Thoughts and progress 9 weeks out
Saw my surgeon the end of last week for a nine week check-up (and my last freebie, cuz insurance deductibles kick in again January 1st!). He reassured me that the daily minor swelling is normal as this point and may continue as I increase my activity level.
Thoughts at this point in the journey:
1. The surgeon told me I’m 80% healed, but the remaining 20% is what will take the rest of a year. That 20% is very apparent to me but not at all apparent to those around me. “Are you running again?” Not yet.
2. Listening to the achilles is key, especially once you’re in two shoes. I’ve found it’s important not to change more than one exercise activity on any given day, that way if my achilles reacts, I know the culprit. I’ve been walking, cycling (heel only so far), deep pool running, and lifting weights. None of these activities hurts or strains the achilles while I’m doing them, but sometimes the achilles is sore and swollen after. If the soreness and swelling is still significant the day after, I rest. In week 7 I walked 3 miles on the treadmill because it felt great. Ended up having to take a 5 day break from activity because it was too much, too soon.
3. It’s very easy for something to accidentally affect the achilles. Today a 30+ mph wind caught the door as I was entering church, with one arm full of music. I instinctively braced against the force of the door, afraid I’d lose my music. My achilles still hurts from that. Skipped my workout this afternoon and iced a couple of times. I think it will be okay tomorrow, but if not, I’ll take it easy as far as activity.
Progress:
- Walking without a discernible limp. Everyone comments on how I’m walking so much better than I did before the surgery. Of course, I had been limping for 2 years every time I got up from a seated position….so “better” is relative.
- One-legged heel raise at 9 weeks. At my surgeon’s request, I tried a heel raise at my last check-up. We were both surprised when there was lift-off, and I did three of them. Of course, I was pretty sure my achilles was acting up the rest of the day because of it, so I skipped my scheduled pool run that evening.
- Able to walk up to 3 miles at 3 mph. Cycling up to 60 minutes at a time, still using heel-only on the surgical leg.
- Surgeon gave approval to begin closed-chain PT activities, such as eccentric calf raises “as long as it doesn’t hurt to do it.” I have PT tomorrow, so am anxious to begin strengthening the gastroc and soleus muscles.
Happy New Year everyone!
Kyle Said,
December 30, 2013 @ 9:22 am
kimc, appreciate the update. I will be 2 weeks post surgery in a few days and really hope to be as far along as yourself at my 9 weeks. I know everyone is different and I am really going to have to learn to be patient. Your post has already made my day because of your comment about PT in the pool. I hadn’t thought about that at this point. We live in a condo on the beach and have a nice pool as well as a full gym for all my workouts. Another interesting pick up on your post was about the limp. I have been dealing with the pain in my heal for many years and any extra stress I put on it would inevitably result in several days of prominent limp. Ironically, I actually beleive the pain after the complete rupture and before my surgery was less in the area. Of course I had no use of it. Point made it that I really understand your comment about “better being relative”. Thanks and have a Happy New Year and continued progress toward being better than before.
kimc Said,
December 30, 2013 @ 11:29 am
Kyle,
Hope you’ll get an ok to move into a boot at your 2 week mark. That made such a difference in getting around and beginning to feel some progress. A cautionary statement about the pool, which I have no doubt your doctor will address: The surgical incision needs to be completely healed, without any scabs, before you go near the pool. Too much risk of a wound infection. That said, the deep water pool running is a great workout. I started these workouts when I moved to two shoes, approximately 6 weeks from surgery. You need to wear a flotation belt so your feet don’t touch bottom. I just used one of the kiddie learn-to-swim belts they have at my gym, but there are actual running belts, e.g. The Aqua Jogger. You “run” intervals. For instance: 5 minute warm-up easy jogging, then 30 minutes of :30 run and :30 jog followed by a 10 minute cool-down. You can also do pyramid intervals. I wear a cap and clip my iPod to the bill so I can listen to tunes while I’m working out. It’s great for all the leg muscles, and you don’t stress the Achilles with weight or much if any dorsiflexion. Great cardio workout! Wishing you well in your recovery!
normofthenorth Said,
December 31, 2013 @ 1:55 am
Nice write-up, Kim! You’ve got the idea about being incremental, but you also keep overdoing! It’s obviously not enough to stop exercising when it starts hurting. Often, you won’t know for hours or even a day if you went too far, so it makes sense to stay close to what didn’t cause pain YESTERDAY! Fine to add 5% or 10%, but not to discover that you can do your first 1-leg heel raise, so you then do THREE! (Months after my first ATR — of 2 — I suffered a 1-MONTH setback from doing roughly the same, prompted by my #$%^& PT!)
In addition to the no-contact aqua-running, a pool can also be used to do all kinds of leg exercises with light contact, i.e., fractional body weight from the buoyancy. Some people are paying big bucks for a similar experience with the new-fangled AlterG treadmill, but people with pool access can get the same effect. Start in deep water, and gradually get shallower and shallower as your strength/healing/ROM improve. Good for body and spirit both, because you can do lots of things in the pool that are still out of reach on dry land.
kimc Said,
December 31, 2013 @ 9:12 am
Always good advice, Norm! Keep in mind….it was my surgeon who asked me to do the heel raises:)
Happy New Year!
normofthenorth Said,
December 31, 2013 @ 11:33 am
And my PT was a Trusted Expert who had never done harm or given me bad advice until the day she told me to do as many 1-leg heel raises as I could. My fault too, because I knew it was too much too soon, and told her so. She insisted, and I crumbled to her “authority” like an idiot!
missedstep Said,
January 1, 2014 @ 2:06 am
Interesting the differences. I was in a boot at first post-op (2 weeks) and have been no weight bearing until yesterday, at 6 weeks. I am expected to be in-boot until at least next visit in 4 more weeks. I have a hard time imagining two shoes at nine weeks, but, then I have only just begun FWB at the moment. First set of two heel raises this morning - I felt almost like I was faking it and the good calf was doing all the work.
kimc Said,
January 1, 2014 @ 1:15 pm
missedstep,
There certainly does seem to lots of variations in casting, length in boot, and moving to partial and full weight-bering. I do think the two protocols most often mentioned, Exeter and UWO, both begin partial weight-bearing at two weeks. I was non-weight bearing two weeks, then into the boot with crutches, moving fairly quickly to full weight bearing.
For me right now, most of the discomfort and pain I’m having is hip and back-related. The tendon seems rather quiet and happy most of the time, but I’m sure hearing from points higher up the chain! My surgeon and PT say it’s because the debridement and Haglund’s removal has changed the mobility of my foot rather dramatically. It’s moving more like it should now, but that means everything up the chain is being stressed in a new and different way - on top of being rather inactive for several weeks.
Best of luck to you in your first weeks of FWB.
normofthenorth Said,
January 1, 2014 @ 1:34 pm
Kim, make sure of a coupla things:
(1) even up your feet/legs by somehow building up your strong foot so it’s as high off the floor as your booted foot. Walking uneven is bad for the bod.
(2) Make sure your stride is as normal as possible, PWB & FWB. The only exception ever is stride length when you’re first in 2 shoes, when it’s good to shorten yr stride when walking past “that” foot. But yr toes point forward not out, yr knee flexes and pushes forward as you roll from the boot’s heel to its toe. Never lock or hyperextend that knee, using yr leg like a crutch or pegleg. RyanB has a vid that’s helped lots of people.
Many of us found boot-walking FWB fast and comfy, and very few have had bod problems if they were using the boot right. Building up a shoe or hiking boot… isn’t trivial, unless you buy a cast shoe or Vaco Even-Up to do the job.
kimc Said,
January 1, 2014 @ 5:04 pm
Norm,
I’ve been out of the boot 4.5 weeks now and am now, at week 10, walking with normal stride length, no limp, in 2 shoes. I didn’t have any hip or back issues in the boot because I used an Even-up. The hip and back discomfort has come with increased mileage in walking. It does seem to be new territory for the surgical leg. Before my surgery I wasn’t walking normally at all. I usually has a pronounced limp, almost no dorsiflexion in the bad ankle, and could only walk on the outside of the foot. So it probably makes sense that normal motion in the “bad” foot now produces discomfort elsewhere.
normofthenorth Said,
January 2, 2014 @ 2:39 am
Sorry, Kim, but I think I remember your situation better now. I wld have had an easier time recalling on your blog…
You and your Doc may be right. Hope it resolves OK. Having discomfort after walking too far with long strides and no limp at 10 weeks in, is what many would call an Enviable Problem!
kimc Said,
January 2, 2014 @ 7:45 pm
Norm,
I was in cycling class this morning, considering whether to “up” the amount of time I was clipped into the pedal with my surgical foot. Two days ago I tried 10 minutes and that seemed to go okay. However, I had a rather strenuous workout yesterday. Sooooo, I found myself thinking, “What Would Norm Do?” WWND. Wouldn’t it be cool if we could all install a WWND app on our phones?
I’m just trying to say a big THANKS for all you do for everyone who finds this site. You’re awesome.
normofthenorth Said,
January 3, 2014 @ 4:52 pm
Thanks for the thanks, kim — AND for the lol!
janis Said,
January 4, 2014 @ 8:56 pm
Kim,
So you would recommend the EvenUp? I have been doing some WB on the down low at 6 weeks out (supposed to be PWB with two crutches, shhhh), but my hips are killing me from the unevenness.
Also, those that use the pool when pwb, how do you get out? I am dying to do something, was thinking I could do some stationary bike and swimming with a pull bouy at LA Fitness.
Same procedure, 11/20/13.
Hopalong Said,
January 4, 2014 @ 9:44 pm
Hi KimC
I found swimming very useful. Eased off the shoulders/back and PWB at chest height gave one the confidence to carry on on dry land. With a buoy, swimming also became my go to phys. Re getting out of the pool, I parked a chair with crutches by the pool. Heave out of pool using arms and park bum on poolside. Repeat onto chair, grab crutches and you are away! Either that, or you could test the lifeguard on their rescue skills!!
Good luck
Hoppy
kimc Said,
January 4, 2014 @ 10:57 pm
Janis,
I certainly thought the Even-up was helpful. I also used various heel lifts and shoes to find good height matches with the boot.
As for getting out of the pool PWB, it looks like Hopalong has it figured out. I didn’t start using the pool until I was FWB (because I still had a small scab on the incision…had to wait for it to completely heal before getting in the pool).
Hopalong - I wish I could swim, but I’m an awful swimmer. Instead, I just strap on a flotation belt and “run” intervals in deep water, using the lap clock to keep track of my intervals. I should consider this an “opportunity” to work on my swimming, huh?
anne Said,
January 5, 2014 @ 12:27 am
I bought the even up and didn’t really use it much. It slowed me down. I like you felt more comfortable using various heeled shoes to accommodate the unevenness.
I started running on an AlterG at 4 months (when almost all surgeons and foot specialists give the go ahead for running) and what differentiates this from pool running is you can manually select the weight percentage. So I started running at 30% body weight and I’m now up to 50% but I ran 5 miles and it felt awesome.
I can only do a single heel lift at 70% of my body weight, so bravo to you on your single heel lift achievement.
I got rid of my limp pretty quick, what’s proving to be elusive is strengthening the ball of my boot. Sigh.
Congrats on your progress~~~
normofthenorth Said,
January 5, 2014 @ 1:38 am
Anne, if you’re doing exercises (or walking or running) in a pool, you can select the weight percentage by choosing a depth. Obviously, at the side of the pool you’re FWB, 100%. And standing in deep water, up to your chin, you’re pretty close to 0%, likely lower than an AlterG can go. In-between, you’re in-between.
Can you do static exercises like heel raises on the AlterG? Certainly no problem in the pool. Running in water is a bit weird because of the extra resistance, but that just adds to the work you’re doing!
I actually never once made it into a pool during my own ATR rehabs, but people here have consistently raved about the exerience and the physical and spiritual benefits. And whether pool or AlterG it seems obviously helpful to be able to rehearse normal movements with PW, before you’re strong enough to do them with FW.
kimc Said,
January 5, 2014 @ 6:55 am
Anne,
I am definitely going to use the AlterG when I get the ok to start running. Luckily, my PT facility has one, and I used it when I was going through a round of PT in 2012, trying to cure my tendonosis.
You know, I have no idea why I can do the heel raises. It’s not like I did anything to earn it, I think it’s just an oddity in my recovery.
I’d like to know if you experienced soreness and swelling when you first started walking and using the tendon for exercise? Gotta say, I do feel paranoid about any soreness, so afraid of starting up the cycle of tendonitis. Does your tendon ache after using the AlterG? The next day? What were you doing at 10 weeks/3 months?
anne Said,
January 5, 2014 @ 6:49 pm
Hi…..
I was just telling my friend about your heel lifts at 9 weeks. Still, congrats!!!!
As for swelling and soreness - while I was in the boot (week 6-11) I was walking outside, using a recumbent bike, and recumbent stair stepper. I was not sore during the exercise, but once I got off the machine I had some momentary weird sensations my doctor said was normal. My foot felt stiff in the mornings.
Week 12 - i started on the AlterG. At this time I could do single heel lifts on the AlterG at 30-50% of my bodyweight.
The huge game changer was walking backwards at an (4-8%) incline in the AlterG. When I first got out of the boot my foot was pointing outwards when I walked and although I had great strength, the ball of my boot was weak and that only comes out during certain exercises. I was completely flat footed. It felt easier than thinking about my forward motion walking.
So walking backwards immediately improved my dorsiflexion, improved my balance (comporting yourself on the AlterG is a bit challenging at first), and naturally (passively) stretches several different areas of your leg. I had a vy lengthening procedure since my ends wouldn’t go together and I’m not allowed to actively stretch my calf for 6 months. (I’m not complaining since I hate stretching).
At about 3 months post op I went to Cali and walked a lot and I experienced a lot of swelling which I attribute to the long flight and walking in sandals, but my feet felt trashed. I could do a single heel lift in the AlterG at 50-70% and sadly I haven’t improved from this.
At 4 month (22 weeks) I started running at 30% of my bodyweight. Ever since I started running, my performance has been inconsistent and it’s a slow incremental pace forward. (Sigh) We started off at .25 run and .05 walk. I am now at 50% of my bodyweight and running up to 7 mph. So this is the rub, every body weight % point means something to me. When I start feeling an ache in my achilles or my heel, i reduce the bodyweight until I don’t feel any pain and if I have to go down too much, I stop. You should know, I was never ever a runner before this injury and I decided I’m coming back stronger than before my injury, so I’m pleased with my progress, but you will probably be able to start more aggressively than I did since you are doing well with the heel lifts. I found the ball of my foot is the weakest.
I haven’t felt sore longer than 1 day, but it’s not my achilles or calf that’s sore, it’s the inside of my foot. When I practice my heel lifts or try walking on my toes, my foot substantially fatigues and I can’t continue and usually have to give it several days before I try again. You probably wouldn’t have this issues since your able to do heel lifts. I found that I run much better when I’ve had a few days of rest.
Right now at 5.5 months, I feel great but I have setbacks every time I improve. I bought a water rower and my achilles does tinge a little but I can finally push off my toes. This has been the only exercise in which I feel my achilles and it doesn’t feel bad, but I feel it. Rowing and running on the same day was a no/no.
If I could sum up my experience thus far, I felt forward momentum up until I started running. Now it’s back and forth, but I am still making improvements.
I will stop rambling now. I am sure you will do great!!!
anne Said,
January 5, 2014 @ 8:14 pm
Oh I forgot to mention. My good leg gets really sore. Which kind of surprises me because I was pretty active before my injury. But my calf, achilles, and quad of the good leg get sore all the time.
Take Care.
adrienne Said,
January 14, 2014 @ 10:17 am
This is a really great post with loads of useful comments. I’m only 4 weeks out and PWB - though supposed to be working towards FWB. My heel is killing me (like a deep bone pain - i had part of the heel shaved off) so I’m afraid the transition will be slow. This post just gives me lots to look forward to. I hope to be doing as well as many of you at the same time juncture. Happy healing!
kimc Said,
January 14, 2014 @ 2:49 pm
Adrienne,
My heel was very sensitive early on where it was shaved off and also where some calicification was removed. At 12 weeks it is still a bit sensitive in those areas, but not painful. The surgeon says those areas may continue to feel a little weird because there are a lot of nerve endings there. I would say “weird” is a better descriptor for how it feels now rather than “sensitive.”
Wishing you steady healing.