Taking the next step – weeks 6 to 12
November 27, 2011 by xplora
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.
Stuart,
Thank you for sharing this. I am at ten weeks, and pretty much on the schedule you have described. I have chosen running shoes, and “Fitflops” boots as its getting cold in California. Fitflops are very comfortable.
I have not ventured outdoors in two shoes for fear of getting hurt, I am still holding on to my beloved Vaco boot until I feel more confident in my stride. The heel raises are very hard, I can barely lift the heel off the ground.
Housemusic - I wouldn’t sweat those heel raises. It is not wise to push them as it could set you back. Although I started them at week 9, they were fairly week and I concentrated on going up with the good and putting weight on the bad going down. I would also hold onto a table or chair to take some weight. What I did find was around week 11 when I started walking some distance, my strength improved quickly and the heel raise became much easier. Having a couple of wedges in my shoe also helped me walk faster and without a limp and it puts less stress on the tendon. When you feel confident and have the courage, it will be time for you to leave the boot behind and venture out. I took mine and a crutch in the car everywhere I went for a long time. At week 10 you are moving into that safer period so things should start ramping up for you soon. This is your race, so run it how you like but I am glad to be help.
Stuart,
I am reading your posts from the start of your injury to this 6-10 week period and you have raised my hopes up so much. I am going the non-surgical route but I believe that the progression you speak of is nearly the same. Thanks for taking to the time to share this.
Stuart…. I loved this post. Tell me, what were your strength building exercises? I exercise a lot in the boot, but that calf just flops.
Take Care.
Anne - Don’t worry about the calf just yet. It will take care of itself as you improve. The best thing for strength building is walking. Building it up slowly. The stationary bike is also good although I hated it. Walking in a deliberate manner without a limp takes some effort but it is important. If you start to limp then you should slow down, shorten the stride or stop althogether. I hate treadmills too but they are effective in controlling your gate and speed. You should also be working on your butt muscles and upper leg but those exercises are too difficult to put in words. Any good PT will be able to show you.
Hi Stuart, At last I found your blog..
My problem right now is going down the stairs. As I don’t have much dorsiflexion. At the moment my toe is 5cm from the wall and touching my knee against the wall. My progress is close to yours.. How long did you able to go down the stairs without problem?
Glen - it has been so long that small details like that evade me. If you are +5 then you are going really well. +10 is when I was allowed to start jogging again and with that stairs would not have been a problem. My notes say week 19. I struggled with dorsi flexion and after more than 4 years I notice it is still a bit stiffer than the other although I have issues with any activity. I think I have healed a bit short. One thing I do recall was after 5 months I started building and was up and down ladders all day. It was a bit awkward at first but seemed good therapy as my calf built up and flexion improved.