Kevin’s AchillesBlog

Well I hit the 20 week mark and All is quiet. There hasn’t been alot of change since last week. Part of the problem is last Wednesday I took a long 6 miles walk and did some strengthening (Calf Raises, Squats, and balancing exercises, and therabands) and 30 hours later my Soleus Muscle and tendon(s) around my ankle started bothering me. Last week my Physical Therapist said, “You over activated the muscle and have some delayed muscle pain, so everything is fine”, but I’ve still been stiff and hurting from this 5 days later. This put a damper on any strengthening exercises for the rest of the week. Although, I did take my daughter on a 2.5 mile hike on Sunday. Minus that, most of this week has been work, ice, and elevation. Today PT said that I overdid last week and have a little Peroneal Tendonitis. I’m suppose to ice massage and rest for a few more days and he said it should correct itself by my next appointment on Monday, so I’ll  be good as new and ready to go back to my full workout again. Has any other bloggers had issue with this? If so how did you treat it?

Also, my Workers Comp decided to end of therapy session kind of abruptly, so I did my best to get a few more appointment. After some conversation with the RN admin and my case worker they agreed to 6-8 more appointments, then switch over to home therapy. Today we reassessed and everything looks good minus the inflammation around the Peroneal Tendon and my strength deficit, so we decided on Therapy session once a week so it will be close to when the doctor clears me for Plyometrics.  My Physical Therapy place also has an alumni program for patient (30$ a month) such as I so we can continue our programs (especially some water Therapy) after getting off of our insurance until my pool is open for the season. I plan on doing this rather than a new gym membership, while finishing up my last few appointments.  After the ALumni program I’m going to join the gym I haven’t been to for a really long time. I still plan on doing these enrties weekly long until 25-30 weeks, so to anyone out there who is just starting their journey to recovery, it only gets better with time, and you have plenty of it. Keep positive and happy healing.

I just got back from the doctor with a new PT prescription (Hopefully, this will be approved by workers comp), he still doesn’t want me to try any plyometrics until after my 6 month appointment in Late March/ early April (maybe longer) and said to focus on plantar flexion and not worry about dorsi. We had a long discussion about my operation and recover, it went a little like this….

You didn’t have a normal ATR repair Your [stale]  injury and subsequent reconstruction was very extensive, but you should be very happy with the results. Remember you had a disconnected Achilles Tendon for 4.5 months and were 2 months NWB. Other patients of mine who had your reconstruction could be in the boot for up to 6 months!

Also, I expect the reconstructed tendon to be slightly longer than the left AT, but you are doing excellent right now and are ahead of schedule. This surgery was probably the best result you could get for this kind of  (stale)  injury and reconstruction, and again you are only 4 months post op, you need to give yourself time to strengthen. Kevin, your tendon is in tact and you are building strength from your last appointment and you are making a great recovery.

Now he did state you could op for a second surgery, to get a possible better result, which you would have a hard time convincing workers comp. you need, but I wouldn’t recommend  a second operation or any other varying treatment to any of my patient at this point  until after you seen the results 8- 12 months from now, so you can see the deficit of strength from your ATR leg.  He then went on to say your right AT is slightly longer now and there will be a strength deficit, much how mush is TBD,  and so far I’m extremely satisfied with your recovery.

The doctor said to keep on working on plantar-flexing, walking/hiking, and strengthening and I”ll see you in 8 weeks. I told him I was concerned about the pain on the top of my foot and the pressure I get on my AT when trying to walk long distances or hike. He said it’s probably from scar tissue and being NWB and injured so such a long period of time. He said that I need to be patient since the tendon is just finished healing and I need to spend time strengthening what was repair, and rebuilding my calf. I still think I’m going to have a hard time getting to a single-leg calf rais and I might join your club Norm ;), but again I’m more concern with my functionality not my competitiveness. He also seemed to imply that he believe that I could get back to 80-90%, although that is yet to be seen.

I’m much better off than before the surgery, that is a given, and I agree that I have a large amount of Atrophy, but I have yet to start  any explosive activity and have only been strengthening for 6-7 weeks.

Sometimes I feel like this doctor is  a good surgeon, but doesn’t do a good job explaining things to his patients. So, off I go for a quick hike before taking the kids to church tonight, and here’s to as close of a recovery that is possible. Ill keep everyone posted.

Another week down in the road to recovery and only a few new things to report. Physical Therapy is still focusing on strengthening and ankle stability. I also managed to complete another 5.5 mile hike this week, although I still feel like 5-6 miles of hills and trails is my limit.

Early today we hit the Mountain Bike trails for what turned out to be a mud hike after the winter weather from yesterday.  Again, 3 miles into the hike I felt pressure and tenderness around the lower end of my AT and ankle. I’m starting the believe this is all related to the weakness of my calf. There is an extreme difference of size and strength between my two calves. Nonetheless, it felt great to finish 5.5 moderately hard miles of hiking with some discomfort, but not near as much (pain) as last time I went out with the kids early last week. I’m just focusing on the small steps during this time of less improvement from week to week.

Physical Therapy is becoming more focused and intense, mainly focusing on strengthening of the calf and ankle stability (which is still an issue).  Everything now included added weight. 30 lbs weighted step-ups, 30lbs weighted squats, 220 lbs double-leg presses times 60, 110 lbs single-leg presses times 60 times. I’m up to 100 80 lbs single-leg weighted calf raises and 160 lbs. of double-legged calf raises. whew!  Most of the rest of my workout is on the Nautilus bike, and different balancing exercises, with my leg slightly Plantar-flexed. I usually do this my using a foam pad, or textbook.  I’ve also started backward walking on the treadmill on an incline in the off position. This is alternated with weighted walking (30-40 lbs.) for now. The most noticeable difference now, is my calf is gradually starting to rebuild some tone, although I’m still fighting the uphill battle of 7 weeks NWB.  :(

My biggest concern has been my ankle stability, because up until the last few days I was having a large amount of joint pain in the top of my foot. The other day in PT JAmes wasn’t to check this out and said he thought my right ATR ankle was less stable/strong than the other. IT kind of feels loose compared to my left. HE said, “Time for some new exercises, but I’m going to have to think about this one”.  Anyway, has any one else on this site dealt with this joint pain in the top of there foot, or ankle instability? What did you do about it?

Here is a a few pic from this week showing the progress of my recovery.

This first one is basically just a comparison of both legs/calves. You can see the considerable difference between my ATR right leg and left. Hopefully, I can get most of my lost strength back.

On my PT and calf strengthening days, I tend to do some double-calf raises top try to work on the range of motion, but notice how the ATR (right) leg is closer to the ground than my left. Its better than a few weeks ago, but still needs a lot of work.

The dorsi-flexion is my ATR leg is within 5-10 degrees of my left. Getting this back came after about a 4-6 weeks of working on Active ROM. I’m now starting to work on more therabands and stretching with both legs.

This picture really highlights the massive difference in muscle size and mass between my right and left leg. I predict lots of calf-raises in my future

Here is my wimpy attempt at an assisted single-leg calf raise. I’m using both set of fingertips on the counter to offset some of my weight. Hopefully, I’ll be doing these unassisted in another month or so, but I feel I still have a ways to go.

In the end this whole process is about the long term result, but we keep our selves motivated and sane by setting shorter attainable goals. Achillesblog is a place we all can ask questions, get support, and vent. Canm anyone think of another website where people obsess over blogs and pics of each others calves, and ankles than Achillesblog…… I think not.

My PT was doing an informal evaluation today and said he thought my right ankle/AT area wasn’t as stable (felt looser) than my good leg. HE was playing with the stability of my flexion in different directions with each foot. I couldn’t tell a difference, but he sure did. I can see how my left ankle feels a little tighter than my right, but up until this point, I wasn’t concerned. HE said he believed that this could be the cause of the joint pain on the top of my foot. This all began when I went 2-shoes, but has gotten better over time, although the pain is still there, especially when walking down stairs, doing lunges (leading with my good leg), and walking down hill.

Has anyone else had some experience with this? Should I be worried about it, or is this just something that many ATR people go through. Any help would be appreciated, especially since I’ve read some things on this site about healing long. Thanks bloggers.

BY no means was I running at the trails this week. I still have to much of a strength deficit to do this successfully. But I did manage to get out there and hike 5 miles with the kids yesterday.  Other than that it has been a pretty quiet week. I feel like the pain is subsiding a little, but I still  suffer from stiffness and pain when I over do it at PT or walking. The only changes this week is my PT is now focusing strictly on strengthening my calf and balancing (to strengthen the calf). I feel like I’m still fighting this uphill battle against all the atrophy from 7 week NWB. SO basically lots and lots of calf-raises. I was a little discouraged when my new PT James said he thought it could take another 6 months before I will be able to do a controlled single -leg calf raise. I feel that its possible. They also seem concerned with my gait and want to correct that since I don’t push off my toes because of the strength deficit. They tell me as this happens over time, the pain will subside. So I’m trying to push my self to do more reps on the leg press machine and double-stair steps and much more power walking, side-stepping, and backwards walking in the pool.  My biggest accomplishments this week was taking the kids put to the Angler’s Park Mtn. Bike Trails for a 5 mile hike. This is the same trail I use to like to run a few times week, and hopefully will be back there doing just that in a couple more months.  The hike left my shin on my good leg throbbing, so I know I’m still compensating for my lack of strength. Anyway, here are a few pictures from our hike. Hopefully, in another month, I’ll have enough strength to hit “Witchback”, which has alot more incline/decline.

Went on my first over 5 mile hike since my injury eight months ago ( 4 months months since my surgery). My girlfriend and I hiked Moses Cone Manor near Boone, NC up to the Firetower. The hike is mostly uphill, in the snow so the incline was’n issue, but fatigue didn’t really set in bad until mile 4.0, while going downhill. I think my tendon got fatigued and swelling some, towards the end it felt like someone pinching the back of it. I was also, a little swelling and soreness that evening, but felt great the next morning (minus the stiffness). I’m not anywhere close to the endurance I want to have for backpacking, but I can visualize the progress much better after the last week. Anyway, it was good to get back out and we got some good pictures.

Here is a map of the trail off the Blueridge Parkway. IS was so cold my phone died, so that is the straight line that didn’t follow the trail.

Here are a few photos.

The mountains over Moses Cone Manor

On top of the Firetower

The Firetower

A Couple of Panoramic Pictures

Well this week the biggest changes have been increasing my strengthening exercises and working on some technique to do this. My physical therapy is progressing great and although the recovery seems to have slowed down, I have a feeling its going to pick up again. My PT feels that our goal will be to increase my strength to a controlled “hopefully” one-leg calf raise before my 90 days appointment (which now falls on April 8th). 2 months from now. Maybe it will happen sooner, but my doc said no explosive exercise until then anyway. Not that I’m even ready yet (See paragraph 3).

The biggest news is today at PT We decided to gauge my AT and calf by seeing how much of a one-legged calf raise I could do. I worked up to 120 lbs. (Although, I didn’t really get it all the way up). SO I’m going to go low and say my limit is 110 lbs about 60% of my body weight, although hopefully I can take off 10-15 lbs in the 2 months also I was able to work 60 with 20 reps,  80 at 30 reps, and 100 at 20 reps! So, the next step is to increase the strength of the calf, AT, and work on my balance. I still plan on working on walking on my off days, taking rest as needs and using this format for my PT workout 3 times a week.

Land Workout

1. 10-15 minutes Stationary Bike (starting at Level

2. 30-50 Double stair steps leading forward and 30-50 from side stepping

3. 120 lbs. 30 times working hamstrings / 105 lbs. 30 times with Quads

4. 30 One legged squats on 6″ steps (Bending knee and touch heel of good foot down) or Wobble board calf raises

5. One legged Balance exercises with ball bounce (30 times each of 3 directions).

6. 180 lbs. 30 times Leg press

7. 90 lbs. 30 times One-legged leg press

8. 80 lbs Weighted calf raises 30 times

9. Mobs / Joint Manipulation

10. RICE (15-20 Mins)

*** (90 minutes total) 3-4 times a week

Water Workout

Treadmills 10 mins. at 3.0-3.5 mph

Backwards walking for 5-10 minutes at 1.5-2.0 mph 5 minutes

Side-stepping at .5-1.0 mph 5 minutes

Double Stair Steps 30 each leg

Squats and Single-leg squats 30 each leg

Calf-raises (shallow Water) 30 times

Single-Calf raises (Deeper water) 15-20

Hip Flexors (3-way) 30 times

Total workout (30-40) minutes

My weight (and/or reps)will be increased over time and I’m sure to substitute different balancing exercises at times and cut things out if I need to rest. Also, once or twice a week I’ll do a water workout with mainly calf-raises, jogging, side steps, stair steps, and  single and double leg squats.

The only issue I had this week was two little accident one when I tried to run towards my son when he crashed his bike, and two a slip on the stairs last night putting all on weight down from a fall onto my healing AT and ankle. Both time my ankle seemed to collapse and searing pain on the top of my foot. The pain would lasted 24 hours and subsided. My PT said it because my calf and AT strength deficit and it would go away as I continue to strengthen the next couple of months.