July 19 2015 Take me out to the ball game in two shoes.

July 20, 2015

I had tickets to yesterday’s baseball game, Washington Nationals vs LA Dodgers, and I just had to go. The Washington Nationals are my adopted team, and the LA Dodgers are the team that I grew up with in Los Angeles so this was a must see. Since my injury I have attended two games, both when I was PWB in the boot with crutches, and I switched out my seats for ADA “handicapped” seats and everything worked out okay. Yesterday I decided to use my regular seats, which are all the way down right on the field in the 3B corner, meaning I have a loooong set of concrete stairs to go down and up to get to the seats. To top it off, yesterday was a heat warning day in Washington DC - high heat and extreme humidity with heat index values in the 100’s. If you have never been to the Washington DC area in the dog days of summer, the place is absolutely miserable. It is built in a swamp and it just swelters, and yesterday was predicted to be the hottest day of the year so far.

So with that background, I decided that it just was not practical to wear my walking boot - it would get uncomfortable, be difficult on the stairs, and also be difficult in terms of people stepping over me to get in and out of the row. I wanted to sit in my seats, not in the ADA section. Since I am at 8.5 weeks post-op and doing well in PT I decided to give it a go in two shoes.

I bought a special pair of shoes just for this purpose. My background is military and law enforcement and I am kind of a nut for tactical gear. A company out in California called 5.11 Tactical makes great equipment and gives me a veterans discount, so I chose them in selecting a protective boot to wean in to out of my Aircast boot. After looking through their selection I decided that I wanted the following qualities in my boot:

- 8 inch height for ankle protection
- lightweight and breathable
- stiff shank to prevent excessive dorsi-flexion
- ability to accommodate a 10mm heel wedge
- comfortable enough fit around my scar
- side zip for easy on and off

I selected the ATAC Sage 8 Inch CST Boot because it had all of those qualities in addition to a composite safety toe (CST) to protect my foot if someone stepped on me. The boots are very comfortable and I took them to my OS appointment and my surgeon really liked them and thought they would be a fine boot to transition into as I moved to two shoes, providing lots of ankle protection and support.

So I am still not driving, my friend picked me up and off we drove to Nationals Park in Washington DC, just south of the US Capitol. We had a parking space right next to the park and I had no problem whatsoever walking in my new boots! I walked a little bit slowly just out of caution, and I was very careful to avoid situations like curbs which would potentially put me into excessive dorsiflexion, but I did just fine. Once inside the concourse I walked all the way to the far side to get to my favorite sandwich stand, over to my seats, down the stairs - no problems at all. Sitting in the seats I was very glad I didn’t have the Aircast boot on as people stepped over me to get to their seats.

After the game I came home and iced my ankle but I really did not have any pain or swelling - I was very pleased as I had worried about both of those issues but neither materialized.

I consider the whole outing a great success, except for the fact that my adopted hometown team lost to my boyhood hometown team :( I hope this info is useful for anyone transitioning to two shoes. I am going to stay in the Aircast boot for most day to day activity for a couple of more weeks, as my OS had ordered, but it is nice to know I have this option and I am going to use the boots as I start driving again next week.

5.11 boots!


July 15, 2015 - 8 Week Post-Op Surgeon Visit

July 15, 2015

I had my 8 week post-op appointment with the surgeon today. The good news, everything looks fine. The bad news - OS wants me to continue conservatively over the next 3-4 weeks, wearing the boot most of the time, continuing with strengthening, and walking in two shoes with a heel lift at home. He also did not clear me to drive, which is a disappointment but one that I can work around (I have a very expensive, luxury paperweight form Germany in my garage!). He said that in a year I will not even remember if I was in the boot 2 months or 3 months, but just to be on the safe side to keep wearing the boot with one lift, and to wear my shoes with a lift when I do PT and around the house. It doesn’t really bother me - I have good ROM, I am getting my strength back, and I would rather not risk future problems, so I will stick with the status quo for now.

In physical therapy I am progressing to leg strengthening exercises now that I am healed and have a relatively normal range of motion, so I will continue to work hard to strengthen it up.

Here is a photo taken this morning - my 8 week post-op anniversary photo:


Week 7.5 - PT Progress And Weaning Out Of The Boot

July 10, 2015

I am in the middle of my 7th week post-op and I have progressed in my PT protocol to a new set of exercises designed to get me back in two shoes and regaining my strength and balance. The protocol now includes:

  • Normalize gait
  • Progress calf strengthening
  • Seated heel raise>>>standing heel raise>>>single leg heel raise
  • NMES prn  (neuromuscular electrical stimulation as needed)
  • Gradually progress dorsiflexion past neutral in stretching and strengthening
  • Progress to equal ROM bilaterally
  • Eccentric plantarflexion strengthening

I am enjoying these new exercises, for the most part, and continuing to do many of the exercises I learned in the past four weeks of PT.  I have stopped wearing the boot to bed at night and I take very short walks without the boot in the house, very carefully.  In PT I use my street shoes with a heel lift.  I am still doing seated heel raises and have not started the stimulation yet.  My range of motion is very good - I practically have the same ROM in both ankles, but I am not about to push it on dorsiflexion.  I am doing plantarflextion on the Total Gym in shoes which is kind of scary, because I have the balls of my feet on the machine and my heels off of it - the idea is to press down with my toes, but I am scared of slipping and going in to a big, unintended dorsiflexion.  I am also enjoying working on single leg balance - I alternate lifting one foot off the ground and standing on one leg for ten seconds at a time.

I have an appointment with the OS this coming Wednesday, and I am hoping to get his blessing to lose the boot and to start driving.  That will be exactly 8 weeks post-op.  Other than that I feel great, no pain whatsoever.  I bought a pair tactical boots which are lightweight and have a side-zipper entry and I plan to wear these in the first weeks out of my Aircast boot to provide extra support and protection. I have worn them around the house and they don’t seem to put any pressure on my scar, which has healed almost completely.


Sore from working out - at last!

July 4, 2015

So I am at 6.5 weeks post-surgery on an aggressive protocol. I recently added new exercises at PT prefatory to getting back in to two shoes, which should be in about a week and a half. Since yesterday was a holiday Friday and my wife had yoga class at our gym, I hitched a ride with her and did a workout based on my PT, here is what I did (all with boot on):

Exercise bike: 40 minutes level 3 80 RPM
Leg lifts - 20 with each leg in all four planes of motion (boot on)
standing balance with 8# ball - 30 seconds on each leg
Leg presses - 2 sets of 10 with the bar and 2 10 pound weights
Squats “sit to stand” - 2 sets of 10
Step ups - 10 with each leg.

In the evening I took the Metro train into Washington DC for dinner with my boys so I walked about 4 blocks FWB with no crutch or cane.

Well, this morning I am sore, but “good sore” - both glutes and hips really feel the work I put in yesterday, which is great. I am looking forward to continuing with PT and with these workouts on my own! Can’t wait for the boot to come off so I can do even more. OS said strengthening with my legs and feet pushing away from my body is what I need to concentrate on.

Oh - also last week at PT, with the consent of my therapist, I had my wife come in while they were doing “scar tissue mobilization” massage and she learned how to do it, so now I am taking the boot off once a day for her to give me a massage and rub vitamin E on my scar. I also still take the boot off once or twice a day to use the vaso pumps (still a chance of blood clots until I am out of the boot) and I also take it off to shower, and to walk between the bathroom and my bedroom (very carefully!) after I shower and before I dress.


Post-Op Week 6 Follow-up, July 1, 2015

July 1, 2015

Today I visited the Orthopedic Surgeon 6 weeks to the day after my surgery.  I have been FWB in the boot for over a week and I am now walking without any crutches or cane.  The doc did the Thompson Test on both sides, noted proper function. He also noted atrophy in my right calf, fairly normal.  I have well-developed, muscular legs so the atrophy in the calf muscles is pretty apparent.

I told the doctor I have been showering out of the boot, standing on my bare feet in the shower and carefully walking from the shower to the bedroom to dress.  He looked a bit alarmed and told me to be careful. He also told me to continue physical therapy, and per protocol to begin to wean out of the boot.  He took one of the three lifts out of my boot which feels much better, and we set our next appointment for two weeks from today.  He still doesn’t want me driving for at least a couple of weeks.  He also warned me not to do any dorsiflexion past neutral in PT, and to continue strengthening through resisted plantarflexion, leg presses, and to start balance exercises.

I feel really good.  I have no pain at all.  My wound is healed and dry except for one little spot that continues to ooze just a little bit.  I have no problem putting more than my full body weight on my right leg wearing the boot - I stand up and put all my weight in that leg and it doesn’t hurt at all.

So, fingers crossed - I will wean out of the boot and continue physical therapy over the next two weeks.  I am extremely anxious to start driving again and hope to be cleared to drive in two weeks - I have a very expensive German paperweight sitting in my garage waiting for me to get behind the wheel!

That’s it for now - here are two pictures that my wife snapped during the exam - you can see the significant thickening in my right calf comparing it to my left one.

6 week post-op
6 week post-op


My Achilles Repair Protocol Week 1-6 Post-Op

June 20, 2015

My Physical Therapist gave me a copy of my Post-Op protocol, which I am following now 4 1/2 weeks after surgery, and I thought I would post it for you.  I am glad I chose my surgeon, with an aggressive protocol.

  • 2 WEEKS Post-Op

Begin PT

Partial WB in boot with heel lift

No dorsiflexion past neutral

Edema control

Ankle AROM all directions

Ankle mobility/joint mobilizations

Foot intrinsic strengthening

Scar tissue mobilization, STM along gastroc/soleus complex

Quadricep/Hamstring/Hip strengthening and stretching

  • 2-4 Weeks Post-Op

Progress WB

Stationary bike in boot

Seated BAPS

Begin resisted plantarflexion (seated heel raises, theraband plantarflexion)

  • 4-6 Weeks Post-Op

Wean off crutches (2 crutches to 1 crutch to FWB)

Begin closed chain lower extremity strengthening in three planes of motion when FWB (Mini-squats, wall squats, leg press)

  • 6 Weeks Post-Op

Wean out of boot at home (with heel lift in shoe)

Progress to no boot over next two weeks

Ankle brace if prescribed by doctor

Single leg proprioceptive exercises



June 19, 2015 - 4 Week Post-Op Visit and FWB!

June 19, 2015

Normal Post-Op on June 19 visit four weeks to the day after my surgery.  Dr. Kartelian performed the Thompson test, everything looked good.  Wound site looked fine, the surgi-strips hadn’t fallen off yet, no problem with that.  I showed off my range of motion, rotating my ankle and lifting my toes up to neutral.  He performed a strength test with me pushing against his hands.  Everything was great!  He told me to continue to wear the boot, keep the heel lifts in the boot, continue physical therapy, continue with the vaso pumps, and over the next two weeks go to full weight bearing (FWB) as long as there was no pain.

Great!  I was so happy I put my boot back on, picked up my crutches, and walked right out of his office on my own two feet.  To be honest, I had been "cheating" a little throughout the week, putting full weight on my right foot while still on the crutches - no pain at all, everything felt fine.  At home I used one crutch a little but mostly no crutches and that night I walked up the full flight of stairs to my bedroom without crutches!  What a relief to be able to use my hands to carry things while I walked, and to be able to bear my full weight for personal hygiene activities in the bathroom!  Taking showers is still a little tricky, taking my boot off while sitting in a shower chair.  I actually started kneeling with one knee on the shower chair which makes showering much easier.

Looking forward to the next two weeks of physical therapy in which I will begin "mini-squats" and other exercises to begin lengthening the Achilles and increasing my range of motion.  By protocol weeks 4-6 will see me wean down form 2 crutches to FWB, but I am already there!  No pain whatsoever, and no pain meds since the surgery.  I still elevate, ice, and use compression pumps in the evening for a few hours, and I strongly recommend that regimen to eliminate pain.  Still sleeping in the boot, I hardly notice it now.  Yesterday my wife told me I "look good" in the boot, and with the full beard that I started growing on the day of my surgery.  Walking with this boot I guess I sort of look like a pirate - the beard stays until a client meeting or other exigency dictates that I shave it off!

I have mentioned the vaso pumps a few times - here is a photo of one on my right leg - I love these things.


Post-Op Week 2-4, Physical Therapy and PWB

June 19, 2015

This post describes the period between my 2 week post-op visit on June 3 and my 4 week visit on June 17.  My visits are on Wednesdays, as was my surgery, so they correspond exactly with my week "anniversary" dates from the surgery.

I was told to begin partial weight bearing (PWB) but I still used the knee scooter almost all the time after coming home from my 2 week post-op on June 3, 2015.  That all changed when I went in for my first physical therapy (PT) session on June 9.  My orthopedic surgeon is part of a medical group in Reston, Virginia called Town Center Orthopaedic Associates.  It is an eight doctor group conveniently located in the same medical complex as our local hospital and ER, and in the same building as the outpatient surgery center where my surgery was done. Sharing the office suite with my orthopedic surgeon is the physical therapy facility, which is really nice because the therapists are part of the same practice, they have access to all the surgeon’s notes, and use protocols developed specifically by my surgeon.  Also, I was getting PT done here for my Achilles tear before I had the ATR, so I already knew and really liked my therapist, Chris Marino, DPT.

On June 9 I showed up for my PT evaluation by Chris. As I mentioned, we know each other.  He took a look at my wound, massaged it a bit with the boot off, and did some basic strength tests.  He looked at the scooter and told me that he never wanted to see it again, that I was done with it, and the we were going to start PWB immediately.  To that end, I put the boot back on, held on to the handlebars of the scooter, and walked across the room holding on to the scooter like a walker.  It felt funky in my right foot and hurt a little bit, but I was walking.  Chris explained that my protocol called for PWB and some basic flexibility during weeks 2-4.

So I started my PT - twice a week.  During this week 2 to week 4 I mainly did flexibility but also some strengthening of the unaffected part of my leg.  I used a BAPS board, picked up marbles with my toes, did seated knee lifts, had my surgery site pretty vigorously massaged. This is a pretty aggressive protocol but I really enjoyed the sessions.  One thing I was seriously warned about by my doctor was not to lift my right foot past 90 degrees of "neutral".  I was still in the boot with two heel lifts so my basic position was slightly toes down.  Man, did it hurt the first time Chris gently flexed forefoot up just a little bit to make my foot neutral at 90 degrees, but after a week I was doing it on my own.

Physical therapy is great.  I also started riding the exercise bike in the boot.  This was great because I had not been getting any exercise.  Chris cleared me to ride the bike as much as I wanted, so on Saturday I went to the gym and rode the bike trainer for half an hour.  I was still getting pain when I didn’t elevate my foot occasionally, so I found the recumbent bike trainer was much better since my feet are naturally elevated on that machine.

My PWB increased dramatically over these two weeks, and by week 3 post-op I was PWB to the extent that I was only using one crutch at home, and when walking with two crutches I was basically walking in the boot and just balancing and taking a little weight off with the crutche. This was progress over those first two weeks.  And yes, I stopped using the knee scooter completely.  I did not consciously increase the proportion of weight on my affected foot, but I found that I unintentionally used it more and more as the pain went away.

Also - I had been using some light aluminum underarm crutches that they gave me at the hospital, but they were very uncomfortable and I found them difficult to use. I went online to a place called "DME Direct" and I spent about USD 80.00 on a nice pair of forearm crutches - fully adjustable with spring tips.  What a difference these made!  No more pain in the armpits, and the spring tips do a great job of absorbing shock. I strongly recommend them - just like I strongly recommend the knee scooter for the period when you are non weight-bearing (NWB).


June 3, 2015 - Second Post-Op Visit and Stitches Out!

June 19, 2015

Between my initial Post-Op wound check visit on May 26 and the second one on June 3 I stayed home, non weight-bearing, with my legs elevated as much as possible.  I stayed in my boot except for my daily sessions with the vaso pump on my lower legs. I scooted around the house on my knee scooter and occasionally on crutches. Nothing too exciting happened during the week, but being non-weight bearing was becoming a major inconvenience.  I really didn’t have any pain during this week - obviously the area with the stitches was still quite tender and I had to be careful to keep pressure off of it when my legs were up.

One thing I want to mention is how significant it is to pick the correct sock to wear with you boot.  I have a tall Aircast boot with two air bladders and a built in pump. It has a foam liner which gets pretty gamey. I tried using boot liners made of synthetic wicking fiber (Coolmax) but they were uncomfortable and difficult to put on and take off.  On Amazon I found socks made by the same company as my boot, Aircast, called "Aircast sock liners for Aircast Walkers".  This is the greatest purchase ever.  The socks are oversized so they don’t squeeze the surgery site when putting them on and taking them off - they are also soft and fluffy. My foot is so comfortable that I don’t even want to take the boot off!

On June 3 I returned to my Orthopedist, Dr. Kartelian. His Physician Extender, Tori, removed my bandage and wound dressing and told me that it looked great - no sign of infection and good healing - my stitches were coming out today!  She put on gloves and took a little scalpel and hemostat and I just heard a little snipping, very tiny pinching sensation but no real pain, and the stitches were out in a flash.

Dr. Kartelian did the Thompson test and I am told it showed that my Achilles was functioning completely normally. Tori put about 5 "Steri-Strips" over the wound site where the stitches had been. These are like butterfly closures. She said that they might stay on for a day or they might stay on for weeks, just leave them on and let them come off on their own.

Ah - I was cleared to go home and shower!  So happy about that, as I had been taking "bird baths" for a couple of weeks and I was starting to smell more like a goat than usual. Dr. K told me to make physical therapy appointments and said that I could go partial weight bearing as long as it didn’t hurt. I was told to remain on two crutches but that I could put partial weight on foot in the boot as long as there was no significant pain.

So that’s it - I was a new man - partial weight bearing!  PWB!  As I left the office I very gingerly used my booted foot not to really bear weight, but to just catch my balance as I walked on the crutches - what a difference in mobility!  I was ready to start physical therapy and the road to recovery. My next appointment with the doctor was scheduled in two weeks.


May 26, 2015 - First Post-Op Visit (6 days after surgery)

June 18, 2015

I didn’t know what to expect at my first post-op visit, six days after my ATR repair surgery.  I was doing well, non-weight bearing. I just stayed home and moved as little as possible, keeping my leg well elevated all week.

At the orthopedic surgeon’s office, we were greeted by Tori, who has the title "physician extender" - she is a certified athletic trainer who works with the surgeon helping with exams, arranging the surgery schedule, and assisting with durable medical equipment.  Tori put me face down on the table and removed the plaster and the splint and bandages and exposed my ankle for the first time since my surgery day. Dr. Kartelian came in and said hello, he said that the stitches looked fine - clean and dry and not swollen, and he announced that he was putting me back in the boot, with heel lifts. He did the Thompson test and everything was working fine (a “negative” result from the test)  He also had Tori order me a set of vaso pumps to prevent blood clots.  These are like blood pressure cuffs that go on your lower legs and inflate and deflate to move blood and prevent blood clots.

So my instructions for the following week were no weight bearing, stay in the boot except 3 times a day use the pumps for about a half hour, elevate as much as possible, use ice, keep the wound dry.  They left the stitches in and covered the stitches with a bandage and some flexible adhesive tape which wrapped around my ankle a couple of times.  I was thrilled to be going back into the boot after just 6 days!  I would have to wear the boot all the time, including in bed, but again, I could take it off to ice and to use the vaso pumps.  My next appointment would be in another week, and hopefully my stitches would come out then.  I have posted a photo of my stitches 6 days after surgery,Stitches at 6 days post-op