Week 5 Day 7 - Start Physiotherapy

Today I got to meet my physio for the first time. She explained there’s not much we can do until I’m out of the boot, but I got some basic exercises to do and a lot of useful info.

Stretching?

My ankle dorsiflexion (i.e. pulling the toes towards the knee) is still pretty limited. When I take the boot off I find I can get to somewhere between the red and orange lines in the picture below before I feel a tug on the tendon. I’ve been wondering if it’s worth gently stretching the calf in order to try to get that range of motion back…

Today I learned I should NOT to try and stretch the tendon. At all!

No stretching then

The way she explained it was to think of the gap between the tendon ends as a pothole in the road. Essentially my body has done a quick cowboy repair on the pothole, filling it with rough gravel and tar (scar tissue) just in case I need to use it to run away from a lion or something. The proper job of laying nice fresh tarmac (collagen fibres?) and smoothing it all out takes months and can’t be rushed.

If I try to stretch it now, I could end up with an elongated tendon. The problem would be that when the calf muscles started to contract, they’d just be reeling up slack in the tendon rather than doing their job of pulling on the heel bone and lifting weight.

There would then be a limited amount of contraction left in the calf muscles to actually move the ankle. I’d end up with permanent weakness in push-off and landing on that side, and probably pain in the calf muscles from having to remain contracted all the time.

Mobility exercises

Six times a day I should get my foot out of the boot and move the ankle the following ways

  • Plantarflexion
  • Dorsiflexion (As much as I can anyway, and very gently, no stretching!)
  • Eversion
  • Inversion

I think basically these are to ensure my ankle stays mobile and doesn’t seize up through lack of use.

Strengthening exercises

Twice a day I need to get out of the boot, lay my leg out in front of me, and at full plantarflexion (so toes already pointing away), try to contract my calf for 5 seconds at a time, as pain allows. 2 or 3 reps at first but I can build up adding one rep at a time as long as it’s not painful or swollen.

If it does cause pain/swelling that’s fine, but I need to skip it for the next day to allow recovery before hitting it again.

I think this one is try to stop my calf muscles wasting away completely and to encourage the tendon to build fibres in the right alignment for a strong repair.

The good leg

We also talked about the importance of looking after the good side, as it’s now doing extra work and it’s already starting to feel bad again. So keep stretching that one and doing balancing exercises, one-legged calf-raises etc.

She agreed that I’ve most likely got some bio-mechanical/movement issue that’s damaging both tendons and has led to this result. Obviously I want to try to avoid snapping the other side as well.

4 Responses to “Week 5 Day 7 - Start Physiotherapy”

  1. This all sounds so scary! I haven’t started therapy yet. I’m so nervous after reading your post! Best of luck!

  2. Oh no it’s not meant to sound scary! More as a reminder to me as I’m the sort of idiot that tries to push things along too quickly. Mine seems to be healing all to plan - no pain to speak of - it’s not that bad really :)

  3. really like the pot hole analogy. I’m at week 14 and can’t get my foot on the dorsi flexion much past the orange line - but my physio has given me a band to try and pull against to help stretch a little, guess it’s all a bit of guess work, but I’m not goign to over do it - will just stretch a little.

    Good luck - will keep an eye on your blog..

  4. Cheers @vietzy101 :) So you’ve been in shoes for a while now? It must be tricky to walk without the range of motion - do you have to go back to 2 crutches when you come out of the boot?