hopalong2’s AchillesBlog

“Father Norm, its been a few months since my last confession/post!”. More like 7 months and 2 weeks since the Greek Gods reminded me I was mortal after all! For those of you also on the slow lane, I though an update would be in order and for those in the fast lane, you can see what you missed!

Background: Left ATR whilst running, slipped on harbour steps. No surgery, but casted for 3 months! So dealing with atrophied calf!

At 7 months: ROM now good – can get knee to wall and beyond.(Unlocking the ankle took around 3 months!) Feels like ankle and tendon are made of stiff rubber in the morning now, as opposed to lead a few weeks ago! At last, not limping - unless tired. Then foot goes out and drags and results in tight aductors the next day. Running and tip toe are off in the future somewhere, as for jumping…..!

Physio: Gone down to once every 2 weeks as opposed to every week.

Own Physio: Normal walking. Pool: Stretch (knee to wall), then heel raises at shoulder level moving to waist level - 100 reps. Slow jog from  chest height in pool to shallow end. Got bored of theraband!

Deep Tissue Massage: After reading a couple of posts here, I thought I would invest. Did a specific massage on both tendons and left  aductors. Hurt like hell, so I must have needed it  …..I think!

Like many, noticeable swelling now at break site resulting in a “thick” tendon. Yep I know should massage it! and oh compression socks, wish I had found them sooner! As for the right “good” achilles, still paranoid about that one, but at least it now gets “looked after”!

Norm rightly points out, recovery is incremental. So if you are having to contemplate a long casting (for whatever reason) once ROM is back,  life does get back to being a bit more normal - I just hadn’t appreciated just how SLOW incremental could be!

Hoppy!

Hi all

Hope Santa brought some new tendons!

Been a month+ in 2 shoes, so thought I would update on the slow slow progress that is the Conservative Approach. So that you guys and gals who rightly decided to go WB/rehab early can see what you are missing! After the discernible milestones of PWB, FWB et al, the achievements in 2 shoes are measured in millimetres!

Quick recap. Non Op, ultra conservative route: 9 weeks casts, then boot for 5weeks. Currently at week 20, or 5 months! So proof if needed that Norm is right! Lots of casting; slow to introduce rehab = “locked” ankle/tendon. So only just now beginning to walk “normally’ albeit very slowly! The problem is as much in the front of the ankle as it is in the tendon and stiff calf. All need to be warmed up/deeply massaged in order to make the new hallowed ground of “knee to the wall”. However achieved that on last physio session, so the New Year is looking bright! (the ankle has unlocked by about a cm a week!) During the holidays did a fair amount of walking - esp compared to the earlier 4 months. Found that all very tiring and have found compression socks really useful (wish I had known about them before the injury!).

In terms of rehab, get physio once a week, which is mainly all about unlocking the ankle at this stage. Swim for my sanity and to loosen off. Have started on the breaststroke kick. Seems Ok and gives a good ROM in the water. Heel raises only in the water at this stage. and lots of walking. Evenings do a self massage and find both calves really tight.

Concerns now are on the OTHER tendon and how best to protect it, as its had a hammering over the last 5 months and as one of the articles on here points out  once one has gone the other is more likely to go. Good leg calf is tight aswell, and got physio working on that. PT suspects tendenosis and rest appears to be the answer!

In retrospect, suspect that there have been a number of contributory causes to the weakening of both achilles over the years. 20 odd years in boots, with laces tied off around the tendon; barefoot walking on hard floors in the house; not stretching tendons off post and prior to exercise; and running up and down mountains probably hasnt helped!

Then more recent contributory causes:

Been living in Merrills Eagle boots for the last 2 years. Always made my lower legs ache, but I tended to ignore and work thru! Mistake! The Eagles have a pretty flat sole. Then 3 weeks prior to the injury was on a diving exped with slightly too large flippers. Then  there was missing a step and subsequent hyperextension during a run!

Have gone for a pair of ASICS Gel NIMBUS (the max for cushioning) as my walking shoe (with heel raise) and wear a pair of mocossans type with insole + a heel raise in the house.

So that is the picture from the slow windy road! I read your comments on jogging with jealousy!

Any thoughts on best footware and on protecting the other tendon most welcome.

cheers Hoppy (although more like slightly limpy now!)

At long last into 2 shoes! Well behind the pack but at least we are there. Have been traipsing around the flat for the last week in 2 shoes and when venturing out resorting to the mental and physical crutch of the boot.

To recap: Non Op, 9 weeks casts, then Vacoboot for 5 weeks,coming down 5 degrees a week. Doc and PT ultra conservative and so didnt get PT until week 14! Due to all this conservatism, ankle and tendon rigid. Couple of experiences for any others on the slow road:

1. Just getting used to being outside the support of the boot took time! A psychological as well as physical hurdle to overcome. Again the pool provided a proverbial comfort blanket.

2. Had real problems getting used to the flat (rocker) Vacoboot sole. Eventually made the transition at neutral, but kept the Wedge with me and put it on if I had a long walk.

3. The tightness in gammy foot was not just associated with tendon area, but with calf, front of the ankle and quads. Even hip! As the song goes, its all connected. Ankle seized up due to being cast for so long, and hip due to gimpy walk one has to do in the boot. (Still find it difficult to point foot forward).

4. Physio made a real difference! Probably stating the blinding, but managed to get an “unofficial” physio session in week 13 and that really freed up the ankle.

5. The shoes transition ensures that the ankle regains its strength. PT very happy at the increase in ankle strength after just 1 week. (As an aside, I sent him the link to this site and he is now very onside to early rehab - one more convert!). However now constantly swollen and different colour than other foot!

6. Walking with feet straight and not like a duck proving to be harder than initially thought!

One more milestone reached in this long windy road!

thanks for all the advice

Hoppy

Hi all

Wondered if anyone has advice on the transition from the Vacocast wedge to the Rocker ( which is not a rocker in any sence of the word-  German humour perhaps)!

Background: I am on the very conservative road. 9 weeks cast at 30 degrees and have been in boot for 3 weeks, slowly coming down from 30 degrees equinous with the wedge sole to 5 degrees. As per the Vacocast instructions tried out the slimmer sole at 5-30 degrees (called the rocker), but now understand all those posts that talk about 2 steps forward and 1 back! Had got quite proficient on the wedge, FWB and no crutches. Tried the thin Rocker sole and ……..when trying to walk with weight, Tendon/calf stiff as hell and need 2 crutches to move at a snails pace! Have to walk on the heel. In fact reminiscent of the hobble back to the house immediately following the ATR.

Couple of people posting here  seem to have had similar issues and opted to go back to the wedge, but thought that this transition may be a necessary evil before the hallowed ground 2 shoes!

Thoughts on a postcard!

Hoppy

Hi all

First thanks to those who have replied to various queries. Its been useful to bounce ideas around.

Quick Recap:  Im non op and on the slow slow windy road - just finished 9 weeks in casts and have migrated to The Boot (VACOcast)! First Milestone! However Im still at 20 degrees equinous with the VACOcast achilles big heel and doc doesnt recommend PT for a month! Infact doc was quite noncommittal - go at your own pace! Concious from this forum, that I am now behind on the rehab front, but thought I would give some of the first impressions of this momentous week!

First off, the Boot is great! 9 weeks in casts was a long haul! Bathing the ankle was heaven and hell! Heaven to get water on it and scratch that inaccessible itch, but hell to see the state of the ankle and tendon and a psychological hell to have a floppy foot that feels extremely vulnerable outside the protection of the cast/boot.

Plusses for the boot include being able to rest/stand for extended periods with little swelling, and when there is, being able to elevate and release the bindings and let air get to the ankle! Bliss!

Each day ones confidence grows as to what the ankle can withstand, and 3 days into the boot I found myself successfully walking albeit extremely slowly with one crutch. Walking is subjective, more like half a step with gammy foot, stick out, and then move good foot into posn - repeat! No pain, but ankle noticeably throbbing this evening.

With no PT on the immediate horizon, I use swimming to get cardio and a bit of work on the ankle. There is a pool on the complex, so its easily accessible - Swim session (with the VACOcast) is:

4 lenghts crawl no legs – warm up

4 lenghts very slow breaststroke – really have to concentrate on what gammy leg is doing, as it tends to float with the boot!

4 lengths breast stroke kick only with board

4 lengths crawl with v slow leg kick - can feel some slight ROM - no pain.

5-6 widths walking at chest height, concentrating on full weight onto the gammy leg.

Although the boot has a tendency to act as a dragnet - with implications to the “to be protected at all costs tendon”, this can be mitigated with a tight rubber seal over the top of the boot. (The BLOCC cast protector cut in half does the job!).

Doc has also agreed to weening off the anti DVT injections - at last. 9 weeks of needles was more than this junkie could stand!

So trust you are all mending well and keep blogging - it beats the history channel!

Hoppy

Hi all

Anyone with experiences of PoolPT to aid recovery would be useful.

To recap, I am on the slow windy road! Currently still in cast at 8 weeks and still at equinous and only just started “touch” weight bearing -  ie not weight bearing at all infact! Hope to go into boot next week! Conscious from this forum that this slow approach is dated, but that seems to be the way here. (Singapore).

What I have found useful is the pool. Not least because its damn hot, but also for a bit of cardovascular. However as I havnt officially started PT yet, all this is off my own back! Would be useful to hear from anyone with similar experiences/advice.

A BOCCO rubber shower protector over the cast has kept it watertight and PWB in the pool seems to work - the water pressure on the cast even at 1m is quite reassuring. Crawl no legs has been good to loosen off the upper body, and even slight kicking doesnt seem to affect things. (Cast protecting tendon - not sure if this would work out of cast/boot). Breaststroke legs are a joke, as have no flexibility in the foot due to cast. However a bastardised side breaststroke with gammy foot down feels good. Quite frankly its just been good to get a bit of movm going on the gammy leg after 2 months!

Any advice/experiences would be welcome - and get me away from the history channel!

cheers Hoppy!

Hi all, Very useful reading all the blogs.

Im 44 active male, ruptured left tendon due to hyper extension when out running. Expat in Singapore. They tend to prefer surgery out here and are not really up with the Jones’ when it comes to aggressive healing, So currently on a conservative non surgery protocol. 3 x 3 week casts, NWB. Currently at week 8 and still in equinous!

Invested in a Vacocast boot, which will be my next stage - cant wait to get in that pool!

All for now

hopalong