bobfv’s AchillesBlog

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.

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

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.