My Journey Through an Achilles rupture phase TWO
Phase Two: 2 weeks post-surgery to 6 weeks
May 23-May 27th
I have the go ahead to start walking using two crutches with only light loading. Although I know I need to practice it is an impractical mode of transport! I Still used the peg leg as this was much faster and set aside time to practice my walking.
I was also allowed to start with the following exercises which was really nice. It was stiff in all directions and it was painful to do seated heal lefts and toe curls. Each day they got progressively easier. It was important to me (and all patients) to regain Talar extension during plantar flexion. This is the final piece of the range and can be seen in the video.
My Calf measurements:
L:38.5
R: 41.5
Me and Mackenzie on the stationary bike
May 27th
Progressing to 50 % weight bearing. I can only really do a step to at this point. As seen. Walking through under more weight is difficult. I took my first of three wedges (some people will have 4) out exactly 3 weeks following surgery. Although crutch walking was difficult I perceive any increase in pain or loss of function following a good nights rest. I didn’t push into any pain at the heal. As long as I’m doing more with it each day there is no rush
I continued to use the stationary bike - this feels great and will be a nice adjunct for cardio as I progress. I started with 5 minutes. I progressed most days except one where it didn’t feel right so I just backed off (By the end of the week it felt totally normal and was able to tolerate 20 minutes comfortably).
May 28th.
I had no increase in pain or symptoms around the heel and I was feeling better through the whole foot complex. I was able to move it more freely and its tolerance to standing was good.
I had a bit of breakthrough on the crutches. I was tolerating a reciprocal pattern through a very short range. As the stride increases it creates more strain and stretch on the achilles. If you don’t swing the opposite leg through the activation is very small. I started by swinging through ever so slightly - maybe 1/2 and just kept practicing.
I also felt comfortable to move side to side and backwards. I was very conscious to keep the ankle in neutral (with a boot it’s hard not to) and I felt like this was good practice for the rest of the foot.
I know the more gradual I can build up the tolerance to walking the easier it will. I don’t want to suddenly get it 100% loading and not be prepared. That’s a recipe for frustration, pain and potential injury. Slow and steady incremental change.
May 29th
Body has been sore the last couple days from using the crutches and walking. The leg feels great but my back and hips are adjusting to the lopsided gait. The shoe lift helps buts it’s not quite right especially with the lifts in the boot. Today was in fact an improvement on Monday. I knew why the pain was occurring so I felt fine moving on and continuing with the exercise regiment.
May 30th-June 2nd
After 4-5 days on the stationary bike the foot and achilles finally feel comfortable pushing the speed a little. I did 8km in 20 minutes and built the resistance up to 10. All in the boot.
June 2nd- 7th
Leg extension is almost equal left to right and I started using the leg press with the boot on by the end of the week. It’s a touch awkward but I was able to do 100 pound single sided. I can do about 180 on the right side.
Walking progressed daily from 5km to close to 10km. It gets tired and sore in the heel as much of my weight is going through the heel before I role over the foot.
Come Friday I felt like my gait took another “step” forward. Still using a crutch I rolled over the foot and through the toes much more smoothly. The boot may always make my gait slight awkward but I’m encouraged that over the next couple weeks it will look almost normal.
I was given the go ahead to do seated weight calf raises at end range. I’ve built this exercise up from 5lbs and can now do 25lb at about 15 reps. This feels good as I get tired in the calf muscle.
Phase 2 exercises
Inversion/eversion
Plantar flexion. Leg straight (gas pedal) and Knee bent.
Dorsiflexion to neutral improve talar end range extension
Weight bearing 25% walking with crutches
Stationary Cycling
Supine bridge (hip lifts from ground)
Machine leg extension
Machine Leg curls
Week by week progression. From date of surgery to week 7/8
Week 0-1
Rest, relax:)…Non weight bearing (NWBT) plus machine exercise
Weeks 1-2 May 13-20
NWBT plus machine
Week 2-3 May 22 - May 27th
Progress to boot after 2 week follow-up with the surgeon and physio. Partial weight bear with two crutches. Continue with machines. Heavier leg extension bilateral and hamstring curl. Work to neutral ankle dorsiflexion. Full plantar flexion and inversion, eversion.
Week 3-4 May 27th - June 3rd
Simple seated heel lift. Floor slides, light band work, Work to neutral. Remove 1 wedge. 50% weight bear
Week 4-5 June 3rd - 10th
Continue with the same exercise. Remove one wedge if able / tolerate 75% weight bear
Week 5-6 June 10th - 17th
Continue with the same exercises. Remove the last wedge if able / 100% weight bear if able
Week 6-7 June 17 - 24th
Start dorsiflexion stretching - may not need to actually stretch it just allow it to come with walking and general exercise. Still in boot. Hydrotherapy. Fitness cardio weight bear as tolerated.
