smick’s AchillesBlog

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…

I get a lot of value reading what other people are doing for PT / exercise at similar stages, so I thought I’d post what my current daily set of exercises is as I had a PT visit this morning.

One note, due to overdoing it last weekend with walking, I basically took off Monday-Wednesday this week with the exception of theraband eversion/inversion exercises on my ankles.

This week (week 11 post-op) marked a turning point in my therapy as we are shifting to strengthening based on my doctor’s feedback that my calf was ready. Since around week 7, I’ve been more focused on building up active ROM, relearning how to walk correctly, improving balance and strengthening my core and hips. Aside from walking, the only strengthening activity I’ve done in the last two weeks has been 1 set of calf raises most days.

I’m definitely excited and nervous about stepping things up and hopefully starting to move out of my current recovery plateau!

My current list of daily exercises:

- 15-20 minutes on the stationary bike, but now I can increase the resistance as tolerated to hopefully get a sweat. Prior to this it was always light resistance and more for range of motion of the tendon.

- Walking (although I’m monitoring this with my fitbit app and trying not to do a total of more than 2 to 2.5 miles of estimated distance outside my boot and using my boot for longer walks outside still, until I’m feeling no aching from the tendon)

- Core exercises - On my back with my knees up and feet held at 90 degrees, pushing up on my knees with my hands and holding for one minute. Then doing alternating touches of my feet to the ground.

- Two Legged Heel Raises - 3 times a day now with 3 sets each time, or a total of 9 sets a day! One set normal, one set toes pointing in and one set toes pointing out. Focusing on a slow eccentric drop of the bad heel. At 10 reps a set and trying to grow to 15 reps per set. Prob 40% weight on my bad leg right now.

- Hip hinges - Standing lunge position where I hinge my pelvis and lower my upperbody forward. 12 on each side, 2x per day.

- Unweighted squats as low as I can go - 10 reps holding at 10 seconds per rep (these leave my thighs burning and legs quivering!)

- Balancing on my bad leg for 1 minute - 3x per day

- PF/INV/EV exercises with the theraband - 2x per day, 15 reps per exercise

The squats, hip hinges and extra calf raises are all new this week and I can feel the burn in my leg muscles. Looking forward to seeing some results by the time I return to PE next Wednesday!

I had my 11 week check in with the doctor yesterday.

Of course, like a naughty child I had to admit my tendon was sore and aching from overuse and way too much activity. Despite that, he was very pleased with the state of the tendon, my strength, the healing of the scar and where I was at in terms of activity and range of motion. He predicted a 100% recovery based on my progress, so I guess it’s on me to not mess things up!

He did say tendon pain was not typical and of concern, although pain elsewhere in the foot and leg was common. I’d already eased off this week, but he said to use the boot if I wanted a break and to push my rehab incrementally not in large jumps. So, although my tendon felt great this morning with no pain at all, I’m going to be in recovery mode again today and try to stay in my boot most of the day with minimal rehab until at least tomorrow.

On the good news front, I asked for another ultrasound of my calf to see if my clot had dissolved. My Xarelto prescription only had around 10 days left and I was worried I needed a longer dose. I was able to get the ultrasound that day and was told the clot had completely been reabsorbed! That at least is a relief and means all the calf soreness I’ve felt in the last couple weeks is from exercising it, like I hoped.

I’ve had on and off pain with the tendon since going to weight bearing and a history of tendinitis with it, so I’m probably going to slow things down since I’m ahead of protocol and not look to set a record at the risk of rerupture!

On the pain question, I’d love feedback on whether people experienced these other non-tendon pains at this stage:

1. Continued mild arch and heel pain, particularly on the back of the heel when I walk barefoot. I’ve had plantar fasciitis and it feels like a mild case of that. The heel pain is bad enough that I avoid barefoot walking except in the morning getting ready or briefly at night going to bed. Walking in shoes or the boot it’s pretty minimal.

2. Pain in my calf that can be sharp at the extreme of loaded plantarflexion. I feel this everytime I do a two legged calf raise when I reach my toes. I don’t feel it as much when lowering (eccentric) and don’t feel it at all with lighter pressure, for instance when I do seated calf raises or just point my toes as a stretch. I’m treating it as “good” muscle building pain for now.

After a very active weekend, I was feeling a lot of tenderness, aching and general weakness in the tendon Monday morning. I decided to ease back and spend more time in my boot again (which I had virtually stopped wearing) and dial back on my walking/rehab exercises. I don’t like the idea of my tendon being stressed and think I’m at a good enough state right now that I can pause a couple days to make sure it is healing well. I don’t want to set up a chronic use injury, like tendonitis, which might make me prone to a re-rupture.

One tool I’ve been using is the Fitbit app on my iPhone. I don’t have the wristband, but am tempted to get one given how useful the app is proving as a barometer of my activity. For those who don’t know, the app is free and runs in the background to track your activity all day long. I have my phone with me or in my pocket most of the time, so its a fairly accurate count of steps which it uses to estimate distance as well.

I’ve been averaging around 8-10K steps per day, which includes a 1 to 1.5 mile walk usually. The distance estimate they give is around 3.5-4 miles for those steps. Most of that has been in two shoes at this point, with maybe .5 mile in my boot if I take the train in to work.

It turns out over the weekend, without even doing any walks, I spiked up to 15K steps or 6 to 7 miles of distance on Saturday and Sunday! Just a lot of activity like kid’s baseball games, cinco de mayo parties, shopping, eating out, gardening, walking around the house, etc. I was feeling it a little on Sunday, but still felt strong despite a lot of swelling Sunday night. Monday morning, however, I could tell I had overdone it and even in the morning my calf, foot and tendon were sore.

Was able to ramp down to around 6K steps yesterday (probably 50% in my boot) and will do the same today. Tendon was feeling better this morning already and I was very tempted to not be conservative, but I really want to make sure I have no pain before restarting activity designed to strengthen it.

Here is a screenshot showing my spike:

Anyway, just thought I’d share the tip about Fitbit, or other activity monitors, as a good tool to gauge how much load you are putting on your tendon. It was shocking to me how much I did over the weekend without realizing it!

Seeing my doctor for the 11 week follow-up later today. Hopefully no issues!

On Saturday I hoped into my unheated pool (wearing a wetsuit) to try some aquatherapy. I’ve been wanting to do this for a while and am very glad I did! I felt it was some of the best rehab I’ve done yet.

Based on feedback from my PT, I spent around fifteen minutes just walking in stomach deep water, really focusing on proper form and pushing off my toes. It felt great to do the right motion and definitely tired my calf out.

I ended with some single leg calf raises, although my calf was already fairly tired so I don’t think I had max strength for them. I found I could do a single leg calf raise in around mid-chest deep water which felt around right as I can press the scale to around 80 pounds. It felt incredible to do them and I focused on doing them slow and in control. I probably did 3 sets of 12 in all.

It was really nice to go through the whole range of motion without pain and I felt like a number of smaller muscles got a nice workout out stabilizing my body as I rose up to my toes and slowly descended.

I’m definitely going to try and get in the pool 2-3x per week now and feel like it will be a nice way to work up to single leg calf raises with full body weight.

Otherwise, things are continuing well. The end of every day leaves my calf tired and tendon a bit swollen and sore, but I start off every morning feeling strong and with no pain.

Ten weeks post-op today and things are still chugging along.

I’ve been trying to still do a 1.5 mile walk every day, but backed off over the weekend after i took it up to 2.5 miles last friday and felt some achiness and swelling in my tendon that night. The next day I felt weaker with my bad leg and a bit gimpier. As a result, I rested Saturday and Sunday (just normal light walking in the house or about in short stretches) and then resumed again on Monday with no unusual pain. I still have a limp, unless I walk extremely slow, and virtually no push off. I do feel like I can confidently shift my weight to the ball of my foot at the beginning of a stride, but when walking faster I definitely have a limp. My pace has been around 3 to 3.5 mph in my walks (17-19 minute miles) which I think is a big improvement from a week ago when it was more like 20-22 minute miles.

Given my walking, I haven’t been using my stationary bike much but plan on easing some time on the bike back into the mix over the next two weeks. I also want to try some work in the pool, both walking with correct form and single leg heel raises while submerged deeply.

I still wear my boot for commuting on the train or in situations where I might be at risk for falling (playing catch with my son), and also still sleep with it on most nights as I feel like it keeps my tendon from tightening overnight. Plus, my main recurring pain remains in my heel/arch which is undoubtedly plantar fascitis related, so the stretching overnight seems to help minimize that pain.

The tendon itself is still very thick compared to my other leg. And there is a bump of scar tissue around the incision site that my PT is working on with ultrasound and the scraping tool. But, there has been relatively little swelling in my foot and overall I feel like my ROM is pretty acceptable at this point. I’m definitely not trying to stretch it actively beyond what walking forces.

I’m so desperately wanting to push things, but have decided to consciously hold back and wait until week 12 to start to be more aggressive about anything except my walking. Things are going well so I’m trying to keep the marathon perspective. Re-rupture is my main concern and given I had some aches and pains in the tendon in the first couple weeks of trying out two shoes, I want to make sure I don’t stress it. Even the two footed calf raises I’ve been instructed to do I’ve barely done, sticking with seated calf raises which I can now pump out easily with little tiring.

12 weeks isn’t really a magic number, I’ve read plenty of accounts now of re-ruptures after that, but I feel like given the statistics if I make it to that milestone with no recurring pain or issues in the tendon from pushing it too hard, I should be in good shape to start to more aggressively strengthen it.

For everyone behind me on this recovery journey, stay patient and don’t be overanxious when you first get to FWB/two shoes and try to push things.