mousta’s AchillesBlog

Glad to see some more back and forth on the healing long issue. Back to the original post, I also have a couple bumps on my achilles at around 16 weeks, and have had them for a while, but I can’t really remember now whether they’ve been there since the beginning. Actually, looking at them now, the one at the bottom of my incision mirrors a bump on my other achilles, so just the way it is back there I guess, though it does tend to accumulate swelling when I’ve been on my feet for a while, and also works out width wise. The other one is at the top of my incision. My pt has indicated they are both scar tissue and does massage to help break it down including light gua sha. She did some ultrasound on it last week. All these tend to help, but when I’m up and about the swelling does come back. No pain or tenderness on either bump - just seems like a knot.

Anyway, keep us posted on your bumps as well as progress in general.

Kristian said: “I will not tell anyone what to do on here with their rehab but when my ROM is equal I will stop stretches except as part of a normal warm-up.”

Agreed. This was how I was advised by PT and OS and I have not healed long.

Hi Glenskieus. That method will not work. You would need to see how much passive dorsiflexion your ankle joints have. Hanging them over a bed or in the air will not put enough force through the calf / achilles to measure the available ROM / muscle length.

The best way I can think of to check if you have ‘healed long’ would be to passively dorsiflex both feet and measure the angles. You are aiming to have the same movement in your non-injured and injured ankles. Decreased dorsiflexion would likely impede your gait, running pattern etc. The biomechanical changes to your gait pattern from having decreased dorsiflexion can cause problems at other joints further down the line.

If you have increased dorsiflexion at the injured leg you are likely to have reduced power and ‘push-off’. I also wouldn’t advise attempting to measure your dorsiflexion range until your PT has advised that you are OK to do stretches with a reasonable amount of strength. Doing it in the very early stages of healing could increase the chance of rupture. Also it could lead to you ‘healing long’, especially if you decided to ‘check’ on a regular basis.

My mai

Hi Donna can we check this (healing long) by comparing the rest position of injured foot to uninjured one by hanging our feet on the air while in bed?

In an extreme case of healing long the dorsiflexion on your repaired leg would be greater than that of the unrepaired leg. In other words, when your repaired foot is pulled forward towards you it would come more towards you than the other one because it has a longer tendon. To see a discussion on possible ways to avoid it and what may cause it Read:

Skelonas

Calf Stretching and Achilles Lengthening - Let’s Settle This!

Thanks Donna for the explanation.
This is quite scary and Im getting nervous about that.
I read a little about it in TomTom, he had a good discussion about that.
As I’m now in 2 shoes and I think Im mostly walking without pain (Week
I’m getting nervous about the healing long thing as it seemed like its difficult to tell when you have it.
In other words, I couldn’t really find factors that affect this except dorsiflexion (I started doing a little of it at week 5 or so).
How can you identify if you are having this problem without having to wait a year ? What are the protective measures for it ?

Thanks!!

Actually I can already correct myself…big smile. The Achilles doesn’t so much modulate or regulate force as transmit force.

I’d suggest everyone with this injury read up on how the tendon works as well as how it heals. Just the basics will do if you’re not a science geek educator like me. Learning these things helped me greatly to understand what happened when my rupture occurred, what is and has been happening within my body as it heals and I go through rehabilitation, not to mention how it helps me understand why the protocols are as they are and why they vary so widely. YAY for LEARNING new things! Keeps me young.

Mousta thanks for letting us hijack your post!

If the Achilles tendon is too long it can’t modulate the work that the calf muscles do so we can walk and so forth. The tendon is a force modulator so to speak….imagine a fan belt in a car or any motor, if it’s too loose it doesn’t work properly. If the tendon is too LOOSE it won’t work properly and it makes it hard to say build calf muscle up. It is not common according to my OS. He said our suturing techniques today are so good even under stress they won’t allow the tendon to give enough to heal long especially when combined with NO stretching or even ROM exercises until the healing phase at 6 weeks is over. But that’s him. His protocols do call for weight bearing anytime after week 3 when in a boot. Controlled weight bearing is not stretching and that is one of the reasons we wear the boot…it helps us to bear weight without stretching the tendon…that’s why at first we wear wedges or used hinged boots to control that stretch. This is why you do not go from your cast to a boot in neutral position. Unless you go form the cast to the boot at week 6, some docs think that is beyon

Can you guys explain to me what is healing long ?

Andrew…I started with an eccentric heel drop program (not raises) at 16 weeks and when I mastered that I began a concentric heel raise program and just reached my goal of 3×15 unassisted twice a day, am 25 weeks this week.

Wow! That is awesome! I put 2 sneakers on yesterday at PT to ride stationary bike. Felt like I had no heel at all such a weird sensation. Had doc appointment after that. Asked if I could walk around my house in 2 shoes to keep practicing she said no way til week 12. How the heck am I going to get going here? It took me 10 minutes to get the guts up to put weight on it in PT. Once a week does not seem long enough to practice this… I am at 6 weeks 4 days non surgical rupture. Glad to read that heel pain seems normal. My last lift removed yesterday thought maybe that was it.

Donna…I was concerned about healing long and I’m hoping that is not the case. How are you doing with calf raises?

Andrew, calf raises come over time and from my observations that date is all over the place in these blogs (I’ve seen 16 weeks to over a year). It surprises me that many can never even do them after a year. I’m thinking that is due to improper rehab or not being compliant and actually doing the rehab…or they have healed even slightly long. Not long enough to really be noticeable but long enough so that they can get some strength back but not full strength, not enough to hold their body weight….if over time you can not do a calf raise it could be due to the inability to build calf strength but since you are doing rehab and are compliant in trying to build it, that Inability to build the calf could be that you healed slightly long. Don’t wish that for you. Hope you continue to progress.

Hey guys i am 22 weeks post op and i have a small bump on the bottom of my incision, which is about an inch above where the tendon connects to the heel bone. It does not hurt but there is discomfort when I wear hightop basketball shoes. I dont get much swelling but this bump started forming around 19 weeks. My bump is also tender and does not matter how much i massage and ice, it is not going away. I am not too worried about it right now because there is no pain. I have been running hard and doing sprints at about 80%. I still am not close to doing a proper single heel lift (come off ground approx 2 cm)..strange because i have been doing box jumps about 2 feet off the ground with no problem. would like to hear how you guys are doing…i wouldnt worry about the bump just monitor it and make sure it dosent get any worse.

I know what you mean Mousta by “what does overuse really mean”…it’s relative to each persons tolerance to discomfort. I know for me it means I’ve done to much when my tendon is really sore and I just don’t want to be up and about anymore. It happens less and less as time goes by. I think it’s different for everyone. If you’re not having any pain…YAY THAT!

Cj you said: ” …Dr. told me that a person’s unique anatomy can cause all kinds of bumps and lumps to form as they’re recovering.” Yes mine said the same thing. I have two bumps one on the bottom related to the repair where he tied the knot in my permanent sutures and one at the top (not near the calf muscle) that he thinks is a blocked lymphnode with some fluid built up. The tendon at the repair site is tender and hypersensitive at both bumps and between these two bumps. I use a topical medication to address it and I am being fitted now for shoes with a Orthotist because the bottom bump if under pressure or friction from shoes is too uncomfortable to walk.

From my research some people’s bumps never bother them, some like mine are hypersensitive and do bother us.They a

I will tell you that I had that same “bump” just below my calf muscle and my PT thought it was where one of the calf muscles had atrophied to the point where it looks like a bump. He said it was actually the atrophied soleus muscle. I’m not sure but at 16 weeks and several workouts/therapy sessions under my belt, that bump is no longer there. The bump you described at the lower part of your leg sounds like the site where they may have performed the actual repair to the tendon but I’m not sure in your particular instance. I still have mine (at the lower part of the leg where they made the repair) and have been told this never really goes back to normal.

I wouldn’t worry too much about it - my Dr. told me that a person’s unique anatomy can cause all kinds of bumps and lumps to form as they’re recovering. Good luck with your continued recovery.

Thanks Donna…

I asked the physician assistant about the lump on the top of the tendon she said they make a knot during the surgery and that was it But when I started noticing the lower lump, I got concerned. I think I will call and ask especially that I’m a week away from meeting with PT.

Yup, I think I do understand the concept of the steps and I agree with you.. What is always nerving to me is the concept of overuse (What does it really mean) without noticing or having pain.. But maybe I should trust my body a little bit.

Bumps really could be so many things. I’d advise keeping an eye on them and if you’re that worried call to ask the doc if they think you should be seen about them.

How many steps a day should you do? As many as you can tolerate without causing painful swolleness. For some it may be 7000, for others only 4000…who knows? It’s individual. I use a pedometer and I am up to 8000 - 10000 before my tendon feels sore, but that’s my tolerance number of steps. Understand the concept?

I can feel your excitement in your post, I am so very happy for you! YAY you!

brombones,
Thanks!! Today I feel a little better, I bought new running sneakers with some nice heel area, its making me feel better.
I can take few steps without the crutch very slowly though. I don’t feel pain, I feel discomfort and that the tendon just wants to bend or twist or something like that.. This feeling is irritating me. However, its getting better today. I’m still following the same policy. Boot outside, Shoes inside the house and at work, mainly using one crutch. Lets hope it gets and feels better in the next day. Didn’t try showering without the boot.. That’s another milestone.

Ed,
Good Luck! I guess we are on the same boat, trust me I was so scared for the first moment in the shoes and it was way easier than I thought.. Be careful. I’m trying to be very cautious and still trying to experiment what I’m doing.

eyceman ,
I will try putting a video. There is a video that Donna shared in one of the post or mentioned the search words on you tube, I will try to find it.
However, I’m not saying that I was walking limp free, I had a slight limp however the movement felt almost natural. Ie. I wasn’t just walkin

can you send me the videos of pushing through shin? I have been FWB for 3 weeks and still have a slight limp in boot. Thanks!

Hi Mousta! Thank you for this post, I’m moving into 2 shoes this week and I’ve been worried about, feeling I won’t be able to and not knowing what to expect. I got a broken femur when I was younger and unfortunately my good leg is about an inch shorter, so I”m thinking I will be using the evenup I use for the boot for a little while. I’m a little behind schedule due to infection but I’m looking forward the new challenge to walk on my on foot more than 2 months after my ATR. Thanks again and keep up the hard work!

Great progress! We’re at similar points, 7-8 weeks post op. I’ve been 2 shoes, switching between tennis sneakers and flip flops inside the house. The flip flops are far more comfortable, though prone to minor snags etc, which are scary.

Ventured outside to run a couple errands today w/o the boot. Other than being very slow and careful, it was fine. The swelling in my foot around my ankle is pronounced, however. No real pain, just swelling.

Keep it up, each day is tangible progress and it keeps getting better and easier. I believe the key will be staying humble and disciplined to prevent exposure to re-injury. Good luck!

Good Job mate, I’m very happy to hear all of us is progressing well

I started PT at week 6…I don’t think it’s bad to start PT earlier than week 6, I just don’t think you can do much anyway and as you said you have a boot doing the work for you! YAY that!…so week 7 is a fine time to start. I didn’t have any ROM to to do until I started PT, I was told I could only wave my gently foot back and forth. However, I do think other active, gentle, and sitting ROM stuff is OK before 6 weeks as long as there is nothing passive or for dorsiflexion. Initial ROM comes back really fast…a week after PT you’ll most likely see huge improvements and may be in two shoes…I was in two shoes at PT on my 3rd visit which was between week 7 & 8.

You won’t have any problems, I think your doing great!

and LINDA…YAY…I’m so happy for you…going down to one wedge tomorrow….another milestone! I hope you enjoy PT Friday, be sure to let us know how it goes.

Glad to hear about your progress and yes it is so exciting to see the improvements week over week. Being a week ahead of you, I saw great progress between week 5 and 6. I see surgeon tomorrow where they will take me from 2 to 1 wedge and then start PT on Friday. I agree the weight bearing in the boot is a form of PT and it is amazing to feel things returning to “normal”. Hope things continue to go well for you.

Thanks Donna, for as usual great response.

I start PT at Week 7, he is planning to put me in shoes while I’m doing PT. Its quite scary, I’m not sure if that is considered late for PT start. Also, they didn’t clear me for swimming or cycling with no resistance yet, no alphabet or any complex ROM exercises

As of now, they are telling me because my boot has a range of motion and its not fixed, that’s the start of my PT.

I agree about your point about the challenges in each phase,
I feel good about my tendon now that I’m so freaked out and keep reaching to move my foot up and down to touch it and feel its there and stretching I don’t want to go back!

Nice description of your progress…I’m sure it will be helpful to others…Great idea on the forearm crutches, I’ve heard others here say they are much better!

Pain in the back of the heel this early could be anything really…however, f it persists it could be insertional tendinitis (sore on the back of the heel) which is not good only because it can become chronic and lead to all kinds of other issues. I had it many years ago and it only went away when I took a lot of time off from working out and never went back to the activity that caused it. When I started doing eccentric heel drops as part of my rehab at 16 weeks I had that same darn heel pain again because those micro tears are still there, so I stopped doing that exercise and am doing the same motion but on a flat surface to avoid the heel pain. My point being as you get into more movement and PT it’s important to add new things in and then wait and see how you do with them over a day or two before continuing. If back of the heel pain, or shin pain (usually shin splints) then it’s best to stop that new exercise and come up with another way to work the same muscle you

Thanks Everyone for the information. As always, very useful.
I started to understand the weigh bearing concept and how to walk, increase weight and use pain as indicator. Quite helpful.

Since yesterday, I started to spend more time on the crutches at work or in the house, I only use the Knee scooter for long distances ( > 10 min walking). I feel comfortable now and I like it..
The only weird thing now, is that my other leg (Calf/Achillies tendon and heel) feel sore after activities. I think that could be normal right ?

I also tried the suggested methods for the compressions socks and it worked awesome!!.. Thanks!!!

A really good tip my PT gave me on the compression sock is to turn it inside out, then fold in the sock where the toes should start and put it on by slowly pulling the sock on inside out… it works great!! I was afraid as well when I first started but this is so much easier than trying to bunch it up.

I concur with everything Stuart said. If you type kaitmeister into the search box on the main page she has two blog posts about steri-strips from Feb. you might find helpful.

Putting the socks on is a pain in the butt but it can be done as Stuart described.

Don’t be sorry for the questions we are all here to support each other! Big smile for you.

1 - see your GP or even a practise nurse. Many people have allergies to medical tape and another 10 days could cause problems. If you have an allergy you should be able to see the redness beside the tape. Your incision may have healed enough anyway for it to come off.

2. Keep you foot pointed down, gather the sock onto your foot then pull it over your heel. With your foot down you are not putting pressure on the tendon.

3. As long as the boot is properly fitted your foot cannot move and your tendon is safe. WB as tolerated means just that. If it hurts too much then stop. If it hurts a little and you can tolerate it then that is OK. It will probably hurt a little but we have to tolerate pain at our own levels. Then as you walk more you will have to take a break to rest and elevate the leg. Everything is incremental. When it hurts back off and when it doesn’t then you are fine. What you are doing with the scales is a good indication but it does not represent a normal walking step and the weight distribution as you transition through your gait. It will come to you. You will be surprised how quick you can take weigh

From the protocol posted’s summary:

“Based on the evidence available, the
AAOS recommendations on the man-
agement of Achilles tendon rupture
range from Inconclusive to Moderate.
Further studies are needed for stronger
recommendations.”

I noticed the date was 2010, which though recent is still 5 years old…there has been more research but not consensus and implementation…from much of it non-op is actually as good and safer in terms of infection, scar issues, etc.

This doctor acknowledges that he has to use his own opinion for many things and that is what all the docs do, however, some base their protocol on old research which is why some have old dinosaur protocols. This one looks good to me in terms of what I’ve seen for most effective protocols.

I find it very interesting how Dr.s can be ultra conservative to very aggressive in there protocol for recovery.

Thank you for sharing. It was a great overview and helps to better understand the guidelines.

Thanks Mousta

Eyceman I’m originally from Boston, semi-retired now and living in Colorado the last 5 years.

Great points Stuart…I didn’t know the body doesn’t use collagen ingested to repair…good to know. I did enjoy all the homemade chicken/beef soups and stews I made this winter though so not a total loss…big smile. I did hear to avoid vitamin C. As for rupturing the other tendon I’m not really worried about it…I look at it this way…I know I’d go non-op next time (THANKS NORM!) so would medically only need someone to put on the first two week cast, I have a boot now and lots of other ATR paraphernalia…and am quite sure I could implement the appropriate protocols and manage my own PT….HA HA. It would suck but I’ve got it should it occur.

Ahhh.. Great input Stuart. So glad I found this website. You guys are the best!!

Regarding exercising the other tendon, the article I posted above has the same exercise you mentioned. I will try practicing a couple of sets a day.

Thanks Donna and eyceman.

I take fish oil. I will try vitamin C and the soup.
I was more interested in whether there is science behind it or experiments for who used over who didn’t. But generally eating healthy is good!!

I was reading recently about diet for tendon healing. It comes up regularly here and apart from eating a good healthy diet there is not much science base to eating collagen rich foods. The body does not absorb the collagen and then use it in its own healing process. Also Vitamin C supplementation caused some abnormal collagen formation in healing tendons. Regarding the 200x risk of rupturing the other tendon. That is something we all, at least those who have only done one, will have to live for the rest of our lives and not just in the healing phase of this injury but we can minimise the risk to some degree with eccentric loading and other exercises. A good one I found was to stand on a theraband and hold it so it flexes your toes then push down with your toes against the resistance of the band. This apparently works other muscles that give aid to the AT. The 200x more likely is not as bad as it sounds because it is based on the number of people in a general population who rupture one AT. A good mathematician could work out the probability as a percentage which is more helpful but I suspect it would be very low. Come on No

Donna,

are you from the USA? Just curious. I know most on here are from the UK and their protocols seem more aggressive than ours.

thanks

I honestly don’t know if there is any science behind this but it does make sense to eat collagen building foods such as jello and anything make with bone stock such as beef/chicken stock soups. If you do a search from the main page in the box on the top right for “foods” or “supplements” I’m sure you find links to blogs that list more. Recently Laetitia made a good list on her blog.

I take vitamin C, multivitamin and Fish oil Omega 3

I can’t wait to have my splint off today . it is too heavy. kept begging doctor to move my first post-op date. so they did move it from 23 to 19th. i hope they can replace this heavy splint with something much lighter or put me in a boot.

i was wondering how soon can i start my pt . will losing some serious weight help to speed up the recovery.

i miss walking .and running with my dogs up and down the hills. man . I am not even good at playing tennis. and i busted my Achilles . so not worth it. hahahha

Thanks Mousta,

Hi Achilles Friends, Whew! Just gone out of hospital.. So far i just feel minor pain. I hope it will stay like this! That sleeping Drug really hit me! I feel Dizzy and vomit when i try to sit when i woke up..:(

Thanks very much for the creator of this page and to all Achilles Family