Achilles Rupture February 26 2008

Today marks 11 weeks from my injury and 10 weeks from Surgery.   I’m getting around well in the boot..it’s definitely loosening up, the straps keep hanging off more and more.   You can also see the tip of the “Superfeet” insole.

Here you can see the boot is really starting to fall apart from the velcro ripping at it.   I’ve been it in for 6 weeks now.

Here’s the calf…didn’t have a lot to start with, but still looking forward to building it back up again.

Here’s a pic of the incision site.  (Sorry Dennis…not trying to rub it in…keep up that Arnica Oil!)

Here’s the heels…they is a healin’  Swelling is way down, I’m very happy after just 2 PT sessions and really keeping up with the massage.

For comparison..here is 3 weeks ago:

Here’s a look side by side….my tear was right in the middle of the tendon and you can still see a little indentation where it is healing.   The AT is still swollen a little above and below the actual tear site.

Here’s a final close up…just messing around with my camera…pretty cool!

Happy Heelin’

To recap my protocol to date:

Splint (NWB) - 2 weeks

Cast (NWB) - 2 weeks

Boot (NWB/ROM) - 2 weeks

Boot (PWB - FWB) - 2 weeks

Boot (FWB - 2 wedges in heel) - 1 week

Boot (FWB - 1 wedge in heel) - to date.

Had my first few PT appointments this week.  First off, really clicked with my therapist…he’s an avid outdoorsman, and although has only worked on a few AT’s in the past year, he did work with a competitive male cheerleader (one of those big guys who holds those 95 lb girls up with one arm) and was very successful.   I told him that I was a little concerned about a re-rup in PT, and he said that he likes to take AT’s pretty slow at first, so I should have no worries.

He was very impressed with my low level of swelling and ROM.   I told him about talking my ortho into a boot at 4 weeks and he thought that was a good idea.   He took some initial measurements.   My calf on my injured side was 4 cm smaller (in circumference through the thickest part) than my good side.   Doc Ross mentioned an average muscle loss per week of inactivity..wonder if this is in line?

Next was some massage, primarily around the tendon and scar, but also quite a bit on the talus as my plantarflexion is currently a lot worse than my dorsiflexion.   The tendon was fairly sore during, but it was a good sore, like any deeper massage.

He moved on to ultrasound and cold laser.   The ultrasound was also a bit painful as it rubbed around the tendon and scar, but the cold laser was completely pain free.    We finished with E-stim and ice for 15 minutes.

He mentioned Superfeet again, and I knew it was finally time to get a pair.   Boy what a difference.   I got the green version, and put them in my boot.  I am supposed to return to my next ortho appt in 1.5 weeks with no wedges in by boot.   When I moved from 2 wedges to 1,  my heel was really irritated.   Once the superfeet insole was in the boot, there was no discomfort with 1 wedge.   I plan to go a few more days with 1 wedge, and then remove that one as well.

In leaving the appt, he wanted me to start some light theraband work (planterflex).   We had to go with the lightest band, in my case that is yellow.   It is funny how my ankle/calf/tendon just wouldn’t fire with any resistance on it.   I could planterflex fine with no resistance, but with just a little resistance, it wouldn’t work.   I kept at it for the first few days, and I think it was more of my muscles needing to “relearn” that motion with resistance, because I am doing it fairly easy now.

My second PT appt was yesterday, after one day in between appts, and there was a noticeable improvement in my dorsiflex and  the swelling level in the upper tendon area.   He said the tendon is sliding nicely in the sheeth, and to keep massaging the tendon upwards towards the calf to get any of the swelling gunk out of the sheeth and into the limbic system.  Along with ROM, and the planterflex with the theraband, I am to start using the theraband to pull a little dorsiflex to stretch the tendon a little more, no weight bearing stretches yet.

I have a couple more PT appts scheduled next week before my next ortho appt.   I have a copay for each PT visit, so I’ll just have to gauge when I feel like I’ve gotten all I can from the modalities and information they provide on exercises.   I don’t think I’ll be able to go for too long though, as it gets expensive quick.  But I figure now it’s an investment in my long term health and activity level, so it’s money well spent.

Happy Heelin’

Had my 4th post op appt this morning.   I’ve been FWB in the boot with 2 wedges in for about 5 days now.  I’ve been seeing progress each day for the last week or so, which is a nice feeling.   The heel is feeling great in the boot, and only some minor heel tenderness when I first bear weight in the morning.

I got the script for PT and already made appts for next week.   The script is for 4 weeks (6 visits), and calls for Joint Mobilization, Soft Tissue Mobilization, Myofascial Techniques, and Muscle Energy Techniques, with specific recommendations reading: “Begin gentle strengthening and therabands.”   I follow up with my ortho in about 2.5 weeks.

My ortho gave a good feel back along the tendon and had me push down on his hand with my forefoot.   He also checked ROM and said everything looked great, the tendon was definitely attached and healing.   I asked about the swelling on the top half of the tendon, and he wasn’t sure if it was the tendon or the scar, but was told to keep massaging that area.   I asked about what the repair site is looking like inside, and he responded that the fibers are continuing to lay down and the scar tissue is developing still.   It is still weak though, and he said an impact could tear it, so to be careful.

Next steps:   I can take one wedge out, leaving one left in the boot.   I should FWB for a week, and then remove the 2nd wedge.    At my next appt (2.5 weeks), we’ll talk about weaning out of the boot…but he mentioned that he likes to do a phased approach for that too..gradually getting into a shoe over the course of a few weeks.   I actually don’t mind my boot right now, it is very supportive and I still feel like the the FWB and ROM is enough exercise for now.

Here’s a pick of my heel today:

For comparison, here is ~2 weeks ago (swelling has come down a lot since FWB started):

Happy Heelin’

Here’s been my protocol to date:

2 weeks Splint

2 weeks Cast (NWB)

2 weeks Boot (NWB and ROM exercises)

2 weeks Boot (PWB - FWB)

 At my 6 week check, my ortho recommended easing into FWB over the course of 4 weeks..so to be full weight bearing by the beginning of week 9…well I’ve progressed a little ahead of plan and got there last week, around week 7.5   I carried my crutch in the car for a few days for emotional support and in case I ran into my doc  :)   I’ve spent the last 5 days without the crutches, each day walking a little bit more.  I have two wedges under my heel in the boot, so the tendon is not getting any direct pressure on it.   I did however grab one crutch tonight…as my heel felt a little overworked and sore. 

Here’s how a day has been looking:  Don’t sleep with the boot on, AT/ankle fairly stiff in the morning.   Swing my feet of the side of bed and work my ankle ROM (dorsiflex, circles, alphabet).   Hit (or should I say sit?) the shower and give the ankle/foot/AT a good massage.   Into the boot and off to the morning.   My legs both get fairly fatigued around noon…and it’s a good sign to have a rest, take the boot off, and work on some more ROM.    My AT was torn directly in the middle…the upper half of it still gets pretty swollen in a few hours of weightbearing.   The spot were the injury/repair happened is not swollen.   My doc explained that this is fairly normal, to experience swelling on either side of the repair.   A massage in this area is a little painful as the swelling makes it a bit sensitive.   Afternoon is about the same pace…although I usually don’t break until after the kids are in bed.   The boot comes off again, and I usually just end the day with some ice on the tendon….and I’ll ice my other foot as well…the heel on my good foot has been taken a beating the last 8 weeks and I don’t want it to feel left out

 My only concern at this point is that my dorsiflex is getting so good, that I wonder if the tendon is too loose at this point?   I haven’t stretched yet with any bands…and I’m close to 90% dorsiflex of the good foot.   It’s amazing how much it’s loosened up in just 4 weeks of ROM exercises.  

I meet up with my doc later this week…I’m expecting another 2-4 weeks in the boot and to start PT soon…will update again after the appt.

Happy Heelin’

A random sampling of quotes from my 3 year old Daughter over the past 7 weeks….aren’t kids great, so honest: 

Daddy…did you hurt you foot….is it an owie?  

Oh…did you hurt it doing baketball?

Oh…Mommy!….Daddy hurt his foot playing baketball.

Daddy…what are those?   Oh….crunches…Daddy got crunches!   (think crutches)

Daddy..did you go to the doctor?   Did you get me a special treat..oh you did get me a special treat.  Mommy…Daddy got me a special treat!  (Think Dum Dum’s)

Daddy…one day your foot will fewl betta.

 Do you have an ouchie…do you need a bandaid?

Daddy…when your foot is fewling betta, than maybe you can play outside with me.

Oh…Daddy got a pink cast…silly Daddy!

And we don’t touch Daddies ouchie.

Oh, daddy, where’s yor udder crunch?

Daddies got stinky feet….stinky feet daddy!

Daddy, one day, when you foot is fewling better, then you can play baketball again….yeah…

Daddy..that’s a big boot.

Daddy…is gonna take a long time for your owie to fewl betta

Had my 3rd post op check today.   I am just about 6 weeks, have been in the boot for 2 weeks now and have been PWB (no more than 40 lbs) for the past week.   I was expecting to get the green light for FWB in the boot, but my doc has a different protocol.   He wants me to ease into FWB over the next 4 weeks, adding 1/4 of my weight each successive week, so:

Week 7 - 40 lbs

Week 8 - 80 lbs

Week 9 - 120 lbs

Week 10 - 160 lbs

 I have to admit, I was a bit bummed.   I’ve been really cursing my crutches for the past few days: tripping over kids toys, having them slide off the counter on to the floor, stashing in the back of my car, catching them on stairs during descent, etc.    I explained to my doc that I’m probably already ahead of his schedule by a week and that my heel felt good in the boot.   I asked about PT as well, and it wouldn’t start until after Week 10.   I decided that it wasn’t time to negotiate, and in hindsight, I think that was a good move, because I may have gotten a little worked up.   He asked to see me back in 4 weeks, so when I left, I made my appointment for 3 weeks.   As I crutched to car, I came to grips with what I’ve known all along, but keep having to remind myself.   Docs have their protocols for injuries, and it’s more or less the same for all of their patients.  It’s based on experience and long term results.

 So, we’ll see how I progress, I think it’s important to listen to your body as well, and right now, my heel is feeling very good.   I did get a chance to slip in a few questions with the doc.   He told me that I shouldn’t feel any pain in my tendon as I move towards bearing more weight, although pain on the bottom of the heel is normal.   My tendon was torn right in the middle of where my incision is….hence the swelling above and below that spot along the tendon.   It’s swelling on both sides of the repair, where the most trauma was during the injury.   He also mentioned that the swelling around the ankle bone could last for up to a year, and that the repaired tendon will always have a different shape than the other one. 

 Here’s a pic of my heel:

Here’s my calf…I’m gaining a little back just in a few weeks of ROM, some weight bearing should start helping as well:

Here’s a shot from the front (chicken leg jokes OK):

Until next time….

A family friend shared her AT story with me and it was good for me to hear..thought some others may enjoy it:

I’m all for talking about my torn achilles - it changed my life.  One year later we were moving to North Carolina because I had decided to quit the job and attend medical school.  Having torn my AT gave me time to study for the MCAT and reevaulate things in life.  But, I don’t wish such a life changing event on you!

I tore it in April of 03

I was playing soccer, keeper in fact - a position I usually don’t play. We were playing at an indoor facility that also has batting cages.  Anyway, I lunged forward (really just stepped, but lunge sounds a little bit more exciting) and fell to the ground.  The ball hits my butt (so I saved a goal).  I’m writhing on teh ground yelling obscenities - something to the effect, who the F*** hit me with the baseball.  I was certain that someone hit me.  I’m holding my calf looking for a baseball.  Meanwhile, everyone on the field just stopped and stared.  They thought I was crazy!

First off - good thing you have a support system, b/c it sucked. I’ll be blunt. Two things that bothered me:  1. being told that this type of injury usually occurss in “older” people who are “weekend warriors” - it really hurt my ego and self image as somewhat of an athlete and 2. the length of time it took to recover.  My problem was that I compared my injury to a friend of mine who tore her ACL at the same time. So the fact that it took me so much longer to recover than her was disappointing. I was not prepared for the time it would take to heal. Be patient, it will heal, you’ll get there, but yes. it takes awhile. But some good news: I was back to playing soccer about 10 months after the injury, but only at 75%, at 90% 1 year later. I’ve never got to 100% - but that’s because I got fat, out of shape, and then had a kid . . . so I can’t blame that all on my injury!!! 

I still do not have the muscle mass that I have in my right leg, and that’s mostly my fault for not doing my calf raises. It also gets “tight” more often but once I do a couple of stretches its ok.  But I’m back to >95% of function. I have no problem playing soccer or biking.  In fact, biking was great exercise for my leg.  However, I’ll warn you - stick to the flat road for awhile.  I tried to go mountain biking far too early (that summer) and it sucked.  My balance was off, I wasn’t comfortable, I couldn’t stand up on my pedals very well . . . again advice is . . . be patient.

Another concern I had once I got back into sports, is will I tear it again?  I was so afraid of tearing the other leg.  I don’t know about you but I had no warning of “trouble” and i wasn’t doing anything special when it happened - so I was paranoid.  It still haunts me from time to time, but that first season I taped my ankles solely as an aid to ease my mind.

When you get the Ok to start exercising, I recommend making a series (2 or so) calf stretching boards, one with a slight incline the second more steep.  I would stand on the incline boards while watching TV, or rest my foot on them while I was sitting at my desk to stretch my calves and “lengthen” the tendon.  Also, I lost so much muscle mass, I spent the first 2 weeks once I was cleared for weight bearing at the pool.  I like to swim so that was good exercise - but right after I was cleared for PT I would spend it walking in the water and doing calf raises supported by the water. 

Ok, well its half time . . . thus the long email.  Better get back to basketball.

Good luck to you - be patient!!

Go KU.

Here’s how the swelling is today:

For comparison, 6 days ago:

 ROM today on 4/3/2008

And a pic of the incision…it’s healing really well.

So I got to thinking yesterday, I read somewhere, maybe on this site, that once you rupture one of your AT’s…..the chances of you rupturing the other one goes up significantly.   Alright…maybe your are thinking, “Why the heck do you want to talk about tearing your other AT during recovery?”….well, I’m a bit of a perfectionist…and I don’t want this to happen again…apparently, unlike this guy:   

 http://news.bbc.co.uk/sport1/hi/football/teams/o/oxford_utd/3654558.stm

 The discussion topic is:  What types of things will you do/change to try and prevent this injury from happening again?   Here’s my list so far:

1. Never play Basketball, Soccer, Volleyball, Tennis, Raquetball, Squash, Badminton, Football, Ultimate Frisbee again :(   Stick to bike riding, golf, and gardening.
2. If I do play those sports again, take a few months to slowly get back into “game shape”..do this everytime I take more than a month off of these activities.
3. Adequate warm up - 5 minutes of stretching not going to cut it…take 3o-60 minutes to stretch, ride bike, practice, etc before “gametime”
4. Daily stretches, isolating the calf/ankle/AT.
5. Work strength exercises into routines, isolating calf/lower leg to keep that muscle strong.
6. Do nothing…it’s all genetics you goofball!

I also think it’s worth pointing out as we all are progressing nicely in our recoveries, not out of fear, but out of the reality of our situations, that re-rups happen.   Although, back to Johnskiers post about survival of the fittest…fear is not necessarily a bad feeling, you don’t necessarily want it to run your life, but having ”fight or flight” is deeply rooted in our hypothalamus….it’s what keeps us from walking in front of that car speeding down the street!

A guy on a forum out of Australia, gathered some re-rup data on the people that were posting and he came up with:

http://www.marfell.me.uk/nuke/modules.php?name=Forums&file=viewtopic&t=723

my observations:

1. all the reruptures listed here happened within 5 months of surgery and 82% of them occurred at around 3 months or less.

2. a) out of the 5 reruptures in the conservative group, 3 were just walking, and 2 were doing physio when the 2nd tear occured.
b) out of the 6 reruptures in the surgery group, 4 were falling accidents, while the other 2 were just walking and climbing stairs. furthermore, out of the 4 that were accidents, 2 happened even before they were supposed to bear weight on the tendon.

these are the reported incidents:

conservative treatment / 5 reruptures:
1) at 2.75 months- walking in the street
2) 2.75 months- climbing stairs
3) 3 months- walking on the beach
4) 3.5 months- physio (going on tip toes)
5) 4 months- doing physio

surgical treatment / 6 reruptures:
1) at 3 months- walking in kitchen (toe push off)
2) 3 months- walking up stairs
3) 3.75 months- accident, twisted while stepping in hole in yard
4) 5 months- accident, tripped on curb
5) 2 months- accident, crutches slipped
6) 3 weeks- accident, tripped

Again..not trying to be “Debbie Downer”….just want to get us all fully recovered with no major setbacks.   Let’s hear your thoughts

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: 

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:

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:

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!):

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.