12 weeks post surgery update

Hi all. I haven’t updated this blog in a while and that’s mostly due to the fact that I’m out of the boot and living life again.

Since coming out of the boot at 9 weeks, in order, I have:

  • Been on holiday to Marrakech (where we got a room upgrade due to my ATR) and walked a LOT although I also had a LOT of swelling. Walking was done with a crutch “just in case” and was very slow.
  • Been allowed to drive - bit daunting for the first couple of miles but can easily drive for over an hour with no issues.
  • Brought my girlfriend a cup of tea in bed for the first time in a couple of months.
  • Started to do double heel raises which get easier every day.
  • Improved ROM on an almost daily basis.
  • Improved walking speed and stride length on an almost daily basis although I still have to concentrate on good form towards the end of the day.
  • Decorated a bedroom and fitted new skirting and architrave.
  • Successfully built a 25m square deck frame from 2″x6″ timber which I’ll complete when the deck boards arrive.
  • Managed to do a full depth squat which I wasn’t even close to 5 days before.
  • Walked to the shop and back to get a bottle of wine and enjoy the sunshine.

As you can see from the above, life is good again. Although I’m still a few weeks off returning to work and really getting back to normal, I’m happy to work around the house and carry on with life in general. My girlfriend is particularly grateful I can drive as she was very fed up with playing taxi all the time. Ha!

The only real negatives at the moment are a sore heel at the end of the day and I still can’t go down stairs correctly.

Looking back, I was very concerned with every little thing when I first injured myself and worried about protocols, if surgery was the right choice, what to eat etc. For what it’s worth, I ate crap and drank beer, gained a couple of kilos and the worrying did absolutely nothing. Once I got into 2 shoes life got much better very quickly. I have faith in my surgeon and PT and so far that faith seems to paying off. The weight will come off once I’m back to kickboxing so, for now, I’m going to enjoy this extended holiday from work and get strong again as soon as my body lets me.

7.5 weeks post op - ditched the crutches

I seem to be getting later and later with these posts but other people seems to be at a similar stage to me and are doing a good job of updating their blogs so I’m a little reluctant to repeat what has already been written.

At physio last Wednesday my PT said he was happy with my ROM and that I had gained around 5 degrees of movement past neutral. This has been achieved without using towels or therabands to pull on my foot, just through regular movement of my ankle joint using my calf and shin muscles.

The PT also started scar massage (not pleasant) which I have to continue at home and he also had a go at forcing my foot past neutral although he didn’t say how successful he was. It certainly felt uncomfortable so hopefully it wasn’t a waste of time.

Yesterday was a major milestone and was my first time walking “hands free” whilst in the boot and the day before was my first time using just one crutch.

I could probably have progressed to this point sooner although I’m not unhappy that I took my time as I only did what I felt comfortable with. I was actually surprised that I was able to use one crutch and then, after a bit of practice, noticed that I wasn’t putting much weight on the crutch. This led me to attempt a couple of baby steps without the crutch which I was very surprised to find quite easy. It’s great being able carry things between rooms and I even managed to bring my girlfriend a cup of tea for the first time in nearly 9 weeks.

We have also booked a week away in Marrakesh as my girlfriend has 19 days off work starting next week. We were meant to be going to Cuba which we had to cancel due to this injury so it’s good to have something to look forward to other than the next mini victory in my ATR recovery.

The lesson I have learned this week is…    don’t be scared but don’t be stupid.

6 weeks post Op - Cast off, boot on and first PT session

Apologies for being a couple of days late with this post but I started watching a box set of the Blacklist and it’s got me hooked! Definitely worth a watch if if you’re spending way too much time on the sofa.

Anyway…. On Tuesday evening I met with the surgeon for the 6 week appointment where he removed the cast and fitted me with an Aircast boot. I managed to push down far enough that I’m in the boot without any wedges which I’m pretty happy about although it did make me feel a bit nauseous.

The following morning I met with my physio. I’d been unable to find out much about him on Google but thought I’d give him a chance and see how things went. It turns out that he’s successfully dealt with plenty of ATRs and clearly knew what he was doing.

The PT session itself was very mild and he basically observed me trying to walk in the boot, checking to see how much I could move his hand by pressing on it with the sole of my foot and general ankle mobility checks.

The plan is to be in the boot for the next 3 weeks WBAT with the intention that I’ll work up to being fully weight bearing by the end of week 3 and able to get into shoes.

I’ve been given PT homework of doing 4 exercises consisting of 12 reps and 1-2 sets to carry out 4 -5 times a day over the next week until the next PT appointment to help with ROM, ankle mobilisation and to start building some strength.

The exercises themselves are pretty challenging and it’s a really strange feeling staring at your foot and willing it to move yet it just doesn’t want to respond. I’m as weak as a kitten. Haha!

On a positive note, I’m allowed to remove the boot at night and for showering. It’s really nice being able to clean my wound and scrub all the dead skin off my foot although I haven’t slept too well without the boot which I’m putting down to a touch of nervousness about doing something silly with it during the night but, as with everything about this injury, I’m sure I’ll get used to it pretty quickly.

Losing the cast and getting the boot means that I no longer have to give myself daily injections to reduce the risk of thrombosis. 7 weeks of injections have taken their toll on my stomach by leaving a mixture of multi-coloured bruises and needle marks. I genuinely feel for diabetics who have to inject themselves forever and genuinely don’t understand why anyone would willing inject anything into themselves.

It moved!

With the disappointment of the last appointment still weighing on me, I wasn’t feeling too positive heading into the hospital for a second try at forcing my foot into a more neutral position.

A nurse removed my cast and as I sat there I was trying hard not to remember the strange feeling of the wound stretching and the unwillingness of the tendon to stretch from the last appointment. Thankfully my girlfriend has got her head around things and is now being much more supportive and did a good job of distracting me while we waited for the surgeon.

This time round I was instructed to lie on my front with my injured leg bent at the knee and pointing up towards the ceiling at 90 degrees so that the surgeon was able to exert pressure on my foot without any unwanted movement in any other limbs.

I found lying on my front to be much more comfortable and when the surgeon began to manipulate my foot I was delighted to find that the feelings of tightness were much less intense this time round although he was still clearly having to use a reasonable amount of force as my girlfriend said his face was going red! The wound still felt pretty inflexible but my Achilles felt LOADS better than last time and the surgeon was successful in achieving a foot position that isn’t too far away from neutral.

The original rehab plan called for my foot to be in this new position a week ago and then there was to be another 3 weeks in plaster until I got into a boot.

With my progress being a week behind the plan I was expecting to be in a cast for another 3 weeks before getting into a boot and beginning physio but, thankfully, the surgeon intends to keep to the original schedule meaning that I will be out of a cast and into a boot in just 2 weeks time. Woohoo!!

After being disappointed by the lack of progress last week I’m now in a good place in my treatment and in my head. Last night was only a small victory but it was still a victory. I’m now looking forward to the next phase in my road to recovery :o)

A quick note about casts and itching

When I originally suffered ATR I did the same as anybody else and Googled the s**t out of it in an effort to understand what had happened and any future implications.

Whilst on my Google mission I also looked into life with a cast and any tips and tricks which turned up the usual info but also one unusual one….. how to stop itching whilst in cast.

A lady on mumsnet swore that high strength omega 3 tablets had stopped her from having any issues with itching during her time in a cast as result of a broken leg. She even said that her surgeon was now recommending the tablets to all his patients.

Whilst understandably dubious of her claims (which I haven’t found backed up anywhere else) I went ahead and ordered a couple of pots of the tablets along with a Limbo cast protector for showering and a little half slipper type thing to keep my naked toes warm.

I’ve now been taking the omega 3 tablets daily for the last 4 weeks and have had no problems with itching. On one occasion the front of my shin was itchy but that’s it. Once in 4 weeks. And that’s even with a healing surgical wound and the shaved area around it!

Can’t say it’s going to work for everyone but it has definitely worked for me and the OP on mumsnet. Hopefully this will help someone else.

2 and 3 week post surgery appointments and disappoinments

2 Week Appointment

Although not really a significant milestone, I was none the less looking forward to my 2 week appointment as it marked another small step in the grand scheme of my recovery.

The cast was removed and my wound was checked to make sure it was healing ok. Thankfully there were no signs of infection so into another cast I went.

It was a bit of a shock to see the size of the wound although the surgeon looked as though he had done a good job of stitching me back up.

3 Week Appointment

This was the day I was looking forward to with a bit of trepidation as I was going to see my foot move for the first time in exactly 4 weeks.

My cast was removed and the specialist began to try and maneuver my foot back towards a more neutral position. The feeling was really really strange and is hard to describe. Tight is an understatement although i’m sure that most of you reading this know the feeling well.

VERY disappointingly, the specialist only managed to move my foot a little bit before deciding to put a cast on it in the new position and leave it another week before trying to go any further.

I reckon it’s only moved maybe an inch or so. Nowhere near the half equinus position we were both hoping for.

I’m gutted as it feels as though I’ve fallen at the first hurdle. It’s clear the emotional side of things is going to be as tough as the physical side.

First 4 days after the surgery

As part of the operation I had a “block” put in my leg which meant I had no pain but after returning home the block had clearly finished doing it’s thing and my heel became pretty uncomfortable. Strangely it wasn’t the tendon or the operation site that was sore so I put it down to the fact that my heel was swelling and I assumed I must have crushed the heel of the cast a little whilst it was still wet.

The next morning my heel was still feeling uncomfortable so I contacted my GP and was prescribed 30mg codeine tablets which sorted the pain and also helped me remain stationary with my leg elevated as I couldn’t really be bothered to do anything. Result.

After 4 days of sitting on the sofa I was beginning to make a pretty good imprint of my ass on the cushion but I was now able to get back onto my crutches and try to get on with life again although I did elevate my leg whenever I was sat down (which was still more that I would have liked).

Getting off the sofa coincided with me stopping the codeine and I went back to paracetamol and ibuprofen for the next 3 days. After this I stopped pain relief all together and have had zero pain.

Early after my ATR a doctor described the surgery as “brutal”. I suspect this was an attempt at getting me to head down the coservative route as I didn’t find the surgery to be anywhere close to “brutal”.

Private healthcare - what a difference!

If you read the previous post about my trip to the NHS fracture clinic you’ll know that I wasted the best part of a day waiting for availability of people and equipment. Here’s the difference between free and private healthcare:

It had now been exactly a week since my ATR and I was desperately keen to figure out what I was going to do and start on the long road to recovery. The next step in this process was to see a foot and ankle specialist at a Nuffield hospital.

5 minutes past my appointment time my name was called and I made my way to the specialists office.

Prior to the appointment I had emailed the specialist with details of my working life, activity levels and that I hoped to return to pre-injury levels of fitness. With this information the specialist made his recommendation and I was booked in for surgery the following day.

My recovery was planned to be as follows:

2 weeks post surgery - Remove cast, check wound and re-cast

3 weeks post surgery - Remove cast. Position foot to half equinus position

6 weeks post surgery - Remove cast, fit Aircast boot and begin physio

Not much to be said about the surgery. I went to sleep on my front with my leg in a cast and woke up about 1.5 hours later sat up in a bed with a new cast on my leg and feeling suitably confused.

The specialist stopped by to tell me that the surgery went well and I was then wheeled back to my room where I was given a cup of tea, a sandwich and told that I wasn’t to get up for any reason.

A “block” had been put in my leg so I had zero pain and had no feeling on the underside of my toes.

After an uneventful night I was sent home with some paracetamol and ibuprofen for the pain that would be coming once the block wore off.

NHS fracture clinic

I attended  the fracture clinic 2 days after my ATR.

After waiting for over an hour past my original appointment time I was led into a cubical to see a doctor who quickly decided that the cast needed to come off for a better look and there was unfortunately a “bit of a wait” as the casting room was busy.

After a “bit of a wait” I headed into the casting room where a nurse cut off the cast and headed off to find the doctor. A different doctor came to see me and I was told that the original doc was busy.

I knelt on the bed and a squeeze (Thompson?) test was done on my calf. One minute I was kneeling on the bed and the next I was lying on a wet floor, looking up at a group of nurses and the doc looking down at me. Turns out I had passed out!

Once I was safely back on the bed the doc said that he wanted to send me for ultrasound as my foot was twitching when he was doing the squeeze test which led him to believe that I may only have a partial tear. Unfortunately the ultrasound department was about to close for lunch so I would have to wait around for about 1.5 hours until it was open again. I was really beginning to regret not bringing a book!

The ultrasound revealed I had a complete rupture and a gap of 8 - 10mm between each end of my now useless tendon. As I was lying on my front for the procedure I didn’t get to see it for myself but the lady explained it to me and got me have a little feel of my my mushy ankle and compare it to the healthy one. Yuk!

A nurse came and wheeled me back to the casting room and the, once again, headed off to find the doctor so we could discuss the way forward.

I was given the option of opting for either a surgical or conservative approach but when asked about the pros and cons of each he started off by telling me that surgery is “pretty brutal” and then failed to give me a well balanced argument for either option. He did throw in the fact that surgery was only really beneficial for people who had a gap of over 20mm between the ruptured ends of the tendon but I haven’t found any information to back this up.

After being suitably scared by the words “pretty brutal” I opted for conservative treatment, was put into a plaster and sent on my way.

All in all, I was in the hospital for a little over 5 hours. 4 hours of that time was spent waiting for doctors, ultrasound and cast removal / fitting!

It wasn’t until I got home that I started to question what I had been told by the doctor and started my own research into ATR and the merits of surgery and conservative treatments. Although there seems to be no real consensus on the best form a treatment I did note that surgical repairs offered a lower re-rupture rate than non-surgical - 4% for surgical and 12% for conservative.

The ATR has been disastrous for me as I won’t be able to return to work of any kind until I am completely healed so the re-rupture rate information led me to contact a foot and ankle specialist at a private hospital and an appointment was made for Tuesday 20th January - 1 week after my ATR.

Unfortunately getting the appointment with the specialist wasn’t as straight forward as it should have been. I was in contact with his secretary and tried to get some advice about his preferred way of treating ATR. The only information I managed to get back was that surgery was very expensive and isn’t an option for most people who don’t have insurance. It wasn’t until I emailed back with an insurance authorisation number that things started to move and the appointment was made. I was pretty pissed off at this point as it is presumptuous to assume what people can and can’t afford and also to assume that I was fishing for a free email consultation.

Who said sport is good for you?

Welcome to my Blog about the worst thing that has ever happened to me. I’m aware of how dramatic that sounds but it is the truth.

I’m 32 years old, from the UK and was in good shape until the injury which came without any warning.

The site has been a big help as it’s difficult to take on words of encouragement from people that haven’t had the same experience as you. I just wish I had discovered it sooner as it’s now been just over 4 weeks since I ruptured my Achilles whilst sparring after a kickboxing class.

Despite the fact that I was kickboxing, the movement that led to the injury was a step forwards. No kicking or trying to do anything fancy. Just a simple step.

I was pretty tired after having attended a class and then staying on to spar. I’d actually decided to finish for the day when an instructor asked if I was up for a final round. It’s difficult to say no to any one on one time with an instructor as you learn a lot from it so I put my gloves back on and set a timer for a 3 minute round.

Around half way through the round a loud pop was heard by myself and the instructor and I felt a heavy kick to the back of my right leg which put me straight on the deck. When I looked up, my opponent was nowhere near me and that’s when I realised something serious had happened. I’m the 4th person the gym owner has seen this happen to so I knew pretty early on it was likely to be an ATR.

A couple of the guys from the gym helped me up and took me straight to A&E where I was correctly diagnosed with ATR, put in cast and given an appointment at a fracture clinic in 2 days time.

Thankfully my parents are retired so they were able to collect me from the Hospital and take me home where I waited nervously for my other half to get home from work.

I knew I wasn’t going to be popular for a number of reasons:

  1. She has never understood why I push myself when training and isn’t happy when I come home with bumps and bruises.
  2. We had booked a long overdue holiday to Cuba just 3 days before my ATR and there’s no way I’d be fit enough to travel.
  3. I was going to be off work for a long time - I work on an Oil Rig and won’t be able to return to work until I am completely fit and signed back by an independent medical company. There’s no light duties offshore!

Just as I suspected, she wasn’t best pleased!