Ahnadlass’s AchillesBlog

Very happy to be PWB after 2 weeks of NWB.  Still in my Vacocast which is super comfortable.  I can put up to 15-20kg on the leg.  I am a bit worried about the feelings that I am getting in my right foot - it’s tingling along the sides and heel - and it can be painful at the bottom of the scar which is just above my heel where I think a scab is forming.

I had an appointment with my surgeon yesterday.  She changed my dressing and pronounced that the incision is looking okay.  We spoke about her rehab protocol, which is normally PWB of no more than 15-20 kgs (33-44 lbs) for the first 2 weeks after surgery.  However, because of the extent of my surgery, she recommends NWB for the first two weeks.

She also showed me photos of my surgery that she took at various moments.  As opposed to the standard Bosworth procedure in the diagram below, there was no full gap as she only cut out a portion of the tendon at the rupture site due to its necrotic state.  Thus a small portion of good tendon had grown back and could remain.   Then she took 3 strips from the upper tendon instead of the 1 strip shown below to strengthen the rupture site.  Everything was then sown together - there must be 50 sutures in my tendon!

I had general anesthesia and local anesthesia for the surgery.  I woke up 3 hours after the surgery with the Vacoped on and with a small tube coming out  which was draining some blood out.  The first night was a tough one, and they gave me some morphine which helped a lot.  Right before being discharged I met with the surgeon who changed the dressing and pulled out the drain.  It is a very very long incision running from just above my heel to the middle of my leg.  The surgeon told me that once she (she is one of very few female orthopedic surgeons here) was inside she found that the tendon at the rupture site had degenerated.  She also found that the calf muscle was not the right size for VY plasty and so instead she used a "modified Bosworth" procedure to bridge the gap.  Here’s a diagram on the original Bosworth technique:

The clinic is admitting me tomorrow night (Tuesday) before the surgery, which is on Wednesday morning.  I guess the thinking is that they can take some blood, do an EKG, make sure I have a light dinner meal, get a good long betadine cleaning in, etc.  This is different than the other clinic I went to where the night before I was at home and took a betadine shower and used the chemical hair remover on my legs which is awfully smelly.  Looking forward to Friday when I should get out.

http://uk.news.yahoo.com/spains-king-recovers-achilles-operation-061949168.html

Met with the Anesthesiologist today at the clinic where I will be having surgery.  It was a short discussion - basically to see what type of drugs I wanted.  He recommended general during surgery followed by a morphine pump which I will control.  That sounds like I won’t feel a thing so I was pretty happy about that.  It is almost the same that I had for my ACL surgery except that the nurses administered the morphine in my IV.  For the Tenolig surgery, they did a local anesthetic so I was awake but groggy during the surgery.  I will be entering the clinic the night before the surgery, and that is when they will do the final checks - a blood test and an EKG.

I am very happy with my new surgeon’s decision to use the Vacoped boot (Vacocast in the US). Whereas last time I had a cast for the first 3 weeks and then a standard heavy metal orthopedic boot for about 4 weeks, the Vacoped will be used for both periods. It really reminds me of a ski or snowboard boot because of all the various adjustments, adjustable inner cuff, and look. It came with 2 removable soles, a flat and a "equinus". I also had a choice of buying or renting it. It was about €500 to buy it and €250 to rent it for 10 weeks, so I will rent it and it is not covered by the French socialised medicine. I noticed on the US website that it is cheaper in the US. After the rental, they send it back to the company, throw away the inner cuff which probably gets pretty messy, and either clean the plastic parts or melt the plastic parts and reuse the plastic. I also noticed on the website that they are promoting 25% faster healing. I hope that works for me too.