Week 4 Post op- PWB

After my 3 week post op visit with my ortho i began the task of PWB.  Each day i’m able to put more and more weight on the foot. I’m back at work seeing patients in the office and once i’m in the exam room i’m able to hobble along without the crutches to perform the exam. I keep my foot up on my desk between seeing patients. I had minimal swelling while NWB but now it has increased a bit. I have a long commute home by car and put my foot up on the dash while driving! Once home I’m really just in bed with leg up and lots of massage. Getting foot out for PT at home three times a day for 10 minutes with gentle active point and flex and wiggling toes. Incision still is oozing just a speck at the end of the day on the gauze but looks clean and no redness. I think this is due to the swelling. Working on trying to be walking in a boot, without crutches by next week. I’m still at 20 degrees so that makes it a funny looking hobble-like walk.

Week 3 post op

I saw my orthopedist yesterday at 3w1d post surgery. They took the stitches out and washed the incision and put some steri-strips on it. It looks like it’s healing well. The doctor felt the tendon as i he flexed my foot back a bit and it felt tight and he said that’s good. I told him that i’m still experiencing some stinging and burning along the incision and heel. He said that that was the nerves. I have sensation all over my foot, it’s just this searing pain. He said as I move my foot more it should resolve. I’m not happy about that. He said i can shower without boot.

Rehab - He said to take leg out of boot three times a day and for 10 minutes focus on flexing (not past neutral) and pointing. I asked him about deep water walking or cycling. He said - for you, no lets wait until 6 weeks. I suppose he said that because i am a 50yo female, but he never asked about my activity level, which was active - kick boxing classes etc… He said do pilates. Whatever. Ill just continue my strengthening routine at home. He said no to acupuncture before six weeks. He said yes to TENS therapy on calf. He said to go to 20 degrees on boot and try and wean off crutches over the next week, but leave at 20 degrees. I got right on that and am experimenting with the one crutch walk.

Work- I’ve worked two days now and it’s ok. I have an hour commute home by car. I see patients in the clinical setting. I came home today and put leg up and found that the area not covered by the internal soft boot was fairly swollen. i think i’ll put on a knee sock for tomorrow.

Pain - May try some CBD oil for the nerve pain. Super bummed about this aspect.

Surgical report - I asked for the surgical report. All pretty standard except for this bit: “Deep fascia overlying the FHL muscle belly was identified. An FHL fasciotomy was performed at this time. This was necessary for a tension-free paratenon closure as well as to increase vascular supply to the Achilles tendon repair site.”  I  googled around a bit and this didn’t seem a too common procedure. My only concern is that a complication of this is reduced flexibility of the big toe. When he was examining me he asked me to curl my toes and the big toe didn’t want to go. It can move up and down, but not curl. He said he saw it “want to.” At the time of this exchange I hadn’t read the surgical report so didn’t know the significance of his assessment of the big toe. Hope this big toe is not damaged.

Mood - With the nerve pain and concern over big toe and being tasked with getting to walking without crutches in three weeks, i’m not very chipper. The caps play the first game of the playoffs tonight and we are going to watch and order wings. Maybe some whiskey…

Yoga while recovering

i found a nice youtube series on yoga while recovering.
http://physioyoga.ca/medical-therapeutic-yoga-for-achilles-tendon-rupture-the-missing-link-in-rehabilitation

Week 2 post op completed.

Tomorrow will mark two completed weeks post op. This was Easter weekend and I did get up and make lamb and my beans, as well as go get my nails done. Small outings. Sitting on the bench in the park with my leg up, but not above my heart, made my leg throb. I go through short phases of - WTH just happened. I think i still can’t believe this is happening to me.

Pain - This week i had some stabbing pains in my heel and where the incision is. I’m taking the aspirin and at night a take 1,000 acetaminophen for the throbbing.

Vacoped boot - I have found myself messing with this to get the right comfort. I developed a sore right on top of my foot where it was rubbing. I found that other people had this happen to them too. I bought some thick moleskine and put a big pad of it on the top of my foot and it solved the problem. I take the straps off and let my leg air out a bit. I stroke the leg gently with a light massage for comfort and for circulation.

Diet - Comfort chocolate is on the regular…. I did have a drink to celebrate my first born’s 21st birthday at the Brazilian steak house. I did have a wine or two with Easter picnic. I have been eating the same stuff every day mostly as my husband isn’t good in the kitchen and I don’t mind. I try and focus on protein/veggies. Breakfast - one coffee, one macadamia nut milk matcha latte with a scoop of collagen powder, 1-2 hard boiled eggs, scoop of hummos or 1/4 avocado, squeeze of lemon, s/p. Lunch - leftover dinner or Amy’s organic lentil soup. Dinner - protein/veggies. Snack - Siggi plain yogurt with spirulina, coconut flakes, cocoa nibs, nuts, seeds, collagen powder, a few berries. Tea. Pelligrino.  All my supplements i mentioned before.

Exercise - I found a rehab protocol that I like. https://tinyurl.com/nsj29mz It’s the Banff  Sports Medicine rehab. I have been doing this protocol for week two, which has some added exercises from week one. I also have been doing some push ups on my knees, yoga- cat/cow, down dog, and some breathing meditation. I plan to talk with my Ortho about the protocol as it’s what I would like to follow. I see him next week for stitches out.

Shower - It’s a field trip/adventure.

Work - I’m hoping to go back on Thursday, which would be 2 1/2 weeks post surgery. I see patients in an office, maybe 15-20 a day. I’m good on the crutches so just plan on that. My only concern is pain/throbbing at end of day with my leg down so much. We shall see.

Day 7 Post Op appointment

I”m one week post op and i was scheduled to go in for wound check and to be fitted in to the CAM boot. I purchased the Vacoped in small. I’m a 39 Europe sizing and 81/2 female American sizing. I was right on the border between small and medium. I called the customer service and we talked it through and I ordered a small.

The medical assistant took the puffy bandages and splint off to expose the leg. I was prepared because i had looked through many pictures but it was still shocking. I’ll post a picture below. She cleaned the wound and put a strip of ointment infused gauze on the stitches and then wrapped a gauze around ankle and then put on a gauzy-type sock thing. We futzed around with the boot and got it on OK. I was then told to come back week 3 post op to get stitches out and see my doctor. No weight bearing.

He had given me a rehab plan that seemed moderately conservative when compared to the two dozen or so plans I had read. I plan to talk with him about my rehab pan. Will post more on that when it gets sorted. Since about three days post op I have been doing some exercises. The first week i did, all while reclining in bed, quad squeezes, 20 every hour; leg lifts, 20 every hour; leg abduction 20 every hour; toe wiggles and toe points 20 x 3 every hour, all from 8am to 8pm.  These were not proscribed by my doctor, but i found them in some rehab protocols. It felt good to do them. I also massaged my toes every hour as they were still numb and i wanted to encourage circulation and wake the nerves up.

Pain  the pain is odd, some nights i had a searing pain where the incision is, but it would be momentary. There is always sort of a pulsing after i’ve been up to walk around. There is a tingling feeling most of the time. I took a few oxycodone when the block wore off, some acetaminophen a few times and twice a day aspirin, for DVT prophylaxis and pain. This is all what I had expected, except for the extended nerve block, from reading through the achilles blog site. I’m writing this for therapy, but also to give back to the ATR community here. What a cool find and so therapeutic for me.
http://AchillesBlog.com/afkv/files/2018/03/kelly_ankle_resized4.jpg

Post op day 1 and 2 and 3 and 4

I was supposed to be in Las Vegas for a board meeting this week. I woke up with leg completely numb still, now 24 hours post surgery. I decided to conference call in to the meeting. Did the board meeting all day until 8pm. My leg was still completely numb. I started to get a little worried. The anesthesiologist said 18-24 hours and i’m now at 36 hours with no ability to move toes. It was now after hours and so i called the doctor to see if this is something to be concerned with. My doctor was out of town, but the doctor I spoke with said that it is rare that the block would last more than 24 hours, but does happen. I told her i was starting to feel some tingles and she said that was a good sign. She also said to monitor for toe color and temperature. I kept asking my husband to check my toes. Like a jackass he would say - they are green! I didn’t think it was funny. And, part of my tongue was numb - more on this below. And, my throat was sore so was sucking on lozenges.

Day 2 post op I start to be able to feel light tingles when my toes are touched but i still can’t move them. This is now 48 hours post op. I call the surgery center and speak with the anesthesiologist. Another weird thing was that a spot on my tongue is numb. The google tells me that this is glosseal nerve damage from the LMA used to keep my airway open. I tell the anesthesiologist about numb at 48 hours and tongue thing. He said both are rare and that they should resolve in days to weeks. Great. I still haven’t taken any pain meds, but start to worry i’ll miss a DVT as i can’t feel anything. By evening the tingles get more intense and i can start to just wiggle my toes a bit.

Day 3 post op - I took 5mg oxycodone during the night as the block really started to wear off. It worked well. I didn’t use any pain meds during the day. I just lay in bed with leg up on two firm pillows. Goal is leg elevation above heart 23/24 hours the first week.

Day 4 post op - holy crap! i was taking the smooth move tea and the magnesium but nothing prepared me for the constipation. geez, i only took a total of 5 oxycodone over three days and the situation is intense. Screw the oxycodone, ill keep with the acetaminophen and aspirin.

Day of surgery

Injury was March 10, surgery March 20. The night before I had a good meal and just tried to relax. My surgery was at 0900 so i didn’t have to wait around all day hungry and thirsty, as nothing to eat or drink from the midnight before. It was rainy and i was getting nervous. I put on this meditation piece that I use. It’s any one of the binaural beats meditations on youtube. I kept my headphones on and just tuned out all through the pre-registration and payment. Surgery center wanted $2,300 and that is after our good insurance coverage. Still have to cover the anesthesia and doctor. No bill from them yet, but they are all in network.

Was called back to pre-op. Got in a gown, BP, temp, IV. I started to get very scared. I was trying to identify why. I trusted the DO and all the providers to do their job properly. I then began to have images of the last time I had general anesthesia. I was 12 and was in hospital for two weeks after a skateboarding accident ( los angeles in the 70’s) and broke my elbow really nicely. I then sort of identified that i was nervous about not being in control while under general and having my body manipulated without my awareness. Ah, that was it, compounded by memories of my previous long hospital stay. Just as i had identified why i was so weepy, the nurse comes in and hands me some pills - ibuprofen and Gabapentin. No thanks on the Gaba, it was supposed to be an anxiolytic. Then the anesthesiologists come in. They explain the nerve block. It’s going to hit the nerve behind the knee and allow for pain block for 18-24 hours. I asked what was in it - robivicaine and decadron (steroids) to make it last longer. OK. In order to tolerate the nerve block they would like to give me some versed IV. I’m like OK with the versed, i know how that works (we give sometimes during a cesarean section if mom is freaking out emotionally). The versed works almost immediately and i was in la-la land, aware but everything was cartoonish and wavy and oh hey there is a big needle going in behind me leg, doesn’t hurt at all and like wow…. Anyway it starts to work and i’m loopy and they bring my back to the OR and tell me to go face down on the table with arm out. Here breathe well through this mask, and three big inhales and i’m out.

I poof! wake up clear headed. That’s propofol for you. My husband is there. I’m a bit chatty. Leg is numb and wrapped with a splint and big puffy bandages and ace wrapping. I get clothes on and somehow get home, it’s not very clear. I was hungry and husband stopped at the greek diner and i got some moussaka and ate the whole thing. I got nauseous. I took Zofran. I went to sleep.

Blew it dancing. Injury to before surgery.

Although it’s been 10 days post surgery i’ll start from the beginning. I am a 50yo female who blew her achilles jumping up at a hard core show (Agnostic Front, Dropkick Murphy’s) at the newly opened Anthem on the waterfront in DC. I’m fit, former swimmer, lifelong gym-goer at a normal weight. I just jumped up and when i came down, i thought somebody had come down on my heel from behind. I whipped around and nobody was really close to me. I was able to limp to the exit. I was in no pain, I just couldn’t walk. I went directly to the ED in Arlington. I got an x-ray, Thompson test - positive for rupture, put in in a back splint with ace bandage wrap and told to see the ortho ASAP. I wasn’t in pain so I didn’t take the narcotic they offered.

I went to work on Monday, two days post injury. I seemed to be very adept at the crutches. I’m a midwife and was able to get around and see patients all day with no pain, or even swelling. I put my leg up on my desk if I had a break between patients. I found a foot and ankle specialist who is a DO, which is a doctor of osteopathy, who works in a big foot and ankle practice in Falls Church. I asked some PTs I knew and they said the practice was good and the surgery center, Mclean Surgery Center, was “clean.”

I saw the DO on Tuesday, three days post injury. He performed a bedside US and confirmed a 4cm gap with full rupture. He discussed surgery and it was set up for the following week, 10 days post injury. The medical assistant put me in a Breg CAM walker at 30 degrees, toes down, and told me not to bear weight. I worked another two full office schedules that week, seeing patients on crutches. I really was amazed at how easy the crutches were for me, and again, i was not in pain, nor was there any swelling. Come the weekend,  a week past surgery, i just rested and researched.

Stairs are dangerous on crutches with one non weight bearing leg. Go down and up on your butt, or have a somebody spot you in front of you while going down and behind you going up.

Leg elevation: I took two firm couch pillows and took them to the bed to keep my leg propped up above my heart.

I was pleased to find the achilles blog and i was able to get a game plan together. Here are some of the things that I did:

Diet: I’m a Certified Nurse-Midwife so health and wellness is my game. As soon as the injury occurred I focused on healing nutrition. Those two beers I downed immediately before the injury jump, were immediately followed by five waters on way to ED! For wound healing, immunity and infection defense, I focused on high quality protein and vegetables. No sugar, no alcohol, no grains.

Supplements: I posted a picture of the supplements i gathered, but the pic is huge and i can’t fix it right now, so i took it down while i fix it. No dosage is given as you should talk to your health care provider before taking any of these things. The quality of the supplement is essential.

Magnesium - prevent constipation; Vit C - collagen building, infection fighting; EPO - inflammation; B-complex - nerve support; matcha green tea - immunity support; mushrooms - immunity, adaptogenic; Smooth Move tea - constipation; Vit d3 - immune, wound healing; homeopathic tincture - wound, healing, pain; arnica massage oil - tissue trauma, bruising; echinacea tincture- infection support, immunity; aspirin - DVT protection, pain; arnica homeopathic pellets - tissue trauma, bruising; probiotic - immune support; lip balm - after surgery dry lips; lozenges - after surgery throat support. Not shown - Vital Protein brand collagen powder for tissue healing.

Gear: After sitting around researching, I bought the following gear:

Shower chair: $30 on amazon. works well so i can sit in shower and keep leg out propped on a chair outside the shower. I use a plastic bag around boot and tuck in the ends. works well for me.

Vacocast boot: $300 um, do not even think twice about buying this thing. my ortho had heard about it but never fitted one. i just ordered it a few days before my first post op so i could bring it with me. more on that in another post. if it’s good enough for Kobe, it’s good enough for me.