janis’s AchillesBlog

I haven’t posted for awhile because I’ve been off living my life so here’s the quick backstory on me: suffered with Haglund’s deformity and achilles tendinosis for 3 years before finally going through with surgery November 20, 2013. My surgery and recovery were very uncomplicated - the surgeon used the Arthrex speedbridge anchor system. 8 weeks in a Vacocast “supposed to be NWB” but was bearing weight on boot after about 4-5. Did extensive PT after released to 2 shoes at 8 weeks and went back to work, Paramedic (no restrictions) at about 15 weeks. There was still a good bit of progress between that time and a year postop as far as flexibility, strength and the elimination of stiffness and pain.

I haven’t really had any setbacks… until now. We spent a really hard week at a friend’s house helping her get it ready for her to move in. This involved lots of climbing ladders, squatting, running up and down weirdly spaced basement steps, and hours upon hours of standing on a hard concrete basement floor (painting kitchen cabinet doors). Followed of course by moving her stuff from a 3 story townhouse. By the last day I had dug my heel wedges out and put them in my shoes.

I’ve had a lot of bottom of foot pain, which I expected - the type you get when you’re on your feet all day. However I also developed some burning and throbbing in the achilles (repaired side), probably about mid tendon, way superior to the repair and anchors. I know my calves and tendons are tight and have been stretching and making sure I wear shoes in the house, but it’s still there - albeit getting a little better every day.

I’m trying to walk a fine line between stretching to keep it all flexible and actually aggravating the pain more (which is what it feels like when I’m stretching). The good news, I guess, is that I’m not having the retrocalcaneal pain or sensitivity that preceded the development of the Haglund’s deformity and led to surgery. Been stretching, resting, using minimal ibuprofen when it gets bad. I guess I’m trying to figure out if this would be better treated with just everyday walking and the usual stuff I was doing in physical therapy, or if that would aggravate it more and I should just rest for a few days.

What do you guys think?

The only marathon I will likely ever complete in my life is the one you see in my sidebar.

Today marks exactly one year post Haglund’s excision and achilles reconstruction and anchoring.

It has truly been a marathon, and full recovery does truly take a year. Having said that, I would do this all over again if I needed to. Life is so much better without limping and hopping and waiting for the painful pluck on the frayed tendon that randomly came, with or without me moving.

Every morning that I get out of bed and put both of my feet flat on the floor, walking painlessly with a normal gait, well… that is worth a year of recovery to me. It’s not a year off your feet. It’s 8-12 weeks off your feet and 9 more months of incremental, almost imperceptible, progress.

9 months of occasional swelling or burning or twinges where you wonder, did I do the right thing? Did I do this all for nothing? The answer, in my case, is yes, this was absolutely the right thing. If nothing else, recovery from achilles surgery teaches you patience and teaches you that consistency brings results. Even in the past month I have noticed a progression in my flexibility and strength.

So, if you’re suffering and miserable with a haglund’s deformity that is shredding your achilles, get a surgeon and therapist you trust, and take the leap. Then trust the process.

Almost at the finish line in my personal achilles marathon. My haglund’s surgery was 11/20/13.

Even in the past month or two, I am still noticing small improvements. Just a general normalizing of how my foot feels - fewer episodes of stiffness, no more limping after getting out of the car or up from being seated for awhile. It really is true, if my OS had told me I wouldn’t be back to 100% for a year, I might have limped out of his office and still be in misery and living a life limited with the pain of haglund’s deformity and achilles tendinosis.

I do things I was doing this time last year (round of golf, climb a ladder, go up and down steps, 12 hour shifts on the ambulance) and marvel at what it’s like to do these things without constant pain and swelling. At the time of surgery and recovery, it seemed so slow. Now, it is such a small blip on the radar. A year has gone by in the blink of an eye and my life is 1000% better these days.

I could wear flip flops all day walking around an amusement park, and not be in severe Achilles pain by the end of the day. If I’d have seen my OS or PT there yesterday, I’d have kissed them and bought ‘em a funnel cake!

11/2013 Haglund’s Deformity excision/Achilles debridement/reconstruction/anchoring

Haglund’s deformity excision with Achilles debridement/repair/anchoring 11/20/13.

What I have learned is that not being active EVERY day = stiffness and some pain as payback. When I say active, literally all I mean is starting the day with a walk, not even two miles sometimes. I noticed when I am sedentary for days on end (lots of desk work at my job, then holding down the couch on my days off), then decide to weekend warrior it and walk the hilly golf course or go for a hike, I am extremely stiff and in a low level amount of pain at the end of the day. Almost like the pain I had when I first noticed Achilles stiffness/aching prior to bring diagnosed. A short ride in the car = limping and flat footed walk the first several steps when I’m not active daily.

When minimally active daily, though, I don’t have any of that. When I’m walking, I notice it’s very easy for me to get lazy and lapse into the Haglund Hop, as I call it. If I spend my walk concentrating on my push off on the op foot, and getting that calf activated, the rest of the day, abd the day following, feels much more flexible and pain free.

Just something I’ve learned the hard way. Hope it helps!

18 weeks + 5 days post haglund’s deformity excision and achilles debridement and repair, I had my last PT session. I won’t say I’m back to normal, but I’m at least 90% back, and I’ll take that.

Where I started 10 weeks ago (8 weeks post op):

• 1.3-1.5mph on treadmill, very painful and uneven gait
• smallest balance board for r.o.m., very painful and slow to get my 400 reps in
• outside of PT, walks of about 1 mile were slow and painful, and caused pain and some swelling for the rest of the day
• lots of pain to bottom of heel

About 4 weeks into PT (12 weeks post op):

• 2.8mph on treadmill, I could go faster but was still getting zinged along right and left bottom of my heel, scar tissue that eventually broke up with massage and r.o.m.
• Squat press 130lbs/50 reps (both feet), up on toes for 5 count, dorsiflex for 5 count
• graduated to tall balance board! 400 reps pf/df, inversion/eversion
• BAPs board on setting 3, 100 reps clockwise/counterclockwise
• Balance on cushion on op foot - could only manage a few seconds
• Walking lunges, 10 laps. Very much illustrated the imbalance between non op side and op side
• Sumo squat with 25lb kettlebell x 50, up on toes at end of each rep for 5 count

At this point I would still leave PT very sore, usually limping a little. Massage progressed from the area feeling bony, to a distinct crunching in massage area, to feeling a freed-up tendon moving during massage. Heel still sensitive to many shoes. Walks are now 2-3 miles, limping and sore the 2nd half. Always feels better to be moving, though, and feels great the next morning.

Week 5 of pt (week 14 post op) - managed a couple of heel raises on op foot! Big victory!

Week 7 of pt (week 16 post op) - back to work with no restrictions

After 10+ weeks of pt (18 weeks post op):

• walking easily 3.3-3.5mph on treadmill, pretty quick for my stumpy legs
• walking outside 3 - 4 miles, uneven ground not a problem. Dog is happy!
• balance board? We don’t need no stinking balance board anymore. BAPs at setting 5 for all r.o.m.
• heel raises in 10-20-30 sequence x3 sets(10 - hold for 5 count, 20 - hold for 1 count, 30 - quick pulse up/down) - difficult and most painful part of pt
• balance on cushion on op foot - getting up there! About 30-45 seconds
• squat press 90lbs x50 reps isolating op foot/leg. Up on toe 5 count/dorsiflex 5 count
• kettlebell sumo squats x50, up on toe at end of each rep for 5 count
• walking lunges x10 laps, up on toe on step through, now holding a 10lb kettlebell in each hand.
• ladder hops x10 laps, hop on outside of each rung with foot on same side
• finish off with 5 minutes on this thing:   http://www.fitter1.com/Catalog/Items/PF2.aspx#   (SO much fun.)

A little more swelling around the medial area of my ankle on op foot at the end of a long day, but I am on my feet more at work and doing a lot of movements with the foot repetitively that are pretty stressful. Also, that ankle has been and will always be a bit of a problem child. Walking - whatever I want. Running… I have jogged a few steps, but it’s not a priority for me. I am reasonably certain my poor form and rear foot strike while doing Couch to 5k program was part of what got me into this situation, along with my goofy foot anatomy - so let’s just say I’m in no hurry to run. I will still be sore after a long day. A long day on my feet still seems to be better than a long day off my feet. Definitely stiff after a car ride or sitting at my desk for too long. I notice the AT itself is sometimes a little sore at insertion, and up a little higher. I could probably avoid a good bit of this with a better calf and AT stretching regimen. Or, a calf/AT stretching regimen. Which is something I’m working on.

All in all, I am still in less pain than I’ve been in for 2.5 years, so it’s hard for me to assess whether or not what I’m dealing with now is “pain”. My theory is, if I have to think that much about it, it’s probably not.

Would I do the surgery again? In a heartbeat. I’m kicking myself for having waited and suffered for so long.

I figured it was time to add in more strenuous activity. My OS’s only restriction at this point is no jumping/plyo for another month. I did a 20 minute kettlebell dvd that included only closed-chain movements: kettlebell swings with feet flat, one leg dead lifts, squats, lunges. Nothing hurt while I was doing it, but boy was I sore on my couple mile walk after.

I think the predominant cause of the soreness might have been that I did the kettlebell workout barefoot. My husband was napping in the bedroom where I had left my shoes and I didn’t want to wake him up. Not giving up on the kettlebell just yet, but next time I’m wearing shoes for sure!  Also, I’ve been slacking on massage and I think I woke up some more old scar tissue today. The old ankle rears its ugly head again!

We did our first round of Par 3 golf for 2014 and it was just wonderful. Not the scores. Not the condition of the course. But, being able to walk the course without pain - that was like a million bucks.

I remember squeezing that last round in, right before my surgery in November. About 5 steps on to the course, of course my heel was killing me and it only got worse with the hills. What a nice contrast today was. Looking forward to more good days like this!

For those still wondering, “when is this going to feel normal?” - I’m not sure this would have been a pain free venture even two weeks ago (not to mention the course was still covered in snow!) So, hang in there! It gets better little by little.

https://www.youtube.com/watch?v=631AgQiLLQ8

I used it in PT today and it was so much fun! He set the timer for 5 minutes and I was so sad when my timer went off - so I just kept going. I really need one of these at home. If only I had $700 just lying around begging to be spent. Also did some ladder hops today. This was in addition to the other stuff I’ve been doing for the past 7 or so weeks. It made me feel like I am progressing and getting back to my athletic self. The challenge will be continuing to do strengthening stuff on my own, as I only have PT one day a week now. I am going to have to put it into list form and make an “appointment” with myself to get it done, or there’s a good chance I’ll blow it off.

I saw the OS yesterday for my final follow up and was cleared back to work with no restrictions. Going to continue pt 1 day/week. He did tell me no plyo/jumping until the 6 month mark.

My scar tissue areas are bothering me less and less, though I’m still a little sore after pt sessions. Life-wise, I’m getting in 10,000 steps most days, which was my goal when I got back into two shoes. The dog is pretty happy we’re back to our daily walks.

I still limp a little at the end of a long day but it’s more due to stiffness and not pain. I literally have not been this free of pain in two years, and kind of regret putting this surgery off for so long.