CardioJunkie’s AchillesBlog

My AT Experience at 12 Weeks

November 20, 2014 · 11 Comments

I have been a regular reader for a few months and getting lots of useful hints and help by reading everyone’s experiences. I want to thank everyone for sharing their experiences. Reading them has been informative, helped me better manage my recovery, and have some idea of what to expect in the coming months. Everyone’s recovery will be different and I know I will have challenges. My OS and PT are my recovery management team. Achilles Blog has been also been part of my recovery team.

I decided it was time to share my experience at 12 weeks post-op.  I may be mistaken, but there does not look like there are a lot of cases with surgery for AT insertion at the heel.  I recall reading some blog entries on Haglund’s Deformity.

I had an accident while on an outdoor adventure vacation with my family.  This was our second trip to Utah.  I was on a rocky hike (not really a trail) with a lot of rock climbing, scrambling, and pulling/pushing to get yourself up to the next boulder/large rock.  It was challenging and sometimes pushed us to our limits.  At one of the easiest parts near the end, I jumped between two boulders and landed with my right foot too low on the sloped part of the boulder below me.  My instinct was to lean forward on my left foot (which was on top) so that I can get back onto the flat top of the boulder.  In that split second, I did not think about the fact that my right foot is down below at an extreme angle and leaning forward to climb to the top meant putting my right ankle at even more of an acute angle.  All I knew at the moment was I did not want to roll backwards off the boulder and fall off onto the rocks and ground below.  I felt a crunch and a snap and knew it was not going to be good.

My return back to the top of the canyon is a story for another day (e.g., during two hours, on one leg going backside up over boulders, using my arms to lift myself over the boulders, hopping on my left leg, crutching when the ground was level, and lots of help from others).  I went to the ER, saw an OS, and had an xray/MRI to ensure I had things checked out before I flew home.  I weighed the decision of having surgery in Utah.  We shortened our vacation by a few days, but I still went ahead and saw the Grand Canyon for the second time in my life (on crutches but view was still beautiful from the rim).  Nothing was really hurting at this point, just hard on my body to be on crutches.  My surgery was on August 20th.

My OS was highly recommended by others and he has been excellent.  Since time was ticking, he came in during his vacation to do my surgery.  He said I am not the usual ATR patient, as I had a partial AT tear off the heel on the inner side and at the ankle.  Two events on my AT… lucky me.  I was considering No-Op, but the AT insertion to the heel tear meant that was not a viable option.  The partial tear off the heel required a titanium anchor (looks like a giant screw on xray) inside the heel bone with sutures to attach the AT to bone so they will grow back together.  Then there were sutures for the second ATR at the ankle.  My doctor told me that I will need take longer to heal than other ATR patients because of the two traumas. 

Before this happened, I was a very active person.  I went to the gym six days a week.  I did kickboxing, bootcamp classes with running and jumping, step classes with plyometrics, Pilates, Yoga, etc. (yeah, I’m a cardio junkie).  I enjoy skiing, hiking, outdoor adventures, and National Parks.  There is no skiing for me this winter (I’m on a ski trip, but my skis are staying home).  I hope to be able to take some short hikes by next spring and outdoor activities by summer.  Like many of you, I want to return back to doing everything I enjoy at the end of my journey.

I created this post in Week 12.  Here is a summary of my recovery so far:

WEEK 1 — My right leg is in a splint PF with toe pointed, NWB.  Nothing was hurting until the surgery.  Doctor told me my ATR is unusual, so I should expect to be in the splint longer.  Learned to get around on crutches and rollabout.

WEEKS 2-5 - Still in the splint NWB and no changes at this follow-up visit.  At Week 2, OS took xrays of the titanium anchor inside the heel.  He was satisfied that it is in the right place and it has not moved.  (During the two week wait for the follow-up visit, I swear I felt the throbbing from the anchor and I knew exactly where it was.)  Was glad to hear it did not move and situated right.  My OS told me that I had to stay two extra weeks in the splint NWB to allow both AT injuries to properly heal.  (Darn!)  I was looking forward to moving onto the boot brace like others!

At Week 4, OS provided exercises to start to get my foot to 90 degrees.  Three times a day, I took the ace bandage off the splint and performed the exercises.  Ankle ROM was getting better and stitches have been coming off on their own,

Boredom – Anyone stuck at home due to an injury knows this.  I read every newspaper, book, and more.  I started to watch TV again (after a three year hiatus).  I shopped a lot on the internet for delivery to the door because I cannot drive.

Diet and Supplements – After reading other blogs, I decided it would be a good idea to include more meat-based protein in my diet and some supplements to help with rebuilding and healing.  I am usually vegetarian, but because of the injury, I felt a non-vegetarian diet can be helpful for the duration of my recovery.

Exercise - At Week 2, I decided to resume upper body and core/abs exercises.  I also worked my quads/hips by doing quad/glute/leg lifts, clamshells, etc. with ankle weights.  Any exercise that did not require standing on my injured leg was okay.  I sometimes rested my right knee on the rollabout to do some exercises for my left leg.

WEEKS 6-7 -  Walking boot brace, FWB, for the next two weeks.  After practicing walking in the boot brace and crutches for a couple of hours (doctor’s suggestion), I found it easy adapting to boot walking.  Good bye crutches and rollabout!

This was the most freedom I felt in weeks.  I no longer had to make multiple trips from the kitchen to breakfast table balancing my coffee and plate on the rollabout.  I paired the boot with a 2.5 inch wide-heeled shoe to keep both legs even.  I take the boot off when I go to sleep and shower.  Once I started walking in the boot, I decided I could work full-time from home.

Exercise - I started to incorporate squats, leg/glute lifts in the boot.  Still continuing with the upper body and core/abs workouts and I can take the boot off if I need to.

WEEKS 8-11 - Two shoes with heel lift.  Doctor told me I would be using heel lifts a week longer than his other patients so both injuries fully heal.  Scar started to disappear into a thin line.  Still dark discoloration in ankle/heel/foot because of the bleeding from the accident.

Swelling and Stiffness - I am experiencing more stiffness and swelling.  Some days, the hotness/swelling is on the ankle only, some days it is at the AT insertion to the heel, and on some days it was both.  The more walking I do, the worse the swelling in one or the other.  The swelling was a little worse at night.  If I overdo things or engage in more walking/exercise, I had to ice several times a day.

Driving - Started practicing driving with my right foot.  Believe it or not, I forgot you need to signal to change lanes and you need to open the garage before you back the car out.  I learned years ago to drive and brake with my left foot and that will be my backup if my right ankle is swelling or stiff.

Sneakers vs. Clogs - Because the surgery was at the back of my heel, I had to wear sneakers a half size larger or the injury would scrape against the back of the shoe.  One runner’s blog suggested cutting the padding off the back of a running sneaker to free up space for tendonitis pain.  That worked for me.

Exercise - I started incorporating a lot of squats, squats with barbells and more advanced movements.  I worked the right quad/leg more intensely to start restoring strength and muscle.

Caution on Exercise and Movement – I talk a lot about doing exercises because being fit has been a key part of my life.  Doing exercises while you have an injury can be a safety issue or put you at risk of injury.  I weighed my options and decided that I was able to maintain some exercises.  I think you should only do what you are capable of and use good judgement.  I am not advocating that everyone should exercise during their ATR recovery.  How many times did I have “near misses” on crutches, go across a wet floor, or took a turn on the rollabout too fast?  You don’t want to increase your risk of injury or delay your healing.

Categories: Uncategorized

11 responses so far ↓

  • Mr WordPress // Nov 20th 2014 at 11:03 pm

    Hi, this is a comment.
    To delete a comment, just log in, and view the posts’ comments, there you will have the option to edit or delete them.

  • herewegoagain // Nov 22nd 2014 at 6:28 pm

    Wow, what an experience getting out from your hike- lucky you are fit and strong! I ruptured a day after your surgery and am around the same place as you recovery wise. Onwards!

  • normofthenorth // Nov 23rd 2014 at 2:14 am

    When I read that your Doc wanted to take you extra-slow because of the double separation, I got worried. Most OSs still can’t believe the new evidence showing how well fast rehab works, so they want to take patients slower if they have an “R” in their name, or if it’s Tuesday, or… etc. I’ve never seen a shred of evidence that it helps, and the logic that says it DOES help is exactly the same logic that said it helps everybody, or especially non-op patients, or… and the evidence now shows that all that logic was Just Plain Wrong. But your rehab schedule seems very close to the fast modern protocols that produce great results, so I’m breathing again!

    Just one thing puzzles me — your note “There is no skiing for me this winter”. I had (we think) a full ATR, treated non-op, and I skied aggressively for a whole week in Whistler, 17 weeks into treatment. I was nervous about my ankle while walking in the condo and in the Village (in shoes), but NOT on the slopes, once I’d taken a few runs. I even took a couple of spectacular falls down “powder cliffs” (really just steep single-diamond bump runs — including a double-release “yard sale” on Whistler Bowl, if you know Whistler), with never a twinge in the ankle or leg or AT.
    I did buy some thinner ski socks to wear on “that” side, because my boot was tighter on “that” ankle. But that was my only concession!
    In advance, I wondered if I’d be ready, and my approach was the same as 8 years earlier (with a MUCH more conservative protocol, post-op) — I held off on buying the lift tickets until the “last minute”, and when I felt like I would be OK, I put “that” ski boot on, tuned “that” heel binding down to ~0 DIN, clicked into the binding (in the basement), and snapped out. Then I kept repeating it, gradually cranking up the DIN on the heel release until it seemed high enough to keep me from popping out way too often, and then I bought the lift tickets.
    I think I ended up at around DIN 5.5, when I was used to (and all 3 of my other bindings were) DIN 7.
    Neither I nor anybody else can guarantee that you’ll be fine skiing this winter, but I don’t see why it shouldn’t work in another 1.5-2 months — still high ski season.

    BTW, after my first ATR (other side) was fixed surgically, my OS — who was a skier and kept me in a cast an extra week while he was in Aspen!! — told me to accompany my wife to Whistler but bring a good book instead of skis and boots. But I skied, aggressively, and had a blast. when I saw him afterwards, he asked if I had gone to Whistler. “Yes, and I skied!” “Did you stay on the groomed runs and take it easy?” “No, I skied all my favorite runs, aggressively, took some spectacular falls, and had a blast!” “Oh well,” he said, “Your ankle was probably safer in the ski boot than it would have been in a shoe.”

    That’s what he said AFTER my ski trip, and it was true, but totally different than what the @#$% told me when I asked in advance! :-(

  • cardiojunkie // Nov 23rd 2014 at 7:15 am

    normofthenorth - Thanks. Yes, my doctor follows more modern protocols (just not for me since I have two injuries to get through). I’m going to rethink about skiing. I’m going to sit out the upcoming Christmas week skiing as I will probably be in PT through January, but my strength training is going well. Skiing the second half of the season is sounding really good. Good to hear advice from a fellow skier.

  • herewegoagain // Nov 23rd 2014 at 2:38 pm

    Cardio- I skied for a week at 16 weeks the first time around the ATR dance floor, the snow was bullet proof and I had terrible balance so it was not the best. I am now living in a ski resort (tough life!) and have not cancelled this years pass. I am going to wait for the holiday crowds to pass and hopefully get the downhill boots on in the New Year which will be 20+ weeks!

  • normofthenorth // Nov 23rd 2014 at 7:30 pm

    Good luck to everybody, including all us skiers! :-)

  • normofthenorth // Dec 7th 2014 at 2:04 pm

    Somebody here communicated directly with Dr. Wallace in Ireland. I’d love to know what he did with ATR patients who seemed to have separation at the heel/calcaneus. I.e., were they treated non-op like the other ~950 ATRs, or were they excluded because of that diagnosis and sent for surgery? I don’t think his article is clear on that. But IF he treated them all non-op - and got <3% rerupture rate and 0% re-rerupture when treating those reruptures non-op - then there’s one more impossible breakthrough he’s responsible for! That would be THREE, by my count: he already showed that most chronic or neglected ATRs can be treated successfully non-op, AND that ALL reruptures can be treated successfully non-op!

  • Heeling // Dec 8th 2014 at 4:29 am

    It was me who contacted Dr Wallace - I didn’t ask him that question, but I’m sure he would answer it! His e-mail is easily found in the paper or I can give it to anyone who wants to ask him anything. I don’t want to publish it on here as he might be inundated.

  • normofthenorth // Dec 8th 2014 at 1:55 pm

    Thanks, Heeling, I may ask him. Maybe after rereading the article! Or the phone may ring first…

  • lauren // Jan 4th 2015 at 3:35 pm

    Hi! I am so happy I found your page. I am PWB in a walking boot (almost a month after I tore my achilles). I went to the gym yesterday to do upper body workouts and abs. I really want to maintain leg strength. At weeks 2-5, what did you do with ankle weights to maintain your leg strength? Did you use the weight machines for your quads or hamstrings during this time?

  • cardiojunkie // Jan 9th 2015 at 5:43 pm

    Hi Lauren - In the early weeks, I did not use the machines at the gym for quads or hamstrings. I waited until I was two-shoes before I used them. Getting in/out and around equipment when you are not steady can be tricky. I bought ankle weights with the removable rods that come in various weight increments (I used 5 and 10 lbs). You can wrap them around your lower quads (uninjured part of your leg, not on knee). Start with no weights, 3lb weights, and work your way up as you feel stronger. You can do multiple sets of leg lifts or hip abduction (you can see picture of the first two on page 6 in “ma general hospital achilles rupture rehab”). This was a safe way to keep my legs strong.

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