On This Day in History
22 Weeks 4 Days Post Op
It was 2 years ago on this day that I originally ruptured my Achilles. Hard to believe as I never would have thought then that I’d still be dealing with the injury today. But, I am and fortunately I’m still able to stay positive. So tonight I’m celebrating my 2 year anniversary.
I am now just past 5 months post op from the second surgery to shorten my tendon. My progress has been slow, but I feel like that is starting to change. I’ve had three sessions of the Graston massage technique and it seems to be helping to loosen the tendon and put a little spring back in my step. It just feels like my calf is starting to engage a bit more over this past week. I’m hopeful this is a trend that will continue and allow me to build back more strength into my withered calf.
Along with the Graston technique, I continue with a daily routine of strengthening, balance, and stretching exercises. I’m still holding off from running, but I hope to test that again in a few weeks. I rely on the elliptical, stationary bike, and swimming for cardio workouts.
I’ve also been getting a pretty good workout from walking the dog the last several days. We received a wonderful mix of snow and rain just prior to the holidays that has covered all the sidewalks with ice. My tendon repair is tested almost daily when I need to catch my balance to keep my feet from sliding out from under me. No problems so far.
Attached below are a couple of current photos. The incision has healed pretty well. The tendon is thick although no worse than expected. A little shape has returned to the calf, but still a long way to go. Hopefully it will look even better next month. Until then, happy healing!
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It’s great you’ve been able to stay positive. Happy healing in 2010!
Happy Anniversary Tom!!,
I think this year is going to be great for both of us! I have just returned to the office from my latest physio session and they are so pleased with my progress I am cutting down to just 1 session aa week with more general exercise.
I will be 2 years in March, still can’t believe it is that long ago, but the progress over the last 2 months with the new physio is nothing short of a miracle. Our weather here in Manchester is as bad as I can remember -9 Centigrate this morning, yet I managed to walk for the bus and the tram through the snow and ice without falling. I impressed myself.
Lets hope this time next year we won’t even remember to check the blog (although I’m sure curiosity won’t let me).
So pleased for you, hopefully things continue to improve.
Annie
Tom - Glad to hear that you are staying positive, and the pictures of your heel/leg look good. Best wishes, and happy new year!
Tom, thanks for your exercise chart! I start PT today and I think it will really help me be consistent with my rehab.
Hi, Tom. I’m wondering how your doctor diagnosed the elongated tendon and if he said what may have caused it? I think I am having the same problem. I had surgery for an ATR on 6/10/09 and am not regaining much strength in my calf. I can’t lift my heel up more than about an inch off the ground and even that takes a huge effort. I’ve been doing the exercises diligently and haven’t seen any improvement in months. I’m starting to think I may have an elongated tendon and may need to start over with a second surgery. It’s thoroughly disheartening, as I’m sure you know. Jolie
Jolie - I actually self-diagnosed the condition several months before going to the doctor. Along with the lack of calf strength, mainly at the end of the plantarflexion movement, I noticed that my injured foot had significantly more dorsiflexion than my uninjured foot. I hoped the strength would eventually return, but I finally went to see a foot and ankle specialist. It took him all of about two minutes to confirm my diagnosis of an elongated tendon. If I remember correctly, the doctor had me try some single leg heel raises, which I could barely bump my heel off the ground, and then he manipulated my tendon and ankle a bit and compared it to my good ankle. I also had an MRI, but I believe this was more to confirm there wasn’t a secondary rupture to the tendon.
As for a cause, my doctor didn’t want to speculate and I didn’t really press him. I have four theories which include and error in aligning the tendon ends and setting the tension during the original surgery, a problem with the sutures holding the tendon ends together, over-stretching or stressing the tendon while rehabbing, or just bad luck due to a combination of all these possibilities.
Looking back, I really think the significant difference in dorsiflexion was the big indicator that my tendon had elongated. Do you notice a difference when you pull your toes back toward your shins? I truly hope that you aren’t experiencing the same problem. Keep in mind that you are still only 8 months post op. Some of us just take longer to heal and re-build strength. I would keep working on strengthening exercises, maybe try changing up your routine. If you haven’t already, it may be worth it to try working with a new PT. AnnieH struggled for quite some time with leg strength, but her outlook is much brighter after visiting with a new therapist. You may want to check her blog as well.
I hope things turn around for you, but feel free to ask any questions you have.
Tom,
Thanks so much for the response. I do have significant more dorsiflexion on the injured leg — I can flex it about two inches more than the other foot — and I don’t feel the same tension as I do with the healthy leg. I spoke to an orthopedist (a friend of a friend) on the phone yesterday (before I wrote to you), and when I told him about this difference, he thought it was significant and, when combined with the weakness, indicated an elongated tendon. In fact, he became convinced while talking to me that that is what I have. But he hasn’t actually seen me, so he can’t be sure. I’m going to make a few appts with doctors in my area and see what they say.
I actually did change therapists after about 3 months with the first one. The second one was better, but I stopped going about 3 weeks ago. The more I think about it, the more convinced I am that there is something wrong, probably an elongated tendon. I know it can take time to heal, but I haven’t seen any improvement in about 4 months. I’m pretty much exactly where I was in late October. When I went to PT in January, the therapist tested my strength — I was able to lift about 20% of my body weight with the injured leg (vs. 100% or more with the healthy leg). Does that sound familiar?
I do have a few more questions, if you don’t mind — First, how’s your progress going this time around? Have you noticed a difference in how fast/well your strength is coming back? Second, I assume there’s a risk that it could happen again — what can you do to minimize that? Just take a more conservative approach? Third, I’m guessing there must be a time at which the tendon has healed and the risk of elongation has passed — has your doctor said when that is? I’m wondering as well when it may have happened for me, assuming that’s what I have. Fourth, besides continued weakness, are there any risks with not fixing it at all or with not fixing it right away? I’m not really doubting I would choose the surgery, but still…
Reading your blog, everything sounded so familiar to me. And it just makes sense. I feel certain that something is wrong. In a weird way, it’s almost a relief to be able to identify the problem, as depressing as it is to think about having the surgery again. What’s been even more frustrating is to keep hearing that everything is fine and it just takes time to heal. I’ve just struggled so much with the exercises, but whatever I do, I can’t get the muscle to engage much at all. The rest of my body compensates for it, and I just can’t work that calf muscle.
Anyway, I want to say how grateful I am to you for your blog. And how sorry I am that you had to go through this.
Jolie
Jolie - Your symptoms and experience sound very familiar. The significant difference in dorsiflexion definitely makes me concerned. As I mentioned earlier that seemed to be the thing that convinced me my problem was structural. It sounds like you’re taking the right approach by talking to some doctors. If possible, I would recommend seeing a foot and ankle specialist. They may have more experience with the situation than a regular orthopedist.
As for your questions, I’ll try to update my blog in the next few days with greater detail, but I’ll mention a few quick items. The progress has been slow, but there are signs that I’m getting some more strength back this time around. I’ve dealt with soreness in the tendon which I think is mainly from the shortening process. It is just taking a long time to get the tendon to stretch back to a normal length. It has also been slow because my calf was probably at about 50% when I had the second surgery, so I’m having to overcome a lot of atrophy.
I’m not sure exactly how to reduce the risk of elongation. My protocol the second time was similar to the first. I spent two additional weeks in a walking boot, but I actually started physical therapy several weeks earlier. The biggest thing was to make sure I wasn’t dorsiflexing my foot past neutral until I was out of the boot at 12 weeks post-op. I guess you could say this was the point when my doctor felt the risk of elongation had passed or at least was significantly reduced.
As for risks of not fixing it, my biggest concern was not for the tendon or even my calf, but for other parts of my body such as my knees and lower back. I know my body was compensating for the weakened calf and I just felt like at some point I was going to end up with some other injury. I asked my doctor about this and he wasn’t overly concerned, but I also spoke with a close friend who is a PT and that was actually her biggest concern. I guess I looked at the second surgery as being preventative medicine.
I know exactly what you mean by feeling some relief in having an answer to your problems even if it means you may have to have a second surgery. It’s just nice to know you’re not doing something wrong and there are variables outside of your control that are affecting your healing.
I hope you’re able to find some additional answers when you meet with the doctors. Keep me posted and let me know if you have any other questions.
Hi, Tom.
Thanks again. I went to see my doctor today (the one who performed the surgery in June). He is a sports medicine orthopedist, not a foot and ankle orthopedist. But I wanted to see what he had to say and to get him to refer me to a specialist — which he did. He also said he thinks everything is fine, it’s just going to take more time. I don’t buy it. At all. But it’s OK, I’ve got several appts in the next few weeks/months (some of the doctors are booked until April), all with foot and ankle orthopedists, and I’m hopeful that at least one of them will give me an accurate diagnosis.
I’m very glad your recovery seems to be going better this time around. … I hadn’t even thought of the increased atrophy. I guess my calf will be pretty much non-existent if I have another surgery. I’m a woman (in case you hadn’t guessed), and my calves aren’t exactly big to start with. Oh, well.
I know what you mean about being concerned about the rest of your body compensating for the weak calf. That’s how I feel too. I already notice things, like my right lower back is sore a lot. I think it’s from not walking properly because I can’t push off my left foot. It’s hard to know what else I’m doing to compensate and what part(s) of my body are being strained.
Yes, exactly. I’ve been second-guessing myself a lot. But I really feel that something is wrong. And I want to get it fixed.
Good luck with the recovery!
I’m with Tom, Jolie. If you can lift your toes (dorsiflex) a lot more than normal, or more than the other foot, I think that means that the AT is (or the AT-plus-calf are) longer than the other side. And that also explains the difficulty in doing a “high” heel lift.
And it’s also sad but true that the contortions the rest of our body does to compensate for these problems can cause problems of their own. . . Been there, done that!