jeffk58’s AchillesBlog

Congrats!

Thanks for your post, and congrats on moving forward!

I am 30 days post-op and agree already that this site is a great resource. I’ve learned a lot from the folks ahead of me in recovery, and appreciate your taking the time to provide some encouragement.

I’ll do my best to pay it forward 11 months from now, as well!

Great stuff.

Hi JeffK – Your “4 Months/Spinning Along” was one of the first blogs I read when I had my surgery at the end of August. It was one I re-read from time to time because it was inspirational and something I could look forward to. I just passed 4 months and glad to be at similar stage in recovery. Good to hear you are doing well and are near the end of your journey. I will be re-reading your “8 Month/Final PT” update in the coming months. I agree with Kim’s comment, it is incredible to have a larger calf after all your hard work. Good luck and Congrats!

Jeff - You are the first poster I can recall who has reported an injured calf now larger than the other one! Way to go after that rehab!Good luck to you as you get back on the tennis court!

David - I am going up with both legs and then down on my injured leg. I am also doing some single leg raises with my injured leg, but can only do about 5-10 reps at most. Just had a fun session with my PT. A lot of balance and agility drills on the ladder - including some jumping! All a bit scary - but I have learned to really trust him.

Wow–good stuff, Jeff! Your running is nearly 1 month ahead of mine, so your return to court should not be far off at all. My PTs wanted me to be able to hop 1-footed before being given clearance. Not to be too technical, but as I understand heel raises now, going up is a concentric contraction (shortening) while going down is an eccentric contraction (lengthening) of the Achilles. I find it a little confusing since I think of any contraction as a shortening, but apparently not here. Are you going both up and down with single leg, or going up with two and then shifting your weight over to one leg before going down? -David

Hey Boredoutofmymind - when you get clearance to ride let me know - I will come join you for a ride out through the Mosier tunnels and we can swap ATR stories over a cold beer at Double Mountain! I am still holding out hope that I can windsurf this summer (perhaps wearing the boot to be safe), but that may be pushing the safety envelope just a bit too far

Chris - others describe it better, but you place your injured foot on the stair tread with about one-half hanging off. That way, you are not stressing your AT as you step down with your good leg. I also hold on real tight to the hand rail!!

What trick do Norm and the others use.

Chris - I can go up stairs normally, going down use the trick that Norm and others have shared. I do not sleep with it elevated, but continue to ice at least once a day. Went for another bike ride today - PT claims riding one of better exercise activities for AT rehab - low impact and builds both strength and ROM.

Very nice! Can’t wait to be more active again. Hope to make similar progress by week 12.

Jeff, glad to hear you’re progressing nicely–and 3-weeks ahead of my schedule for road cycling! I’ve been biking now quite a bit and I totally agree that it’s a great feeling. Keep it going! -David

Nice Jeff. Glad to hear things are going well and thanks for the light at the end of the tunnel comment. Hopefully I can get back on my road bike in a month or so.

wait at 3 months you are walking like it is nothing, are you walking up or down any steps? DO you sleep with your leg elevated.

Jeff, I’m glad to hear your vacation is going well so far and your Achilles is holding up! You’re on the road to “getting back to normal” now. Just pace yourself and don’t overdo things and you should be fine. -David

That’s great. Enjoy!

Thanks for the golf advice! I think I will do the first round in the boot just to be safe, but will surely be doing an “abbreviated” swing as well.Sorry to hear that you have joined the ATR club - best wishes for a speedy recovery!

By the way, at 6 days post op, I’m surprised every day at how little pain I’ve had since injury and anticipating a speedy recovery. I’m going to Ireland in 3months to the day and don’t want to miss out on playing!

…risk the drift to your toes and and force a more explosive, “jump swing” which will definitely put more pressure on that Achilles.

I’m 6 days out of ATR surgery and a golf pro at a club in Boston. I play a good amount of local competitive golf, so I’ve done a lot of thinking about the injury and how the swing will work around the flawed Achilles in the last week.
Remember this if you think your return to golf might be a little early… The most common swing flaw for amateurs is the old adage of “I don’t keep my head down.” The fact is, your head stays right where it belongs (on your shoulders) and your body “jumps” to adjust for faulty mid swing balance. The vast majority of golfers have their weight drift into their toes as they swing, they innately feel a sensation of falling forward and they push out of the toes (rise or jump) to adjust. This common move seems like it is going to cause a lot of trouble for the ATR golfer. If you are felling like you are not yet 100% but have to play! my advice would be to learn to swing from a position where you balance more of your weight in your heels so as to not

It always does. I was a bad golfer with a good AT, so it likely will not be pretty. But when Dad is 88 years old and still likes to golf, you take one for the team

Jeff, I haven’t golfed yet, although I have thought about it and also thought it’d be OK at this stage. It’s just not as much of a pull to me as tennis and cycling, so I can more easily resist (although, a family event would be harder). I would suggest using a cart, if only to limit the time on your feet. If you walk it, plan for increased swelling and some time to rest and ice before you go out for drinks and a meal afterwards (assumption!). Also I’d just be generally careful of your footing on any and all uneven or hilly terrain you encounter. Let us know how it goes–and my last bit of advice, unrelated to your ATR, is to hit ‘em straight! -David

As long as the game doesn’t ruin your walk!

Congrats Jeff! Enjoy the game.

Jeff, I actually moved pretty quickly. I had very little guidance about the process and didn’t ask for details either. In anticipation of the official boot-weaning period, I started experimenting a week early–although very limited. Then, during the first week of my 2-week boot-weaning period, I only used my boot on 4 separate occasions where I felt the surroundings (terrain and/or people) put me at risk. Otherwise, I was in 2-shoes or barefoot all the time. At the end of week 1 I decided to go cold-turkey and ditch the boot altogether. Perhaps I moved a little too fast, and that may be why my ankle swelling picked-up during that second week, but I felt confident that my foot was ready to support me sans brace and I don’t regret it now. I think you just need to listen to your body and let it guide you on how fast to move along. Good luck! -David

David - how quickly did you “ramp-up” the two shoes? My doctor said start at about an hour the first day, then add an hour or two a day. I already cheated a bit, as I did 3 hours today

Jeff, congrats on moving to 2-shoes. It is a little scary at first, but soon you’ll be looking to banish the boot to the basement, attic, or out at the curb! Keep up the PT (and the RICE) and incrementally increase your walking–focusing on using a good and normal gait. I did notice an increase in swelling after initially moving to 2-shoes, which felt like a regression, but I think it’s due to increased activity and re-energizing muscles that were immobilized in the boot. Swelling peaked for me a couple weeks after 2-shoes status and has since gone way down. -David

Jeff

You’d be improving your mobility and recovering some ankle flexibility if you could put some ROM into your boot. As an example, Exeter’s protocol allows for 30º pf to 0º at 6 weeks (and then to 10º DF but I certainly wouldn’t recommend that you go straight there. You might want to try 5º or 10º more each week, and I guess that you might want to talk to your doctor first… You have a good boot - use it well. Taking it off at night I hope?

As far as I know the Vaco boot has just the 2 soles, so easy-peasy really, with the wedge being suggested for settings from 10º pf to 30º pf. I seem to remember moving to the flatter sole at 15º but then I was on a go-faster schedule!

H

I had an earlier, pre-Vaco version of a ROM boot (and an AirCast for the first 7 weeks of ATR #2 rehab), and I don’t recall any problems walking right after angle changes. The simpler older boots don’t have the Vaco’s multiple soles, which may introduce some complexity, I’m no Vaco expert.
And around week 7 of ATR #2 rehab (and much later in ATR #1, post-op with a super-conservative OS), I started letting the boot hinge from my basic angle down to pretty extreme equinus = plantarflexed (as far as my ankle would flex), which gradually increased my walking speed until I was the fastest walker in my gang of friends!

Jeff, glad things are going well for you. BTW, you can edit your own blog posts after they’re published–so you can correct your error without commenting on it. Every recovery milestone seems to be met with an initial slow-down as you get used to the new mechanics. On the Even-Up, mine also was losing the bottom layer around the edges after about 4 weeks, but it made it through my 6-weeks of boot walking in OK-shape. Thankfully, I don’t need it anymore! -David

Love mine…made PWB with the crutches much easier. Doc saw my evenup at my followup yesterday and he loved it. He wrote the info down and i shared with him how to order one. Raved about mine to him. To those that read this…get one, get one, get one!

I did push the Even-up specifically, because I’ve used it personally and found it to be extremely helpful. In fact, I’ve shown it to both my OS and my PT and both were very interested in it–and neither had ever heard of it. I went so far as to recommend to my OS that they should dispense one along with every boot given out–as a set. -David

Hey, I just push evenness, not any specific technique. (I used a hiking boot with a fat insole outdoors, myself, and a Cast Shoe - similar to an EvenUp - myself.)

I imagine those first few steps felt fantastic. Great job!

Keep on keepin’ on!

IIRC, RyanB wrote that he evened up his gait just by bending his booted knee. Not for me, but you may be able to make it work. Perils include hurting your back, knees, hips, etc., OR learning a new way to walk that you have to unlearn (maybe with PT help) later.

Jeff, I’d recommend the Evenup shoe to balance your leg lengths–it makes both PWB and FWB in a boot much, much better. I bought mine on Amazon for ~$30 (well worth it). In fact, I think these boots (mine is an AirCast) should come standard with an Evenup–it’s that important. You really can’t develop a good gait when your booted leg is an inch longer than your other leg. -David

Most of the Vaco protocols with the great results, like Exeter, go at the speed of the very successful bit.fly/UWOProtocol which is faster than the ones you’re all on. So NOT so aggressive, though we’ve seen slower too. If you’re all post-op, the evidence suggests that there’s little or no harm from going slow, apart from spending extra time impaired for no clinical benefit. (For non-op patients, going slow has clinical costs and risks, too.)

Tennis is what got me here…when I’m back, I’m back in the saddle. Horses seem like a better bet than the court:) I had the cast on for 2 1/2 weeks, boot will be on for four this week. The lifts are out but I’m not able to walk without the crutches yet. Boy oh boy, I can’t wait for that. They said I could be in the boot up to 12 weeks. Or possibly shorter…I guess it all depends on the healing. I’ll know more when I see the doc on Thurs for my 1 month check since I got the boot.

It’s always interesting to see the differences in post-op protocols. You were 2 weeks in a splint (me, same), but you went straight to the boot while I spent another 2 weeks immobilized in a cast. However, at 4 weeks we’re back in sync–in a boot and PWB. Then, at 6 weeks, we remain in sync–still in a boot, but FWB (this is where I am now). We deviate again at 8 weeks when you’re expected to ditch the boot and go “2-shoes”, while I’m to wait til the 10 week mark. Hopefully, we both eventually end up back on the tennis court right where we left off! -David

Love the tumbling in mud story! How could you do anything else but laugh? Not hitting your freshly repaired leg was all that really mattered. Especially after you had to wait all that time to finally get it fixed.

I’m right with Norm as well - ATR became my #1 fear many years ago when a few of my father’s tennis friends did it playing in their game. I filled in for them and heard the stories and timelines for recovery. I actively ski & bike much like yourself as well as do high impact plyometric workouts, TRX one legged strengthening, balancing etc., but playing competitive tennis twice a week is my true love and something that I want to do well into my 80’s like my father still does. This is where I most feared this injury, and I went ahead and did skiing awesome fresh tracks in CO in my tight ski boots!

I also loved getting out of the house and continuing to move around right after surgery. It feels great to get out of the house and focus on anything other than your leg. Getting exhausted is totally normal. No matter how much we want to remain normal, your body is experiencing traumatic changes. Stay positi

That’s a great out look! No doubt you will have a successful recovery with that kind of attitude.

What Norm said. I was surprised at how many of my tennis playing friends knew about ATR. It gave me the impression that this is fairly common in the sport. Your post op baptism must have been quite a sight. I can imagine your son’s expression. I think I saw that a few times on my kid’s faces too

For an ATR (unlike say a head!), tennis is way scarier than cycling or skiing. And the better the traction, the scarier!

Sounds like the new non-op cures didn’t get a full and fair presentation, but that’s still very common, especially in the States. Check them out if you’re unlucky enough to join me in the “both sides now” club.

And huge congregations on having the inner calm to manage that roll into the mud puddle, instead of instinctively “saving yourself” with your post-op foot! Very few of us ever pulled off that move, though most of us got a chance!