Jul 15 2011
Flexibility, slowly losing the limp, and PTs.
Ok, well - I sort of went on a rant about my P.T. session on Wednesday, and then decided to pull down my post, as I felt my attitude wasn’t in the right place and it did nothing to serve other people on this site. I’ll just say recovery (mine at least) is a swing of lows and highs.
For a recap, let’s just say I didn’t feel I was being led by an ATR ‘expert’ at my first weight bearing PT session. I had another session this morning and still feel largely the same way, but I also realized she was right on Wednesday about needing to push my flexibility before I get too ahead of myself in other areas such as strengthening. I was basically at neutral but couldn’t follow through in my step with my bad leg beneath me because of this limiting angle. I could get around this somewhat with the heel wedges in my shoes, but I really wasn’t seeing much progress in bare feet.
So the last few days I really just focused on stretching and trying to increase my dorsiflexion enough to enable my walking gait to feel more normal. I started stretching my achilles just to the ‘edge’ of discomfort as my PT suggested (using a towel to pull my toes toward me, sitting in a chair and sliding my feet towards the chair, etc. ). I assume this is one of the most scary things many of us will do during recovery. After all, at first every time I would put pressure on the tight tendon, the back of my mind is hearing (and fearing) one thing: ‘pop’. But you can’t be afraid forever, and it took me awhile to stop hiding behind the fears and realize the tendon is strong enough to be reasonably pushed (well, pulled - technically).
The stretching really paid off quite quickly. I couldn’t have gained more than 5-8 degrees of ROM in two days but it was enough to make a huge difference in my walk. I ditched the wedges in my shoes and spent quite a bit of time on the gym track focusing on my walking technique. What a great feeling. My limp decreased to the point where my walking motion is not ‘interrupted’ by the bad leg. Right now, it is just limited in the size of step and the amount of push-off my weaker calf can give. This is just fine for now - I’m not looking to burst out of any starting blocks anytime soon.
Perhaps progress in your walking gait doesn’t warrant a full blog post, but for me it was a big deal so I’m sure someone out there also found this to be a milestone. I posted my ‘first steps in shoes’ video last week, so I’ll post another one later this weekend showing my shiny new walking gait.
Footnote: Thanks, Stuart, for your comments to my previous post before I yanked it back off the site 
My doctor didn’t specifically mention heel wedges in shoes, but she did indicate that I shouldn’t expect drastic improvements in my dorsiflexion before our next visit in 5 weeks. The heel wedge idea made sense to me, so I tried it and it felt good. This is where much of the disconnect with my PT was - I was just really taken aback when she acted like the heel wedge idea was the craziest thing she ever heard, as it seems like such a common technique used by other people rehabbing on this site.
18 Responses to “Flexibility, slowly losing the limp, and PTs.”
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Absolutely! Getting that flexiability is huge! The other night I was doing my ROM and broke up some of the scar tissue that was attached to the tendon. This immediately increased my range a degree or two, gave me more comfort, and a little more power. It also made me realize I still have a long way to go, but these “little” milestones are a big deal in our recovery. Right now I’m enjoying the smaller steps that add up to gaint leaps, and all of them are always worth posting. Have a great weekend!
Getting your walking gait toward normal is a bunch of big milestones, Jeff, so don’t apologize for celebrating them! Celebrating milestones is a big part of winning the mental game, IMHO.
OTOH, I generally preach wimpiness and caution on the road to full dorsiflexion ROM. Aggression in getting to FWB seems to be associated with excellent outcomes in the best studies, but aggression in getting to full ROM (e.g., speed of removing heel wedges in a boot) does NOT seem to be associated with excellent outcomes. We also know that one of the most important bad outcomes is “healing long”, which limits plantarflexion strength and ROM forever, and responds better to a re-operation than to PT. There’s no proof of what causes “healing long”, and bad surgery is probably responsible for some of it. But it stands to reason (IMHO) that over-stretching the AT when it’s healing is responsible for a lot of it.
So I’d continue to progress with your FWB and your gradual strength exercises (still in a chair for a while), but I’d preach caution on rushing to regain your full dorsi ROM. Very few of us have experienced long-term dorsi-ROM deficits, and I think virtually all of them result from surgical choices. (The surgeon who repaired my first ATR said he was trying to make it a bit shorter than before, and he did. It worked great.)
Jeff, Good post. I will celebrate with you. Yesterday I was walking bare feet around the house and although my stride was not a long as it was in shoes, I was walking without a limp. I wasn’t even thinking about not limping. It just happened. My partner was there and I got all excited and showed her but the excitement seemed to be lost in translation. I then explained my disappointment at her reaction but I shouldn’t be too hard. She has had to bear with this, as much as me, probably more since she is able to do all the fun things but the person she does it all with is not. She has been so supportive.
Anyway, I thought things had reached a plateau but this gives me more confidence and encouragement. The excercises my PT gave me are really working. I went for another ‘long’ walk yesterday (in shoes and only 3km), picked up my grand daughter and walked to the park for a play. She was very excited. “look Stuey, I’m skipping” Way to make you feel good. Kids!!!
Stuart, the fascination and empathy we all feel about passing milestones (or HEARING about that experience) that bore the @#$%& out of our friends and relatives (including our Beloved Partners) is one of the things that keeps this site alive!
for those of us lucky enough to have beloved partners to help us through this - celebrate them often and in plenty
I have a question regarding walking: The doctor agreed me to ditch my boot into real shoes, however I’m still on crutches. While I’m trying to walk without crutches (barefoot in the house), I can make some small and limpy steps, but my injured foot heel starts to feel sore, kind of missing some cushion compare with my good foot. Do any of you experience this when you first start walking? Is it normal? Is there some muscle or something under the heel need to grow back before we can walk again? (I’m 13 weeks post ATR)
Thank you very much!
dancingbunny,
I had the same problem, and it went away in about three weeks.
dancingbunny, the sole and (especially) heel on my injured side HATED being barefoot on anything that wasn’t deep carpet or foam rubber, when I first started walking bootless. My solution — and that of many people from my “generation” here — was Crocs.
In Crocs, it’s as if you’re walking barefoot on a thick squishy foam/gel carpet, except that you’re carrying the carpet around with you. Of course, there’s ~0 support, so you’re barefoot as far as protection goes, but the comfort from the squishy foam is enormous.
Even several weeks later, the bottom of my bare foot was still abnormally sensitive — DESPITE all those layers of ugly dead skin that most of us take out of casts or the boot!! Accidentally stepping barefoot on an electrical cord, or the little strip across a threshold, or (God Forbid!) a concrete floor, or the rough-soled “exercise sandals” I used to wear constantly at home, would all feel like walking ona bed of nails.
Thank you so much, Norm! This is great information! You are so funny and so upbeat!
Happy healing!
DancingBunny, I do remember that very uncomfortable sensation when I was still non weight-bearing. Particularly, I remember sitting on the chair in the shower and not being able to get my foot comfortable because it felt SO “unpadded”. This went away rather quickly though as soon as I started putting weight on it - I first did this in the boot, which is heavily padded. I’m guessing that since you went much longer than I did (6 wks) to walk barefoot, your feeling of lacking cushion might be greater than mine was and take another day or two to subside - but it will! I think the crocs idea is a really good one - I’ve been using the pair I purchased while in Hawaii over 5 years ago and they are still comfortable despite being very heavily worn down - might be time for me to shop for a new pair too!
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Hearing about you guys strting to walk got me really excited for my recovery. I ruptured my achilles about 6 weeks ago and had my 3rd follow up yest . Doc said i can give partial weight but atleast 3 weeks till i completely get rid of the crutches. Do u guys kno how much longer after tht id have to wear my brace and how long after that id be limping?
Hi Jeff,
Thank you very much for your message! I guess since I didn’t do my share of putting on enough weight while I was in boot, so I have to make up to it now with bare boot. Just to be fair for everyone in the game.
Cheers!
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