Small victories, still waiting for calf strength
Written on March 1, 2010 – 3:45 pm | by normofthenorth
Just past 11 weeks after “the boot” arrived, my left ankle keeps feeling better and doing better, and my lifestyle has returned to normal in almost every way except sports — but I still have a little “dip” in my stride, because my left calf still can’t “push off” enough to lift my weight. Now, it feels as if my AT can do it, but I still can’t.
Doug53 calls this the “frustrating plateau”, and it has been a little frustrating, because my progress up to ~3 wks ago was so strong and steady and fast, that I was ready to bet that I’d be doing 1-legged heel raises by around now. But no.
Meanwhile, the seat is gone from the shower stall, the kneeling footstool is gone from in front of the bathroom sink, the stack of clean clothes is back in the closet instead of beside the bed, and I’m just about to stop taking my backpack everywhere I go in the house, because I’m comfy walking around with my hands full, even on stairs (sort of).
Traveling around, by foot, by car, and by subway, are back to normal. I’m a year-round urban bicyclist, though, and I’ve avoided that for the last week or so because we’ve had snow and slush and some frozen slush and the like. I’ve biked a few times, but always in my hinged boot so far. Now it’s been so long since I’ve put the boot on, it would feel weird to wear it just for protection when I bike. I suspect my next bike trip will be in snow boots or low Merril-type “$hit-kickers”, and it will probably be in a few days, depending on the weather. I’ll try not to crash my weight onto my left foot too hard, especially while rolling forward — that’s probably about the only way I can still hurt my AT and ankle badly.
Standing on one foot (the “bad” foot) is remarkably solid, and I almost never get any abnormal “signals” (pain, discomfort, tingles) from my ankle any more. The only exception is when I stretch the AT hard, like doing 2-leg heel raises while hanging over a stairwell step. The ROM limit on that ankle still feels a little different than the other ankle, but that difference has faded enormously and is almost gone. What’s left is more like stiffness than pain or weirdness.
There’s an amusing postscript to my previous post: It was about a dumb “faux pas” I did about a week and a half ago. I was walking fast, outdoors, in shoes, and I got frustrated with the “dip”, so I tried “dipping” the rest of my stride to match. Dumb idea! I ended up dorsiflexing and loading my ankle-and-AT way too much, and I almost crashed, with a pretty sharp pain.
Well, last night, walking home from about a block away, I tried it again, carefully. I got crouched down enough, while walking, that I could walk perfectly straight! Of course, it’s just a slightly different “silly walk”, but (a) it’s interesting that I can keep my eyes at a constant height while walking, as long as it’s a bit lower than normal, and (b) it’s interesting that the same move that hurt like crazy about 10 days ago is now comfy.
It’s all good, all in the right direction, and all much faster than last time (and without surgery! Miraculous!!). But I’d really like to be able to “push off” and walk straight at full height!
Doug53 took about 3 weeks for the transition from limping to walking straight. My physio guessed that it’d be a month. I was guessing a week or two, but I think my guess has already expired.
I’ve been trying to calibrate my progress by pushing down on a bathroom scale, but I think I’ve been too inconsistent in how I’ve been pushing to get good info that way, until quite recently. Now I’ve started consistently doing it “the hard way”, with the scale behind my body, and the ball of my foot pushing down on the middle of the scale, just like a walking “push off”. 100 pounds is still a stretch, and I need more to get to a straight stride, not to mention a 1-leg heel raise. But it’s enough that my 2-leg heel raises are now normal (though I’m mostly doing them on a stair step, so I can include some dorsiflexion).
The ROM on my “bad” (left) ankle seems to be matching my right ankle exactly, which is totally weird! My right ankle LOST a bit of dorsiflexion from my ATR surgery 8 years ago. (My surgeon said he tried to err in that direction rather than make the AT too long.) But my left AT had a big gap in it, and the ends were never drawn together surgically, they just “healed up”, presumably with new connective tissue “filling in the gap”. If it healed at the original length, it would seem like a miracle, but a smidge shorter?!? This whole non-surgical cure is way magical. . .
Good healing, everybody!
12 Responses to “Small victories, still waiting for calf strength”
By normofthenorth on Mar 2, 2010 | Reply
I’m starting to RANT!! I posted a rant about Docs that prolong the NWB period at http://achillesblog.com/momoftwo/2010/02/25/4-weeks-post-surgery-today/#comment-7 .
And a day or two ago, I posted a rant about people who call the non-surgical approach “conservative” — even if it’s faster than most of the SURGICAL approaches!! — on chana7’s blog, at http://achillesblog.com/chana7/2010/02/28/22-week-update-conservative-everything-but-running/#comment-4 .
I know that label has been used a long time, but I think it still makes little sense! Mind you, if a slow approach produces WORSE outcomes than a quicker one — including more re-ruptures! — as seems to be the case, then it doesn’t deserve the term “conservative”, either!
By "Frouchie" or "Grouchie", or just "Chris" on Mar 2, 2010 | Reply
Sounds like you’re on the mend…keep up the good work.
I still have days where the limp is worst than other days. I’ve been walking pretty good, but only when I talk smaller steps. I’ve been walking and pushing off with my toes with the repaired AT foot, but it gets tired very quick.
Keep us posted, and Good Luck.
By chocolata on Mar 2, 2010 | Reply
The progress you’ve made is steady and sound and I’m so glad for you! While reading your update, I felt so good, as I imagined myself being able to do the things you described later in my recovery.
As a starter, I hope I can get a nice boot!
Take care, and I wish everyone happy healing
By normofthenorth on Mar 4, 2010 | Reply
Last few days, I’ve been a commenting “fool” on other people’s blogs here, while neglecting the home team, or home page. . . Rather than posting links, I’ll summarize here:
First 2-shoes bike ride was yesterday evening, very pleasant and without incident. YAY!! I could clearly hurt myself if I fell, or maybe even made an emergency stop, but I think I’ll be doing much more of that, as carefully as I can. (My bike has been outside, and it’s about as “rusty” as my body! ;-D ) There’s a bit of snow and ice on the ground, but not much, and the forecast is for some serious thawing, including a high of 10C (50F) on Saturday!
I’m working pretty hard at my physio’s new strength exercises, and only half-heartedly at the new stretches. My ROM is already as good as my “good” leg, and I don’t want to be greedy — especially if it’s at the risk of having an AT that’s too long.
Basically, I got a pair of serious dorsiflex stretches (straight knee and bent knee) and a pair of heel-raise-type strength exercises (straight knee and bent knee). I’m sometimes doing the straight-knee raise on my Total Gym gizmo, but mostly on the bottom stair step.
The bent-knee strength thing is a little complicated: I sit on the edge of the bathtub (on a folded bathmat for padding), with the front of my foot on the bathroom scale, and a full bucket of water on my knee for weight (on a folded towel for padding). And I do a bunch of heel raises and slow lowering, from one ROM limit to the other. (When I need a heavier weight than the full bucket, I’m not sure where I’ll turn! I may have a taller bucket in the basement. . .)
Chris the Physio says that the straight-leg moves work the Gastroc Nemius “head” of the calf muscle, and the bent-knee moves work the Soleus “head”. He thinks it may still be several weeks before I’m walking normally with a real “push off” where my calf and AT essentially lift my body weight. And we’ve scheduled more frequent physio visits, almost 2/week.
Eight years ago (first ATR, with surgery, slow rehab), it was at 17 weeks that I first walked normally. Then my physio convinced me to do “as many single-leg heel raises as I could”, and I couldn’t walk normally again until 21 weeks. This time has been WAY faster so far, and at 12 weeks, that “push off” thing is the only thing between me and a remarkably normal existence!
As it is, my “bad” ankle now feels remarkably normal in every way except that calf-strength thing. I only elevate occasionally, and usually because it’s easy, not because I feel swollen or uncomfortable. My balance and ankle stability are very close to normal. I still watch where I’m stepping, but I’m not very worried about twisting my ankle, because those little muscles and tendons seem to be in pretty good shape.
My next “firm deadlines” are a ski week on April 11, and the first sailboat race on May 7th. The latter means hanging out the side of a small (15′) sailboat with my ankles under a seatbelt-like strap(!). So far, I’m feeling pretty good about both of those dates.
My ski week is around 17 weeks in, and I sure HOPE I’ll be walking perfectly normally by then, though this “step”(!) has been a slow one already, after a bunch of rapid progress past many earlier milestones. But being “stuck” with a tiny limp for a few weeks sure beats being “stuck” on crutches in 3 casts in a row (then a boot!), as I was 8 yrs ago!!
Good healing, everybody!
By lotte Vestergaard on Mar 5, 2010 | Reply
Hello Norm.
Thanks for your comments for me. I still havent´t made a blogg, but I would like to join you for ealy and agressive rehab. I think and hope it will work for me. I am now 9 weeks and 2 days after my rupture. And already free off my walkabout. Yesterday I went on for a walk outsside for 3,5 km, I was walking home in my 2 shoes from my job instead of taking a taxi and it all went good. Later yesterday I had to go back to my job, and as I haven´t been driving the car for more than 2 months and not knowing if I got enough straingt in my injury right leg to drive, I dicided go by bike both way, total 7 km. I was tired but it all felt great.Today I went by bike again with no problem and later this afternoon my husbond and I went to an empty parkinkgplace to see if I could drive the car. And I could without any problem. It is just a miracle. Right know I can feel the tendon sum a bit, problerly I have pused it to the limit today - did som exercise too and now I paying for that. But still I feel that is the right way. Pushing it, but still listen.
I can see at your blogg that you are very inn for conservative treatment. Me to. At first I was very sceptic (is that a word in English?)but i did some researc and I end up with a believe on, that this was the best for me.
Wish you a good and nice ski trip in May.
By normofthenorth on Mar 5, 2010 | Reply
April, Lotte! “Sceptic” and “skeptic” are both fine words in English, but I’m trying to stamp out “conservative” on this website, as you can read in the first comment above. My cure this time has been non-surgical, but it’s been much LESS conservative (and faster) than my first ATR cure, which was surgical!!
With a right-foot ATR and driving, you should make sure that you get used to pushing the pedals — especially the brake pedal — with your HEEL. If you ever have to make an emergency stop and you put the BALL or TOES of your injured foot on the brake pedal, you could end up re-rupturing the AT and ALSO hitting whatever it was you were trying to avoid. That would be Very Bad!
At 9 weeks, even with a quicker protocol than you’ve been following, you’re still at risk, so be “cautiously aggressive”.
The vast majority of re-ruptures happen in the first 12 weeks, so that’s a rough rule of thumb for when you become relatively more “safe”. But after 12 weeks, it’s still easily possible to do enough harm to set your rehab back significantly (or worse). Check my first blog entry for a personal example from 8 years ago, my first ATR.
By normofthenorth on Mar 5, 2010 | Reply
I just posted some SERIOUS RANTS on jenn’s page, at http://achillesblog.com/jenn/2010/03/03/good-bye-crutches/comment-page-1/#comment-36 and http://achillesblog.com/jenn/2010/03/03/good-bye-crutches/comment-page-1/#comment-37.
She was expressing wonder that I was surviving this ATR thing a SECOND time. And it made me realize how much EASIER it’s been this time, and why! (Thanks, jenn!)
By normofthenorth on Mar 8, 2010 | Reply
Still SO CLOSE to a real “stride” with a “push off”! I’ve definitely hallucinated a few, but maybe that’s all.
Yesterday, on a glorious day, I went for my second boot-less bike ride. Flew around the neighbourhood, nowhere special to go, it just felt good. When I got back home, I did another spin around the block. Great fun! Monday evening, I’ll be doing some serious cycling to actually GET somewhere!
By marina on Mar 8, 2010 | Reply
Really glad you enjoyed your riding
Well, I went to the basketball court again last Saturday. This time, I took some short distance jump shots and the warmer I became, the longer the shots I did, but didn’t want to overdo. I even ran for the ball when I missed and it felt so good, but this is when I realized how weak my calf is. I’m thinking today I may ask my PT to let me have a couple of kms on the treadmill, I don’t know if it is too soon, but I believe it will help me to work that calf. Also as of today (I should have done this earlier), I’ll use my bike to go to the PT, it will only take me around 10mins to arrive and another 10 to get back home, when I usually do half of that on the stationary bike. We’ll see..
By normofthenorth on Mar 9, 2010 | Reply
Today I took my third bike ride in shoes, to my PT appointment. It’s a good little distance — mapquest says just over 4 miles each way — and it’s WAY uphill! Up the banks of the prehistoric Lake Ontario, I think, sometimes know as “the escarpment” in Toronto.
Gorgeous warm day for early March, maybe 9 degrees C or so. I was smart enough to remove my fleece vest before starting out, but I was still wearing a zip-T, a shirt, and a ski jacket, and I roasted like a peanut! It was my first aerobic sweat since the ATR, with both the huffing AND the puffing!
Some of the not-so-impressive uphills got to me worse than the biggest one, maybe because they came later, when I was already whipped. I actually got down into my lowest “granny gear” on my 18- or 21-speed mountain bike! Cycling beside a pedestrian crossing in that gear, I was only going maybe 5 or 10% faster than the pedestrian beside me!
Several times, I started cresting the hill I’d been climbing, and I was wondering why I hadn’t started accelerating yet.
In short, my left calf and AT have lost a LOT of conditioning, but the rest of me has lost quite a bit, too, and today’s bike rides highlighted that. But as ultidad blogged a few days ago, it’s a good hurt — or in my case, a good huff and puff.
This evening, I bicycled to another meeting — 2.78 miles each way, apparently. Downhill to the meeting and uphill on the way home — another slow trip, but I stayed out of the Granny gears!
The only part of any of the trips that bothered my ankle was hitting bumps in the road. When I had weight on my left (=healing) foot, the shock-impact of the bumps would cause discomfort, minor pain, and major anxiety. I’ve been in the habit of taking bumps with my weight split between my feet, to give my rear end and my hands a break. Now I’m re-training myself to take them standing on my right pedal, to give my rear end and my hands AND my left foot a break! That worked a charm.
I’ve posted a new blog entry, and I hope to see you folks there!
By grecha on Mar 28, 2013 | Reply
hello, Norm, can you tell me how high above the ground can your heel raise on single leg lift (talking about the foot with elongated achilles)?
By normofthenorth on Mar 28, 2013 | Reply
Grecha, I’ve never measured it, but it seems like an inch or 1.5″. With a 2-leg heel raise, I go full height fully balanced 50:50, and a smidge past that (more weight on the left-long-weak side) — but not much more than a smidge. Doing a tiptoe “silly walk” is OK, and I can go pretty slowly on the “2-up, 1-down” exercise, though I don’t think I can stop at the top.
I’ve thought of going back to the Sports-Med clinic to get another, more thorough test on the biometric machine (see my blog page “And the Results are IN!”), but I never seem to get around to it. Mostly I’ve been ignoring 1-leg raises and exercises, just bicycling, skiing, playing competitive volleyball, sailing, etc. (I also don’t ever play basketball, because I suck at that, too!)
If I had to guess I’d say that I’ve got around 80% or so of my right-side strength with bent knee (I was around 70% when I posted that blog page about the results), and probably more like 50% with straight knee.