Week 16 Achilles recovery: PT is coming to an end

In the past month, my biweekly physical therapy was reduced to once a week. At first, it was my March work schedule that limited my time. In April, it seems I’ve reached plateau. PT sessions have become, shall we say, too easy. Now what?

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April 9, 2025

One cortisone injection later, the discomfort has been somewhat alleviated. At that appointment, the doctor recommended I lay off of the single heel raises, which was the one movement that I did not have the strength or coordination to do with any comfort. Since I’m not even at four months of healing, I need to back off of those.

How is the ankle feeling?

In general, the ankle is much better. This is a recap of how things are feeling at the moment:

The scar

I started using a night cream by Mederma that says it works with your body’s natural healing at night. Could be a load of bunk, but it can’t hurt to try.

The Achilles repair

I’m not really feeling much pain in the Achilles itself anymore during my everyday activity. I have to warm it up in the morning when I wake up, but my first steps are no longer painful. I sometimes still wear a compression sleeve or sock to support my ankle and foot. When I’m really active, I think that helps get me through the day.

The front of the ankle

I’m still vigilant about pushing too far into loaded dorsiflexion. The cortisone has helped, but it’s not a miracle cure. There’s definitely soft tissue in the way of the joint and the bone ends have been damaged a bit as a result.

If I can allow it time to heal without hard landings, maybe I’ll get lucky and it will heal more. If the cortisone wears off, I’ll likely schedule the cleanout surgery. But stairs and long strides are definitely easier than before.

The limp

I’m still working on eliminating the limp altogether. If I’ve abused the ankle by working all day, my brain will rebel and make the limp happen anyway.

Walking smoothly is still an exercise in mindfulness and physical restraint. Those fast, long strides take their toll on my ankle. My husband and I took the train to Yankee Stadium and did a lot of fast walking. That limp won more often than not.

The calf muscle

It’s very weird to see them side by side. For reference, there is a full 2-inch diameter difference between them (15″ vs 17″). I hope that in a few months, when I can start doing more single heel raises, the calf strength and size will start to return.

What is my normal?

In the past two months, I’ve been slowly adding more complex movement to my life. At almost four months post-op, I’m much closer to what I recognize as “normal” now. My normal looks somewhat different than most people my age. This is a snapshot of what getting closer means to me.

At work

The lion’s share of the classes I teach are dance. Fortunately, we are out of the heavy pounding of technique and we are well into concert choreography mode. I don’t have quite the same repetitive movement demands on my body as I do with our regular units.

As we create choreography, I am noticing a good return to functionality. Save for big jumps, turning in relevé or standing on just my right foot toes, I’m able to do most things. What I can’t do fully, I fake it enough for the kids to know what they need to do. Because it looks like I’m back to normal, I have to remind my students of the things I still can’t (or shouldn’t) do.

In the hallways, I am now moving much more quickly. I find myself getting annoyed again when slow walkers are in my way. Another sign of healing progress.

At the gym

I’m back at the gymnastics studio 2-3 times a week. My training is much lighter than before the injury, but it’s slowly increasing. I start with an extended warmup that includes a lot of ankle work. As I try different things, I pay very close attention to ankle fatigue or pain. With any sign of strain or discomfort, I back off immediately.

Most recently, I’ve added light jogging on the sprung floor and trampoline bouncing into the mix. I’m starting to experiment with lunging into a handstand off the bad side. It’s not a full push through the foot, but it’s a good start in retraining the movement.

I’m not ready to do cartwheels on the floor or flips on the trampoline, but I get a lot of conditioning and fundamentals done. My body will be prepared when the ankle is ready.

At home

I can do most chores that I need to. I can go up and down stairs with much more ease, especially since getting the cortisone shot. While I prefer my husband to lift heavy things, I can do it myself. I rest a lot. I prioritize sleep and good nutrition to maximize healing.

In short, I’m doing more in my everyday life than in physical therapy.

What physical therapy looks like now

For each session, Sagar does the usual manual manipulations, strength and mobility checks. He says that my Achilles is easily pushing about 100 lbs while sitting on the table. The fact that I can’t do a single heel raise on that foot is not surprising; it’s just a matter of time before that happens.

I do some stretching, squatting and balance work, but it’s nothing I can’t do at home or work or the gym. The electrostimulation is great, but I can get one of those machines on Amazon if I really want to.

I hate to say it, but it seems my time with Sagar is soon coming to an end.

In a way, that scares me. I am very mindful of several things:

1. The injury site, which I’ll be feeling for quite some time, and that the tendon will “never be as strong as before” (so says Sagar).
2. I’m over 50 and healing isn’t as quick and efficient (or complete) as it was when I was younger. The fact that many of the ligaments in my foot have chronic tears is evidence of that.
3. I have a penchant for needing to be strong and mobile and pushing my physical boundaries.
4. I always feel like the next physical advancement at the ankle will re-injure me and set me even further back.

Finding the right path through all of that, without the weekly check-in with a medical professional definitely makes me nervous. For the last three months, I’ve been chugging forward, ahead of the curve and feeling pretty good about the progress.

I’ve now reached a point where I am close to “normal” for most people. I can walk without much pain. I can do most regular daily activities with minimal struggle. That’s a great thing. And I’ve done it all before hitting the four-month anniversary of the surgery.

My concern is about the need to pull back from the more adventurous stuff. Certainly, I understand the need for great caution now, but what about in a year?

Six months after breaking my foot, I was back to doing hard landings on the floor and advancing my gymnastics skills. With all of the soft tissue injury the MRI revealed in that same foot, I don’t know if I’ll get back even half of what I was doing. Mr. Lizard’s protective grasp is tight.

And that makes me sad. There’s definitely a weird grieving process going on here, even through this accelerated healing progress.

Moving forward

The best I can do is continue the step by step, day to day work. I search all over for Achilles rehab information and ideas.

On Facebook, I follow the Achilles Tendon Rupture Group to see where others are in their rehab process.

On Instagram, Dr. Chris Smith’s Achilles.rebuild offers lots of ideas and tips or rehab exercises to try. I have incorporated a bunch of those ideas into my repertoire.

At some point, I hope to “bullet proof” both of my ankles as I continue doing this work. Check out the video below to see a bunch of the warmups I’ve collected.

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So, as I get ready to say au revoir to Sagar, I will be sure to remember the following things:

• Proper warmups take a long time. Don’t skimp.
• Even if I don’t return to certain skills, there’s still plenty to do at the gym.
• One step at a time is the only way to move forward.
• Pay attention to how the ankle feels. If it feels strained or tired, back off.
• Acknowledge the sadness of having to step back, but remember that specific skills don’t define my identity or my badass status. My resilience and willingness to build back slowly does.

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You can see all of my Achilles and gymnastics stuff on YouTube, TikTok and Instagram. Enjoy the journey!