9 month update - discharged from PT!


I went on a holiday at the beginning over November and went hiking (semi-scrambling) up some hills and it was OK. I last saw my PT mid- November and he was happy with how I was able to handle dynamic movements on the floor and bosu ball. So he said I didn’t need to see him anymore, but can continue to build up the complexity and duration of my exercises on my own. He said I’m able to play 3-on-3 basketball socially, etc and just see how it goes. So I saw the PT a total of 21 times, starting off twice a week, and towards the end it was more like once a month (been busy with work and travel) - I finished PT at the 8.5 month mark. I think if I hadn’t had that set-back in July, and if I had put more work into rehab I could’ve been at the same stage maybe 1.5-2 months earlier. The PT said that stressing the achilles (like stressing your muscles to gain muscle) helps the achilles repair and recover, of course you don’t want to over stress it. In the grand scheme of things, life is a long journey and I’m not bothered by a couple of months delay in returning to sport. I still think back to when I ruptured my achilles, and when I was in the cast and on crutches, and when I was trying to walk normally - I’m still very grateful about the little things like being able to walk around unassisted, carrying a cup of tea on my own, and getting up on my tippytoes to get something from the top shelf!

Just a final thought on recovery - although it’s very useful to compare our rehabilitation against peers for a benchmark, recovery varies so much case by case. It varies by the severity of ATR, op protocol, PT protocol, how much time and effort we are able to put into PT rehab, what our goals are, etc. It’s clear that the timetable for recovery for all of us bloggers will likely vary. But let’s look at an example of professionals. Brandon Jennings, and NBA player, ruptured his achilles in January 2015 and is yet to return to competition (expected to in late December 2015). While Wes Matthews, also an NBA player, ruptured his at the start of March 2015 and returned a few days after the 7.5 month mark, in late October 2015. These guys will have similar resources, schedules, and goals yet I was surprised to see such a difference.

Finally, I’m probably not going to visit this page as often now. I’d just like to thank all of you who have been on this journey together - thanks for the comments and answers to my questions, and thanks for sharing your journeys also. Happy healing!

Question for skiers - when can I get back on the slopes???

Hello skiers out there,

I’m thinking ahead to December, as I would love to go skiing somewhere this winter. But the question is, would my achilles be up to it?

By that stage I would be at the 9.5-10 month mark post-op. If you’ve gone back to skiing after an achilles rupture, I’d be very keen to hear of when you first made the return to the slopes, and how your achilles handled it.


7 month update - back on track after a setback


Man, it’s been a while since my last update. Work has been so busy, I haven’t had time to visit this site much. Also means I haven’t had time to rehab as much as I would’ve liked.

I hit a speed bump at the 4.5-month mark post-op. I took an antibiotic called Ofloxal for something unrelated to my achilles. After a while I noticed that my achilles, particularly my good leg, was getting incredibly tender and sore. Other joints such as my elbows and shoulders were getting sore too. So I googled it and it turns out that a rare side effect is joint pain, and there’s an increased chance of achilles rupture too! Woah!!! I stopped taking those antibiotics, laid low with my exercise, and those symptoms went away. So I’d say I’m about a month behind schedule in my rehab now.

At the 5.5 month mark, my PT was happy for me to start jogging. It started off really basic, perhaps just a total of 200m, very slowly. At the 6 month mark, I jogged 800m at 6kmph, and I’ve built that up to 2km at 8kmph. I feel like I can go further and faster, but I’m just building up slowly, especially because I haven’t been able to find the time to go to the gym regularly.

PT had also got me started on double leg forward jumps, and alternating leg jumps, and single leg hops. Also jumping up and down on a small step.

In today’s PT session, I’ve now built up to doing box jumps. I can do double-legged  jumps onto a box that’s a little over 1ft high, and also single-legged jump landing on opposite leg. For the single-legged hop, I can do maybe 2/3 of the height. I feel I could do more, but I’m happy taking it slowly.

Today I also started doing ladder work and was quite surprised at the agility and speed I was able to get. Achilles was feeling it, but not too bothered, so I was happy as Larry.

Week 17 update

Hi all,

Rehab seems to be progressing OK. When I last posted at the Week 14 mark, I was hitting the gym around 5-6 days a week, working the legs 1-2 hours at a time. But every time I finished up at the gym I felt that my achilles was really fatigued - it would hurt and I would limp more. The PT had said that the exercises he told me to do were static so I should even be able to do them a couple times a day. I don’t have time to do them multiple times a day but it suggested that doing them everyday shouldn’t be a problem. I asked him if pain normally came with fatigue, and he said it is not unusual. But I got worried that I have been overworking it so decided to go work on my achilles and legs only on alternating days. I’m glad I backed off the intensity because the pain subsided and I was able to do my exercises more effectively. The lesson learned is that I needed to listen to my own body - my PT and OS doesn’t know how I feel. There have been other instances where my PT has told me to try something and I just said my achilles isn’t just up to it so we had to take smaller steps.

Over the past 3 weeks, the exercises the PT has had me do has progressed to incorporate some single-leg balancing work that involves balancing on the front of my foot only (heel hanging off the edge of a step) and some basic dynamic stuff such as lunges onto a bosu ball with round side up and striking with the ball of my foot. My double-leg heel raises have been good so I’ve progressed to try some single-leg raises (2 legs up and 1 leg down, and also the reverse). I’ve been doing these while holding onto a fixed bar with my hands to take  some weight off my achilles, but am almost at the point when I can do them without holding onto anything. I’m now also starting to do some leg presses with heels up (balls of feet only), and some lightly loaded knee drives on the TRX, which is the first type of explosive movement I’ve done since ATR.

My injured foot is still a bit swollen around the ankle but it seems to be coming down slowly. In terms of movement, from the week 15 mark I was able to descend big steps with no trouble, and my walking pace and gait is pretty normal. Although last week I had a limp, which I think was due to my achilles being worked when I went boating - my achilles would’ve been activated more due to the rocking of the boat and I had to step between boats too, which was a bit of a challenge.

As for my ROM, my active dorsiflexion is as good as that of my good foot but my passive dorsiflexion is still not as good (e.g. when I squat down with flat feet the knee on the injured leg cannot go down as far). In the last 7 weeks or so I haven’t been as aggressive as I had been during the preceding 4 weeks. I know there’s been a lot of caution about elongation of the tendon or "healing long", but I’m wondering if there risk of healing short and losing flexibility? And when can I expect to get my flexibility back? Is everyone else still incorporating stretching in their routines?

Happy healing everyone!

Week 14 post-op, the beginning of the comeback

Here’s a quick recap of my timeline:
- Complete ATR on right leg on 1 Mar 2015
- Operation 3 Mar 2015 and into cast (foot angled about 50 deg away from neutral)
- 3 wks post-op: Changed to 2nd cast (foot about 35 deg from neutral)
- 6 wks: Came out of cast and into 2 shoes with no wedges, started PT
- 7 wks, 5 days: Ditched crutches indoors
- 8 wks, 1 day: Got foot angle to neutral
- 9 wks, 4 days: Ditched crutches outdoors
- Week 10: Started at the gym

I’m now in my 14th week and in a way feel that my comeback has just started in the last few weeks now that I’ve headed back to the gym. I’ve been progressing to more and more challenging exercises and have been building up the weights for the leg extensions and the resistance and RPMs on the bike. I’ve noticed some better definition in my legs and the swelling has been coming down too. I’ve been heading to the gym most days of the week and work out for 1-2 hrs each time.

From week 12, I was able to get my injured foot to almost the same amount of active dorsiflexion as my good foot, but when trying to do so passively (eg. doing a standing calf-stretch), the ROM is definitely not as good. At week 14, this is still the case. It’s fair to say that I’ve not been as aggressive or frequent in my stretching in the last 3 weeks though.

In terms of movement, I would say that my limp is not noticeable unless it’s fatigued after the gym. I used to wear comfortable sneakers to commute to work and back, but can manage my leather dress shoes now. Descending big steps in a slow controlled manner is still a challenge, but PT said this is not unusual at this point as that movement puts a lot of tension on the Achilles and knees.

In my 12th week I also went on my first holiday since the ATR, flying to a nearby beach destination in SE Asia. Felt so good to get away! Bought a compression sock for the flights and it did a good job at controlling the swelling. Did quite a bit of swimming and snorkeling and the Achilles was fine. Climbing in and out of the boat was a slight challenge, but manageable. Scrambling up the side of a small hill was very challenging, and I had to be extra careful. No problem walking on sand, although soft sand would give the heel a good workout.

Below is some added detail into my PT regime and OS visits.

Week 12
My last post left off with me being extremely disappointed with my last PT and looking forward to starting with a new one. It was the best decision! Changing PTs has changed the game. My new PT is very knowledgeable, answering all my questions with a good amount of detail, and he was able to pick up minute details on my bio-mechanics.

Exercises he got me doing:
- Continuing with leg extensions, leg curls, and biking (leg presses too if I want to, but I haven’t been)
- Calf raises (with knee straight as well as bent)
- Double leg squats (keeping glutes and thighs engaged)
- Single leg balancing with raised-leg supported against wall (keeping glutes and thighs engaged)
- Single leg reaching to mid-shin with raised leg pointing backwards

Saw my OS this week too and he was happy with my progress told me I don’t have to come back to see him. I asked him about massage around the Achilles as I’ve noticed (as did my PT) that the top-most layer of my skin doesn’t move around "freely". It feels stuck to the bottom layers if you know what I mean. My OS said this fusion to the subcutaneous layer is normal with the scarring of surgery and I should just rub it gently with an open palm (doing so has made a difference).

Week 13
This week my PT progressed me to the following exercises:
- Double leg squats on a bosu ball with flat side up.
- Bosu ball double leg in a sustained half-squat position, whilst holding weights with my hands and moving them about in various patterns.
- Single leg step up onto a bench, punching weight to the sky as I bring my other knee up
- Split legged exercises (like lunge position), with both heels raised. On the floor, or alternatively with front foot on a bosu ball (flat side down), moving hand-held weights in various patterns.

I told my PT that up until this point, my calf raises weren’t quite with a 50/50 weight distribution between my legs and that I could get up on my toes on my bad foot, and that my knee seems to come forward as I do this exercise. He gave me a few exercises to stretch out my toes.

Week 14
The toe stretching exercises have seemed to make a difference. I’ve been able to get up higher when doing calf-raises and keep my weight pretty much evenly distributed. I also noticed that with my quads getting stronger, I am now able to keep my thighs engaged when doing calf raises so that my knee doesn’t come forward.

This week’s new exercises:
- Single leg on bosu ball (flat side up) holding weight. Bring other knee up and raise weight to the sky, then bend forward reaching to mid-shin pointing other leg backwards.
- Added variations to the split legged exercises by using cable weight machines, throwing medicine balls at the wall (front and sideways like a rugby pass) and bouncing them on the ground on both sides of me.
- Lunge forward onto bosu ball (flat side down) and raise heel. Push off backwards, and repeat.

Week 11, plenty of updates

Sorry, it’s been a couple of weeks since my last update - been busy at work and been spending less time on my backside, which is a good sign of recovery. Much has happened of late…

Week 8 - Everyday I’m shuffling
At the 7 week and 5 days post-op point (1 week and 5 days out of cast and into 2 shoes), I started moving about indoors without crutches, a pretty big milestone! But I was far from having a normal walking gait. I was shuffling along, moving my injured (right) foot forward then bringing my good foot just slightly in front of my injured foot. But this has opened up a whole new world - I was able to make a hot drink and carry it over to the coffee table, and I was able to move items about in the apartment without carrying them in my satchel!

Week 9 - Monster week for change
Getting to neutral: A day or two into the 9th week I was able to get my foot to neutral, which was also another big milestone. It enabled me to stand with an even weight distribution over both feet and not have my right foot slightly in front. It is also another step towards a normal walking gait. By the end of the week, I was able to get about 8 deg beyond neutral.

Post-cast OS visit: Saw the doctor at the 8 week and 2 day mark and he thought I was progressing ok, but probably a bit behind average since I was barely at neutral, and still on 2 crutches. He encouraged me to be much more aggressive in my stretching, which is surprising since most protocols I’ve come across have said gentle stretching at this point. I asked if there was any risk of re-rupturing with this aggressive stretching and he said that it is minimum at this point. I told him I would feel a "tearing" sort of pain and he said that it’s normal - any stretching of the tendon actually results in slight tearing in order for it to lengthen. He said that he could prescribe painkillers if it’s the pain that’s holding me back from stretching more. The key point he gave about stretching was that it needs to be sustained for about 20 sec or so for it to be effective. I asked him about scarring and the size of the mass in my heel, and he said that it’ll take a couple of years for it to return back to normal.

Change of PT: I was happy with my previous PT but I would’ve only been able to go a max of 6 times due to an insurance benefit limit. I realised that my insurance would provide more PT sessions if I changed to another PT practice, so I made the change. I was very unimpressed with my new PT - not only was his personality obnoxious, he was quite hands off, with the session consisting of 5 min ultrasound, 20-30 min of TENS, and 15-20 min of waiting around for him. I’d say only a total of 5-10 min of time covering Q&A and hands on treatment (the previous PT involved a solid 45 min of hands-on 1-on-1 and no ultrasound nor TENS). The one positive from this first visit was that showed me how to get in behind the Achilles and massage away some of the swelling and scarring. I figured I would be patient and give him a chance.

Weaning off crutches: Did anyone else feel that this was an anticlimax? I mean, not only was there no fan fare and people high-fiving me with every step I make (jokes), it wasn’t exactly a clear transition point where you go BOOM, I’m now walking without crutches! It really is weaning. During week 9, at home I would be crutches-free other than when I would get up in the middle of the night, when I would use 2. In the office I would use 1, dropping down to none by the end of the week. Outdoors 2, dropping down to 1 by the end of the week.

Going solo on public transit: HK is quite a crowded city, there are lots of pedestrian obstacles to get to the train/tram/bus, and sudden stops wouldn’t be so great for the Achilles if I couldn’t access a seat. I’ve been riding public transport for a couple of weeks with my wife present, but mid-way through this week I finally built up the confidence to do it alone. Woohoo!

Week 10 - Look no hands!
At 9 weeks and 4 days post-op (3 weeks and 4 days out of cast), I finally felt comfortable enough to ditch the crutches outdoors - woohoo!

PT still disappointing: One of the sessions this week, I went for a whole hour without seeing the PT (other than him sticking his head in for 10 sec to see how I was). This hour was again filled with ultrasound and TENS (administered by an assistant who is more or less a receptionist!) and waiting for the PT to show up. The ultrasound head actually hurt my scar a bit, and it’s left a bit of a rash, which I’m not thrilled about either. The one thing I was happy about was that he got me on a stationary bike (medium resistance for 15 min and 40rpm) and got me doing leg extensions to work on my quads. I really had to push him to get advice on next steps and exercises I can work on between PT visits. He would let out a sigh and say, "Rome wasn’t built in a day", which I found super frustrating. I’m not looking to go do a marathon, but simply take the next step and work on rehab in between visits.

Back to the gym: Now that I’m more mobile without crutches and had some exercises could work on, I realised I could get back to the gym. I’d ride a stationary bike for 15 min and get a sweat on, do leg extensions, and work on areas other than my legs also.

Week 11 - Walking better, and walking away from my PT
My flexibility has been coming along - I can now bend my ankle so that the front of my knee is just in front of my toes. My walking has been coming along too, with the limp almost non-existent at times. I can now descend stairs with either foot without holding the hand rail. Although when stepping down with the good foot first, it’s not as slow and controlled and for larger stairs I end up landing the good foot out a bit to the side. I’m finding that my heel would be quite stiff at the start of the day, and both stiff and very sore by the end of the day.

Today I said bye bye to my 2nd PT clinic. Over the past few days, I put a lot of thought into whether this clinic is working for me. I felt that I’ve been wasting my time with this guy and couldn’t take it anymore. I consulted 5 PT friends who work across Australia, NZ, Canada, and the UK to get their perspectives about the treatment I was receiving, particularly around the reliance on Ultrasound and TENS. Here’s the low-down:

Ultrasound: 3 said that ultrasound can be helpful in healing and reducing swelling but only in the first couple of visits post-injury. 2 said that there is no evidence-based research that proves ultrasound is beneficial in rehabilitation, with one of these 2 saying you’ll be hard pressed to find an ultrasound machine these days in a reputable clinic in the country he works in.

TENS: All 5 believe that TENS is helpful for pain relief, with 1 emphasizing that it doesn’t always work well. However, I’m finding the pain manageable, and I don’t think this pain is completely avoidable anyway.

All 5 said that they would expect to see more hands-on rehabilitation, with a focus on strengthening and proprioception.

I will be going back to the previous clinic, but to a branch further away that happens to be covered by my insurance so I will be able to get more visits in too. I feel relieved to have parted ways with the useless PT and am looking forward to the next session.

Week 8, learning to walk again

Not too much too report from my post about a week ago, as the improvements have been minute.

Day 1 after the cast was removed (removed 6 wks post-op), my dorsiflexion range was 21 deg from neutral and there was about a 10 deg difference between the plantarflexion of my good and bad feet.

Day 5 post-cast, my foot could get to about 12 deg from neutral.

Today (day 11), it’s at about 10 deg from neutral and there’s little difference between feet in the plantarflexion ROM.

A mini-milestone that I’ve recently achieved is being able to stand on two feet without crutches with my knee slightly bent (not hyperextended), with weight distribution almost 50/50.

Still on 2 crutches and 2 shoes, so progress is not as fast as my OS had suggested or that I had hoped. But I’ve cancelled my travel plans for the next couple of weeks so am no longer under pressure to progress quickly. I would say that I’m putting about 35% weight on my foot as I walk, with more weight being applied once I roll onto the ball of my foot and toes. I’m still uncomfortable putting more weight on my foot as it starts the heel lift in the walking motion - I think partly because of calf strength, but the tendon also feels tight in this position. My foot would swell up a lot through out the day - I really look forward to going to bed, when I could elevate it for a good number of hours!

Had my 2nd physio appointment a few days ago and the exercises recommended are:
- plantarflexion and dorsiflexion resistance with dyna-band (try to control the contraction both ways)
- inversion and eversion resistance with dyna-band (try to control the contraction both ways, and do these with foot in plantar and dorsi flexion postions)
- seated heel lifts

PT also helped loosen up the ankle joint by manipulating the joint with her hands and the corner of the massage bed.

6 wks, out of cast and into 2 shoes PWB, started PT!

Tuesday 14 April 2015 marked 6 weeks post-op and it was a great day. There wasn’t a cloud in the sky, it was warm, the humidity low, AND I CAME OUT OF MY CAST!

To recap, here is my timeline:
- Complete ATR on right leg on 1 Mar 2015
- Operation 3 Mar 2015 and into cast (foot angled about 50 deg away from neutral)
- 3 weeks post-op, changed to 2nd cast (foot about 35 deg from neutral)

The last 3 weeks
When I got into my 2nd cast at the 3-week mark, my leg started itching big time, making it tough to sleep. The new cast had less padding too so it was less comfortable. During the last 3 weeks, I’ve kept my leg elevated as much as I could as it would swell up inside my cast otherwise.

6 week mark - day of cast removal
After my cast came off it took most of the day for my foot to start waking up. ROM was very limited, and I didn’t know how to move around. Over the past 6 weeks on crutches, I managed to get around almost at normal walking pace by hopping. But trying to walk in 2 shoes (and 2 crutches) was very awkward as my tendon and ankle was really tight. I would go at a snail’s pace, and didn’t know whether to extend my right leg so that the foot was flat (this would result in knee hyperextension), or keep my knee bent and do a little hop over my right leg. When I put my foot down, my ankle joint and other parts of my foot would experience pain.

My protocol, which seems to be atypical, involved 6 weeks NWB in a cast then straight into 2 shoes. So the transition into 2 shoes is a big jump rather than a small step. I felt extremely fragile and vulnerable no longer having solid protection around my foot, and not having experienced any form of WB or foot movement since the ATR. I don’t have the option to put a boot or cast on as I navigate the crowded streets here in HK so I have to be extra cautious.

A great thing about taking the cast off was finally being able to clean my leg - what a great feeling! I noticed that my leg was also quite dark, this was partly due to my skin being irritated but also because of the build-up of blood and fluid. Surprising my right calf was not noticeably smaller than my left. I had measured my calves on the day of surgery as well as on the morning I had my cast removed; it turned out that I lost 3cm in girth on my right, but surprisingly I had also lost about 2cm on my left - I put this down to being very inactive period, so both legs wasted.

1st day post-cast – start of PT
I booked my1st PT session for the day after the cast came off. At first I was hesitant, thinking I should give it a couple of days – as recommended by my OS. But I was keen to get into rehab ASAP as I was due to travel by air about a week later so I wanted to be able to progress quickly. I also figured that the 1st session would mainly focus on ROM and waking up un-used muscles. After finishing the 1st session, I was glad I decided to start PT that soon.

My plantarflexion ROM was about 10 deg away from as far as my good foot would go, and could get my dorsiflexion position to about 20-21 degrees from neutral.

PT told me to do the following exercises as much as I can tolerate throughout the day:
- Dorsiflexion and plantarflexion
- Inversion and eversion
- Big circles and spelling alphabet with big toe
- Dorsiflexion stretch with weak elastic band (I said that I’ve been sitting on a chair with foot flat on floor and gradually pulling it back to give the tendon a stretch. She said this was fine too)
- Sit in chair with both feet on floor, lean forward and sway side to side transferring weight between feet
- Foot flat on floor, flex toes up, then push toes down to grip the floor
- Move a ball around using the sole of foot and press down on the ball as it feels comfortable
- Quad and ham-string: Leg raises, leg extensions, and exercise where leg is out straight on a bed or couch and you push down with your knee

PT said fluid/blood doesn’t circulate very well below the knee if your muscles, particular the calf, aren’t contracting, hence the reason for the swelling. So the exercises not only help ROM and strength, it helps move fluid. Massaging the foot in a movement up the leg can help also. Once the wound heals up, you can also start massaging across tendon gently to break up scar tissue.

Walking… after showing my PT my awkward walking, she said that if I can’t lead with the heel and rock over to the ball of my foot, it’s better to do toe-touches with a bent knee so as to not hyperextend the knee. It certainly was a toe TOUCH, as I was barely putting any weight on it. At this point, I think a lot of it is psychological, but I also don’t know how strong my Achilles really is.

2nd day post-cast
Better ROM. I tried to lead with my heel and follow through with a normal rock over to the ball of my foot, and I was able too. This felt like a huge milestone, and I was very happy about this. I started with barely any weight applied to the foot, but got to maybe 5-10% weight by the end of the day.

5th day post-cast
Over the past few days, I’ve had slightly more flexibility and greater ROM. Now maybe 10-15% weight whilst walking. I’ve noticed that with the added activity, my foot swells up like crazy now.

My PT said to do as much of the above prescribed exercises throughout the day as I can tolerate. What have your PTs told you - a couple times a day, multiple times a day with breaks in between, or as much as you can?
When does the swelling go away? Does it continue for weeks/months, as the foot takes on more challenging activities?
- Roughly when can I drop down to 1 crutch, then no crutches? From some stories I’ve read, maybe I can drop down to 1 crutch after 1-1.5 weeks, then none after 2-2.5 weeks. What have you found?

Story on NBA player Wes Matthews’ 5 Mar 2015 rupture

Hi all,

Just wanted to share this with you guys in case you weren’t aware of NBA player Wesley Matthews’ ATR on 5 March 2015. This was the day I was discharged from hospital following my operation, so as a mere mortal, I will be following his progress against mine. Wishing him a speedy recovery to get back on the court.


The article shares his emotional journey thus far. Here’s a snapshot of his timeline, which I’ve extracted from the article:

5 Mar 2015 - Ruptured left Achilles during basketball game.
11 Mar 2015 - Surgery.
19 Mar 2015 (8 days post-op) - Switched to 2nd cast.
31 Mar 2015 (20 days post-op) - Switched to 3rd cast that allows for PWB.
16 Apr 2015 (5 weeks, 1 day post-op) - Expected date for switching into a walking boot. Initially his doctor targeted 21 April (5 weeks, 6 days post-op) but has been pleased with Wes’ progress so pushed the date earlier.

3 weeks post-op… time to change the cast

Two days ago marked 3 weeks post-op for me so I thought I’d post an update.

Dealing with a cast and crutches
As all of you can probably relate to, immobility is quite a pain in the butt. Hong Kong is especially tricky I think - fast moving escalators, pedestrian footbridges, and it’s a busy city with lots of people and traffic. I’ve had to rely on my other half a fair bit (I definitely haven’t held up my portion of the household chores!). It’s the simple things that I miss - like being able to make a cup of tea and carry it over to the coffee table. I spent the first week off work, then headed back to the office - partly just for some company and to get out of the apartment.

A big disappoint has been cancelling our trip to Sri Lanka over Easter. We were due to fly out tomorrow, but after the first night showering in the comfort of my own apartment, I knew it would be a challenge in a cast and crutches somewhere more intrepid. Probably could’ve managed it, but don’t think I would’ve enjoyed it as much.

How my leg has felt
At the time of the rupture, I had a bit of pain but it wasn’t too bad unless someone actually touched the rupture zone. As long as it was still, it wasn’t enough to warrant painkillers. The emotional pain definitely hurt more, knowing that there’s a long journey ahead and that I may not return to as good a form again.

The past 3 weeks haven’t been too painful either, but it does tend to vary with how swollen my foot is. The swelling isn’t to do with the operation, but more so with it being in a cast and whether there’s a lot of blood flowing down there. I’ve been surprised that I’ve had to keep it elevated most of the time - it doesn’t take too long for it to swell up if I’m sitting with my foot down, or standing.

First post-op visit to the OS
The night before my doctor’s visit, I figured I would do some exercise - I did some sit ups and push ups (on knees). I had been doing nothing since the operation, partly because of laziness (just feel so zapped of energy when you sit on you butt all day), but also because I didn’t want to sweat up inside my cast.

Off to see my surgeon. I’ve spent 3 weeks post-op in a cast now so according to the protocol he follows it’s time to adjust my foot angle and put a new cast on for 3 more weeks. It was a fairly nervous time - I was curious to see how my tendon and wound are healing, but the act of sawing off the cast was also a cause for nervousness (they used an oscillating saw that supposedly doesn’t cut skin easily).

The doctor cleaned the wound, which looked quite good, and then proceeded to push against the base of my foot to stretch the tendon. I could feel that the tendon was really tight, which was such a foreign sensation. I had mixed feelings too. I could feel that the tendon was well connected, which I was quite happy about. But as he pushed, I was super worried that it hadn’t healed enough to take that level of pressure he was exerting. I don’t think he applied a brutal amount of force, but it felt slightly beyond gentle. He applied another cast with my foot in a new angle. Initially my foot was at about 50 deg away from neutral (foot flat on floor while standing), and now 35 deg from neutral. It seems like a long way to go to get to neutral in one go!

I asked him about the next steps and he clarified that I will be in 2 shoes in 3 weeks’ time with the aid of crutches for about a week thereafter. For the past 2 days, my leg has felt slightly more achy than before, but not too bad. This cast has less padding though, so it’s quite a bit more uncomfortable.

Questions for you veterans:
- Has anyone else had their foot stretched like how I described, either at the few-weeks mark, or in PT sessions later on? I assume it’s normal for angle changes from cast to cast, but wouldn’t imagine that it would be done before removing each wedge for the moon boot protocol.
- Is a jump from 35 deg to neutral quite big? It’s 35 deg! Given that I only stretched it 15 deg in the first transition.
- 6-weeks out of a cast and straight into 2-shoes, what level of dependence on 1 or 2 crutches can I expect? Will I be able to walk fairly normal soon after?