Phil, let me heartily endorse the above advice. As for the calf, I have a lot of atrophy — that’s going to take some time. Range of motion, well, seems to be going slower for me than Pablo comparatively, but I’m getting some back.
This is a long haul, buddy. First few weeks seem to fly by, but as soon as therapy does start, the gains can be incremental, barely noticeable from week to week. Cummulatively, I’m definitely doing better — but feeling that way. Well, it’s not as easy.
All best w/ it, and please find a good therapist for yourself soon.
I agree with Ryan - find a good PT who has worked with alot of these injuries. My experience has been that the docs are generally great at what they do - which is repair… but the physical therapists are the ones who know more about and have more experience with recovery. I also agree that you’re not too far off the mark - my first 6 weeks, I wasn’t instructed to do much of anything either - my PT explained it as the tendon needing the time to knit… as for your calf - from what I’ve read you were going to lose it no matter what. At 14 weeks, I’ve got about 90% of my ROM back and I’d say about 30% of calf strength back… rebuilding the calf is a slow road.
Good luck - & get onto a program quick - gonna feel great to be doing something!
Sounds like you got abandoned by the doctor who quit- it was probably his responsibility to hand you off to someone as he left. But, I think the clinic bears some responsibility too; they should have taken steps to ensure all of his patients were followed up with.
That said, it’s water under the bridge now. Your choices seem to be to either find a new doctor you trust and can work with. Or, just take matters into your own hands: Get a copy of a modern protocol (something like the UWO) and figure out how to get back on track. The good news is, after 6 weeks of immobilization, you’re not too far down the road; and probably haven’t diverged that far from an optimal path. You’ve probably missed out on some of the early joint mobilization, and my recommendation would be to gradually transition; working your way back towards a protocol you like. Many many people have been completely immobilized for this long, and have had good recoveries. It’s still the norm for many docs. Calf atrophy is normal and expected at this point.
I would say that finding a good physical therapist is even more important than a new doct
Stay away from Skechers Shape-Up shoes or any shoe like that. That is the main culprit in my original development of Achilles tendinitis, causing my eventual rupture (not to mention two subsequent ruptures). That style of shoe is specifically designed to shorten the AT and unnaturally displace your weight, challenging stabilizer muscles to do excessive work. Coming back from an ATR, you cannot afford this additional stability challenge.
I do agree with Ryan on the Crocs, though everyone’s foot is different. Dansko-style clogs are great if you can handle the weight and are comfortable with the elevated platform (once again, not best for your first shoe back). I bought a pair of cowboy boots with a low-heel because the back of the boot does not touch my heel and the minimal lift gives me even displacement with my gait (even now when I’m basically just learning to walk again!). I feel a lot of that discomfort is due to the loss of what is the biggest callous on anyone’s body and building that buddy back just takes time.
Congratulations on your increased mobility! I can’t wait to get back on my bike. I would reall
That heel pain you describe is normal, and to be expected. Some people have found Croc’s provide a lot of relief. I also found rockered shape-up (Sketcher) shoes help; since they put more weight on the center of your foot. However, the shape-ups will also work over the Achilles area (depending on where you’re at in recovery that can be a good or bad feature).
At 6.5 months out, I still have occasional bouts of tenderness in my heel; though the frequency and severity are much reduced.
Can you elaborate on KT tape? How it’s used, if it needs to prescribed, etc. I’ve heard of this before but don’t know much about it. I’m getting the “itch” to start kicking this recover, (PT part), into high gear and I’d like to see if this will aid in what I’m doing. Any info you can provide would be appreciated….Thanks and good luck with your recovery
Glad to hear your PT regime is on track. I’m starting PT next week, so I haven’t been doing too much on my own — just getting about right now is enough. Bu the bike rehab sounds like a great idea. Think I have a friend with a bike-trainer stand he’s not using. Maybe I’ll get my mountain bike cleaned up just a bit, and pressed into service on it. I’ve also noticed the heel pain — somedays more than others. Almost as if my heel has lost its natural padding. I guess that’s another area which needs to be gradually reconditioned. Thanks for the update & info. All best.
Sounds like you are making good progress Phil, I will continue to read with interest, I am 2 weeks post op and got my boot yesterday. I subscribe to the theory (my own theory) that everyone has a healthy ‘base’ weight. I have cycled to work for the last 4 years, 10 mile round trip, before this I weighed 200lbs. After 2 years I weighed 188lbs and have not moved below it since! I think I eat too much pasta, but I love it and won’t give it up!
Oh how I would love a power meter, but then I also would love a ferrari and they are both unfortunately outside of my financial means right now, although I do have a lottery ticket….seriously though, I cant afford a power meter, but I look at them and drool over them often. I have always battled with weight, and running really helped me out alot with that. It seems no matter how little I eat, I just stick at a weight and never lose it, I could eat celery and gain a pound lol I want to get into the triathlon scene once fitness returns, before I had the AT issue I would ride 60 miles every other week or so, ride 13 miles most nights and run long runs of 13 miles every other weekend, with short 2 or 3 miles a night….and still got stuck at 230lbs , if there is a horse bigger than clydesdale then thats the group I belong in…I am not eating a calor-horrific running intake or anything
I agree with Ryanb here, your tendon is not healed and you need to use caution to avoid the setback of re-injury. With regards to the injury contributing to weight gain, it seems some people gain, others lose (I lost a lot of muscle weight and have not been able to gain it back).
I think you could do a couple of things to keep your weight in check. The stationary bike is very safe, if you set it in front of the TV time goes by rather quickly. You can also manipulate your calorie intake, specially carb calories. If I had to pick one change, I would stop the bread/pasta/rice/bagels/pizza. And I know it’s easier said than done!
What you really need, to measure fitness, is a power meter- a way to chart your heart-rate against the watts your generating. The best ones seem to be integrated into the crank; using strain gauges to sense instantaneous torque in the spider, which is integrated through the full pedal stroke to derive power. They’re not cheap: tinyurl.com/6qv8l7v
I ordered the cadence sensor for my bike and should receive it today, that way I can hook up the heart monitor, bike cadence and see where I am for fitness again. Before I get out on the trails again I will get the foot cadence sensor to be sure I am consistent and not overdoing it or overstretching my steps. ryanb- I will take it easy, I like the idea of working the bike for a while longer. Janus - the lack of cardio is the hardest part of all this, there is \almost no way of keeping weight off when I have the metabolism of a sleeping winter bear other than running and if I swing weights around I could either hurt the achilles by connection to stabilizing muscles or end up looking like popeye. The weather is very good for Minnesota, once I have a week or two of basement bike then I will take it outside and see how it goes…I htink next winter I will try out some rollers to work those stabilizing muscles
RyanB, sounds like great advice! Phil, thanks for documenting the experiment. No hill-running for me in the immediate future, either. No real cardio either expect what I get doing push-ups and the like. Wishing you the best with planned runs later this year.
6 weeks post surgery, 2 shoes…. you’re entering a dangerous time. I would probably say, THE most dangerous time.
It’s tempting to listen to your body; but for the next little while, be very careful and conservative with the tendon. This is when re-ruptures happen, and they usually happen with no warning. It will be week 12, or even 16 (3 or 4 months) before your tendon is anywhere close to full strength; it might feel a lot stronger than it is. You’ll only know that you’ve reached it’s strength limit after the fact - after you’ve broken it. Try to stick to things that are low/zero impact (swimming, spin bike, etc.). I would - for sure - keep exercising the joint, but use low force, high-repetition exercises that avoid high stress on the tendon. Careful walking is very good too…
Hey, Phil, great to hear that it’s going well so far bootless. Can’t speak to how properly walking prepares you later for running, or how soon you should start jogging again. My Dr’s advice in my case: no jogging/running until I’ve completed basic PT and am 3 months past surgery. I trust him so that’s the plan. Sorry to hear about your wife’s R.A. Wishing you & her the best w/ it all.
Great post, thanks for your insights. Your comment on family and friends telling you to stop your “foolish” running, sounds a lot like what I am hearing now relative to trying to play soccer post 50 While my passion and goal is to play indoor and outdoor soccer versus run marathons, the euphoric rush of feelings you note are all there when I am on the field. Good luck on the race and know that you have lots of supporters out there!
I had to use mine for a few days after not wearing it for around 4 months or so. I now know its not that ununsual. Its good to have for the odd day if you overdo it or out in crowds and feel a bit vulnerable.
My man, good luck! At somepoint you have to take matters into your own hands. Keep us informed of how it all goes. I’m now six weeks post surgery (5 months post-injury, tho) and just dropped another wedge from the boot. But my range of motion is still so limited, that I expect the boot to stay on for a bit longer. I’ll let you get out in front — you can be the leading goose, so to speak, in this current small flock of ATR sufferers in flight to recovery.
Hi Norm (and others who may be following my non-op recovery).
I am now at week 8 and my last wedge is to be removed tomorrow. This is the same day as my 1st physiotherapy session.
I started partial weight bearing at 7 weeks. This was painful but not due to the Achilles, it was because of the amount of fluid on the underside of my foot creating pressure.
My leg and ankle always swell because of this injury unless my leg is raised.
At 8 weeks I am now full weight bearing and going for short walks though still with the large walking boot fitted. This seems to be also keeping the swelling down.
I believe that in 2 weeks I will be able to discard the boot and then at last be in normal shoes. I will report more on my progress at that time hoping that it helps others.
Phil, I still have a bump but it has improved. It was worse pre op. Don’t worry about it too much, so long as you have function. (I had a different procedure from you so don’t like to advise on the exercise front, but I found the blog invaluable for ideas).
Check out the UWO protocol, PJ, and try to duplicate the exc results they got (& published) with it. Most of us found that the bump eventually went away. It, and the “fat AT”, linger for a while — OK, a LONG while, but they eventually return to normal or very close.
The UWO patients started PT at TWO weeks post-non-op, and home exercises then, too. FWB at 4, bye-bye boot at 8. The study and the protocol are both here, so use ‘em to get a good result with min hassle. Ask if you can’t find ‘em.
Pls install the ATR Timeline Widget to answer our FAQs.
Congrats on “halfway mark for boot-dom.” Seems our surgery times were fairly close? Mine was 19 January.
I think you’re absolutely right that if the first great challenge is recovery, the second great challenge is how we make that downtime before recovery into an opportunity. I’m still very much working on that.
But also as you’ve mentioned, there’s a lot of success stories out there about people overcoming the same obstacles and challenges that you and I have. Resilence being on of the keys.
Congrats again on hitting your first post-surgery milestone
Phil, the main job of your calf muscles, the job that keeps them buff and solid, is to pull on your AT to straighten your ankle and lift your body or propel it forward when you walk or run or jump. Since you tore that AT, those calf muscles (gastrocnemius and soleus) have been relieved of all duties, so naturally they’ve atrophied. Gradually, as your AT regrows and strengthens, it will be safe and appropriate to give those muscles an increasing fraction of the work they used to do — the work that built the other calf up to its present size. Meanwhile, there are ways to keep most of the rest of your muscles from atrophying, but not those muscles.
In addition to trying to maintain the fitness, size, and strength of your other muscles, you can also try to get on the fastest proven rehab protocol you can find, which will keep your muscle’s time-out to a minimum and (logically) minimize the atrophy you’ll have to reverse as you start tensioning your healing AT.
BTW, if you can please install the ATR Timeline Widget (see the Main Page), it will help us all answer our FAQs about you.
It came as a shock, I figured I was walking around in the boot, and that it was getting used even for just holding me upright. It quite amuses me to look down and see dissimilar legs. I just was’nt expecting it.
I am now in the ‘this darn boot catches on everything, legs of chairs, walking sticks, doorways, steps…and when people ask me how I am I say fine and forget that they mean that they want to know why Im wearing a duck bill’d plastic boot.
My man, if you’ve only lost an inch or thereabouts you’ve suffered marginal atrophy so far. Take that as good news! For reasons I won’t get into here, there was a delay (weeks, not days) between my injury and surgery. When the calf muscle is not engaged, the leg becomes a peg-leg from knee down.
That said, I think rehabbing and rebuilding up the calf muscle on the injured leg is common for all of us. So wishing you the best. (& hoping the same for myself).
Have you tried a stationary bike with the boot? I biked with my boot. It was a bit odd but it worked. That got me back into it slowly. I also attempted a spin bike with the boot. My trainer was with me, good thing because I really thought I might fall off because of the weight of the boot but I didn’t. You will get there.
Firstly, good luck on your March 3rd mile!!!, I hope everything goes great and its an important step back on your road to recovery.
I too care very little where I place, I see people who complete a marathon and are so dissapointed with thier time or place… sure we all have goals and if we dont reach our personal expectations it can be disheartening, but really…. how can anyone be dissapointed to finish a 26 mile race?? Not me, it appeared that the longer the race went on, the happier the people around me got, because we were all just trying to get to the finish, no matter how long it took.
I think it would be cool for achillesblog members to run or walk a race together sometime.
Thanks for sharing. As I posted in another reply, I was supposed to run a half in March (actually 2). I am now hoping to walk a mile race on March 3. I’m also signed up for an Aquathon in April which I should be able to manage. It is funny how important racing has become to me and how much it is a part of my life. I don’t really care much where I place. It is the act and the people I meet. I am a 50+ runner and only started to run again about a year and a half ago. I can’t wait to run again.
I am one of those 40+ runners, although only got into running in the last 5 years. I never realized what an important piece it played in my life and how much I would miss it. Hoping I can hold on to the gratitude for it when I am running again. I am hopeful because my brother tore his Achilles a few years ago and he runs 5Ks, skis the Birkebeiner every year, bikes, and plays Hockey.
Last week I ran for the first time (7 months post op). It was only 25 min on a treadmill and 2 min run alternated with 2 min walk…but still. I almost cried with joy! I resisted the temptation to sign up for a race right away but plan to after I have a few real runs under my belt.
Thanks for sharing your feelings on injury. To me, that has been the hardest part. But I have learned, and am learning a lot about myself in the process. I feel like I am a completely new person since last July.
I made it through to 40 with only a handfull of times when I had to visit a doctor, very active. I had the good fortune of health, and I still do really.
I tried to self-rest and recover from this injury thinking that just a few weeks would do it, but now its 6 months later and still hanging out with a really attractive grey plastic boot on. People who havent had an injury think they understand, as I did before this, but now I know that you lose control of your actions and your future, you question yourself deeper than you ever did before, this is not something you can just wipe away.
I remain grounded because my wife suffers from Rheumatoid Arthritis, and unlike my injury, there is no cure for her. I will return to running, so that I can raise some money to help doctors find a cure for RA and as always I appreciate the mental grounding I get from the people that share thier stories here and tell each other that we will make it through this bump in the road, thankyou
I know your pain and I share your feelings. To me, this injury has been the most devastating event I ever experienced in my life. Some people can handle adversity better than others. I’m not one of them.
My life up to now had been easy, I never had too many problems and reached middle age in excellent health with just a few sports injuries that healed fairly quickly. People who have had to confront major life challenges are more resilient and to some, this is only a bump on the road. A lot of factors come into play. A strong support system and an optimistic outlook, even if unrealistic, can help make for a more pleasant recovery. Yes, there is light at the end of the tunnel, but the time we lost is gone, the opportunities we lost are gone, and the future does not come with guarantees, specially with the guarantee that we will be able to run (or whatever other activity we like) like we did before.
Hi Phil, understand what you are saying. I started identifying more and more with injured people and less with able bodied throughout the trajectory of the injury. All the way through,and especially at my very worst, only the thought of climbing outdoors again kept me going. Only we who have had the injury really know how it feels. Hang in there.
I was in a boot from Sept - beginning of Nov, in a cast from Nov. 8-Dec. 29 and back in a boot until Jan. 30. Between Dec. 29 -Jan. 30 I was out of the boot around the house so my transition to walking was not bad. I have not been able to run yet and it is killing me - well, not really but it is really annoying. I have an entry in the Seaside Half on March 3 and won’t be able to do it - not even walking. (It sells out every year but I got a spot. Guess I will have to try again next year.) I missed a number of races in the fall. I don’t even want to add up how much I lost in entry fees.
I was in my boot about a month… I first got my boot after the rupture and before surgery, and I LOVED it then–my foot was so unstable that I would stumble & pitch forward at the drop of a hat, but with the boot I could walk around…
After the second cast came off, I was happy at the thought of the boot, but found it difficult to walk again. It became easier week by week as I removed the heel lifts. After about 3 weeks, I found that at home I preferred to walk with some weight on crutches and no boot on foot most of the time. This was with my PT’s blessing, and has helped get me back into 2 shoes, the left one a little more worn looking than the right.
I did ask my PT about contrast baths today, as I had more swelling in my ankle due to walking a lot yesterday & not icing last night. She said that they would work better than icing, so I will probably take that up when I go back to work and have to be on my feet more.