By week 6 I was walking without crutches outside and had started some ambulation exercises at physio. These exercises are aimed at your glute and core muscles to improve your gate. The 6 week mark is one of those milestones in this journey. The tendon should be knitted together with its own tissue but that tissue is still very weak and disorganised. The next 6 weeks is when the work really starts on remodelling the collagen tissue and regaining some flexion.
This period is generally characterised by the transition to 2 shoes and then learning to walk again, building strength and being careful.
A boot or cast provides a great deal of protection, mentally and physically but there comes a time when we have to let it go. Walking in a boot without crutches poses other problems with your body because of its weight and size. It is difficult to match up the height of the boot with the other shoe and therefore you tend to walk with your toe pointed out putting pressure on your knee and hip. Getting rid of it too soon means you have a longer period where you need to be careful not to trip or misstep. Finding a balance is an individual thing and the associated risks must be accepted. Going into 2 shoes does not mean you are ahead in your recovery but it does mean that your lifestyle will change. The first thing you notice is how much slower you get around.
Transition is what it is and it is mostly done over a period of days or weeks. I started with 2 shoes, with the heel wedges from my boot under the orthotics, around the house, using crutches at first then when confident ditching one and then two. My shoes were ASIC Gel Evolution and the type of shoes are very important. My physio advised me to select a shoe with good motion control. Bend it from toe to heel and it should only bend at the ball of the foot, not under the arch. Then twist it holding the toe and heel. The shoe should again twist under the ball of the foot. Modern runners have a heel higher than the toe so are ideal for the transition to shoes. The next very important part of this transition is to walk in a controlled slow manner without limping. Limping is very bad for you and if you have to limp to walk faster then you are walking too fast or taking too long a stride.
A little over a week and I was ready to give the 2 shoes a go outside the house again using one crutch for support and to give others around me an idea why I was not getting out of their way. Planned small journeys followed by rest, elevation and ice. Swelling and soreness will be a problem for some time to come.
Although some do not advocate heel wedges in shoes, I cannot speak more highly of them. My physio attended a tendon seminar with a world renowned therapist and was confirmed in her thinking. Pressure is taken off the tendon and your gate/stride improves quickly. When you are able to walk at a normal pace and cadence without limping then it is time to take a wedge out.
The next thing to try was driving. Being my right foot I needed to be sure I could push on the brake if needed. It is ridiculous to try and drive before you are ready. The risks to other road users because of a selfish desire for independence could be considered criminal if you were to cause a collision and injury someone. Get a clearance from your doctor. If you cannot operate the controls of the vehicle properly then you should not be driving. Modern cars do not need a lot of pressure on the pedal to stop but to be certain then you should always keep a generous distance between you and the car in front. Of course if it had been my left foot then it would have been much longer before I would be driving unless I bought an automatic. Again, short planned trips until I was confident.
I hate treadmills more than stationary bike but a treadmill is a good aid when it comes to forcing you to walk at an even speed. Week 9 had me 10 minutes on the treadmill and I was surprised how well I did although by the end I was getting quite sore and tired. The strength build up is slow and deliberate. It is not something to be rushed and trying to jump ahead will only set you back. Walking barefoot around the house is very tempting but again you have to go slow and walk without a limp. Because of the lack of dorsiflexion this will be difficult. It is very tempting to try and stretch the hell out of the tendon early in an attempt to regain dorsiflexion. It is something I was advised to avoid. It will come in time as you return to more normal activity. A functional rehabilitation focuses on the things that are important to get you moving properly again. Severe stretches too early could be a cause of elongated healing.
It was almost week 10 when my physio had me doing two leg heel raises. Going up on my good leg and coming down slowly on my bad. The going down is more important. Taking it slow and building up strength. 3 x 10 until that is easy then adding weight in a backpack when it is easy and put more weight on the bad leg while going up. Still have to keep up the butt and thigh exercises. Every week there is a new exercise to do and as you have become more mobile and independent, it seems you are getting too busy to do them all but you have to make time. Massage, rest, ice, exercise, mobility – no time to be depressed now and plenty of distractions.
The next 2 weeks are summed up by more and more of the same. Building slowly, walking further and waiting for that magical 12 week mark when it is said the risk of re-rupture declines. It doesn’t suddenly go away but it becomes less likely every day after that. Of course there will be individual differences but the science says there is no way to make it go faster. The collagen type 1 is needed to build strong tendons. It is thin, flexible, organised and much stronger than the collagen type 3 laid down in the first phase of healing and comes with the strength building, walking and massage. I concentrated on getting stronger, walking further and increasing the resistance on the stationary bike. I had taken one wedge out of my shoe and put it in the other shoe. It slowed me down for a few days but then it was back to normal. Some days I would push too hard or far and when fatigue set in I would limp. It is hard to gauge how far but I would suggest you plan you walks with an escape route. Don’t walk anywhere you cannot be picked up and don’t be so brave to push it past the pain. There is no benefit. A little often or just a little less. Getting off the stationary bike was also a big plus at this time. It was a bit scary but fortunately there is a good cycle track nearby and it is flat. The first thing remember is not to push off with you bad leg and the next is to practise stopping. At first I instinctively put my bad leg down, like going down stairs on crutches but due to the lack of flexion I quickly found this to be the wrong way. Good leg down for the moment. This would change in the weeks to come when my flexion improved. To clip in my spd’s or not was the next question. No real benefit at this stage as it hurts to twist the foot out and the power gain is not required.
