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Soj - I hope you have progressed since your last post.

I am at 9 mos post non-op ATR and 1 leg heel raise is 1-2 cm. OS suspects I have healed long but ROM in both feet is similar, but less resistance to dorsiflexion in injured left so OS suspects healed long.

How has your progress been since your last post?
Have been able to gain push off strength and/or height on the heel raise?
My experiences are discussed on my blog site.

Appreciate comments from you and others.
All the best!

Hi there,

So I have not confirmed it with my OS, but I have come to believe that I also have “healed long”, based on the facts that: 1) I still walk with a slight limp at 6 months; 2) I cannot do a one leg heel raise (or even start to); and 3) I have greater dorsiflexion on my operative side than my nonoperative side.

I was not involved in sports prior to my injury, and I don’t really intend to take up basketball or whatever at a time like this. Like you, I just want to walk normally and be able to participate in normal activities. I think I mostly am. This problem would not be worth another surgery to me personally, unless it got worse than it currently is. My initial repair was weird, as I have said in other discussions. My tendon was degenerative and 40% avulsed from the bone, split up the middle, and 60% ruptured higher up. With an injury like that, I’m not sure I can expect perfection.

Good luck to you, and hang in there.

There’s no science proving what causes healing long, though the logic seems simple and obvious enough - I.e., the AT somehow got stretched too long.
In my ATR#2 rehab, I became a stretching wimp as soon as my DF ROM seemed to be heading toward normal - or even = my other ankle, which is a bit DF-ROM-shy because my ATR#1 OS repaired it short on purpose. And I often preach that wimpiness hereabouts, based on the frequency of healing long.

But most of us also landed on the wrong foot once or more while crutch-walking, so it’s impossible to know for sure what caused what.

Thanks!
I am so happy today - worked with my physio on muscular simulator called compex and I don’t have to see her until 2-4 weeks times as I can work on the compex machine on my own free time and to be honest i can feel the difference straight away! Also my walking isn’t perfect but I can feel improvements like not limping as much (not saying it’s magic!) but just a combination of my efforts past four weeks and then my conditioning training!
Anyway now that I have lesser pressure to do a heel raise but have smaller milestones and goals I think it helps me psychologically to be honest.
I wish someone told me I was healing long in the early stages but hey I got there somehow!

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I’ve listed recently a bunch of at&calf strength tests. Good 1-leg heel raises are the toughest common test, and walking fast normally with a good push off is WAY easier, maybe close to a 50-50 balanced 2-leg raise. Even the Silly Walk, up on your toes after each step, is easier than the 1lhr!
It sounds like you’re in good hands, so I hope the strength returns, at least enough to make you happy. I believe the only other alternative is a surgical do-over if you’re unhappy.

Thanks norm
Yeah I think from now I will just focus on building strength but its do hard not to focus on heel raise as I don’t want to walk with a slight limp (its not very obvious now)I just wan t my life back
My quality of life isn’t back to where it used to be
I just want to be normal (not asking to be able to jump or do sports but just simple walking and going out without my trainers on)
If anyone has any advice on heeeling long let me know!

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I have a “glass half full” observation: You chose the surgical route, against the advice of at least the first of the several professionals you saw. As you probably know, I think the CLINICAL case for ATR surgery has essentially vanished, with the new studies of fast non-op treatments. But if you’d chosen non-op and had your present frustrating clinical results, you’d probably be beating yourself up for not having chosen the surgery. So psychologically or spiritually, your choice has probably worked in your favor, letting you look ahead without the second-guessing you’d probably have from the other choice.

Meanwhile, I wouldn’t obsess on getting a World Class 1-leg heel raise, as your goal. Based on my personal experience, that exercise is way overrated as a measure of important strength, for activities of daily living and for a whole bunch of aggressive high-performance sports activities (like competitive court and beach volleyball floor defense and spiking and blocking at the net). I’d recommend setting proximate goals: If you can walk normally now with a short slow stride, try developing your strength enough to double that st

Hi,

I am 19 weeks post rupture - squash/no operation - full w/bearing at 4weeks, boot off at 6.5 wks.
I can do maybe 8-9 small straight leg heal lifts - these are about 1.5 inches vs 2.5 on good leg. At 12 weeks I couldn’t do any, even though I could jog w/o a limp. I think my current performance reflects my still relatively weak muscles. The big boost to my muscle strength started from running at about 13 weeks and this continues alongside a tough cycle 20-50miles a week and some controlled movement on a squash court.
Academic research/ a comprehensive nordic study showed that in many cases - operative/non-oper - a key feature post rupture/healing is an elongated tendon. My consultant said this was a risk he was seeking to avoid with me - hence boot at 15 angle. In my case I am sure the tendon is maybe a cm longer - how do I know ? - well simply I can flex my whole up at a higher angle on the weak foot ! and it is not as “tight” when I move it to full stretch.
So to counter this, I have stopped stretching the tendon - it now appears to be getting “tighter” slowly. Alongside this, I still think my struggling with heel lifts is

During rehab for my 2nd ATR, non-op, I worked very hard to build up enough strength to do a 1-leg heel raise. Ultimately unsuccessfully, because I still can’t do even one good full-height one with straight knee. But all the work/exercise overworked and inflamed another muscle-tendon pair (not the calf-and-AT), and I think it was this one. (My blog may remember more of the details than I do.) I apparently have a permanent strength deficit in my Gastroc-AT system (probably from healing a bit long), and I was overusing this smaller muscle-tendon pair to try to lift my body weight — NOT what it was designed to do! On my PT’s advice, I backed off for a while and the pain went away.
My case may be less serious than yours, because my strength deficit is small enough that I have a fine push-off at the end of my stride, and can even do a decent “silly walk” up on my toes. And no problem bicycling, playing volleyball, etc., etc. Mind you, if you’ve inflamed that muscle-tendon pair the way I did, you may find that everything works better (and maybe even well enough that you don’t really have a problem, like me) after you give it a chance to

Sorry to hear about the heel raise woes. Sounds like something else could be going on though. Hopefully that can be sorted out without surgery. You did mention you could heel raise in the pool. So it sounds like there is some level of calf strength there. How much of your body is supported by water when you pool heel raise? Is it painful when you try to heel raise or just weakness?

Yikes! Sorry to hear. I hope it doesn’t require a reop. Good luck.

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@davidK: it really just depends on how well your scar is moving. I think I returned to work way too quickly and because of that I am behind a little. I still has some restrictions along the scar. It should be able to move in every direction equally. If it feels tight, it still has some restrictions. Some PTs believe in just letting stretch out over time, others like to get rid of it. Mine does not limit any ankle motion but it still feels thick so they work on it but just not as much as previously.

wow! am overwhelmed by the responses here. i guess through this i am not alone! because i have been reading all the success stories so far, which meant to give people hope but at the same time gave me unrealistic goals and expectations.

Norm - i suspect i am healing long My dorsi is better than my good leg and when i PF, my toes curl and look awkward. I change physio on Monday (one day after i published this post) and i will be seeing her next week for twice a week. This clinic is good as its 5 min away form work and allows me to use the gym anytime e.g. wobble boards, wedge box etc for me to practice/do my own assigned exercises. At least there is some hope. I understand i should save the therapy cash but i think if it helps me and force me to set aside an hour to two hours a week on having supervised exercises it will still do me good whether or not its just psychologically or mentally.

This week i was given a series of exercises i could do at home,and at the clinic, and I have tried hot yoga which seems to help a bit. Definitely feeling a bit stronger but still no calf raise and that is my aim for end of this month - sing

dmbfan

A good summary of the work involved during rehabilitation.

However, most PT’s do follow a protocol - they use it but tweak it according to the specifics of the patient and his or her injury. I’m not even sure that they would vary their routine between surgical and non-operated cases, unless the side-effects of surgery were causing difficulties.

Wow, dmbfan32

Thank you for this post, this really hammers home how we all heal differently and reaffirms how a 1yr recovery really is the correct goal, hence the ‘marathon tracker’! The way you have written reply this is a breath of fresh air and I hope it helps you and gives you piecs of mind soj9

Greg, on a side-note, are you still doing scar massage at 4.5 months? How long do you recommend this? My PTs were never big into this for me, although I used to do daily on my own up until about week 15 and have since stopped altogether. Thanks! -David

Soj9: Hopefully I can shed a little light on this. I am an orthopedic physical therapist who has a practice in California and I am also going through therapy for my Achilles repair (at 4.5 months now). I hope to helpfully ease some stress you may be having.

1. Return to sports in 6 months is nearly impossible. Most surgeons will tell you that you should not return to light jogging until 6-8 months, light plyometrics at 10-12 months, and return to sport in 1 year.
2. I myself am at almost 5 months and I cannot do a single leg heel raise. I can get maybe 20-30% of the way up. This may be due to healing long but more likely due to just weakness. I also see how I am doing by checking how many steps I can take without my repaired heel touching the ground (i.e. toe walking). I use to make it 1 step but I am now up to 3 or 4 before my calf can no longer hold me up.
3. Therapy sessions: my patients are in therapy for 60-70 minutes. I will do 20-30 minutes of manual therapy (scar tissue mobilization, joint mobilization, and most importantly neuro re-education). The remaining 30-40 minutes are for progressive exercises and then ice if

Liza - all the indications were right for you to go down the non op route at first but having read many reports from scientific studies it appears some people, not many, do not heal and they were taken off the trial and given surgery. Some non ops have re-ruptured and gone non op again with success but you will need to make that decision in consultation with your doctor. I am not the non op expert here but it seems your doctor has been following a more modern protocol which is very effective. If your doctor suggested non op in the first place and was using a modern protocol then I would trust his/her advice. I have heard of many having cramps in bed but non have re-ruptured to my knowledge if they were wearing their boot but a cramp is an involuntary shortening of the muscle. They are self sustaining and you only get relief by actively stretching the muscle. I feel is it may have been possible for your calf muscle to open the gap but I really don’t have anything substantive to back that up. I have found taking magnesium supplements and calcium (it aids the uptake of the mg) helps cramps. Mg is slow to return to the body b

Apologies if this is not in the right place but I am after some advice. I am 7 weeks post rupture - ultrasound showed complete rupture, ends in close proximity in PF and 5mm gap in neutral. I originally found this site whilst sitting in A&E (ER) which informed me of my options regarding treatment - many thanks to all who have posted….Conservative treatment in Aircast - 5 wedges with a programme of removal. This week was to be a final check before weaning off the boot however over the past couple of weeks I have felt what I described a dent and when I showed this to the consultant he sent me for an ultrasound which I had today. This is now showing an increased gap in my tendon (poss 3 cm but not sure I get the written report tomorrow) with scar tissue filling the gap between the tendon ends and no tendon connection…. so sadly things have got worse not better. I have not slipped tripped or fallen although I have had wicked night time cramps - I did mention these to the consultant at about week 3 as I was concerned whether they would pull the tendon but he was not overly concerned……… has anyone else experienced a

Librarian, were you walking well in the boot? Is the bottom of your foot tender? Is your stride only impaired by the length of your stride with your good foot? If so, just keep walking with that stride shortened, and it will gradually lengthen as you gain strength, ROM, ankle/leg muscle tone, balance, and confidence.
If your sole or heel bottom is tender, try squishy gel footbeds or Crocs to cushion it.
In addition to DC’s recommendations above there are many discussions on this site about recommended - and not - shoes for ATR rehab. Search?

@ Librarian — don’t worry, the first few days out of the boot are awkward for everyone! I’d first ask your doctor for recommendations — “sneakers” is a pretty open category and the right pair for you is going to depend on things unique to your foot, like the height of your arches, the width of your foot, and how you place your feet when you walk. If your doctor has no recommendations, try a specialty running store. Employees there usually have fitting experience. And if all else fails, the “Shoe Dog” find-a-shoe feature on the roadrunnersports website is better than nothing. Good luck!

SOJ9 - I am 9.5 months from surgery and still hit plateaus of seemingly no improvement. For me, some things have gone faster than others, other things much slower. But from this point, I can tell you that the overall arc is one of progress - even when you can’t see it at the time. Your body is still healing that tendon, and time is one big key to healing. This marathon certainly gives us lots of opportunity to practice patience and positive thinking. If FWB doesn’t allow you to walk without a limp, the suggestion of pool walking or an Alter-G treadmill might just do the trick! Wishing you a 6th month of more visible healing!

What a relief to read these posts. I am 7 1/2 weeks post op and my boot just came off yesterday and I had my first P/T yesterday also. I can hardly walk though I am trying and have lowered my expectations of when I will be doing things normally. Had I read these posts prior to surgery my expectations would have been more realistic. My doctor wants me in “sneakers”, but I have no idea what to buy. Any ideas from anyone?

This is a frustrating injury for everyone. I’m at 12 weeks, still in das boot, which is incredibly frustrating. My PT routine is pretty much the same as atr2014’s. I only go once a week right now since the only thing the PT provides is massage and ROM work. I do my own ROM work at home.

Hang in there, get some rest, do something that makes you happy.

Great post, btt222! Should be a Sticky!

20 weeks is still early days in terms of full recovery.

My physio used to tell me if the OS says you will be back at running/sport etc in a certain time like 6 months then double that and that should be about right.

Find a good physio and work on the program at home. My physio during recovery told me not to come back for at least 4 weeks. The people he sees often are ones who don’t follow the program outside of PT.

If your phone has a video camera, get the PT to tape some of the program if that helps when you see the PT.

Also, rehab and recovery involves both working the achilles/calf and rest in between. If you don’t seem to find any improvement, try switching up the work vs rest ratio. For example, take an extra day off for rest before going back to your routine. Muscles fatigue quicker during rehab and if you are constantly working it, you may find that instead of improving you start to plateau. On the positive side, you may find after an extended rest period a clear improvement once you get back into your program.

When I was doing daily single legged heel raises, I actually found my biggest improvement came

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Hi, I don’t stop by very often, but your blog here struck a nerve.

Even if you can afford a decent PT 3 times a week, don’t. A really good PT will set you up with a challenging program that will last you 2 weeks, maybe keep in touch by phone, text or email.

Perhaps it was your first few weeks that set you back (if that is the case), I don’t know if your rehab schedule encouraged early mobility.

Spend the rest of your ‘therapy cash’ on seeing someone who will help you to chill a little, clear your head and see a way through.

Now, take a few deep breaths, have a good evening. I’ll check in later.

Sony, when you sit, do you have more DF ROM on your injured leg then the other one? Some people do Heal Long, and that usually improves DF ROM but decreases PF strength. Up to a point, it ends up OK, more nuisance or curiosity than serious problem. My left (ATR #2, non-op) is like that. Past that point, it’s a problem, and some consider (or get) a reop to solve it. Still early times to predict where you’ll end up.
One other indication of healing long is that your Gastroc muscle seems higher, more contracted, than your other one, at same ankle angle. (2-leg HR w/ a rear-view mirror…)
Another thing: even worse than fixating on others’ schedules, is glorifying them! 6 months back to sports is much faster than average, IMO! Think 12-month marathon and you’re closer. And the frustrating plateau earned its name honestly. Many of us got stronger over the SECOND year… this is not a sprint!
That doesn’t prove that everything’s fine, but it may turn out that it is fine, just slow in coming and frustrating as @#$%&!

Good view of boot-walking on RyanB’s page and YouTube. Your PT should be able to show you too. It should work well! Strike the heel, roll to the toe, pushing your knee forward, not locked… toes pointing forward, as normal as possible.

I am six weeks post-op and have been FWB basically since my cast came off at week 4. I’m going to PT 3x a week at the moment and my sessions last about 30 minutes. To be honest, most of the stuff I do is stuff I can do at home and haven’t seen the value of what I am doing there. For now, my physio has me doing the following:

30 rotations to the right
30 rotations to the left
30 seated heal raises
30 toe scrunches
30 second heal stretch (x2) - basically bringing my foot as close to neutral to match my other foot while seated

The above I can do by myself at home (which I do 3-5 x daily). In addition, they have me use half a foam roller to move my foot side to side and front to back. They also have me on a wobbly footboard (while seated) in which I move my foot front to back, then side to side and finally completely around - all for 30x each. Those actually engage my calf muscle and I see the benefit of that particular exercise, especially since I don’t have the equipment to practice at home.

I then lie on my back and do leg raises with weights to work my quads. I finish with my physio massaging my incision to brea

Have a read of dcoughlan’s page too. Sound advice I think. Take care n good luck.

Hi, know I’m not as far on as you but do know that feeling of frustration and that you’re never going to achieve the next milestone. I felt like that before FWB. It felt like it would never happen. I know its so good to set goals but when it gets frustrating I found that just not expecting it to happen by a certain date and getting my head down to consistently exercising/trying things out worked better. Just kept telling myself its not going to be for ever n just keep going. Any exercises you’ve got done frequently will be making some difference however small. David’s advice about walking sounds good. Good luck and try to stay positive. Keep us posted with your progress.

Soj, so sorry to hear you’re feeling frustrated. Do you have a pool and/or anti-gravity treadmill that you can access? I found that walking around at a reduced bodyweight really helped me with strength building, and also put me in a much better place mentally — feels great to walk around barefooted without a limp and really feel everything working like it should.

Also, how’s your diet? It’s really important that you’re putting the right things in your body to help the muscle building process along.

soj9, if I’m making you worry, then I apologize and suggest you ignore my comments. My intentions were good. All I have to go on is your account of your situation–and it does strike me as unusual. But, if your own PTs aren’t concerned, then maybe nothing’s wrong and you just need to change your expectations. As for my PT, my sessions last about an hour each, with the last 15 minutes dedicated to RICE. I go twice a week. On my own I do exercises daily, plus I take walks and bike rides. Of late, long walks and bike rides have been the best rehab for me. Good luck to you. -David

Davidk- why do you think it’s unusual too? I am not saying I have no strength just not progressing enough weekly to see significant improvements. You are making me worry even more. What do you do at each in of your sessions and how long does it last? What do you do at home? Do you do more on top of your physio exercises? I can’t push off on the leg press machine on one leg at the moment. I’m not seeing results weekly like you have been posting and it frustrates me when I don’t know what else can I do at home. I have been placing weights on my thighs and doing toe raise on a chair but that’s easy and not very challenging on my calf muscle. Seated toe raise isn’t challenging at all either.

soj9, your situation does seem unusual, but perhaps you’re just on one end of the spectrum of normal healing time. It seems as if your PTs aren’t overly concerned about your condition. Are you making progress, just slow? If so, doubling-down on your exercises (with or without PT) might be your best option. I would recommend simple walking at this stage, while focusing on your push-off and gait, for as long as you can muster each day. Throw in some seated and standing heel raises as you are able, also. You should be able to feel your calf muscles engaging as you do these things, and that’s the evidence that you’re working and building these muscles. I know you’re frustrated, but try to stay positive. Hopefully you’ll hit a turning point soon and start making great strides! -David

I, like Katherine, had part of the calcaneus removed (tendon partially detached from the heel for that procedure) and am experiencing a longer/slower healing rate than the average on this blog site. I still walk with a limp and I’m 8 months out… Not yet cleared to run. And have a lot of swelling, scar tissue and pain still.

I think those who are having a rough time aren’t really posting as much…. I know I’m not. Whether normal or not, don’t get too discouraged about how long it’s taking, but do be proactive about your rehab and make the changes that help you reach your recovery goal. I have gone back to my doctor multiple times about my pain and am on my 3rd PT….

Good luck!

For what it’s worth, I’m at 16 weeks now and I’m about where you are. Still swelling, still walking with a limp, just getting starting with PT, really. I can’t do a single leg heel raise. Don’t get too discouraged. Talk to your ortho, if possible, and your PT. You might switch PTs, as others have suggested.

In my case, my repair was a bit different, and I blame that for the slower recovery. My tendon was 40% pulled away from the calcaneus, requiring an anchor to reattach. It was also split up the middle and the other 60% ruptured higher up. My ortho also had to correct a Haglund’s deformity and debride the tendon where it was degenerated. Anything weird like that with your repair? Maybe that is to blame.