smick’s AchillesBlog

I forgot to check back in here in February on my actual 1 year anniversary, but wanted to leave a brief note about my recovery. Hopefully this is will be some positive inspiration for those of you currently suffering through an achilles rupture!

I’d say I’m fully recovered at this point and probably in the best shape I’ve been in years at this point. Rehab exercise transitioned into a renewed focus on staying in shape to prevent another injury like this and I’ve managed to make exercise and stretching part of my weekly routine. I consider that probably the only “benefit” of the injury, that it was a wake up call about needing to keep my body in better condition.

I’ve gotten into road biking as part of my rehab and am now addicted. I have another metric century coming up this weekend in fact. I have also resumed my other favorite activities, including hiking, surfing, skiing and snowboarding this past winter. Snowboarding was how I injured my achilles originally so I was still sightly nervous about wearing soft boots versus the hard boots of skiing, but when I finally tried it at the end of the ski season it was a non-issue. The only activity I don’t do much of anymore is running, but that is mainly because I’ve found cycling to be so much easier on the rest of my body that I’ve lost interest in running.

Functionally, my injured calf is still significantly weaker than my good one… I’d estimate around 80% in terms of strength. Endurance is good and once I got to being able to do around 8-10 one legged calf raises I gave up on pushing strength as the returns seemed pretty marginal and I can do everything I did before with seemingly no performance impact. I haven’t done calf raises in months and will probably check to see if I can still do the 3 sets of 8 that I had set as my six month goal last year.

Overall, life is back to normal and I’ve moved on to the point of not even noticing my achilles anymore or having any issues. The achilles I do think about is actually my good one, which has lingering pain of the tendonitis which was the precursor of my tear. I’ve half-heartedly tried to do some exercises like calf raises with weight to strengthen it, but it is a low concern right now.

Those of you in the early stages, there is a light at the end of the tunnel and you will be as good as new in what feels like no time!

Hey everyone,

It’s been a while and just thought I’d check in and post a report at the six month mark for anyone looking ahead and needing inspiration.

Life has continued to get better and better. I’ve bought a road bike as biking has proven to be the best rehab exercise for me, and I’m up to riding around 50 miles a week and training for a metric century in October as a goal. I find that even after a hard 20 mile ride with lots of climbing, my achilles still feels great. Swimming is also another great rehab exercise, but I find riding is much more fun than doing laps in a pool.

I did get cleared for a return to run program three weeks ago, but I’ve only attempted it once so far. It’s mind numbingly slow (1 minute of jogging, 5 minutes of walking, repeat 5x) and I could tell the pounding bothered my achilles even in that first day. For now, I’m sticking with riding and will likely try to do some more jogging in the Fall when it gets wet.

For other activities, my PT wants me to do 3 sets of 10-12 full single leg calf raises before I go back to playing any cutting sports (tennis), which I’m about 1/2 way to accomplishing. I can do around 8-10 3/4 height unassisted calf raises, but only about 2 sets of them. I’ve been slacking a bit on calf raises given how much I’ve been riding, but am going to refocus on them for the next month.

I’m still going to PT, although dropping to once a month. The focus is now on strength, agility and balance. Lots of jumping, single and double legged, ladder drills, squats and balance exercises on the bosu ball. Hard enough that I am sweating and exhausted by the end!

The only negative is that I still have some tingling numbness under the ball of my foot. Doctor said it was a side effect of the nerve block, and should go away by now. I’ve since read that it can take a year, and maybe never go away. It has gotten better, and doesn’t bother me really, but is annoying that it has lingered this long.

Other than that, life is feeling back to normal. I’m surfing, going on long walks, have done some 3-4 mile hikes, and mostly forget about my achilles. Keep up your PT and maintain a positive attitude, things do come along fine!

-Smick

It’s been around three weeks since I last wrote and only good news to report!

I’ve been on vacation and have been very active, walking, biking, hiking, swimming and otherwise using my leg. The biggest update is that I went surfing several times as well, probably the activity I most want to return to! All seemed well, though my leg is still weak and balance shaky.

In general, the achilles has faded as a day to day concern and I did everything I needed to do while on vacation with two active kids. I was more concerned with spraining my ankle on rocky hikes than hurting my tendon! Pain and swelling were minimal and everything seems well on its way to healing; I just need to keep building strength.

I went back to PT today and could do around 8 single leg calf raises, although most after the first one were at 1/2 height at best. That is still a big improvement from the 2-3 I could do 3 weeks ago before vacation. I abandoned all exercises while away, so all the strengthening has come from just being active.

The plan is to start easing back into jogging next week and continued strengthening of my calf over the next couple weeks to get to doing 3 sets of 10 single legged calf raises!

It’s week 18 for me and I met with my surgeon two days ago. He said that I don’t have to come back, unless I feel the need to, which is encouraging! Also said he thought I was ahead of schedule, which is to get to doing sets of single leg calf raises by 6 months. Until then, he still doesn’t want me jogging or trying to return to sports.

In terms of calf strength, which at this point is the main issue, I’m almost at the point of doing single leg calf raises. I’ve been able to do a couple, pathetic 1/3 to 1/2 height raises for the last couple weeks, but the full movement is still not possible even once. That first bit of strength comes back much faster.

The good news is that with even a very slight, fingertips on a counter level of pressure, I can do a single leg calf raise. So I’m very close. Most of my “double” leg calf raises are now done with my good foot resting lightly on its toes, so probably 90% or so of my body weight on the bad foot. It’s only the top part of the range that is difficult to finish and I’m focused on that part of the motion as the bottom third is pretty strong. I am concentrating on a slow, eccentric lowering on the descent as well.

Otherwise, the injury is really starting to fade into the background for the most part. I am still stiff in the morning, or if I am sitting for more than an hour, but it goes away. I don’t have much swelling or achiness anymore and what pain I get is more in the muscle, though the tendon and ankle can throb a bit at night if I have a busy day.

I’m trying to walk 1.5-2 miles 5 days a week, usually at lunch time. Also been doing some biking on the weekends, typically just 7-8 miles as I ease back into it. Other than that, I’ve got a half dozen or so exercises from my PT that I rotate through, but probably do them 2-3 times a week at max.

The only odd thing is that some days I’m feeling stronger than others and walking faster, but I can walk 2 miles at a fast past (15 minute miles) without losing strength most days. Once the calf is exhausted though, at the end of a day, I do get a little limp unless I purposely walk slower. I have noticed I’m no longer tagging along and walking slower than people and everyone seems to think I’m back to normal!

Hopefully my next post will be about getting clear for jogging and sports!

It’s crazy that tomorrow will be four months! Things have moved faster than I expected in some ways, but still it’s daunting that I’ve spent a third of this year dealing with my AT and recovery!

I can report a marked decrease in pain, soreness, stiffness this week from last week. Even in the morning its not so bad. I can also report an increase in endurance. I get a good push off in my walk longer.

Also, I just don’t think about my bad foot as much anymore. I used to worry about which foot to put down stepping on or off curbs or in uneven ground, now I just walk and do things without stressing.

The only thing that is still frustrating is that strength is not back yet and I’m not much further along in doing a single legged calf raise than last week. I’m definitely a little bit stronger, but I think the week to week gains in strength are decreasing as I get stronger. Maybe I gained 5-10 pounds of force in the last week, versus the 10-20 pounds it seemed like I gained every week from 6-14. I can easily support my full body weight now (~175lbs) and can go up stairs on the ball of my feet with the heel hanging off.

Anyway, I’m happy that everything seems fine and that my life has pretty much returned to normal with the exception of sports and running!

Not too much to share. Continuing to do my calf raises, walking and some stationary biking.

I’ve settled on Monday and Friday as my “rest” days where I try to not walk and skip my calf raises. Weekends are very active so Monday is a natural rest day where my achilles is feeling sore anyway. I still do core strengthening and balance exercises on those days.

I’m feeling continued strength building in my calf and can get a decent push off and heel lift walking on slight downhills. Still not doing unassisted one legged calf raises, but I did around six calf raises on the bad leg last night with just my fingertips on the bathroom counter. I’m guessing I’m around 20-30 pounds away based on the light tension I put on my hands. I can also push down/support my full body weight (170 lbs) on the scale and while walking up a step with everything except the ball of my foot hanging off! I feel like I’m getting very close!

I still get aches and pains from my foot and achilles, especially in the morning or when I have been sitting around for a while. The achilles achiness/stiffness goes away fairly quickly, but I also have weird intermittent pains at the front of my ankle and on the side, plus a little lingering ache around the insertional point of the achilles on my heel.

I’ve decided at this point that my Achilles achiness, which is not ever that severe, is just a warmup thing that is not going to go away magically. Not much inflammation or swelling, which is good, so I’m just trying to keep it to background level and not let it flare up to bothersome like it did on the weekends when I’ve overdone it.

Best wishes to everyone else in their recoveries!

Another short update. After a great week last week (felt strength increasing and little to no pain) this week has been a bit more disappointing. I feel like I take a step forward and a half-step back with this recovery!

I think I overdid it Memorial Day Weekend with three full and active days, including lots of calf raises and walking in the pool every day. Plus I was on my feet all day walking around, playing baseball with my son, playing ping pong, etc.

As a result, starting Tuesday my tendon and ankle have been a little sore and I’ve backed off a bit with less walking. I have kept up the calf raises, but in general I’ve felt not as strong as the prior week and like my tendon is “looser” with not as much push in my stride.

No pain while resting ever, but when I walk and take a stride that loads the achilles there is still a bit of an ache at the calcaneal bone or insertion point of the achilles, which I’ve had for six weeks now. My PT says my calcaneal bone isn’t moving and pronating like it should and has been able to fix it a bit with some mobilization that makes the ache go away for a while.

More alarming, my tendon has also been a little sore above my rupture where my PT says it starts to attach to my calf muscles. That could be from the overuse and may be the muscles complaining. The actual rupture area itself feels fine with no tenderness.

Anyway, I’ve toned it back all week and today (Friday) it feels much better so I’ll ease back into walking more and being more active again this weekend.

I’d still love to just push things through pain at this point, but I’m trying to stay patient.

Just a quick update. Slow and steady progress here. Haven’t worn the boot in a week so I’m fully off it. Confident enough to do anything without it at this point (obviously no sports still!).

I’ve continued walking almost everyday and doing my pt exercises (throwing in a rest day from calf raises every third day) and feel strength building. I’m getting a micro push off now with every step (heel lifting slightly before my other foot is down). Also was able to do one footed calf raises in waist deep water today!! Big improvement from mid chest last week. I’m guessing I’m at around 70-80% of body weight now in terms of calf strength.

Pain, tenderness and swelling all better but still flare up if I overdo things.

Anyway, looking back at two or three weeks ago, all big improvements!!

So today is officially twelve weeks post surgery! It’s very nice to move to months as my counting metric from now on and I’m sure my posting frequency will slow, The progress is going to be incremental and more steady work at this point, so hopefully not too much to share that is exciting!

I met with my PT today and my doctor last week so I feel like I have a pretty good sense of where I stand. Both said single leg raises are the goal to work towards. My doc thought 5 months would be an aggressive goal for them and my PT thought 6 months was more typical in her experience.

Here is my recap of the good and the bad/frustrating so far:

Good Stuff
- Solidly in two shoes at this point, including sleeping without my boot. It felt like giving up a security blanket! I will continue to use it when I do athletic activity I’m not permitted (playing catch with my son on a grass field for instance), but I anticipate it slowly starting to gather dust. I do wear it on the train for my commute home, but not in the mornings now when I am feeling strong.
- Strength is recovering, but I feel like my incremental gains are slowing. Four weeks ago I could press around 40 pounds on my scale. I got up to 100 pounds last week after three weeks, but in the past week I’ve only gained around 10 pounds of pressure. If that continues, its at least 8 more weeks to do a calf raise on that leg.
- Functionality is high - I feel like some semblance of my normal life has returned. My calf is shot by the end of the day and my tendon can get achy when I overdo it, requiring ice and taking it easy for a day, but I’m for the most part doing what I normally would do except for sports. Swimming and biking are the two things I can do right now.
- Scar has healed well and looks good.
- My walking for the first part of the day can look pretty good, although still no heel lift, but any limp is subtle at a slower pace

The Bad/Concerning:
- I still limp, unless I walk fairly slowly. I have to force myself to walk slower and in good form versus limp quickly, particularly on longer walks outdoors. I have to rewire my brain to stroll instead of walk!
- My calf endurance is weak and by 5pm I’m usually totally spent and the calf feels like a rubber band. My limp comes back and there is little push off.
- I still get aches and twinges on my tendon, particularly when I overdo it. I’m trying to be conscious of that but its frustrating that I have to slow my recovery pace down instead of being able to go full throttle.
- My dorsiflexion range is around the same as my good leg (actually 2 degrees higher at 12 degrees versus 10 degrees for my good leg). I’m listing this as a concern I am worried about healing long. My PT said I don’t need to actively stretch that leg and I probably need to stretch my other leg as my calf is likely tight.
- My core atrophied as I didn’t do enough PT work on it in the first 4 weeks. Starting to ramp that up now with more plank and core exercises, but it is really pitiful. My upper body is also likely a disaster as I did some infrequent push ups on my knees in the first 8 weeks only.

I will say for those earlier in the process that the frustrating plateau after two shoes is very aptly named. I know I’m getting better (slowly), but not seeing immediate results makes it hard to stay inspired! Thanks for all the help, support and guidance from this board so far and a special shout out to Norm for all he does!

Bonus shot of my ankle with the bump by my incision:

Just a random question that has been bugging me and I forgot to ask my PT last week.

I’ve never been much of a weight lifter, but I always thought the traditional method of building strength was 3 sets of 8-10 reps of a muscle followed by a day of rest.

Are calf muscles special or do you do it differently when starting with an atrophied muscle? It seems like every ATR rehab patient gets told to do 3 sets of 12-15 reps 3 times per day, everyday. I’ve been doing them and getting stronger, but am concerned about overworking the muscle… plus it gets used walking as well.

Just curious what the logic is…