Startin’ PT

Started physical therapy today.

My therapist said he was “shocked” that I walked in without “the boot”, but after telling him that my surgeon (Dr. Ted Parks - I’m gonna plug him shamelessly from now on…) said that it was OK for me to be in hiking boots, my therapist agreed.  I did get a mini-lecture on the perils of healing long and was given an extra 10 mm worth of heel wedge to put in my hiking boots.  Given what I’ve read here, I was in complete agreement with my therapist’s plan to wait another 2 weeks (until I am 8 weeks out) before doing any stretching or strengthening.  So, what did I get today?  First an exam, then heat, ultrasound, massage, 15 min on an exercise bike, using my toes to bunch up a towel on the floor, and then ice.  Nearly all of it peppered with more warnings about progressing too quickly and healing long.  The only thing that hurt some was when he was massaging away the edema on the top of my foot.   I’ve been being rather ginger with the area around my incision, and it felt surprisingly good to have a firmer hand there.

I’ve been given a couple of things to do on my own and OK’d to be on the exercise bike at home which is good, because I feel like I’m starting to put on some extra weight.  Speaking of weight, I’ve been surprised that I haven’t put on more.  My activity level is obviously way down and I’ve actually been eating more - especially during the first two weeks when I wasn’t working.  I am wondering if the injury/surgery induces somewhat of a hypermetabolic state?  Googling “injury hypermetabolism” yields a bunch of citations regarding severe burn and head injuries, so no help there…oh, well.

5 Responses to “Startin’ PT”

  1. Thanks for this post. I am a bit like you and wanted to get on with things but didn’t realise about the tendon healing long. The last thing I want to have another op to fix it. I was going to book some private physio but think I will wait until I see my surgeon at 8 weeks out and see what he says.
    Thanks for this useful post.

  2. I’m 8 weeks post op and AT still very tight.. so don’t know how you can heal the AT long after surgery which shortens it. I’ve heard of the AT healing long with conservative treatment but not surgery.
    If you do walk without the boot and don’t want to stretch the AT, then keep the bad leg in front more.. and don’t step too far in front of your bad leg with your good leg.
    In any case, I would follow you doctors advice to be on the safe side.

  3. Ultidad: Funny you should mention the weight thing. I thought it odd that I lost so much weight after my rupture. The only answer anyone tried to offer me was that I had just had a huge shock to my system. Duh!! But it still didn’t make sense. I was really frustrated. I guess it was better than getting bigger but I still had to go out and buy new pieces of clothes. I am glad someone else brought that up so that I don’t feel so crazy.

  4. tedb and others - I am proof that the tendon can heal long following surgery to repair a ruptured AT. You can read my blog at achillesblog.com/tomtom which includes my current recovery from a surgical procedure to shorten my elongated AT. You’re correct that the AT healing long with conservative treatment is more common, but it definitely occurs after surgery as well. There are a few others that are in similar situations.

    I can’t be certain as to how I ended up with an elongated tendon. I’m not sure if something went wrong while in the operating room, or if it got stretched too much during rehab, or if I just have some odd, stretchy collagen. Initially I thought it most likely occurred during the first surgery. However, now that I’m recovering again, I see how easy it can be to stretch the tendon too much before it regains full strength. And, unfortunately, I don’t think its just a matter of not stepping too far forward with your bad foot while walking without the boot. I have been very careful with my movements after both surgeries and have always followed doctor’s orders.

    I’m not trying to scare anyone, just trying to help share information. Cases of elongated ATs are rare, but it does happen. We all need to be careful while we heal and don’t get too caught up with how quickly you’re able to get back on your feet. I know sometimes it seems like our doctors are stubborn, but I think they are often trying to protect us from ourselves.

  5. Tom- I knew that I had read about someone’s recent shortening surgery. Thanks for filling in my faulty memory.

    Smish- I wish that I’d lost enough weight to require new clothes :)

    tedb- without going into a boring micro-cellular lecture, I can actually easily understand how a tendon could heal long, even if the ruptured edges are trimmed before being sutured together. Tendons are not non-stretchable structures, so if there is longitudinal tension as the new collagen is being laid down, then those collagen fibers will used up the space that is available to them. I wish that I could come up with a non-medical analogy - maybe someone can help.

    graham- even though I’ve been OK’d for 2-shoes, I’ve actually put the boot back on when I knew that I had a bunch of walking ahead of me at work. Hang in there.

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