W80 | Long Due

Over a year after my last post, and 1.5 years since the ATR - an update is long due.

I am back to doing everything I used to do - balling, running and snowboarding.
The AT does not bother me at all, no matter what I do.

I haven’t lost a step; speed; jump or have any degradation to my athletic abilities.

What I have lost - is confidence in my body.
As a result, I no longer want to hit the court and compete like I used to, and in general I avoid any team sports (even a 1 on 1).

I know its now a purely psychological issue - and yet - I no longer trust my body to handle and compete without being injured.
It became a chance I am just not willing to take … or maybe its ’cause I am pushing 40?

The Good:

• My repaired AT is way stronger than my non-operated one
• My athletic abilities are in par what they used to be, pre-injury
• I exercise daily, without any pain or soreness in the AT
• I have no limp or anything visual to remind the ATR, except a barely visible scar

The Bad:

• I avoid any competitive sports involving other players
• I have lost the trust in my body, fearing an injury - if I push it too much

W20 | Calf Raises

Almost 2 months after my last post, so a quick update:

I am progressing faster than I expected - about 2 weeks ago, I started with unassisted single calf raises.
Only going for 3-4 at a time, but not because of any pains - just being careful and taking it slow.
These do not cause pain - but I do feel some discomfort in the lower heel area (not the tendon).

Other than this, I tried to jog a little bit and even tried some jumping with both legs - absolutely no discomfort.
Again - being cautious, so not trying to actually run or jump with my ATR leg.

Riding my stationary bike every day (5-10km), stretching my ATR leg with a theraband and doing other drills (no PT, on my own).

Walking up/down stairs is absolutely normal and so is walking at any speed, though people do say I still have a slight limp while walking fast.
I notice that if I focus on it - the limp goes away, so its rather a psychological issue than a physical condition.

The temptation to put on my Kobe 9s and go to shoot some b-ball - is great.
I am trying VERY hard to stop myself from going out.

I will surely hit the court at 6 month mark (Jan 29).

The Good:

• Balance is 100%, walking on any surface is normal
• No Swelling, scar is barely noticeable
• Single calf raises, tiptoe is super easy

The Bad:

• Slight limp (when I am not thinking about walking right)

W13 | Offroad

This week was the first time my tendon and calf sustained a lot of physical-impact activity.

My SUV got stuck while mudding off-road and I spent about 3 hours of digging and paving under the wheels - to get it out of the mud.
It involved a lot of squatting; walking on slippery & uneven terrain - with all sorts of balancing & stress angles of the ankle/tendon.
I didn’t slip bad or made any unnatural movements - but the day after - my tendon and mostly the surrounding muscles ached much more than usual.

The good news are that I was surprised how well it braved all the physical impacts, without any apparent damage or setback to my recovery.
The bad news are that I strained and exercised my leg the most - in the last 3 months (much more than during PT).
I also had 3 very short episodes (3-4 seconds) of tingling pain in the ankle area (NOT in the Achilles tendon itself) in the days after.

As a result - I don’t trust my tendon now (which I think its mostly physiological).
I keep thinking that it might give up at any point now, even though there is no pain or elevated swelling, my gait & speed are almost normal and my tendon strength is tons better.

My PT said that my distrust in the injured leg will be very high when I resume b-ball and running activities in 2 months.
He says that I will be scared to jump with the leg or stress it - for a long time.
I will have to re-build my trust, which may take up to a year…

The Good:

• Gait is almost normal
• Internal stitches knot got a lot smaller
• Pace is almost as fast as pre-injury

The Bad:

• Some tingling pain, very few times
• Overall discomfort and distrust of the tendon

W12 | Still Limping

On Sunday I will enter my 3rd week at work in 2 shoes.
It’s been a good week - progress wise, as I am able to go faster and faster, loosing the limp as I go.

This week I tried to wear all the kinds of shoes that I have - tall ones, 3/4, 1/2, flat sneakers and even flip-flops.

I didn’t feel discomfort while wearing any of them.

The ankle still swells up moderately - but I got so used to it, that I barely notice it.
-

Next Wednesday will mark my 3 months since surgery, and I will finally post my scar pictures, in comparison to Kobe’s at 3 months.

I am also trying to tip-toe at least once a day, and already can put full weight on my bad leg, if just for a couple of seconds, before I cheat with my good leg.

The Good:

• Gait is getting better
• Pace is getting better

The Bad:

• Tip-toeing is not comfortable
• Calf muscle is still a wimp
• Walking about 3/4 speed of my pre-injury pace

W11 | 2 Shoes

As expected - this week’s follow-up was indeed my last - and I was fully cleared by the OS to get back into 2 shoes everywhere and pickup the “bad” leg strengthening pace.
He noted that I could have been back into 2 shoes a bit earlier (around week 9) - but holidays prevented a visit to see him.

The tendon itself is fully healed according to him, but the calf and all surrounding ligaments and muscles are not strong enough due to atrophy.

-

I am to start a more aggressive PT schedule in two weeks (3 months post op) and gradually increase the conditioning of the bad leg.
Basketball will be allowed to get back into - slowly, around 5 months mark (Yay!)

-

Despite the good news - if I were to rate my recovery progress, I would say I am about 60% good to go.

The limp is still there, very visible - while walking (its my 4th day without the boot).
I feel the muscles around the tendon pull with each step and its not very comfortable to go faster, due to this.
I am also uncomfortable to go down on stairs (up is no problem at all).

I hope my gait will get better, fast.

The Good:

• 2 Shoes
• Much more eccentric movement and knee bending
• The lump above the tendon decreased in size

The Bad:

• Lower leg muscles (not calf) - feel resistant to flawless movement
• Gait is visibly bad
• Walking about half speed of my pre-injury pace

W10 | No Progress

It has been a very unfruitful week, probably the less productive I ever had since ATR - recovery wise.

I actually feel that at this point (9th week in the walking boot) - wearing the boot most of the day actually impedes my progress, instead of helping me recover.
I realize that it fills a protective role now, much more than a recovery one - but the trade off seems to be bad.

I work for 10 hours a day, with a 2 hours of  driving, which totals the time of being in the boot to ~12 hours.
I don’t really walk that lot in the few hours I am at home after work, and sure not walking while asleep.
So almost all of my walking is at work, in the boot.

I am not able to utilize the calf muscles or do much eccentric movement in the boot, so there is just no rebuilding progress of the calf.
I do believe and feel that my tendon and surrounding ankle ligaments is recovered enough, I have full ROM for about 3 weeks and I am already working on strength much more than balance during PT.

I always feel great after PT and working on stretching my AT and calf - walking and moving is super easy.
Contrary to that - after wearing the boot for a whole day - I am uncomfortable to walk without it, my calf feels weak and unused and my lump above the tendon swells up.
I also limp bad - compared to almost no limping after PT or after sleeping.

But the surgeon said to keep the boot on until 3rd post-op inspection (which is due next week) - so PT and I don’t want to deviate from his instructions.
I want to do some exercise after a full workday - but I am too tired and my AT and calf are too uncomfortable to work on - in the evening.

The Good:

• No accidents/slips
• After sleeping - its actually easier to walk

The Bad:

• No progress at all - calf did not get stronger, walking did not get better
• Boot feels limiting, uncomfortable and counterproductive to the recovery progress
• Had 1 day of shooting pain in the bottom middle of the heel while putting weight on it - went completely away the day after (probably nerves waking up)
• The lump above the tendon (near the connection to the calf) gets big after a whole day in the boot

W9 | Balance

This week I worked mostly on balance and on trying to achieve a normal walking gait at home.

Balancing on the ATR leg became too easy during PT exercises - so I moved to a new drill - walking toe to heel:

It was quite difficult the first few times, but progressed quickly - becoming easy in a week time.

Walking without any “bad” gait is harder, the faster I walk - the worse is my limp.
My tendon and calf are getting stronger each day and I can walk and move much faster.
This causes my limping to get more noticeable and I start dragging the bad leg behind.
I slow down - and the limp virtually goes away.

I tried walking up and down the big staircase at my parent’s home.
Up was easy. Down was scary - so I cautiously side-stepped down.

I think I did this because my mind does not yet fully trusts the bad tendon not to cause me some freak slip accident which will send me flying down the stairs.

The Good:

• Tendon is very strong, I can feel it during massage, PT and walking
• Walking slowly - without any limp
• Balance is back to normal (though I did not yet try impact/sudden balancing)
• ROM = -50°; +20° (full 70°)

The Bad:

• The lump above the tendon (near the connection to the calf) is still visible
• Picking up the walking pace causes a gradual limp, which becomes worse with speed
• I am very tempted to take the boot off, but so far win the struggle and keep it on - while outside

W8 | Full ROM

Finally! Full ROM of the ankle without feeling discomfort in all directions and in par with my good ankle ROM.
But with this injury its just another milestone out of many…

The new challenge is to be able to make a full eccentric stretch with the bad leg stretched backwards and the good leg knee fully bent.
Currently, I am able to go somewhere halfway - feeling the tendon and calf resisting, so I stop there as PT advised.

-

Walking is still not 100%, but given the fact that I spend most of the day walking in the boot - I am not surprised.
At home, without the boot - I am pacing forward and backwards - trying to fully utilize the tendon when pushing off with it.
Can’t say that I am not “cheating” with the good tendon - but I do feel the pull each step (its not painful or anything - just lets me know its not 100% yet).

Standing; balancing; sitting and standing is almost absolutely normal - I don’t feel any signs from the tendon - no stretching; pulling or any discomfort.

The Good:

• Sleeping is back to normal - as if I never had an ATR
• Walking around the house is better, still limpy
• Right (good) knee pains are gone!
• ROM = -50°; +20° (full 70°, yay!)

The Bad:

• The calf muscles that connect to the tendon are swollen creating a small but visible lump.
Its not painful to touch and goes away with icing - revealing a very firm connection of the tendon to the calf.
I think its due to all the workouts and calf rebuilding that I am doing.

W7 | Progress

I have to say that this week felt as the best one - progress wise.

I have been walking with a small limp at home, which actually gets better when I am wearing sneakers (barefooted walking is much more limpy).

I am using my tendon each step, not stretching it fully or putting all weight on it, but I do feel it working and assisting me make the step.

Conducted a self Thompson test - my bad leg moves exactly as it should when I squeeze the calf muscles!

It moves much less than my good leg during the test, but it’s due to the much weaker calf muscles that are building up on my bad leg.

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Switched gears in PT, now being able to easily balance on the bad leg.

With my ankle ROM being almost 70° - I have started to work on strengthening my surrounding muscles and stretching the calf so that my whole knee will be able to bend further, with my entire body weight on it.

I would say that it’s half way there, compared to my good leg bending.

Also got myself a Head magnetic stationary bike, to warm up and exercise at home:


-

Got the stool out of the shower, now standing up like a proud men while showering!

Swelling is no better and no worse than the last couple of weeks - it swells up a little around the ankle bones in the evening, bot there is no pain whatsoever.

The Good:

• Sleeping without the boot is epic!
• Walking around the house, getting confident
• Right (good) knee pains subdued a lot
• ROM = -50°; +16

The Bad:

• Had a scare squatting accidentally on my tendon while barefooted, but was able to shift weight fast to my good leg and avoid full stretch
• Trying to step sideways fast - stretched the ankle muscles abruptly, but since I was in the boot - no harm to the tendon, except some swelling above the tendon in the calf by the evening.
This is why wearing the boot is still important at this stage!!! - I am sure I would have damaged the AT if I was in normal shoes.

W6 | Meet the Doc

Back from my 2nd follow-op inspection this week.
Doc was extremely pleased with my results - no swelling, great ROM, solid strength and fast incision scar healing.
Noted that I am extremely advanced in my recovery compared to other ATRees my age and athletic form. (Wohoo!!!)

He even told me that I am advancing too fast and should be limited a bit, thus - prescribed the boot for another month to wear it in public places (work/outside).
I am allowed to walk without it at home; when PT allows it during seesions; and can sleep without it as well.

I am totally not bummed about it, since even if he would okay 2 boots, I would still wear the boot for 2-3 weeks anyway on my own accord.
Even without PT and the Doc I can tell that the tendon needs more time to heal and the muscles around it need progressive conditioning.

-

Discussed my bad knee issues with the Doc - he assured me that its quite common with tall (I am 190cm/6′2) persons who were engaged in active sports for many years.
My knees have some bad history, so with the “good” knee now bearing twice what it got accustomed to for 6 weeks straight - I got some wear on it.
Prescribed a full knee brace for my knee (which I already own from past injuries) - I am to wear it every time I walk/get up.

My ATR heel pains are also expected and usual - according to the Doc.
Its the stitches rubbing against the skin - the ones which are stitching the lower part of the tendon (next to the heel bone) have less space than the ones right next to the calf, so there is more internal friction against the heel skin = pain.
These will go away in 4-6 weeks.

-

I am walking without a boot and have a big a limp at home.
Taking it slowly and cautiously - though, since I still cannot (nor should, at this point) raise my leg using my toes - stressing my tendon while walking.
It just feels too weak.

I understand that strength of the muscles around the tendon which will allow normal push-off walking without any limp - will be achieved very shortly.
The prerequisites for it though - are: full ROM of the ankle, a completely healed incision and of course - being cleared by the Doc.

-

I have been very careful not to set any goals for myself, but I sincerely hope to be walking without a limp in 5 weeks time (mid October).

Being positive like this, I decided to treat myself with AT braces for both ankles (you never know):

I realize that getting back to basketball is still 4 months away, but could not resist the urge to order a Kobe 9 shoes (with these cool stitches over the tendon area) - that he got made right after returning from his ATR:

The Good:

• Great results according to the Doc
• No pain anywhere, as I didn’t do anything stupid this week
• Scar tissue is getting less and less noticeable
• Allowed to sleep without the boot
• Allowed to walk without the boot at home
• ROM = -50°; +15°

The Bad:

• My right (good) knee is still hurting
• Minor swelling after walking a full day in the boot

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