Physical Therapy

Information on Physical Therapy. Get your leg back in shape!



Some info about Physical Therapy

  • Electrical stimualtion addresses inflammation, muscle strength and spasm. (thanks Ross!)
  • Ultrasound deals primarily with increasing circulation to the area. (thanks Ross!)

153 Responses to “Physical Therapy”

  1. I just posted an excellent pdf about ATR overview, recovery descriptions, rehab exercises, etc. Written by Dr. Eric Berkson

    If you are starting out on this journey I think this is a good guide to read first.
    (It’s the first one on the list.)
    http://achillesblog.com/physical-therapy/

  2. Dennis - I came across this link that has a lot of good calf stretching and strengthening exercises. However, I must say that these exercises should only be performed after consulting with your doctor or therapist. Most of the exercises are probably best done once out of the boot, or even further down the road.

    http://www.netfit.co.uk/members/calf_exercises_muscle/calf_exercise_exercises.htm

  3. Tom -
    Thanks, I posted this on the main site, under “Physical Therapy”.

  4. Has anyone heard of a machine called a DynaSplint? Apparently once hooked up, it moves your foot up and down by itself. My doctor wants me to use it every evening as part of my PT but i’m a little worried. I’ve never heard of it before.

  5. leeisme - I haven’t used it, but it looks like it can be useful. If your doctor recommends it, then I think it’s fine. It looks like a great little device that’ll help you get your foot moving.

  6. Hi all,

    I just came back from my first post op Dr. appt. (8 days). I was shocked that they cut the cast off. It sure felt good for a moment.

    Dr. said he has never seen anyone heal so fast. He said he could take out the staples today, but will wait until next week. Absolutely NO swelling, no bruising, and wound look healed.

    He recasted me, at full 90 degrees. He felt the tendon and said that surgery went amazingly well. He said I can start putting weight on it next week.

    Walking boot in 3 more weeks, at which time he will start me on PT. I am absolutely ecstatic.

    He said I only had 4% of tendon left.

    The wound was at least 10 inchs long. It started on my heal, hooked up a bit, and then up to the calf.
    I forgot my phone, but will take pics next week.

    The new cast is shorter, with more toe out and lower beneath the knee.

    The nurse said that mine was a clean tear, like someone cut it, and that helped in surgery.

    Dr. expects me walking without crutches at 9 weeks post op.

    Mike

  7. Mike R - sounds like you had a great visit…I loved that feeling I had after my first post op appointment. It was so good for me to see the wound. Happy Healing!

  8. MIke R–
    glad to hear the visit went well…The fact that it was a clean tear and not “spaghettied” (frayed) means that the fibers should heal quickly. Take it one day at a time.
    Doc Ross

  9. Dennis,

    I am 54 in one week.

    I injured my AT on March 18th, and had surgery on March 25th. I injured it hiking when I jumped down on a rock, and my toe hit without my heel, and heard the snap. I had to hike another 1/2 mile out of a steep canyon after I did it, and might have caused much more harm doing so, but will neve know.

  10. Well, I am out of the cast and into the boot. I start PT next Wednesday, 5 weeks post op.

    I took my boot off a few minutes ago for the kids to see, and it was shocked when I saw the sagging small leg muscle, especially next to my good one.

    I tried to move my foot just a tad, and it doesn’t work too well yet! That was a very strange feeling. It that par for the course at 4 weeks post op?

    Dr. said the tendon is healing strong, and to put 50 - 60 lbs. of weight bearing on it. I am ok to ride a stationary bike, which I am on my way to do right now.

    He said I will be out of the boot in no more than 4 weeks.

    What is the usual PT for the first week? i assume very light and lots of range of motion, right?

    My PT is in mr Dr.’s office, and I have 5 weeks, three times a week.

    He did say to keep the boot on all the time, except for showersand that I should be ditching the crutches in 2 weeks.

    How did you guys do at 4 weeks?

    Mike

  11. Dennis,

    I would like to be added to the atrpt. I tried and thought I set up my own blog, but I cannot find it

    Off the the YMCA for my first bike work.

    Mike

  12. Mike R - I’ve added you to:
    http://achillesblog.com/atrpt.php
    Found your blog! :)
    http://achillesblog.com/miker/

  13. Mike R -

    The PT was fairly lightweight the first week. Some ROM and some light resistance bands. My first PT was around week 7 though, and my ROM was pretty good.

    I think you are right on par with the average. Brendan’s comment sums it up best: :)

    Averages of those on AchillesBlog:

    28 - Days Immobile
    28 - Days to PWB
    31 - Days to FWB
    49 - Days to Shoe
    42 - Days to PT
    (Please note, averages are just that, some rehab protocols are longer or shorter based on surgeon, specifics of injury/surgery, individual, etc…DO NOT USE THESE AS TARGETS/GOALS FOR YOUR RECOVERY)

  14. Thank you guys for your posts…I have learned alot from you so far. This blog is awsome!
    I have done the surgery on the 3rd of April and until now I am on cast, and my doctor wants me to visit him next week to remove the cast which will makes it total of 2 months on cast….is this normal?! I was unable to remove my leg for the past 2 months because of the cast, although i have heard on the net that its better to start moving the ankle to avoid having weak achilles tendon…and its better to start using the boot as early as possible….but I have not. I live in Dubai city and I am unable to find doctor that I trust ;-(

  15. prince -
    Are you bearing any weight on your cast foot? Well, I hope the averages at least give you a feel for what everyone is doing.
    The earlier you start bearing weight, the less of muscle atrophy you’ll have. If you are still NWB, your doctor’s protocol does seem conservative.

    I recommend that you also checking out: http://achillesblog.com/atrpt.com to see what everyone’s protocol has been like.

  16. Thanks for putting up so much information. My doc had planned to have me in a hard cast for 3 months, but I discussed getting into a boot sooner last week & he said I’d have to go to another doctor - this is what he’s done and all he does (I had even taken in clippings from the medical journals/articles on the site and he glanced at them but would not consider researching alternative protocols). I called several other doctors and although my insurance will let me switch, I couldn’t find a doctor willing to take over care until 3 months post-op. Then, yesterday, I went into my doctor’s office for a medical release for work (I’d been working from home and was planning on going back to the office soon) and he agreed to switch me to a boot - however, he said I am doing my own thing as to how to progress since it is not his protocol. I was a bit surprised since I didn’t bring it up, but I figured I should take advantage of the opportunity and as long as I carefully research this (and get a qualified PT), I’ll be able to do this safely. As of the appointment yesterday when he took the 2nd hard cast off, he said it looks great.

    So, I am in the boot & looking to see what ROM and other gentle things I can do safely. I’m at week 5 post-op (today) and at PWB (and have been for 3 weeks). These documents are a great resource to compare to other readings and to provide more details for when I am talking to the PTs.

    Am I nuts for taking him up on the offer? Or is this worth doing it on my own for the benefits of being able to do ROM & other things before 3 months?

  17. Has anyone here had a re-rupture or partial re-rupture? If so, does it feel like the original rupture when it happens? I hit the pool yesterday..7 1/2 weeks post op and was doing some walking in the pool with slight toe raises and then decided to do a lap with full kicking, etc., and I felt a twinge in the achilles. I immediately stopped and got out of the pool. Everything seemed okay, but today the scar looks different (small indent where the achilles originally ruptured) but I don’t feel any abnormal pain & I can still flex my foot and calf with no problems. Was also wondering if anybody knows anything about inadvertantly legthening the tendon due to too much stretching, etc., etc.? Has anyone else gotten in the pool at 7 1/2 weeks and used a kick board while kicking the length of the pool? Wondering if this is too much too early??? I appreciate anyones input on the above subjects.

  18. My re-rupture did not feel the same. The pain the first time was like being hit with a bat, while the second time it was a sharp pain and a feeling that something kind of let go inside…. but I did not have surgery the first time, so it was not solid enough probably.
    Hopefully you just over worked it with full kicking. I could not move my foot after re-rupture, it was painful and stiff.
    I would ask for advice from the PT before doing full kicking.
    Your foot might not be used to such fast moves, even if you are not bearing weight.
    My surgeon told me not to swim when I asked at 6 weeks post op.

  19. Hi Kevin,
    If you have been doing toe/heel raises while walking without issue I would be surprised if swimming caused any serious injury. I haven’t been using a kickboard (don’t own one) but have been thrashing around at my comical ‘freestyle’ stroke at full throttle since 6 weeks and am considering taking my scuba fins along next time to increase the resistance, as it doesn’t feel close to the effort required to do a heel raise or pedal my bike (I’m at week 8.5 now).
    As far as what a re-rupture feels like, I can’t say, but…the second time I went to the pool (around week 3.5 post-op) I slipped and weighted my bad foot, more than 50% body weight with no boot. That gave me a nasty twinge and it was sore for 24 hours afterwards, but everything turned out fine. My guess is that it may have been an adhesion tearing free. The pain was different to my original rupture, a sharp stabbing pain, whereas the ATR was more of an ‘electric shock’ sensation without normal pain (which I know is different to what many others experienced).
    Good luck,
    Dylan

  20. Didn’t make it clear above that my ’slip’ was on the wet floor in the steam room, not in the pool, hence how I put so much weight on the foot!…

  21. Hi Kevin,

    I am 9 1/2 weeks into recovery from a total rupture and what you described sounds like a possible partial rupture.
    As you mentioned an indent.

    You might know by now what it is anyway.
    Good luck to you.
    Koru

  22. For me this has not only been a journey of physical recovery but spiritual and mentaly as well as I needed a break.

    I had to ask for help from a lot of my friends, to take my kids to school, do shopping , take me to the specialist etc.
    I have taken this time to go within and appreciate time for healing and all the kind people that have come out of the woodwork, so to speak, to help me.
    I just started driving again after 9 weeks taking care of me!
    I do appreciate to have had this time and now I am ready to give back to what I received!

  23. In July 08 I went through my first achilles surgery done by a Podiatrist. After weeks of being in cast, boot, and then physical therapy I continued to have pain. Ealier in March 09 I went to an Orhtopedic surgeon who did a different surgery in May 09. I am about four months out and PT was going great. I had been feeling good to the point the Doctor this past week released me from PT despite me telling him I was having a little pain. Possilby stepped on a stair wrong. I am finding that I may have reaggravated it base on the pain. Swelling and pain in the achilles and stinging in the heel. Has anyone ever gone through something like this? I hav ebeen dealing with this for almost two years.

  24. Howdy everybody!

    When I tore my ACL 6 years ago, I found a useful board similar to this and now that I’m recovering from my achilles, I’m glad I found this site. So much useful info and everyone sharing their experiences definitely helps.

    As of today, I am 9 weeks Post-Op, FWB, and in a boot. However, I’m a bit concerned that I havent started PT yet. And according to my Doc, I won’t be until Mid-November (???) I know everyone’s recovery is different, but I didn’t have any complications post-op and was FWB at 7.5 weeks. I’m 28 years old and very active. I train 5 days a week and before my rupture, was playing basketball twice a week plus boxing. Not sure if its my “macho-ness” or ego thats making me anty, but I’m really starting to question why I have to wait 12 weeks before starting any physical therapy.

    Any thoughts or advice would be great. Thanks!

    - Kirby

  25. “I’m really starting to question why I have to wait 12 weeks before starting any physical therapy.”

    Indeed. So many of the doctors who do this surgery focus on what we “can’t” do, instead of what we *can* do. We tend to be fearful after this injury, so we typically do what they say.

    I agree, 12 weeks is a very long time, unless your situation has unusual circumstances.

    Good luck,

    Doug

  26. Maybe your doc is afraid of your macho-ness? He may think that if he allows you a little bit of work you will recklessly push yourself?

  27. @Doug - Yeah, I hear you. I’m not one to make waves or question what my Doctor thinks is best for me. Koru’s post said it best that this is definitely a “mental trial” as well as a physical one.

    @2ndtimer - Perhaps. We did discuss my lifestyle before the surgery so maybe its playing an impact on his plans for me. And to be honest, I probably would push myself, though definitely not recklessly or in a way that I might hurt myself again. I just think the fact that I cant “do” as much as I used to at the moment frustrates me.

    Guess I’m just trying to gauge whether 12 weeks of no activity on the leg is average?

  28. kirbynyc - welcome to the site. Just a quick question. I know that it was some time a go, but do you happen to remember where the ACL board was?

  29. @Dennis: It was called Bob’s ACL Board. Definitely not as fancy as this blog, but there are a lot of helpful people as well and I think its still up.

    As for an update, I’m thoroughly enjoying the boot. Feels so good to be walking again. After 3 and a half weeks, I get to see the Doc again this Thursday. Here’s to starting PT!!

  30. Need advice! I am 9 weeks post op. Had my cast removed 7.5 weeks post op. Had extensive repair/reconstructive work done during surgery. Doc told me put as much weight on the foot/leg the day he removed the cast and begin PT pronto - which I did. I am walking (taking steps!! I wouldn’t call it walking!) with one crutch. Seems my foot is swelling quite a bit but with ice and elevation it goes down. About 5 minutes after I have it back on the floor - it swells up again. Is this normal? Also, I am having alot of nerve sensation in the rupture area and in the heel. Has anyone else had this occur?
    Any info or advice is much appreciated!
    thks in advance!

  31. Hi Susan,
    I am 8 weeks post surgery. I was in a cast for 6 weeks. Once removed I have been going to physiotherapy twice or three times a week. As soon as my leg came out of a cast I was told to be careful and to nurse it. The physio has been massaging it and has given me some exercises to get the circulation going.
    I totally disagree with you doctor telling you to put as much weight on your leg as possible, there is no use rushing the healing process now that you have been through so much. Take it easy and be patient. Go to a physio and ask him or her advise.
    I too had bad swelling but since the circulation has been better the swelling has gone down drastically. I too had the nerve sensation but after a while this too dissapears.
    I am walking now but with a limp and a walking stick. But I am improving everyday.
    Be patient is my advise.
    All the best for the new year and happy healing.
    Tim Martin

  32. Hi Tim,

    I will be 8 weeks post-op tomorrow. I have the circulation problem as well. When my leg is up, it is not swollen and the color is normal. When I hold it down, it changes to darker red-purpulish color. I have been doing PT for 3 weeks - mostly ROM excersises. What excersises do you do to improve circulation?

    Thank you,
    Marina

  33. Hi Marina,
    I am doing a lot of ankle an calf exercises and I am actually going to gym now and under a trainer am working on my upper legs, it really does help. Every evening I work my leg in the pool by dong plenty of kicking, I then take a hot bath then I massage my leg with a product called Iceman. I push all the swelling up my leg and I massage my lymph glands in my groin. This I have been told by the physio takes all the fluid out. You should try this as it does do a world of good.
    I am also walking for a mile and a half, slowly with my walking stick.
    I hope this helps and let me know how you are doing from time to time.
    All the best,
    Tim

  34. Tim,

    Thank you - this is very helpful! I will hopefully see the doctor today (it is snowing here so I hope he does not close his office) and will find out when I am allowed to walk. As of now, I am told to put my injured foot down and immitate the walking movement on crutches but not to walk on it. My PT would really like to get me walking but my foot needs to move another 20 degree to get to a flat position so will see what my doctor says. I cant wait to do to the pool.
    What ankle and calf excersises are you doing? I am doing foot lifts up (30×5), alphabet (x5), and toe crutches (30×5). I am also keeping my foot on the floor trying to push through the heel as often as I can.

    Have a great New Year and may all the trouble stay in 2009 and the 2010 bring you only health and happiness !

  35. Hi,
    My partner snapped his achilles just over 6 weeks ago. He was in a full cast for 8 days then a backslab/half cast. We went and see the ortho surgeon yesterday and all we got told was that when we got home for him to take the cast off and start stretching it. Nothing about support ie boot or strapping, and she doesnt want him to do physio as she thinks its best he does it on his own. I have been searching the web for stretches ect, as we are both sort of scratching our heads unsure of what he should be doing and how often or anything. She was very vague about the whole lot. Has anybody else had this happen or should we go seek a different dr and get some more advice. I honestly think he needs physio so we know the boundries and where he should be at, plus wether or not it needs some supporting still. we are both wary about the injury happening again *cringe* or him doing damage because of no real guidance. Cheers for any help :)

  36. If it was me, I would finding another doctor. It sounds like the doc you saw doesn’t want anything to do with you once the surgery is completed. You need to find a physical therapist who knows what to do.

  37. Hahh Gerry, you are so right. Its just like in Three Men in a Boat by Jerome K. Jerome -reading the medical enciclopedia you will conclude that you have every desease that is described there.

    That said this site has been tremendous source of information and support for me - THANK YOU DENNIS!!!

  38. mshap - you’re welcome! :) happy healing!

  39. I ruptured my Achilles tendon (actually about 70 to 80 % and then delamination) on 12/29/2009 had surgery on 1/6/2010 and NWB until 2/2/2010 and then a walking cast until 3/4/2010. It is now 2/14/2010 and I am now at home and shuffling around without my walking boot. I started PT with elector stimulation and mild flexibility exercises. I should probably say that I have had very little pain from since the rupture. The Dr. noted that I have more flexibility and strength and less swelling than most. The plan is for me to be in shoes on 3/4/2010 and doing more active PT and back to competitive tennis in June. I am wondering if those who are competitive athletes who have had a ATR how they have progressed back to competition?

  40. Hi, Everybody.
    I’m at 5’th week post operation now.
    I’ve ruptured my left Achilles tendon during the thai-boxing training. It was a full rupture. I had an operation week and a half after the injury and I’ve removed the cast by myself a week post op. I don’t know if it was a wise thing to do, I just couldn’t bear the cast anymore. I’ve started to walk without any boot (if you may call it walking) about 2 weeks after the operation. When I first visited the doctor (2 weeks post op) he was pretty mad at me finding I’ve removed the cast and I was recasted at 90 degrees this time. I could walk with cast now but it was still very unpleasant. I’ve removed the new cast by myself about 3 weeks post op. Today, 4 and a half weeks post op I can walk with little limping but I can see the improvement every day. I’m not doing any physiotherapy but I’m walking a lot every day. Maybe the classical protocol is a safe; however the recovery is much slower.

  41. Genadiy, you should start your own blog here, to keep your discussion in one place. That will also remind everybody where you are and how long it’s been, etc.

    Some of the “classical protocol” is actually less safe (according the the scientific evidence) than some faster protocols. On the other hand, you’re obviously increasing your risk of some kinds of accidental injuries for the next ~8 weeks, so be careful about where you put your feet! This is NO time to be talking on the phone while going down stairs, or carrying canoes over rocky shores!

    You can find a modern semi-fast rehab protocol on my blog, and a number of studies of “EWB” (Early post-op Weight Bearing) compared to delayed WB linked from the Main Page here. And doug53’s blog tells the story of his very aggressive (and successful, at least for him!) rehab.

    Bearing weight early seems like a fine thing, though your Doctor also seems to have approved WB (maybe FWB?) at 2 weeks, which is pretty early, esp. for FWB. Bending your ankle past 90 degrees in your early weeks, especially while FWBing, is a risk that most studies don’t take, though Doug did.

    The two primary bad outcomes you have to avoid are (1) re-rupturing your AT, from over-stretching or over-tensing your calf, most likely during a trip or fall, and (2) “healing too long”, from over-flexing the ankle and over-stretching the healing AT.

    If you can avoid those bad outcomes, you’ll probably get back to “normal” faster than the rest of us. If you don’t avoid them, you’ll probably wish you’d gone slower.

  42. I fully ruptured my achilles playing basketball on May 26 and had surgery the next day. I got the cast off on June 8 and was placed in a boot. So far, so good with the recovery until last night, when I had a dream that I was falling and woke up with a violent shake (I am not kidding). Now I am paranoid that I re-ruptured the achilles. Is there anything I can do on my own to confirm that I did not. I am able to press my foot down with force when I am in the boot, so I am hoping that I am just being paranoid. Thanks.

  43. Charmcity, it doesn’t sound like a re-rupture, and many of us have done worse without lasting harm. The standard test is the Thomson test, described elsewhere here. If your ankle moves when your calf is squeezed, you have a connected AT, at least part of one. If not, not.

    Nasty dreams and muscle spasms are ALMOST as scary as losing your balance and falling, or catching yourself. (The “catching” is often worse for an AT than the falling!)

    Don’t get TOO aggressive with the “press my foot down with force when I am in the boot”, either! If you re-ruptured while trying to reassure yourself that you hadn’t, you’d have to use the OTHER foot to kick yourself! :-)

  44. I completely ruptured my Achilles tendon at the end of April. Had surgery and a graft put in. Was in soft cast for 2 weeks then in walking boot. Everything was healing up great then 4 weeks out I had a horrible infection. Had to go back under the knife again and the graft was removed and the area was cleaned out. Had a PICC put in and dose myself with antibiotics once a day for 4 weeks. Was back in soft cast for 3 weeks and then back in walking boot for remainder of time. Last tuesday was the 3 month mark and the doctor said I don’t need the walking boot anymore. I asked if I would start PT then. He said walk on it for 2 two weeks and if I was still having trouble to give him and call and we would discuss PT. My scar from the second surgery is still scabbed in some spots (man is this way slower the second time than the first .. 4 weeks healing versus 8 plus for the wound to completely heal).

    I currently only have a slightly limp. The leg feels great. Have started working out on it. I actually have been doing Shawn Ts insanity work out. Mind you though I have been modifying some of the moves so as to protect my tendon but it is getting stronger rapidly. So I guess you can say that I am doing my own PT. At this rate I expect to be back at 90-100% by the 4 month mark.

  45. Elexsor, you have to be very smart and very aware (and probably a little scared, too!) to push DIY PT without seriously re-risking a re-rupture, so be all those things! I’m sure we all agree that you’ve already suffered enough with the surgical infection.

    There have been some interesting lawsuits after hospital infections, where the settlement required the hospital to take serious, systemic, and meaningful steps to eliminate infections. Is yours even required to PUBLICIZE their infections rates? Just requiring that publicity, as a matter of “WHY NOT?!?” public policy, seems to eliminate a huge percent of all infections, and the response to a good post-lawsuit settlement can do as much or more.

    I’m on a bit of an anti-ATR-surgery crusade here, and it would be convenient for me to argue that a high infection rate is unavoidable with surgery. But I think the best evidence on THAT suggests that the vast majority of the infections are avoidable, and caused by neglect of proper hygiene, misunderstanding of simple procedures (like how to use disposable gloves!!), and the like.

    Every surgical patient should ask every health professional who comes into to the room to TOUCH him or her, when they last washed their hands. If the answer is NOT “Just now, just before entering your room,” tell them you’ll wait while they do it!

    There are a number of other serious complications of ATR surgery that may be unavoidable risks, but infection mostly isn’t. [/rant]

    Anyhoo, sorry about the infection, and glad your leg feels great now. Watch Your Step! And start a blog, too.

    Good luck and good healing!

  46. @normofthenorth I have a PhD in Chemical and Biochemical Engineering with a focus on S. aureus infectious. My infection was not from the hospital. It was 4 weeks post op. With a collagen graft implant all it would take is a scratch or abrassion on your skin to introduce bacteria into the cardiovascular stream. Once there it can easily travel to the site of the implant. S. aureus (my infection and one of the most common) readily adheres to collagen and just about any other material implanted in the body. With an area as traumatized as the achilles tendon after rupture and trying to heal plus with the low circulation in the ankle area an infection is not that hard to occur. With that being said hospital rates of infection are heavily driven by those that care for the patients practice proper hygiene procedures. Having a bottle of Purell in every patients room and having it properly used everytime the room is entered (include from friends and family) will drop the infection rate to nearly zero (has been done and proven in several hospitals already). Unfortunately with me having worked with S. aureus for some many years there is the high probability that I am what’s known as seeded which just increases my chances of having an infection. [Also just so everyone knows 1 out of 3 people are seeded with S. aureus. That is they have it on their skin all the time. 1 in ~100 are seeded with MRSA. The organism is harmless on your skin. It is once it is in you when the problems start.] Being that my infection was at the tendon and thus so close to the bone a 4 week round of antibiotics is prescribed to make sure it goes away. Also a good idea since I have a titanium rod in my femur. The rod can also act as a reservoir for bacteria. If they attach and form a biofilm then it will be what is known as a low grade infection. The body won’t see it since it is in the biofilm but can keep seeding the body with bacteria from it.

    I would never advocate your own PT. Not unless I could talk to you first. In my case my doctor just doesn’t think I need it. I think his fear comes from a PT trying to push me to do too much and re-injuring it. There are a lot of things you can do that will not risk re-injury to get your mobility and strength back (just increased amount of time for recovery). I already had 70% of my strength and ~95% of my flexibility back. I had/have the advantage of being very athletic and staying in shape through recovery. I worked on my flexibility throughout the healing process. I also heal very quickly and produce muscle quickly. Even so I’m not pushing my tendon super hard. My workouts have the bulk of my weight still on my good leg. Some things you can do and some you can’t. Gradual improvements. Your doctor knows best so if PT is prescribed for you then do it. :)

  47. I ruptured my achilles just before July 4th playing tennis. After 6 wks in a hard cast; I was put into a aircast last week. I am on wk 7 post op and just had my first ” PT ” treatment at my doctors office. I was not real happy with it. The treatment was 30min. long and consisted of electro, heat and hydro therapy. I really expected to be doing exercises to get some movement back to my foot and ankle. Sounds like this is going to be the treatment I will receive for the next few weeks. Has anyone else started out treatment this way? I have two small kids at home and I really need to be able to drive. The doctor claims he may let me drive after wk 8 but I don’t see that happening with this type of therapy. Any thoughts?

  48. Hi bccatc, It’s interesting reading about PT and some of the therapies like electro, heat and hydro. I’ve never had any of those in my PT. I started PT at week 7 post-op and will be 11 weeks post-op tomorrow. I’ve only had tendon massage once. From day one, I started on the stationary bike, walking and ROM exercises, one leg balancing and two legged toe raises on the “total gym.” More exercises have been added since then but I’m interested in other peoples experience with electo, etc. and what they are intended to do that exercise and ROM exercises won’t do.

  49. bccatc, there’s no risk in doing gentle ROM exercises out of the boot (while seated) at 7 weeks! I started them at TWO weeks, following the most successful carefully-studied protocol around, at bit.ly/UWOProtocol . The study that used that protocol (for surgical and NON-surgical patients) is ref. #7 in the Wikipedia article on ATR.

    If I were you, I’d start at the beginning, and start catching up, like doing 2 or 3 weeks of exercises each week. Probably a reasonable compromise between continuing to do nothing and “going nuts”.

    My physio treated me with massage, manipulation, and high-tech gizmos, and also sent me home with a sheet of exercises, changing occasionally, with the UWO protocol’s schedule. That was at a Sports-Medicine clinic. I’d expect most hospital PTs to be slower and less return-to-sports oriented, in general.

    By 7 weeks, without surgery, I was walking faster than my pals, in a hinged boot. We all have better things to do than linger in an old-fashioned rehab protocol — especially since the evidence shows that it doesn’t do any good!!

  50. I agree with normofthenorth. Do something makes a big difference both in mobility and in strength.

    I’m now 2 days shy of 18 weeks post op. 6 weeks out of boot. Did PT on my own as the doctor didn’t think I needed it. I think he was really just afraid of a therapist making me do a bunch of crazy stuff on it and re-injuring myself.

    I’m now back at 98% running 5-6 miles with ease. Still walk the really big hills as I’m not not going to try ball to ball foot action just yet (just heel to ball).

  51. I had my surgery on August 16th 2110 and was put right into a boot with my foot at 90 degrees right after surgery. Partly because of claustrophobia, but the doctor didn’t have any issues with it. Let me add that these are the team doctors for the Phoenix Suns, Sun Devils, Mercury and the Rattlers, so i assume they are very up to date on protocols. My follow up was one week later and at that visit the doctor said to come back at week three (appointment in a few days) and then i’ll be putting weight on it. I have to admit i was on the exercise bike (boot on) four days after surgery, rode a few times then decided to hold off. But i’ve been lifting weghts regularly. the tendon feels good, i have good movement and down force, the wound looks good too, so i think i’m doing pretty good and healing fast. Oh i forgot to add this is my second tear, i did the other leg two years ago! The post of was a bit more conservative with that one, but not too much. I was out of the post op “wrap” in about a week and into a boot. Started weight bearing at about 6 weeks and totally good at about 4 months.

  52. Hi everyone,

    I’m loving this blog, it’s been my friend through bad times until now. This is the first time I’m posting since I can’t find helpful info about this.

    Here’s the history:
    - I ruptured my achilles on 09/21/2010
    - got surgery 2 days later: 09/23/2010
    - 1st post-op 1 week after surgery - he changed my cast: 09/30/2010
    - removed second cast on week 3 after surgery
    - removed third cast on week 6
    - removed fourth and last cast on week 9 on 10/26/2010 (last week). Doc gave me a ‘robo-cop boot’.

    I am to stay in that boot for 2 more month. First boot appointment on week 4 of boot period. Then I am supposed to wear it for another 4 weeks again - until Christmas.

    I’m sure by now you are wondering when I’m doing PT in this. I’m supposed to start it after 4 months post surgery! That means a record 16 weeks.

    I have called him today to inquire about reasons for not starting surgery before. I am not talking directly to the surgeon, only to the doc who took care of my cast and works for the surgeon. He said Dr Prieto (the surgeon) has a quite conservative protocol and simply wants me to avoid re-rupturing my achilles. He said I should not try to use my achilles AT ALL before the 4 month mark because blood circulation does not fully return before that. It’s his protocol. Period.

    Since this has nothing to do with me or my progress and only my doctor’s protocol, I am questioning the protocol used at this hospital (St Francis Memorial Hospital in San Francisco).

    I feel fine, no pain, just very weak and atrophied calf since I was in a cast for 9 weeks. I want to recover fully but without taking any risks that are not advised. I had no complications and I see people on this blog starting to walk with a crutch much faster so I don’t understand…

    I would absolutely love to hear from anyone who has an opinion.

    Thanks,
    Ludo

  53. You will find that just about everyone here has an opinion. The usual procedure with my surgeon was in a boot immediately after surgery, sutures out at 2 weeks and begin PT(mostly ROM exercises) and remain in boot. I think I was also to become PWB at 2 weeks post-op, transitioning to FWB at 4 weeks post-op and two shoes as soon thereafter as I could. I had lots of complications so mostly that never happened, but that was the plan. He told me there was absolutely no evidence that going slower led to a better outcome and some indication that the outcomes were actually worse with a go slow approach. Having suffered a huge amount of atrophy because I was NWB from August 3 until about a week before Thanksgiving, I can tell you that it is no fun trying to gain the strength back after that length of time. We have people on here who had no surgery at all for complete ruptures and have been FWB much sooner than you. If it were me, I would be looking for a physical therapist that was willing to start working with me now. And if I couldn’t find one I would be looking for a new doctor. BUT, I have a very low tolerance for anyone becoming possessive of my Achilles tendon. That’s my opinion but if you read any of my blog you’ll find that I’m fairly opinionated. Good luck and I hope you get your strength back 100%.

  54. It seems extreme. What position is your foot in now?
    Is it still pointing down

  55. Ludo, if you want to challenge your Doc and start an intelligent debate, just present him with two bits of information: (1) A just-published study, that produced great results, that I call “the UWO study”, summary posted at http://www.medscape.com/viewarticle/588904 , and (2) the protocol used in that study, posted at bit.ly/cBFmjM .

    As you and he will both see from those two pages, that study produced excellent results — including a very low re-rupture rate — with a protocol that is months and months FASTER than he’s got you following.

    Then just ask him — in the nicest possible way, of COURSE!! — for HIS results, using his “conservative” protocol. Has he kept track? Published? Got a list for you to see? An estimate? Does he think his results are better than those in the study? And even if he does (and even if they are), is the gain worth the pain?

    The evidence seems to show, as Gerry’s surgeon said, that ultra-slow protocols generally have higher re-rupture rates, and certainly not lower ones. What may happen is that some doctors use slow protocols, just to be safe. Then, when some of their patients re-rupture, that “proves” that they didn’t go slow enough, so they go even slower!!

    It seems so logical, doesn’t it? “I tried to be careful, but they STILL re-ruptured, so it wasn’t enough!” That’s why we need randomized studies to find out the truth, because logic alone isn’t reliable.

    The main purpose of the UWO study was to compare surgical treatment to non-op, but you can just ignore that part of it. They used the same fast protocol on everybody, and (especially on average), they came out fine.

    Even if you only PARTLY convince the Docs, you’ll probably make life better for yourself AND for the next 100 ATR patients that go through that hospital!

    Good luck, and good healing!

  56. The easier-to-remember quick-link to the protocol is bit.ly/UWOProtocol . (My hotkey program is on the fritz, and bit.ly is case sensitive!)

  57. The evidence seems to show, as Gerry’s surgeon said, that ultra-slow protocols generally have higher re-rupture rates, and certainly not lower ones. What may happen is that some doctors use slow protocols, just to be safe. Then, when some of their patients re-rupture, that “proves” that they didn’t go slow enough, so they go even slower!!

  58. This is very helpful for me! this site has been tremendous source of information and support for me. Good luck and good healing! Thanks!
    Physical Therapy Supplies

  59. Hey everybody. First of all I would just like to wish you all healing at God speed.
    I injured my AT 7 and a half weeks ago. Went to Urgent care and Dr. said it was a partial tear. He told me to get RICE and slowly rehab after that. After reading all of the injury stories, it seemed to me that what I experienced (a deep sharp pain and what I thought I heard was a pop). Went to my PCP a week later and asked if I needed an MRI? He said that there was no need and gave me the Thompson’s test which I passed. He advised me also that it was a partial tear and that I needed to RICE until I was OK to start rehabing it. He said I could do it on my own or refer me to a P/T. I opted for my own rehab as I did quite extensive research on it and am a gym rat. There is improvement definitely especially in strength, but I feel that coming up on 2 full months that I should be at least walking w/o a limp. It is minimal since when it first happened but still present. I called him again today and he recommended P/T which I obliged to. It seems that there is a fine line between a complete rupture and a partial tear. Should I be concerned or is this normal? Thanks everybody!

  60. AZBacker, the short answer is “I don’t know”, but I won’t stop there. (I never do!)
    Most of us wish we could examine our injured and healing AT several times a week, naturally, and most of us recover pretty well without it. But in your case, the desire is way more understandable than average.
    In my case this time (my 2nd), I had 3 UltraSound exams, and the results were contradictory and confusing — it’s total, it’s partial, it’s partial-but-multiple!! I was being treated non-op with a boot anyway (protocol above), so it didn’t matter much.
    My experience with MRI (though not for ATRs) is similarly “contradictory and confusing”, so I’m frustrated with the state of the art of medical scans of soft tissues. (One of the most respected back-pain experts hereabouts suggests sending your worst enemy for a spine MRI — and almost nobody else!)
    If you’re passing the Thompson test and walking almost normally (slight limp in 2 shoes) 8 weeks after your “pop”, I’d say you’re probably doing well and should stay the course. If you can rebuild your calf to normal strength without injuring your AT over the next month or two, you’ll be functionally fine, and sooner than virtually all of us. Will you be at elevated risk of an ATR in the future? Maybe. But so were all of us, we just (for the most part) didn’t know it!

  61. Amazingly I virtually agree with just about all you’ve stated. I guess it’s good to re-look at the way you think because you enter into many habits inside the head. Appreciate the comments.

  62. First of all thanks for the post. I have read in one health magazine, that there are a number of serious complications of ATR surgery that may be unavoidable risks, but infection is not that much serious thing about to worry. Once again thanks for the valuable information.

  63. Hi. I fully ruptured my achilles on May 12 and had surgery on May 18 (1 week ago today). I am enjoying reading the blog and different pieces of advice, but I am beginning to get a bit skeptical about my proposed recovery plan. I saw my surgeon on Monday, and he told me that his best guess is that will be in a cast for 3 months. I have only been in it for a week and already feel as if I am going crazy. I am assuming he is very much on the conservative side of recovery, and I don’t know what to do at this point. I am 5 months pregnant plus I have a 16 month old daughter I stay at home with full time. It has been very depressing not being able to care for her or myself too much for that matter. Any time I try to get around on my crutches, I immediately feel the blood rush down and the throbbing begins. So, I have no choice but to sit/ lay around with my foot elevated. When does the throbbing stop? Did anyone else feel really sad after surgery? Should I be looking for another doctor?

  64. Hi Kristin,

    I’m now 6 weeks from a full rupture, and 5 weeks since surgery and i’m walking about without a cast or crutches (albeit with a limp). I’ve pretty much ignored most of the advice of the surgeon who wanted me in a cast for 8-12 weeks and pushed on myself (slowly but surely). Had my first visit to the physio today and she said i was making great progress and to keep doing all the things im doing (but be careful as poss).

    I did a number of things that i think has helped accelerate things a bit. Might not work for everyone, but so far has worked for me.

    First of all, don’t be sad, try and use every bit of mental strength for the fight to recovery, and stay as positive as possible. Know how hard this is as getting myself sorted in the house, going to the shops etc etc while i was on crutches and just out of hospital was a nightmare. But time flys by and you’ll be reasonably mobile in a month if you look after yourself.

    Diet - loaded up on omega 3 and 6 (Udo’s oil, i recommend it), also took protein supplement once a day with a pint of milk. Eat loads of fruit, plenty flax seed etc. Basically a really healthy diet with foods that aid recovery and reduce swelling. Also drinking a ton of tea with slices of fresh lemon in it. Not sure what it does but it makes me feel great.

    Immediately got myself a pulse massager off the internet. Squeezed it down the back of the cast and let the vibrations move the blood around. As soon as i got the cast off i applied this to the calf muscle with a fairly hard rubbing motion 4-5 times a day (still doing it) and have had no muscle loss as a result.

    Whilst in the cast and crutches, i did plenty excercise ranging from wiggling my toes a lot and moving my foot around as much as the cast would let me. I also got out and about every single day for a hop along on the crutches, sometimes doing 3-4 miles (but my arms ended up pretty done in). Kept the body working though.

    Got this other thing called a circulation booster which i put my feet on and it sends ultra-sound pulses up my leg. Used this when i got the cast off regularly, still do, as it seemed to strengthen the tendon and reduce swelling. Not sure if it’s medically proven but my physio wanted to know all about it today when she saw my leg today.

    I was swimming in the ocean last week on holiday every day without any problem (infact it increased the strength and movement). And im back driving my car this week.

    Having the cast on is easily the hardest part of all, especially post op. The feeling when you stand up (especially in the middle of the night to go and pee) is a nightmare. And all the hassle doing the simple things around the house can be a strain. I placed things around the house strategically so i could get access and stuff. Ate all my food in the kitchen (took a bit longer to make stuff but i’d get there in the end). BUT….i reckon, from what i’ve read on the subject, and from what i’ve experienced, it is not unreasonable to push for one of those airboots after 4 weeks (i argued for it and got it, although i only used it for a few days). Once you get that boot, you can hobble without crutches and things can move on pretty quickly depending on the things you’ve done throughout the post op period (diet, keep blood moving, stay happy, excercise).

    My foot is dragging a bit to the side at the moment if i dont think about walking slowly and rolling it as you would normally. That was the only issue the physio had with me today, apart from that…..keep going!! I’ll have to as im off sea kayaking in 2 weeks (ill not be telling the surgeon). Talking of which, i go back to see him on Monday to erm get the boot off or maybe take one of the supports out!! I’ll have to tell him some porkies so i don’t offend him but i have no intention of going back after Monday. I’ll stick to my own little plan and the physio.

    I hope you can cheer up and start to look ahead to better times.

    Best of luck!!

    Steven

  65. Kristin,
    For me the swelling and throbbing stopped by around 2 weeks. I tried to keep my feet elevated as much as possible. Im at almost four weeks and can keep my feet down without any issues.
    As for being sad the answer is yes! I think you will see on this sight that this is an emotion that a lot of us go through. If you read my blog you will see that my doctor changed his rehab plan after some discussion. I would first do everything in your power to educate yourself on this injury. This sight has some very useful research articles and rehab plans. 12 weeks in a cast seem long to me. Some physicians do allow weight bearing in the cast so be sure to ask him about this. In short be prepared on your next visit to discuss your options.

  66. Nice your life i hope…total life is sort game.
    Get nice proposal, won your life game…Fully online natural health school About 30% of the population in the world today are using different types of physical therapy or alternative, and alternative employment opportunities health care is now known as the possible forms of treatment of diseases, because people keep searching for alternative medicine or natural health care to live a healthy life and happy.

  67. Well that is another way of looking at things. It is great to have ones ideas shaken up now and again in order to re-examine your individual bias and habits in thinking. I may not go along with everything, but I appreciate your own insight.

  68. hi guys

    im at week 5 since i ruptured my achilles and i took my cast off by myself,there was no pain or anxiety when i did this,my current docter from a saudi arabia has only given me a brief explanation as to my situation ,and felt that was enough as to my multiple questions which did not get answered,i did alot of internet surfing and found this sight which i thank the lord for,my physical therapy so far is being done at home and the level of intensity is very very low and can only wait another 2 weeks till i leave for south africa to get a physiotherapist to give me he/shes diagnosis.

    i would like feed back from anybody about my situation,i would really appreciate it.my email is paul_cotton1983@yahoo.com

    please guys exercises,information,advise

    thanx again

  69. Hi all, just found this blog.

    I had my Achilles tendon lengthened when I was around 7 years old, 23 now. That calf has always been a good bit smaller, even though I have the strength basically even. I also play racquetball competitively and can run fairly fast, cut on it, and everything. I’m just so tired of being asked about my leg all the time. Is there a way to rebuild the size, or is atrophy from these surgeries pretty much final? You would think it could be rebuilt, I just don’t have the resources to pay a personal trainer.

    Thank you all,

    CM

  70. By the way, please email me at number_1_steeler_fan@hotmail.com if you have advice. I’m at the end of the rope on my leg!

    CM

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  73. Tore Achilles 18m ago, being wholly overwhelmed with parenting, running a business etc I didn’t pay enough attention to the little physio advice I got. Now I have a substantially reduced calf on side that was ruptured and chronic tendinitis on the other. I walk a fair bit and now have an exercise regime but the loss of muscle and continual inability to be fully active because of tendinitis in the leg that was ok is driving me nuts.

    I’d be hugely grateful for any advice.

    Thanks

  74. Nick, tough times. Have you had a scan on the ‘uninjured’ leg. Find out if you have ‘tendinitis’ i.e. inflammation which responds to rest and ice, rather than ‘tendinopathy’ which is not inflammatory. The collagen structure has changed, the cells are immature and won’t heal properly and the tendon is prone to injury. Don’t be hard on yourself for not paying attention, many of us are too busy to think about it until we have to. Eccentric heel raises may help but….. you need to get to the bottom of whats going on first. Talk to your doc (or podiatrist to also sort out orthotics if you have an underlying biomechanical problem) Im just talking from personal experience. Hope this helps.

  75. Hi guys Im new this blog. I am 7 weeks post operation since rupturing my right achilles. The injury happen on July 15 in the morning on the basketball court. Doctor said I should be in a walking boot on Oct 4th. What should I expect from there concerning exercises and physical therapy? This a great blog with some helpful information keep it up.

  76. Charles - Your doctor should write you something like a prescription for you to take to a physio. It is hard to know what he will prescribe but initially you will be starting to get some movement back into the foot. It has been locked up for 7 weeks and you will have probably be writing the ABC with your foot. Your tendon is together now but it is not strong so there should not be anything explosive or too strenuous. You will probably start getting some massage of the tendon and muscle and that is something you will have to do yourself for a long time. Being in the boot you will probably be doing some exercises to help you walk and stengthen other muscles that have not been used in a while like your glutes. Physio’s all have slightly different approaches so you will have to wait and see for the most part. Hope it helps. Sorry you didn’t get an answer earlier.

  77. Thanks alot for the answer. Yeah I will be going to the doctor next week so hopefully the boot will be the decision. Had another question for you guys. My toes tend to swell a little in every cast. The swelling then goes down with RICE needed or just in the morning. Anybody else still have those symptoms 7 weeks post operation. I still have pain (about 3 on pain scale) couple of days a week. Im 28 and in great shape because of military life. I just hope this injury is not career threatening.

  78. Hi All, Had (high) Achilles rupture 9 weeks ago. No surgery. 3 weeks on crutches, boot and cane weeks 4-6, boot only weeks 6-9. To date mostly walking in boot, ROM and light stretching exercises. Won’t see Dr. again until week 12. After reading the blog it feels like they are bringing me along really slowly for a non-surgical rupture. Dr. did not give me any specific exercises, just said walk or ride bike in the boot, swim without boot. Is the tendon healed by now? Re-gain strength and flexibility the goal? Suggestions anyone?

  79. Hey, thanks for very useful info regarding physical therapy.

  80. Hello guys once again great info. Stuart thanks for you great answers as well. I made some progression since last doctor visit. I have been a camwalker for two weeks now. I can now take a standup shower and walk up stairs. In addition, I finally went back to driving thank the lord. Probably will start physio on Tuesday , surprisingly I have a decent amount of flexibility right now. Im trying to take this really slow to keep up the good progress.

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  82. Hi, I fully ruptured my achilles tendon seven and a half weeks ago. Decided to go down the conservative non surgery route. My leg was initially put in a back slab half cast for ten days and was then put in a full cast just below the knew for the next four weeks. During that time I had two cast changes with a change in foot position at each cast change. I kept my leg elevated at all times and did not put any weight on my affected leg. After five and a half weeks my cast was removed as the Thompsons test was carried out by the ortho surgeon and my tendon was working. My leg was put in an air cast boot. I was informed that I could now put my weight on the leg when it was in the boot and use crutches. I had physiotherapy the next day which felt strange as my foot and leg were used to being supported by the cast. I was informed by the physiotherapist that it only takes three weeks in a cast for the strenght in your leg to go and it takes six weeks to build it back up again with physio and light exercise. During this first physio visit I was shown several non weight bearing exercises to start me off on the road to recovery. These included using a thera-band to stretch and build up the calf muscle, tendon and increase joint mobility. I was also shown how to use a towel stretch for my calf muscle. I was advised to take the air cast boot off for an hour that day when I was in my house, wear my sneakers with a heel insert and use my crutches when moving long distances to take some of the weight off of my leg. And to remember that exercise technique is more important than quantity. Over the next week I gradually built up the time out of the boot so that when I returned for physio again (week six and a half) I was not using the boot and was wearing my sneakers with heel insert and using the crutches for support. At this physio session my progress was monitored and a noticeable improvement was observed. I was now told to use one crutch (in the arm opposite the affected leg) as I still have a slight limp and to concentrate on rolling my foot when walking to improve my gait and take the pressure off of my hip and knee. Doing the physio exercises had definitely paid off. My sideways foot strength (turning foot inwards and outwards) was the same strength as my unaffected foot. My foot strength (pushing down and pushing up) had improved. I was given an additonal exercise-the heel lift. I had my third physio visit at week seven and a half and I have progressed further. The physiotherapist did some deep tissue massage on my calf muscle and my tendon (to break down scar tissue) which was painful at the time but my tendon area felt much better after the massage and I was able to stretch it more. I have now been given additional exercises where I have to stand on my affected leg barefoot with my other leg raised and try to stay upright without touching the counter for as long as I can. I can build this up gradually. I have also been given weight bearing stretch exercises to stretch the tendon gradually. I now only use the crutch when I am outdoors and I have been warned not to walk on uneven ground. I can now use my stationery bike at a low resistance setting and build up gradually. I have my next physio session in ten days time and it will be nine weeks since the rupture occured. At the beginning when the rupture occured I was told that it would take 6 to 8 weeks before I would be out of a cast. It is a great boost to be feeling better physically and to be more active. I know that it will be another 4 to 6 months before I will be totally out of the woods and that the risk of a rerupture will be less likely. This is constantly at the back of my mind but the physiotherapists have been great and have given me the confidence to know that it is good to push yourself but to know your limits and a slow and gradual approach is best for this type of injury. From my own experience I feel that several things I did assisted my recovery (1) keep the leg elevated when in the cast/boot by placing on several cushions/pillow (2) take a tonic for convalesence (3) I also took several homeopathic remedies which are specific for tendon injury recovery and prevent scar tissue build up (4) do the physio exercises correctly. I hope that telling my story helps others who maybe at the start of their recovery journey and for those of you who have not had surgery as a lot of the information out there relates to post surgery recovery.

  83. My achilles burned an froze up preventing me from walking. I applied RICE and and am able to walk with no pain. I am curious to see if it is tendonitis. Thanks for bringing all of the information regarding the achilles to one site!

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  85. Hi sharon, it was a nice summary and motivation as well.
    I too opted for non-surgery but after the cast for 6 weeks,my doctor did not advise me to wear special boots.i guess it’s not the norm here in malaysia.
    But after 2 more weeks of nwb after the cast, i’ve tried to walk on it with crutches and barefoot. Don’t know if it’s ok though.

  86. Thanks for helping out, fantastic info .

  87. Really superb visual appeal on this website , I’d rate it 10 10.

  88. [...] [...]

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  90. Had my cast removed on Thursday been in it for six weeks. Air boot for the next four to six weeks. I can walk in a fashion without the air boot on. I. Am working the tendon in the pool everyday and my leg is now at 90 degrees from my foot. All recovery needs to be supervised my benefit is a premiership league physio as a pal. I will update on the blog with his procedures happy healing

  91. Hello its been 2 weeks.
    Since my surgery. Got my.cast off and wearing a cam boot no weight just.crutches. i can take boot.off to do some.excercises . excercise with my.foot. glad i found this board. I wont see the ortho till.another 6 weeks and then will start walking. Glad i found thia board and will.keep.update on my recovery.r

  92. Hi Everyone,
    I’m a long time reader, but first time poster. This site has been so inspirational in helping with my recovery. I just want to say THANKS! to all who have shared their lives.
    I’m a senior (58 years young). I’ve been playing high level tennis for most of my life (NTRP 5.5). In May 2012 I took a “wrong” step on a slippery hardcourt and ruptured my right achilles. The injury was pretty severe. The surgeon said there was a 2 inch gap between the ends…
    I’m 15 weeks from surgery and trying to stay as positive as possible. I opted for early weightbearing, but my doctor insisted on no “active stretching.

  93. Hi Everyone,
    I’m a long time reader, but first time poster. This site has been so inspirational in helping with my recovery. I just want to say THANKS! to all who have shared their lives.
    I’m a senior (58 years young). I’ve been playing high level tennis for most of my life (NTRP 5.5). In May 2012 I took a “wrong” step on a slippery hardcourt and ruptured my right achilles. The injury was pretty severe. The surgeon said there was a 2 inch gap between the ends…
    I’m 15 weeks from surgery and trying to stay as positive as possible. I opted for early weightbearing, but my doctor insisted on no “active” stretching. He is very experienced (300 procedures) and cautioned me about healing “long”.
    I’ve spent the summer on the bike (wonderful), stairmaster (my weapon of choice) and the track (joyful but frustrating).
    I’ve tried to “listen” to my body and stay as positive as possible through the ups and downs. This site has helped inspire me and instilled patience and perspective. It’s been a beacon of light in a sometimes dark tunnel.
    I wanted to share a couple of things that helped me significantly: When i was in the boot, there is a device called Evenup that levels out your leg length and allows for more comfortable EWB.
    http://www.amazon.com/Procare-Evenup-Shoe-Balancer-Medium/dp/B006IUU2TK/ref=sr_1_1?ie=UTF8&qid=1346336664&sr=8-1&keywords=evenup
    Also, a cream called Penetrex that I found helpful to dull the ache and allow for more a “normal” gait pattern.
    http://www.amazon.com/Penetrex%C2%AE-Anti-Inflammatory-Discomfort-Associated-Fibromyalgia/dp/B0026HDURA/ref=sr_1_cc_1?s=aps&ie=UTF8&qid=1346336824&sr=1-1-catcorr&keywords=Penetrex
    I’m grateful for the simple pleasure of walking, jogging and riding bikes with family.
    The last few weeks, I’ve been dealing with tendinitis in my “good” AT. I’ve tried to continue exercise routines for my entire body, but it’s difficult to “balance” things completely and my “good” AT inevitably takes more load…
    When the injury happened, I was resuming training for senior tournament tennis. I was a semi finalist at the US National Championships in Mens 55’s, and I was planning on resuming the chase for the “Gold Ball” (US National Champion). It was my last “goal” in the sport.
    I hope to play tennis again, but that still seems “light years” away. My surgeon, who has worked on a number of athletes, says that most can resume their sport, but that very few ever get back to that last “elite” level. I was inspired by Misty May Treanor at the Olympics. It took her 18 months, but she came back and won gold.
    In any case, I’ve been trying to learn the “life lessons” that this injury offers.
    I’ve been so inspired by others on this site.
    I would like to help anyone that I can, so feel free to ask questions (or offer any advice to a “geezer jock” ).
    Thanks again!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  94. I don’t know how to delete the double post.
    If anyone can help, please advise.
    Thanks,

  95. Hi everyone,

    I’m 14 weeks post surgery and having a lot of concerns about recovery. My doctor indicated that I should be weaning myself off crutches at my last appointment (4 weeks ago), but I’ve been unable to do this because my knee gets really, really sore from trying to walk in the boot. I think my boot is junk. I’m hoping the knee problems go away when the boot goes away.

    I’m not sure when he’s planning on letting me out of the boot. He will not discuss anything except what he wants me to do between each appointment. He’s never mentioned physical therapy, but I’ve heard a lot about how important it is in achilles recovery from others.

    I live in a state that does not require physician referral for PT. And, my insurance doesn’t require it, either. Should I seek out PT on my own, even if the doctor doesn’t suggest it or tells me that I don’t need it?

  96. Hi Dwaine

    That’s a long time to be in a boot, and way over time for crutches - for many people, but not all. Have you had a complicated ATR or other difficulties with the leg?

    What make of boot do you have and do you believe it to be the correct size? My first one was too big and the supplier exchanged it for the next size down. The bigger one rubbed against my knee, front and back whereas the smaller one was perfect - a huge difference. I began to wean off crutches at about 3-4 weeks and had stopped using them by about week 5.

    However, as we know, there are many variations to this injury, and every post that you read will be different to the next in some way. ‘No PT’ at 14 weeks is a concern though. I wonder why your physician hasn’t started you on some exercise by now.

  97. Dwanie-
    It’s a shame that we all get so little guidance on how to proceed with these things. My guess is that you need to adjust your walking style in the boot. Are you hyper-extending your (injured) knee as you walk- pressing your knee back to push yourself forward? It’s a common mistake to make, and can easily cause knee pain.
    To walk in the boot, as you are stepping with your hurt leg, you’ve got to drive your shin into the front of the boot, and get it to roll up onto the toe of the boot. It takes practice, but the trick is to do this with a relaxed ankle- allowing the structure of the boot to take the load. Once you figure this out, I suspect you’ll be able to make faster progress, and walk without knee pain. I put miles and miles on my boot- just about wore the sole out on it.

    Without a whole lot of details to go on, that’s just a guess though- A PT might be able to take a look at how you’re walking in the boot, and see if they can better identify the source/cause of your knee pain.

  98. I agree with you, Ryan about the potential for hyper extending. What I don’t understand, as a former boot wearer, is what you mean by “driving the shin into the front” of the boot. How does that work? Not being difficult, just trying to understand.

  99. Hi Hillie,

    Thanks so much for replying!

    I’m not aware of anything special about my ATR and I’ve not had any other problems with my legs. The injury (a high tear) occurred during a softball game in May.

    I’m not supposed to be using the crutches. But, the knee gets so bad that I’m not able to sleep at night if I don’t. I’ve tried to call the doctor, but no call back.

    It seems like most people have some sort of hinged boot. Mine is not adjustable in any way. I walk in it in a sort of peg-legged fashion as the toes point up to such a degree that the heel is about the only thing that hits the ground. It doesn’t feel natural. In fact, if feels quite unstable. I think that’s why it tweaks my knee.

    I’m concerned about the advice I’m getting from my surgeon. I’m beginning to think that I may have to have to make some decisions on my own and seek counsel from a different professional if I want to recover from this. I’ve never questioned a doctor before. This is really hard.

  100. Instead of pushing your knee back… you initiate the step by push it (your knee) firmly forward. You’ll feel pressure, up the front of your shin, as your lower leg drives forward into the boot structure. As you do this, it naturally causes the boot to rotate - the heel will lift off the ground, and the boot will start to roll onto it’s “toe”. Then, from that position, with a bent knee, you step forward… pushing “down” to drive yourself forward. You’ve got to have the boot rotated forward enough so that the “press” (through the heel, wiht a relaxed ankle, you don’t want to try and press though your toes, via the hurt achilles) doesn’t start to rotate the boot back to flat. Rather, that press should drive you forwards, and as you extend, roll the boot even a little bit farther onto it’s toe as you complete the step.

    Heck, maybe it would just be easier to shoot another video like the “stairs & crutches” one on my last blog post ;-)

  101. Dwaine-
    FWIW, I never had a hinged boot. Mine was a very basic, fixed model.
    My recommendation is to *always* question your doctor(s) :-) Don’t feel bad about doing so- they’re just (very busy) people.

  102. Interesting analysis Ryan, looking forward to the video.

  103. Dwaine

    Walking that walk http://tiny.cc/kmmfkw.

    Looks like this boot is fixed too.

  104. Thanks Ryan!

    I do walk the way you describe when I’m on my crutches (haven’t tried to walk without the crutches for over 2 weeks). But, even the crutches haven’t completely eliminated the knee pain. I really hope that I’ve not incurred some sort of damage on the inside of my knee that isn’t going to resolve itself.

  105. The only problem with the “walk” in Hillie’s linked video is that the woman’s uninjured foot isn’t high enough off the ground. Every time she steps from her booted foot to her other one, she’s stepping down, and vice versa. That teaches bad walking habits, and also messes up the alignment of hips, knees, etc. Vacoped sells a gizmo that raises a shoe up to boot height, and there are other ways to kludge it, too.

    Dwayne and Ryanb: I’ve used boots that were hinged, hinged boots that were set “fixed”, and fixed boots that were unable to hinge. In the earlier stages of rehab (until you’ve got enough calf strength to start “pushing off” at the end of a stride), there’s little or no difference, because the boot will stay dorsiflexed (= in the fixed-boot position) under your body’s weight until you’re strong enough to plantar-flex it.

    But what Ryan says about not hyper-extending the knee is super-important and right on. The boot has to be snug enough and stiff enough and trusted enough to support your body weight on the ball of your injured foot, transmitted to your shin through the front of the boot shank. That’s how you roll from heel to “toe” without putting strain on your calf and healing AT.

    With your foot-heights adjusted to be equal, your gait should be remarkably fast and natural — in fact, far more fast and natural than you’ll be able to manage in two shoes, until you build up some more calf-and-AT strength.

  106. Dwaine - since you don’t need a physician referral for PT start asking your friends & family if they know anyone who has had PT and what they think. If you know any nurses - ask them. Look up local PT places nd look them up on the Internet. Call them and tell them that you’re at 14 weeks post op and ask if they have anyone that specializes in feet, ankles & knees.

    At 14 weeks you should be more than ready to lose the crutches & boot. Do you have another appointment with your doctor? If not - get one and ask him if you can get rid of both.

    This YOUR recovery! It’s up to you to take charge of your own body.

  107. Dwaine,
    Have you discussed your knee pain with your doctor? There is a chance that you may have some physical problem with the knee that is separate from your use of the boot. I had an inexpensive boot too. I also have some torn cartridge in my knee from an injury I incurred more than 40 years ago. Fortunately this injury was never bad enough for surgery. Still I was concerned that the use of the boot would make my knee worse but it never happened.

    There are some tricks to walking in the boot that are difficult to explain in words. I did find several videos on YouTube that helped me figure out the proper boot walking technique. If your knee problem is because of improper walking technique in the boot doing a search for “walking CAM boot” or “walking orthopedic boot” on Youtube should bring up several of these videos.

    If I can still remember how to walk in my boot, maybe I’ll challenge Ryanb to a “battle of the CAM boot walking” videos. LOL

  108. Here you go:
    http://www.youtube.com/watch?v=XZ4apPM2Wl4

  109. Thanks everyone for your words of advice and encouragement. Nice video, Ryan! I’m not able to do it the way you do, but for now I have figured out that the knee is more tolerable if I simply walk on the ball of my foot and try to keep from striking the heel at all.

    My next appointment is on Friday. I’ve tried to contact the Dr. between appointments, but he’s never available and never calls me back. Not sure where he’s going to want me to go from here. We’ll see. At least I have more information and some ideas about a plan of my own if it doesn’t go well. This is MY recovery.

  110. Hi I am 57 years of age and had my complete rupture 8 weeks ago. Orthopaedic surgeon operated 10 days later. 2 weeks later initial bandaging removed Stitches removed and placed in cast 4 weeks. Then into Cam Walker with crutches of which Im now 2 weeks in and now partially weight bearing and exercising with passive dorsiflexion and plantarflexion. Going well 3 times a day then back into boot. Also hydrotherapy included in my rehab 3 times per week. all is well except when I dorsiflex there is a burning stinging sensation which is contant. my ROM has much improved almost as much as my good foot…so what could this be ? Part of the repair process or is there a problem anyone had similar ?

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  112. So, the Dr. wants me to stay in the boot for another 4 weeks. That will get me to 18 weeks post surgery. He did concede that I could begin to transition into a shoe, but only when I’m inside my house. He seems to be overly concerned that I’ll re-injure myself. In reality, I can’t walk for beans anyway, so I’m not sure it really matters right now.

    Still no discussion or mention of PT. My brother-in-law is a retired MD. He’s advising me to strike out on my own or I may never be able to build back some of the muscle I’ve lost. So, I’ve set up an appointment with a completely different ortho group and have my first rehab session tomorrow.

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  114. Has anyone thought to use a blood stimulation wrap? Like what they offer at physio ? You can get them over the Internet. http://www.kingbrand.com/Ankle_Injury_Treatment.php?REF=Boris1011

    How affective are they? I’ve heard good things? Anyone else?

  115. [...] Achilles Tendon Injury Recovery Blog » Physical Therapy [...]

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  129. [...] Achilles Tendon Injury Recovery Blog » Physical Therapy [...]

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  131. Hi all….I’m 9.5 weeks post op. Ditched the boot inside my home and office last week. However, I’m avoiding venturing out in the snow and ice for the next few weeks. Anyways, would like to hear from you “foam rollers” how soon after op or non-op you starting using it. Want to make sure I do more good than harm. Thanks.

  132. I’ve spent the last 16 weeks in a Fibreglass cast & Aircast boot…Yesterday i went back to the hospital and got put into 2 shoes.
    I asked about physio and the doctor told me i didnt need it.
    Has anyone else not had to do physio?
    This worries me…my ROM isn’t good at all & my muscle atrophy is ridiculous!

  133. kimbarweee, you’re far from the first, but most of us got PT and felt that it helped us. And all the new studies with great results used PT, though the details vary, and there’s no PT-vs-no-PT study to prove the benefits. If nothing else, it can provide a kind of second opinion.

  134. Hey guys. Im 4 weeks post op. Was put in a boot 2 weeks post op. Still nwb for another two weeks. All of this seems pretty standard. But how much should I be moving around my foot right now? Doc said 15 minutes morning 15 night up and down side to side movement. Any other tips?
    Also, doctor says he wants me to meet at 6 weeks, hopefully begin weight bearing, but doesn’t want to start PT till week 12. Should I request with him that I want to start pt around week 6 or 8

  135. Additionally, I hurt myself playing ball. I was very explosive. I don’t want to go back to being able to do 5ks or jog. I want to be able to dunk again and sprint and be explosive. Any additional tips

  136. @wearingthe45 - getting the explosion off that foot back is the hardest part and may take some time I understand. And, i’m sure you hurt your dominant foot, right? Well, Kobe came back to play in the NBA after 6 months of recovery, so its definitely feasible with work once the tendon is ready for PT.

  137. @smick thank you. Im scared shitless of tearing the other one. My whole ankle foot Achilles of the good leg has been sore since it’s the only one im using and it was my weak one. Some minor soreness is normal right?
    Also I’m very young 21, which seems young anyoneelse young?
    1. Anyone dunk or get back to sprinting times after recovery?
    2. anyone from Chicago and recomend a good PT who will be able to have that sports focus and not treat me like someone who just wants to jog again?

  138. @wearingthe45 - at your age i’m sure you’ll recover to 100% once you can get into intensive PT. Just don’t start really pushing strength/etc. until after 12 weeks when the high risk rerupture window is closed. And my good leg took a beating when I was NWB.. hopping around and doing everything on it killed my knee, calf, quads, etc.

  139. @wearingthe45 - As far as foot motion, sounds about right. If you check my blog, a couple posts down, I pasted an image, and associated link that shows the simple and limited exercises you could do for weeks 4 to 8.

    On the sore non dominant leg/Achilles topic - I too had swollen other side and was a bit worried I was going to tear or rupture that side before the ruptured side healed. I babied it the first 6 weeks post injury. Got plenty of good nutrition. Laid off the partying, and so far it appears fine. But I still step very carefully these days. I am 7 weeks post injury, and just over 4 weeks post op.

  140. Wt45, most of us return to the sports we love, including the one that ruptured our AT. And many of us returned to our former intensity and speed, either subjectively or objectively. I was afraid of losing vertical at the net in court volleyball, but I was spiking down at the same angle as pre-ATR after EACH of my TWO ATRs (both from volleyball). I’m a geezer compared to you, though I play comp league ball with guys way younger, mostly 20-40-ish.
    I was back on the court full bore about 10-11 months post-op after ATR #1, and I would have returned about the same time post-non-op 8 years later after ATR #2, except for a “minor detour” for some heart surgery (!). Just a year after THAT, I was back at volleyball, though more beach than court - but I played in a great 2-on-2 match with 3 30-year-olds on my first day back(!).
    Some people do lose some strength or speed, others not. Some who weren’t in top shape do better afterwards, because the rehab gets them into a better fitness regime. I think the majority lose calf SIZE, often permanently. (I’m more symmetrical, now that I’ve done BOTH ATs! :-) )

  141. 2 more questions I swear haha
    1. How long does that medical tape take to fall off. My doc said 2 weeks but it hasn’t yet and it’s been 3. They’re like half off can I just remove them, since they’re loose.

    2. Im 5 weeks post op. In 10 days I have an appointment and my doc plans on starting the weight bearing process. Although he tells me exercises at home, he doesn’t want to start PT till 12 weeks even though weight bearing at 7. Should I ask starting soon?

  142. 1 - I don’t know, ask your Doc’s office. (Some people consult with their GPs (PCPs) as well as their OS during ATR rehab.)
    2 - I’d say Yes.

  143. QUESTION THAT HAS BEEN ON MY MIND FOR WEEKS

    does sitting down count as weight bearing?
    surely everyone wasnt elevated for 4-8 weeks until weight bearing process began.

    Is it okay if a couple hours (2-3) are spent every day in a non elevated position, sitting down with feet on ground. and if so has anyone done like the pillow under the leg to decrease pressure?

  144. Hey guys. So I started weight bearing in a boot today at 45 days post op. Doctor told me to use 1 crutch for a few days to get used to it. Is the heel tingling normal? Does it go away. Not really painful just a weird feeling. Also I’m very awkward with walking its like I’m intimidated. Can someone give me some insight.

  145. Hi everyone this is my first post. I fully tore my left Achilles’ tendon playing pick up basketball. I did some research at the hospital & knew right away I would need surgery. I tore my achilles August 6th & the surgery was completed August 15th (2 days ago). The surgery went well but the pain has been non stop for me. My first day/ night home I got only a few hours of sleep & I was forced to go see my doctor the next morning & switch cast because the other one was so uncomfortable for me. (I believe I have the fiberglass one now). Last night I only slept for an hour or two because it feels like my foot is being suffocated. I can feel the back of my heel just pressing against the cast & it is very uncomfortable. It’s been numb since yesterday & it worries me. I spoke with the doctor this morning & he says if nothing changes give him a call. Did anyone else have this discomfort in their heel a day or two after the surgery?!!

  146. @ Zachary24,

    Are you elevating it high enough? At times, the blood would rush to my foot and I could feel my leg swelling and feeling the cast up-but when I’d elevate it, it would go back down.

  147. @ lance I went & seen the doctor again today.. He loosened up my cast by cutting it & it now feels much better. I keep it elevated at all times unless I am using the bathroom. Thanks for the help, I am finally relaxed & in recovery mode!

  148. I’m 5 weeks in, and I’m PWB bearing with walking boot (1 wedge). I have a little pain in the bottom of my foot when I flex my ankle up (towards shin). It feels tight, have any of you experienced this?

  149. I’m at 7 weeks after surgery. My Cast Came off last week. I can walk slowly with a little limp in my leg. Is it ok for me to go swimming to strengthen my calf muscles?

  150. Hi everyone, I am 12 weeks post op and have started my physio. I am walking with a small limp, and the question I have is if anyone else has had swelling and pain around the surgical area when they have started walking. My physio has instructed me that I need to force the walk to get as normal as possible which I have been doing and it has been getting better. However, when I wear shoes, the top of the shoe tends to push against the wound and it makes it harder to walk properly. My physio has also said that it can take a full year for swelling to go down. I would be grateful if anyone can shed some light. My surgeon has been very pleased with the surgery and the tendon is attached and feels strong. However I am just wondering if others experienced the same. The area where it was reattached still feels a little tender but I guess that is normal?

  151. trimichael1, I went to 2-shoes at the 12-week mark and noticed an increase in swelling for a few weeks afterwards. I think this is normal. Your activity level is likely picking-up and your foot and leg are now calling dormant muscles back into action. After increasing for maybe 2 weeks, my swelling then started going down and was nearly gone by week 16. I know it might seem like a step backwards, but it’s just part of the healing process. -David

  152. trimichael1, you have to protect that healing wound - the skin and the deeper tissue both - from abuse. And unfortunately, many shoes are abusive. Physical protection is the key. Different shoes, padding, bandages, double socks, whatever. If it protects the wound, it’s good, if it doesn’t it isn’t. (I wore Crocs a lot post-ATR, for several reasons.)

    Eventually the scar should be OK with normal abuse, but that can take a while, and some scars - especially those that were abused early - take forever.

  153. Thank you both David and Norm- really grateful and will see how I get on. The movement is getting better and swelling is always minimal during the day but tends to get more so at the end of the day. Will walk with open shoes for a few more weeks as I’m in week 14

    Thanks again

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