More small steps at week 13.5

Written on March 15, 2010 – 11:06 pm | by normofthenorth

Physio last Friday and today, as my schedule and PT Chris’s would have it. He spent a lot of time digging HARD at a tender spot just below my “inside” (medial?) ankle bone. It hurt WAY worse than the rupture or most anything else connected to the ATR!

He says that spot is the attachment point for the OTHER tendon that can dorsiflex my foot. (Most of you know that somebody with a 100% torn AT can still point their toe and even push a gas pedal normally, but not climb stairs normally. The other muscle and tendon do a similar job to the calf-AT pair, but they’re much smaller and weaker.)

I’m guessing that I’ve been over-working that muscle-tendon pair a bit with all my concentric and eccentric heel-raise-type exercises. And last night, I was grunting and clenching my fists while walking fast, in a successful effort to eliminate the limp-dip at the end of my stride. Probably some of that was with this ancillary muscle-tendon pair, too.

That experiment at least FINALLY confirmed what I’ve been guessing — or wishfully thinking — for maybe 4 weeks already: that I’m really, REALLY close to having the strength to walk normally.

Today I bicycled to Physio again, up one of Toronto’s meanest hills. BOY, am I out of shape! My AT and calf were the LEAST of my worries, and part-way up the steepest part, I stopped and walked my bike the rest of the way! (That was AFTER shifting into my lowest “Granny gear”!!)

The good news was that the smaller hill, farther on, that almost wiped me out the last time, was a “piece of cake” this time. The other good news was that I actually arrived on time to Physio.

After PT, I ran several errands by bike. On my way home, cycling in traffic after dark, I had a novel and nifty experience: At one point, I suddenly REMEMBERED that I was nursing a torn-and-healing AT. Then I realized what that meant — I had FORGOTTEN all about it, for the very first time since December 8th! Now THAT was fun!

Good spirits and good healing, everybody!

P.S. If you have any comments specifically about surgery vs. non-op approaches, please post them in a comment on the previous page, which is now linked from the home page here — thanks, D!

  1. 12 Responses to “More small steps at week 13.5”

  2. By mikek753 on Mar 16, 2010 | Reply

    Looks like you have solid recovery and that adds optimism to me too by reading your progress ;-)
    Looks like you already seen light at end of the tunnel or even came to end of it where you can start looking around.
    Pls. keep posting your progress.
    So glad for you.

  3. By normofthenorth on Mar 16, 2010 | Reply

    And I forgot one more “small step”, until I posted about it on another blog page here. Here’s the slightly edited version:

    “Now that you mention it, I was [alternating jogging and walking] this evening, on the way back from our local mailbox (~3 blocks away).

    At ~13.5 weeks post-no-op, I still usually have a little dip-limp at the end of every walking stride, but my slow jogging actually seemed easier and more “normal” and balanced than my walking! Maybe that’s because my quads and knees are strong enough to give me enough of a “bounce” (while my bad foot is still flat-footed) that I can push off with my “bad” foot while my momentum is still upwards.

    The good news is that it was fun and didn’t hurt a bit. The bad news is that it was just one more thing that reminded me that I am WAY out of shape from 3 months without any serious cardiovascular exercise. (My ~4-mile bike ride up one of Toronto’s biggest hills earlier today was also a reminder!)

    Each of these steps back toward our normal life is a victory! (And there are so many of them!!)”

    Hang in there, Mike, and Good Healing!

  4. By Lou on Mar 16, 2010 | Reply

    Hi Norm

    Congrats on the AT progress.

    Please be careful. That other tendon, the posterior tibial tendon, is the one I ruptured in my right ankle 11 years ago, and recovery from that is much more serious and difficult, requires surgery, and I still have a knot in that tendon that will restrict my ROM in the right ankle forever. That tendon maintains the arch in your foot, and sensitivity is not a good situation, and may indicate inflamed bursae, etc..

    Pain is your body giving you feedback. I’m aggressive, but listen closely to what my body tells me.

  5. By "Frouchie" or "Grouchie", or just "Chris" on Mar 16, 2010 | Reply


    If the weather would break and start to warm up here in Illiois, I be breaking my mountain bike out and riding from home to the fitness center and home again. I know what you mean about being out of shape, my rides have had me breathless and wornout…but I love doing it.

    Glad to see you’re out on the bike and riding everywhere. Keep going and be safe.

  6. By doug53 on Mar 16, 2010 | Reply

    Hi Norm,

    I remember doing that slow jog, too, getting that feeling of rolling weight over the foot without any hitches. I wonder if doing that helped mentally more than physically.

    A quote from Beckham’s doctor, “He will have to take it very easy during the next two to three weeks or a month, and then he will continue with a recuperation program slowly. The foot won’t take much strain for two to three months.” I guess it all depends on what he means by “very easy” and “slowly” and “much strain,” but it sounds like the famous patient might be getting a pretty conservative rehab.

    The snow has been melting away fast here in Minnesota. I finally got the bike out for the first ride of the year on Sunday, just a dozen easy miles over the rolling terrain here, but it sure felt great.


  7. By normofthenorth on Mar 16, 2010 | Reply

    Thanks for all the comments, folks.

    Lou, that is definitely a scary story, and an important cautionary tale! 8 yrs ago (1st ATR), I strained my ATR (at the back of my heel) by overdoing with 1-leg heel raises on the first day when I could walk “perfectly” in bare feet (around 4 months post-op). My physio insisted! I had serious heel pain for weeks afterwards, and couldn’t walk right again for a month.

    It’s possible that I’ve gotten my posterior tibial tendon into a minor version of that same overworked state. Hmmm. Yesterday I worked unusually hard, between cycling and physio and walking and jogging, so maybe I’ll take today off.

    Doug, I’ve also been surprised by how slow the “Beckham cure” seems to be. On placervillemadman’s blog, I suggested that you and those two Japanese surgeons should take over, and get him playing in the World Cup in just under 3 months!

    Good healing, all!

  8. By Lou on Mar 16, 2010 | Reply

    Good decision Norm. The Posterior tibial tendon runs under that medial bone in a sheath, and your tendon and/or sheath is likely inflamed by over-activity. In my case, I fell out of a tree, snapped the medial bone and ruptured the PT tendon. The knot in the repaired PT tendon will not pass through the sheath.

    Regarding Beckham, I think the docs are concerned with him stretching the AT and making it too long. My PT guy is not stretching my ankle for more ROM because he is concerned that excessive use of the calf muscle (I went PWB & FWB early and have little atrophy) will stretch the AT and make it too long, even though I had surgery. Just being 2 shoes should complete my ROM work.

  9. By normofthenorth on Mar 20, 2010 | Reply

    After a couple of days of moderate walking and cycling and no aggressive “sets” of “reps” of 1-and-a-half-legged heel raises, the tenderness in that spot seems to have gone away. As I return to the exercises, I’ll try to pay careful attention to that “soft spot”!

    BTW, Lou, I’m surprised that the non-surgical approach isn’t used for a rupture of the ptt. I guess in your case, they were likely operating anyway, to set the bone and stuff?

  10. By Lou on Mar 20, 2010 | Reply

    Great that you are back on track!!

    You are right. Surgeon had to operate to rejoin the bone with 2 X 2 inch screws. The PTT was guessed at - my foot went flat - but confirmed during surgery. No way the PTT would have healed without being sutured. Had an 8 inch incision for that one. The PTT went way up into the leg and had to be retrieved.

    BTW tried a short jog about 600 feet today. Found that inexpensive new high top sneakers (Reebok Tre Ball - $30 @ Kohl’s) plus Futuro ankle brace gave enough support to eliminate most of my limp, so I thought I’d give it a go.

  11. By normofthenorth on Mar 20, 2010 | Reply

    The short jog sounds MUCH better than the tendon that had to be “retrieved”. Shudder!

    Most of us here are in the elite group — “9 out of 10,000″ was the catchy phrase from an old ad, maybe for the aperitif Cynar? — that has experienced the ultra-creepy feeling of a tendon sliding unopposed in its sheath. Shudder! The first time I tore an AT, I felt the wierd feeling at the initial “pop”, then probably again the first time I tried to walk, then definitely again the first time I put that foot on a stairway going up. Creepy stuff — really painful for many, but just ultra-creepy for me.

    (You need a blog here, Lou!)

  12. By normofthenorth on Mar 21, 2010 | Reply

    mikek753 just asked me some questions by e-mail, and I hope he won’t mind if I repeat them and answer them here “in public”, where they may also benefit others who have the same questions or concerns. I’ll start his questions with a - (and put them in bold) and my answers with a +, so you can tell them apart.

    -I need your help to understand right transition from NWB to the next step.
    Its about time for me to start using my boot with 3cm insert based on protocol.

    +The protocol says 2cm, but I got 3cm by accident, and it’s probably OK. (If I were starting, I’d use 2cm, as long as the heel wedges were solid enough not to crush under my weight.)

    -So far I keep my foot above floor all the time.
    +That’s certainly NWB, though I took the liberty of resting the weight of my foot on my foot, either on the floor or up on a footstool, etc. Just not supporting any of my body weight.

    -What did you do when you moved to your 1st boot?
    +I never did that, because I started in a boot. You started in a cast, but I believe it was set up essentially the same as the boot would have been — casted in a toe-down “equinus” position roughly equivalent to the angle in a neutral boot with your heel elevated with 2cm (or 3cm) of heel lifts.

    If you’re asking what I did at 2 wks, when the protocol calls for “protected Weight Bearing”, I started resting my boot on the floor as I crutch-walked, initially just “along for the ride” with no real weight on it, then gradually applying more weight as time went on.

    -How to know what’s partial weight?
    +Good Q. The UWO study protocol doesn’t actually say “partial” WB, it says “protected” WB. I took that to mean a fraction of my weight, always under my complete control, because the crutches were there taking most of the load.

    -Is it like 20% while on crutches or 50% or even 100%?
    +The short answer is that I don’t know, I never asked, and nobody ever told me. At 4 weeks after you become immobilized (which is very soon for you, as I recall), the protocol says WBAT= WB As Tolerated, which means that 100% is fine as long as it’s not uncomfortable or painful. Before that point, 100% is more than the protocol calls for, and 50% may or may not be, I don’t know.

    -How to use my 1st boot right?
    +The boot is designed for you to roll over the rounded sole, from heel to toe. (They’re sometimes called “cam-walkers” because of that shape.) The important thing is to keep your “bad” toe pointed straight ahead at all times (except possibly on some narrow stairs), and NOT to get into the habit of spreading your feet or your toes apart and rolling over the inside of your foot. (That can be a hard limping habit to break.)
    If you “clomp” down hard on the heel of the boot, you may exacerbate the heel pain or discomfort that so many of us feel when we move to FWB, so it may help to try to put the boot heel down GENTLY.
    Basically, your boot moves with your crutches (and your other foot moves opposite), so you are always sharing your weight among the three supports — one boot and two crutches. That’s the “protected” part. (On the other step, your “good” foot is all by itself.)

    -I’m looking just for your experience and opinion, pls.
    Any web url that have pictures or even videos are very welcome.

    +I don’t have anything more, what you’ve got is what I’ve got! YouTube may have great stuff, for all I know, I haven’t looked.

    -Did you use ice packs after exercise?
    +I was told by my Physio to use ice, and he used some on me during my sessions. When he did, he left straight ice (in a plastic bag or a fancy “cuff”) right there (with the back of my leg resting right on it) for 20 minutes or so — that was somewhere between COLD and CO-HOOOOOLD!! When I suggested 5 minutes on and 5 off, he made fun of that, and said it would only chill my skin, and that this injury and inflammation were deeper than that.
    But at home, I only elevated, I never actually iced.
    Doug53 had good results with compression, the other component of R-I-C-E used to control inflammation. I never used that until a couple of weeks ago, when my surgeon suggested I try an ankle “sleeve” because my ankle was puffy the day he saw me. The problem with elastic sleeves for you is that you could easily hurt your leg putting them on and taking them off, at this early stage. (Same thing with a tall sock, which will make your leg feel more comfy and “normal” in the boot — but it’s probably too soon to do safely.) I think Doug used an elastic wrap, which might be safer (but probably still too scary). Elevation usually works well enough, and it’s pretty safe, because you can do it while still safely immobilized in the boot.

    -I have some pain at night when I’m about to sleep and trying to place my foot on sides to reduce pain in lower calf area.
    You’ve mentioned that on your blog, too. I think one of D’s main pages (on the first 2 weeks after surgery) recommends elevating while lying on your stomach. I never did that, but if it works for you, go for it. On the side worked well for me. Some people gather up pillows and blankets from far and wide. . .

    I think many of us find that the important thing is spending a lot of our time at least partially elevated — leg up on the kitchen table, or a nearby chair, or a footstool — and avoiding long periods where your leg is below you. I found that if I spent an hour standing at my workbench, or at a party, I’d get very uncomfortable, and I might be tempted to “stand on my head” afterwards. But if I just stuck my leg up on a chair after 10 or 15 minutes of having it below me, that would be high enough. I hope that makes sense.

  13. By normofthenorth on Apr 8, 2010 | Reply

    Wow, posting Mike’s answers here, instead of e-mailing them to him, turned out to be a BIG mistake, because the site vanished almost instantly, for over 2 weeks!

    I hope you’re back, Mike, and that the answer is of some use. I hope it’s also useful to others.

    Come back, AchillesBlog gang!!

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