Monday was my third physio session. So I was 3 weeks cast + 5 weeks boot + (nearly) 3 weeks in 2 shoes (non-op).
She had a look at my walking and straight away commented that I was “blocking”. I think this basically means limping where I stop and jerk expecting pain to arrive. She also noted my shoulders were tense as I walked, probably for the same reason.
She got me to try to walk with smaller steps and to try to relax my shoulders, which worked - just made me slower. I’ll have to just try to step faster instead to make up for it!
She also pointed out I wasn’t extending my knee fully on the bad side - which we established was the same thing - me trying to stop before I feel pain. Again walking with smaller steps and trying to remember to extend the knee should help.
Since then I’ve tried to feel what I do with the “good” leg, and realised I sort of can’t remember how to walk “normally” any more! I wonder if I’m also keeping my knee bent because that’s what I did in the boot to overcome the height difference. I looked at some videos of people walking but it seems that knee extension varies between different people.
Some seem to keep the knee bent (top) whilst some look fully extended through most of the step (bottom).
Massage - as long as it’s not the rupture site
I asked here before about massaging the lump on my tendon. I actually rang the fracture clinic and they’d said it was fine (though I was sure I wasn’t talking to someone clinical!). I’d had my girlfriend dig into my soleus a bit, and it did feel better afterwards.
I mentioned this to my PT and she said that as I still shouldn’t be massaging the tendon itself. It will make it feel better apparently, something about triggering pain receptors and releasing endorphins, but that doesn’t mean it’s a good idea!
She palpated the back of my leg and did make a face implying “oh yeah that’s quite a big lump” when she got to the tendon, and found it was very tight around where the tendon meets the soleus a little bit further up (but lower than I thought it would be - around the very bottom of the thin red bits on the image below). This is actually the bit that hurts to palpate, and apparently is fine to massage here, it’s just muscle tightness.
Maybe I mis-heard and it’s not that we can’t massage the Achilles so much as the rupture site specifically.
As before my ankle ROM is the same as the good side except in dorsi-flexion, which is still a few degrees over neutral.
My PT had a good squeeze around my foot and found I was really locked up between the 2nd and 3rd meta-tarsals (so above the middle of the inner arch). She described why she thought that was and it makes total sense to me. When I’ve been walking I try to lock my foot and ankle rigid as I roll towards the toes, again to prevent it dorsi-flexing and triggering pain in the tendon. Sort of imitating walking in the boot again I guess. So I need to try and relax the foot more and let it push off naturally.
I mentioned that I’ve been experiencing good days and bad days, and she pointed out that I need to be doing my physio exercises little and often, not in great marathons at the end of the day like I have been!
The physio exercises I’ve been prescribed for the next 10 days (along with normal walking with smaller steps as noted above) are:
Stand on one leg
She asked how I’ve been getting on with this. I’d been building up and was at 3 sets of 20 seconds. Ideally she wants me to build this up to a minute. This morning I managed a whole 2 minute electric toothbrushing session on the bad leg so that’s gone well!
She also asked about standing on one leg with my eyes closed. I can barely do that on the good leg I’m going to work on that too, but it’s too early for the bad leg. The good leg I can do 20 seconds on a good day.
Long step walk
Whilst she wants me to take short steps for general walking, she asked me to practice a few long steps at home as part of my physio routine. I think mainly to get over the rigid foot/blocking issue.
She demonstrated this to me - I’d actually say it’s almost like a lunge-walk, just not as deep.
Calf-raises - 2 up/1 down
She also prescribed (bodyweight) calf raises for the first time. I’m to go up on my toes on both feet, then lean my weight to the bad leg and return to ground with the weight on that leg. Apparently this is important in order to trigger eccentric contraction of the calf muscle (which presumably helps to line up the collagen fibres in the tendon). This is quite painful if I try to “fight” the heel drop a lot, but she said it’s OK if I drop quite fast as I’m still creating an eccentric contraction (even if it feels like a really weak contraction to me!)
I do also get a bit of pain as I near the top of the heel raise on the bad side, though that comes and goes.
Overall she seemed pleased with my progress. I mentioned that I’ve put back over an inch of the 2 inches that I lost on the calf, which apparently is good going at this stage. She asked me to book in in 10 days time since I’m doing quite a lot on it now.