Nov 21 2013

1/2 a calf

Published by pablomoses under Uncategorized

Ok, so clarification on what was going on with the calf… Only the medial head of my gastroc muscle isn’t firing / re-gaining any girth… The other side is there and in pain from overuse.  Visit to ortho confirms this and he agrees with PT that it is very strange and haven’t seen it before.  Still on PT program to rectify and will post progress in a couple of months.

One response so far

Nov 08 2013

Guess I’m in the “elongated” Club: 22 months post ATR

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Haven’t posted anything here in well over a year.  Felt like I was on the road to full recovery: mountain biking over 40 miles, alot of back-country skiing/hiking, stand-up paddling, surfing, and working with not too much discomfort - though never got the one-foot calf raise dialed.  Then, about 6 months ago, things seemed to start getting worse, most notably on long walks or hikes.  More recently all walking is uncomfortable and running is painful - and my calf has never developed on the medial side.  I decided to go back to PT and see what was up… no calf and very difficult to make it fire at all - he was as baffled as I was.

I decided to do some research on this site and found a couple of stories of healing with an elongated achilles (notably "tomtom"’s story).  This sounds like me: My calf hasn’t come back at all, but I don’t feel like I have and real difference in ankle ROM from the good side…  I’m also getting pain and soreness on the lateral side just below the knee - this, I think, is because the smaller muscles there are doing all the work.

For now, back on a regimented and (hopefully) correctly-directed program to see if I can get the calf to wake up & at least make that part of the leg sore… because walking, jogging, biking, surfing SUP, and snowboarding are not doing it…  I cannot fathom going under the knife again… don’t even want to visit an ortho surgeon - but that seems to be next on the list.  I’ll post more once i get either results or more information.

17 responses so far

Jul 02 2012

6 Months - Things I Can Do

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So its now been 6 months - this was my goal to be “back in the saddle” so to speak… Not nearly as far along in recovery as I was hoping - I guess my friends who’ve had this injury too were right, this will take at least a year.

Current status is that the achilles is tight and still requires alot of stretching each morning. ROM is probably around 90%, but getting to that range takes some stretching and the limits of extension, etc. are uncomfortable at best. When trying for full extension onto the ball of my foot there seems to be a spot at about 85% extension where there is a “hitch” which is very weak - kind of like a car door when it moves past the partial open point - it just gives in to the last bit… Calf strength I would put at about 50% - 60% - I measured 1″ difference between the calves about two months ago, just measured it now and am at about 3/4″ differential - progress there I suppose - I have some muscle on the outside of the calf, but not even close to filling it out on the inside. Still no jumping, and no 1 foot calf raises. Still doing strengthening exercises and working on longer and longer trail walks and moving into light jog/walking at short intervals.

In order to keep sane and positive I am trying to focus on the things I can do vs. the thing I can’t do. I have been out rafting and stand up paddling on local rivers. Not hitting any larger rapids on the SUP yet, and duration is best at 1-2 hours or so, but I think this is great PT for strengthening the foot & ankle muscles. I can bike up to a couple of hours and about 10-15 miles of hills (only cardio I can get), but not really on single track yet - downhill riding on uneven terrain and standing in the pedals is not there yet. Hiking on trail up to 5-6 miles is about the max. Working: lifting and carrying up to around 100 lbs. is getting easier and a bit less frightening.

Anyhow - here’s hoping this info is helpful to folks who are earlier on this journey. Peace to all…

14 responses so far

May 14 2012

Survived San Juan River Raft Trip

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My brother and I floated the San Juan River last week - a five day trip.  The recovering foot did quite well despite one really scary slip on rocks just under water accompanied by some new pain… Overall, I was able to do a couple of side canyon hikes up to about 6 miles round trip with some good vertical climbing and descending - and even get out on the stand-up paddle board for an hour+ at a go, in the flatter water sections.   I think the SUP is a great rehab exercise for all the foot/calf muscles and for balance & stability.  Overall, I was able to escape the trip with a bit of swelling and soreness - not bad….  Here’s a couple of photos from the hike and SUP (I hadn’t seen a photo of my calves from the back til this one… left one is still really skinny!):



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May 04 2012

Ankle Issues at 18 weeks?

Published by pablomoses under Uncategorized

Has anyone out there, in the later stages of recovery/rehab, experienced pain / tightness at the front side of inner ankle bone? For me this is associated with mostly with plantar flexion at the end of my range… and is preventing me from getting a full range in that direction.   To further explain, doing bi-lateral calf raises - I get to a certain point and the pain & tightness in the front of the ankle bone stops me from getting to full extension rather than calf weakness or achilles soreness.    It also crops up sometimes with more intense achilles tendon stretches.  Doc took a 5 second look and said "slightly pronated" &  gave me a lateral heel wedge for my shoe (inside edge, which I am not sure as to whether it is helping or hurting the situation).  PT says stretching the top of the foot by kneeling with toes pointed back and sitting on my heels - which I have been doing religiously as a part of my regimen, but still not seeing progress with the issue.

Frustrating to have everything else going well and being hindered in ROM and the duration that I can be on my feet by a "non-injured" part of the foot!  So wanted to check and see if anyone else has gone through this type of issue…  my inclination is to push through it, but I also don’t want to create new problems in doing so.  Any thoughts or experiences, stretches or strengthening ideas are appreciated.


3 responses so far

Apr 14 2012

15 weeks - & counting…

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Quick 15 week update.  Now going in to see  PT once every 2 weeks.   I am in my slow (read "dead") season for work right now, so really all I have to work on right now is re-habing this thing.  Achilles still wakes up very stiff & I spend an hour + each morning with: massaging/stretching/toe-raises/lunges & various one-footed balance exercises.   Then after projects, chores, etc. I either bike on road for about 90 minutes (10-15 miles with around 2000′ climbing) or walk for about 30 minutes.  The walking is by far the more difficult of the two options.  I finish the day with a general all-around yoga-style stretch session & add in push-ups / sit-ups / & some core strengthening stuff.  Progress is slow, but still progressing.  Very literally the two steps forward, one step back progression  - sometimes when I am out walking and get some weird pain I’ll curse it out loud - if anyone was around I’m sure they would think I have turrets…  Long days on the foot are still pretty painful - went to Thievery Corporation concert last night…  took a ski pole with me to lean on - good show, foot hurt!  I think long term standing is harder then walking.

My goal right now is to be able to mtn bike with my buddies by sometime in June - it would be nice to get back to 30 - 40 miles on dirt and feeling good about it!  I feel this would also mean I am fit to go back to work sans-boot (work entails lifting & pushing around heavy (300 lb.) blocks of ice)…  Raft trip coming up in about a week - figure pulling oars & bracing with feet is something I can do - just a little leery of the uncontrolled river environment.  We’ll see…

Solid healing to all & keep the good thoughts!

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Mar 20 2012

IV: 12 Weeks…finally

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Had 12 week follow up with surgeon & the prescription was: "No restrictions, but take it slowly".  My goal for 12 weeks was to be walking normally - I am not.  Still a bit gimpy and a lot of the time the pain at the base of the inside ankle bone.  Surgeon gave me a lateral shim for my shoe for this - PT felt that the pain was from my tib/fib not "gliding" forward over my ankle bone, but rather "pinching" down into it - still being restricted by tightness of Achilles and other bits in there.  All in all I am finding that at this stage the main difficulty (besides building calf strength) is getting the entire foot system back to smooth function.

As I re-read that paragraph it sounds a bit gloomy - not the case… things are good.  I’ve been riding my bike around 6 miles (with 1200′ vert), building igloos, carving ice (work), playing guitar with my mates (standing up!), and moving/feeling better each week.  Progress is moving forward, and I don’t plan on getting down unless it halts.  Still doing PT every day and still icing at least 1-2 x’s a day… still can’t fathom doing a igloo1

one-foot calf raise, but getting more pressure on it with the two feet and trying out the one-foot lowering too.  Here’s a shot of the igloo:

So - with doc’s orders, I am going to ease into some things using the same decision making process that I’ve been using since day one: "does it feel like a good & safe idea?"  If so, then I’ll try it out.  I think the first assay into activity for me is going to be XC skiing (on flat-ish terrain), there’s still some snow around here and that sounds just fine… we’ll see.

4 responses so far

Mar 13 2012

wk 10: Rode Bike Outdoors!

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Yesterday - got in about 3 miles (1.5 of climbing)…

Pretty awesome to get outside moving!

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Mar 02 2012

III - Weeks 6 - 9: Learning to Walk with Big-Boy Shoes

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Getting out of the Boot:

To recap: at my 6 week office visit I was told to start wearing 2-shoes inside and try to kick the boot habit over the next two weeks.  Its now 3 weeks later and I am 2-shoeing just about everywhere - VERY carefully outside in the snow.  I am still wearing the boot to work in my studio as ice sculpting involves lots of heavy lifting and carrying, and I am often walking around in oddly shaped ice scraps.

As if anyone needs a disclaimer in this: but this is just my experience - everyone’s different so consult the professionals before jumping into anything.

Week 7 PT apt:

My first PT apt was at about week 7 (first apt I could get).  I walked in with the boot on and PT said, "So I see you’re full weight bearing."  Yes, for the past 5 weeks.  He checked it out and we did ROM exercises.  The script said to "avoid 10 degrees dorsiflexion" - after taking measurements PT said I was already at 10 degrees.  Here’s a run down of the menu I took home and did at least 2 x’s per day for the next week:

  • massage calf & tendon & manually mobilize foot
  • seated position, put foot on floor and lift the four "borders" of the foot
  • easy towel stretch (seated, leg straight, towel around ball of foot)
  • roll soup can under foot-feels good!
  • seated calf stretch- foot flat on ground, find the stretch
  • seated toe stretch- ball of foot on ground with heel in the air

I also did a couple short walks (in shoes with a ski pole in the opposite hand), less than 1/2 mile - Simply awesome to get outside! & got on the stationary bike low resistance for about 20 minutes most days.

Week 8 PT apt:

Week 8’s PT started with massage and manipulation that really pushed my comfort zone… a little scary.  I kept with all of the week 7 ROM exercises and we added in some strengthening stuff:

  • seated theraband exercises
  • partial weight-bearing calf raises (two feet): seated on edge of a table or couch arm with hands on knees to add a little weight (this was almost impossible at first!)
  • slowly shifting weight from foot to foot while standing
  • slight knee bends
  • 1/3 squats with an exercise ball between my back and a wall (quads)
  • gentle stretch with foot flat & toes at a wall - move knee til touches wall & as it gets easier, start moving the toes away from the wall

I upped my number of walks and walk lengths to about 3/4 mile (still taking a ski pole)… up and down hills, there is no flat to walk near my house.  I found that walking alone was best both because no one has to wait for you, but mainly because I could listen to my body and focus on a correct heel to toe gait without stressing anything too much.  It actually takes a lot of concentration.  Also upped time & resistance on the stationary bike.

Week 9 PT apt:

Where I was impatient with not doing any PT at week 6, I am finding that this regiment is really a challenge.  I’ve now "caught up with myself" and this is my present situation: Stoked to be moving, walking, engaged and challenged by the PT… & really careful as I feel that this is the "danger zone" for me for a few more weeks.  Stay positive - stay cautious.  Here’s my week 9 menu, and it’s not easy!

  • stretching calf and achillies but putting toes up on something (rolled towel for me) and applying weight - hold onto something for balance!
  • bi-lateral calf raises (two feet)  standing with assist from table or counter
  • hands & knees with toes pointed back to stretch out the top of the foot (I’m finding that the top of my foot is giving almost as much trouble as the achillies right now)
  • side-stepping (I do it barefoot) both ways
  • cross-over side stepping both ways
  • balance on one foot (with two ski poles in hands for assist if necessary, and it is!) 30 seconds at a go.

That’s it, that’s where I am now - I’ll try to hit an update in a couple weeks.  I feel from reading some of the stories on this site that I am lucky and doing well so far.  To everyone out there in this unfortunate brotherhood and sisterhood of brokenness: Stay positive, stay cautious, but don’t be afraid….

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Mar 02 2012

II - Weeks 2 - 6: In the Boot

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Boot Time = Muscle Atrophy

I spent post-surgery weeks 2-6 in the boot, full weight bearing.  I used it to work, but a clock started ticking as soon as I put the thing on.  I could stand it (pun intended) for about 4 hours on my feet, then had to get the thing off & get the ice on.  I think I was icing at least 4 times per day during this period. Doc’s orders were that I could move foot in dorsiflexion, bringing toes up and let it fall back with gravity.  That’s it, nothing else til next office visit at 6 weeks post-surgery.

I think around week 3 is when reality sunk in.  Looking at the non-existent calf muscle is frightening… brain sending signals for your calf or toes to do something and getting no response is terrifying.  I was wrapping the straps of the boot further and further around as there was less and less meat on my leg.  I am an active person - I enjoy snowboarding, mtn biking, xc skiing, rock climbing, surfing, SUPing… like many people, its part of what keeps me sane.  This time was the hardest psychologically for me - being able to get on my feet to work and then have to just sit back down… bit of a downer.

At week 4 I took another shim out of the boot as instructed by the doc, so only one left in there.

At week 5 I was really chaffing, I wanted to start some PT- I felt the time was right.  I got some info through this site and connected with someone on a PT "fast-track" who had started in on PT at week 5.  I very gently started some ROM exercises, & it felt good to be doing something!
Week 6 office visit:

So I show up for week 6 visit and the doc checks out my Achilles.  We chat a bit about how its feeling: pretty good all things considered.  And he tells me to start wearing 2-shoes with heel lift around the house and try to wean myself off the boot over the next 2 weeks.  This was a bit of a shock for two reasons - firstly I had been instructed to do just about nothing up to this point, and secondly, per reading a lot of the stories on this site, I was given to understand that this was a BIG step.  He also said, when I asked, that I could get on a stationary bike.

And that was it… so I asked, "What about PT?"  To which he responded that he would write me a script if I wanted, but claimed that there was no evidence of PT getting people back to normal activity any faster than just easing into walking, etc.  Now, I like my surgeon.  He’s given me good information and been very straightforward throughout the process… but this seemed really strange to me.  I took the script and went to a PT that I know and trust (we have some really good PT’s here in Vail).  The whole process is a reminder to me that I need to really take time to organize my thoughts and questions before seeing the doc - the only way to get the information I want is to ask.

One response so far

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