Bittersweet 8 weeks post ATR

hi all,

i attended hospital on Monday, 8 weeks and 2 days after my ATR. I was expecting another week of  having the boot on, but the doctor told me to do away with it. This was very exciting, and I went straight home and proceeded to walk around my living room with shoes on, albeit very carefully, and without putting any weight on my bad foot past neutral flexion.

2 days on and I’m now a bit concerned. I was aware that when you move to normal shoes there will be issues with flexibility and of strength in the calf, however, I literally cannot put any weight on my bad foot as my good foot strides ahead of it, without very strong stabbing pain in my bad achilles. Is this normal? As I said before, I was expecting a tightness that may have prevented me from walking properly, but the pain I get is leading me to believe that if I put much more weight on it in a dorsi-flexion position then the tendon will re-rupture.

is this normal or should I be concerned?

i have been doing seated calf raises with weights over the knee and also plantarflexion exercises with Therabands with no issue at all, it just seems to be flex ion past neutral and into dorsiflexion

i have my first PT appointment on Monday but I really would like some views and thoughts now as Monday seems a long way off at the moment.

thanks in advance, Joe

20 Responses to “Bittersweet 8 weeks post ATR”

  1. Hi Joe, this sounds normal to me. I think there are two reasons. The first is that you probably don’t have much dorsiflexion beyond neutral yet, it’s going to take time to stretch that out, so when you try to step passed your bad foot it will stretch and this will be painful. The second is you will be avoiding putting any weight onto the balls of your foot as this engages your calf and in the boot you’ve been avoiding that for so long - we all come out the boot with a tendency to put all weight into our heel. Because of this, even once your good foot has landed and is taking weight you probably aren’t allowing your bad foot to roll up from the heel to the toe which makes the stretch even worse. I had the same problem and the exercise my Physio had me do was to hold onto something, then step normally with my bad foot and then normally with the good foot making sure that as I stepped off the bad foot my heel lifted and I rolled all the way up over the toes (weight is supported by your good foot by then and you’re holding on for balance so it’s not a calf raise its just a roll through action). I then had to do the same backwards, so still holding on, place your bad foot toes first and rolling onto the heel and then do the same with the good foot. I had to do this all watching my ankles and hips in a mirror to try keep everything even and holding onto a chair or something for support. At first I was scared but going back and forward like that you get used to it and it helps to warm the tendon up a bit and stretch it a little. Helps so much with your gait when walking. It did hurt a bit, I could feel the uncomfortable stretch in the tendon. But as it stretches out this gets less and the tendon never hurt afterwards, only while I was stepping. The safest bet is to wait for your Physio on Monday and in the meantime not worry about it too much. I wouldn’t actually stretch your tendon yet, it’s only 8 weeks so let it get stronger before you stretch it with anything other than walking. And if anything is very sore or hurts afterwards don’t do it. When I say it hurt when I did those walk throughs it was a 2 out of 10 at most, just uncomfortable. The fear of re-rupture amplifies what we feel and that’s a good thing. Re-rupture is to be avoided at all costs, so rather do less and go slower than push it and have to start over. I hope that was helpful and congrats on 2 shoes! Yay! You’re in the danger zone now tho, so be careful! Happy healing! Let us know how things go.

  2. Joe, heel wedges in both shoes will also help. Stuart suggested this for me and it worked a charm.

  3. Thanks Beanie,

    Unfortunately I think your response has confirmed my fears! When you say a pain of 2/10, that is what I imagined would be normal, just a bit of tightness and maybe some aching etc. unfortunately what I get if I put even a little bit of weight on my foot whilst in any sort of dorsi-flexing is a flash of 9/10 pain that takes your breath away and just feels like it’s probably doing damage…

    I guess I’m just going to be taking things very easy until I see PT on Monday.

    With regard to the motion of rolling my bad foot up and through to toes, I can do this, but only once my good foot is planted and taking all my weight, and then the bad leg just goes through the motion but with no load on it…

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

  4. Hello Joep
    Sounds like you and I are in the same boat. I’m eight weeks post surgery and today my surgeon said I can come out if boot and back in shoes, my first PT is on Monday morning. Bit scary really so I’m taking it easy on until I get to PT and am guided on how to walk correctly given the stage of progress.
    I was told I couldn’t rerupture unless I have an event that is not normal, eg twist or fall on ankle, fall down stairs or really hurt the repair. Otherwise expect a little discomfort as normal movement takes place. Just be really careful and conscious of each step and our footing. He did say however there should be minimal pain more discomfort that us short lived. Any really bad pain should be discussed he said. I certainly will feel better post discussion and guide of PT, but have to say very mindful of the fact that 8-12 week mark is a danger zone so remain mindful at all times.
    We must swap notes post our PT session. I do hope all is well with you and
    you can be reassured sooner than later. Beanie has been a great support.
    Beanie 8 have my L’s in in two shoes, so any advise hints & tips most welcome

    Safe healing Robyn

  5. Joep
    Ps
    I did have surgery so no doubt our circumstances are slightly different
    at this stage. I was told due to the technique of stitching he performs that my repair is very strong. I do not know how that compares with non surgery.
    I do wish you safe healing let’s hope it continues smoothly.

  6. Hi Robyn,

    Thanks, it’s great to hear somebody who is at exactly the same stage, albeit after different treatment. I’ll be sure to post what the PT says on Monday! Good luck.

  7. Joe - there could be some adheasions or scar tissue around the injury site which is common. Probably more common after surgical repair but it could still be an issue. This may be the cause of the pain. As you begin to walk they break away and sometimes people have felt it like a pop. They then fear a re-rupture. After the scar tissue is gone dorsi-flexion increases. I would suggest as well you take it easy until you see your PT. Massage of the tendon may help and your PT can advise how you can do this. So far your recovery seems to be going well apart from this pain.

  8. Hey Joe, 9/10 doesn’t sound good but hopefully Stuart is right and it’s scar tissue. Let us know what your PT says on Monday … holding thumbs for you!

  9. Hey there Stuart I’m glad I just read your response as I felt a pop like sensation last night around my repair site, wasn’t too painful, more uncomfortable but definately felt like a pop, followed for a very short period of a little mild stinging
    then it was all fine. I wasn’t sure what happened but the Achilles still felt fine so I just presumed it was part of the healing. Very reassured to read others have had this and likely to be adhesions scar tissue separating. I did have surgical repair.
    I chose to rest up awhile and let it pass. Will discuss with PT on Monday
    Love all the moral support on this site, reassuring and certainly helps to keep spirits high
    Thank you

  10. Hi Joe
    Yes I will be sure to give you an update post PT appointment Monday
    Take it easy in the meantime, look forward to stage two of our recovery
    Rehab & PT
    Safe healing

  11. Thanks again guys - I am hoping it is the scar tissue - of which I’m sure I have quite a bit… If you follow my leg up by gently squeezing with finger and thumb, the heel and start of the Achilles feels as it did before the injury, then you get to the injury site and there it seems to feel in tact but slightly thinner than the rest, and then once you go about an inch above the injury site there is quite a substaitial lump, which I’m presuming must be scar tissue? It’s just a bit strange that it’s an inch above the injury site as opposed to on the injury site - not sure if this is common or not?

    So I’m hoping PT will start work on this and then release some tension and start to remove the pain. I went the whole of yesterday without experiencing ‘the pain’ by just taking it very easy

  12. Hello Joe how did you go at the physio today , I have put my post up detailing how my visit went, I’m feeling so much better and very positive moving forward with the guidance of the PT
    Look forward to your update too,
    Cheers

  13. Joe I should’ve signed off bobbie24 (Robyn)

  14. Hi Robyn (and all),

    Firstly Robyn, I read your latest post regarding your physio and sounds great! And a bit better than mine!

    Mine really just confirmed what I already knew with regard to ROM, all very good, except for dorsi-flexion which is poor. She believes the lump just above the rupture site is scar tissue, as I thought. She said my limp was quite bad, and was due to lack of dorsi-flexion and also loss of strength.

    Ultimately she gave me exercises and stretches to do, most of which I’m already doing, but also told me to start to massage the scar tissue. She didn’t really explain how to do this so I guess i’lol have to YouTube it! Or if you could give brief details of the one you received that would be great.

    I must admit, I am convinced that the route of my tightness and therefore lack of dorsi-flexion is due to the scar tissue, so it would be great to relieve it. I’m a bit annoyed she didn’t offer to do it for me!

    So ultimately I didn’t gain too much, but I do feel i’m on the right path, I just need to keep doing the exercises and start with the massages :-)

  15. Hi Joe
    The physio showed me how to do the massage on the scar tissue
    Firstly get some massage gel something that soothes & slides
    I use natural organic cold pressed coconut oil, comes in a jar great for massage, hydrating & healing. With your three middle fingers firmly concentrate on the area in a small circle, star like pattern
    Up down move a bit to the left, up down move bit to the left and repeat to you complete a circle, then again kind of like making a star or a stick figure ’sun’
    And go over about four times firmly pressing the area out, you move along the scar tissue in these repeated circles
    You’re doing well, light at the end of the tunnel, keep me posted
    It really eased and free the area up and today was great so much more flexible than before. She also showed my exercises to help with dorsiflexion with yellow band. Also foot rolls, Sit with feet flat on ground then do heel toe rolls. Heel to toe then toe to heel. Keep rrpeating these rolls about 15 times two or three times a day. When walking remember to go heel roll to toe, as good leg comes through etc really helps with the limp. Feels much better than limping.
    Part of my visit will be massage and part exercises for the first couple of weeks, then just exercises and manipulation & strengthening

  16. Hi Joe, I’m glad to hear that the pain you are feeling when stepping isn’t a cause for concern. I hope that it’s lessening as the days go by. I only got told how to massage my surgical scar so I’m afraid I can’t help much with how to massage the deeper scar tissue. Surprisingly although I have deep scar tissue, my physio has ignored it. He does release on my calf muscles and in the ankle joints and the bottom of the foot (which hurts like crazy, I really don’t like people touching my feet, so him pressing hard along those muscles sends me through the roof, urg!). If you find some good techniques for massaging away that scar tissue please let us know, I’d be keen to try on my lumps and bumps. Good luck and happy healing!

  17. Hi guys,

    I attempted to massage the area myself on Monday evening, and then my partner did it last night - today is much better already! Today I am much closer to walking normally, and only have a minimal limp really!

    The leg/achilles does seem to fatigue over the course of the day though. Yesterday I did quite a bit of walking and last night once home I was really struggling to walk… woke up today and I’m now walking better than ever!

    Robyn, I just went on Youtube and found this video: youtube.com/watch?v=Yty47jNGJvQ
    The video says it’s for massaging the area generally and for treatment of tendinitis, not necessarily scar tissue, but I used the techniques anyway. To be honest it’s quite difficult to know if it’s the massages that have helped or just time, and everything settling back down…

    Bobbie - I have googled cold pressed coconut oil, the products that come up appear to be coconut oil for consumption (eating), is this the stuff you use or is the oil you use a proprietary massage oil?

  18. Hi Joe, yes the coconut oil can also be in jested, I out a dessert spoon on my smoothies each day to help with internal healing as well. Great all round for internal or external use. Extremely good as is Bio Oil also both from chemist or health stores.
    YouTube does have a video for Achilles’ tendon rupture recovery scar tissue massage.
    Time & massage together I think do wonders.
    I can’t wait for my next PT massage but am doing what she showed me at home it it has made a heap of difference.
    Pineapple is also great in assisting the healing of the tendon it has bromalain in it which actually helps tendon repair can get tablet form from health shop also. I live in Adelaide SA where are you Joe.
    Safe healing cheers

  19. Hi Joe hope all is going well with your progress now and the scar tissue massage is helping, let me know how you are tracking
    Cheers

  20. Hi Robyn and all,

    Sorry for the delay in replying - things were crazy busy over the Christmas/New Year period!

    I’m pleased to report that things just keep getting better, slowly but surely!

    I can now walk almost limp-free whilst in shoes, and when bare-footed at home still have a bit of a limp. The modest heel-lift that most shoes have really make quite a difference compared to walking bare-footed!

    To be honest, I have only done 3 scar tissue massages in total so far, so I guess time is the biggest healer for me.

    I also have been eating Pineapple ever since I ruptured. I found a link on the Livestrong website, which claimed both Pineapple and Papaya had enzymes in which aid tendon healing. I love Pineapple but not Papaya so much, so I just went with the Pineapple. As with most things with this injury, it’s impossible to say whether the Pineapple did in fact have any positive benefit to the tendon. All I can say is I feel my recovery has gone very well, and couldn’t have hoped for much better, so I would say go for the Pineapple to anybody else reading - it can’t do any harm that’s for sure!

    How are things going for you Robyn?

    Ps I am in Petersfield, England

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