Posted by: brendan | March 28, 2008

2nd Post Op (Day 25) Appointment…Got the Boot!

I had my 2nd post op appt today…Recovery to date has been:

  • 11 days splint (downward pointing toes) 
  • 14 days cast below knee, foot at ~75 degrees, NWB, exercise - moving toes  (up, down, spreading)

 Overall, it was a quick visit, I only got about 5 minutes with my doc.   He examined the wound, but didn’t try to move it at all.   It felt good to have the cast off, my daughter was tired of the pink at this point, and wanted blue next.   I, on the other hand, was excited to not move into another cast.    I think it was Dennis that mentioned how shocking the calf atrophy was…I was prepared for it…but again, still a shock…just 4 weeks without using it: 

 picture-006.jpg

Here was my list of questions for the doc:

Copy of the surgical report - forget to get, they are mailing it to me..will post when it arrives

Can I get into a boot/aircast for mobility? - YES..I have two wedges in the heal.   I can take it off to sleep at night and to do ROM stuf…here’s what it looks like:

 Boot

ROM exercises - Basically #1-3 on this sheet: http://achillesblog.com/files/2008/03/exercise_at_home.pdf   I started tonight, and am starting with a little heat first which feels good.   I can’t get to 90 yet, but I wasn’t immobilized there either, so that is not suprising.  It’s really tight feeling, which at first bummed me out, but at least it tells me that the tendon is attached  My doc thought that within a few days, I would be amazed at how much looser it felt.   

Weight bearing - Doc still wants NWB for 2 more weeks.   OK to touch down.   If you remember I had to negotiate to get the boot for ROM after 4 weeks.    He typically likes to immobolize, NWB, for 6 weeks.   I asked about PWB, and he doesn’t see the benefits of weightbearing at this stage, apparently he feels the risks of weightbearing (pressure on the tendon) aren’t worth the benefits.   From all the research I’ve read, I don’t necessarily agree…so we’ll see how the next few weeks goes.   Realistically, I know that in a year from now, waiting 2 weeks to bear weight is probably not going to make a difference…so I might just stick with his protocol.   I have though just been touching down with my foot as I use the crutches, sort of going through the walking motions and just that feels pretty good.

Can I start riding stationary bike? - when I asked, he looked at me, and I could hear him think, “should I really be putting this guy into a boot?”   He said yes, but no resistance yet.

When does PT start? - 2-3 weeks from now (week 7-8)

Has incision healed so that I can start to shower, get it wet? - yes!   washed it fully tonight…lots of skin and stink are now rafting down a dark pipe to the waste water treatment plant where I’m sure some friendly bacteria will digest fully….ahhhh…cycle of life, isn’t it a beautiful thing!  I’m still a little scared to take the strips off as the wound still appears like it could open up (this is in my head, I’m sure)   Here is what the wound looks like now:

picture-001.jpg

Walking in the pool? - didn’t even go here, since NWB.

Goals (dates) - riding bike, swimming, walking in shoe? - didn’t get to this.

At what point is infection not so much of an issue?  - after 3-4 weeks, not really an issue

At what point are blood clots not so much an issue? - after 3-4 weeks, not really an issue

When can we safely stop elevating the leg, if I never really had much of a swelling since the first few days? - didn’t really get the specific answer to this, but he said that at my stage (3.5 weeks post op), elevating is not helping the healing the process.   My swelling is definitely evident still…kankle in full effect….yet looks familiar to some other pics I’ve seen as well: (sorry for the toenails…note to self…CUT THEM!):

picture-013.jpg

Do involuntary muscle spasms at night.. (or when you “kick”, when sleeping) do any sort of damage to the tendon? They are painful for a couple of minutes. - didn’t get to this question

What are your views on EWB? - didn’t really get an answer.

Can I start massaging the tendon to break down scar tissue? - yes, can start massaging.

The only other thing to note is the bottom of my foot is very sore and stiff..must be the planter fascia stuff that Doc Ross was talking about.   I hope to keep working that a bit as well.

Responses

Brendan -

Good luck on your second post-op appointment.
It looks like it’s a pretty good list of questions.

I am really reaching here.. and probably may not be applicable to your case, so you may want to ignore a lot of these.

But how about:

At what point is infection not so much of an issue?
At what point are blood clots not so much an issue?
When can we safely stop elevating the leg, if I never really had much of a swelling since the first few days?

Do involuntary muscle spasms at night.. (or when you “kick”, when sleeping) do any sort of damage to the tendon? They are painful for a couple of minutes.

What are your views on EWB?

Hmm, I can’t think of anything else.. maybe others would like to add?

:)

I’ll keep adding to the list and ask as many as I can…

Thanks Brendan.

I downloaded the latest Progress spreadsheet. 23 people on the list. I think if everyone stayed away from bouncy round objects, most of us wouldn’t have needed surgery. There are 3 skiers too.

This is a quite an extensive list!
Jim is on the fast track with FWB on day 17.

Brendan - Looks like a very comprehensive list to me. If you do get into the boot right away you may want to ask if you can start lightly massaging the tendon to break down some of the scar tissue. I’m not sure if it may be too soon to start massaging.

That’s a great question Tom…thanks for adding that!

good for you
love the boot
it’s a bummer that you can not WB
we’re in the same boat
iv’ got 3 more weeks to go
like you say, in 2 years, that 2-3 weeks of NWB won’t make a difference, really
so let’s hang in there, i know it’s tough!
especially when you have kids around the house

it feels good though to be out of that cast
my foot is not swollen like yours at all, difference between having a full on cast and a half cast i guess

my leg is so small, i can’t believe it
the muscles are almost all gone, it’s pretty ugly
i’ve got the same problem with plantar fasia
kind of wierd feeling under there

you’ll love moving that foot around
i do feel more free and the way to success

Nancy - Sounds like we are on similar rehab protocols. I do love moving my foot around…I’ve just been doing it for the past 30 minutes or so, and it’s incredible how good it feels. Here’s to another milestone in the journey!

DUDE! You had surgery the same day as I did, and now you are in a boot, and I’m in a cast for the next 10 days. Lucky dog. I really think it’s because I scared my MD. When the splint was coming off I said “I can’t wait to go swimming today.” The look on his face changed and he said I’d get a cast for 3 more weeks (my first post op visit was 15 days in). He had mentioned a boot at 2 weeks before, but I think he was saving me from myself. He did have a different view on WB. He just told me with a cast shoe I could bear weight as tolerated. It took me about a week to get comfortable with FWB, but that’s for only limited times. Today I did get around the house a bit without crutches, but short distances on carpet. Thanks for asking all those questions, lots of good info.

Jim

To Nancy’s point earlier..it’s interesting the range of rehab protocols. I read this entire article last night to prep for my appt: http://achillesblog.com/files/2008/03/ewb-maffuli.pdf

In the end, all surgical rehab protocols appear to lead to the same long term end result…the differences are almost more about the quality of life during the recovery phase (no crutches, normal daily activities, returning to work, etc.). So in a sense, it’s good that our docs are considering our well being based on our activity levels when deciding about WB, Mobility, etc.

BTW, nice custom pillow..that thing is HOT!

Brendan-

Excellent post. Lots of useful information especially for us newbies. I’m happy to know that negotiating with the doc can sometimes work. I have a feeling that I’m going to have some negotiating down the road. I’m happy for you that you appear to be progressing well. The shower part seems like some distant dream. Did you ever do the garbage bags and tape routine? If so, how did it work? Keep up the good work.

Michael - thanks..glad the posts are helpful. I never tried a cast cover and/or garbage bag thing for the shower. I always just went with the bath with the cast hanging over the side…it kept it elevated at the same time.

The first week is the longest…and each successive week goes by quicker. You’ll be in my shoes (well..not really shoes) before you know it. :)

for the shower, having a bench really helps so you can sit and extend your leg so it does not get wet
with my half cast i always put a plastic bag over top of it
still do with my splint

the bench helps with not falling and being able to take your time to wash off, etc

good luck michael
like brendan said, everything gets easier as the weeks go by

brendan
have you found anything about how to “get rid off” your plantar fascia?
i’ll look into in tonight

brendan
have you found anything about how to “get rid off” plantar fascia?
i’ll look into in tonight

Brendan - I completely agree with your following statement:

“In the end, all surgical rehab protocols appear to lead to the same long term end result…the differences are almost more about the quality of life during the recovery phase (no crutches, normal daily activities, returning to work, etc.). So in a sense, it’s good that our docs are considering our well being based on our activity levels when deciding about WB, Mobility, etc.”

We all want to be running and jumping as soon as possible. But, when considering that it takes some 9-12 months for complete recovery, a couple of weeks just isn’t that big of a deal.

I’m glad that everything went well with your post op visit. Keep doing the ROM exercises. It does take a few days to start noticing some results, but after a week you’ll be amazed at how far you’ve come.

Tom - thanks for the reassuring words. I worked my ROM exercises today, although not as hard, and it feels pretty good. I did finally take a few advil and that helped with the dull/crampy pain in my calf.

It looks like you did some PWB at week 4, but were casted until week 6….do you remember your docs reason for allowing PWB, but no ROM stuff at that point? It’s interesting to me because, I’m doing ROM now at week 4..but still NWB until week 6.

My bracket is busted….4 #1 seeds for the first time! I was really pulling for Davidson this afternoon..that would have been sweet!

Brendan - Not sure why my surgeon had me PWB without ROM. I think he just feels comfortable with casting for the first 6 weeks to reduce the risk of taking the boot off and doing something stupid. But, I think he realizes the need to start some weight bearing to keep from losing too much strength.

I know I’m probably in the minority, but I didn’t mind being in a splint and cast for the first 6 weeks. This forced me to just let the tendon heal and not try and force anything. I just have a feeling that curiosity would have gotten the best of me if I had free access to my leg at week 4. My cast was also about half the weight of the boot, so it was a little bit more comfortable crutching around with the cast.

Brendan, I totally agree with your assessment that we are all taking paths that ultimately end at the same place.

For me, I was allowed to bear as much weight as I wanted as soon as I was in a cast (at 15 days post op). I can FWB now, but I don’t do it that much, and still use the crutches more often than not. If anything it has helped keep my thigh from shrinking as fast, and has put a tiny bit more tone in the calf. I think it’s because the calf (the outside muscle group) crosses the knee joint and can assist with bending the knee. As for the fatigue cramping, I had the same type feeling when I started with WB attempts.

Take care all

Jim

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