wacaine’s AchillesBlog

@Ed,

I am ~1 year 4 months since I ruptured and the bump is still there. It does not hurt much if at all anymore which is good. I think I was over doing the stretching. I pretty much stopped my therapy for about a month because I was getting defeated with the pains and such. I continued to live my life, walk and bike etc. but stopped trying to increase my range of motion by stretching or doing heel raises. I think that did it because the pain in the heel went away, the bump did not though. This was around ~9 months. I keep saying I will follow up with the doctor for an x-ray to see what it is but as long as it is not hurting I have no urgency. Only issues I have with it now is I get a blister when I wear certain dress shoes.

I am still having issues with my Posterior Tibial Tendon (PT) though :(. It has gotten loads better but still is painful when I first get up. My ankle pops in the morning a lot too right in that spot. I can do full single heel raises now with only minor discomfort in my inner ankle (PT probably). My calf is still visually smaller than my good leg and its strength is not fully there but I stopp

Hi Wacaine,

I hope you are doing well! I am currently about 6 months post-surgery, and my state of affairs is almost exactly like yours was when you made this post (pain and bump in same area). I was wondering how everything turned out, how you resolved the pain issue, what it was, etc. Let me know if you ever catch a free moment! Philip, if you are still around and could chime in, id be curious as to how to progressed and what you did as well!

-Ed

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My DF seems to be relatively good. Now at 23 weeks I can get to 9cm, but with the caveat that that is only after two previous stretches - on the first stretch I will be at about 6cm, then 7.5cm, then 9cm. It hurts though, especially at the end of the stretch as the tension is released. The real limiting factor seems to be the PT - the main tightness is very much on the inside of my ankle. My good leg has good flexibility - c 13cm.

At the physio yesterday I got strapped into a biodex machine to test the relative strength of my ankles for the first time. The bad ankle is at roughly 50% of the good one (although my good one is relatively strong as a result of doing a lot of cycling the past 5 years). My physio seemed a bit disappointed with that as I think he’d wanted to be able to say I could start thinking about running soon, but to be fair I’m only just back on my bike (which is my main sport) so I’m happy I can now push on and really concentrate on a combination of heel raises and ever longer cycle rides.

I’ve also found the hot tub is a really good pain/tension relief for the PT. It only lasts a short while after I’m out, b

@Philip S

Thanks Philip for the post! I too have a very hard lower calf along the scar line. The skin used to be tightly adhered to it as one solid piece which has loosened tremendously by is still attached to the below muscle/tendon below.

Just curious what is the range of your DF right now? Mine at 22 weeks was toe moved 4 cm off the wall and could still touch wall (vs my good leg of ~12 cm of wall).

I have been logging my progress of DF stretch since the beginning. I am gaining just under 1 cm a week (I am most likely pushing it a little too hard which either gave or at the least is not helping the PT tendonitis and bump pain I am having). At this point I can now move my toe away from the wall ~7cm and touch the wall.

Also, what I think has been helping me I think is my bi-weekly visit to the pool and sit in the hot tub for ~20 minutes. Putting my ankle near one of the jets also feels awesome.

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Hi wacaine

It looks like you recovery progress is very similar to mine. I suffered a full rupture playing field hockey on astroturf at the end of September (so, 3 or 4 weeks after you did yours?). Treated conservatively in a cast for 5 weeks, then partial weight bearing in an airboot for 5 weeks with physiotherapy once a week.

I’m now 22 weeks post injury and have been going to the gym regularly for 8 weeks. Strength is gradually returning to the calf but, like you, I’ve had inflammation of the Posterior Tibial tendon and have a lump on the tendon in much the same place as you. The other noticeable issue is a build-up of firm tissue towards the bottom of the calf - I don’t know if this is calf muscle or scar tissue. Do you have something similar as well?

In terms of recovery, my flexibility is gradually improving with some aggressive, full body-weight stretching - this is really uncomfortable, but I’m starting to see the benefit and can touch the wall with my knee.

Pain from the tendon lump during exercise is easing now, so hopefully that is improving.

I thought the PT tendonitis was going, but my physio had me doing

I didn’t pay much attention to bumps, but when I overdid (1-leg heel raises as soon as I could walk without a limp), I developed a pain that seemed to come right from there (back of the heel), that lasted a month. My cure was to back off the exertion, and go back into a hinged boot until the pain went away, a month later. No pain there since, and no bump that I notice, anyway.

I know some people have had bony spurs removed from the back of their heels (some with AT removed and reattached, some not), but I don’t THINK that’s what “heel spur” usually means. I don’t think so. . .

Bummer, Wacaine, hope it improves for you. That issue of the healed AT lengths, not length — i.e., the sometimes different lengths to the two different muscles — doesn’t seem to get much attention, even when we’re discussing “healing long” and “healing short”. My AT-soleus also seems shorter than my AT-Gastroc, but in my case I prefer the AT-soleus length.

Details are on my blog. I hadn’t exactly left my boot yet. Hinged boot, SLOW rehab, I realized that I was walking normally in the hinged boot, and had just taken my first normal no-dip steps at home that morning. When my young PT (University sports-med clinic, tho I was ~55) saw me walk, she paraded me barefoot around the whole (large!) clinic!
Then we went back to her table and did more work, mostly exercises. She told me to do 1-leg heel raises. I told her it was too soon, because no way could I do 8 of ‘em — my resistance-training rule of thumb. She said “Just do as many as you can,” a sentence that should NEVER leave a PT’s lips, IMHO! I did maybe 3 or 4, grunting and sweating. TWO dummies!
I then bicycled back home in the boot, but I think I’d started not using at home. (This was ~11 years & another ATR ago!)
The pain started a few hours later. It was way worse than the ATR pain, tho the post-op pain was pretty bad. It was obviously from overuse, so coming out of the boot seemed wrong. It was exactly a month, in the hinged boot, before I could stride normally again without that pain at the back of the heel.
I’ve always

Norm,

Question about your set back. Did you go into the boot because it was that painful or could you still walk with it? Mine for the most part is bearable, kinda like a bruise.

As for my heel pain I figured it might be from overuse. It is just soo hard to not do stuff now that I am starting to be able to. I am going to lay off my leg for a few days and see if the pain lessens. I have mentioned to my OS and PT that my heel hurts. It has been hurting since I could bear weight and they said a little bit is OK and expected, a lot is not. Pain is relative so it is kinda hard to know when I am reaching where it should not be.

Seeing a PT? Still doing any follow-up with your OS? Either one might have a smart opinion about the lump, and maybe the discomfort/pain, too.

There’s an old joke (VERY old!) that you remind me of with your “If I limp around it hurts more than if I force my calf to engage.” Something like this:
Patient: “Doc, it jurts every time I do THIS!”
Doctor: “So don’t do THAT!”
BadaBUM!

The bottom of the AT attaches to the back of the heel (”calcaneus”?) bone. (Pulling up on that spot rotates the ankle joint, toes down.) Based on my own 2-ATR experience, I think that pain there is NOT generally something to be worked through or ignored in a “no pain no gain” way, but a sign that you’re overdoing. Not a statistically significant sample, but that’s where my leg hurt (a LOT) after I over-did heel raises after ATR #1, and set myself back a MONTH (back in the hinged boot!) until that pain subsided.

Otherwise, 15-16 weeks was still very early times for lots of us, when it comes to walking perfectly, “losing” the swelling, and expecting your two legs to look identical.

If you consider the leverage or “mechanical advantage” involved w

There’s a time to stretch and regain DF ROM, and you’re probably pretty close. Nobody really knows when the window for “healing long” ends, but the window for re-rupturing starts closing around where you are now (~12 weeks post-whatever).

Some patients, especially post-op, never regain full DF ROM, because their surgeons trimmed the torn AT ends a lot, then stitched it tight and short. My OS from my first ATR told me he’d done that on purpose, to make sure I didn’t heal long. He also kept me immobilized FOREVER because he was that kind of a guy. It took me a while to get back, but by 10-11 months post-op, I was back on the volleyball court, with no deficit that I could see or feel. Eleven years later (recently), I was told by a podiatrist that my short right AT was causing harm to my foot joints, so healing short is not a complete “freebie”. (See my blog for more details.)

I’m usually a serious “take it easy wimp” when it comes to DF stretching, but you could certainly use some. Don’t go nuts, though. If it’s included in bit.ly/UWOProtocol by 12 weeks, I’d say Do It. That definitely includes some gentle-but-passive DF stretch

At 12 weeks, I was right about where you are in dorsiflexion, and planterflexion was near 100%. I actually didn’t do any active stretching until my 12th week, as I was more worried about healing long than I was about regaining my ROM. My thinking was that I would rather get my ROM a little later, than to heal long. So my only form of stretching up until that point was to just shuffle around my house. It was enough to loosen up the adhesion that stiffened up my ankle.

After 12 weeks, I began to actively stretch. I would stretch just enough to feel a little pain, but nothing past that. Every day just a little bit more. I was super careful not to push hard. For the wall test, it took me about 20 days to finally be able to touch my knee to the wall. I probably could have done it in about 2 weeks, but I was aiming more to stretch out the adhesion instead of stretching the tendon. I put such little pressure on the stretching that the entire process was pretty much painless.

However, I should mention that I was non-op,

I’m at 19 weeks now, and I basically have the same ROM as my good leg. Right now I’m just trying to

My blog remembers my answers better than I, alas!

My swelling lasted way longer than I preferred, and I started a page just about that! The foot hurting thing faded steadily, but took a while to vanish completely. Like maybe 3 months in, if I stepped barefoot on a thin phone cord or walked onto concrete, I still “noticed”. Crocs felt great, and I still wear a pair around the house!

+1 to what Starshep said!! I used a “cast shoe” — a strap-on Velcro “sandal”, designed to add a sole to a walking cast. But I strapped it to a sandal, and wore that assembly on my “other” foot, opposite the booted foot, while walking around the house. It made me level, so my knees and hips survived. For outside, I added multiple footbeds inside my tallest hiking boot, and I was very close to level. DO NOT train your body to walk out of balance! Even if you avoid injury, you’ll probably mess up your natural gait, just as you’re starting to try to remember how it goes!

Wacaine:
You will need to find a way to level your good foot with your foot that is in the boot. Having the 2 feet at different levels will put a lot of strain on your body. I was able to do it by shoving a pair of folded up athletic socks into the heel area of my shoe. There are also commercially available heel lifts and you could also get custom made ones at a shoemaker. Or perhaps your doctor has some ideas.

Hi , I certainly felt a certain discomfort inside left of my ruptured ankle and still feel a tightness more on this side when doing certain exercises . I can only speak for my own injury , but my PT explained that when healing you get adhesions forming . In other words scar tissues also connects to the surrounding tissues . Now I am in two shoes my PT massages the thickened area to remodel and help reduce these adhesions . I believe through time these reduce and the tendon gets leaner .
Heal well !

cgdh13,

My surgeon gave them to my wife in the waiting room without me ever asking for them. I didn’t even think that was an option. I am glad he gave them and I will ask ever surgeon for photos if I ever need another surgery (I hope never again though).

I think part of the reason he gave the pictures is he has a good sense of humor and right before I went into surgery I asked him “Do I really need this, I can still point my toes?”. His first words to my wife when he handed the photos over was “Your husband didn’t think he needed surgery”.

ALSO, I am pretty sure most surgeons take photos of all surgeries for their “resume” of what they have done AND for insurance purposes OR to at least protect themselves should they get sued.

Great pictures. How did you get those?

Good luck. I can’t wait to be fwb. I am glad to be pwb now. I still have my stitches in and worry that I will reinjure it every step I take.

normofthenorth,

Not sure why. Ill ask if he does not give me weight bearing when I see him this Wednesday. Only 2 things I can think of is my scare on the fourth week where I put a ton of weight on it and felt something let go OR my rupture was higher than normal meaning I ripped through some muscle and then my whole tendon. He mentioned he was not worried too much about the tendon holding but the muscle he had to stitch back on which is softer than the tendon he was not sure would hold as well if starting putting a lot of strain on it. We will see this Wednesday.

Any clues why your Doc is keeping you NWB so long? You’ve had your ATR repaired surgically, and you’re staying off that foot way longer than many of us who skipped the surgery (and those who skipped the surgery in the UWO study, too). There are several links on the main page (look for “studies” or “protocols”) that found no benefit (or worse) from delaying PWB and FWB.

Pushing too fast to neutral (0 heel wedges) can be scary, though the UWO folks took that step at 6 weeks with or without surgery. But they also went to PWB at 2 weeks and FWB at 4. There’s no reason to wait for neutral position to start Weight Bearing, though some people (and maybe some Docs) confuse the two.

Bummer
I don’t envy you but I reckon you’ll be OK. At least the squeeze test is the same before and after. Hope it is good news.

Sheena,

I asked my doctor about the Thompsons test and I was actually trying the Thompsons test before I fell. I failed before I fell and failed afterwards. The doctor said that was because my ankle is resting at where the Thompsons test would end. My ankle is still pretty stiff and pointing maybe 75 degrees down still which makes sense.

I most definitely hope it is not a re-rupture. I do loose sleep still thinking about that moment and every possible thing I could have maybe done to avoid putting my foot down. Like just taking the fall which did flash through my head a split second but I was half way up the stairs and that is a ways to fall. Most other damage would have been worth it probably should I trade that for a re-ruptured. Or I could have broke my good leg and been completely immobile. Who knows now.

Hi there,
I re ruptured at 14 weeks and felt it snap and heard a pop. At your stage of recovery you wouldn’t neccesarily hear a pop. Hopefully you haven’t re ruptured. The reason I’m replying to you though is because after my re rupture the most painful part of my leg was my calf. It felt as though I had been booted by a donkey it was that sore. I know you’re not so bad. I would push for an MRI as soon as it would give you a good result. I knew mine had gone again but a new doc I saw as mine was on leave wasn’t sure and an MRI did confirm for me.
I was non op though and your stitches sound very strong. Time will tell but an MRI, will confirm.
A question though, are you passing the Thompson/Simmonds test. Seems to me that mechanically that is the most sound way of telling if you’re still intact. I failed it on my re rupture.

A number of posters here have reported ripping sensations that were not reruptures, and they often experienced better ankle “performance” soon afterwards, and interpreted the experience as a break-up of scar tissue, including attachments (binding of adjacent layers — layers that should slide past each other — by scar tissue). That may be what you experienced. Alternatively, a slip on stairs can easily cause a minor injury (muscle pull, strain, sprain, etc.) to a healthy, fit, and strong ankle, and an ankle that’s been left to atrophy for a month is probably more prone to any and all of them. Legs aren’t simple. I’d stay the course with your plan, and I’d expect (and hope!) that the rest and time and near-magical healing will solve the problem.