oscillot’s AchillesBlog

Entries from July 2015

Week 12 update: Gait training

July 29th, 2015 · 4 Comments

I still wear the boot when leaving the house, but my gait got much better this week. My PT instructed me to focus on pushing off with the calf during my pool walks, rather than taking micro steps with my foot always in front of me, or over-stretching the achilles by keeping the back heel on the ground. The first couple times I did this, I felt pressure, and my ankle swole up pretty good, but I gradually progressed from 5 ft depth to 3.5 ft depth over the course of 3 days. Now if I put all of my strength into all five toes, I can do this on land without pain. My strides are still shorter than normal, but the limp has faded away like Keyser Soze’s. Amazing!

This stage of healing has also coincided with more balance / proprioception work. I started standing on each leg for five seconds at a time (30 reps/day on each side), then graduated to doing this on a pillow, and by the end of the week I expect to get permission from my PT to do this on a bosu ball. I never realized how useful those stabilizer muscles in the ankle and inner foot are when pushing off.

Every day, I feel scar tissue breaking up, with an immediate increase in ROM. Neither side is very good, but the injured side is suddenly approaching the “good” side, so that’s encouraging. Now that I’ve passed the 12 week milestone in which 86% of re-ruptures occur, I’ll experiment with going bootless outdoors, while being extra careful when climbing inclines or going down stairs.

To those of you who are earlier in your healing, keep at it! The gains come really quickly after the first few weeks of PT (third month for me). Once your body allows you to ditch the crutches, then the boot, and finally the limp, you’ll be back to living an almost normal life.

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#firefighterninja update + questionable rehab

July 26th, 2015 · 6 Comments

Firefighter and fellow ATR recoveree Dennis Lappen qualified for the American Ninja Warrior finals in Vegas! His city finals run didn’t make the telecast, but here’s his inspirational qualifying run, which also documents his on-course double rupture from last year:

Before my rupture, it was a dream of mine to try out for the show. I think my feelings have changed now that my body has reminded me that I am 35, but who knows how I’ll feel next year.

Here’s a vid of me “warming up” for some unbooted pool walks yesterday. It isn’t of any rehab value, but the neighborhood kids get a kick out of seeing my “robo-leg” sticking out of the water.

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Week 11 update: Weaning off the boot pt. 2

July 22nd, 2015 · 2 Comments

Last night, I slowly and carefully took my first steps sans walking boot since the injury. Here’s what it looked like:

OK, that’s actually Honda’s Asimo robot, but my stride looks exactly like that. One foot in front of the other - literally 12″ - is as much as I can comfortably stretch my Achilles on pushoff. Asimo’s still got me beat on stairs, hopping, and jogging.

My PT suggested using heel lifts while transitioning into two shoes, and I’ve been really happy with the 1/2 inch lifts I got off Amazon. They provide more lift, pain relief, and comfort than both versions of Dr. Scholl’s gel heel lifts I found online. Rather than carry around a crutch for longer walks, I found this $10 expandable hiking pole. This ice wrap also rocks.

My healing continues to progress. I graduated from home dumbbell and ab exercises to Nautilus machines at the gym. It’s located on the same Navy base as my tot’s day care, so I stop in for an hour or so after dropping her off in the mornings. Most days, I’ll also practice walking barefoot in our community pool. It’s been really nice to leverage my paternity leave for Achilles rehabilitation.

While doing Theraband exercises this afternoon, I felt some scar tissue loosen up on the inside of my ankle, followed by a couple degree increase in dorsiflexion ROM. So that was neat.

I’ve had one PT appointment since the last time I posted. He added one-legged stands, forward and back rocking, and half squats - all while holding a chair for balance - to my exercise routine. My unloaded, active plantar flexion is 20 degs (should be 30-45 degs), and my dorsiflexion falls short at 0 degs (should be -15 degs). His guidance for exercising as well as gait training was to move slowly, as this will lead to better results in the long term.

Did anyone else find wearing the Vaco rocker sole to be torture? I started using it at zero degrees, not the recommended 5 degrees, because it felt like it was excessively stretching my calf while standing. I occasionally hinged my Vaco cast, too, but did not find it to be especially helpful with gait training - certainly not as good as walking barefoot in the pool. It does strain and stretch the Achilles more than a locked position, though. I still appreciate the security of the boot when necessary, but for me, the discomfort of the rocker sole is serving as extra motivation to get into two shoes.

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Week 10 update: Weaning off the boot

July 17th, 2015 · 7 Comments

I had a double whammy this morning - PT, followed by my week 10 OS follow-up. I tried some light reps on the leg press machine, with a 3/4″ raised heel. It felt great to perform a (very lightly) resisted squatting motion without my boot. 11 weeks ago I was squatting 285 lbs! Hopefully, I can work my way back to that.

My healing has been devoid of any setbacks thus far, which I attribute to our conservative post-op approach. Doc said to wean off the boot in the next two weeks. My plan this week is to transition to the Vaco rocker sole, and continue my daily pool walks at progressively shallower depths until I am comfortable in the very shallow end (3 ft depth). Next week, I’ll incorporate walking around the house into my daily exercise routine.

Happy healing, everybody!

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Week 9.5: pool walking + big toe stiffness

July 12th, 2015 · 3 Comments

I finally mustered up the courage to try walking in the pool without my boot! Using a mask, snorkel, and the corner of the pool in 5 feet of water (I’m 6′1″), I slipped off my Vaco cast and held onto the edge of the pool for those first slow, tentative steps. After a couple laps of the width (not length) of the pool, I was walking with a normal-looking gait (really short strides, though). My Achilles felt sore afterwards, so I’m only going to do this every other day for now. Hopefully, I can graduate to progressively shallower water depths as I transition to 2-shoes.

Thanks to my Theraband workouts, I’m also confident enough to sleep bootless now. So that’s two milestones in two days.

Did anyone on here experience tightness and a loss of flexibility in their big toe when healing from their ATR? The base of my big toe used to get sore when I was distance running, and my PT says I probably compensated in other ways, contributing to the ATR. Now that I’m walking in the pool and paying particular attention to my gait, I noticed that as my weight transfers from the heel to the balls of my feet, I’m actually jamming my big toe into my foot. This doesn’t happen on my good foot. I’ve also lost a ton of ROM in my big toe while immobilized, which has forced me to shorten my stride. If anyone on here has experienced similar issues, please let me know how you overcame it in the comments.

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Week 9 Update: The Power of Patience

July 9th, 2015 · 7 Comments

I’ve steadily progressed these past two weeks. Transitioning from 20 degs to 10 degs of plantar flexion in the boot was “a stretch” at first. My doctor asked me to go down 10 degs every two weeks, but I’m going to listen to my body and go with 5 degs every week instead. After each boot adjustment, it’s a little uncomfortable, and I find myself needing crutches for a day or two.

I went to 5 degs tonight, which meant swapping the wedge sole out for the thinner, flatter Vaco cast “rocker” sole. I only recently got used to walking in the wedge, albeit still with a very minor limp. Hopefully, the rocker is easy to adjust to.

PT has been really good. “Punisher Jim,” as I call him, is a portly bald fellow who likes to golf and talk about sports - so we get along great. He’s also a sadist masseuse, wrangling my foot and tendon in ways that make my teeth clench (along with an occasional yelp), but my tendon is magically and permanently a lot looser afterwards. The increased flexibility is well worth the $20 co-pay.

“The Punisher” also prescribed me a typical ATR recovery strength routine for the ankle and foot. I quickly built up to doing 2 sets of each exercise daily (30 reps each):
- midfoot curls
- marble pickups
- alphabets
- toe/heel/side foot lifts off the floor (emulates the wobble board)
- toe/heel/side foot theraband exercises
- icing

My calf was scary atrophied at first, and looked like a deflated balloon. Throughout the day, I’ll fire off my calf muscles in isolation for a minute or so of exercise while keeping the Achilles stationary. This helps to reawaken those nerves and neurons while filling out my calf.

After my second session, the last remnants of the surgery scab flaked off, so I am finally able to take advantage of our community’s pool after two months away. This had been a nightly routine for me, so this is a milestone. After a long day of work and putting my daughter to sleep, there’s no better feeling than going for a dip. The Vaco cast is bulky, creating a lot of drag, but it also floats, eliminating the need for a lounge float. ;)

My therapist suggested standing and hopping around in chest-deep water, so I might try and muster the courage to try that soon. Has anyone taken their boot off to rehab in the pool, and if so, how did you know you were ready and what exercises did you do?

I had returned to work in week 4, but was in pain and constant fear of re-rupture for another month. As the pain and fear have subsided, I’ve taken steps to return to some semblance of a social life. Last week, I met a buddy for lunch downtown, and walked three blocks from my parking spot to the restaurant without incident. Then, on the fourth of July, I willingly and knowingly surrounded myself with friends enjoying adult libations at a house party. It felt amazing to reconnect with so many friends in one place and enjoy a frosty beverage after two months of living in isolation.

Regaining the use of one, then two hands while losing the crutches has marked a near return to normalcy. I’m able to carry things to and from the kitchen, walk up and down stairs (relying heavily on the bannisters), load my daughter into the car, and drop her off at daycare - all things that I had taken for granted before my ATR, and am so thankful to get back.

The gains couldn’t be timelier. My wife and I are expecting our second child (a girl) sometime between now and Monday, so pretty soon I’ll be able to return the favor to her for taking care of me during that first month of misery.

One thing this injury has taught me is patience. Most people on this site are progressing faster than I am, but I subscribe to the notion that slow and steady wins the race. As far as I know, there is no long-term benefit for surgical patients to rush back. 80%+ of re-ruptures occur within the first three months, so I’m erring on the side of caution and keeping the boot on until [the beginning of] month 4.

The marginal increase in strength and mobility that I feel each morning is barely perceptible, but noticeable, and trending in the right direction. Most importantly - no setbacks. I’ve challenged myself when walking / standing too much, or when adjusting to a new boot angle, but always with a strategic, measured approach. Learning to be patient is paying off so far.

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