Achilles Diary

It’s been a while since my last post and here I am at 12 weeks post op. Time flies when your summer is really sucking due to unexpected sports injuries.

My recovery continues to go well and so far trouble free. Still going to physio although I have cut down to once a week. I’ve gone a bit beyond the actual exercises they are putting me through, but still feel like  I am getting benefit from massage on the scar tissue. Also the time out from work to concentrate fully on the ATR once a week is a bonus.

Here’s a quick rundown of the status:

• Been at 2 shoes since week 6, crutches & boot a distant memory.
• Physio since a week before 2 shoes (13 visits to date), just started wearing normal vs training shoes this week.
• ROM more or less normal, maybe a couple of degrees to go on plantar flexion.
• Walking also basically normal except at the end of a long day. Going down stairs is still a challenge, but improving with some physio exercises directed specifically at this area.
• Strength returning, am doing double leg heel raises and double raise followed by controlled lowering on bad leg only. Single leg heel raise is still a stretch goal, but I feel it’s just around the corner.
• Just got cleared to start back on ellipticals in the gymn and to go back to golf.
• Started driving again with right foot about a week ago (previously using left) and apart from being tiring in traffic its ok.
• I do get some stiffness in the ankle first thing in the morning, but luckily I’ve been able to get into our gymn at work most days and 10 minutes walking on the treadmill cures it.

So all in all things are progressing faster than I’d ever dared to hope.

I continue to be fascinated and inspired by all the stories on the site and am checking the blogs everday. So wish everyone well in their recoveries till next time.

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I had my first visit in a month to my surgeon today and expect it will be the last. He basically said don’t come back unless you have a problem. After taking a look at the ankle he pronounced himself happy with the results and then enquired into the PT situation. I told him all was good and that ROM is about 90% there, but strength is still a problem. He seemed to think that was pretty normal and basically said keep going to PT until I feel like it’s not benefiting me.

Actually he surprised me with an unusually (for a surgeon :-)) insightful comment that this stage, 2 months post op, can be tricky as it’s the point where real life starts to intrude into ones recovery and PT regime. I’m definitely feeling that right now, much as I love PT, going twice a week for an hour and a half + travel time etc.. is a hassle and increasingly finding time for exercises during the day is getting harder. I’ve let a few things slide work wise and now really need to catch up. Going to have to re-arrange a few things and get back into some discipline to make sure I keep up with the PT homework.

Essentially I think I’ve reached the point where the AT is no longer “THE PRIORITY”, but “A” priority amongst many.

AT wise things are good. As mentioned above the ROM is pretty good and I’m even starting to be able to walk down stairs normally which was my last hurdle to regular walking. I’ve started strengthening exercises on the calf, but not seeing huge improvements yet. Both my surgeon and therapist say that I’m past the danger point for re-injury so whilst I’m not about to take up karate or anything I feel a little less paranoid. Surgeon says follow the same routine for another month and then at three months go back to normal activity as much as physically able.

That’s it for now, hope everyone else is doing well.

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Had my latest PT session today (6th appointment) and things continue to progress smoothly. Looks like I’ve developed a bit of a peg leg being in the boot which I will now have to train out of, but nothing major. Meanwhile they have started me on some one legged balancing exercises and given me the go ahead to do stationary biking without the boot.

In the real world I’m now 100% bootless which is great. The only down side is people tend to assume everything is back to normal whereas I know it’s anything but. Still probably another couple of months before I can resume sports in any serious way I think.

I will probably be a bit less frequent with posts from now on, will keep checking the site and following all your stories, but for me I suspect that barring any emergencies the story is going to get a bit dull, just slow steady improvement.

Good luck all and I will post an update from time to time to let you know I’m still here.

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 Just thought I’d add a few updated pics at 6-7 weeks for comparison.

 The scar is looking great, all closed up and a bit less violently purple. My only issue is a  sort of “bump” at the bottom of the incision that is taking a while to calm down and is aggravating as hell when wearing shoes.

And here’s the obligatory calf muscle comparison shot.

Last time I measured I had lost 0.4″ on the widest part of the right calf muscle which I think is at the lower end of the scale, but still fairly depressing.

I’m now pretty much out of the boot altogether, although I think I will still wear it for gymn workouts for a while, that’s something I need to check with my PT therapist.

At the moment not allowed to do much in the way of directly strengthening the calf, but I guess just walking on it is the best thing.

Hope everyone else is doing well and keeping spirits up.

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Yesterday was the big day….the day my surgeon had set to start going without the boot. As I had a pretty busy work day I actually did not push too much and left it more or less till today when I had a PT appointment and an easier day of it.

So as of this morning I’m in two shoes (more like slippers round the house) and doing gait training with the bad foot on the treadmill in PT. For this week I’m going to continue wearing the boot out of the house and my goal, discussed with PT therapists is to totally ditch the boot in a weeks time. For now my stride is very short and am having to really work hard on the heel-toe action, but hey it’s walking !

Obviously I have not walked any great distances, but so far am pleased with the lack of pain & swelling. The only problem I’ve had is some discomfort around the heel and incision when trying to wear shoes again, even just running shoes. That is going to be a problem, but I guess the foot will get used to it.

After some thought and discussion with the PT guys I have decided not to bother with a cane at this point. Physically I don’t need it and they confirmed my suspicion that basically it’s just another thing you can become dependent on and ultimately will need to train yourself out of. I did think there was a psychological advantage to the cane in reminding me not to go crazy, but I guess I’ll just have to remember.

So overall it’s been a great week even with the summer cold I picked up over the weekend. Looking back I can hardly believe I’ve come so far as quickly as I have. Never thought I’d be at this point so soon, I really have been fortunate compared to many ATR sufferers. A long way to go yet, but life is starting to come back together.

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Today was my second PT appointment and things are starting to get a bit harder.

In addition to my first set of exercises they’ve now added more glute strenghthening, a devilish mode of torture called “the clam”. This actually is a great exercise and one I’ll continue after the ATR experience is over. I’ve also been started on leg presses in the boot with very low weights + stationary cycling which is great.

Finally they also had me standing and doing weight shifts from foot to foot out of the boot. That was a little scary at first, but quickly getting the hang of it again. I’m really glad of my years of Tai Chi training as I seem to have few issues at all with regaining balance on the bad foot, was even able to stand one footed for 10-15 seconds. That impressed my therapist :-). I’m technically allowed to walk without the boot from next week and up till now I was quite nervous about it. However with the guidance and prep work I’m doing in PT it’s starting to seem reasonable.

I did have a lttle more swelling than normal after today’s exertions and some aching in the ankle, but it has cleared up pretty fast with some icing and elevation.

I’ve read a few blogs of people going through ATR recovery without PT and I have to say I’m astonished. For me the actual physical improvement combined with the psyhcological support of having a professional guide back to activity seems completely essential.

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Here I am at basically 5 weeks post op. Time flies when you’re having fun.

Today I had my first PT session which was good and the ankle feels looser and stronger just from the one session. Seems like I had a pretty standard PT experience starting with the whole patient history spiel followed by testing the current range of movement. My dorsiflexion and plantar flexion is about 10 degrees less in the injured foot than the good one, ankle inversion looks good, but eversion is pretty wimpy at this stage.

This was followed by pretty strenuous massage in and around the incision which felt fantastic, a little discomfort at times, but nothing too worrying and my initial 6 exercises for homework (ankle pump, inversion/eversion with stretchy band, toe curls, hip abduction and assisted hamstring stretch). For now it’s all fairly conservative stuff as I still have a week left in the boot. Will most likely have two sessions a week for the next 4 weeks or so and I expect it to get a lot more challenging.

The only slightly depressing thing was my lack of strength in the calf, could not really do seated calf raises too well at this stage. I measured my calf this morning and even though I seem to have only lost about 1/2 and inch on the bad side the muscle is basically just a passenger at this stage. Weirdly I feel as if I may even have been too conservative in the exercises I’ve been doing up to now. It’s hard to know how much you can push when you have no professional guidance and are justifiably terrified of re-rupture, but I feel like I could have been further along. That said it’s fantastic to be actually doing something positive to recover and I know I’ve been luckier than many in the speed of my recovery so far, so it’s all good.

Hope everyone else is having a good day and keep hanging in there.

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Well after yesterdays frustrations it’s been a good day.

This morning I had my third follow up with my surgeon at 1 month post op and so far everything looks good. He confirmed that it was ok for me to go to zero degrees boot angle (a bit late now given yesterday’s shenanigans). Also he declared himself very happy with the state of the tendon, after grabbing and manhandling it with enough force to scare the hell out of me!

So I have another 2 weeks in the boot after which I can start to walk in normal shoes. Like many other people’s experience he did not exactly give me detailed instructions on this, just go out & walk on it. He also okayed me to start PT which is great so I’m hoping that the PT guys can give me more guidance on whats appropriate.

I will read through all the material posted on the blog, but would appreciate any feedback that people have on 2 shoe do’s and dont’s?

Here’s the scar at 4wks post op for comparison to earlier snaps.

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No major disaster and the day ended well, but I have had a day of terror, frustration and pure rage.

I decided to drive myself in to work for the first time today having mastered left foot driving. All went well and I was having a great day until around mid morning when I had to walk over to a meeting. Coming out of the elevator I hear a metallic snap and suddenly discover that my foot is no longer at the correct angle in the boot. So I hobble over to a nearby chair and examine the instrument of torture. My boot (see picture below) has a contractption at the heel that allows the foot plate angle to be changed and it turns out the one of the retaining bolts for that mechanism has completely sheared off instantly taking me from 7.5 degrees to somewhere nearer 0.0 degrees. Arrrrrgh!

So I get back in the car and drive 45 minutes to the doctors office and very gingerly make my way in (8th floor of parking garage & no elevator) to explain the situation. Turns out that I have not done any damage, but looks like insurance will not pay for a new boot. The nurse suggests a nearby orthotics supplier she believes is a cheaper place to buy a replacement and once again I very carefully make my way over only to find their price is at least $100 more expensive. Back to my doctors office.

Another hour later and they have worked a deal whereby I do eventually get a new boot on insurance. As I was due to go to 0.0 degrees tomorrow anyway they believe they can swing it to re-equip me on that pretext. Frankly by this point I would have gladly paid double just to get out of the old one and be able to go home and take a shower followed by a cold beer. They could have just taken my credit card and named a price.

So ultimately I ended up flat footed a day early, although I still have to see the doc tomorrow and no harm done, but another 3 hours wasted in doctors waiting rooms. Man I just want this to be over.

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