cayles’s AchillesBlog

Danger: wet tiles

December 18, 2014 · 18 Comments

Visiting Quebec during holiday season in NWB mode is not optimal: snow, ice, slush, etc.  But the most hazardous surface, by far, is shopping mall floor tiles, especially the puddly ones near the door.  Wet, waxy death traps.  I blew a crutch today in such an environment and slapped the boot down, giving my tender tendon a rude jolt.  Hope I haven’t set back my rehab too far…

Categories: Uncategorized

18 responses so far ↓

  • herewegoagain // Dec 18th 2014 at 9:58 pm

    Quebec is a beautiful province but it sounds treacherous for crutching around. Hope the ankle is OK, maybe spend some extra time elevating and icing!

  • normofthenorth // Dec 19th 2014 at 4:18 pm

    And wooden floors - in fact all smooth floors - are no better! And it doesn’t matter which is wet, the floor or the crutch tip(s).
    One of many reasons to vet to PWB and FWB ASAP, IMO.
    Otherwise, winter in Quebec is great!
    Also, watch out for the great alcoholic beverages - I still remember losing control surprisingly quickly from something called Caribou…

  • normofthenorth // Dec 19th 2014 at 4:20 pm

    Vet –> get. Please turn on AJAX Editing, everybody.

  • mansour // Dec 20th 2014 at 6:47 am

    Hi
    To share my experience, third day after surgery
    When I was trying to go down the steps, I failed
    From five steps, fortunately mostly with hands
    And healthy legs, knee. I felt a strain on my surgery locating when I was tumbling down,but
    Mt tendon didn’t,the hurt. Yesterday at 51th day
    Of my surgery, when I was taking shower, the
    Curutch slipped and my injuries leg hit the floor
    And my weight totally went on my foot. I felt pain and still after one day of resting I have bad
    Sense. Sorry for my poor english

  • cardiojunkie // Dec 20th 2014 at 10:03 am

    Crutches seem to be designed so that they are sturdy and able to grip the ground well. I also found out the hard way in a rainy day going through the door into the mall and almost slipped on the tiles right inside the door. The rubber tips don’t handle wetness at all. I was walking alone at the time after being dropped off at the door and barely managed to stay upright. — Hope your ankle is okay.

  • cayles // Dec 20th 2014 at 10:52 am

    I bought some cheap crutch crampons which help a lot on ice, but they are pretty fiddly - prone to flipping off. Good option to have, anyway. My little slip doesn’t seem to have set me back, but it’s hard to tell what’s going on when you never use that foot. Mansour, hopefully at 51 days yours was strong enough for a little test.

  • normofthenorth // Dec 20th 2014 at 1:02 pm

    Yes, Man sour, we all hope you didn’t do any serious damage. 7 weeks after surgery is very late to still be using (scary) crutches. Some doctors still think slow rehabs are safer, but the evidence says no.
    Some fast rehab schedules with great results at AchillesBlog.com/Cecilia/protocols. Maybe your doctor will read one of them…

  • normofthenorth // Dec 20th 2014 at 1:03 pm

    Man sour –> Mansour!

  • squashedat // Dec 23rd 2014 at 10:57 am

    Thanks all for contributing here and sharing your experiences…..this blog has been a source of both comfort and inspiration

    Just had my Right AT Reinsertion surgery 12/10/14 and had a slight mishap (lost balance) on day 11 and had to re-balance myself by bearing weight on the affected leg for a brief second.

    Was cursing myself for not being extra careful and ruining it with a concern that I may have just set myself back on the recovery. It’s after this that I discovered this blog and was comforting to know that 1. I was not alone and this can happen and two that it may be ok since I had no pain or swelling from it(got it verified later by talking to the doctor’s office).

    One of the things I noticed after this mishap, was that my cast was not as snug as before and am just starting to notice that as a result I may have a blister forming on the inside due to the cast rubbing against the skin. Has any one been through this? Any Suggestions? I also feel a lot of sweating on the inside of the cast, has anyone had a similar experience? Would love to know your thoughts.

    I am supposed to see my doc in 3 days, but was not sure if this was an area of concern and should have them look at it earlier (given the holidays). Would love to know anyone who has been through a similar situation.

    So thanks again for your contributions, will try and add as I document my experiences for others.

  • normofthenorth // Dec 23rd 2014 at 12:57 pm

    You’ve discovered one of a dozen ways casts are obsolete, inferior to boots. If your sore spot becomes a real sore, it can easily hold back your rehab, which is dumb. You have rehab needs, and they shouldn’t be sidelined because your skin got scraped by a stupid slab of fiberglass!
    I can’t tell you how urgent your sore spots are, but I’d try to escape early, and fight for a boot instead of another cast. Same protection, but better padding, lots of adjustments - including the possibility of adding padding or bandages or socks - and the ability to take your foot out for cleaning and drying and gentle exercises and PT (which starts at 2 weeks in most of the most successful published studies).
    Good luck!

  • normofthenorth // Dec 23rd 2014 at 1:04 pm

    SquashedAT, did you rupture an AT playing squash?
    Was your surgery (and injury) unusual? What was reinserted, your AT reattached to your heel bone?
    (IMO, most OSs - heck, most SURGEONS! - tell most of their patients that their problem and their op was very unusual. Maybe 85% were in the top 20%, if you follow…)

  • squashedat // Dec 23rd 2014 at 10:53 pm

    Hi Norm,

    Thanks for the tips. Yes I did ask for an appt and saw them late today and they kind of combined it with my 2wk post op that was scheduled for Friday and I am now in a boot-Yeah!!! Definitely a better alternative to the cast. Not to mention the feeling of progress.

    I have also been asked to transition from PWB to FWB over the next 6 weeks at my own pace (whatever I feel I can handle) Not sure what that means but any suggestions on that would be welcome. I was also asked to use a compression sleeve - any suggestions on a good one….there are so many choices and also one that I tried was quite tight and not easy to roll it up over a bandaged leg.

    My sores were not as bad and hopefully the boot should help with the healing going forward.

    Yes I was playing squash when it happened (thought I’d play a safer sport than basketball - where I had torn an ACL). From what I understood, the tendon itself was not broken nor damaged but a piece of the heel bone came off where the tendon is attached. I think they called it an avuncular fracture or something to that effect. Not sure how common or uncommon that is…..

  • normofthenorth // Dec 24th 2014 at 1:00 am

    It sounds good, squashedAT!

    I’ve mostly heard it called an avulsion or avulsion fracture. I don’t know the frequency, but it certainly does happen during traumas like yours, and it’s also common for it to be caused surgically, typically during surgery to remove Haglund’s deformities and maybe other bone spurs on the back of the heel.
    I think the AT is usually reattached to the bone with screws in all those cases, either plastic or titanium.
    Squash and basketball (and badminton and volleyball…) are similarly high-risk for ATRs, because (a) they’re all “fake-out” sports where a player may have to change urgently from (say) back-pedalling to running forwards and (b) they’re all played on a clean smooth high-grip surface in gummy rubber (”squeaky”) high-grip shoes. With those moves and that near-perfect traction, the Achilles (and its attachment point) is subject to the maximum instant loads possible without jumping off a roof.
    The transition through PWB to FWB is sometimes prescribed in precise detail, but for most of us it mostly happens naturally and organically. Some of us spent a few days with one crutch (I hated that!) or a cane (a bit less bad), but mostly we went fairly quickly from PWB with 2 crutches to the point where we couldn’t remember where we’d left the crutches (or crutch, or cane)! THAT’s what we call FWB.
    Some Docs prescribe specific %s of body weight for specific periods, but most patients seem more confused by that than helped.
    At first in PWB, your booted foot is basically “going along for the ride”, resting on the floor AS IF you were walking normally but with crutches. As you get more comfortable, you can apply more weight incrementally — usually by gradually spreading your crutch tips apart as you crutch-walk. Then you may find yourself carrying them around for a while, rather than the other way around.
    Many people here have enjoyed using compression sleeves, partly to minimize friction with a boot and mostly to control swelling. I never loved them myself, though I did generally wear a (fairly thick) knee sock inside my boot. You do have to be careful when putting on and taking off either of these, because normal people use their calf muscles and ATs a LOT when donning and doffing socks!
    Stay with the program, keep it incremental, Watch Your Step, and Good Luck!

  • gravity // Dec 24th 2014 at 3:47 am

    I can only echo what Norm said, I think the transition will come naturally, from what I’ve read (and my own single experience), it seems to be a lot about people trying it and realising that FWB in a boot is not that scary. If the boot is fitted properly, and you learn to walk in it (push your shin forward!), you should be ok.
    On the compression sleeves, I would suggest compression socks instead of calf sleeves, as with the sleeves the bottom ends up right on your healing scar. I wore these for the entire time in the boot, but without a comparison difficult to assess benefit, I had them in any case and they felt good on the foot…

  • squashedat // Dec 25th 2014 at 3:09 pm

    Thanks @norm @gravity. I am starting out with just placing foot down while standing/sitting for a week (with cructch support, etc -~10-15% pressure). I am assuming next step up may be standing with one crutch/cane support (~30%) and then standing on two feet (~50%) followed by walking with cane and then FWB walking in about 4-5 weeks….does that seem reasonable to shoot for ?
    @Eric, thanks will reach out separately via email.
    Merry Christmas to all!!!

  • gravity // Dec 25th 2014 at 11:02 pm

    @squashed, I would say that the best is to go at a pace you feel comfortable with, the transitions from NWB to FWB vary a lot from people going directly to ditching the crutches in a day to much more incremental approaches. A lot of people skip the whole walking with cane / one crutch stage as it is awkward and at that point many are comfortable enough in the boot to do so. Also, what they did to your foot seems a little trickier than the standard ATR fix, so don’t know how well it can handle e.g. early FWB in comparison.

  • normofthenorth // Dec 26th 2014 at 1:29 am

    What gravity said! I think it’s more important to stay sensible, be incremental, and keep creeping forward, than to make detailed plans. The good protocols can give you a guide on the scale of weeks, but from day to day just keep creeping forward.

  • mansour // Dec 27th 2014 at 7:45 am

    Thank you so much for comments and sharing condition. At 57th after surgery, I saw my doctor again. He mentioned, it,s not possible
    To take new MRI but, after touching, he told
    Tendon has its continuity, but about 4 cm above the heel, tendon became thinner. At the end he concluded, I have 50 percent chance to be OK and I have been wanted to be on 2 crutches. I,like be very grateful to read new comoment. Tc all

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