9 months out - sort of back to normal

I’m sorry to have neglected posting - but not much happens once you start walking well, etc. :)  I was released from PT at 6 months, and while I’m far from “back to normal,” they couldn’t do much more for me.  I have very limited DF on my injured (postop) leg, and just healed too tightly for some reason.  The surgeon had to trim a lot of tendon because of the explosive nature of my rupture, and set the AT at a “ballerina point”  for the initial few weeks.  Not sure which caused the problem, but I still can’t run due to inability to flex properly.

The good news is that I can road bike better than before, I have plenty of strength in my leg, and am building calf strength and size consistently.  Surprisingly, DF is continuing to improve monthly at this late stage, without tremendous focus on my part - just normal stretching, etc.  I had a setback a 6 months as early calf raises bothered some small tendon on the inside of my ankle, causing excruciating pain when turning the foot inward or pressing on it.  No issues  at any other time, but the doc said to lay off calf raises so it’s delaying my lower leg building a bit.  The AT is stiff in the morning, and I prefer slippers with a slight heel for the first 15 min. of walking and going down the stairs.  After that, barefoot feels better.  This could be due to age as well!

My AT is STRONG - but large - like a stack of quarters.  It’s not visible from the front, so no vanity issues, but I did have to purchase an entire size bigger in shoes making many of my older ones “obsolete.” :(  I’m hoping I’ll get in the old ones again, but it’s not looking good.  A rather expensive inconvenience.  My boots were ok, just anything with a grip around my formerly small heel/ankle had to go.  My AT gets sore after long hours on my feet - but normal activity doesn’t faze it.

I stumble, pivot, and twist all the time now - and no issues unless I irritate that small unrelated tendon on the inside of the ankle.  I think releasing from my bike clips irritates it, but I’m not giving up my biking.  It doesn’t help that at 50 I try to out bike younger neighbors - putting strain on my old legs for pride’s sake.  Pitiful, I know.  Unfortunately, I also got my big butt back - bummer.  I didn’t realize how much of it was muscle!  Seriously, though, I didn’t realize just how much atrophy affected the entire lower body - I can’t fit in my post injury sports wear.  Work hard on those hip/thigh exercises!

I can walk very fast with no limp, but just can’t get the DF for even a jog.  My leg is somewhat like a fused ankle, and my knee can’t take the strain when I try to run.  No pain, just technically impossible right now.  I’m hoping that the DF continues to increase - we’ll see.  If I sound nonchalant about the running thing, it’s because I didn’t do much before the injury anyway - my knees are shot from years of high mileage when young - so biking is my main pursuit now.  I’m able to throw a ball and move quickly to catch with kiddos, so other than the need for dodging traffic in China, my goals are mostly met. :)  I would probably be running now if I really cared, but I haven’t worked hard to get that back - please don’t let that discourage anyone. I expect that will come back in the next few months.

On a sad note, I lost my handicapped parking status one week short of Christmas.  Parking with the peasants is not fun during the holiday season, so that’s one thing I miss post injury, haha!

My sympathy goes out to those who are rehabing and in the early weeks.  It seems so much longer than it really is.  Hang in there as it really goes quickly once you find things to accomplish during the down time.  I learned great admiration for those for whom this is a way of life - injured soldiers with permanent disabilities, etc.  Their stories were very inspirational and I recommend seeking them out when you get “down in the dumps” about it all.   I’ll try and add a pic later to the post, so you can see what it looks like at this stage.  Best wishes to those working to get back on your feet.  Blessings, Kim

Gaining DF at 18 weeks

Just a quick update to say that I’ve gained some DF this week - coinciding with swelling subsiding.  The main difficulty with DF seems to be scar tissue and skin all sticking together around the ankle, but it’s loosening with more fast walking.  Despite increased exercise, my swelling is really slight as well!  The only thing different has been extra fast walking each day (I was relying mostly on biking) and swimming laps with kicking.  The kicking really seems to loosen the tendon as well.

So for those of you fighting lack of ROM, I think it’s more than just healing short in my case - more mechanical restriction of all that glued together tissue.  You’re not doomed to be short forever at 3 mos. like my doc said - it continues to loosen (like the folks here said!) Pic below is after a long walk - I’m a little swollen - but not much.

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I’ve been able to get about an inch off the ground for a single calf raise, and my AT feels really strong and flexible.  My calf is building every day - it’s slow but steady.  Just waiting for the rest of this scar tissue to release and I’ll be back to normal.  Hang in there, newbies - it goes fast once you’re able to start WB - no need to rush.  Blessings, Kim

Tool to help balance

Just a quick post to show my favorite tool for leg strength and getting balance back:

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It’s really HARD to do - unlike the therabands - and you can see the strain in the balancing foot on the left to grip the floor while you hold your stretches: forward, side, and back.  It really helps your hip and butt strength which dwindles during the cast stage.  After doing these a week, I was MUCH more stable when standing on my single injured foot.  I got mine from my therapist, but they’re cheaper on this site:

http://www.ballsnbands.com/rloop_rehab_loop_bands.html

The owner is a friend of my PT.  The band is really soft - but hard to stretch - I wish I’d used it sooner as it’s really helped leg strength.  I also used it for shoulder and arm exercises when my crutches made holding dumbells painful.  GREAT tool and pretty cheap.  Make sure you ask your therapist WHEN you can use this thing - I started when I was FWB HTH’s someone.   Kim

16 weeks - feeling stronger/shoes

Hi all,

Life has gotten busy again (after I said I’d learned to take it slower!) and I have less time to check in.  I wanted to post some of the challenges I’m experiencing in case anyone else runs across them.  Overall, I feel much stronger, can walk without a limp when warmed up, but limping is my default position when I’m not thinking.  I’m still DF challenged - and while making progress, I am no where near the uninjured leg.  Here are two comparisons:

injured leg at back

injured leg at back

uninjured leg at back

uninjured leg at back

So even though the AT feels super strong (PT calls it a stack of quarters) - it doesn’t flex much and I’m afraid at some point I may re-injure it.  I’m not particularly careful or stressed about it anymore - so the fear is gone - which is good.  Like many, I have to stretch a second or two after sitting a while if I want to walk comfortably.  If I wear my running shoes for long periods, they cause a lump on the AT from the heel irritating it. I stick mostly to my Merrells and Crocs for now - they have a tennis shoe bottom but no back:

Merrells

 Crocs

Crocs

Lower backed black sneakers

Lower backed black sneakers

The skin on top of the AT does not move freely and it appears that the scar tissue underneath is stuck together and limiting my DF.   The PT works on this each week - but I only have 4 sessions left on my insurance - bummer.  Any suggestions about how to loosen this myself?  I do the massage - but it doesn’t seem as effective as the ultrasound/deep massage/suction cups they use at therapy sessions.  Here’s a pic of the scar after workout:

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I yank the sock up to keep the shoe from bugging it.  I still have swelling in the evenings - mostly on the outside which is where my DF seems inhibited also.  Still have the indentation at top of scar which is tissue sticking together and makes stretching difficult during DF.  I can do double calf raises, but can only get about an inch up on my injured leg alone.  Not sure if it’s mental or physical, lol, but I definitely feel the exercise on the doubles.  I’m starting to build noticeable calf muscle - but am no where near the uninjured leg.  I limp when walking barefoot all the time - I really need shoes or slippers on to walk normally.   So….that’s about it! I can keep my foot down all the time without discomfort - HUGE blessing compared to even a month ago.  It appears to be tied to the muscle development.  Can’t run or really walk fast normally(I can limp at a good clip)  - but I can navigate uneven ground easily and do the stairs with a little accommodation over the edge with the injured foot.

I LOVE doing single calf raises in the pool - do this as soon as you’re able!  It’s a great morale booster.  Did anyone else struggle with single calf raises at 16 weeks?  I keep  moving foward - but it’s micoscopic progress with DF.  I’m not sure how to release all this scar tissue that seems to be holding me back.  It could be that the tendon has just healed short as well - won’t see the doc till next month.

The good news is that I’m in excellent shape from all the rehab exercises, biking, and weight lifting - and my hips and upper legs feel good from the band exercises.  I’m just patiently working on my calf.  The band exercises have contributed the most to my good balance on the injured foot and overall ankle/leg strength.  Get one of those r-loop thingies (see previous posts) from your PT if able.  It has been a huge help.  Would love any advice from veterans for dealing with the scar tissue.  Blessings, Kim

14 weeks; Making Progress in DF

Hi all,

There wasn’t much to post last week, so didn’t do my weekly update (which is mostly for my own benefit in marking progress!)  The slow progress is discouraging sometimes, but at least it’s a continuous forward crawl - no backwards movement.

I am now walking pretty easily during the day - when I focus on using the ball of my foot.  It’s easy to slump back into limping when I haven’t stretched the tendon after sitting or I’m just not thinking.   When I first get out of bed in the morning, my AT is tight and I need to stand and stretch a few moments before walking normally.  It warms up before I get to the door of my bedroom and I can walk fairly well.  Ditto after sitting for long periods.  I’ve found that walking more brings progress faster - even more than PT and biking.  I can do two legged calf raises, but am putting very little injured leg into the lift.

My DF is about +6 active, and +14 passive.  I still have to get it there with a lot of stretching.  Here’s pics of the improvement:

img_1401 img_1412

The atrophy looks bad - but it is MUCH better and calf muscle is coming back quickly.  It looked like a 100 year old leg last month. :)  This is a pic of the scar and swelling mid- afternoon after PT and biking:

img_1409

And here is my eversion/inverson:

img_1415 img_1414

For those who are struggling with ROM like I did.  I’m getting there - slowly but surely.  Last but not least, my straight leg DF is better but still WAY away from my good leg’s ability:

img_1404

And this is with a fairly good inclined walker shoe. Not so great, and it’s what’s causing my biggest problem with normal gait.  My AT is TIGHT - and really only feels loose after a good hour of biking and PT.  Once I cool down, I’m really not very flexible again, and have to purposely get it warmed up by walking and stretching.   Sooo…I’m not where many are at this stage (which drives my sick, competitive nature nuts :) ), but life is getting back to normal and I’m able to do everything I need to, albeit slowly.  I’m still unwilling (not unable) to get back on my road bike as I don’t want to chance a bad hop off before 16 weeks.  I’ll stick to stationary as I only have TWO MORE WEEKS for that magic number…!!  I know, ryanb and eastcoastrunner - I’m a wimp - but I’m just so close and my AT is so tight, that I feel like a hop onto my injured heel would re-rupture at this point.  I just don’t have the DF to compensate for any sudden load applied.

I still have significant adhesions and the swelling gets a little worse at the back in the evenings - but not much more than you see above.  I shopped for back to school, visited a friend in the hospital, and walked over a mile easily with 4 wild kids during a 6 hour outing in shoes the other day.  I had swelling - but nothing noticeable by others. I wore dress shoes to Church with no physical repercussions- and that made me happy.

So I’m thankful to be where I am - and learning patience about getting to where I want to be.  I can take care of my family again, drive the cars, and clean the house.  I can move quickly if needed, but can’t run yet.  I’m in really good shape despite the limitations and my calf gets stronger everyday!!  I can really feel it when I walk.  Sorry for such a boring update - but "life as usual" is what I’ve been craving for these last few months - and that part is back. :)  I’m feeling good about my progress, and seeing a light at the end of the tunnel - PTL.  Praying for those of you just beginning this journey and thanking God for the little things I can do that I used to take for granted. Blessings, Kim

12 Weeks! Good news/bad news

Today I’m at 12 weeks - and have mostly progressed since my post last week!  The good news: I’m walking better, am much stronger, and have gained some dorsiflexion.  The bad news:  I’m much more swollen, still have a large adhesion (or just dent) near the top of my scar, and still feel really tight after much walking.  Here are the pics of the swelling and DF against the wall.  Compared to my last post, there’s quite a difference in both.

img_13901

img_1405

The swelling is worst at the rear of my outside ankle bone.  My AT is sore when I take larger strides and sometimes pulls painfully at the heel or higher if I try to go too fast.

My balance is getting better on my injured foot as the PT has me doing leg lifts to the front, side, and rear while standing on the foot.  This forces all the associated muscles to tighten in my injured foot/ankle to hold me in balance.  This week, the PT added leg presses and hamstring curls.  I don’t like the latter as it puts a lot of pressure on my AT - but my hamstring is really weak.

He’s also introduced this tool - which I really like:

img_1389

You put it around both legs and do the above leg lifts and it really helps at the hip/hamstring area.  I also used it on my arms for flies, etc., since my hands still bother me occasionally from the weeks on crutches.  I’m continuing with the theraband exercises and seated calf raises.  I need some extra weight - should I put a book on my leg?  Trying to get creative at home.

The PT really (painfully) worked the suction cups on my scar and I lost several adhesions.  The big dent isn’t going anywhere and it might just be the way the tendon was sewn together. :(

I don’t think I’m walking enough as I’ve kind of gotten used to my invalid outpost and working from my chair. Not good.  But the more I walk, the more I get set back with swelling - there seems to be a fine line there and I haven’t found it.  I still can’t do two leg calf raises without a lot of pain, so haven’t pursued them yet.  I think I need to work up the ladder with maybe some weights on the seated calf raises?  Still going down the stairs backwards when carrying stuff, but can go down forward with my injured foot half over the edge if I’m walking hands free. (not sufficient DF to reach the next stair with the good foot.)

The trend is forward, but I have some really tight AT, limpy, discouraging days.  On those days,  I look back at my own blog and see how far I’ve come - and that gets rid of any blues!!  Praying for all of you who are still in those early days.  It’s gets better fast - starting at week 4. :)  Blessings, Kim

Freaky looking adhesion/DF issues

As I’ve walked in two shoes with limited DF, my AT has become more swollen from the yank on the push off.  Now I can see a large "sticking point" that wasn’t there before, and it seems to be where the AT "sticks" on stretching.  Does anyone have experience with this?

img_1390

It also looks pinched from the side - the good leg doesn’t have this catch in the AT:

img_1392

I’m gaining strength quickly in the calf as I just began working it this week with seated calf raises and therabands.  Unfortunately, the leg is completely atrophied, so it will be a long haul.  I experience the same "hitch" in the calf raise that I’ve heard about from other posters.  I also have a harder time with standing leg lifts on the good leg since my injured leg’s outer muscle isn’t as strong in supporting the lift.  It looks ok from the front - but the skin is taut around my ankle bones from swelling near the heel and I need an extra half size shoe:

img_1380

The right leg looks really bad from the back - no calf muscle at all.  Here’s a pic of my DF - it’s pitiful - and this is with the heel in my shoe:

img_1382

My DF is really bad since I stopped wearing the boot.  The boot kept my foot in a constant flex - I thought I was imagining it - but I actually went backwards in DF this morning after sleeping fairly PF’d last night. I’m considering wearing the boot to bed…ugh.  I’m having a hard time getting flat today. :(  I put my foot in the boot for about 30 min this am and cranked it down to +10  - now I’m in pain.  Of course, it’s PT day, so I win "idiot of the week" award since this will make the PT’s "massage" particularly painful now.  What is it with Mondays and motivation to "get this injury done??" sigh.

The doc said I’d have good days and bad days.  I think I’m creating my own bad days with lack of patience.  The good news is that I’m getting MUCH stronger on the stationary bike - almost ready for my road bike again if I could just lose the fear of hopping off at the end…I also feel more comfortable "pushing off" in my stride - but still have to do it on purpose since the "habit" is a limp now.  I’ll let you know what the PT says about the adhesion…it doesn’t seem like anyone really knows anything about this stuff - but the hole and sticking point at the back of my AT (looks worse in person) gives me the creeps.  I want it gone.  Blessings, Kim

Two Shoes!!

Better late than never! ;)  Finally saw the doc today and he told me that I could go to two shoes permanently.  When I asked him how long each day, he said, "as tolerated." So I’m wearing them all day.  The boot isn’t very tolerable to me - so what’s the difference?  I guess I’ll wear the boot if I’m out and about - or maybe not.  I don’t feel "insecure" in shoes at all.  My heel hurts if I don’t consciously use the ball of my foot - which is not so scary anymore on day 2. No more wearing it while sleeping, either.

The doc is looking into something called a "flexi0nator" or something like that as he concerned about my lack of DF.  He basically said I’ve only got a few more weeks to gain some flexibility and then I’ve "got what I’ve got."  Bummer.  I think I’m already using one of these at PT - it doesn’t help as much as ratcheting down my boot.  I may try this to the really high DF angle - it’s painful - but so will limping be for the rest of my life…

Last but not least - he told me that without a fall and with normal use, I am not going to re-rupture my AT and to quit worrying about using the ball of my foot and calf.  I’ve read so many stories about people re-rupturing in the 8-12 week period, but he says I’m worried about nothing.   So00…I started by vacuuming the house and cooking in my two shoes - no problem other than a fat ankle after about an hour or two.  I’m going to elevate and then go at it again.  I really hope that loosening the scar tissue and walking around will get me some DF.  The stretching alone isn’t doing it.

One last item: I found in the last week of my boot that going down the stairs backwards was MUCH faster than having to do one step at a time forwards.  Just a thought for those who hate going slow.  You don’t need DF for backwards. :)  Blessings, Kim

9 weeks

img_1376

The good news is that you can barely see my scar - it’s really healing nicely.  Bad news is that my leg still discolors when down and not putting a lot of weight on it.  It’s ok when walking, but when just standing around, I still don’t have all the pumps working well.   This is an afternoon shot when the swelling is worse.  I have some adhesions at the lower part of my scar behind the heal, but the top of the scar is completely flush and disappearing.  I have a big lump near the top of the scar to the inside that I can feel when massaging the leg.  The PT says I need to work it out with deep massage.  She told me I need to use this tool - which is the same one they use when they torture massage my scar at PT.

img_1369

Although my knuckle works just as well, it grosses me out to feel that lump, so I prefer to use this.  The pointed ends work very well on the adhesions (puckers) behind my heel, but the last ones just don’t want to come.  My AT is too narrow at the bottom to use the small suction cups.

I have added seated calf raises and theraband stuff (minus the DF one) to my PT each day, and I get stronger every week on the stationary bike.  I tried to sleep with the boot off for a full night, but felt sore the next day when stretching into my boot.  Half nights work ok - but the whole night was too much.

Next Wed., I start to wean from the boot at 10 weeks - whatever that means.  They still don’t want me to use the hinge function till next week - and I pulled the back of my calf/AT pretty sharply while practicing the other day.  No damage done - but it didn’t feel good.  I guess I’m an example of slow protocol - but it was a pretty ugly AT blowout.  I feel good out and about - but definitely get swelling if the leg is down to long or I walk too much.    I make incremental progress in DF - but still can’t get more than +5 on my own - which is the problem with using the ROM boot function.  Hope this helps somebody who’s looking forward!  Blessings, Kim

A Roach and near re-rupture

I am not making this up:  we’ve lived in our home 18 years and rarely find a bug.  This morning, a week after the pest guy was here, hubby woke up to a monster roach crawling on his leg.  He jumped out of bed, and it crossed my mind that if I’d done that without my boot, it could have been trouble.  One hour later, sitting downstairs in a chair with boot off, a ROACH crawls up my leg!  I swished it away, and the dang thing crawled up my shorts!! I freaked out, jumped out of the chair and landed on one barefoot - the injured one.  Hubby saw it happening, jumped out of his chair with his coffee, which promptly flew all over my laptop keyboard.  The roach then jumped out of my shorts and hubby killed it.  I just stood there trying to figure out if I had re-ruptured my tendon or not - it all happened so fast and it was just pure reaction…

I didn’t feel much pain when I did this the first time - so it was very scary.  The Thompson test never works for me - so I just moved it up and down and it looks like everything is working and still tight. sigh.

Doc called later today and said no getting out of the boot till 10 weeks and I’m not arguing.  Who would have thought such a stupid thing could have put me back to square one - I was so mad at myself!  On another note, I guess the AT is doing ok since I jumped onto it and it held…(I hope!)

Doc also said that I couldn’t do 10 degrees DF until 10 weeks - my PT has already forced it to 14 - whoops.  At least I won’t have any more forced pushing on my foot (which they promise won’t break the AT)  I can only get about 3 up on my own. He did say I could do 0-10 ROM on the hinge, so I’ll try that this evening.