Oldandwayslow’s AchillesBlog

I have been doing physical therapy for three weeks now. My PT began with simple resistance band exercises and some stretching. I have been working the eliptical a bit, both forward and backward, for about 5 minutes each way in each 30 minute session. These PT sessions are very short!

I would say double heel raises are pretty easy, although it is all but impossible for me not to favor my good leg when I do them. I have been attempting (at PT) single heel raises with the bad side, but so far I simply don’t have the strength to pull it off. I have been doing various exercises on the stairs to try and slowly build strength, and others to build balance. Since I have only been doing strength stuff for two weeks, I need more time.

Also getting utltrasound treatment at each session. Still have a persistent bulge at the bottom of my incision. Not painful, not huge, but there. Ultrasound is supposed to help.

I have no problems walking, and I have even tried running a few steps. I need more time…. Oh, and I did schedule a golf trip for March!!

Good doc visit on Tuesday. Tension returning to my achilles. One swollen spot at the bottom of incision will “require monitoring”. Could be a suture reaction, or maybe not.

Asked when he thought I could logically return to basketball, and he said “it depends on how much risk of re-rupture you want to take”. A classic surgeon non-answer. Lack of communication is my only real complaint.

Did my first PT session today; mostly paperwork and measurements of flexibility. Dorsi near normal (18 on bad and 20 on good leg). More variation on plantar (40 on good, 26 on bad). Most surprising was the difference in “turning my foot out” (that is rotating my foot with big toe down and little toe up and out to the side as much as I could). On my good foot, I think she said 20 degrees, on my bad, only 4 degrees! I think this issue predates my achilles injury.

Four exercises were prescribed. Toe curl- picking up a towel by curling toes; lower leg stretch with belt or towel, both with knee locked and slightly bent, and done without pain; ankle plantarflexion stretch; and what I will call “arch flattening stretch” to help me get off the outside of my foot while standing or walking.

Feels good to wear two shoes! I can walk almost without limp if I focus on a good normal stride. Weeks of hobbling have made my mechanics “limpy” so I need to think and execute good steps when I walk. I will keep the boot handy if there are any conditions that will put me at any risk.

Taken to icing that “bad spot” daily to reduce swelling. Also wearing a stretch ankle support which provides good compression of the area.

Very happy with my Physical Therapist. She communicates well in stark contrast to my surgeon. He spent 15 seconds looking at my tendon, and she spent three minutes and actually commented as she did!

Told my PT that I want to play BBall by summer. This is the goal. When I make it there, I will be happy. Right now, I am very happy with my progress. I am told that I am lucky to have good leg muscles and good skin healing. I am ok with a few more months of recovery, as long as I can make steady progress.

P.s. my diet is working, down 7 lbs in the first two weeks. That’s still 3 lbs more on me than before the injury, but I am making progress there too.

I continue to do well. Went from two lifts in the boot at week 4, to one at week 6, to no lifts now. I am walking around the house, carefully, without the boot. Very,very slow and careful on stairs. I have handrails on both sides so that helps. If I didn’t, I don’t think I would even try it without the boot.

My achilles has definitely been “tightening” and now I feel it most of the time. It has some nice tension to it. It is clearly much thicker than the good one. i have a modest lump at the bottom of my incision, and it likes to swell there a bit if I do quite a bit of walking. Doing lots of ROM daily.

Last 8 weeks have added about 10 pounds to me, so I started taking that seriously 1/1/2013. I am a very active guy who loves to eat! I really can’t wait to be more active again. More weight ain’t good, period, so I am on it.

If you want a laugh - snow shoveling with the boot requires planning. Two heavy socks help, but it is important to keep your booted toes out of 16 inches of local snow! While shoveling is not on the PT plan, it sure is aerobic! This isn’t the recommended way to ice your achilles!!

Ice all around - so. I think it will be some time before I venture outside without my boot.

My achilles feels stiff, with a sensation that it’s pretty inflexible in a two inch segment. My range of motion is about 85% of my good side. better with plantarflexion than dorsi, of course. I can really feel the tightness on active dorsi, and I do stretch it as best I can, just short of pain. No point is overdoing it now, and some of what I read suggests that week 7-10 is a critical time to avoid re-rupture. I am sure that I can’t rupture with active stretching, but my brain says go easy.

Next appointment on Tuesday. I expect my surgeon will be happy with my progress, and will scold me a bit for walking without the boot. He has spent 8 minutes with my achilles since the surgery which includes 5 minutes to put on a cast. Reading everyone else’s PT schedule has been helpful. While I do understand that patients and doctors are different, it has encouraged me to go just a bit quicker than my doctor suggests. So to be clear I am not playing doctor, but I am moving a wee bit quicker given my good progress to date. My goal is to be deliberate and to make steady progress.

By the way, I have to “remember” to walk slowly and correctly when i take my boot off. I take smaller steps, but I try to make them a normal walking motion. I do have a limp.

I have had some modest hip pain at night. I have done my best to even up my two feet when I wear the boot, but at the end of the day my hip on my boot side has been waking me at night. So I figure this will improve as I use the boot less often.

Back to doc on 1/8. I am ready for PT!!

Things seem to be gong well. The boot is mostly comfortable. I have one small spot on the incision that is sensitive ( looks thin) that I cover with a bandaid. Otherwise external healing looks very good.

Went to a single heel lift (docs instruction) just a couple of days ago. I am also continuing daily isometric stretching. It’s a bit uncomfortable, and only slightly painful. Active only - no resistance, foot off floor.

My foot posiition in my cast was just short of 0 degrees, and that seems quite different than most others in the blog. My two heel lifts in the boot after 4 weeks only elevated my heel about 1/2 inch. So now I am 1/4 inch from zero. So I actually went to more plantarflexion in the boot for two weeks post cast, now back to where I was in the cast, and on to 1/8 of an inch now, and in two weeks to 0. Doc says that a little stretch is good for fiber alignment vertically in the healing tendon. That’s my layman’s interpretation. A more vertical “repair” means a stronger tendon down the road I guess.

I take the boot off when sitting. I crutch to the bathroom - that’s my story and I am sticking to it. I am being very, very careful.

I have a sensation of a large (more than an inch) internal scar that moves some as I do iso. I “push it” to discomfort, but not to pain. Tendon has definitely tightened and can be felt taunt, but certainly not nearly as much as my “good” side. I have been doing some painless massage of the area too. By nighttime I do feel a bit of soreness and tightness. Dorsiflexion is only a few degrees beyond zero. But, I have Better plantarflexion - about 90% of my “good” side.

Walked the mall and did my Christmas shopping and that went pretty well. I was kidding my girlfriend that I was going to take the dog with me, bandage one of her legs, and invent some heroic story to impress the gullible at the mall. She doesnt think I am as funny as I think I am.

I see the doc in less just over two weeks and then I guess we begin to move towards more substantial rehab and shoes.

Lots is written on this blog about what I will call the technical aspects of treatments and recovery. That’s a good thing!

I am thinking more about recovery and return to normal life for the aging athlete.

I am 56. I have been active with golf and cycling and basketball all of my life. Sports are critical to me, keep me sane, and keep me in reasonable health. For me, I need to compete, and i hate to lose. the only thing i hate more than losing is sitting on my backside.

I really don’t have the discipline to exercise without a competition - it’s always always been that way for me.

Basketball is one of my great loves; but it does exact a toll on the body. I have had countless ankle sprains, knee injuries and dislocated fingers, and hurt shoulders over the years. I have hurt my achilles before, which I now think was a partial tear back then. I have healed from all of them (months in some cases) but some injuries, and time, have effected my skills. I am not looking for any sympathy at all.

If you play a hard court sport, or anything that has a hard surface, someday, sometime, you are going to get hurt. And, when you are over 50, something, somewhere in your body, hurts at least a little.

Basketball is a central part of my social life. So, I will return to it after I heal from this, my most significant injury of my life. I suspect my game will be effected. That’s life. I probably can’t dominate a game like a few times in my distant past (memories get better with age), but you had better guard me!

I don’t call myself oldandwayslow for nothing! Before my injury, I had lost a good chunck of my vertical “leap”. I don’t run fast. I know the game. So I encourage you, even if you aren’t quite what you once were, to heal, and to compete, to push yourself! Heal first, of course..

I am encouraged by the many on this blog who return to their sport, whatever it is, particularly those that stick with it when they know that their performance isn’t what it once was. That means you truly love it in my book!

Been in the boot since Thursday afternoon. Using crutches without the boot around the house and continuing to be very careful. Not really walking on my bare foot with crutches, but I am balancing a bit, and never putting any real stress on the tendon. I get back and forth to the bathroom slowly, without the boot (with crutches of course).

Went and did some Christmas shopping with my GF and went to a community Christmas event last night in the town square. I wore my boot. Walked quite a bit. Some challenge with the height of the boot which is off the ground compared to my “good leg”. I wore my best hiking boot on my “good” leg and added one heel lift to it to do my best to reduce the height difference from right to left. It made walking much easier. Also returned my Knee-walker!!

My heel is always “tinglely” when I first get up. Heel not happy about the lifts in the boot. I am not going to take them out however. It’s hard for me, but I need to follow instructions.

My knee and hip are a bit sore from walking, but more so in my opinion from the unusual alignment when I am in the boot and the impact of walking, weight, unevenness, etc.

Good news is my calf does feel like it got a bit of work yesterday with the walking. Let’s say its awake and complaining just a bit! A bit of foot swelling last night, but not a great deal.

I said previously that my range of motion on isometrics was pretty good, but now looking more carefully it really isn’t. My ROM isn’t great in my “good” foot either, but there is a huge,huge difference.

When I do the simple ROM exercises, i can feel stiffness and my tendon moving just a bit. Feels like a good amount of tendon around the repair site is very stiff and inflexible right now, four weeks after surgery. Odd sensation when it moves a bit with iso exercises. No pain, and I am not pushing it. I do ISO often.

It’s Sunday. I’ll move around the morning in the boot and do a few chores, then I will park on the couch, watch football until my mid-afternoon nap, and do some more iso.

I have no pain in my achilles, and my incision is remarkably healed in four weeks. One smallish puffy spot the size of a quarter. SIzeable “divot” when looking down the tendon from above.

Hoping internal healing is just as good as the incision appears to be! Human body is really a remarkable “machine”, isn’t it? Need to give it some time right now…. Not easy given that I am a very impatient person by nature.

Cast was taken off today, and the boot is now on. Surgeon says go slow, and allow weight as I can tolerate. Two lifts in the heel totaling maybe 1/2 inch. First steps were pretty tentative, and my heel is resisting awakening from a 4 week rest. I am home now, just having enjoyed my first complete shower in 4 weeks. That was a good, good feeling. Wound looks great. hard to see 1/2 of it already. nearly no swelling. And yes, I do have that dent that everyone talks about in my achilles.

Surgeon repeated three times- go easy, and no walking without the boot- NONE.

Walked around a bit at home w/boot, and outside for a few. Enjoying the little benefits of two legs. Out to dinner to celebrate a small victory tonight.

Doc says boot for 4 weeks, take out a heel lift at two weeks, and he second at four. Ok to sleep and watch tv without boot. Encouraged flexibility exercise, with NO asisted stretching. My own muscles only, with my foot off the floor. Suggested I spell out the alphabet with my foot as a good exercise. Asked specifically about dorsiflexion, and he said to my surprise that it was fine, as long as I was only using my own muscles to do so while exercising. (Foot in the air, no weight, no assited stetching of any kind).

I actually think my range of motion is pretty good. I’ll go slow…time to heal some more, and enjoy more freedom.  

My cast comes off next Thursday, and on to the walking boot. I can’t wait. I was one week in a splint, followed by a planned three weeks in the cast. Longer than many and shorter than some on this blog. Getting around on my scooter, and sometimes on the crutches, and occasionally on my hands and knees! I live alone, but I do get help.