Achilles Tendon Surgery: Four Weeks Post-Op Progress

Four weeks and one day after my Achilles tendon repair surgery, I returned to the doctor for my second follow up. Spoiler: it went really well.

January 18, 2025

Earlier this week, I posted Achilles Tendon Rupture: What Can I Do? It looked at the progress I’ve been making and how I’ve been inserting myself back into my life.

I was really proud of the progress I had made in the two weeks since getting the boot. Because of that, I was looking forward to seeing the surgeon. Based on the rate of my healing, I had my sights set on four things:

1. Making sure the incision is actually healing well.
2. Making a plan to take the wedges out of the boot. Walking in 6-inch platforms all the time is a real drag. (And not the fun kind of drag.)
3. Start standing on my feet without the boot.
4. Get clearance to drive.

Here’s how the check-up went and how we addressed these goals.

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Follow up visits with the surgeon are usually super quick. Doctors have really full schedules and do not spend quality time talking to patients. You have to be armed with your questions and talking points. Once they check your progress, the rapid countdown clock sets and they have one foot out of the door.

Fortunately, I was armed and ready to advocate.

In the exam room

I took off the boot and my Apolla performance compression socks and was ready to go. He came in, asked how I was doing, and the clock was ticking.

1. The incision ✅

I proudly showed him my scar. He was very impressed with the rate of healing, admiring how cleanly healed it was. I commended him for closing it up so beautifully, but he said I did all the healing work. 😀 That felt good.

I shared that I use vitamin E oil on it twice a day, and deep massage it often. He approved.

I asked him about the silicone scar products, and he wasn’t a fan for my situation. One, it’s still too soon; the incision has to set more before applying that stuff. Two, since the scar is on the back of my heel, no one will see it. (Unless I go out of my way to contort myself to show it off, lol.) I’ll stay the course with the vitamin E.

Funny side story: I mentioned that I couldn't figure out exactly where on the tendon was the repair. After the surgery, he said that he had sewn in a collagen patch, but I couldn't really feel the spot. He said that he took some pics in the OR of the repair. Wide-eyed, I eagerly (like a nerd) asked if I could see them. He looked at me sideways, then pulled them up on his phone. 

There it was: my exposed, repaired tendon with the postage stamp-sized collagen patch sewn on. I immediately asked if he would AirDrop it to me. He laughed and did so. (I won't include them here because it's a little gory.) Suffice it to say, my fascination with medical stuff was completely satisfied. Later, my gym rat buddies Tammy and Lisette were also tickled by the sight of my innards. 🤣🤣🤣

2. The boot plan ✅

Ankle mobility

He checked my ankle flexion, which he noticed was at a right angle. Again, he was impressed.

He asked me if I had taken any wedges out yet. I was shocked, because he hadn’t mentioned that I could. Since I am a huge rule follower, I hadn’t. I guess some of his other patients are more impatient/risk-taking than I am.

He set the plan for wedge removal:

• One came out at the office.
• Two days, take another out.
• Week five, take the third out. Then, I’ll be flat-footed in the boot.

Here’s the kicker: At week six, I’d transition into a sneaker. That surprised me most. As slow as this healing process has felt, six weeks seemed fast to be in a shoe. But it makes sense, based on the progress I’m showing.

3. Standing on bare feet ✅

A big question was if I still had to sleep in the boot, which was really uncomfortable and annoying. He said I could leave it off, but asked if I get up at night to go to the bathroom. I told him that I do, but I’ve started to stand flat-footed for balance. He asked me to show him.

I got off the table slowly and stood strongly on both feet. Impressed, he approved a little Frankenstein walk without pushing off the toes. I would gradually need to get more weight over that foot anyway. I double checked, asking “You sure it’s okay? I don’t want to make you mad.” He laughed and said it wouldn’t.

With these advancements in mind, I now feel more comfortable testing more of my range. I am resolved to continue the steady progress. 👏👏👏 

4. Driving ✅

My biggest question was the small matter of driving a car. For my broken foot injury in August 2023, it took seven weeks for the doctor to give me driving clearance. An eternity, for sure.

This time, I had some encouragement from the physical therapist at my last session. Based on our last three sessions, he thought I had plenty of strength and control to drive. However, I’d need clearance from the surgeon to be safe.

With great hope (but expecting to hear a “no”), I asked the doc, So, how about driving?
He thought for a moment. Yes, you can drive. Take the boot off in the car, change to a sneaker, then put the boot back on to walk around.
I wanted to make sure I heard right. I needed to hear the word. So, I have clearance?
Yes. Just don’t drive in my neighborhood.

He’s a funny guy.

All jokes aside, this was huge. For over a month, I’ve been relying on the kindness of family and friends to get me around. I haven’t really gone anywhere except the necessary places (work, medical appointments, Sunday family dinners and a couple of gym visits).

Moving forward, I have the clearance to be more independent.

Physical therapy

After the follow-up, I had my fourth physical therapy appointment. I reported everything about the doctor’s visit. My therapist was trying to figure out how to move forward with my treatment. Apparently, I’m way ahead of the curve when it comes to timing of the usual Achilles tendon protocols. He doesn’t want to move me too far forward, but he knows I’m probably about ready to move forward. Soon.

More to come, I’m sure.

Progress at home

Once I got home, we had dinner and I went upstairs to do my extended evening routine. By the end of the day, I am completely spent. Since I have to prepare everything so the morning isn’t rushed, I go upstairs by 8:00.

In the boot, things have had to happen in a certain order. Here’s a look into the bedtime routine that often took two hours to complete:

1. Go to the bathroom.
2. Pick my clothes for the next day and place in a neat pile near the bathroom. Put my sneaker with the EvenUp in the bathroom for tomorrow.
3. Get pajamas from dresser, sit on the bed and take the boot off.
4. Put pajamas on without putting bad foot down on the floor.
5. Rub vitamin E oil into the tendon, use cream to deep massage the leg and foot.
6. Do ankle mobility exercises.
7. Put the sock and boot back on before getting up again.
8. Put the dirty clothes in the hamper.
9. Go to the bathroom again. (I’m 53, in perimenopause, and this is my norm.)
10. Put the pillowcase over the boot
11. Boot leg goes over the comforter, good leg goes under. I used a comfy Nap blanket over the top of my body.
12. Crank the foot of the bed up.
13. Situate the dog on the correct spot. She’s really stubborn and always starts in between my legs. Not viable for comfortable sleeping.
14. Set alarm for 15 minutes earlier than usual since it takes me so long to get ready in the morning.
15. Find a somewhat comfortable spot and settle in.

Yeah. It’s much more complicated to take care of life when you don’t have two healthy feet.

Testing my ankle

That night, once in my pajamas, I decided I’d try a little barefoot walk. I’d been really reticent to do that before, because I didn’t know if the doc would approve. But he did, so I tried it.

That night, I slept in my bed, with my unbooted foot under the covers. That felt so good to snuggle my entire body under the bedspread. I slept well all night, only got up once, and safely returned to my bed in the dark. It was a sweet night.

Four weeks, two days

I spent the next morning assessing how things were feeling. I still didn’t want to push things too far, but I suspected that I was capable of doing more.

The shower

The next morning, I reached another milestone: I took a shower on my feet.

For the first time, I stepped inside the shower upright. I didn’t have to employ an extraordinary Quasimodo balance routine while holding onto the window sill and shower chair for dear life. I carefully stepped in and felt the weight evenly balanced on my feet. I felt steady, and there was no pain. I moved the chair to the side and enjoyed a regular shower.

I stood up the whole time. Well, except to wash my feet. I used the chair for that. I was able to dry myself without getting the towel wet sitting on the shower chair. It felt amazing.

The boot

In the morning, I decided to take one more heel wedge out (a day early), leaving me with just two. There was honestly not much difference in how it felt. Since I was already able to comfortably hobble flat-footed, I figured this wasn’t going to do any damage.

I worked another full day at school. The only issue with the lower level was adjusting the foam pieces that covered the hard wedges at the heel. In the boot, there’s a lot of pressure on the bottom of the heel and not much cushion. So, while walking was a bit more uncomfortable, it wasn’t from the incision or the tendon. Also, I taught three dance classes (in the boot and modified). By the end of the day, I needed to get the boot OFF.

As soon as I got home, I went straight to the couch and took it off. I did my Theraband exercises and decided to stand up and try walking barefoot. It felt so much better, even if I was only able to putter around slowly.

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Setting goals

The most valuable advice I could offer to anyone overcoming this kind of injury is this:

Be very intentional with setting
short-term and long-term goals.

As with any challenge, we must identify:

• where we are
• where we want to be
• what steps will get us there

Overall, my report was really positive. All of my previous progress goals were met, and then some. Now it is time to set more for the next couple of weeks.

This is what I’m thinking for weeks five and six:

Short term

1. Increase passive range of motion (no load) in dorsiflexion past 90°. If I can get closer to the angle of my left foot, I’ll be really happy.
2. Keep up the Theraband work in all directions, using the blue band (more resistance).
3. Standing on two feet and bending the knee on the injured side. This will stretch the skin and tendon so it gets more comfortable to walk.
4. Test standing on the injured side for a moment to wake up the stabilizer muscles. (Holding onto the counter for support.)
5. Slowly walk around the house more in slippers. It actually feels much better than the boot.

Long term

In two weeks, walk slowly but more normally in the sneaker. Even once I have transitioned into a sneaker, I’ll probably still use the boot at work in the beginning. There’s a lot of risk there. I move all over the place, often too quickly, and the boot will remind me to slow down. My doctor has no problem with me being careful.

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The next time I see my doctor will be in another six weeks. That will be ten weeks post-surgery. I thought that was a long time, but again, he didn’t seem too concerned. I guess he saw my progress in four weeks and trusted I’d continue with care.

Until then, I’ll continue my bi-weekly physical therapy visits and my work at home. I’ll also keep up my conditioning at the gym and at work. Progress comes slowly with effort over time.

I’ll keep on reporting about my progress. Please feel free to reach out with any questions in the comment section. If you are dealing with this injury, let me know if there’s anything else you want to know about. There’s a lot to deal with, for sure. For notifications when I post, subscribe to the blog!