Mission Accomplished
14 Months 5 days Post Op #2
33 months to the day of my Achilles rupture and two surgeries later I finally achieved my primary recovery goal. After all the highs and lows and twists and turns of this journey, I finished another journey this past Sunday by completing my first post-ATR marathon. The race went well and I didn’t notice any unusual soreness with the Achilles during or after the race. Perhaps the soreness in my hips and thighs is masking any AT pain??
My recovery from the second surgery is still a work in progress. As a quick recap for some of the newer bloggers, my AT healed long following the original rupture and surgery and I had a second surgery to shorten the tendon. I’m now 14 months post-op from the shortening surgery and I continue to experience some tenderness and stiffness in the tendon. In addition, my calf is still weaker than I’d like it to be. However, all of these symptoms are improving, especially when I compare how things felt 3 and 6 months ago.
I checked in with my surgeon back in June and he was not concerned about my progress. His opinion was that the tenderness was likely the result of multiple surgeries and the subsequent scarring that built up around the tendon. He advised to give it more time and continue exercising as long as it isn’t too painful to do so. I was also reminded of a comment he made prior to the second surgery in which he said it could take up to 18 months before I know the success of the surgery. I was hoping to realize faster progress, but it looks like his timetable may be pretty accurate.
The healing process continues to remain a significant part of my life. The tendon is still the first thing I think about when I wake up and the last thing when I fall asleep at night. More and more I find that I’m doing some small, reactive movements without thinking about the tendon, but I’m still looking forward to the day I start jumping and running without any reservations. I’m hopeful this will happen once more strength returns to my calf.
I’m glad that my experience with this injury is still a rarity, and that most of you continue to heal well and on schedule. However, I hope that my experience may be helpful for those who’s recovery does get sidetracked for one reason or another. Try to remain positive and don’t give up. While I’ve finally achieved my primary goal of running another marathon, I know that I still have plenty of work to do to improve my calf strength and hopefully one day put this injury to the back of my mind.
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Awesome! Congrats on running the marathon. You stated that your calf is still weak,how did your it hold up? I have been running as well, but any type of speed work gives my calf trouble. I would like to run a marathon again soon so thank you for the inspiration.
tomtom - Congrats on finishing the marathon. Glad to hear from you again, and I wish you the best on your continued recovery. Thanks for your post!
+1 to your “More and more I find that I’m doing some small, reactive movements without thinking about the tendon”. I noticed that a LOT this time. It’s amazing how many times I do (and have always done) little “dances” that would have scared me witless when I first got into 2 shoes. . .
I’m surprised that the second-surgery rehab is so much slower than a normal first-timer, and that your Doc knew it would be, too!
Good Luck, and continued Good Healing!
@Josher - The calf was fine during the race. It was a little sore after, but nothing unusual following a marathon. I believe my gait has adjusted to compensate for my weaker calf, so some of my other leg muscles are probably forced to work harder. I’m not sure if that is why my upper legs still feel pretty sore, or if that is just my legs still getting used to running longer distances. I didn’t do any speed work while training for this race as I was more concerned about just getting my legs strong enough to cover the distance.
@Norm - The reason for the longer recovery time is the state at which my calf was in prior to the second surgery. I was starting with less than the normal ATR patient. I had only gained maybe 50% of my strength back following the first surgery. It wasn’t like a normal initial recovery where your calf is starting at 100%. My surgeon had a formula that estimated about 2-3 months of recovery for every month of atrophy. I’m sure that isn’t lab tested, but based on his 15+ years of experience, which I trust.
Tom,
Fantastic news!!! Congratulations on completing the marathon and achieving your goal!!
Jolie
tom - congrats on the marathon..wow, what an accomplishment. i’ve been pre-training for IM-Wisco next September and my knee on my repaired leg is giving me fits. i’m prettty sure it’s because of the weaker quad and calf on that leg…going to try and hit the gym a bit this winter to work on strengthen those muscles back up. crazy how 8-12 weeks of immobilization can take years to build back up from. I’m hoping theres a category in the IM for Achilles rupture recoverees! Best to you in your continued recovery.
Tom, congratulations on the completion.
I’m still concerned as to what information you received that made you believe your tendon was elongated. I have done plenty of research to discovery that tendon elongation is a natural consequence of acute trauma to the tendon.
Please advise,
Thanks, my tendon is a bit longer than the other one and i was told this is normal. It took me a bit more time to be able to do the unassisted 1-legged calf raise, but was still able to accomplish after 7 months.
Thanks,
@livelaughcry – There is more detail in some of my previous posts, but I’ll try to summarize here. The symptoms ended up being pretty obvious even though it took me about a year to realize. Most significant was the lack of end range plantarflexion strength. I could only bump my heel slightly off the ground when trying a single leg heel raise, and couldn’t really extend upwards. My calf muscle couldn’t contract enough to account for the extra slack in the tendon. And this was still the case at 18 months post-op with very little change in the previous 6 months.
I also had significantly more dorsiflexion on the involved side which was obvious to the naked eye. I don’t remember any exact numbers, but it wouldn’t surprise me if my involved side had an additional 10 degrees or more of dorsiflexion. When I finally saw a foot and ankle specialist, it took him about two minutes to confirm the tendon had healed long, which is what I had already concluded.
You’re right that some elongation is difficult to avoid during the repair and healing process and is probably natural. My surgeon mentioned that elongation can be up to 5 mm, and I remember reading something similar in a journal article. For comparison, my surgeon removed approximately 2 cm of tendon, so the elongation was significant.
If you are able to do unassisted 1-legged calf raises without any problems, then I wouldn’t be too concerned about elongation. I only elected to have a 2nd surgery when it was clear after 18 months that I had regained only about 50% of my calf strength and that it would likely affect me for the rest of my life.
Wow well done Tom, so pleased for you and your successful marathon. I bet you were really pleased with yourself, I hope you gave yourself a nice ‘treat’.
I can’t believe how the time has gone, I am now 31 months but unfortunately my calf muscle is still ‘missing’ I just wish I knew where it was, and how to get it working again.
Just the other day I was crossing the road outside my office and a Police car came hurtling round the corner and I really needed to move out of its way, I tried to run but nothing, I just managed to walk a little faster, fortunately the Policeman must have realised and slowed down, I hope that does not mean that whoever he was chasing got away !!!
Anyway, really well done on the marathon.
Annie
Hi again Tom,
My spam word was FRIENDS, which I thought was very appropriate, thanks to Dennis I am also still in touch with Smish, I had an email from her only today, and also Richard, we email with comments to each other about our football teams. So big thanks to Dennis for giving us friends from all over the world.
Annie
@Annie - Thanks for the comments. I’m sorry to hear that your calf muscle is still “missing”. I know how frustrating that can be.
You are spot on with regards to “Friends”. The one positive I consistently take away from this injury is the terrific cyber-friends I’ve meet through this blog. It has been such a big help to be able to communicate about this injury with people who know exactly how you feel.
That’s probably a good reminder for us all to make a donation to help offset the cost Dennis incurs to keep this site running. It’s easy to do by clicking on the “make a donation” button in the upper left corner of the Achillesblog home page.
Hi Tom, Just randomly checked the blog today to see if I recognized any names and there you were. Glad to hear you are doing well. I continue to improve also 2.5 years later. I finally feel like things are getting back to normal and the gait continues to improve. I am hoping to do a marathon too.
Jim
@Jim - Thanks for the comment and I’m glad to hear that you are feeling like things are getting back to normal. I think it’s great that you’re thinking about doing a marathon. It really is a rewarding experience. Good luck!
Thanks for the response Tom, very much appreciated. I see now that after 18 months one would expect a massive increase in strength. Good thing you had the second surgery then
Glad you pulled through both because that takes tremendous mental energy and stamina. I hope you have treated yourself to many gifts!
Thanks again for your blog, it has both helped inform and inspire.
Thank you
Hi Tom, I have spent hours and hours reading yours and others blogs - thank you for sharing your story! It’s unbelievable yet invaluable information and inspiring to others facing the same problems. I was so happy for you when I read about your success running the marathon in this post after everything you’ve been through!!
I fully ruptured my left AT and had an open repair 8 months ago. It’s now been confirmed that the tendon is long. You were about the first resource I found during my immediate internet research and from reading through your posts, I have similar symptoms that you faced…. the lack of calf, inability to do 1 leg heel raise, increased dorsiflexion (~6-8 deg) on injured leg, almost non existent calf strength at the end of the plantarflexion movement (past the ball of the foot).
My next move is to talk to a 4th orthopedic doctor about possibly a revision surgery now that I know what the issue seems to be. But finding one that has dealt with this is not that easy. I’ve hit so many dead ends, now they’re just uturns for me (as I am sure you are fully aware)! I’ve seen quite a few people asking the same question in various posts but haven’t seen any answers yet (although there are many more blogs I haven’t gotten to yet). I was wondering if you have the names of some surgeons that have done revisions? Would you be willing to sharing them via email? I would be so so grateful!
suzb
suzb - Sorry I didn’t reply sooner to your comment. I still check into the blog, but not as frequently as I used to. Anyway, sorry to hear you are suffering from similar complications that I ran into. I sent you an email and I would be happy to share my experiences with you. Perhaps I’ll post an update to the blog as well as I notice the “healing long” topic comes up from time to time. Not a lot has changed, but there could be some long term information that people find useful.
Hi Tom
Have finally had time to read your whole blog.
I too have an elongated tendon after rupture 1st April 2010. I had conservative treatment. After which they could not get any response to the Thompson test.
Carried on with physio for 6 months with no real improvement. My walking gait was terrible. Foot out to the side and no real flex of the knee. My calf weakness was so bad that I could not step off a 3 ” step leading with my good foot, without crabbing down sideways.
After ultrasound scan confirmed elongation I was offered FHL transfer as a correction.
Decided at this point to try a different physio. So went to a speciallist sports physio. He really worked the calf muscle hard. I had explained that I did not care if I re ruptured as consequence of my future surgery would be much the same.
Within a few weeks he had improved my walking gait, and general strength in the calf to the point where I could do a limited single leg heel raise.
I am not a marathon runner, never was, never will be. So I felt justified in my decision to cancel the surgery.
I think your story is remarkable. Choosing to put yourself through the agony of the immobility, especially after the inital experience would have been so fresh in you mind.
I feel pretty happy where I am at the moment. I can walk as far as I need to, over rough terrain, with little discomfort. I havent broken into a jog yet, but if a work on my general fitness I feel as though I could with no problem.