suthrnman’s AchillesBlog

I just re-ruptured . . . this time it was painful and swelled immediately.  I thought things were going well, but I guess not.

After hurrying for a short distance with a fast walk/slow jog, I stopped to pick tomatoes and took a leisurely walk back to the house which was maybe 100 yds away.  Everything felt good and then when I was almost to the house it suddenly ruptured.  I am devastated . . . Many other people are suffering worse than me, so I can’t feel too sorry for myself; however, I can no longer see the light at the end of the tunnel and feel I will never get back to running.

I seem to be progressing well.  I can press 140 lbs on the scale and weigh 175 lbs, so I still have a ways to go before I make the one leg heel raise. Yesterday I walked on the treadmill at 2 incline and 4 mph.  I used the cheater rails to keep from limping, but after 15 minutes was able to walk pretty clean with out support.

On my previous post, I described a series of incidences where there was a pop and pain.  These events were followed by a week or two of recovery to get back to where I was.  The pain was on the upper lateral side (outside) of the Achilles where the sural nerve crosses the tendon.  There is also a notch on the Achilles in that location.  The best I can tell the sural nerve was somehow bound up at that place and ripped out when I over exerted myself–very painful.

The good news: I now seem to have moved past that complication and my strength is increasing with little of the previous type pain limitations.  I can walk pretty well if I go at a slow pace. My strength is about 120 lbs pressure on the scale.  I still don’t have full ROM, but I am now able to stretch more effectively and hope for quicker improvement.  Good healing to all!

I have had two occasions while trying to hurry  where something popped and then there was pain on the lateral side of my tendon.  I wonder if this is a nerve that is still damaged or maybe scar tissue that is breaking up.

The first time this pop happened was about a week and a half ago.  There was new swelling and bruising which caused me to limp badly again.  I wore the boot for a day and took it easy.  Everything seemed pretty good a week later and then while walking up a hill it popped again.  This time there was not the bruising and swelling, but the pain was back.

Does anyone know what is going on?

I will give a quick update, since not much seems to be happening–”frustrating plateau”.

I can walk pretty well if I keep a slow pace.  However, when I walk in my best form there is always a little pain at the tendon muscle connection.  The swelling is still a problem when I walk a lot.  This past week I spent days at the beach and New Orleans.  In both places I walked quite a bit with no real issues.  I was a little concerned about the beach, but, other than walking in the real soft stuff, I did well.

The tendon itself is at least three times thicker than the good Achilles and I still have not reached full ROM.  Cycling on the stationary bike seems to help a lot and I used the elliptical machine last week which worked well.  As far as strength, I am slowly improving and can now push down on the scale as much as 90 lbs until the pain prohibits.

Overall, I am pleased with my progress, but the reality of the long journey is setting in.  At least I am able to walk around and feel confident of my path.

Blessing to all, pk

I haven’t been concerned about ROM too much, but have now started to quantify it and work on progress.  The last few weeks I have worked pretty hard on the bike trainer.  I am doing several intervals in a high gear; however, I haven’t really tried to stand in the saddle yet.  My strength as measure on the scale pushing down on the ball of bad foot is only about 60 lbs before the limiting pain kicks in.  I have pushed as much as 70 lbs when I was well warmed up, but haven’t been able to repeat. I really expected to have increased more than 20 lbs on the load test over the last few wks (I was at 40 lbs wk 8).

Tonight marks the 8th week since ATR.  I’ve been in 2 shoes for a couple of weeks and have started getting in some pretty good rides on the trainer.  Still limp a lot and can only press about 40 lbs on the scale w/ the ball of bad foot.

My ROM is pretty good; however, the Achilles just above the rupture is still very enlarged and a bit tender when stressing.  This area seems to be the limiting factor w/ my ROM.

Also, an interesting thing is the Soleus muscle (?) on the front inside of my leg seems to be high and enlarged (out of place).  Has anyone else noticed this?

All in all things are progressing well.

Last Saturday I experimented with putting on two shoes . . . and it was practically impossible for me to go back to the boot for messing around the house.  My tendon feels good and solid, but the upper connection to the muscles is swollen and pretty stiff.  I still can’t flex much past neutral and don’t feel confident to stretch it hard yet.

I also experimented with my bike/trainer.  My bad foot was able to exert enough pressure to clip into my pedals and I found it easier to use a high gear rather than low.  I rode for about 10 min each for two days not putting much pressure on the pedal, but enough to feel it in my calf.

Massage and soaking in hot or cold is a daily event and usually done multiple times.  The tendon/muscle connection seems to be the limiting factor at this point.  Since I have been working the ankle over the week, I have gain slight improvement in ROM . . . maybe 5 degrees increase in dorsiflexion.

Hopefully, I am not pushing too fast, but I really fear atrophy of both tendon and muscle more than the risks of re-rupture.  Also, I don’t believe I am putting too much stretch at this point . . . just active movement.  If it heals long, then maybe it will be due to the over-stretching I did a few weeks back–hopefully not, but won’t know for awhile.  Pressing on.

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?