as far as I am.

Physio has become my ‘happy place’ the last 14 weeks. I always see results each and every time I have gone for a session.

If you can afford the sessions you won’t regret them, especially if you have a great physiotherapist!

Frustratedcoach,
I had 28 PT sessions and thought they were indispensable. There is a lot to learn in terms of rebuilding your strength and balance after being in a cast and a boot for several weeks. My PT also guided me in terms of how hard to push things. I would highly recommend you going for PT.

Yup, on my one month post op visit I got my boot and a PT referral.

Coach, I think I’d distinguish between pain below the heel (and sole), which is almost universal, and pain in the calf, which may be something different. For the former, I padded around in squishy Crocs around the house, and put similarly soft gel insoles in my shoes for going outside.

The medical world seems split about 50-50 on the subject of heel wedges inside “2 shoes” or not. I followed UWO, which doesn’t use them, but many Docs go the other way. I’ve never seen any evidence to help resolve it, and I’m guessing it doesn’t matter much.

While in the boot I had 4 one inch wedges and took one out each week for 4 weeks. That gradually stretched things out until I was ready for shoes. Even with that preparation my foot & heel was painful. I found the right shoes made all the difference. I bought a pair of Asics Gel Kayanos and some very supportive inserts. They were a little pricey but I believe they really contributed to my recovery.
Scott (aka: Skutr)

I went from a boot to regular shoes (no wedge). Oh, my foot hurt so much.
The bottom of my bad foot was tender, the bones on the top of my foot ached, and my tendon and scar were tight and swollen.
There were days when I was almost in tears when leaving work.
It does get better with time and a good pair of tennis shoes.
Joan

I went from the walking boot to my regular trainers and barefoot around the house after 6 weeks. I never had any issue with pain other than having my foot become accustomed to not having a heel wedge for about the first day or so. If you’re having heel pain running your foot over a ball seems to help from what I’ve heard. I’ve actually used a softball to run my foot over to help reawaken my foot. Hope this helps!

I went from the walking boot to shoes with a heel wedge as well at 8 weeks. I still have the wedge in at 13.5 weeks and will be tapering off in the coming weeks. I also had a lot of pain, especially when trying to push off on my toes. I still have quite a bit after PT but getting better day by day..

I went from a cast to flat shoes, not sure if that is the same? I went into very supportive trainers with two rubber heel wedges in each. The bottom of my heel and foot hurt quite a lot for a week or two till my foot got used to walking again, but I don’t recall much calf pain. Are you actually in fashion heels?!

Hopalong

Have you been in the same cast for 5 weeks? No change of angle, etc? What is your rehab timeline going forward from here?

Not expert on casts in excess of 2 weeks duration so cannot comment on irritability.

I am 5 weeks post op and feel almost bedridden. Leg still feels really tight within cast and after 10 mins or so upright or in my chair feels like it will explode. Injury site hardly painful now but need to take ibruprofen for rest of leg. Are all casts this irritating? Other leg recovering from dancing injury so don’t feel too happy on crutches. Can’t imagine ever walking never mind biking. Hard to keep spirits up.

Hi rogerg, I have experienced little to no pain at all. I mentioned this to my physio around the four week mark as I had similar concerns and he said because it was a complete rupture that is to be expected since the two ends were pulled apart. No need to worry, I seem to be healing just fine and never required a pain killer what so ever.

Hi, call me paranoid or what ! 6 weeks nwb (3 in pot, 3 in VACOped), 3 weeks fwb in boot/wedge sole and I’ve had no pain since the injury; due to see my ortho on Monday; worried that it has not healed ? One of Norms early postings suggested that pain is a reflection of the healing process. Yes, I had non op protocol and have stuck to my specialist orthopods dictat completely, as well as sticking to a diet with nuts, lots of fruit & vegetables etc etc: can anyone out there give me any reassurances ?
rogerg

At 10 weeks post injury- is pain still normal at rupture site? It hurts on the left side of my rupture in a gap of scar tissue.

I had my ATR on 7/12 so I am far from recovered but I dislocated my ankle 2 years ago that kept me NWB for 9 weeks. My left calf never got back to the size of the right although it was within a half inch (I have soccer player calves). I think with diligent strength training, they would be close to equal but it might take a year.

I feel that the biking is helping my muscle immensely! I also swam yesterday and it felt great. It has even helped relieve some of the tightness. I am thinking I might want to start walking in 2 shoes without the boot because I’m staying in the boot due to tightness but it also seems that the boot may be preventing me from getting away from the tightness. I think if I walk in shoes the range of motion would improve? And I’m sure it would help muscle tone,,,

@normofthenorth- thanks for your consistent feedback and reassurance. If you read my blog- you know that I was in panic mode the first time you responded to me. The non-operative approach was scary but so far I am glad to have avoided the knife. I think it would be so helpful for each blogger on this site be identified as operative or non-operative. It definitely helped me knowing that I was not alone.

I can relate to the leg thing. I got my cast changed today and was shocked by my “chicken leg”! I’m 4 1/2 weeks post-op and 7 weeks post-injury, but I’m surprised how much muscle mass has been lost in such a short time. Hard to imagine that it will ever look like the other again.

The leg shape question is tricky, and pretty variable among ATR patients. If you had perfect and perfectly symmetrical calves, you may have a challenge to resume your career as a leg model — unless of course you end up rupturing the OTHER one, like me and a small bunch of others!

Using the boot as a shield after you don’t need it as a cast can make perfect sense. You know the pros and cons, use your judgment. The safer you feel, with healing, strengthening, and safer environments, the less you need it or want it, obviously. Especially if it isn’t a hinged boot set to hinge, using it will slow your progress, but also keep you from going back to square one.

I am just behind you, time wise, take a look at my blog to see what I have been up to!!!! Keep it going and it will get better!!!! I push it until it starts to hurt then stop and elevate. It works for me!