Walking again

Hey everyone,

I have started physical therapy and walking again without the aircast.  Walking again with regular shoes takes some getting used to.  Since I have absolutely no strength in my calf, I can’t raise my heal off the ground while walking.  Consequently, every step I take puts a lot of pressure directly on the heal, leading it to get sore and painful.  Has anyone else had this problem?  Any possible solutions?

Savi

10 Responses to “Walking again”

  1. Congratulations on walking again, it is definitely a huge milestone. Heel pain is a pretty common problem when people start walking again after having an immobile ankle for weeks or months. Norm posted about rolling a golf ball around on the floor with your heel, while seated of course. One thing you can do to help is slow your stride and really focus on getting your “bad” heel off the ground before you good foot touches down in front. This take some effort, but it helped me immensely when my PT pointed out that I wasn’t doing that and made me focus on it.

  2. HI Savi,
    I am with you there! I am at the same stage as you and I find that the heel pain and stiffness is what stops me. Well done for putting o shoes - I only managed to find one pair of sandals which still could barely fit (I tend to have tight shoes it seems)…Happy walking!

  3. Getting that heel to come off the ground before the other foot takes some weight up front is simply not possible until the calf has quite a lot of strength. I suspect that is not something you can do at this point.

    You are at a very delicate stage now, where a single misstep can cause rerupture. For example, if you step on something that keeps the ball of your foot off the floor, your weight could push the unsupported heel down and stretch the tendon too hard.

    There is a balance to be struck at this stage between walking in shoes and safety. One possible compromise is to walk in your shoes when you can pay full attention to your tendon’s safety, but use your boot for protection when you are concentrating on other things. This is a time when a hinged boot can be useful, allowing you to move your ankle as you walk, but still protect you from too much dorsiflexion.

    Good luck,

    Doug

  4. Hi Savi, Congratulations on walking in 2 shoes. I just began walking in two shoes a week ago so I’m no expert but PT has me taking a short step with my bad leg and a long step with the good leg so that the bad foot rolls over the toe as I walk and gives me the feeling of what a normal stride feels like. He wants me to slowly lengthen the short, bad leg stride as comfortable over time to reach a normal gait.

    Don’t know if this will help with your heel pain but the shorter stride with the bad leg may put less pressure on your heel while still allowing your bad foot to move through a normal walking motion.

  5. Thanks for your encouragement Gerry, Andrea, Doug, and jla! The heal pain seems to be getting less each day b/c my calf is slowly getting stronger each day!

  6. Congrats, Savi. And +1 to Doug53’s comment above. When you’re first walking in shoes, you should be looking for ways NOT to “load up” your calf and AT. (Gerry was much farther along than you when his PT spotted the hitch in his gait.)

    Walking downstairs normally is an especially hard test for calf and AT, and you don’t want to take that hard test yet! So step down onto the nose of the step, half on, half off, and roll your foot over the edge. You probably used that technique in your boot, and it’s even more important to use it in 2 shoes. (You’ll also get downstairs twice as fast as the folks who always lead with the “bad” foot!)

    Jla, your PT’s advice also sounds like a hard test for a vulnerable AT, unless maybe you described it backwards. Most of us started walking with the BAD foot way forward, and the GOOD foot just coming up to it, or only passing it by a little, precisely to AVOID rolling over the bad foot’s toe — which shifts all your weight onto your healing AT!

    For heel pain, many of us adopted Crocs as our “2 shoes” and heaved a sigh of relief. Much cheaper than re-carpeting the whole house in 1cm-thick gel foam!!

    Also, if you don’t mind, please install the widget at http://achillesblog.com/dennis/2008/03/08/achilles-timeline-widget/ so we can all easily see how long it’s been, which leg, where you are, etc.

  7. I discussed this business about not being able to raise the injured heel before the non-injured side touches down without “quite a lot of calf strength” with my PT today. He got this confused look on his face and said, “That is one of the primary ways you build strength in the calf.” He said it doesn’t matter if you can’t do it well, the thing is to work on it all the time and it will get better. So, in order to regain strength in your calf, you have to do things which are difficult now but become easier the more you do them.

  8. Gerry,

    I don’t see what is confusing. Savi said he has “absolutely no strength” in his calf, so he cannot lift his heel while walking at all, unless I am misunderstanding what he is saying. When there is more calf strength, raising the heel before the other foot strikes the ground becomes possible. Perhaps your PT is saying to push down with the calf while walking, even if it cannot lift the heel.

    Doug

  9. I highly doubt he has “absolutely” no strength because that would mean basically no muscle at all. The point the PT was trying to make is that in order to build strength, you have to work at doing things which may be nearly impossible. I weigh 138-140 pounds and can now press my body weight, but a year ago I could barely press 90 pounds. I had to work at doing something nearly impossible until it finally became possible. The same thing applies to rehab.

  10. Gerry, I think I’m with Doug on this. When your PT found a hitch in your gait, you were almost a year past the surgery that reattached your torn tendon ends. You’ve had a bunch of setbacks and some extended immobilization from them, but you should be way past any reasonable fear of re-rupturing your AT by walking, no matter how you do it. Savi, on the other hand, is maybe 6-9 weeks post-op (Install that widget please, Savi!!), and extremely vulnerable to re-rupture if he overloads his AT.

    I don’t think anybody here is more into pushing his leg fast and no-pain-no-gain than Doug, based on his own very fast rehab, probably the fastest documented on this site. But for Savi to try doing something close to a 1-leg heel raise while he’s in single-digits weeks post-op would be asking way too much, IMHO.

    I was personally around 17 weeks post-op from my first ATR — and enjoying the first day when I could walk normally in bare feet — when my PT foolishly told me to do as many 1-leg heel raises as I could. I foolishly did what she asked, and did maybe 3 or 4. It was very strenuous, but didn’t hurt — until several hours later! Then it hurt worse than anything I’d done in 17 weeks, INCLUDING the initial ATR! And it continued to hurt for the next MONTH, and kept me from walking normally until that month was over.

    There’s a time to work hard to lift heels, build calves, and subject the healing AT to heavier and heavier loads. You’re definitely at that time, and you have been for a while. Savi is not, and should wait, and concentrate on NOT loading his calf-and-AT with “normal” loads just yet.

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