Jun 12 2010
20 Weeks - An Overdue Post
I’ve been meaning to post for weeks now and have been checking the progress of my fellow ATR folks on this site from time to time. Perhaps as a benchmark to my own progress, so time to give some back…
I’ve been feeling really good lately, swelling is down considerably over the past few weeks, even after a strong PT workout or just general activity around the house. Some mornings I’ve got the limp until the AT warms up, but usually it’s ready to start the day each morning. Scar is nearly healed and the AT itself is getting thinner. Bumps on the AT have smoothed out as well. Seems all good there.
I can now do at least 15 single leg calf raises, but not nearly as high as the "good" leg. PT has me on the treadmill now doing a fast walk to warm up, then run at 7.0 for 1 min, walk for 1 min, about 5-6 times. I don’t have extra swelling or excessive soreness from it either. I’ve been mountain biking again (since last week), and even surfing (past 3 weeks). I can say that I’m pleased with the progress. Had my Ortho follow up on 5/26 and he essentially dismissed me, saying call if you feel you need to see me. I’ve got PT for another few weeks and then I’m on my own.
The only issue I have is when I crouch down low and put all my weight on it, I get a pinching pain in the front of the foot (opposite from the AT). PT said it could be due to the swelling around the ankle bones, tendons and bursas. I feel the pinch after I land after a jump or a low crouch while surfing. Seems to hurt for a few minutes then goes away. Anyone out there have a similar experience?
It’s clear I’m nowhere near 100%, but I’d say 65% is probably close. Hey, kinda like that Marathon tracker, eh? 
Overall, progress comes weekly now, where I feel I can do slightly more of all my PT exercises (jumping, heel raises, running, dips, etc). Just in time for summer! Still playing it smart, not going full steam into sports I know could set me back and especially those I don’t usually do (which is how I got here in the first place.)
hi,
Glad to read your progress
Did you try surf around 16 weeks?
How was landing on the board and balance and etc for your foot?
Is ATR foot front or back at the board?
What kind of board do you surf? Fish? Longboard? etc.
At what week did you try jumping?
My
PT told me I should not jump till I can do 20 1 heel raises without pain. And with jumping it isn’t about going up, but landing that apply most to tendon.
That’s why I asked about surfing … not like it’s jump, but like as.
Sounds excellent to me, Dan! You’re much more active and also stronger than I am, 6 weeks earlier, so keep going!
Just for you, I got up out of the chair and crouched down as low as possible, shifted all my weight to my (extreme dorsiflexed) “bad” foot. It definitely felt like something I haven’t been doing a lot of, but no hint of pain or pinching, so no help from me. (My “good” heel lifted a smidge off the floor just before the “bad” heel did, which made me smile! My “good” ankle lost a smidge of ROM after ATR surgery 8 years ago, and the new one healed up a smidge closer to “factory specs”, without the surgery!)
It sounds like it’s probably a lingering complication of immobility (rather than of surgery), though you’ve been so active for so long that it’s a puzzle.
When you do the crouch you describe, are you max-dorsiflexing “flat-footed”, or crouching on the balls of your feet with your heels lifted up a lot? (I did the “flat-footed” one, thinking it was harder and more likely to be uncomfortable.)
Glad to hear you are doing so well! I would love to get back out on or in the ocean (I’m in Santa Cruz). You have made incredible progress. It sounds like you have an excellent PT who has moved you along well. How many days a week were you in PT? Did you do alot on your own too? My DR and PT follow a fairly conservative protocol and I am a bit frustrated with my slow progress. I had my 4 month follow up appt with the doc this week and everything I asked him about doing (sailing,surfing, mtn biking etc) His answer was “when you can walk normally” which I guess means enough strength in the calf and flexibility in the tendon to have a full stride (not limping). KNEE PAIN has been bad for me, HAS ANYONE else had that problem? “THEY” say it is from not walking normally.
Mike,
I did start surfing around 16 weeks - ATR foot is my right and it’s in the front of the board. I ride a shortboard/fish. Balance was fine, the only issue was that strange pinch in the front of my ankle. The mental aspect was a major hurdle. Found myself backing off of waves that I easily would have gone on pre-ATR. That will come back in time and practice. Not quite ready to charge big stuff yet, but summer time surf is going to be great to get myself back in the game.
I started “jumping” on the pilates machine while lying on my back and progressed to jumping with 2 feet over a stick on the floor and jumping up on a step platform. These exercises really work the calves more than the achilles, but the landing is where I can feel the achilles take the strain. No pain, however.
Since starting PT at week 4, I’ve gained back 3/4″ of the calf muscle circumference. My PT said I lost 1.5″ due to the atrophy when she measured at my first visit.
Norm, during the crouch, the weight is on the balls of my feet, maxdoriflexion and heels down. That’s where I still get it. PT gave me some exercises to try…place a rubber band around the front of the ankle, the other end tied to a heavy table and lift the leg forward and slightly up. It puts pressure right on the pinching spot and seems to help. We’ll see how that goes….
BTW, love the “factory specs” reference! I like that…
Rad,
I’ve been in PT 2x a week for the past 10 weeks (or maybe a few more)…I’ve done my homework at home and work hard during my visits. Dr did give me another 6 weeks, but I think I’m going to end it at the end of June and work on my own. I like going, it’s just a tremendous time commitment. I haven’t had knee pain, so I’ve been lucky there. Hang in there, you’ll be there soon…the mental game is in many ways the major part…
norcalsurf70, I think everything you’re doing sounds sensible and great. But just for the record, from a long-time picky person, I think your “These exercises really work the calves more than the achilles” can’t be right. As you know, the only thing the calf muscle “does for a living” is pull on the AT — that’s why it over-contracted (and STAYED over-contracted) when we ruptured the thing! So I’m not really challenging your judgment that your jumping exercises are terrific, but I’m pretty sure they work the calf and the AT more-or-less identically.
Notsorad, when I was recovering from my first ATR (VERY slowly, post-op but what I call “conservatively”!), I think I got into trouble with BOTH knees. Part of it was from overworking the “good” side, on crouches for MONTHS, and part of it was kneeling a lot on the “bad” side (over-extending that knee) while I was in 3 casts in a row, before I finally got my Ortho to prescribe his first boot ever.
For sure, crutching and caning and “walking funny” are all bad for our joints, maybe especially knees. So you should be working at making your gait as straight and normal as you can. If you’re still using a heel lift on the “bad” side, make sure you do exactly the same on the “good” side. And eliminate any unneccessary or “habitual” gimp-limp techniques you’ve developed along the way, as soon as you can. Our bods were designed to walk straight!
norcalsurf70
I am basically at the exact same point as you. I’m 21 weeks post op and doing the same kinds of activities and exercises you are. I also have that feeling in the front of my ankle. I wouldn’t describe it as pinching though, more like restriction. I have that pinching feeling in the top of my foot right now, where all the smaller bones are. It feels like I need to crack my knuckles or something. I don’t know why that is but I’ll ask PT about it on Thursday.
Let me know if you figure it out because I’ve been wondering the same thing.
Jenn
Norm,
You are correct. What I was referring to was really where I “feel the burn” during the exercises, all working towards getting the calf stronger and to the original size pre-ATR. Agree the AT is working simultaneously.
Jenn,
I was inspired after I read your post on returning back to the v-ball court - and in the sand! I feel I could do that now (if in fact I was a v-ball player). Great to hear you are getting back to the sport you truly enjoy.
I still have the “pinch” and I agree, it’s really more of a restriction on flexibility (with pain) when I’m deep into dorsiflexion. I do still have minor swelling in the front and around the AT, and my PT suggests that may be the reason why.
What’s interesting is I’ve got a friend who ATR’d a few weeks after me and he’s got less swelling. There’s just so many variables and no two ATR injuries are exactly alike. All I know is it’s great to feel like there’s a shot I’ll get back to near 100%.
I had my surgery on Jan 4th, 2010. Still in PT and wearing a compression hose for the swelling. There is still a soreness around the insision and by the end of the day it hurts like a rubbing of a shoe around the area. It was doing so well and the limp and walking were really coming along until about a week or two ago and now there is a pain when you press against the insision and by evening if you were to lay you leg on a table and you put your foot on the table on the insision it really does hurt. There is this burning feeling more now than it was. HELPPPPPPP. Thanks Cindy
I know exactly what you mean by the pain in the front of your ankle. In the first 3 months of recovery the lack of dorsiflexion caused the tendons and tissue there to tighten. This takes a bit of time to stretch out and become supple again. Give it time and don’t force it.