bobfv’s AchillesBlog

Today marks 9 weeks to the day since my ATR surgery. In my last post I wrote about my outing to the ball game in shoes (boots) over the weekend. The following day I had a great PT session, working on standing calf raises and gait normalization, then yesterday my wife and I flew from Washington DC to LA. I wore my Aircast boot and had no problem at the airport, went right through “TSA Pre” without any extra scrutiny, and had no problem boarding. We sat in first class so I had enough leg room, and I took my Aircast off and replaced it with a comfortable street shoe with a heel lift as soon as I was seated. It worked out fine, I used two shoes to walk from my seat to the lavatory. A couple of hours in to the 5+ hour flight I put my vaso-pumps on my calves and let them run  for about 90 minutes, a hedge against blood clots. When we landed I put the Aircast back on.

At LAX we picked up our bags and took the shuttle to the car rental place. I am an LA native and learned to drive here, my wife is a little nervous about jumping on to the LA freeways, so I took off my Aircast, put on my tactical boots (see previous post) fired up the rental car and jumped on to the San Diego Freeway at rush hour. I had not driven in about 2.5 months, but I had absolutely no problem. No pain, no issues whatsoever. My heel just rests on the floor of the car and I plantarflex to operate the throttle and brake. Piece of cake! I am so happy to be driving again!

When we got to our destination in LA my ankle felt fine but it was swollen from the flying and driving, and I iced it down. I had not had any swelling in weeks but all those hours with the leg down on the ground took their toll. The swelling went away after icing and I didn’t even need to take a Motrin or Tylenol.

Today, celebrating my 9 week anniversary, I got up early and went to the gym. I went in two shoes - I picked up a pair of Hoka One trail running high-tops to give me support in the gym and they worked great. I rode the exercise bike for 45 minutes, then I did most of my PT exercises including one leg balancing, step ups, basic proprioception, and 2-legged calf raises. I recommend these great shoes for transition workout shoes. I put a 1cm heel lift in the heel of the right shoe.

That’s where I am at week 9. I feel like I am making great progress now and getting my old life back!

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.

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.

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.