Archive for December, 2014

10 weeks post-op - Towards a new year

So, it’s been another week, and I feel like I continue to make progress. I’ve started to walk at my normal pace and stride with a normal push-off during the last week. Sometimes (first thing in the morning etc) I still have a bit of a limp until the foot warms up a bit, but other than that walking is completely normal. I’ve also transferred to using my normal “minimalist” shoes for longer walks instead of more traditional sneakers, and that is working well. Also going up and down stairs more normally now, although not fully loading my weight on the front of the foot yet.

It’s also gotten better with the workouts, I’m now doing up to an hour on the elliptical or the bike, with no pain or strain. I still use a higher rpm rather than a higher resistance for the longer runs, but comfortable doing an hour with an avg HR ~155 with no problems. I’ve started to also mix in some more interval-type training with higher resistance periods mixed in. I’ve been going to the gym twice a day on most days, with a longer work out in the morning and more strength focused stuff in the evenings. The physio protocol of heel raises etc I do twice a day. I’ve started increasing weight on the heel raises more toward the injured side on the slow descent specifically, and I can feel it is slowly getting stronger, but still a ways off from doing a single raise. The calf visually looks better as well, with some muscle definition starting to come back, and the swelling around the tendon seems fairly limited (probably what it will look like for a long time).

So it’s been a happy week, I have been tempted by the treadmill a few times just to try it out, but have decided to hold on that until the next physio in two weeks, no point in doing something stupid now. Generally I feel like I’ve gotten to a good point in ten weeks, and can start the new year feeling like a normal fully functional person again, even if the road to truly being fully functional is still a long one.

Happy New Year to everyone!

EDIT: Finally got around to adding the photo of the current state of the scar as well. So this is a week earlier at 9 weeks.
9 Weeks

9 weeks post-op - Progress (slowly)

Been two weeks since I posted last, didn’t really get to it in the pre-holidays hassle. But things have continued to be generally good with no significant issues. Progress is noticeable, but painfully slow, I’ve come to appreciate the term “frustrating plateau” :)

I’m now 9 weeks post-op, and three weeks into two-shoes. Walking has gotten gradually better, almost at a normal stride now. I naturally have a fairly long stride and I’m a fast walker, so not quite up to that level yet, but walking with a more conservative stride happens without a really noticeable limp now (depending a bit on the time of day and what I’ve been doing). I’ve been somewhat religious about the rehabbing and trying to really build strength in the leg. Basically my standard routine is the one I included in my previous post, but I’ve added some time on a stationary bike as well (more for cardio than necessarily building strength). I can comfortably now do about 45 minutes on the bike without issues, noting that the longer runs especially I do with low resistance and a higher rpm (EDIT: I’ve now today also added the elliptical to my repertoire, 30min no problems, but a pretty “flat-footed” approach). Also a lot of heel raises and squatting as well, two-footed heel raises are no problem with weight evenly distributed, I do 3×15 twice a day at the moment, and the same with seated heel raises leaning on my knees for weight. Generally it feels very good to be back to doing cardio that really makes you sweat, mentally that has been important. ROM also continues to get closer to the healthy foot, no tightness in foot when e.g. squatting below parallel, getting back to the usual point where my hip flexors are the main issue in really squatting ATG :)

Otherwise it’s a bit of a strange period, I feel that (apart from exercise) I feel close to being fully functional in terms of everyday life, but the jump from here to being really fully functional is a long one. Sometimes I think that there is no progress, but then I think a week back and realise that there is progress, even if it isn’t the “big steps” of moving to FWB, two-shoes etc. At the same time, I’m painfully aware that I’m just hitting the peak period for re-ruptures, so I don’t want to push too much until I hit the ~12 week mark…

Decided to also transfer my rehab to a warmer climate for a couple of weeks, and took off to Thailand. Actually this was originally meant to be a golfing trip, but now I can focus on my rehabbing instead. Two days in, it has been great, no freezing snow to worry about, walking around bare foot, and just combining easy lounging with long gym sessions without a rush to be anywhere :)

Finally, I’ve been reading a number of the new stories on this site, and really come to appreciate my OS, his approach to rehab and recovery. When there is no evidence of a longer casted period or longer NWB/PWB period having any benefit (mostly the opposite, within limits), I think I would’ve gone mental spending a long time on crutches especially (the boot was manageable FWB). Also now that I have a better appreciation for what that muscle atrophy actually means in terms of strength (not just visually), I have become a believer in minimising that with early FWB and physio. I commend the people for enduring 10 weeks in a cast / PWB, but at the same time I know that knowing what I know now about the studies and protocols, it would’ve been difficult to take. Even if the results (for surgical) even out in the long run, the difference in quality of life is huge for that time period… (/end rant)

I wish everyone a great holiday period, stay safe and recover!

7 weeks post-op - Mixed week

Well, it has been a week of mixed feelings. Went to two shoes a week ago, and the first couple of days were, in a word, frustrating. Moving from walking around very comfortably and quickly in the boot, going to fairly tender and slow walking was a bit challenging. Even knowing that it is good progress, it felt almost like a step backward, certainly in terms of mobility. After a cozy four weeks in the boot it was definitely a wake-up call for how long this process is, and how early it still is for me.

Anyway, once I got over that, I got back to work. I’ve been walking quite a bit now, and it is actually getting better by the day. I’m still not really pushing off the front of the foot properly, but it’s close. I find that I need to actually concentrate on walking in order to walk more properly, if I don’t I have a more pronounced limp. When I concentrate, I can walk almost without any limp at all, especially barefoot (for some reason I find it more difficult in shoes for now, might be the pressure on the tendon). In the last couple of days I’ve actually been happy with the progress again, as I’m getting closer to walking around at normal speed, and there has been no pain or swelling at all throughout the process. So for those who are struggling a bit the first days in two shoes, don’t let it put you down, you’ll get used to it quickly.

Finally, had another physio appointment today, and she was again very happy with the progress. Should maybe be noted that I don’t go to a physio to actually do the workouts, I go to check on progress and go through the next set of exercises that I then do on my own. In addition to the basic ROM and atrophy follow-ups, did a test on how far from a wall I can stand flatfooted and push my knee to the wall, managed to have my toes 9cm from the wall (compared to 14cm on the healthy side), which was actually better than I expected. Also tested how well I could squat and a couple of similar things, all of which was actually surprisingly good compared to my expectations. Then we went through my new rehab routine, which I’m supposed to do daily. In case someone is interested, it now involves:
1. Back squats, not below parallel for two weeks, allowed some small weight
2. Split squats, with back foot on bench, some small weight allowed as well
3. Standing two foot heel raises, initially with part of weight on table etc support
4. Sitting heel raises, leaning on knees for weight
5. Toe raises leaning back to wall
6. Balance exercises, standing on one foot etc
7. Three different stretches (two more for calf, one for tendon)

This new routine made me very happy, as it is starting to feel more like real exercise and strengthening the muscle, rather than just maintaining mobility.

So in summary, after a somewhat frustrating start to the week, I feel like I’m back up to speed and on track again!

6 weeks post-op - Two shoes

Had my 6 week post-op check up with the surgeon this morning, and progress has continued to be good. He started by checking the tendon and the scar, and was happy with both, the tendon is clearly continuously there as it should be, with no significant bumps etc. Scar has also continued to heal well, so no issues there, got some instructions on rubbing the scar in a certain way, in order to maintain movement between the tendon and the skin and prevent scar tissue build up. Generally the swelling around the area is according to him as expected, but actually fairly limited.

Moved on to checking ROM, which he thought was very good for six weeks (I have only a very slight difference on the dorsiflexion compared to the healthy foot at this point, barely noticeable). Finally he had me test a couple of two foot heel raises, which I managed fairly ok, although the strength in the injured foot is clearly somewhat pathetic. Calf atrophy is clear, but he said that he has seen much worse as well. In the end he cleared me to move to two shoes from the boot. I’m meant to walk with a “normal” gait, and roll the foot to the toes as normal, but just leave out the final push from the injured foot for the first week or so, depending on how comfortable I feel. In addition, I was cleared to start some other activities (swimming, stationary bike, squatting with minimal weight, etc), basically the instruction was to not do anything that causes pain, but otherwise fairly liberal. He was also very clear in pointing out that although my progress has been good so far, that as I now don’t have a constant reminder of the boot on, to be careful and bear in mind that it’s still early on in a long process. The expectation now is that if there are no setbacks and progress continues to be good, at 12 weeks I should be able to start running on a treadmill and incorporate some heavy resistance work for the calf to properly recover strength, which sounds very positive to me.

Also had a brief discussion with him about the differing protocols for treatment. He basically said that he prefers the fairly quick transfer from cast to FWB and from boot to two shoes primarily as he believes that (in addition to the easier life for the patient), it obviously helps reduce the muscle atrophy and losing strength in the leg. This in his view helps recover quicker to normal activity, as after the initial 10-12 week period it is the lack of strength rather than the tendon itself that is the main challenge, and as much as that can be avoided early on, the easier the recovery. For him the only benefit of longer periods in cast / boot is to protect the patient from themselves (i.e. not being careful enough).

I’ve now been walking in shoes during the day, and it is actually going pretty well. Clearly my stride isn’t really normal, but I am able to roll through the injured foot without any pain or without feeling like it is stretching the tendon. Walking is still slower than it was with the boot though, but it’s not crawling at a snails pace, hopefully as I get more comfortable and start getting used to this, I will be able to get back to normal walking fairly soon. Will during the first week at least use the boot though in higher risk environments, like when heading out for a few beers tonight to celebrate my freedom from the boot (while wearing the boot) :)