Healed Long - Month 10 Update

Figured I would come back here to provide an update to my journey on the recovery from my left Achilles rupture.

For those who need a refresher, I completely ruptured my left Achilles playing basketball in late February of 2018, with surgery March 7 2018. My surgeon did things the old fashioned way - with an open surgery. However, he also used a Stryker graft to augment the repair (make it stronger and more resilient).

I think this is a lesson for all of you starting this process now - regardless of how healthy you are, and how optimistic you may be, BE VOCAL WITH YOUR DOCTOR.

I was non-weight bearing for more than 10 weeks, a full month longer than typically recommended. My doctor also took me straight from plantar flexed in a cast for two weeks to neutral in a boot, with no gradual decrease from plantar flexion to neutral. I voiced twice that I had read this was not typical, and he pushed back each time.

Fast forward to today, 10 months later. I have been doing rigorous PT for more than 5 months. While my calf is very slowly returning, it is still a full 1.5 inches smaller than the “good” side. My push off strength is nowhere near normal, and I can not complete a one legged calf raise. Again, it is slowly getting better but VERY slowly.

At my PT’s urging, I saw two of the best Podiatric surgeons in Los Angeles. One is the Chief of Podiatric Surgery at UCLA Medical, the other is the former Chief of Podiatric Surgery at Cedar Sinai. If you need recommendations for LA doctors, these two are the best at the University Foot and Ankle Institute.

I saw both Dr Briksin and Dr Bob yesterday. Their conclusion was that I have definitely healed long. The most likely culprits being the time I spent non-weight bearing as well as the rapid move to neutral without gradual decreases over time.

The options now are to continue trying non-operative with PT to see how much progress we can make, or surgery to shorten the tendon with FHL transfer. I have vacations coming up, so will likely give PT a couple more months and elect for the surgery in April/May.

At this point, I am tired of not having much strength in my left side and not being able to fully get back to sports like Basketball or running. I can shoot around, but have very little push off strength. I can surf, but still wobbly. I can walk, but still with a bit of a limp and hard to push off. And my calf looks like a 10 year old. I know it will never be 100%, but it has to be better than this.

Here is a photo of what my ankle looked like about two months after surgery… I brought the apparent lack of tension up to my Dr multiple times and was told it was normal.

Also including the last 5 months of my calf recovery (Sept-Jan)
Sept:
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October:
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November:
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December:
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January:
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Anyone who has gone through the shortening surgery with FHL and can comment on your strength pre and post would be greatly appreciated. Are you glad you did it? How long was the recovery? How was it vs the first go around?

Healing long?! Can anyone help?

Hey team! I am 7 months post - op and making progress with my PT, but VERY slowly. My calf is still small, and I feel as if my strength is slowly coming back. About two months ago, my left (bad side) calf was 13.5 inches and is not 14 inches. My good side is right at 15 inches.

I’ve had two doctors check for lengthening, and they both said they weren’t concerned based on my dorsiflexion… i.e. my bad side is not flopping back when pushed and is just about in line with my good side. Perhaps a small difference.

However, the time that is taking to get my strength back as well as my inability to do a one legged calf raise is concerning for me. I can do one legged raises in the pool only!

Any advice on healing long or just being patient with PT and rehab?

Healing long??

Hey team - a few quick questions. I’m 5.5 months in, and was in a boot for a long time (almost 12 weeks, 10 weeks non weight bearing). I’ve read the other blogs from TomTom and others around healing long. I’m in a tough spot right now, as I recently found out that my PT was really god-awful. We had made little progress in the 2 1/2 months that I had been seeing them, and a large part of that was because my form for calf-raises was putting very little weight on the impacted leg.

I’m now seeing a new PT, who is fantastic. We’ve done 2 sessions so far, and I’m noticing that for the first time the calf in my injured leg is sore. I’m hoping this will help build the muscle/strength back. We’re also working on walking as I am still limping a bit or more accurately I have a bit of a pop in my hip as I favor the healthy leg. That is gettting a bit better.

My fear is that I may have healed long, as the calf is taking FOREVER to get back and I feel like after almost 3 months of walking on it I should have more strength/mass. Putting more and more weight on my bad side when I do calf raises and struggling a bit but seems to be getting better.

What are the ways you know you healed long? My degree of dorsiflexion is actually less on my bad side vs the healthy side, while my plantar flexion is just as good on the bad side vs the healthy side. I understand that the degree of dorsiflexion is a kind of de-facto test of healing long? Any help?

20 Week Update - and question

Hello ATR family!

We are 20 weeks into the recovery, and things seem to (SLOWLY) be progressing. My walking and gait is getting better, and the limp has definitely reduced much more occasional. Not gone completely, but getting there.

I walk 20 mins on the treadmill every few days. I probably walk 1-2 miles a day.

Strength and muscle mass is taking FOREVER to come back. My calf is still very small compared to my other leg. I also have a strange lump above the scar, right around where the Stryker graft was sewn into the tendon at the very top of the repair. It’s not related to the tear at all, and the Doc said it could be scar tissue or it could be “recessed tendon” which I have no idea what that would mean. When I massage it, it goes down but comes back a day later. The lump is hard, but softens up and goes down quite a bit as I massage it. Anyone ever run into this? Pictures are here: https://imgur.com/a/pikSyff.

Also, when were you able to do one legged calf raises? I still can not do one.

https://imgur.com/a/pikSyff

Week 17! Questions galore, can anyone help?

Hey team! The MRI came back from the 10 week mark (more or less) without anything majorly concerning. There was a small amount of fluid, and the Radiologist assumes this is from “Post-surgical” change. I have been working through PT for the past 5 weeks, which has been good. We’re getting some strength back, but MAN is it slow. I am still walking with a bit of a limp, and I’m trying to lose that.
Questions:
1) When did you lose your limp? How?!
2) There is a bit of occasional “tingling” or uncomfortable feeling at the surgical site. I wouldn’t call it pain so much, and it only lasts about 1-2 seconds before it goes away. I’d say it happens once every few hours. It’s been happening for a week or so. The tendon itself feels strong when I push against the ground (seated calf raise)… anyone ever experienced this??

Week 11… and an MRI this week… Quick question for the group!

Hey team! I’m now down to one crutch most of the time, and working towards my first unassisted steps.

Last week I went into see my surgeon, and he is a bit concerned about the small gap in the back of my tendon. The gap really only is apparent when my foot is plantar-flexed (toes pointing downwards) With pressure against my toes, that gap is less detectable. When my foot is neutral (again with pressure against my toes) the tendon feels strong and the gap is almost un-detectable.

When I lay down or sit with the back of my leg up (if that makes sense) the tendon feels strong and the gap (again) is barely detectable. It’s really only when I flex my toes down.

If you can recall, about 1 1/2 weeks post-operation I lost my balance getting up from my chair, and I placed my then casted foot on the ground (weight through my heel for a second before I braced myself). I didn’t fall, but I did put weight on that foot. The doctor is concerned that I may have done some damage to the repair as the result.

I’m going in for my first Physical Therapy appointment tomorrow. My leg is very atrophied and small. I’m thinking part of this has to do with the fact that I’ve only been weight bearing for two and 1/2 weeks and haven’t done one PT session.

I’m also going in for an MRI tomorrow to determine what’s going on with the gap we’re feeling… I’m incredibly nervous that this means I’ll need another operation. But I’m also feeling as if there’s no rupture or tear, and what we’re dealing with is the result of other factors.

Has anyone else ever dealt with this?

Week 9 - Still Partial Weight Bearing

HELLO WORLD!!

I am happy to report that we are now about 1.5 weeks into partial weight bearing. My surgeon has been very cautious and conservative, despite the fact that we did surgery and he even augmented the repair with a xenograft (Stryker).

I am walking around with crutches, and have been slowly increasing the amount of weight that I bear, and can now bear about 50-60 lbs before my heel feels uncomfortable while standing. I’m 6′3″ and 180lbs, so that’s about 1/3rd my body weight. It’s not so much pain in the tendon or leg, but really just an uncomfortable feeling on the bottom of my heel. My guess is that this is related to the fact that I had gone 8 weeks+ without any weight on that foot.

Some days, my leg (including the tendon) feels sore. I’m assuming this is normal.

My biggest concern now is the progress towards full weight bearing… I’m approaching 10 weeks, and I know that many people are in shoes by this time. I am still wearing my boot all day, and even at night when I sleep (my choice). I have not yet started PT, and am hoping to do so next week.

So, here’s a general question… is two-three weeks of partial weight bearing normal?

We are walking!! (with crutches)

Hey team! Good news today… got the go ahead to start walking with crutches. Up until this point, I have been on the knee scooter and basically NWB for 8 weeks. Needless to say, I was excited!

I am taking it slow the first week and do not plan on trying Full Weight until week 2 of crutch walking. We’ll see how it goes - but thus far I’ve been taking it slow and easy here.

A question: did you find that your strength in your calf began coming back as you started walking with the boot/crutches?

Quick question - help calm the nerves here!!

Hey ATR team…

I am almost 7 weeks post op, nonweight bearing still. I have had what feels like a small gap in my repair for as long as I can remember. By gap, I mean when I run my finger along the repair from top-to-bottom, I can feel an indent. I believe this is where the rupture¬†occurred, based on the pictures I’ve seen (!) of the surgery.

Is this normal? I’ve seen my doc probably 8 times since we first went into the boot and I felt this. Each time, he’s inspected my tendon and said all was good. When out of the boot, I can still point my toes downwards (getting stronger!) and it feels like there’s still a small dent there when I’m pointing toes down.

Week 6 Update - still non-Weight Bearing and losing (a bit) of faith

Hello everyone!

Went in and saw my PDM yesterday. It’s been 6 weeks and 2 days since surgery. I was able to push off of his hands and point my toes with more strength than ever before, which is great!! However, I am still non-weight bearing, and the doctor seems to be using 8 weeks as a marker for beginning weight bearing. I have read so much material about even CONSERVATIVE approaches starting weight bearing around 4-6 weeks, and I am starting to lose faith.

If you recall, I planted my foot when I lost my balance about a week and a half after surgery. The doctor checked it out after the misstep, and said it looked fine. I think the doctor is still tied up in the risk of me falling/re-rupturing.

Every hour/day/week that I sit around is getting more and more frustrating… I was ok with waiting to week 5 to be safe… but still being at week 6 and looking at week 7 or 8 before starting weight bearing seems outrageous.

Is this a stage where I should seek a second opinion?!