Wilco’s AchillesBlog

It’s been quiet on my blog for a very long time, simply because all was fine and I got on with my life as usual, gradually increasing my activity level, starting to run, slowly increasing the distance and speed. Every time i noticed some stiffness in the morning after I would give myself an extra day of rest and run a bit slower the next day. This seemed to work nicely, so in september i started training volleyball again. Wow, that was something else than running, and worst of all was my jump! I used to reach 3m50 in the good times before my rupture, now I only just got off the ground! Very scary as well, to start jumping again, but after a shaky start, I noticed no bad effects. The day after I was sore, but not specifically my achilles tendon. After a couple of trainings my jump had improved to ca 70% my pre-injury height and I played a 4 set match. After that I was a bit sore in the morning and the soreness did not go, but got worse every day. So now, two I have pain in my achilles again in the morning, and when I run or jump, so no more volleyball, no more running and back to 3×15 eccentric heel drops twice a day, for 12 weeks. Only thing I still do is on the stationary bicycle.

Very depressing, just as I was starting to believe I could come back to volleyball. But I guess the hard lesson is that with my style of play (1m jump in the good days), my tendon is not going to carry that… So after a couple of weeks when I can run again, I will stick to that and avoid the high-impact sports for good.

or at least 99% limpless. Back from a two week holiday on Mauritius which I thought (when I had my AT operation) was going to be nothing but sitting on a beach chair reading books and see others having fun. Also I was resigned to having to bring my boot and probably my crutches. As it turned out I could go without both boot and crutches!
Of course much of the cool stuff such as waterskiing was way out of my reach, but there was a lot of cool stuff I could do.
I went swimming, snorkeling, diving (popped an eardrum, less pleasant…) catamaran sailing and generally would walk a lot, mostly on flat surfaces. I was careful walking on sand the first days, but that went fine as well.
My PT told me before I left to exaggerate the walking motion with both feet: land on heel, roll over the side of the of the foot and push a bit with your big toe. Also to always keep the movements of the left and right legs symmetric, (step length, and rolling off). Over the last two weeks this really seems to have eliminated my limp at the end of my stride.
Also I can walk down stairs normally now, something that I have avoided for a long time.

I saw my surgeon again yesterday and he was very surprised and happy at my recovery and said I was more or less fully recovered according to him, and could go back to jogging now, and explosive sports by January-February. That sounds a bit aggressive to me, which is funny as he was very conservative to start with (he originally wanted me in a cast for 6 weeks + fixed boot for another 6 weeks, only PWB).
Anyway, I promised myself that I will NOT return to volleyball, badminton etc before next season, to make sure the tendon will be completely healed. I realize that I was in the high-risk group in the first place (before tearing) so I want to condition BOTH my tendons properly before going all out again. But I will start some slow jogging on a flat surface next week.
Unfortunately the swimming is off the menu again for a month or so, till my eardrum heals, but I’ll keep up the biking.

One more note on the swelling. Ever since I started to walk more ‘actively’ rolling off and pushing off with my big toe, I find I need to elevate more to control the swelling. Also I may get some ‘fatique’ in my heel and bottom of my foot after a longer walk.

Oh, and NO one-legged heel rises for at least a month or two…

I have had virtually no swelling for weeks now and no pain either. Today I had my first warning. I was driving and had to brake hard to avoid crashing into a car pulling out from a parking spot. Should be no surprise in Paris, but I did not see it coming (no lights, no blinkers, this is Paris…) and slammed the brake with full force and felt a little twinge in my leg. No pain, but tonight a bit of swelling and some pain on the bottom of my heel towards the end of the day. Achilles is still pain-free but I guess this was a warning that I was close to the limit. Stupid thing is that I probably did not need to slam the brake that hard, but it all went without thinking.

It’s been a week in two shoes now, and I have not used the boot except for once on friday last week, when we were walking around in Bruges on cobblestones in the dark. I did a 5km walk the other day on the unpaved paths around here (not exactly hiking, but still nice) and everything works nicely. My pace starts to get longer and the slight limp at the end of the stride is as good as gone by now. Also driving back from Holland was no problem (I drove ca 3,5 hours of the way), but I did feel a pressure point on the side of my heel (where it rests on the floor), but that is gone now as well. All in all, the transition from the hinged boot to the 2 shoes was very easy and quick, I can really recommend new AT rupturers to get a hinged boot (and lock it in the beginning!).

So I made the transition to 2 shoes, at least around the house. I found myself walking around on bare feet more and more, in spite of my plan to stick to the plan: hinged boot until WK10 and then to two shoes. I will still wear the hinged boot (30 plantar to 7.5 dorsal now) outside for a while, especially as there are no proper sidewalks here and when I need to bring my son to the daycare (I completely forget my AT when he does something stupid and I have to intervene). But indoors or in other flat areas I will be wearing my two shoes.

So now I have to learn to be careful again, especially on stairs, which does not come naturally. As to exercises I am doing now I thought maybe a few pictures will help to explain. With the thera band I do the following:

I knot the band at the back of my foot and anchor it between my toes, so it does not move while doing the exercises. I’ll do 2×30 repetitions which is just about right for now (no pain, but I feel I tire the calf muscle a bit).

Another exercise/massage is the tennis ball under your foot. If you haven’t tried it, you should! It really helps massaging the plantarflexor and gets the blood supply going in your foot. You slowly roll the ball under your foot and heel.

And of course my el cheapo stationary bike. The saddle does not go higher so I will have to do something about that, it starts to be annoying. I removed the toe-strap to make place for my boot.

Yesterday we went out with to get some 2nd hand kids stuff at a sale in central Paris. I was on my feet the whole day, walking around, playing with my son and in the late afternoon we had a good walk in the park. I figure I must have easily done over 5km, but no swelling or pain at the end of the day, just tired calf muscles.
Then last night my son had a nightmare and when I heard him cry I jumped out of bed. Without the boot. I was at the door when I realized what I was doing and took it a bit more careful. No point to go back to put the boot on, but at least a little more care when walking. Everything went fine but jumping out of bed was not a great idea…
I won’t go to 2 shoes for real yet, will try to stick to my plan (2 shoes at 10 weeks) as good as I can.

Yesterday I decided to go hinged (after some early try at W5 when it felt I was not ready yet). I also put the boot straighter, which actually means that although i have it set to hinge between 15deg plantar and 0 degrees, it seems 0 is actually 5 degrees or so dorsal:

It feels great. Walking instantly becomes more fluid and I have not had pain so far, except from a slight feeling that I ‘worked’ the tendon, when going to bed at night. I still do all the range of motion exercises, and when contracting the calf muscle to get the max plantar position, the tendon felt slightly tender.

Bicycling is also a lot more natural now that I can do the proper motion (well, to 15 degrees).

Norm, if you read this, when exactly did you open the hinge and what were your settings? Also did you notice the same dorsiflexion even thought the setting says o?

Tomorrow will be 7 weeks PO, and I am doing around 30min biking each day. Yesterday I went on the bicycle to the PT and back, and it was great. For those of you biking on a real bike with the boot on (like me), careful with the front wheel when turning. It’s like having size 15 shoes and the front wheel may hit the toes of the boot (especially if you are biking like me with the saddle a bit low).

The PT was alright, ultrasound + massage and then some upper body exercises to make me loose some fat I gained in the last 6 weeks. I just continue with the theraband exercises and from next week will start to hinge the boot from 30 deg plantar to 0, and keep it like that for two weeks. The whole set-up there seems to be from the seventies or eighties, with archaic training machines. The tendon & calf massage was good though, but I am not sure about the proper rehab. Will probably check out ahnadlass’ PT in la Defense when I get further.

This morning I brought my son to daycare on bicycle, which was a bit scarier as I had to get on/off the bike with him in the child seat, but managed fine. Will not make it a habit yet though, as the whole balancing thing to get on/off is a bit too risky, not least for him.

Are a peculiar bunch. Mine was a quirky French lady asking me all kinds of things including some relevant questions and was making fun of me for asking what everything was that they were injecting me with what it does etc. Anyway so since I was a giant according to her (when I was pro volleyball player I used to be one of the shortest players in my team at 1m91) she did not want me to lie down, but had me sit up while giving me the epidural then told me to quickly turn to lie on my left side. As I did so I asked why and she told me that gravity makes the fluid go to my left leg only. Eh, right but it’s my right leg that they are going to operate on! Quickly turned to the other side, already numb on the left. In comes the surgeon and the lady tells with a straight face “I told the guy to turn on his right but he turned on his left…” rolling her eyes. WHAT? Anyway I realized this was no time to start a fight with two numb legs and I would still need her help probably. But that was shameless.

Hi, here are some pictures of my boot and scar at the moment. The boot is not the Vacoped, which I have not been able to find here, but a Maxtrax ROM air, similar to Normofthenorth’s boot.

So far I am happy with it, especially the ‘air’ bit since I can pump it up when I have a bit of swelling or when I want some extra support (going on escalators in Paris metro during rush hour is one of those moments). I still have the hinge locked at 0 degrees. I went from 30 degrees at two weeks, to 22.5 at 3 WKS, 15 at 4 Weeks and 0 at 5 WKS.

Very happy with how the incision is healing so far, no funny things happening and very little itching. The ankle is a bit swollen though at the end of the day, as you can see on the picture. My treatment for the wound was lots of babycream (around it not on the wound of course) to keep it soft and happy, rarely some Voltaren cream to make sure the inflammation stays away. During week 3 I would clean it lightly with medical alcohol every night and keep a bandage (later a large plaster) on it to make sure it does not get irritated by friction from the boot.