:Didn’t Achilles’ Mom Want an Invincible Hand?

I hadn’t thought much about my Achilles over the last 2 years.  I saw Ryan Howard of the Phillies rupture his on the last swing of the bat for the Phillies this past fall in their loss to the eventual World Champs, the Cardinals.  That was a big time bummer for me and my family since we are Phillies fans.  I knew the second I saw it that that is what had happened and now he is going through a long rehab to get back (hopefully he will get back after the All-Star Break).  Anyway, mine has been holding up just great.  I have been doing almost everything that I had been doing prior to the injury EXCEPT play volleyball.  I miss it but figure I am 38 now so I don’t need to be running around playing against 20 years olds anyway.  I figure as long as I can help run around and coach my 10 year old son’s baseball team I am happy!  A poster had asked if I had a current comparison photo to share so here you go (This one’s for you Eross).  Take care and quick healing to every0ne.

Calf Comparison and scar 156 wks post-op

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It seems that the achilles rupture has been in the news lately as a handful of professional athletes have been sidelined, and it has been slightly over a year since my injury, so I was reminded that I haven’t updated the blog in a while.  I guess that’s how it works with this blog - when you are early on in the injury/surgery/recovery phase, you rely on it heavily for advice but as you get back to normal you are busy doing other activities and don’t have time to post. 

Things have been going very well lately.  I just ran a sprint triathlon on last month (my first) and didn’t have a single problem with the achilles.  Also, I have recently run several 5Ks and I continue to teach spin class with no problems at all.  The surgery scar is fading and now is only noticable if you are looking for it.  I haven’t played volleyball or basketball or anything that requires explosive movements, but hey I’m 36 and as long as I can help coach my son’s little league team I am happy!

Not much else to report at this point but I wanted to touch base at least.  Take care all!

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Sorry I haven’t posted in quite a long time but it is because my life is back to “normal” and I had no pressing need to refer to all of the helpful info on this site.  But yesterday I hit another milestone and figured I would post: I went for my 6 month post-surgery follow up and the doctor released me to full activities.  He recommended that if I play any sport with explosive leg movements that I ease into it at first since my injured leg’s calf muscle is still not as strong as it was prior to the injury.   I did a month of rehab with a physical therapist starting when I got my boot off and that definitely helped with ROM and some strength BUT I am now resolved to the fact that the strength will take longer to recover than I had hoped.   I continue to do calf exercises 2 - 3 times per week on my own in the gym but it seems I have hit a plateau.  So, my hope is that now that I can start doing things like running and playing some sports that my strength will come back more quickly.  My scar seems to be fading and my thickened tendon seems to be getting smaller over time.  I have been very busy teaching spin class and that has probably helped with blood flow and some strengthening and stretching of the tendon.

Overall, I am really satisfied with how everything turned out.    I am in PA and there is snow everywhere so when it starts to get warmer in the Spring I will start jogging and riding the bike outside too.  In the meantime, I am going to get back to snowboarding starting today (going after work).  I am not a jump/trick kind of rider (I like to go as fast as possible from top to bottom) and in general snowboarding isn’t a huge calf/ankle stressing activity so I anticipate no problems.

Well, that’s all for now.  For those who are still in the throes of recovery, hang in there.  It’s over before you know it.  Fortunately (or unfortunately) time passes quickly and you’ll wonder where all of those months of casts, crutches and PT went.

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It has been a while since I last posted partly because I have been back to my normal life for the most part and also since there really hasn’t been much to report.  I have been going to PT twice a week for 5 weeks now (minus a week I was on vacation).  I am back to spinning and I can jog a respectable distance without a limp (I am not ready to try and break into a full run yet but at this point I don’t need to unless mine or my family’s lives depend on it).  So the focus has been building size and strength in my injured leg’s calf (right leg) as well as trying to reduce the scar tissue on the tendon itself.  For the strength and size I have  been doing lots and different types of calf raises.  For the reduction of scar tissue I have been massaging, soaking in Epsom and ultrasound to increase blood flow, and of course stretching. 

Early on I was very good at periodically keeping track of my progress in a spreadsheet but I got discouraged and have been keeping track less often.  Below are my measurements for those folks like me who can relate better to numbers.  I know that I probably seem anal about this and should really be happy that I am back on my feet but I am adding new goals as I accomplish the old ones.  The measurements fluctuate wildly depending on the time of day and my activities.  I think I will come close to closing the gap on the difference in my two calves but I am not so sure about the thickness of my tendon because of all of the scar tissue.  Has anyone had made any real progress in either of these areas or am I hopelessly optimistic?  Also, below is a current picture of the scrawniness.

Calf Comparison and scar 13 wks post-op

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I have really been pushing myself hard since I got my boot off last Monday.  I’ve done 4 PT sessions, walked a mile and a half twice, took spin class twice, taught spin class twice and have been to the gym for weight training pretty much every other day, not to mention mixing in band stretching while I am watching TV and using my new Wii Fit (more on that later).  My strength is coming back but to be honest, not as quickly as I’d hoped considering how aggressive I’ve been.  But all the therapists keeps telling me that it takes time.  My yardstick for my progress has been a handy little exercise one of my therapists gave me - simply walk around in bare feet on my toes as much as possible at home.  When I do this, my good ankle stays pointed as I step onto it but the injured ankle can’t quite hold pointed.  For now!

As I said in my last post, the therapists are really big on mixing targeted calf/ankle exercises with whole body strength and balance movements.  For example, I have been doing lunges, farmer walks, leg presses and upright rows from the floor with a 95 lb kettle bell.  But I have also been doing standing calf raises and seated calf raises as well as all kind of one-legged balancing exercises.  In addition to the PT sessions, I have been doing a lot of the PT exercises on my own at the gym.

Spin class has really been great.  I really feel I am building my strength and balance when we do standing positions.  Distance walking has also been great, mostly in building the soleus muscle that runs along my shin which had been unused for 9 weeks so it needs the work.

My wife and son got me Wii Fit for my birthday and this thing is amazing.  There are all kinds of great exercises for balance and strengthening.  There is a hula hoop exercise that I have been ranked 4 stars in that really helps balance and range of motion.  I have been doing about 2o minutes a day on it.

I will miss PT next week as I will be away on vacation but the therapists are confident that I will be doing exercises on my own especially since the cruise ship has a gym and a walking track.

My injured leg calf seems to be getting a little more size with all of the rehab but I will post some measurements next time.

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Yesterday was a great day in my recovery.  Actually it was the second of two back-to-back great days.  Monday I started walking in 2 shoes again with only a little hitch in my step.  So, I went out and walked a mile Monday night.  Tue morning, the only soreness I had was a little in my injured leg but not at the heel - it was a little sore in the muscle that runs along my shin bone, probably just because of a sudden increase in activity after not using my leg for 2 months.  In fact, I have never been a big runner but when I did run, my shin muscles would always be sore the next day but it would go away the following day.  Guess these are what are referred to as shin splints.  Anyway, no soreness there today.

Yesterday I went to spin class for the first time in over 2 months.  I am also an instructor (now on hiatus because of the injury) so it was important for me to get back in the game before the busy season starts in the fall.  I kept the tension light and didn’t do any standing moves since I wanted to ease into it.  Everything felt great!  My cardio has taken a hit over the last 2 months but that’s to be expected.  I will continue to go to spin class 2 times per week and work my way up in tension and into standing over the next month or so.  I had planned on taking it slow but think I will be more agressive than originally planned because of my experience at  my first physical therapy session.

It was my first session and we went right after it.  My surgeon prescribed PT 2-3X per week for a month and my therapist totally agreed after an initial examination (in fact he himself is a former ortho surgeon).  He started me with some core exercises as a warmup which I was not sure of the need for but I am glad we did because I was going to need it.  He believes in target exercises for the calf and achilles in addition to working in more complex whole body exercises.  So I was introduced to the kettle bell and several different excercises.  It really got my heart rate up, my entire body engaged, and most importantly it worked my injured leg’s balancing muscles without me even focusing on it.  After the session I was sweating like a hostage and my legs were twitching.  Even before the injury and without the 2 months off from real exercise, I would still have been huffing and puffing like I was.  I was a little scared to do some of the more targeted exercises like balancing on the flat side of a Bosu ball with only my injured leg or doing shoulder presses standing on the ball side of the Bosu with both feet (thank god).  But I made it through okay.

I did have more swelling yesterday than I’ve had in a long time due to the increased use of the leg.  Instead of ice, the therapist recommended a hot soak with Epsom salts.  I iced last night but will try the Epsom after tomorrow’s session.  I asked him about massage and he agreed to work in some massage next session.  Back again tomorrow to both spin and PT and can’t wait.

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I was finally able to use a right shoe today for the first time since June 5th!  I am now officially out of the boot.  That puts me at FWB in 2-shoes with no crutches at 8 weeks 4 days.  Today was by far my best milestone to date.  All I have is a little heel lift in my right shoe.  I walked around normally all day with 2-shoes and even walked a mile after work, all that and no PT yet!  I barely have even a hitch in my step.  I have no pain and no swelling (although to be safe I iced my ankle after the mile).  The doc must have sewn my AT up very well.  Tomorrow I am going to spin class but I will go easy on the tension and not do any standing.  Just want to get some cardio.  I am also going to call the PT doc to schedule my first appointment, hopefully for tomorrow.  The doc prescribed PT 2-3X per week for 4 wks.  I will be on a cruise in two weeks so I will need to make sure I continue with self-administered exercises that week.  Things are starting to look up!

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Not much to report other than I am very antsy to start PT so I can work my way out of this boot.  I have my next follow up appointment with the surgeon on Monday.  It has been a month since I last saw him when he put me in the boot.  If all goes as planned he will give me the script to start PT and I plan on starting immediately.  I think I am pretty ahead of the game since I have been walking around the house without the boot and been doing lots of ROM exercises on my own.  I have a slight limp but not too bad for just limiting walking to my house, and my range of motion is equal to my uninjured ankle.  Best of all I have zero pain.  I am still not sure where to go for PT but there are lots of options in my area.  I want to go somewhere sports-oriented because of my active lifestyle.  Hopefully my next post will be after a couple of sessions so I can tell you about my experiences.

Took my first business trip since the ATR.  I normally travel quite a bit so the long break has been nice (missed 3 trips due to the their timing and the surgery/cast/crutches).  I have the security process down to a science but with this boot on I had to be specially processed with the wand on the way out to San Fran and on the way back.  The TSA guys were very cool so no complaints there.   It’s amazing how by the book they are as both agents went through the exact same process and explained it to me verbatim while one was in Philly and the other in San Fran.  It just added a couple of minutes to the process which is no biggie.

Lastly, I talked before about my concern about the atrophy of my calf.  Just to record a baseline so I can monitor my progress with PT, I have measured the circumference of each calf at the same point (2 inches below the bony protrusion directly under the knee) and as of right now my uninjured left calf is 16.25 inches (41.3 cm for those of you whose countries are smart enough to use metric) while my injured right calf is 15.625 inches (39.7 cm).  Hopefully soon I can make those numbers a little closer.

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It has been a while since I posted, mostly because nothing has changed in my recovery since I got my boot on 7/10.  For a while there it seemed like things were moving along nicely since every 2 weeks post-op something was happening (new cast, another new cast, boot).  Surprisingly, when I got the boot on the doc didn’t want me to start PT (only ROM on my own) and wanted me to come back on 8/10 and check me then.  So I am in the middle of this, the lengthiest span between milestones so far. 

There is nothing much to report other than I am leading nearly the same life I did prior to the injury (minus any sports of course).  I have been getting around pretty well.  In fact, the boot doesn’t really affect my stride all that much (however, when I get it off I am sure I will need to get to the chiropractor to get my hips back in line since the boot is higher off the ground than my shoe).  I am back at the gym doing upper body as normal which is helping my psyche.  I am not doing any cardio because, to be honest, I don’t want my boot to get all sweaty and stinky.  I figure I can wait a few more weeks until I can do 2 shoes on the spin bike.   I have been about town as normal too - weekend at the beach, Phillies/Iron Pigs games, Eagles training camp, parties.  The only thing that bothers me is after a while standing in the boot, my heel starts to hurt.  Hope that wears off once I start with 2 shoes. 

While lounging at home or while seated at my desk at work I have been leaving the boot off as much as possible (this lets my leg and the boot get some air).  At home, I am walking the short distance to the bathroom and to my kitchen etc. which seems to be helping with my balance and stride.  My ROM exercises have really helped and I think I will be in good shape once PT starts.  Since I haven’t done any resistance exercises yet, the calf is still pretty atrophied but the scar seems to be fading in color and it isn’t as stark as it once was (see pictures below). 

Fingers crossed that on 8/10 my doc tells me I can start PT.  That day I will be on the phone scheduling my first PT appt.

7 weeks post-op calf comparison

7 weeks post-op scar

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2nd Follow-Up: Cast off and boot on

On Friday I went to the ortho for my second post-op follow up (4 weeks post-op).  I finally got the cast off after wearing 4 different hard casts over the last 5 weeks.  The new boot is very comfortable and has an air pump like the old Reeboks (see picture).  Since my last cast was 90 degrees, this boot is also 90 degrees and I don’t need any heel lifts.  It is not really any heavier than my fiberglass casts (I had been worried about that since lots of posters on achillesblog said that their boots we very heavy) but it is a lot bulkier.  So I can’t wear pants with the boot so thanks to my boss for being cool with me wearing shorts in the office. 

The doc said I should wear the boot all the time except for showering and bed.  I was relieved since many achillesbloggers’ docs have them wearing the boot to bed.  He recommended that when I have the boot off I take time to do range of motion exercises although he didn’t recommend any other than just rolling my ankle in the air (I am sure I can find some on the web).  It came as a happy surprise at how good my ROM is.  I really don’t see that much difference between my good and bad ankle and there is no pain.  What disappointed me though is that my doc didn’t want me to start PT until after I see him again in a month.  This was a surprise considering that I thought my doc had been relativelyaggressive thus far.  To compound my disappointment, I got my first good look at my atrophied calf.  I am an avid weightlifter (not competitive or anything) so I had always taken pride in my calves.  All I can say is I have some serious rebuilding to do (see picture).

Best of all, I was able to finally wash my leg.  I took a long hot bath and soaked it, took off the steri-strips and used a loofah very lightly to get some of the dead skin off my leg and feet.  The incision area doesn’t look too bad I guess (see pictures).  There is not much symmetry between my two heels any more but I hope it will gradually get closer over time and with therapy.  So, I am looking very forward to 8/10 and my next follow-up.

DonJoy Walking Boot

4 weeks post-op calf comparison

4wk post-op heel comparison

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