petediddy’s AchillesBlog

Good news on the first jog and great to hear swelling under control.

Right on Pete, glad you are doing well man, I have always followed your posts as I am a week behind ya. You will be jogging soon, you need to definitely wait til you feel comfortable and confident.

Having less swelling when you walk is a good sign that your calf muscles are working. I still swell up a little if I stand around more than walk. Walking and biking are really good exercises. Your confidence on the bike will increase. Good to hear things are moving forward again for you.

petediddy
Thank you for this info.

All good advice. I’ll continue to move slow.

CM, I started PT around 8 weeks. The exercises started with pushing in different directions with the therabands. I was also doing exersizes for my leg in general to regain stregth (quad, hamstring). Shortly after we went to single legged raises on a seated calf maching (started at 5 lbs.) and doing some balance work on a tilt board.

Hi Pete.
My advice is take your time to recover. I first ruptured my Achillees in May. Had surgery and was recovering really nicely. I was doing heal raises on both feet (about 50-50 weight on each foot), riding on an indoor trainer with no problems and walking with almost no limp. At 11 weeks my physio advised I was ready to try riding on the road but as I pushed off to get on my bike I re-ruptured the tendon and was back to square one.

It’s easy to say now, but in hindsight it was too early and too risky to try riding at only 11 weeks. Everyone is different but unfortunately you never know for sure until you try. As it’s been mentioned, the risk of re-rupture will reduce with time. This time I plan on giving myself a lot more of it. Good Luck.

Hi petediddy
When did you start PT and what was the first exercises you have done.

I am nearly to 4 months and would love to be running again. I tried it a couple of weeks ago for a few hundred metres and could manage a shuffle. I was feeling so much stronger and wanted some mental evidence that I was getting better. I haven’t run since then because I don’t see the point. My physio has given me a direction (much the same as an order) that I was not to run until I am what she calls +10 and can do 40 one legged jumps on my bad leg. the +10 refers to dorsi flexion range - with the toe 10cm (4″) from the wall, your bare foot flat and your knee touching it. Having been a runner most of my life I can see the logic in what she is saying. The lack of dorsi flexion will only cause stress on smaller tendons, in particular the plantar fascia which runs from your heel to the big toe. The forces of jogging or running are much greater than walking or cycling. For the moment I am content to regain my flexion and strength. I have been riding serious hills and walking faster and further. One leg heel raises are quite hard to get your head around. I can do them now but I would not suggest that this is an indication anyo

Sounds like everything is going for you the same as me Pete. Seems like progress has slowed down like I am not reaching milestones as quickly as the beginning right after surgery. I am 13 weeks tomorrow and go to the doctor Thursday. He said at the last appt 4 weeks ago that I could start jogging after this appt. Like you I just don’t think I am ready for that yet. I still have trouble walking at a fast rate with a long stride, much less jogging!

Hi PD

I have a good friend who had AT surgery on jan 5th, 2011.

Recovery schedule ( a competitive Triathlete)

5 wk both feet on stationary bike and exercising fine
6 week in a shoe on a trainer spinning with a little pressure on the foot (twice wk)
8 Week 1st bike ride outside. Very Easy tempo…Not much pressure.
10 week boot off walking no heels
12 week 40-45 min walk (flats)
16 week walking slowly up hill part way (hills are tough)
20 week (running 5 miles okay) hills still difficult

I am understand the hard part now is the uphill walking and cycling. Flats are easy at 6months.

Good luck you’ll get there…My advice from 4 ACL surgeries and now at ATR is don’t push to hard, but keep at it…it comes when it comes….

I do think its just down to intrinsic weakness and have been doing what you say, stretching a bit more which I think will help. Hope all goes well with the single calf raise!

Ali, it is getting better little by little. When I walk, I make it a point to push off with my toes so that I feel a little pull on each step.

I have also been stretching my foot (just using my muscle) several times a day for about 20 seconds. I think this is helping with ROM. It is starting to feel better when I am pushing off now; it hurts less. I just push myself to do what I can each workout. my PT wants me to be able to do a one legged calf raise within a week or two. That may be too ambitious.

Hi I’m also having problems with the push off. My gait is like this
heelstrike - pushoff - ow
How is it going now?

Pete,

I’ve been pushing pretty hard at PT lately and do get some discomfort doing heel raises. It especially happens when i concentrate on evenly loading both legs. However, my discomfort is very low on the sides of my heel. My calf/ankle just gets tight around my AT but doesn’t really feel painful per se.

I was about 17 weeks post-op on my first ATR when my PT got me to overdo 1-leg HRs, and I got a miserable pain at the back of the heel that didn’t go away for a MONTH of taking it easy. (Actually walking and running around a lot, but in a hinged boot the whole time.) My pain was at the AT-calcaneous junction, not very close to my ATR or the surgery.

Your whole leg has been loafing, and if you overdo, it might not be just the “no pain no gain” muscles that notice. Me, I’d back off to make sure the pains don’t become chronic.

Hey Pete, again I am one week exactly behind you. I too get pain it seems right in the spot where the tendon was sewn back together when I put a lot of pressure on it. I have been doing 2 leg heel raises much easier now and with my weight evenly distributed on both feet vs a couple weeks ago when most of my weight was on my good foot when doing the raises. However when I try to put more of my weight over on my bad foot when doing the heel raises I start to feel a little pain. I don’t think there is anything wrong I think it is still just healing. I told my doc what I am telling you and he stated that was my body talking to me telling me that it was too much pressure on it. Hopefully it goes away soon for the both of us. I am hoping to start jogging by week 13 which is in 2 weeks!

Hey Pete: I am also coming up on 12 weeks. Any limp for me is in direct relation to the type of shoes that I am wearing. I don’t have a limp in my running/workout shoes, sandals or barefoot. I do have a limp with any shoes that rub on the back of my heel. I expect it to get better or I am going to start wearing sandals to work..

Pete,
I am one week behind you and I still have limp as well. It is not as bad in my tennis shoes but with flip flops, barefoot, or dress shoes it is def still there. I think it is just different for all of us. I am a pretty big guy and my AT is pushing around quite a bit of weight so I can understand that I may have a limp a while longer than others. Everyone’s body type is different, keep your head up! I too am waiting for that 12 week mark. My Dr stated that was the point at which I could begin more aggressive workouts and exercises.

I’m in the same boat with the limping. I think mine is more restricted by ROM than calf strength at this point. It feels like my bad leg is longer than my good leg in my stride, which is simply because my good foot dorsi flexes a bit more when pushing off - this problem is even more noticeable when walking on an uneven sidewalk where my bad leg is higher than my good leg. I think regaining ROM will be a very slow yet steady process. Hopefully, only a few degrees to go for both of us before the elimination of the limp is just another milestone crossed off the list. Good luck!

Sounds good, Pete. I don’t recall how you said your swelling is coming, but even a bit of swelling causes a surprising amount of tightness, so keep fighting it with RICE.

Jeff, you should stay active, but NOT because your surgeon “seemed pretty confident that there are no stats supporting the theory that people who have experienced a rupture will experience one on the other foot as well” — because she’s completely wrong about that!!

If you visit this site’s “Protocols, . . . studies” page, you’ll see a link to the 2003 article “Contralateral tendon rupture risk is increased in individuals with a previous Achilles tendon rupture”. The risk they found — though only looking a few years after the initial ATR — isn’t high in absolute terms but is hugely elevated compared to the “normal population” we used to be part of.

Here’s a short excerpt from the abstract:
“Ten patients (6%) experienced a rupture on the contralateral side during the follow-up period (OR:
176 [70–282] vs. the expected rate based on the general population risk of this injury, P<0.001). [The follow-up period was "median: 4.2 years
post injury". -NotN]
Thus, this study suggests that patients with an Achilles tendon rupture are at significantly increased risk of a contralateral tendon rupture, as well.”

The “OR: 176 [70

Hi Jeff,

I am FWB but with the boot. I am just about to lose it and go into a regular shoe with 2 heel inserts. Yesterday was my first PT appointment, so I haven’t had time to really improve my range of motion. But just through removing the heel inserts, i can get my foot a bit past a 90 degree angle. It is nowhere near the range of my other one yet. But, according to my PT the dorsi range on my good foot is about 25 degrees. She told me that the average person has about 10 degree range of motion. Not sure if that is relavant.

As for rupturing the other tendon, my PT said that she has dealt with many many ruptured achilles and that she never saw someone who ruptured the other. (However, I have heard some horror stories on here. So I know it is possible). The PT said as I age that I will have to spend more time stretching and warming up. I guess there is enough preventative stuff that we will or can do to really minimize that risk. Let’s cross our fingers.

Just curious on your range of motion exercises. I just got cleared for FWB but really feel I need more ‘dorsi’ range of motion to help remedy my limp. Are you seeing much weekly progress in those measurements?

Also, today I asked my surgeon (who used to be a tennis player) if she felt my good tendon will be at higher risk of rupture just due to the fact that my other one went bad and maybe I’m just at higher risk in general. She seemed pretty confident that there are no stats supporting the theory that people who have experienced a rupture will experience one on the other foot as well. So I plan to stay active, but ease into high risk activities like tennis and basketball by making sure I’m at my preferred body weight and that I feel very fit generally before jumping back in too heavily. I wouldn’t write off basketball if I were you, just focus on being in the best shape possible before participating again.

It all sounds like a great idea, then someone comes
along being practical. I agree with Bob. The question
does not really pertain to me, I drive a stick, so left
footed driving is out of the question. I sat in the car
with the boot and quickly realized driving with it was
a no go for me. The boot was too big and clunky. A
few days after I went out of the house with two shoes
I drove! And it was wonderful.

Check with your insurance company first. No matter what anyone says here. At the end of the day you will be the in that loses out should something go wrong, and the insurance company wriggle out of any responsibility.

I was slow to follow Chuck’s advice, Pete, because everyone in my life was having panic attacks at the thought of me driving left-footed. Last Wednesday, after 7 weeks of being driven around by my husband, parents, friends, I had had enough. My CRV has a cup tray that folds down, so I jam my right foot in there. The first couple of times out I was too heavy on the brake with my left foot (make sure you go out alone at first. You might give your passengers whiplash). But now it’s all good. Freedom! (I wish I had done it sooner.)

Hey Pete: I ruptured my right achilles on May 10, had surgery May 13 and was driving a week later with my left foot. My car is an automatic, Honda Ridgeline. I was able to easily move my right leg out of the way, over to the passenger side, and drive with my left foot. I drove around the neighborhood to get the hang of it, and then off I went. I have about a 40 mile trip to work, one way, so it was a necessity to drive. After a short time, I was driving so well, that my wife was even willing to ride with me and commented that I was a good drive left footed. (probably her first complement on my driving….ever) So give it a little practice, but I didn’t have any dangerous incidents at all. I am at 7 weeks, and driving right footed again, now. (boot off, of course) Good Luck!

Use your left foot for both.

My guess is that it is probably not that uncommon. I guess I will take it easy as much as I can and ease back into things slowly while I cross my fingers.
As much as I hate to think of this, I may have to hang up the basketball shoes. At least indefinately until I would feel full strenghth again. Time to look into a bike and some golf clubs.

I’m nearly to week 5 and have experienced the same thing in my good leg. My good tendon feels a little sore at times, but not bad enough to be sure that its not just all in my head. I suppose it is a combination of overcompensation and some worrying - either way, I’m going to ease back in to activity slowly!

I felt as having an ankle sprain at around week 5 post surgery, It went away after two weeks!

Some people find it easier to walk with wedges removed, some the opposite. It isn’t just your calf that’s had a bunch of weeks “off”, it’s all the muscles, tendons, ligaments, and nerves in your foot and leg. Also the “proprioception” circuits that are responsible for control and balance. Avoid pain, but keep working toward normal. . .

Pete,
I had my cast removed yesterday which had been on for almost 3 weeks. It has been 3 weeks 3 days since surgery and my dr put me in a boot yesterday. He said to get my foot into the boot and that it would be really hard and painful to get it to the 90 degree angle the boot is. I have read on here that most people start with a wedge or two first as I was a little scared of stretching the tendon that much. He jokingly commented that was for babys!! I am so mentally paranoid of that thing popping again just like you. He said the same that your dr said, the sutures were so strong that it would be very difficult to re rupture. He told me to take a deep breath as I placed my foot into the boot and he shoved my heel all the way down into it!!! I bout s**t my pants!! I hardly slept last night because the stretch and pain in my heel was so uncomfortable. So I am jealous that you get the wedges, I’m not liking this at all. He wants me off the crutches and FWB in one week and start PT in 2 weeks so we will see how that goes. Keep us updated as you get off the crutches, I know that I will be relieved to see them go! Good Luck!

Nick

My protocol — with NO surgery — called for PWB at 2 wks, and “FWB as tolerated” starting at 4 wks. It took me just a few days after 4 weeks to forget where I’d put the cane and start walking FWB. So I don’t think it’s necessary to be “relying heavily on the sutures” to start walking soon FWB in the boot.

Many people find the transition scary, but it’s also probably the most liberating and empowering “step” you’ll take since the ATR! Getting out of the boot at 6 weeks is definitely quicker than average, though others have done it. (If you’ve got a hinged boot, I honestly don’t see the advantage — there’s a relatively minor benefit, IMO, and a big increase in risk. With a “fixed” boot, the benefit is a bit bigger, but arguably not big enough.)

Your “worry about a re-rupture” is well placed. Stay nervous and careful, as you progress and advance! The vast majority of reruptures happen in the first dozen weeks, so you can take that as a Rule of Thumb. . .

I am definately going to wait until the end of the two weeks to do full weight bearing. I am going to try and go as gradual as possible over the next 2 weeks. When I put a significant amount of weight on my leg, it definatley feels weird…like there is a lot of pressure on my heel or something. I guess it must be a combination of not using my leg for a month with it being pointed down in a huge boot.

No, I have not started physiotherapy yet. He said that in 2 or 3 weeks we may start light exersizes of pushing some weight.

This is scary every step of the way.

Wow! That does seem fast, to go from partial weight bearing in a boot to FWB in shoes in two weeks. Sounds like you’re doing great, congratulations! Are you doing physiotherapy as well?

I’ve also suffered from some pretty surprising atrophy — I’m most shocked about the muscle loss from the front of my leg, along my shin. I never really thought about the muscles there, but when I compare my legs you can see where they’re missing. Bizarre. Hoping they come back asap!

Pete, I think you’ll find “how tight did it feel” experiences are all over the block, from nothing at all to unbearable pain. My protocol — at bit.ly/UWOProtocol — called for a complete removal of all 2cm of wedges, “cold turkey”, at 6 weeks in. My tech accidentally gave me 3cm instead of 2cm, and I found it uncomfortable to make the jump all at once. (I’d been FWB for a couple of weeks by then, so I was boot-walking faster than most of my “able-bodied” pals!) I just spent a couple of days doing it gradually.

The part I worry about is the COMBO of the new stretch AND lots of WB, which I think is more likely to do damage than either alone. (In fact “lots of WB” seems to avoid damage, not cause it.)

Thanks for all the input. I really don’t have and exact timeline layed out yet. But I have a question for everyone. When you start to take out the wedges out of the boot, should the tendon feel really tight? I don’t want to pull it to much. Also, when did everyone start PWB? How much weight did you start with?

I think everyone who has done their AT worries about rerupture, you are normal!! I always have to remind myself that there is a very low percent of it happening. Reading success stories on this site helps too ;P
Has your dr given you a protocol to follow at all?

Pete, I’m almost 7 weeks post-op and I’m finally beginning to feel close to normal. I have 4 weeks in various casts, then a boot for the last three weeks which comes off on Monday. I think week 3 to 4 was the hardest psychologically, boredom setting in, weeks more to go, and no end in sight. Getting rid of the cast (and crutches) at week 4 was progress and it gradually improved from there. It really takes about 6 weeks for the tendon to start feeling stronger. Hang in there. It will get a lot better!

Pete, in general, going faster (within reasonable limits) seems to be safer (against re-rupture) and produces as good or better outcomes than going slower. Most or all of us shared your fears, but these things do heal, and getting them moving seems to help.

One trick that helps when removing heel wedges is to do it at bed-time. Then your ankle, calf, and AT all have the night to get used to the new position without the extra challenges of any WB you may be doing. (My fave protocol — bit.ly/UWOProtocol — introduces PWB at 14 days post-whatever.) If you’re still NWB, it probably doesn’t make much difference when you remove the wedge.

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