hongkongexpat’s AchillesBlog

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.

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