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Walking boot for achilles tendon treatment

It was one year ago when I has the surgery to repair my achilles tendon. This is a blog I wrote last year as I was coming out of the rehab process.

Before April of 2015, I never really thought much about my Achilles tendon. As a Performance Enhancement Trainer, I did everything right in prevention training for injury. None of that really mattered when I stepped down on some faulty flooringwhile coaching my 16 year old basketball team.

As my foot made contact, my Achilles felt like someone snapped it with a whip. I didn’t really hear the “pop”, but I felt it, much like a buzzing sensation or a fast shock. I knew something was wrong, and I dropped to my knees. My foot was limp in plantar flexion (pointing downward) but surprisingly, not really any pain.

The next morning I had it confirmed to be an Achilles rupture, and immediately scheduled a surgeon for justa few days later.

The surgery was not bad at all. I woke up with no pain (thanks to modern anesthesia) and already in a cast. I was wheeled out of the hospital to begin the dreaded recovery period this type of injury brings. The prognosis: up to one year before I returned to 100%. What does that mean, back to 100%? The very thought of being down for 4 weeks was hard to handle, but a year?

The first week after the Achilles tendon rupture was set as time to rest. I took pain medication for the first 2-3 days, and then worked to wean my way off. I did not move the foot at all in the cast, even resisting moving the toes around. I followed the doctor’s orders of rest and no weight bearing. I kept it elevated to reduce swelling and followed a very clean diet to prevent weight gain. Without the ability to burn excess calories, I knew comfort eating would be a mistake.

During the first week I also hit the research trail. There is a great deal of information out there on Achilles tendon rupture surgery and repair, so I needed to sort through them and make an educated decision.

The following are my tricks of the trade that I personally used to get back on my feet. As always, you would want to consult with your doctor, but as you will see, I consulted with quite a few.

One thing was for sure, I did not want t spend weeks on end on crutches. One day out from the orthopedist and my armpits were already bruised. So, post surgery, I needed to know all of the options.

If you are experiencing an Achilles tendon rupture, and have had or are facing surgery for repair, there are a few things that you need to know.

1.)  A big part of Achilles tendon rupture recovery is going to be mental. The idea that you will be immobile for weeks into months can be daunting, but with precautions and a little education you can be moving and on the road to recovery as fast as possible. You must know that this will pass. It is what you do between now and when the doctor says you are clear that will help decide at what level you will be back.

2.) DO NOT sit around feeling sorry for yourself. Been there, did it, it didn’t help.  I quickly developed my mental resolve, falling back on the words of Admiral Stockdale as remembered in the book Good To Great.  He states, “You must retain absolute faith that you can and will prevail in the end, while at the same time confronting the brutal facts of your current reality, whatever that might be.”  Easier said that done, but those words go a long way if you really read into them. You are going to come back. We just have to get you there as smart as possible.

3.) DO NOT rush back, work your way back. Achilles tendon rupture recovery does take time. I’m going to give you my personal experience, and all doctors will vary. Mine is not medical advice, I’m just saying what worked for me. You can research it more yourself. Only you and your doctor can make the final decision on what you will actually do.
The Tools of the Trade

Immediately after surgery, I woke up in a fitted cast. My follow-up appointment was one week out, and I knew that not moving my toes at all would add to the problem of the neurological connection when it came time to walk again.

The cast limited movement (important) but does not allow for icing of the area. I decided to go with something called a vacocast that is a specially fitted boot that also allows for plantar (pointed down) flexion of the foot as the area heals.

Neither the surgeon, therapist, or foot specialist that I saw had seen a boot just like it. It was my close friend for 5 weeks straight. I removed it to ice, shower (with a medical seat for the shower area), and to let it breathe then back with the boot. It allowed me to feel like I wasn’t trapped because even though I didn’t remove it all the time, knowing I could was nice.

Crutches are terrible. Within the first day of moving on them I was already getting blisters under my armpits. I knew they had to go, but getting around while non-weight bearing is a tough road to travel.

My first line of transportation was a scooter. This is a knee high device with handlebars
that is great for getting around the house. It was definitely better than the crutches, and I kept it all the way to the 14th week, several weeks after I became weight bearing. Achilles tendon surgery is no joke and the major issue is your independence. The scooter helped.

The next tool you will need, especially if you are a little more mobile or athletic, is called an iWalk. This device allows you to place your knee into the structure and move around on a “peg leg.” This allows you to be mobile while standing, have your hands free, and weight bear the quad and hip, preventing some of the atrophy that accompanies non-weight bearing periods.

There is a learning curve, but if you can use it I highly recommend it.

Healing Time

From my experience and research, 4-6 weeks is the time needed for the surgery to heal enough to take. During this time, you really aren’t supposed to do much. I spent the time doing upper body and core work while eating clean.

At the two week mark, I visited my good friend Lee of Carolina Physical Therapy and began a protocol of dry needling (to stimulate the calf muscle) and laser therapy to improve circulation and speed healing. I really believe this helped a great deal with the swelling and helped speed the initial healing process.

At around 3 weeks, I was allowed to move the foot gently. This was awesome. Light dorsi and plantar flexion felt great but I could tell the foot was weaker.

At the 4 week mark, it was recommended by my foot specialist to begin attempting to walk. This was ahead of the 6 week mark, so I approached it with caution. In the boot with a crutch made me feel like I was making progress. The crutch (now bearable because you are using partial weight) goes under the opposite arm of the injured leg.
As soon as I stood for any period of time, the swelling began. My entire foot swelled, especially the ankle area. Staying off of it more than not and elevating when possible seemed to help.

My foot specialist suggested a long compression sock. This helped with the swelling around the ankle, but the swelling began just above the sock around the calf. This just takes awhile. Expect the swelling for 6 months, but it gradually gets better.
You will be sleeping with the boot on for 4-5 weeks. This is very uncomfortable, but will prevent you from tweaking it or getting up in the night and forgetting about it. I slept with one leg out of the covers because the boot got so hot. I had my injury just as it got hot outside, and my leg sweated a lot .

When Out of the Boot

One of the first things you will notice when out of the boot is the fact that your injured leg has shrunk. The atrophy associated with the Achilles tendon injury can be dramatic. I spent a lot of time doing isometric contractions with the calf (without moving the foot) and also with the quadriceps.

As soon as I was allowed, I also began light stretching on a daily basis. Then, I moved on to the resistance band, pointing and flexing the foot.

Work as soon as possible to restore your walking gait to normal. Walking incorrectly can cause other issues such as back pain, knee pain and pain in the opposing ankle.
After getting out of the boot, I continued icing and elevating. I wore the compression sock daily and was very careful with movement.

Once I was cleared to do walk, I began light bodyweight training with a TRX suspension trainer. The light squat motion was easier on the tendon (allowed me to squat without stretching it) and gave me a light leg workout.
As I finish this blog, I am approaching the 16 week mark after my achilles tendon surgery. I can walk smooth without a limp, although I have swelling at night. I’m pretty much pain free, and while I can move I really stay sure I don’t do anything too fast.
Getting back to normal

As the weeks pass, you will want to work to get your normal movements back. I like the TRX suspension trainer as a way to do bodyweight exercises without stress on the tendon. Resistance bands are another great tool. You will want to consult a good trainer/physical therapist to help you design a program to help you get back to normal.

One Year Later

Exactly one year from the injury, things are pretty much normal. I have worked to regain my first step quickness, i’m sparring, playing basketball and doing plyometrics. The thought of the achilles is finally gone, as in I don’t think about it when making certain moves.

It was definitely a learning experience, and, as with other things I will use the knowledge I gained in the future to help as many people as I can.

This is just my experience with the surgery, and not intended to be medical advice. Consult your physician, and remember a wise man seeks the counsel of others. 🙂
Allen Branch

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