np13’s AchillesBlog

A few folks here have had trouble “winning the mental game”, Bree. The injury is a bummer for all of us, though lots of your neighbours are suffering with worse. Stay sane, keep coping. There aren’t any freak-out moves that will make anything any better — definitely including cutting off your cast!

Bree - I felt the same about the cast and I found I had a type of claustrophobia. Go to your GP Doc. He can help you with some medication to ease the anxiety in the short term and then see about getting into a boot ASAP.

Stay calm Bree. When was your atr? Can I suggest that you post on the main blog, achillesblog.com or create your own blog within it? Do you have a rehab protocol and timeline? Op or non-op?

Take it in small chunks of time and try to manage what you expect and when. Definitely read the posts regularly - helps you to understand that you are not alone in this. Masses of real life experience too.

If you’ve been in the cast for more than 2 weeks, ask why. In many cases you could be in a boot after diagnosis, and certainly at 2 weeks. Mobility as soon as possible, and don’t leave the weight bearing too long.

Keep posting - being ‘crazy’ will slow you down! But I know what you mean…

OMG I went through this last night, which is how I found this thread. I can’t deal with this cast, I just can’t. It’s all I can think about, it’s making me crazy and I am not normally crazy or dramatic. I fear I will cut it off at home tonight!

Hey there cwessels I also suffer from tendonosis in both legs much worse in the left am in a boot now for less than a week after trying eccentrics for 3 months plus physical therapy and iontophoresis . Did u have a Debridement or tendon transfer and how are you doing? My doc suggest no surgery at this point the MRI shows tendon thickness but no partial or full tear although I am sure there are many micro tears . This site is wonderful many good folks on to encourage you and offer sound advice I have found a few wonderful folks here.how long have u had the tendonosis and did u try orthotics and such first as well? Hang in there it will get better I hear!

I suffer from achilles tendonitis in both legs and had surgery on the left one on Tuesday, April 10. I ran across this blog today and am finding the posts really helpful. This is the first day that I haven’t taken pain pills during the day. I’ve switched to ibuprofren. Didn’t realize I was going to have a cast and just today received the cast cover I ordered Tuesday, following the surgery. Am looking forward to a real shower tomorrow! But first, I’ll need to crawl up a flight of stairs.

Can anyone tell me how to start a blog on this site? I’ve created a user ID and received a password but can’t seem to find where to begin. I know it must be staring me straight in the face somewhere!

np13- I also had an experience very similar to yours. I had a broken fibula and a dislocated ankle (surgery with a plate and screws).
My “attacks” happened twice; both times in the evening. It was always much harder for me when the sun set… I became really nervous about night time coming.
I too thought I was going insane and it felt like a rabbit hole that I might not be able to come back out of. The worst thing I have experienced in my life and I consider myself a brave person. I am lightly claustrophobic (I am OK with elevators but not so good with MRI’s). This was a feeling like I was trapped/locked in a 2′ by 2′ box and couldn’t get out… but there was no box. I can also remember thinking while I was going through this that I did not want to live with this feeling…. Could not live with this mental state and I have never had that thought before in my life. I can remember thinking please let me not remember exactly how this feels. It was very traumatic. That is the best way I can describe it. And if you are not a claustrophobic person I don’t think you are going to “get” any of this.
Both times I had thes

Hello np3…i’m sure you are out of your cast by now! congratulations..i envy you. i just had Achilles’ tendon surgery 6 days ago and have already had some minor cast induced panic attacks. this same thing happened to me 2 years ago when i had another similar injury. this time i asked the dr. to prescribe something…he did…prescribing an anti depressant, Trazodone..i think it’s helping a little but i TOTALLY relate to waking up in the middle of the night and going somewhat crazy…”let my foot out of prison!” I was thinking today about a way I could explain the feeling…similar to when I used to ski and I recall a great feeling that I had at the end of a long ski day when I would unbuckle my ski boots and remove my feet…ahhh…how sweet. I just WISH I could reach down NOW and be able to do the same with this cast….drats…I guess I’ll just have to hunker down and try to keep it together…here we go!

omg. this baby is

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About a year ago, somebody started a popular page with a title like “That @#$%^& 1-leg heel raise!”, where we all compared notes — and a lot of frustration at the “plateau”!

First ATR, the 1LHRs came at something like 20 weeks. (And I did too many of them that first day, and I went back into a boot — with pain, even! — for a MONTH!!)

Second ATR, I think I’ll probably never get back to a full-height 1LHR with a straight knee. But amazingly, it doesn’t seem to have slowed me down in any way — even when playing 2-on-2 beach volleyball or 4-on-4 court volleyball, or skiing hard and fast on expert slopes in Whistler, or bicycling. . .(!). I’m pleasantly surprised how little that particular demonstration of calf strength seems relate to running and jumping and diving and such.

re the swimming, i’ve never heard of those dangers, though i’m also not a PT and unfortunately am not in PT so not sure… i haven’t had ANY problems w/cramping other than a small cramp in the toes of my “bad” foot the other day.. but that quickly went away. swimming has been awesome for me.

Hmm, not sure how to describe my boot.. looking on the back of the heel it says “MAXTRAX”.. big black, soft boot w/velcro straps. has been pretty easy to drive in except for one incident 1 week ago where i thought i was stopping, but d/t the width of the boot, i was actually pressing on both pedals at the same time, causing my car to lurch fwd and almost hit the car in front of me.. thankfully i quickly figured out what was happening and readjusted.

I’m behind in reading posts, so forgive me for chiming in at this late date. I was getting irritated reading your original post about how snarky your doctor is. I’d fire him. I agree with Ryanb that the docs work for you. At a minimum they need to respond to your questions in a timely manner, without the attitude, and if they can’t pass that simple test you should move on. Find someone who will take an interest in your medical journey and help facilitate a full recovery. I don’t think that’s too much to ask. Sounds like this guy should have found another profession where sarcasm is appreciated.

A good PT can help you navigate the road ahead. Even with a supportive doctor, the PT takes over with some very general guidelines from a doctor. So, assuming your surgery protocol was routine (no complications) I think that a PT with experience in achilles tendon repair rehab (that’s important) can easily deliver on the rehab plan for you and be your partner in healing. Good luck!

Regarding swimming, my doctor said no swimming or pool running (non- weight bearing) until she sees me this month. It will be 11 weeks post op when I see her. Initially she was worried about an infection at the incision, but once that heals she was worried about the torque provided by kicking (a swimming friend who is also a physical therapist commented prior to my surgery that I should stop kicking because the torque is a bit too much on the ankle/achilles). Water is a lot more resistant than water, as you know, so there is a concern that you exert too much pressure when pool running (what I did exclusively for quite a while prior to surgery). Perhaps swimming with a pool buoy would work for you.

My surgeon and PT both gave me the OK to start swimming before 7 weeks. No mention of a cramping risk.

I know products like Cytomax can help endurance athletes prevent/reduce cramping; but I think the underlying mechanism (electrolyte imbalance) is different that what your PT is worried about. Still, it might be worth investigating.

The only calf cramps (spasms) I encountered were when I was immobilized. Getting my joint moving (eg. swimming) didn’t cause calf cramps, it made them go away.

All that said, I’ve had toe cramps when swimming (not since my ATR), so I understand the risk. Like everything, you’ve got to balance the risks vs. the benefits, and decide what’s right for you. It might be worth a quick call to your surgeon for a 2nd opinion.

Hey just a quick question that maybe someone can help me with…..I am 7 1/2 weeks post op and am in two shoes now and everything seems to be going to be going fairly well, although I am alot slower now in 2 shoes than I was in my boot. My question is, when I went to see my pt I asked her about swimming and she told me that I definitely should not swim. She said that the problem with swimming is there is a chance that a person will get a cramp in their calf due to the postion a person’s foot is when they swim and this cramp could cause tearing in the tendon. Has anyone heard of this? Would love to start swimming! Thanks!

Hi, I too am addicted to working out. I’ve also kept up the upper body weight workouts as well as abs & lower body w/o weights. The hard part was getting in the cardio. I haven’t gone swimming yet but got the go ahead yesterday.I am 5 wks post op. My question to you is what type of boot you are wearing? I have a very clunky,non-flexible walking boot. I drive left footed easily but am interested in the boot that allows you to drive & cycle. Thanks for your exercise post…it’s always interesting to hear how others are doing!

thank you for the info bcurr.. much appreciated!

Your achilles is not 100% knitted together until week 12. Healing long at a guess is happening whilst its still knitting together so its most likely the earlier in them 12 weeks than the later, probably when the first 2 collagen layers are happening (google “achilles collagen type 1 2 3″ for more info)

Not much you can do until you are full healed I think (12 weeks) but the test is:

* Lie on a bed, on your front
* Feet off the edge, completely relaxed
* How your foot hangs on your good foot is normal
* If your heel is further away from your leg then that is heeling long. The amount is key though as a ruptured tendon will usually be a tiny bit longer anyway. How much though is something best answers by a doc/PT

I don’t have a good answer for you np13, but can direct you to a good conversation we had on this topic not too long ago:

AchillesBlog.com/ryanb/2011/10/05/healing-long/

This gives me hope. I am a swimmer and it is awful being out of the water. I am two weeks post op.

lol, no flip turns for me.. more like, stop swimming, stand turn awkwardly, start swimming again.

and thanks for adding the part about the incision.. NO WAY would i be swimming if my incision wasn’t completely healed.

I think swimming is a super activity for us. It’s about the earliest way to hit your cardio system, and I think the somewhat random forces on your foot help to loosen it up and are simply great for it. Just be careful doing those flip turns

My only caveat would be: make SURE your incision is completely healed, so as not to risk an infection.

Hi, I had some inserts made by an orthotist pre op, then Norm said he got some Sketchers shape ups post op - I got some of these and used the 2 together. I did try running shoes but the Sketchers were more comfortable for me. I have bought inserts in the past but I would prefer to have them made as I had no idea what height to aim for. I had an underlying biomechanical problem so the correct height was important once past the wedges stage.
I did get an achilles strap pre op (You can replicate something similar with tape - I had this for quite a while- its quite a skill), but I didn’t need either post op.
Hope this helps.

My PT only really recommends good running shoes.
Asics are a good brand and I’ve been wearing mine for about the last 8-9 weeks, even in work as I found work shoes to cause some niggles so thought it best to remove all niggle inducing things

good idea ryan, i will probably give that a try.. did you use any sort of heal lifts or anything when you first went to 2 shoes?

thanks camperkate.. happy healing to you too.. i’m looking forward to getting into 2 shoes, but also a little, no, very, nervous about it.

One tip I can offer is to start out with footwear that gives good support and a little heel lift; think hiking or work boots. I found that, when starting out, good boots improved my walking ability, and made a big difference in my comfort. I still use them, and they still make.a (less drastic) difference.

Hi np13
I am a week 10 non surgical recovery from a full ATR. I am also transitioning to two shoes as I write this. I have been in two shoes at home and for physio and workouts for a couple of weeks now and now I am starting to take it to the streets. I still fall back to the boot for longer, faster walks or crowded places. But I have decided that this week I will go bootless more often since they want me weaned off it by week 12. Once I have warmed up and the leg feels looser, I can stride out a little more til I feel the stretch but I am trying to reduce the limp and walk with a normal gait , rolling thru my stride, so that does mean a shorter stride. I try to a little stretching first thing in the morning to warm up the calf/Achilles but not too much. I agree with Norm and did not go back to the crutches and/or cane once I was off them. Last week I did lug
my spare shoe around and put the boot on and off as needed but it was too much to carry around. So this week and next I will work on more shoe time and kick that boot to the curb. The strength and stride have improved greatly in only one to two weeks. Happy feet to you

The UWO protocol does call for returning to crutches if needed, when weaning off the boot. I regard that as “the work of the devil”, mostly because it seems so brutal psychologically. The crutches are deep in the cellar or the attic or the closet, and they should STAY there, I say!!

Instead, most of us just slowed way down when we started in 2 shoes, especially when stepping forward with the uninjured foot. Initially, it’s a lopsided gait, “bad” foot forward, and “good” foot just catching up, to avoid the FWB dorsiflexion. Then gradually, as strength and flexibility and stability and confidence all build, that uninjured foot starts stepping farther past the injured one. Eventually, the only “hitch” in the gait is from the lingering strength deficit in the “bad-side” push-off.

IIRC, the UWO protocol DOES call for some active dorsiflexion (e.g. with a looped towel in both hands) in the weeks preceding the 8-week “wean off boot”, and I think that approach makes sense. In this whole progression, exercises and “moves” that are “just right” at one point are risky just a few weeks earlier, and boring or useless a few weeks later — t

NP- I don’t think you need your surgeons prescription for PT… you just need a prescription. If your surgeon won’t hook you up with one, perhaps your GP would.

Just a thought-

Hi, not sure how it works there but I referred myself - I didn’t realise I could do this initially. I have to be up on my feet for work. Worth a try.

yes,we have occ health.. funny thing is i actually work for the same company (Kaiser Permanente) here in CA where I am getting my tx. Not sure I can go to Occ health though as it was not a work-related injury?

BTW I wasn’t referred formally - one question, do you have occ health at work or similar??

Yeah, I do know what you mean. I didn’t know what was healing and what was pain, I still don’t sometimes but post op it was more confusing. I did find the PT provided some emotional support as well as physical advice if I am honest, that feeling of not being on my own with it helped!

thanks ryan. i definitely get that the doctors are busy and don’t have too much time to be responding to 1000s of questions etc… just seems that my doctor is very “locked in” to his approach, which seems, for whatever reason, to not include PT as he has declined my request for a referral twice now. My thoughts re PT were 1: i could have someone else to help me monitor my progress and teach me some exercises or use equipment that i might normally not have access to, and also another way for me to monitor my progress… however, his response continues to be “90% of pts don’t need PT” which blows my mind… maybe i need to spell out specifically the role i feel PT may be able to play, but seems that he takes any “suggestion” on my part to be some sort of an attack on him/his approach… tricky to navigate and i need a referral from him to go to PT: i don’t believe i can just refer myself. you’re right though, when it comes down i call the shots in my recovery; just want to make sure i’m not doing ANYTHING that might get in the way of my recovery.

I look at my doc and PT as consultants. They work for me, and give me advice. Their opinions are important, and are factored accordingly into the decisions I make. But it’s my leg. I’m running the show. I decide when it’s OK to walk around without my boot, or stretch, or lift weights, etc. The great info I’ve found here on the blog is another important source of info, which (sometimes) weighs just as heavily in my decisions as the doctors advice.

Unless things take a terrible turn for the worse, your surgeon was essentially done with you 7 weeks ago. There’s really nothing more he is equipped to do for you. He’ll of course want to keep an eye on you, and give you guidance about the post op protocol he’d like you to follow- but I’m not too surprised that he isn’t too interested in being a long term consultant for you. When he hands you off to PT, he probably will be even less engaged. Don’t take it personally, those guys are very busy.

My doc told me he didn’t think I needed PT either. I was making great progress on my own. I told him that I thought they would probably be able to augment the exercise

hi ali, thanks for the response… i completely get the need to be careful and use pain as a guide, but i guess the confusing part for me is that, in recovering from any injury, there is some degree of discomfort/tightness/minor pain that you have to be able to “work through” in your recovery…. this seems like such a tricky line to navigate and i worry that if i avoid “pain” at every point, that i’ll never be able to build my strength back… then again, maybe it’s my line of thinking that’s faulty and i need to start thinking differently?

Hi, do use pain is a guide, and be careful even when you don’t have pain right now. I saw a private physio a few times which helped. I’ve had much advice/support from the blog at every stage in recovery.
I am 5 months + and still get swelling, although it has much improved. I do wear a compression sock/flight sock during the day to help manage the swelling.
All the best for a full healing.

good question… for some reason my doc does not want me doing any PT until another 3 weeks. when i initially asked him when i’d be starting PT, his exact quote to me was “not will probably not be necessary as 90% of people don’t need any PT”… i had never heard that before and seems to go against everything i’ve read here, so i’m very confused.

np13,
I’m close to 8 weeks post op, and today was my first PT day. I had not stretched or even moved my foot much until today.
My therapist instructed me to do the towel stretch, bringing my foot to a 90 degree angle with my leg. I also did some calf pumps and dorsiflexion. All of these movements were controlled, slow and moderate. When I started to stretch further he stopped me and explained aggressive stretching early in the healing process - which he defined as the first 90 days - can result in the tendon healing long and this is not a desirable outcome. So I am stretching but not at full range, and i’m supposed to do these stretches twice a day every day. Did you ask your therapist to give you guidance on do’s and dont’s<?