Frustrating Plateau

Hey all. I’m on week 9 of recovery, and I don’t seem to be getting better. I chose not to do surgery and am wondering if I’m going to regret that decision. My biggest complaint is extreme weakness in my bad leg. I have almost full ROM, (my bad leg can dorsiflex further than good leg, and plantar flex almost as far as the good leg), and virtually no pain. However, I can’t even come close to doing a calf raise. I feel I should be able to do this. My achilles feels strong. I didn’t immobilize myself for too long, so I don’t think calf muscle atrophy is to blame for the weakness. I’m beginning to worry that my tendon healed too long. Or maybe I’m just expecting too much, and an inability to do even a partial calf raise is normal at this point? I’m just very frustrated because the recovery was coming along so fast, but now it’s seems to be at a dead stop. I was comfortable enough to walk in regular shoes after 4 weeks, so I figured by now I’d be further along. Also, I just got called back to work last week, so now I’m on my feet for 8 hours a day. It’s really taking a toll on my heel, since I can’t walk on the ball of my foot at all. I’m also very active, and won’t be happy until my athletic performance is where it was prior to ATR. Hobbling around with a weak leg is no option for me. Any advice, suggestions, or questions are more than welcome. Thanks in advance, and good luck with your recoveries.

7 Responses to “Frustrating Plateau”

  1. A little background information…

    1. ATR on March 28 playing basketball.
    2. Spent 2 weeks in a plaster cast.
    3. Next 2-3 weeks in a boot with heel lifts.

  2. Mi5htymike,
    I went the surgery route so I have no idea what your timeline looks like. However, I will tell you that it took me a LONG time to get to calf raises. Since I was immobile for 6 weeks, it took a while for my brain to literally remember how to activate the muscles in my lower leg. I worked very gradually from partial 2 footed calf raises until I was able to easily do 2 footed calf raises, then partial one legged calf raises, then full one legged calf raises. It took a long time to get there with a lot of slow and gradual work. Don’t get too frustrated, this is a slow process (I know that’s not what you like to hear). Take it easy on yourself. You’ll get there when you get there.

  3. Mike, I think the only unusual or especially worrisome part of your story is the fact that your healing ankle has more DF ROM than your uninjured one. That does raise the possibility that your mostly-healed AT-and-calf-muscle “system” is longer than the other, and longer than it used to be.

    The rest of the “plateau”, and the feeling that you’ll never be able to do a normal 1-leg heel raise, is unfortunately all too often among us ATR folks, with and without surgery. AFAIK, the use of the phrase “frustrating plateau” to describe this phase of recovery was coined (or introduced here) by doug53, who recovered and rehabbed maybe faster than anybody else in the history of, and has also regained full function and returned (though belatedly) to the “high-risk” sport that tore his AT. But he felt the frustration, and he certainly recognized in his fellow AT bloggers.

    There’s at least one whole blog page/thread devoted to “That @#$%& 1-leg heel raise!” with lots of comments. Several post-ers were still waiting for it at 4 months and more, sometimes much more.

    Ironically, your transition to 2 shoes at 4 weeks may have made the plateau even flatter and more frustrating, by putting that exciting landmark behind you while the next few are still pretty far ahead.

    So yes, I think you’re expecting too much at 4-ish weeks post-non-op, but that doesn’t prove that your AT-and-calf has NOT healed too long, or won’t (sorry). For now, I think your “percentage play” is to stay the course, build strength and stability and control, and avoid unnecessary stretching. Your strength (& s & c) will definitely improve, and in a month or 3, you will probably have a better idea of whether you’re heading toward 100% results or something less.

    I say “probably”, partly because I’m still scratching my head for a similar answer after ~17 MONTHS! But my return to running, jumping, and sports was interrupted (by heart surgery!) in ways that yours won’t be, God Willing!

  4. Just be patient mate - it will come!!

  5. Thanks for the replies everyone, and I agree that I probably need a little more patience. Like you said Norm, the fact that I was in 2 shoes at 4 weeks I think is what gave me such high hopes, and is making the road to the next landmark seem like it’s taking forever.

    Norm, are you able to get back to pt for your AT yet? You sure have a lot on your plate with dealing with an ATR and a heart surgery. Hopefully that’s behind you and everything heart related is going well!

  6. Mike, I’m going to concentrate on using my leg, rather than treating it. I’d already finished with normal PT and given up on gym work, nothing to do with the heart. For the summer, I think cardio rehab (probably mostly bicycling, then maybe some running) will take precedence, along with sailing and sailboat racing (and bicycling to and from the lakeshore).

    If I get time, I may go for repeat biokinetic ankle/AT/calf tests, both legs, both bent-kneed (which I did before) and straight-kneed (which I didn’t). Just to get a quantitative handle on the strength deficit, both ways. Probably more from idle curiosity than diagnosis or treatment. But if I can scratch that itch for $65. . .

  7. Hmmmm … I am 6 weeks post op. I have never been casted but have been in boots the whole time. I was scared about doing any ROM and can barely get to plantigrade. At 6 weeks how comfy should I be about doing dorsiflex stretches?

    mi5htymike … how is it going ?

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