Avulsion for once

March 27^th to April 9^th

There wasn’t much going on this week, simply getting things done that I had promised myself I would be able to. Not being allowed to work was liberating and I did manage to get a fair bit done that I had intended. Figured out how to cook as well which was a nice change, even barbecued. As long as I had a chair handy I could stand without the crutches and even move dishes back and forth between the counter and the table. This of course also means I could do dishes.

Once Monday rolled around I was able to go back to work since I had been able to hand in a note from my surgeon. Basically it was worded to say I could work as much as I felt and that I had to elevate my foot and walk around.

I’d gotten pretty good with the crutches to by then, or so I thought. My wife and I decided to meet some friends for lunch, its a pub I like but don’t frequent often and as such I screwed up the directions, getting off the subway nearly two stops too far but I crutched my way back and we had a good time. In all it was probably near to two kilometers, needless to say lunch took a good long while.

Being that we were within walking distance of our friends place we decided to walk back and guess what - it was another 2 kilometers. We stopped often and they were exceptionally patient and even gave me the last beer in the house. We stuck around for a while and chatted, it was pretty good fun and I think it helped considerably in the end. Not only was my conditioning for crutching showing marked improvements but there was significant improvement in my abdominal area, I was getting ripped!

On the bus on the way home a woman who had gotten on at East York General started talking with me, asking about my condition and telling me about her issues with her knees and how things weren’t progressing well. I impressed upon her the excellent service I received at St Mikes and she seemed to think my advice sound. I hope she managed the trip because I think it might have been worth it for her.

I really was getting along quite well with my crutches and as I was returning to work on a near full time basis I needed to make a covering for my toes so as not to offend anyone in the office. I was also lucky in that I was able to fit my dress pants down over the fiberglass cast, though I had to wrap the cast itself in a compression wrap so that the sharpish ends of the fiberglass wouldn’t catch on the fine fabric and rip it to shreds.

I had to get around well because my office was not built to be completely accessible. There were no power assisted doors and the washrooms didn’t have handrails or any other assistive device installed which made figuring out how to handle carrying lunch using crutches and opening doors essential. Luckily the city had yet to implement the mandatory 5 cent fee for plastic bags so most of the time I was able to get lunch to carry away in a bag.

The leg itself felt pretty good. For the first couple of days after my appointment there was a fair amount of tightness in the calf as the tendon and muscle stretched back out. There was also a lot of popping and snapping going on along the incision as scar tissue broke up and started to slide. Sometimes it hurt a little, sometimes it didn’t hurt much more than the original injury but it was neat to feel that pain and figure out how and where it was coming along and just what layer of tissue was giving way.

Finally the Thursday morning appointment rolled around and the cast was removed again, there was little in the way of scabbing left, most of it simply stuck. I picked and peeled scabs while I waited for the surgeon to come through and take a look at his work, even sat there and flexed it a bit, trying to pull the foot into neutral simply on dorsiflexion alone. I even put a little weight on it to see how it felt that way and it wasn’t too bad but it still hurt enough to make me really cautious.

Finally after I had cleaned up as much scab and callous as I could the surgeon came in, I was able to brush the small pile of dead skin and blood onto the floor without anyone noticing. We lifted up the foot, flexed it back and forth under muscle power and with his own hand, the foot actually flexed into neutral and I was able to hold it there without assistance. He poked at the heel and examined my fresh x-rays and determined that this was as good a week as any to take off the button.

Now imagine what I was thinking. This is heavy duty suture he’s put in place and its been in my leg for three weeks. It runs up through the bottom of my heel, through the calcaneous, out and through the Achilles, back down through the calcaneous and back out through the heel. I’d spent much of the previous week trying to imagine what it would feel like to have that suture get pulled out through all of that.

Two little snips later (which actually stung a fair bit) and the surgeon starts to give instructions to the orderly about how to place my foot and cast it. So I asked, first does the suture stay in? Second can I have the button? And yes, the suture stayed in, it wasn’t going to offer any issues and if it started to push its way out they’d cut it back far enough it wouldn’t be able to do that. And yes, I could have the button.

So Ricky Gervais set my foot up as close to neutral as we could manage it and I left the clinic with a nearly flat foot, sutures creeping back into my heel and a button in a bottle.

Yes, I could feel the suture working its way back up through the various layers of dermis and into the deeper tissues of my foot, it was very weird, like there was something burrowing in my leg.

Creepy, but I was more free than I had been in a long time!

Pictures

The incision as it looked on week three just after the cast had come off.

This is what things look like after three weeks. I’ve picked off the loose scabs, the dry skin and most of the callouses. Its jagged, a little angry and scary looking. The gathers are what I fear most, if those don’t absorb in some way they stretching that skin back out would be a painful and terrible day.

A pretty good shot showing the relationship between the button hidden in the surgical sponge and the heel.

This does show the relationship between the button on my heel and the point at which the Achilles mounts to the calcaneous. Right under the deep scar still on my heel is the tendon and the suture pins that hold everything in place. This angle also provides an excellent visual representation of the way the incision was altered after the discovery that the diagnosis was wrong.

What the button looked like fully dressed. The pressure on the sponge was enough to crush the structure - it didn't bounce back.

This is a detail shot of how the button looked before it was removed. The sponge had folded over during the previous application of the cast so I had to hold it out of the way. The pressure on the sponge was so great that it actually crushed the sponge flat and it didn’t return to shape after being release, it had solidified. It wasn’t that much fun having the surgeon pry around under the button to snip the sutures one by one, but nothing moved when he was done!

The heel after spending three weeks in close proximity to a surgical sponge soaked in iodine. Pretty.

My heel is finally naked. Most of the dark splotch is from the iodine that the sponge is soaked in, they gave me a cloth to clean up the foot before they recast me and man did it feel good to wash that down. The two black circles are the holes that the sutures came through, the darkness being scab tissue, you can’t see it but in the middle are the ends of the sutures. Over the course of the next two weeks I could feel those sutures sneak back inside my foot, pulling through the various layers of skin and fat and finally into the meaty bits. I swear I can still feel them move. It creeps a person out I tell you.

This is all that kept my Achilles in place for three weeks, a simple white nylon button.

It really isn’t very much different from the buttons found on surgical scrubs, it creeps me out to think where it might have come from, images of my surgeon completing my surgery with his scrubs puddled around his ankles doesn’t thrill me. Perhaps it was one of the lovely ladies though.

What would I care I was so unconscious I didn’t wake up for a day!

Its not terribly clear but the white bit mid bone are the suture pins.

The white bit near center are the surgical pins. Below the pins, causing the bump in the bottom of the cast, is the button. It still kinda freaky to me to think that’s my foot.