paulg’s AchillesBlog

Thanks for the encouragement LL, Peadar and jla2010. The calf raises are going ok. A little more weight on the recovering leg each day. Slowly does it. Also i find the ankle is getting quite stiff at times, during day and first thing in the morning. I think it is because of the increased walking and then ironically lack of use during the night while sleeping.

Hi PaulG, Sounds like your doing well. Don’t worry about the weight distribution. You will naturally begin to shift your weight more to the ATR leg as you feel stronger and more confident. The main thing is to do the leg raises with proper form and full extension. I think it’s best to do them barefoot so you’re truly raising and extending rather than rolling up to the sole of your shoe. It’s a completely different feeling and, I think, much more effective. All the best and keep healilng.

Great stuff Paul,
I am 9weeks 5days post op. 8 of which were in a cast.
I hear you on the 2 leg calf raises. I def am favouring the strong leg. But bit by bit I’m putting a bit more weight into the injuried one. They are tough.
having read your post I think we are also in a similar position. Great to be back walking all be it a slow walk. Can just about walk down the stairs normally now. The swelling in the ankle area is also improving, but after a lot of excercise I know about it.
Keep us posted on the wobble board and the single cast raise. Both will be landmark days in your recovery.
Be carefull with those two

take Care
Peadar

I too had the increase swelling initially but that decreases slowly. I think that’s the nature of the injury, each increase in activity brings a little swelling. My resoning is - if it’s back to normal after a night’s sleep I’m ok with it. It sounds we’re at very similar points in our recovery, keep up the healing and have a great Christmas and new year. LL

Brilliant Paul, it really sounds like you’re on the road to recovery. Although I’m a couple of weeks ahead of you I think we’re at a similar point in our progress. I too have just started walking round the house and occasionally venturing out. The stiffness is SLOWLY going away but I can see this is going to be a long term goal. Good luck with your future recovery and remember ‘watch your step!’ Carry on healing

Congrats to you Paul! I also know the vulnerability you feel regarding walking with no boot. My friend the Physio came by last night and even though I don’t start Physio for 2 more weeks he gave me two exercises without the boot (one at a time for me ). One was a motion exercise where I stand with my toes at a counter (for support) and move my knee forward to the cupboard. I am to do this for a couple of days then progress to moving my toes back from the wall. This exercise helps with the walking motion so when I get out of the boot in 2 weeks, I won’t walk like a penguin. The other exercise is more of a confidence booster. Stand at a counter and while holding on with one hand, close your eyes and stand on your ATR foot. Then when you can do that, let go of the counter. These are my goals for the next 2 weeks. Good luck with your next phase of recovery!

Enjoy the swimming, it’s really helpful. I only got a boot at around 9 weeks and to be honest didn’t get on with it very well, I found it put a strain on my knee, it was useful for being outside though I did feel more protected.
Bit by bit, day by day you will feel more comfortable and less vulnerable on your own two feet, going barefoot seems to be easier than shoes. The weather is a nuisance as it does make you more wary. Maybe get used to downtown first, I seem to remember all those walkways in Calgary centre.
Good luck - if you don’t try you’ll never know if you can do it!

I know what you mean about feeling vulnerable. Everytime I take my cautious steps across the living room, my heart is literally still in my mouth. I still have tightness in my achilles and not at full dorsiflexion yet, how about you? Also since not sleeping in the boot I find I’m quite tight in the morning, but this wil no doubt improve with time, as everything does.

Hi Paul wow i must start walking without boot to,but i just can,t .Mentally it is a hugh step.I think im going to stay in this boot for life. Is your foot well pass neutral?

Thanks for the encouragement. I wish you all the best too. I am at my most cautious since the op. Walking for the first time barefoot with crutches and a few steps without them is worrying. I feel vulnerable and am nervous. Easy as it goes!

You are soooooooo lucky I have just come back from seeing my consulatant, I am at 39 days post op today. I am not allowed to start Physio for another two weeks, no swimming and I am still in the big Vacoped walking boot and will be for several more weeks. You are doing so well, keep up the good work!

That sounds wonderful! I love reading things like this… I am 8 days post injury (non surgical)…
I’m glad things are progressing so well for you!!! Thanks for the boost!

Hi Paul it sounds as though are experiences are very similar. My OT nurse had a very similar nonchalant attitude. I felt like screaming with joy and she just said oh yes time to get in shoes. Good luck with your healing.

ems72, every injury is different and the fact that it has been so long since you have walked makes FWB all the more tentative. I hope you will find, as i did, that when you start to FWB that you will see a vast improvement in mobility over a short period of time. When i first started FWB two weeks ago i would never have thought i would be going for walks, shovelling snow and basically doing everyday activities two weeks on. I do still use my crutches in the house when out of the boot.

Take it slow at first and soon you will be surprised at how much more you can do. Stairs are awkward and a handrail is invaluable. I found going up easier than down. When i go down i use the handrail to stop me from falling forward as i ride and roll the step in my boot(this is when i take most care).

Good luck with the FWB and i look forward to seeing good reports. Paul

Wow. I’m really stunned at how fast you’re progressing! I’ve been told this week to start putting full weight on the foot, in the boot but I’m finding quite difficult. Also the bottom of my foot seems really tender - I haven’t really walked on it for nearly three months though as I was in a boot for 6 weeks before surgery.
I live in terrace house as well and the stairs are quite steep, so I did try stairs but struggled to fit the boot on the step and have gone back to sliding down on my bum

Anyway - you’re doing fantastically well. Hope it continues for you x

Good stuff! I made myself a wobble-board or two, years ago. IIRC, a local lumber yard sold hardwood hemispheres with a big woodscrew buried inside, sticking out in the middle of the flat side. I bought one, turned/screwed the whole thing into the middle of a small sheet of plywood, flipped it over, and voila! A wobble board!

Wow, i’ve been off crutches for 8 weeks and I still couldn’t walk 1km. Guess it shows how different all our bodies are.

Paul, your progress sounds great. Watch out for the crutches outdoors in winter conditions AND when coming back in. My worst slip this time came after I made it through the snow from the car to a friend’s house. I said a big “PHEW!” to myself, then almost killed myself on their hardwood Dining-Room floor, as my crutched slid out from under me on a micro-puddle from a few melted snowflakes! That “suction cup” shape of the crutch feet seems as if it was designed to store some snow, “for later”!

Hi Cheryl, I see that you had your surgery a day after mine. I wish you all the best in your recovery. I hope that you can get mobile on the crutches soon. Take care in the winter condtions upon us. I will follow your recovery. Paul

Hi bronny, I have been doing the same outside walk daily since i was put in the aircast boot at 12 days post op. Always with crutches for safety although i probably would not need them now if it were not for the recent snowfall(spikes added to bottom of crutches!). The amount of weight i put on the operated leg has increased over the past couple of weeks as does the pace of the walk. It is only 1km long but undulating. Over the course of the day i walk much more during daily activities. I walk without crutches in the home and have been “crutchless” outside on a couple of short occasions. Best of luck with your recovery. Paul

notn, there is not much left of the single remaining heel lift. It has flattened with wear so i feel i am close to neutral when in the boot. When sitting i can put both feet flat on the ground with my legs at 90deg to floor(not uncomfortable with slight tightness in tendon). Having not done much physio(1 visit), just the regular ROM exercises at home, i feel it is the gradual transition in the aircast boot(and the walking in it) that has eased the stiffness in the achilles. The boot is doing the initial work for me. I do not want to get ahead of myself but i am happy where i am at. Physio tomorrow(wednesday). regards, Paul

notm, thanks for the insight into what to expect when the “two shoes” go on. That will be a tentavive period. Your posts are informative and helpful.
Paul

A fellow Calgarian! Welcome! I am extremely jealous of you right now being that I had surgery on both legs on Oct 15 and am merely longing to be on crutches. I marvel at yours and everyone else’s accomplishments to date and hope that I will see such strides when my time for those crutches come. I can only offer up extreme caution to you right now in light of our blustery, snowy weather. Good luck to you.

Cheryl

Paul - what is “a decent walk”. Do you mean a few miles or a few hundred metres? I can’t believe you are going for walks at 4 weeks or so…

Paul, you say “My foot, after a decent walk today(little to no swelling) was at neutral.” It’s not neutral in the boot yet, so do you mean that barefoot, while sitting down, it’s easy to pull your toes up as far as neutral? Or do you mean something else? If you mean what I’m guessing, that bodes well for the removal of the last wedge in a week and a half.

Virtually every ATR patient starts rehab in plantarflexion and gets moved to neutral (and beyond, mostly in 2 shoes), but the speed and timing and size of those moves varies a lot among protocols. Some people find the moves quite painful, and others feel like they could have done them sooner than they happened. They’re often more uncomfortable (and maybe higher-risk) when done in conjunction with FWB. (If I had a choice, I’d change the angle at bed-time, ~8 hours before the WB starts.)

Your recovery sounds excellent and keeping to a nice fast rehab schedule, Paul. I think the UWO Protocol says something like “if necessary” when describing the use of crutches at the 8-weeks-in “wean off boot” stage, and I bet they won’t be necessary for you. Since you’ll have already been FWB for a while, and you’ll probably choose shoes that are just about as cushy as your boot (or add gel footbeds to them), you should be fine for comfort. So the only real issue is the loss of protection and support.

Most of compensate for the loss of the boot’s protection and support by shortening our gait when stepping forward with the uninjured foot, rather than using crutches again. The scary move in 2 shoes is stepping past the injured foot, leaving it behind. That makes it dorsiflex past neutral while there’s still weight on it, which is new, difficult, and potentially hazardous. For your first 2-shoe steps, you’ll probably keep your recovering foot well ahead of your body. You won’t walk as fast as you did in the boot, but that’s life, while making that transition.

Then over time, you can gradually let it drift farther back, lengtheni

Hi notn, Thanks for your post!
I do like my surgeons protocol as it makes sense to me and so far so good. He is out of Banff Sports Medicine and i am doing my physio at U of C.

The aircast boot works well. At week 2 i had a 2cm lift and now at week 4 i have a 1cm lift. At week 6 i will remove the final heel lift and be at neutral. I feel as though i could remove the final lift now but i do not want to rush anything. The early walking and gradual transitions with removing the heel lifts seems to, in conjunction, stretch the ankle and strengthen the leg. My foot, after a decent walk today(little to no swelling) was at neutral.

I was wondering about what it would be like to return to crutches at week 8 or thereafter. It may be necessary for balance? or just for peace of mind so that people are aware you are in recovery? I was thinking a walking stick may suffice.

Having last seen the doc 12 days after surgery and the physio just a few days later i have not lately had a proffessional opinion on my recovery rate. This is why i am concerned about my flexibility. Am i where i should be at this stage? My physio will a

Paul, your “At week 8 i am to wean off the aircast boot and return to crutches/cane and then wean off the stick/s” is almost the same language as the UWO protocol, including the choice of AirCast boots in the first place. I wonder if your Canadian “highly regarded sports medicine orthopaedic surgeon” has (like mine — the chief surgeon of the Toronto Argonauts) consciously adapted his rehab protocol in the direction of that recent Canadian study. Or it could all be a coincidence.

Your Doc is using a more gradual transition from 2cm heel lift to 0=neutral, and I found the UWO protocol’s “cold turkey” at 6 weeks to be very abrupt, and I spread it out a few days on my own. (Your Doc isn’t Dr. Nick Mohtadi of U of Calgary, is he?)

BTW, that “return to crutches/cane” was the only other detail in the protocol that I rebelled against. Instead, I moved into a HINGED boot at 7 weeks, and used it on and off — weaning off it — until I was comfy in 2 shoes without any sticks.

Does “I am concerned about flexibility” mean that you think you’re short of it, lacking in ROM? Make sure you assess your flexibility while your swelling is com

Thanks notn. Since injuring myself i have done plenty of research on surgery/non surgery and rehabilitation of ATR. You have to go no further than reading the posts on this site to realise all the “variables”. I am aware that my surgeons protocol is fairly aggressive. He advised me that i may go back to work 8 weeks following surgery. I trust the physiotherapy protocol that my surgeon gave me and i will stick to the task. Some of the goals do seem unrealistic at first but with hard work i do believe they can be reached. At week 8 i am to wean off the aircast boot and return to crutches/cane and then wean off the stick/s. Right now, just over week 4 this seems unlikely but a week ago i never thought i would be walking around with no sticks and only a 1cm heel lift. Early progress seems to come quickly with careful commitment to the exercise program. I can imagine it getting a little more difficult down the road. Some days i am thinking if i am doing enough and i am unsure how far i can push it. I am concerned about flexibility. I am sure my daily exercises and walks are helping as well as the removing of a heel lift las

duke88, good luck to you too and i will follow your recovery closely as our dates of rupture were close. Take care. Paul

Hi duke88, thanks for your comments. It was the emergency room doctor who casted my initial temporary splint(before surgery) who told me that it would take me a year to recover from my injury. I must admit i was a little surprised to hear that eventhough i knew it was an awkward injury with a lengthy recovery. I wondered how he could make that determination over such a quick examination. This was his last involvement apart from referring me to the surgeon. A couple of days later a second professional comment had my head spinning. This time it was from my highly regarded sports medicine orthopaedic surgeon. Before surgery he told me that i would never recover 100%. He related to Donovan Bailey who had an ATR. After surgery he made a terrific recovery and again ran a sub 10 second 100 metres although he never repeated his previous best. I was not sure what to make of this other than he was telling me that it is possible to achieve a high standard of fitness but i should not expect to ever be the same again. What are your thoughts on this.

Also, i believe that my surgeons physiotherapy protocol is aggressive. I know t

Paul, your surgeon has you following a schedule very close to the one I recommend (and recently followed), from a new study done at Western — bit.ly/UWOProtocol . They got very good results both with and without surgery (basically equally good), following that fairly aggressive protocol, so I think you’re on a well-paved road.

One of the themes of this website is that the road we’re on is more-or-less, on average, a 1 year “marathon” to the “finish”. You can install a widget here, as many have, that maps your progress (what fraction of a year you’ve endured) compared to the NYC Marathon. (Me, I “push” the OTHER widget, the “ATR Timeline”!)

Of course, it’s just an average Rule of Thumb, and ATR patients, and legs, are remarkably variable. Some of that variability is in our hands, and a lot of it seems to be pretty random. Some of the scientific studies in the field even comment on the surprising variability — here’s a recent one: “The mechanical variables showed a large degree of variation between patients that could not be explained by measuring error.”

Even after a year, most studies that measure outcomes find that most

Hi Paul - Don’t believe it will take you a year for this, at all. 6 months on the outside (unless unforeseen circumstances). I was back at 100% at 5 months after my left ruptures in 2009. I have just ruptured my right one on Oct 10 (4 days behind you!). I am doing range of motion stuff and will go to Physio in a couple weeks when I am given FWB OK (despite already walking on it without the OK). Anyway, just be careful but religious in the motion exercises and PT and you will see good progress. I don’t know anyone that took a year and am surprised they said that, especially with allowing you out of cast at 2 weeks. That, in itself, is very helpful with recovering by preventing too much atrophy of calf and all little muscles. GOOD LUCK and Chin UP!