suthrnman’s AchillesBlog

Last week I went to the Mall w/ the girls (wife and daughters), so I took my usual place at the Barnes and Nobles coffee shop.  As I sat reading blogs (doug53 to be exact) and having a decaf, I took my boot off at 3 wks 6 days post ATR and began dorsiflexing using muscles only–no body weight.  The load I pulled with was probably 10 lbs or so.  I adjusted my VACOcast to neutral using as a guide for ROM.  I quickly increased my ROM to neutral and slightly above, but when I felt my Achilles it was deformed or stretched out at the place of healing.

So, it seemed the increase in ROM was due to the stretching of the tendon at the rupture site.  This kinda freaked me out considering many attribute tendons healing long to over-stretching.  I decided to place my foot at 30 degrees plantar and go back to PWB for a week.  I would have gone NWB, but I was already en-route to Charlotte and only brought a cane.  Fortunately, the airports and others let me be a wimp and wheeled me around.  I even toured the Biltmore in wheelchair getting the handicap discount on admission : )

After taking it easy for a week, the tendon had tightened up and felt more solid.  I now can dorsiflex to neutral with just a slight pull . . . just until I feel it pulling.  I am now back to FWB, but if I am in awkward places I adjust the boot to 30 instead of 20 degrees to keep from pulling the tendon too much.

I now believe I have a better understanding of the UWO protocol where it calls for dorsiflexing to neutral from 2-6 wks, but stretching only after 6 wks.  Perhaps having sutures would give the tendon more strength in the early weeks to stretch as Doug did, but also everyone will heal slightly differently.  So, my experience is to be careful with the stretching before 6 weeks until the tendon hardens a bit more.

Maybe the stretching of the tendon that I experienced is common, but it unsettled me.  I wonder about the protocols that recast early, within a few wks,  to neutral.  A few have commented how it felt really tight for a day or so after the recast.

Anyway, I hope this input helps someone.  I believe I am on track for good healing and plan on sticking to the UWO protocol.

Does anyone understand what is being stretched out when we do dorsiflexion–muscle, tendon or both?

I did my first session of hydrotherapy (hot tub)tonight and it felt great.  I should have been doing this for the last week or more (I’m at 3 wks 5 days post ATR), but I believe I was freaked out a bit not knowing whether my tendon had grown back together.  Now that I can clearly see/feel the continuous tendon, I feel much better about ROM exercises.   Good healing to all.

I finally felt tension in my Achilles, so this was a nice reassurance of its healing.  I have been using a high frequency massager on my ankle and calf much like doug53,but maybe more.  I experimented with fwb at 30 degrees and everything felt good.  After loosening it up I changed the degree to 20 on the VACOcast which is more in line with the UWO protocol’s 2 cm wedge.

I feel much better about my progress now, but still cautious about pushing to fast.  UWO calls for dorsiflexion to neutral and I am not confident to push it there yet, but getting close.

I am having non-op anxiety : )  I can’t really feel if the tendon has healed together by touch.  There is still a ‘ridge’ of swelling above where I believe the break is/was, so it’s hard to tell if the tendon is continuous.  How early is safe to do the Thompson test?  I know I am still early at almost three wks, but wondering if I have enough healing to perform the UWO protocol for dorsiflexion.