It’s been a year since my last post and 3 years and 10 months since my initial injury and surgery.  I still check in at achillesblog from time to time, but generally leave the commenting to the newer crop of rupturees.  I decided to add another post because I notice the “healing long” topic comes up every few months, and I know there aren’t many resources available for reference.  So, as one who “healed long”, I’m including an update to give a long range perspective now that it’s been over two years since I had a second surgery to shorten the tendon.

Life is back to “normal” in the same way it has been for the last year.  The injury is still a part of my life, but it doesn’t hold me back from doing or trying the activities I enjoy.  Running continues to be my main source of exercise and I completed another marathon earlier this month, my second since the injury.  I finished up a few minutes faster than last year, achieving my main goal, and just a minute off my personal best.  I can’t help but think that I would have cut several more minutes off my time if I wasn’t still trying to overcome this injury.  Aside from a break during marathon training, I still work on strengthening my calf which continues to be the main shortfall of my recovery.

The rehab from the second surgery has lasted much longer than I ever imagined.  My surgeon did warn that it could take 18 months, but of course I felt like I’d be back to normal within a year.  18 months passed and I was still concerned/disappointed with my recovery.  I made some slow progress, but my calf strength was still lacking and I was dealing with some nagging tenderness in my heel.

Eventually I decided to meet with a new ortho just to seek a different opinion.  I was fortunate enough to get in contact with a foot & ankle specialist who was not only familiar with achilles reconstruction as a surgeon, but also as a patient.  Dr. C had chronic issues with his ATs which eventually required surgery a few years ago.  He had lengthening issues in both tendons following surgery, and eventually had shortening surgeries performed on both legs.  One leg even required a third surgery.  My appointment with him was very surreal.  I felt like we were a couple of war veterans swapping combat stories.  Unfortunately, I got so caught up with talking to him as a person and fellow patient that I forgot to ask many of the medical questions I had such as, “What can cause a tendon to heal long?”.

After comparing calves and recovery stories, Dr. C described a tendon augmentation surgery that could improve my situation.  However, he quickly recommended against such a surgery as he felt the potential benefits were likely to be minimal and not worth the inconvenience of another surgery.  Hearing a surgeon recommend against surgery just about knocked me out of my chair, but it made his opinion that much more valuable.  At that point I felt I had explored all my options, and determined that time and continued strength training were my best options for getting closer to 100%.

It’s been 6 months since I met with Dr. C and I’m happy that I continue to notice some small improvements.  My right calf is still weak when compared to my left leg, but it is better than it was earlier this year and definitely better than it was prior to the second surgery.  The tenderness that I constantly felt in the tendon finally dissipated within the last few months and my ankle movements feel more fluid and natural.  I still struggle a bit with single leg heel raises.  I can’t quite get the last bit of push to really extend up onto my toes.  I’m able to do so if I cheat a little bit and use my finger tips to help with balance and offset a bit of weight, but still a bit weak. My running stride is also a little weak and I still feel I’m recruiting other muscles to offset the lack of calf strength.  But, this too is better than where it was 6 months ago.  I may try some different things with my stride, such as shortening it, now that I’m done marathon training for awhile.  We’ll see if that makes any difference.  In the end, I think it just comes down to calf strength.

So, where do I go from here?  The last few months have been encouraging even though my calf is still not as strong as I’d like it to be.  It’s good to know I’m still making progress given that the second surgery was over two years ago.  I’m somewhat resigned to the fact that a 100% recovery is not in the cards for me, but it doesn’t mean I can’t continue to move forward.  If I had to guess, I would say I’m somewhere around 75-80%.  As I mentioned earlier, the missing strength doesn’t keep me from doing anything I want to do, but I’m not able to do things quite as well as before the injury.  I can’t jump as high or as long, but I can still jump.  My running stamina may not be as strong, but I’m still able to run long distances.  So, overall I can’t complain much.  The last goal I’d like to achieve is to get to a point where I don’t think about my calf or tendon when attempting to jump or hop on my right leg.  Hopefully that happens soon.

Healing long seems to be a poorly documented and/or understood complication of an achilles injury.  Fortunately for those concerned, I’m sure the main reason for the lack of information is the infrequency of the condition.  It is something to be aware of during rehab, but hopefully not something that creates any more concern than the injury itself.

]]> http://achillesblog.com/tomtom/2011/10/17/healing-long-2-years-later/feed/ http://achillesblog.com/tomtom/2010/10/04/mission-accomplished/ http://achillesblog.com/tomtom/2010/10/04/mission-accomplished/#comments Mon, 04 Oct 2010 21:46:43 +0000 tomtom http://achillesblog.com/tomtom/?p=346 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.

It’s been awhile since my last post, as seems to be typical at this stage of recovery.  I am now around 6.5 months post-op from the second surgery, and while I try to put this injury to the back of my mind, it still remains a top priority.  I guess I just haven’t felt a need to post much lately as my recovery is still moving along slowly.  The tendon is still a bit tender when it’s stretch to the extents and during some lateral movements, but it is better than the last time I posted.  My calf is a bit stronger, but still far from normal.

I just started receiving the Graston massage treatment when I last posted .  I ended up having a total of about eight Graston sessions.  I noticed some improvements during the first three or four sessions, but then the results started to plateau.  My PT decided to switch to ultrasound to help break down and even out the scar tissue.  The ultrasound may be helping as my tendon feels a bit more pliable than it did a few weeks ago, although it’s difficult at this stage to determine how much of a factor time is to my healing.

In addition to the manual therapy, I continue to work on an endless array of exercises to improve my strength and balance.  It feels like I could spend 2 hours at the gym and still not get through all the exercises.  So, I do my best to attain a good, daily balance of strengthening, balance, and cardio exercises.  I have recently advanced to some plyometric exercises which should help build some explosive power back into my leg.

I also started to ease back into running.  Over the last couple of weeks I’ve progressed from two minute intervals of running up to about five minute intervals, with a couple minutes of walking in between the intervals.  There is definitely a fair amount of fatigue in my leg, so I’m cautious not to progress to quickly.

While I occasionally get discouraged about my calf strength progress, I remind myself that my current recovery is a bit different than a standard ATR recovery.  I went into the second surgery with a calf that was probably at half its normal strength, so I’m trying to overcome a fair amount of atrophy.  My surgeon told me prior to surgery that it could take a year and a half to get back to full strength.  If that’s the case, I can’t be too upset with my current status.  Hopefully the tenderness will continue to subside and I’ll be able to get a bit more aggressive with the strengthening exercises.

Cheers!

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!

At my last follow up appointment my surgeon suggested trying a deep massage technique called Graston to determine if some of the discomfort I’ve experienced is related to the scar tissue and any adhesions around the tendon.  My physical therapist was not certified with the Graston technique, so I needed to find a new one.   Fortunately I found a PT clinic that is convenient to both home and work.

Today I had my first appointment with the new PT and my initiation with Graston.  Several people with first hand knowledge gave me fair warning of the pain that can be involved.  I also read that people with red hair and fair skin may find the treatment more painful.  Of course, I have both red hair and fair skin.  But, I was more excited to try something new rather than nervous of the possible pain.

After discussing my long history with this injury and the science of Graston, the PT got to work.  I was pleasantly surprised that I didn’t find the technique to be all that painful.  I don’t consider myself to have an unusually high pain threshold, so I’m sure the level of pain is different for everyone.  I believe the PT also mentioned that she would probably start off a bit easy to see how my body reacted to the treatment.  Perhaps the pain will come later??

It is obviously too early to tell if the Graston massage was helpful, but my ankle and calf did feel a bit looser following the treatment.  The PT mentioned that it generally takes about 3-4 sessions to notice if Graston is providing any benefit.  I’m hopeful that I’ll see some improvements by the end of the year.