17 weeks, still improving (though slowly)

Written on April 10, 2010 – 12:16 am | by normofthenorth

After weeks of hanging out here several times a day, the death and re-birth of AchillesBlog.com gives me an unusual double-snapshot of a slow phase of recovery. It’s like seeing an old friend for the first time in a long while, when it’s easy to notice physical changes that might have been invisible if you’d stayed in touch.

On the other hand, most of my improvements are still evolutionary rather than revolutionary. My walking gait is now USUALLY normal or “perfect”, except for the first few steps of the day and the first few after I get up from sitting for a long time. I no longer have to grunt and strain to walk without that little “dip-limp”. On the other hand, I’m still too weak to do even one single-leg calf raise, much less a bunch.

Everything else — except strength and sports — is pretty much totally normal now. I’ve been wearing all my normal shoes, and moving around as I please, and sometimes even forgetting that I tore my AT 17 wks ago(!). I’m not especially nervous about tripping or being tripped any more. I’m even mounting and dismounting my bicycle without thinking much about where my foot is on the pedal, and ditto while walking down stairs — except that I’m treating both of them as calf exercise most of the time!!

Walking around the house and down stairs, I’m often doing the “native American dance”, starting high on the ball of my foot and trying to drop down slowly and in control. (No drums or singing, though!) That controlled “drop” is still a challenge. After I do enough of that kind of exercise, I sometimes have trouble walking perfectly, so the progress is still THAT gradual.

After my speedy progress through the first 8-10 weeks of my (non-surgical) protocol, I was clearly expecting my left leg to be stronger by now than it is (and I said so in my blogs, too!). But I’m still about a month ahead of my progress 8 years ago, after ATR surgery and in the care of a very conservative ortho-surgeon with an excessive fondness for casts.

The excitement now is that I’m about to head off to Whistler for a ski week! This trip has been scheduled for a long time, and it’s been one of my landmark goals from the start, and now it’s just a day or two away!! Yay!!

I’ve tried on the ski boots, and the left one fits fine on my still-slightly-oversize foot — frankly to my surprise, because my boots have always been quite tight, giving me black (bruised) toenails when I get jammed forward, and such. (I think I’ll be elevating my leg a few times a day.)

My physio noticed that my AT is “slimming down” much closer to the shape of the other one than it was a month ago, and I’m starting to regain those hollow “pockets” on either side of my heel. (They should have a name! Anybody?) And he measured my ROM while pushing hard, and he says it’s (a) indistinguishable from the other ankle, and (b) well within the range of “normal” and “fully functional”.

So it seems that this non-surgical cure has managed to do the one thing that seems most impossible, which — is to build an AT of the proper length out of one that had a sizable gap in it. Don’t ask me HOW a human body can do this by itself, because it still seems impossible. But the recent studies show that it usually happens just as successfully as with surgery, and my experience seems to show it, too.

He also tested a bunch of other kinds of ROM (besides plantarflexion and dorsiflexion), and he proclaimed my foot and ankle solid and stable and suitably mobile in all directions — just weak in the calf, and also not especially strong in the posterior tibial tendon, either.

Interestingly, I’ve always had some trouble with my right (”good” foot) arch collapsing when I ski (and probably other times, too), and Chris-the-PT thinks that’s all because the posterior tibial muscle-tendon pair is weak on my right foot, too. (Like chiropractors and Faith Healers, some Physios think they can heal everything that ails you!) I’m trying to exercise them both, though not with a Theraband, as Chris recommends. I’m mostly putting both feet up and pushing them against each other, imitating a Theraband.

Chris has decided that he can’t do much more for me with Physio, so he’s transferred me to a colleague for more exercise-like work. Dynamic Motor Therapy, or some similar phrase. That starts soon after my ski week ends. And in about 4 weeks (at 21 weeks), I’m scheduled for a series of “Bio-dex” tests, to quantify my strength and ROM etc.

I spent a week in Florida at the end of March, and I had a surprising amount of swelling in my “bad” leg and foot for several of those days. Probably just too much standing and walking and shopping and kite flying and sitting normally, and not enough elevation. When I finally noticed it, it was pretty ugly. So I started elevating a bunch (and also using an elastic sleeve brace and even icing some), and I was surprised how long it took the swelling to go away. I think an ounce of prevention is worth a pound of cure, as somebody once said.

So, wish me luck on the ski slopes next week! I’m not sure which part of my body will be most at risk, but I’m sure NO part of me will be totally safe, alas! (I have a knee and a shoulder that still occasionally remember ski “blow-ups” from past years!)

Eight years ago, my physio told me I was crazy to go skiing, though, and this time Chris thinks I’ll probably be fine — at least around the left ankle! I’m about 3 weeks earlier on the Achilles Marathon this time, but everything has been coming along much quicker this time, so I’m reasonably confident my ankle will be OK.

I hope everybody else has been healing well while we’ve been apart, and I hope our little “gang” will gather back here again, now that the site is up and running again! (Thanks, Dennis!)

  1. 14 Responses to “17 weeks, still improving (though slowly)”

  2. By kristinatl on Apr 11, 2010 | Reply

    Skiing at 17 weeks?!?!? Go Superman Go! Way to get out there. Be careful though! Maybe you could ski with an inflatable bubble around you. That way you’d be safe…or a big hamster ball. :) Enjoy skiing, and rest some too. Your blog is full of good info. Gonna read the rest of it now.

  3. By normofthenorth on Apr 13, 2010 | Reply

    I survived my first ski day, and LOVED being back on Whistler mountain — YAY!! I started the day nervous about my left ankle, of course. My ankle had been behaving well until the travel day, with lots of walking and standing and sitting on a plane and driving a few hours from Vancouver to Whistler. After that, it was puffy, and it was still a bit fat yesterday morning.

    When I got into the boot with my regular fat ski sock on, it was way too tight. So I switched to a thin (non-ski) sock, which felt OK. I was considering going barefoot inside the boot, or wearing a thin elastic sleeve (”brace”?), but there was no need.

    I walked the ~100 paces from the condo to the gondola and uploaded 4000-odd feet of vertical.
    I’d marked my skis (to tell them apart) and played with the setting of my left heel-release on the binding. I finally compromised on DIN 5, or a hair below, after snapping out of it at DIN 5 in my basement.

    It had been almost 13 months since I’d skied, so I wasn’t exactly “in the groove”, even without the ATR. When I started skiing, I quickly started concentrating on remembering how to ski, rather than the left ankle! In fact, I had enough physical distractions from other body parts complaining — my right ankle(!), my right knee, both thighs — that I didn’t spend much time thinking about my AT.

    It was a bluebird-sky day, and Whistler had just snapped from a cold snap to a warm snap. So the snow went from perfect to warm-and-heavy-but-nice, then to heavy-alternating-with-GLUE!! By the time the snow started turning to glue, my thighs were exhausted, and I was having trouble continuing on “noodle legs”.

    We quit after about 4 hours including a long soup break, with around 13000′ of vertical skied. That’s a very wimpy day by my normal standards, but my thighs are still burning now, the next morning!

    The good news is that my problems are all enviable problems, and have little or nothing to do with my ATR! (YAY!)

    The only hint of an ATR connection is that staying in balance on yesterday afternoon’s snow — that alternates between slippery and sticky — was a bit more nervous-making than it would have been without the ATR. Of all the “moves” that worried me, getting thrown way forward was the scariest, and skiing on “glue” is a great way to get thrown way forward.

    We’re getting a slow start today, partly because I’m still so stiff (waiting for the Ibuprofen to kick in!), and partly because it’s been pouring rain in Whistler Village! It’s not raining up on the mountain, but it’s still hard to spring out of the condo when it’s pouring out!

    So, enough computer time, the boots are going back on (yay!)!

  4. By mikek753 on Apr 13, 2010 | Reply

    good to know about your amazing progress ;-)

    Hmm, about fat ski socks …
    I don’t have fat, but “performance” shaped ski socks that have extra padding at front ankle area and the rest are thin.
    Snowboard socks are “fat” - IMHO.
    anyway - take it easy
    any 1st day on ski is tough as your body has to adjust for ski position and constant twisting / pushing.
    your brain adjusts faster then your body.

  5. By normofthenorth on Apr 15, 2010 | Reply

    Now 3 ski days done, and I’m lovin’ it!

    Yesterday started out with zero visibility over all of both mountains. Snow falling a lot of the time, through pea-soup fog. NOT the perfect conditions for remember how to relax and “dance” on the snow — with or without a healing AT!

    After a couple of tense slow runs, we discovered that the visibility was clearing up at lower altitudes. Unfortunately, Whistler is still unusually warm for mid-April, so there was a pure tradeoff: Stay high on nice cold snow and ski blind as a bat, or drop down and ski on heavier, warmer snow with better visibility.

    We dropped down, and skied the Garbanzo chair — alternating between Raven/Ptarmigan (the Men’s Olympic GS course, I think) and upper Dave Murray (the Men’s Olympic Downhill course) followed by either Bear Paw or Tokum. The sun came out, so it was a lovely afternoon, though the snow was heavy and slow, with growing patches of “glue”. We didn’t break any endurance records — thighs turning into noodles again around maybe 12k-13k’ of vertical.

    Today was a gorgeous day, maybe a bit warmer than the first two, glorious sunny views in all directions. I skied pretty well all day, on groomed and several runs off the groomed — 4 or 5 on Glacier Bowl, one run down Franz’s Meadow. The best runs were off the Peak Chair, where the temperatures were cool enough that the snow was still “Winter”. I almost risked a run down the LONG and challenging Whistler Bowl to Shale Slope, but my thighs were getting tired by the time I considered it.

    The ski club we were members of for a long time (High Park SC) has a trip here, and we bumped into a dear old friend, and skied with her all this afternoon, then got together again for apps and wine in our condo then dinner out.

    Since day 1, I’ve been skiing with mis-matched ski socks — a thinner one (supposedly with magical ceramic temperature-control threads) on the bigger ATR side, and a thicker one on the other side. (Mike, I had gravitated to the thick ones instead of the fancy shaped ones over the years, not sure why.)

    My thighs are ruined, my right knee isn’t sure it loves skiing as much as I do, and I groan when I get up from a chair. In short, all my problems are normal ones for an out-of-shape old guy who hasn’t skied for a year, not “medical” problems. Yay!!!

  6. By normofthenorth on Apr 17, 2010 | Reply

    Now we’ve done 5 days out of 6, and it’s still great! My thighs are still wimpy, and still getting a serious workout in some serious Spring skiing conditions.

    It is Spring, but in Whistler, even in late April, I’ve usually been able to find “Winter” snow to ski on. But we’ve had a bit of a heat wave while we’ve been here, and the snow has been soft (or even sticky) from at least noontime on, virtually all the way to the summits, which is unusual — and hard work!

    And there’s another unusual thing about the weather: With two annual timeshares for the past maybe 13 or 14 years, we’ve come here pretty often, and we can almost always count on getting 18″ or more fresh snow during the crucial week (our first travel day and our 6 ski days). At the high end, we got 58″ during that week a few years ago(!). But not this week! They’re saying we’ve gotten 7 centimetres in the past 7 days, and it’s going to be clear tonight and not a blizzard tomorrow, so that won’t go way up.

    As compensation, the crowd on the mountains seems unusually small. No lift lines at all, and I’ve skied a few entire runs without seeing anybody else. Today starts the World Ski and Snowboard Festival here, which has drawn a bunch of people, though a lot of them look like they’re not going up the lifts tomorrow, or at least not with skis or snowboards on their feet.

    The other good news is that the visibility and views have been incredible, except for that Tuesday morning with the pea soup.

    Yesterday and today, I’ve gotten much more relaxed and comfortable on my skis, and I’ve started skiing some of the hardest runs I usually ski. Those are ungroomed runs with a lot of pitch and deeper snow, and they build up big bumps (”moguls”) after a day or two of traffic without a bunch of new snow. Today, I even tried one such run that I’ve never tried before! Unfortunately, it was a bit too rich for me, especially with my left heel binding set down to 5 instead of 7. I blew off my left ski twice on the way down, and had to climb back up (right under the chair lift!) to recover my left ski!

    Again, I view all these problems as delightful, enviable problems, at this stage of my healing, and I’m grateful to have them!

    My daily “vertical”, according to my altimeter watches, took a real dive two days ago, when I started skiing harder stuff (and stopping even more frequently to rest my legs)! Yesterday I wound up with around 10,000 feet of vertical by the time I ran out of thigh strength. Today it was more like 15,000′ — still wimpy by my former (and hopefully future) standards, but enough!

    Good healing, all! There is a normal future after an ATR (even, or maybe especially, without surgery!), and parts of it can begin relatively soon!

  7. By normofthenorth on Apr 17, 2010 | Reply

    Today should be ski-day #6 of 6, except that it’s pouring rain in the Village, and apparently all over the mountains, too. My wife’s lift ticket is already paid-for, but she’s not heading up the lifts. Mine isn’t, and I may also wimp out rather than putting the plastic bag over my almost-waterproof ski suit. If there’s one thing that can make snow even heavier than warmth and sun, it’s rain! Actually, I’ve sometimes skied on rain-soaked snow that was pretty slick, rather than the glue we’ve been hit with at the ends of the warm days, so that might be OK, at least ’til my suit and gloves get soaked through.

    I do love Whistler, but anybody who comes here for great (or even predictable) weather is 100% nuts. I don’t think I’ve ever before missed a single day of skiing here because of bad weather, and I’m torn about it today. If it just calmed down to a drizzle instead of a downpour. . .

  8. By normofthenorth on Apr 22, 2010 | Reply

    And I made it home safely, too!

    As I posted elsewhere:
    I had my first serious muscle-workout-in-the-gym PT session today. My past sessions (with a different PT) were mostly massage and gizmos (laser, ultrasound, interference current) and take-home exercises. But these are more like “5 more, 4 more, 3 more, 2 more, 1 more, rest now!”

    I get to take the exercises home to do, too, unless they’re on fancy equipment I don’t own, but this woman definitely wants to WATCH me sweat! I guess that’s good for me, though I’d rather build up my strength skiing and bicycling and walking or running, than doing multiple sets of multiple reps of anything!

    I’m still not convinced that any of my new exercises are better than the 2-leg heel raise on the stairs, with a 1-leg lower (over and over and over)!

    My former PT Chris handed me over to Tanya because he’d seen my ROM and ankle stability progress to where they were essentially identical to my “good” ankle. So I’m officially up to full speed now, except for my wimpy calf strength! (Details, details!)

    That should be good enough for the sailing season, which starts any minute now! And bicycling back and forth between home and the sailing club should help build up my calf strength — and my thigh strength and general fitness, too, I hope!

    Good healing, all!

  9. By normofthenorth on Apr 28, 2010 | Reply

    Today I ran a bunch of errands by bike, and felt almost 100% normal. I cycled off several curbs and even went down two shallow sets of outdoor stairs on my bike(!). (And at 65, even!)

    I think my thigh strength and cardio fitness are less pathetic than they were a coupla weeks ago, Thank Heaven! I may not rush back to do more gym-physio, partly because “I’m still not convinced that any of my new exercises are better than the 2-leg heel raise on the stairs, with a 1-leg lower (over and over and over)!” And I’d rather walk and bicycle and sail (and work on boats, even!) than push machines around.

    I spent one day at the Sailing Club last weekend, and wow! In general, I’ve almost completely gotten past the scary-nervous phase where I watch every step like a hawk, for fear of twisting an ankle or tripping, but Holy Nelly! My entire club (www.torontosailing.com) just looked like one Gi-normous Tripping Hazard! The grounds (on a sandy island on the far side of Toronto Harbour) are riddled with tree roots and saplings and scrub and rocks and chunks of concrete and such. And all the buildings are still jammed full of all their Winter-storage stuff, as well as all their Summer-storage stuff, so there’s nowhere to step, and LOTS of chances to hurt yourself.

    At one point, I actually DID twist my ankle by stomping onto a big tree root, while moving a boat on a dolly (walking backwards, yet!). It was my “bad” (left) ankle, and it hurt a bit, but I don’t think it felt any different than if I’d done the same move with my “good” ankle. And it was totally gone by the next morning, no harm done. But I’ve got to go back a do a LOT more work on the boats — not to mention SAILING!! — so I’ll have lots more chances to trip, and in the dark, too!

    Racing starts on May 7th, and I plan to be there, boats fixed up, all my gear at the club, and MAYBE even with one or two sailing sessions under my belt first.

    Unless I kill myself tripping on something, I expect to be ready. The main work for an ankle whle sailing these boats is mostly dorsiflexing to hold a big nylon “hiking” strap on top of your ankle, while your Center of Gravity is hanging out the side of the boat, helping to keep it right-side up. That position may well be another challenge for my wimpy thighs, like skiing in soft snow. But it should also strengthen them.

    Of course, I’m delighted that all my problems continue to be “normal” ones, not much related to my almost-20-weeks-ago ATR!! :-)

  10. By notsorad on Apr 29, 2010 | Reply

    Norm, you inspire me to keep pushing through the challenges in PT to get my strength back. I am currently looking for a cruiser bike with a few gears so I can start riding my son to school again. I think that my old one speed beach cruiser will be a bit much to pedal around. I am hoping that my time on the stationary bike will help me get back on a real bike. I have also been doing “quad sets” several times a days since week 2 post op. I was thinking just to be safe I would use the dreaded boot when I start back on my bike. We had a work day at our Yacht Club for the Jr program last weekend. I know what you mean about one big tripping hazard, I sat and cut bailers to stay off my feet. In terms of hiking out, you could try crossing one leg under the other to take a quick “rest” on the weak leg. (I have taught sailing for years) What class boat are you sailing in?

  11. By normofthenorth on Apr 30, 2010 | Reply

    There’s no shame in using the boot for scary situations, and bicycling for the first few times is definitely one of those.

    I race Albacores, 15-foot centerboard dinghies, no spinnakers. Toronto is a HUGE center for sailing, especially Albacores. We have a Friday Night series that runs for NINETEEN Friday nights and averages maybe 45 Albacores (and a few Lasers) finishing!

    At my best, I’m a half-decent sailor/racer. 12th at the 1999 Worlds (Rehoboth Bay Delaware) is probably my peak. I was ninth-best community-club skipper in Toronto in 2008, one of my better years. (Don’t ask about 2009!)

    I only teach informally, in my club, and I take fancy race-training classes from the Albacore elite whenever I can. I’ve been top racing skipper in my (not-so-successful-in-the-races) club for the past 8 years, though I almost blew it last season.

    Check out our club at http://www.torontosailing.com if you like.

    I’ve gotten into dirt-cheap department-store bikes, which keep getting better. Around here, you can usually get something half-decent (though heavy) for under $100. Alloy rims, great brakes, indexed shifters with lots of gears. They’ve gotten me out of the habit of (a) buying used and (b) doing maintenance(!).

  12. By Ross on Nov 28, 2013 | Reply

    Hi “Norm”
    I’m a newbie here on AchillesBlog.com after just recently rupturing my left one.
    Very interested in your “skiing” experience as I also have a ski trip pre-planned (at 15 wks post non-op however)and ones I’ve figured out how to navigate properly though this site will be checking out how you got on.

  13. By normofthenorth on Nov 28, 2013 | Reply

    Welcome Ross! You found my skiing experience (at 17 weeks post-non-op), at the top of this page. And that was it for that ski season. Following seasons were fine (except for the heart surgery!), though I stayed with the thinner left boot sock.
    Every time I’ve skied soon after an ATR (2x, after 2 ATRs!), I’ve first gotten into “that” boot in the basement and practiced snapping out of “that” heel binding, starting at DIN 0 and cranking it up incrementally until I was confident that I could ski OK, neither re-rupturing nor constantly losing a ski. First time (post-op), I think I went with DIN ~3.5, 2nd time (post-non-op, 2009-10) a bit higher, almost DIN 5.

    This past March, I popped out once or twice when I wish I hadn’t, and discovered that my left heel binding was still a bit lower than my normal (still ~7 at 68yo), so I boosted it and stayed in it for the rest of the week, IIRC. (If I did pop out, it was when I SHOULD have.)

    I recommend that pre-trip prep and adjustment. Many good skiers think everybody should pop out of all 4 bindings intentionally each season before skiing — not a bad idea. Maybe 5 minutes “wasted” to make sure you’re not going to break something foolishly.

  14. By normofthenorth on Nov 28, 2013 | Reply

    Ross, now that I see you’re on the super-slow track, you will NOT be ready to ski at 15 weeks for sure, unless you get on the fast track. Not after 12 weeks in casts and AirCast (boot). Switch tracks ASAP. Do whatever you’ve got to do.

    Even with Best Medical Practice, 15 weeks may still be pushing it, especially if you ski as aggressively as I do. Time will tell, if you manage to get treated well.

  15. By Ross on Nov 30, 2013 | Reply

    Norm, I’m going to do what I can to get on a different protocol, as for the aggresive skiing, I like to think I ski at a pretty good level, and was hoping to try some “backcountry” stuff this season. That’s not going to happen now. At 15 weeks i’d be happy just to get onto skis, glide down some blues, and try to keep up with my 5 year old.

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