smick’s AchillesBlog

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.

9 weeks post-op as of yesterday. Nothing major to report, although I am feeling incrementally stronger and more comfortable in two shoes every day. Still walking much slower than normal and without any real "push", but flexibility is improving and there is no pain or discomfort in the tendon in normal walking, although it is a little swollen and tender by the end of the day.

I still wear my boot commuting as the train can be busy and the boot helps ensure I get a seat and don’t have to stand. I also wear my boot at night locked at 0 degrees as it seems to help stretch the achilles and plantar tendons. Other than that, I’ve moved into two shoes the rest of the time and feel pretty good doing everything I need to do, albeit at a cautious pace.

I’ve been trying to do flat walks of 1 to 1.5 miles every day for the last couple days, gradually increasing distance every day. Also continuing PT which is mostly balance exercises (two foot and one foot), strengthening of the non-achilles related muscles of the foot with an exercise band, and seated/two legged calf raises. I’m guesstimating I’m putting 20-25% of body weight on the bad foot when I do a two legged raise and there is some discomfort/tightness in my calf at the top every time.

Overall the achilles is feeling pretty good, although it requires icing every night and elevation as much as I can or my foot starts to throb. I am still getting sporadic heel pain and plantar fascia pain on the bottom of my foot, plus some pain on the inside of my ankle. My PT thinks this is just all the secondary tendons, ligaments and muscles restretching as my body gets used to walking again and recommends I do the theraband and balance exercises to keep strengthening them.

Hoping for some major advancement, but I think it’s going to be step by step for a while. My doc was pretty clear about waiting to do real strengthening or active stretching of the achilles until 12 weeks when it should be fully healed and strong enough for more aggressive PT.

Sort of in the doldrums right now, moving around and much more functional, but just feeling slow and gimpy even though my walk is looking much more normal.

I am 8 weeks post op as of two days ago and just had a pt visit yesterday where my dorsiflexion and plantarflexion angles were measured.

Here are my numbers:

- dorsiflexion with straight leg: 6 degrees bad foot / 8 degrees good

- dorsiflexion with bent knee: 12 degrees bad / 16 degrees good

- plantarflexion: 28 degrees bad / 42 degrees good

I’m curious where other people are at or were at. My pt said the plantar flex range comes back with strength and the dorsiflexion range with stretching.

I’ve been in two shoes 4-5 hours a day now, essentially only indoors on flat surfaces, and using my boot outdoors during longer walks.

The cool thing is I’m seeing strength improvements every day now and actually feeling a tiny bit of push from my bad foot! It’s barely there, but enough that if I walk slowly only a close observer will notice a limp. I do have to walk slowly and very carefully to pull it off, but it is exciting to feel that foot finally doing something!

Tomorrow is 8 weeks at which point I’m officially into two shoes. I’m definitely going to use my boot still for any longer walks outside or on uneven surfaces for another week or two, as two shoes still feels a little scary. But, progress is definitely giving me more excitement than I’ve felt since I ruptured two months ago!

I have a PT appointment on Thursday so I’ll see what new exercises get thrown my way. For people who care, what I’ve been trying to do is as much walking in two shoes as I can tolerate, plus as much walking in the boot as I can tolerate on top of that. I’ve been riding a spin bike for 15 minutes 3-4x a week at a low friction level, more for stretching and range of motion than cardio as my tendon starts to hurt if I set it high enough to break a real sweat. I’m also doing various balancing exercises on two feet and seated heel raises. No stretching past 0 degrees or active strengthening yet.

Question for other people on the transition to two shoes. I’m a little worried about pushing myself too hard as the tendon does ache whenever i take a longer stride or push off harder. It also gets tired quickly. I can back off and limp more, but I’m wondering if having an ache whenever you do a fuller step is typical? The pain goes away as soon as I take the load off the tendon so I think its just from stretching/using it. How much did you push yourself in the beginning?

7 Weeks post-op today and am finally starting to see a light at the end of the tunnel… although very small and dim still!

To recap my 5.5 week post-op visit, my doc wanted me to go to week 8 primarily in my boot, while weaning to two shoes. Walking in the boot is definitely easier these days and I’ve gotten pretty fast. My single crutch is gone as of a week ago and I did a couple 1 mile plus walks over the weekend! It’s actually become fairly tempting to just keep getting around with it and delaying the next stage. I know I have to force myself out of it to progress, though.  As a result, I’ve been trying to use the boot mostly when I go outside and to get more and more time in two shoes in the house or in the office. Today I probably spent around 4 hours in two shoes at the office and I was actually surprised by how good it felt!

Walking without the protective boot is still definitely stressful. I’m conscious of every step and action I take. Plus, I found out from my physical therapist that I don’t really know how to walk anymore! As a result, I’m walking frustratingly slowly and concentrating on bending and extending my knee at the right time and rolling off the foot instead of compensating with a fast transfer to my good leg. The speed difference when I walk in two shoes drives me crazy when I know I could chug along in my boot at three times the speed!

The good news is the improvement in my two shoes endurance and comfort has been growing steadily, up from 30 minutes a week ago to the four hours today. I can feel like the tendon is strengthening and some semblance of plantar flexion strength is returning in the push off phase of my stride. I still get a bit of aching, swelling and soreness by the end of the day and have to watch how hard I push things.

What is amazing is how atrophied all my other ankle muscles are from lack of use! I’ve been doing balance exercises per my PT’s instructions and can barely stand straight unless I use my other leg to balance me! No chance of passing a field sobriety test! A great exercise I’ve been doing is placing one foot in front of the other (alternating) and balancing while shifting weight to my bad foot. I also do shifts of weight back and forth from one foot to the other in this position and work on transferring pressure to the balls of my foot and pushing off to shift weight to the other foot, all with my heels on the ground.

Another milestone has been riding a stationary bike with shoes on instead of my boot. My calf/tendon gets tired fast but I’ve gotten up to 15-20 minutes with very light resistance and not too much discomfort afterwards.

Baby steps..

I’m at 5.5 weeks and am using one crutch only for longer excursions where I might want to rest my foot if it starts aching. Still have an achy heel when I walk for more than a couple minutes and a burning/stretching feeling in my tendon with steps that stretch it more, but otherwise all good so far!

Here are some tips from using my Vacocast for the last three weeks that I’d thought I’d share:

- If you swim in it and didn’t buy an extra liner, I just remove the liner and swim in the air bladder. Makes drying afterwards a breeze!

- When I got to PWB, I still locked the boot at night to force my ankle at whatever angle I’m supposed to be at. This stretched my achilles overnight (I could feel it burn!). The next morning I set it to hinge to aid with walking.

- I took off the soles at night because they were dirty, but also it makes the boot a lot lighter when I have it elevated on pillow.

- I didn’t pay a lot of attention to setting up the liner the first week and had some strange lumps of the beads inside, a huge lump at the ball of my foot for instance. This actually made walking/weight bearing more difficult. Make sure you follow their instructions and smooth out the beads to make it even, particularly the sole of the liner. Then suck the air out and strap it up. The downward pointing angle also tended to make the beads gather by my toes.

- Being able to wash the liner is a big advantage over my old boot which got smelly within days. I just did a quick hand wash in the sink and then a tumble dry on low temp for thirty minutes while I iced my foot nearby and it smelled great!