Peter’s ATR blog

I went to see my surgeon for my 7 week follow up.  I’ve been walking in the boot since week 2.5.  I’ve been doing my stretches using the front of my leg very regularly (5 times a day), and have seen good progress on my ROM.  I’m now slightly past neutral.  If I put my toes against the wall, I can bring my knee to 5cm away from the wall.  As a comparison, with my good foot my toes are 15cm away from the wall, so the difference is 20cm.

My surgeon is concerned that I may be progressing too fast with the ROM.  He didn’t seem too overly worried about the long term, as long as I stopped doing any more stretches for 3 weeks.  So basically, it isn’t too long yet, but at the rate I’m going it could get too long.  So take it easy, and basically wait for 3 weeks and do nothing.  Weight bearing is OK, but keep the boot on with the wedges in.

I’m OK with this, as I’m pretty much back to normal lifestyle and am comfortable with the boot.  3 more weeks until my tendon is “set” and I can start doing rehab and go 2-shoes!

Peter

An update on my progress in the boot.  I was a groomsman in a wedding over the weekend and had to walk down the aisle and stand front and center.  My boot is black and I could put my dress pants over it, and with my Walmart raised shoe to compensate for the height difference of my legs, most people didn’t even realize anything was abnormal.  I guess I’m not limping at all.

I also got out yesterday and went for a REAL mountail bike “downhill” ride.  I was going pretty much full speed, only I avoided the bigger jumps on the trail to be “responsible” given my injury.  Pedalling up the steep access roads (and having to walk the steepest parts), I can say that it was my fitness, not my injury, that was holding me back.

So overall, I’m really happy to be getting back into what I love a lot earlier than I first feared.  I was really glad I didn’t have to be in my friend’s wedding on crutches!  Although I have a long way to go in terms of healing of the achilles injury itself, and going back to something like soccer, I am glad to be basically more active and capable than some of my non-athletic friends, thanks to the boot.

To think if I’d followed my doctors instructions to the letter I’d still be 1/4 weight bearing on crutches still!  I have a doctor’s appointment with the surgeon this week to see if I’m ready to go to FWB in my boot.   Um… yes..?  Should I limp in on crutches?  Probably won’t.

I’ve also found a way to try to use my “rigid” boot with similar functionality to the vacoped boot some people have.  I just put it on really loose around my leg, so it acts like a shoe for the first while, but at a certain level of dorsiflexion it hits my shin and prevents the tendon from being stretched.  I’m limping again when I do this, because my calf is actually being used, but I think it’s good for weining off the boot.

Since getting to FWB in the boot at 2 1/2 weeks, life is cruising along.  I’m gaining flexibility (down to 1 wedge) and some strength (70lbf plantar flexion with my toes).  Incision is healed nicely and swelling is quite low.  More than anything, I’m gaining some confidence that the tendon can’t be re-injured while I have the boot on.  It doesn’t swell up or hurt after exercise.  I biked to work last week: 44km total trip.  It felt good, other than a bit of chafing on the boot.

So today I went out on a full suspension bike, and cruised around the neighborhood.  I did some small jumps and drops (less than a foot high), hopped speed bumps and went down a few flights of stairs.  It all felt good.  I’m thinking I might go and try a real trail in the next week or so.  I also want to get back into rock climbing.  I think if I adapt the toe of the boot with some stiff sticky rubber I could start getting back into that too (at a lower difficulty level of course).

Having full support in the boot I’m wondering if I’m going to develop a dependency on the boot.  So I have a question about other less restrictive type braces for later in the recovery process.  Once I am comfortable walking without the boot, I’m going to want to continue to do mountain biking and hopefully some rock climbing.  At first I may just put the boot back on, but sooner or later I’ll want to use the proper shoes for the job.  But I really don’t want to risk re-injury, as a slip or fall of the bike could be bad if I’m not booted up.  Are there braces out there which allow you to wear normal shoes and perform sports activities, but limit the dorsiflexion of the ankle to prevent over stretching the achilles?  I’d love to hear about some.  I was thinking of making my own if nothing else.  Something like an “L” plate that straps to your shin and loops under your heel to keep it from riding up.  Or attaching a telescoping rod (like a gas strut used for the hatch of your car) from my knee to my toes?  If my toes go too far up the rod bottoms out and starts taking the load?  How can you tell I’m a mechanical engineer . . .

That’s all for today.

It’s amazing how fast things change.  From the depths of despair when you first get injured, to the pride of being able to go down stairs on crutches.  I feel like the “exciting” part of the injury is over - the pain, the surgery, the crutches, the sympathy, the daily challenges to do the simplest tasks.

I’m 3 weeks post op and I feel like life suddenly went back to normal.  I can walk around as much as I want with no pain thanks to the boot.  All of a sudden I have to do chores again:  making dinner, picking up after myself, take out the garbage, doing the dishes.  In just a few days since getting the boot I’m no longer a cripple - I’m just a guy who can’t do sports, walks funny, and wears a silly robo-boot.

I’ve been going on bike rides to try to stay active.  Each day I’ve gone out for an hour or so of hard pedalling.  I think biking is a really good thing for me since I can really go all out and get some exercise.  The geometry of pedalling with the boot on is quite favorable.  You sort of point your toe in a similar angle with the good foot anyway, and it feels mostly balanced.  It does get really wet inside though afterwards from the sweat buildup.

My calf is regaining some definition, but is still quite small and soft compared to the good one.  I can now raise my leg while sitting and with my other leg crossed over top.  Although it feels strong, I measured that I could push only 30 lbs with my toes (plantar flexion) before I felt a tug of pain on my tendon.  With my good foot it is likely more than 200lb strength.  So I’ve got a long way to go.  As a point of interest, I also measured the reverse strength of my foot (dorsiflexion) to be about 30 lb.  This is of interest since the doctor said I can stretch the tendon using the muscles on the front of my leg.  So I should be able to put 30 lb worth of tension on the tendon using my calf safely too.  Since this is the same point where I feel pain, it sounds like my pain receptors and my surgeon both agree on how much force my tendon can take right now.

That’s all for now.  The next milestone is 2-shoes.  Maybe by 8 weeks?  Hopefully sooner around the house.