lesliekay’s AchillesBlog

Normal DF is 15+ degrees past neutral, FWIW. More does no harm EXCEPT that it can be the symptom of a too-long AT-&-calf.

I’d assume that AT-lengthening surgery could be repeated ’til it works. That’s nobody’s first choice, but it sounds better than limping toes-out forever.

Recovery from AT surgery on ONE leg is way nicer than TWO.

When my 89-yo FIL was a boy, he walked on his toes, and got successful surgery on both ATs to let them lengthen. (I say “let them lengthen” because I think it’s essentially surgery to cut them apart but NOT to stitch the ends back together, followed by “non-op” rehab, letting natural healing rebuild ATs that are longer than the originals. I’m guessing that the initial immobilization is NOT done in ballerina/equinus/DF position, but closer to “neutral” position.

He recovered fine, and went on to lead a long and athletic and active life, not over yet. He’s got problems now at 89, but his ATs aren’t on the list.

Thanks for the blog posts! I have a 13 year old daughter that is very active in sports and because she was a toe walker ( I was told she would grow out of it) she has very tight tendons. She recently severly injured her ankle and now needs surgery to fix so the Dr is planning to do the tendon surgery at the same time. People tell my I am crazy for doing something so invasive but she has a lot of pain associated with the tight tendons. We hope that this will fix her ankle and help with all her knee and hip pain. Best of luck to your little guy I am sorry we waited so long!

My son (who is 7 years olf) actually had the surgery on both ankles and he was in 2 boots but did not cause any pain to him. He was in his comfort zone with them on because they provided the extra support. When he was cleared to have them off, was a huge change for him and that is where he struggled the most. Please let me know if you have anymore questions. I will be glad to answer them

Hi, my name is Natalie, I’m 16 years old. I am interested in this blog because of a health project I am doing for my school. I injured my Achilles tendon in April of this year during a soccer game and it still hasn’t healed. The doctors aren’t sure what’s wrong with it but I have had two MRIs, one boot and have been through physical therapy. I have found your blog very helpful and I was wondering if you were in a boot and if it helped you or not. When the doctor I was seeing put me in a boot and it caused more pain than I originally had and this is what my entire project is based off of. Thank you and I hope you have a good day!

Good luck!

Thank you for your concern Karen I just posted a new blog

Hi LeslieKay

How are you and Ethan doing? I see from your last post he was to have a follow up at the end of November, how did he get on?

Karen

I’m glad it sounds like he is make more positive progress than your last blog entry. And I hope that it keeps getting better. Keep everyone posted.

Unfortunately for Ethan, when we bend our knees while standing, we have to simultaneously dorsiflex our ankle to keep our foot flat on the floor/ground. So if Ethan’s right hamstring is so tight that he can’t straighten his right knee completely, he needs even more ankle flexion (=calf-and-AT length) than if he could.

Mind you, MANY people — especially MALES — have trouble sitting on a floor, back straight and knees straight. When I was a kid, I could stand straight-kneed and touch my toes or even touch the floor below my toes, but I couldn’t sit like that. (I had two older sisters who both found it silly easy, but not me.) That particular inflexibility never seemed to hurt me in sports or walking, but it was there.

If Ethan now has either fair right-calf strength OR a relative freedom from pain in the right leg, I think he should be able to walk with his right foot straight, just by lifting his right heel off the ground/floor a bit earlier than others.

Have you tried adding some skinny heel lifts to his shoes, until he can walk straight? I do know you want to lengthen his calf-and-AT, but if it’s so hard now that he’s c

I very sorry, but I would listen to nutkin. Get a second opinion and make sure you have a good relationship with your Therapist.

Hi
I was really sorry to hear about Ethan, that must be quite a shock to both of you and discouraging. I really encourage you to seek another opinion, and if you aren’t happy with the way in which your PT is working alongside you then I found it was a good idea to look for someone who will. I did find it was really important to make it clear to people I had to work with long term as to what I needed and therefore what I expected from them i.e. clear instructions, review dates to analyse progress that sort of thing. I remember when my leg finally came out of the moonboot and the PT was able to measure the movement in my ankle he was okish with it, but helping reduce the scar tissue in the ankle area helped it even more. I think the only thing I say is hang in there, find someone who is going to support you and Ethan and provide the kind of medical assistance he needs to come right. It is a long road to fix an Achilles lengthening and you need all the support you can get.

Take care and best of luck, Karen

Just a matter of perspective and/or frame of reference. Pulling your toes “up”, is the same as flexing your knee “down” (typically when standing). I’ve heard dorsi-flexion describe as either “up” or “down”, depending on how the flexion is being applied.

They can’t get him back to neutral nor can they get him to flex upwards.

LK, when you wrote “They took measurements and could only get him to 6 degrees below neutral on his right foot and 4 degrees below neutral on his left.”, did you mean 6 degrees and 4 degrees ABOVE neutral? If not, I’ve got something backwards.

Ditto on the pool - it really helps loosen the ankle area and build confidence!

I am so relieved that he still could progress with the aid of PT. The PA was about 50% on Ethan’s tighteness being physical or if it’s his subconcious protecting his tendons by resisting against the PA flexing his feet upwards. He said that through PT will help Ethan either loosen up physically or teach him to trust his new flexibility. Also, PT hopefully help his gait. Our first PT is Monday.

Hi
Sorry to hear that the tightness is a big issue for him still. I argee with the above comment about PT, I found that once I started PT I moved forward in the recovery path. Did the doctor say why he thought the tightness was still there? Did he suggest swimming, as I found it really helped to get some movement in the ankle area without putting pressure on it. Also water walking, backwards, forwards and sideways. You do need to get the ok of the PT to do this, as they may or may not want that much movement in the leg. I hope you have some success with the PT
Karen

I really hope so. I have one his age and you just don’t want to see your kids struggle. I hope the PT gets through to him. I’m sure they will.

I suspect the PT will do some magic. We all hope so!

Hi

How did Ethan get on at the doctor’s?

Karen

Hi
I am sure there will be a solution for you. I had my op in Sept last year and I would honestly say it has only been in the last 3 months that the Achilles area looks normal, but I have been walking for quite some time. My point is, is this is going to take a while. I found I had to go quite slow with walking as otherwise I tended to revert to a walking position that would reduce the pain, rather than being a good walking position. I did find swimming was great, you do need guidance from your PT as to what strokes you can and cannot do, but I found that after each swimming session I got more and more freedom in my ankle area. I also walk in the sneakers/trainers that my surgeon and PT approved as this helps me alot. Hope all goes well, let me know how you get on.
Karen

@nutkin - that would very well make sense. The PA at our last visit said that Ethan’s tendon area felt thick in places. I kinda think Ethan’s mind is trying protect his injury. And I also agree with you. Ethan does not know how to walk properly. He does need to be retrained how to walk and that is another reason that I am anxious to start some form of PT. The nurse suggested that the PA will give us stretches to preform at home. We shall see.

@normofthenorth - thank you so much for your insight and knowledge. He walked in his Air Boots with no crutches for 4 weeks prior to 9/12. Took him 1 week to get used to them and by week 3, he was playing soccer in them. He was so excited to get them off after 10 weeks of being “confined” and for him to complain of pain and risk being put back in the boot, really means that his pain is unbearable to walk properly. I have a friend that is an Orthopedic PA and I was finally able to see him this weekend. He checked Ethan out and said that he would get him checked out immediately, he would recomment PT, and that the right leg (the one Ethan is dragging) felt loose (which is good), but the left leg felt tight). I asked why our doctor hasn’t ordered PT and he said that kids usually “bounce back” so quickly, that no PT is needed, but if the child is having trouble as Ethan is, he would put him in PT. We will know more Wednesday when we go back to our PA. I have to acknowledge Optum Orthopedics. I had to leave messages with both the appointment clerk and the nurse and I received a call from both of them within 3 hours.

Hi LeslieKay

Good to be getting checked it checked at the doctors. I found I had quite a large build up of scar tissue after this op, and the PT had to do deep tissue massages in my ankle area for quite a while to ensure I could keep up my mobility. He also gave me a lot of exercises to train my foot to walk properly, frustrating at first, but it does get there. Hope all goes well and you come away with a solution.
Karen

LK, I’m not clear on how long he was walking FWB (no crutches) while still immobilized in a cast or boot. My fave protocol is fast but it still spends 4 whole weeks in that phase. I wouldn’t skip it or skimp on it.

At this stage, we’re all hoping for the best. Get it checked out and do what’s best. Limping asymmetrically — with one short stride but toes straight ahead — does no harm. But rolling over a foot that’s splayed out to the side as you describe is a Bad Thing in a few ways and should be discouraged.

Hi there,
really hope it isn’t a setback and hala is right!

I’m sure your good fortune isn’t running out! Once I started walking, I was often tempted to walk like that as the excess scar tissuewas not yet broken down so normal walking was painful. I’m sure the PT can help with some exercises and massage. Good luck!

Hi Lesliekay
I saw your last post and felt really happy for you and your son. I had my right achilles lengthened in September last year and while the recovery is a long journey I am so glad I had it done.
I see he is at the partial weight bearing stage, I imagine he thinks it is total freedom compared to non weight bearing. How is the swelling and pain? One of the things I started to do a lot of when I was transfered into the boot was to start taking my leg out of the boot, and making sure I was seated somewhere safe, so not to risk putting weight on the leg, I would give the leg and foot a rub with my hands, brushes whatever I could find to help bring back the normal sensation to the leg. The key with this stage is not to think you are unbreakable and to try and do too much, so no superman acts of flight on crutches
Hope his recovery continues to go well

Karen

Hi Jarvis
I had my Achilles lengthened in Sept last year. I will point out that I have being have leg issues for quite sometime and so have a number of things wrong with my right leg, in addition to the Achilles, so some of my timeframes will seem quite long.

I had my right leg operated on, and through keyhole surgery the surgeon made three incisions into my Achilles, from what I recall they are about 1.5inch apart and went about halfway through the Achilles. I was then placed into a plastercast for 2 weeks and then a fibreglass cast for 6 weeks. Tips: Get a wheelchair, he will love going about in that - He will probably need to keep the leg elavated for a while so you can get extensions to add to the wheelchair to help with this. The pain for the first two weeks was not great, had a lot of heel pain. My doctor was able to help me here and gave me some medication directed soley at that. If he goes into a fibreglass cast stay away from the heater - fibreglass is a conductor of heat and it does and will burn.
After the fibreglass cast came off I was placed into a moonboot and I had to wear this for ages - mainly because of some

Hi There my Son is 7 years old and has also just been advised that his Achilles needs to be Lengthened. I am trying to find out if someone has had the operation and how it affected there Future.. because my son is really good at sport and not sure if he will ever be able to play again

2 things: (1) Try squishy soft footbeds inside the boot for comfort, and (2) Check out bit.ly/UWOProtocol and try not to let Ethan’s Doc take him much slower, ’cause there’s no benefit according to the best studies.

Hang in there!

Lesliekay: Week 2 was my absolute worst week. The first week flies by and you think this isn’t so bad.. then week 2 just drains you. By week 3 things were picking up and it’s been a LOT better ever since then. Hang in there!

Ethan sounds like me in the first few weeks - poor kid! I set up my “invalid outpost” to quote another poster, with LOTS of stuff to do within arm’s reach - snacks, water, books, remote control, and activities - so I didn’t have to call so much.

All my girls did morning “PT” with me which consisted of girl pushups (on knees), crunches with legs in air (felt great for swelling), leg lifts - front, side, and inside, and dumbell presses and curls. We did it twice a day with music to make it fun and it was at least some kind of exercise until I could do WB stuff. It felt good to be down on the floor instead of stuck in the chair constantly. I used a stepping stool to inch back up to the chair. (Make sure it’s ok with his doctor.)

The Wii games sound like a great idea, also. It gets better fast, Leslie. Hang in there - I know you must be exhausted!

Hi,

Do you have a wii system? Many of the games there are arm waving ones , even the dance game can be done sitting and waving your arms. May get rid of some energy and keep him busy?

Curlygirl

Lesliekay:
When my dad was wheelchair bound in a nursing home the staff used to play games with the patients involving catching and throwing back or batting back beach balls/volley balls. I don’t think it will burn off as much energy from a boy as it did for a 90 year-old but perhaps it may help.

Leslie,
I came across your post while searching for information on flat foot surgery. I am glad to hear that your son is doing so well.
My 10 year old son has been recommended for heel cord lengthening and a flat foot implant. I am very concerned and scared of this surgery, as he has no pain and is very active. We have seen a podiatrist, but I want to see an orthopedist.
Did your son have pain before the surgery? What type of orthotics does he have. We have ucbl’s but they have not worked. Does he toe walk?
I talked to one mom whos son had the implant and she said his feet were still flat. How flat were your sons feet? I can send you some pics of my sons feet for comparison. Do you have any before and after pictures. I guess you cant have after pictures until the cast comes off.
You can email me at wilberger51@gmail.com, If I am not bothering you too much with all my stupid questions. I just don’t know what to do.
Thanks
MB

Kids are amazing - I still need elevation at 10 weeks postop! Glad to hear he’s doing well.

Happy to hear that your son came through the surgery well and is at home already. Praying for a speedy recovery. Hang in there!

Ethan is in the hands of a great Mom! Wishing you a calm and stress free recovery for Ethan. Stay strong! You both are in our thoughts.

It is so hard to see your children in distress. give him a big hug from me and keep us posted of his progress.

XX

I am so thankful surgery went well and the healing road to recovery has begun. We will be praying for Ethan and all of you throughout the coming weeks. Love you all!!!

Leslie and Ethan,
We will be keeping you and your family in our prayers at the center and at home. I pray that God will give the doctors wisdom in helping you to overcome this minor setback. God is in the business of healing and I know that He will make all thing right.
We love ya and miss you,

Good luck to both/all of you. My new podiatrist has discovered that I’ve been doing a similar compensation for my right AT, which was surgically repaired short (intentionally) almost 10 years ago. Details at achillesblog/normofthenorth , top page I think.

I hope the AT lengthening helps his ligaments and foot joints recover their “designed” stability quickly, despite the doctor’s pessimism. I doubt that many health professionals have seen many similar cases. . .