Just another Achillesblog.com weblog

It’s been long enough since my injury that I’m not counting weeks or months  anymore.

Any advice on start up running again?

I’ve been biking pretty heavily the last few months (from about month 3).  One positive part of the recovery has been rediscovering the joy of biking. Because I’ve been biking to get around and get excercise, I’ve been pretty lazy at starting up running. Why slog at a jog when I can fly on a bike?

Well, it’s now well past safe to start running. I suppose I should, obviously, not start with attemping 3 8 minute miles. I have jogged around a block or two every now an then, just to guage where I’m at. That no longer hurts. 

Off - topic- Other stats: 

Can now walk just about as far as I want. I 2 mile, 1000ft hike at month 6 (carrying a 2 year old)  was possible. I was quite slow on the uphill. 

Pain? Still have a little bit. It doesn’t get in the way. 

PT? Not in a month. Probably should, but my insurance co-pays and cost shares are too high to make it regular.  

Playing soccer again? No. I’m looking for a perambulating soccer league, where the whole game must be played walking or race-walking. I’ll probably start subbing in at my teams games soon - after I’ve been running a few weeks. 

Off topic - Biking tips: 

Do use clipless pedals (cleats) and do pedal really fast (90 beats per minute). Flat pedals and slow pedalling are the most common bicyling mistakes - also made by me.  Flat pedals will hurt your calf, and slow pedalling hurts your knees and everything else.

Pedals: After I overcame any fear of falling off and stomping my bad leg (month 5), I replaced my flat pedals with clipless pedals. Keeping your foot on a flat pedal takes a lot of calf work  and makes me slow- my right calf was getting quite sore and limitting how much I could ride. It took about a day to learn how to use the new pedals - now I love them. I didn’t go all the way: My pedals have a clipping side and a flat side. I use the flat side for short trips through the city. 

Cadence: After a few months of light activity my legs were in poor shape. Biking was tweaking my knees and leaving much more sore than expected. All my bike guru friends were telling me to keep my cadence at 90 - that is each leg should go around 90 times a minute. I gave in and tried it - all knee pain was gone in 2 rides.

I’m almost to month four, this is the best description of my condition: My wife frequently forgets I’m injured, because I can do most everything now. I can drive, walk across town to pick the kids up at daycare. Going downstairs to do laundry is no longer an odyssey. I’m not limping around the office anymore — my walk is nearly normal — so all my coworkers have forgotten, except those on the soccer team.

While others don’t notice, this last month has been the most painful except for the week or two after the surgery. Now that I can walk and crank on the PT exercises, I do. I can participate in the Saturday cleaning frenzy, so I do. Consequently, I’m pretty sore by the end of the day.

My only words of wisdom from this month: Don’t take these blogs to seriously and don’t compare my progress to yours. Your injury and recovery may not be comparable to mine all. At last post, I’d systematically analyzed when other people tossed the boot, and decided I was "late". Well, I tossed the boot, most precipitously. It was great to drive, but I went crying back to mamma FP Walker (my boot) in just 3 days. My doctor can say "I told you so."

(I wore the boot for all long walks for the next few weeks, and am finally able to walk a mile or two without it).

Other milestones:

Three weeks ago, I could finally hold my weight on my bad right foot, after the left helped me tiptoe. I was so excited I did it all day long … and hit the ice pack hard that night

Two weeks ago, I discovered I was passing people on the sidewalks.

One week ago, I kept up with a co-worker walking quickly straight up 3 blocks of a steep hill. (And hit the icepack and the ibuprofen that night.)

This week, I’m walking for pleasure again. I’ve been biking for a few weeks, and might just hike this weekend.

I’m still in the boot at 10 weeks. My next ortho appointment isn’t for 4 weeks. Looking at the stats on http://achillesblog.com/atrpt.php, that puts the doctor at the heavily conservative end for switching to two shoes. I called my doctors office for their thoughts on getting more aggressive.  The holiday week is not the easiest time to get ahold of a surgeon. I may get an earlier appointment, may not. We’ll see next week. 

Should I just liberate myself?  That is the question of the week. The only reason I haven’t ditched the boot on my own is that this time period (6-14 weeks) seems to be exactly when re-ruptures occur. 

Is anyone else holding onto the boot past 10 weeks? 

Progress:  

• I can walk around fine with boot. I can actually manage a 2-3 mile per hour stride in the boot for almost a half mile. That hurts, though. I’ve done as much as a mile with the help of one crutch.  
• I do get pretty awful heel pain if I walk around too much (20-30 minutes brisk walking) It goes away rapidly.
• Doing my PT exercises rigorously. 
• I’m at 10 degrees past neutral. 
• I rarely wear the boot unless I need to walk somewhere. Actually I sometimes don’t wear the boot inside at all. 
• I can balance 40 seconds on my bad right foot, a couple hours on my good left foot

Off topic

Played Frisbee with my 4 year old tonight - something I haven’t been able to do in months. We’ve been playing Frisbee since he was 2 and a half - the disk is actually easier than a ball. In the shameless bragging department, he rode his bike to the park without training wheels. I can’t quite run or lunge to catch his wild throws, but it worked out just fine. Occasionally the frisbee came close enough for me to catch. 15 minutes icing the heel and calf afterwords, but entirely worth it! 

I am now at 8 weeks post op, and have had two blissful booted weeks. One late night, I groggily got out of bed, and thumped into the kids room to check on a two year old, and realized I hadn’t worn the boot. Since then I realized there are a lot of things I can do now, and it’s all a question of whether or not I should. Inspired by stories of fanatics golfing at 3 weeks post op, here’s my list of bad ideas.

• Walk a mile and a half across town (in the snow) with a boot and just one crutch? Tried that when the busses were snowed in. My bad heel really hurt for a few days after that.
• Play ping pong, with boot, no crutch? Yep, tried that. It is a bad idea. It’s too easy to get caught up in the game and stomp on the foot.
• Sledding? The crutches make great rudders.
• Skiing? I did not try it, but chased my four year old around when he went skiing. That was the worst idea of them all, as the uneven snow is the best Achilles breaker around. Also, a wet boot is stinky and hard to dry out.
• Bicycling, with boot on? Definitely a bad idea, but I rode around the block. I did not put the two year old in the bike seat for this trip. It is horribly tempting to start biking again for exercise and transportation. I can’t drive for quite some time since I did my right foot, vehicle 1 is a clutch and motor vehicle 2 is a heavy motorcycle.
• Working out? I’ve been continuing upper body workouts since a few days post op. Glad I have been.
• Stomping around the house without the boot? I discovered that it’s actually more comfortable to cook without the boot on, and just limp around. I can’t go as fast, but it actually hurts less.

So, am I a re-rupture waiting to happen?

I have been searching for statistics on re-rupture causes. So far, the only study I’ve found pointed out that all re-ruptures (x percent of 80 people tracked) occurred in patients under the age of 30. I’m over 30, but wondering if I am acting like I’m under 30. Or, if I were under 30, would I be doing all of the above, and more, and not pause to think about it?

A few practical tips on life in the boot

Walk straight and as normal as possible. Do not walk with your leg sideways, even if it seems like you can’t get over the front of the boot. On the insistence of my PT, I figured out how to walk with foot straight forward. For a week or two, I needed a crutch to get over the toe, but it felt better and moves me faster than going sideways.

Wool socks in winter. I pity those who must where a boot in summer.

Physical Therapy is worth it. Try at least 2, they’ll have different things to say.

You only need to where the boot when you are going to walk. I am fast at taking mine off and putting it on. If I’m going to sit down for 3 minutes or more, it is off. This avoids cramps, airs out the boot, and feels much better. Don’t walk bootless until your doc tells you, by any means, but don’t where that cast a minute a day more than you have to!

I’m 5 days in the boot and having far too much fun with my partial weight bearing status. I am embarrassed to admit that it took a full 2 days to discover that it is much easier to walk sideways in a boot than straight forward. Now, I frequently move sideways rather than trying the clomp - stop - slide that the boot seems to require.

Does anyone have any videos of graceful movement in a boot?  

Things that suprised me with the boot: I can easily move around without crutches, and it doesn’t actually hurt. I do start to hurt if I go without crutches for more than 15 minutes. I knew in theory about the atrophy, but I swear that that beanstalk is NOT MY CALF.  

Well, after 8 weeks of waiting for surgeons and the body to do their thing, it feels like I’m on the road to recovery and making progress at last.  I’m looking forward to bulking that calf back up. Physical Therapy starts tomorrow …

In the meantime, i’m going to go enjoy yet another cast-free ablution. 

* In case you don’t know what a boot is, it is a removable rigid boot that immobilizes my ankle at 90 degrees. You can also walk in it. Those are the joyous key pieces of information: you can remove and you can walk in it.  My boot is an FP Walker Aircast Foam Pneumatic. 

Boot boot boot boot! It’s possible I may have my hopes up too high. I have my 6 week check up tomorrow and really want out of the cast. The time for the boot is here!!!  

Getting careless though … I was a very good patient until this weekend. I was changing my pants with no chair neaby. I did not notice I was standing on my cast until I had my pants half on. That may be dangerous, but the cast seems to provide good support. Anyway, since then, I’m getting more and more casual. You’ll frequently hear me and my cast thudding around tight spots on the cast, rather than hopping or doing the one foot sashay.   I’ll be good if I get a boot, I promise

Questions

Obviously, I’m tired of being careful and limitted mobility. Common folks - scare me back into common sense. I’m rereading all the re-rupture stories.  

Do I have a good chance of being PWB or FWB tomorrow with boot at 6 weeks post op? Feels like it. I’m debating commuting with the knee scooter or crutches tomorrow. If I’ll be PWB after the appointment, I’ll take crutches. 

How to find the right physical therapist? 

Physical therapy starting soon. So far, I’ve established the following criteria. Anything else I should look for? 

• Location, location, location. I work in a downtown area, and have 3 choices in hobbling distance. 
• They’ve handled achilles repair before. They are willing to listen to my long term health goals.
• But I don’t have a clue how to establish that they are competent.  

I never finished my drafted post for the 2 week post-op. This means that around that time, I returned to somewhat normal functionality, got busy at work and no longer had time to blog.

The theme of weeks 2-6 seems to me: This is really getting old, are we their yet? Not there yet. I am done with the excitement and drama and now have a long slog of extreme inconvenience and thinning patience of my support crew (wife, Grandparents, and so forth). According to the cruelly honest Achilles marathon widget, I am at mile 2 of 26.

It strikes me now how sorely our story tellers miss this aspect of injury. Sure super tough hero or heroine can keep going with three bullet wounds and a crab pincered onto her ear while loaded with adrenaline … but can she stay sane through 6 months of recovery? Or … hero gets injured in that dramatic initial chase … must suffer the indignity of supporting role for the rest of the movie. There be drama there - I wish I had more heroic examples to follow from our cultural icons. However, I suppose the telling of such a story probably switches your audience from block buster to a dusty English Majors bookshelf.

At two weeks post op (purple cast)

I finally got to see my foot. I’ve never gone 3 weeks without seeing my foot before. Stitches came out, and we switch from a split to a cast. I chose purple.

I now understand the different between a splint and a cast. The splint had support around the back and sides, but had no plaster in front (just tape) to allow for considerable swelling.

Back at work, up to speed, simply highly annoyed with how long it takes to move anywhere.

At four weeks post op (black cast)

I’d heard of some people getting boots at 4 weeks and was irrationally hopeful. The leg feels great most of the time. When they cranked me up to 90 degrees, I decided I really didn’t want the book after all. I suspect the purpose of the 2 week cycle is entirely psychological: Let’s ensure that our patients remain careful and cognizant of their injury by giving a painful yet harmless reminder of their fragile state every two weeks.

Boot next time? I hope so.

How do I describe my injured calf when I saw it out of the cast? Soft - but how to express the floppinesss? Jello? Water balloon? Both too firm. It reminded me a bit of a cows udder after a good milking. Flop flop sway.

This post is all about things I attempted to do the week after surgery, and how it went. I hope to provide as concrete a picture of the post-op recovery as I can. 

From what I’ve seen, experiences vary wildly. One poster described not much pain post-op. I had a lot of pain … but it seems to drop off rapidly over the first week. 

Things I tried to do the day of surgery

Before surgery, I was in total denial. I actually got some work done - that worked great.

I eschewed offers of transportation and took the bus to the hospital. That didn’t work well. It was raining, I slipped on slick walkway outside the hospital and landed on my bad leg. I finally got to say 8 when they ask, “on a scale of 1 to 10, how much does it hurt?”. Hopefully, I’ll be more careful after surgery. 

The surgery was on Halloween. I had general anesthesia, most of the day is vague, and I can’t tell you how the surgery went. I’m fairly certain it was an open surgery in the correct leg. I left the hospital 2 hours later than they expected I would … so I think anesthesia recovery did not go well. 

I tried to answer the door for trick or treating. This didn’t go well. I could not manage to get off the couch to open the door. I fell asleep. Drowsiness is a side affect of narcotics.

I sent my kids trick or treating with the grandparents. That worked great … quite the haul.   

Things I tried to do a 1-2 days after the surgery (lots of swelling, on Narcotics)

Time off the couch before swelling and pain were intolerable: 5 minutes, 30 minutes by day 2. 

Pain (1-10) : 7, with oxycodone

Surgery + 1 day: Doing nothing worked well.

Sign a check: Nope, I couldn’t quite figure out how to sign a check. I kept getting the numbers mixed up. 

Dishes: I tried to do dishes on day 2. This did not work well at all, it really really hurt.

Sleeping: Did not work well, there was no comfortable place to put my foot. I moved to the couch so my wife could sleep.  

Things I tried to do 3-4 days after surger (off the narcotics)

Time off the couch before swelling and pain were intolerable: 20 minutes, 45 minutes by day 4. 

Pain (1-10) : 3, with tylenol

Stopped taking narcotic paing killers for Tylenol. That worked great. I have no idea why people take narcotics for fun. Oxycodone was good for the pain, but otherwise, a misery of muddled mentation. It gave me headaches. What kind of pain killer has head-aches as a side effect? 

At surgery + 4 days I took a bus, just to get outside. I actually went to the gym and did a very light upper body workout. After 5 days on the couch, that felt great.  I had to leave my leg up for 30 minutes at a coffee shop before I could get on the bus and go back home.  

At surgery + 4 days, I voted. 51% of the country thinks that went just fine. I had plenty of couch / internet time to research the issues. 

Things I tried to do at 5-6 days (no painkillers)

Time off the couch before swelling and pain were intolerable: 1-3 hours (once a day).  

Pain (1-10) : not much if I keep the leg elevated. 5 after 30 minutes without leg elevation.

I tried to work. I have a desk job, and theoretically don’t need me foot. Working did not work well at all. I was too tired and uncomfortable to be effective. However, I’m out of sick time, so I don’t have much choice. Well, there is always a choice - but I don’t like options such as cancelling my Christmas vacation or unpaid leave. For next week, the best choice appears to be, my life shall be working and sleeping - sleeping enough that I can make it through an 8 hour work day.   

Things I tried to do at 7-8 days

I’m getting close to the level of functionality at had pre-op. I don’t crash in the middle of the day, pain is still much worse than pre-op.  Its the weekend, so I’m not trying to do much. 

I am leaving the house, seeking destinations suitable to my knee walker (lots of smooth walking surfaces).  This works fine, although I need about 10 minutes of leg elevation each hour to keep up the activity. 

Starting with some comments vaguely related to this blog posting

(Note - I just woke up from post surgical haze — about a week of post surgical haze. More on that later, now I’ll finish my post on getting around.)

(Note 2 - I’d really love to here other peoples experiences with other crutch alternatives. The One-crutch,
I walk free, and so forth Getting around seems to be the main challenge with one good leg).

The weekend before halloween, my neighorhood businesses open up for trick or treating. There is nothing more delightful for the kids. It’s a parenting experience I treasure - and I couldn’t imagine doing it on crutches. This was 4 days post rupture. We ran out and rented a knee walker just so I could go. I managed 1.6 miles that day, some carrying a 26 pound bumblebee. So, I love me knee walker.

After 2 weeks on the knee walker, here’s all I know about it.

Summary of the knee walker experience

Crutches? Anything but crutches! I love my knee walker! After a few days on crutches I was desperate. I had know idea how inconvenient crutches were. Let’s point out the obvious: you can’t carry much with each hand on one crutch. (Yeah - I figured out the trick of hanging a satchel over a shoulder). Absolutely impossible for the daddy of two busy children.

However, don’t throw out the crutches. There are many places you simply cannot go on a device with tiny wheels. The back yard, the beach, poorly maintained sidewalks. I crutch around periodically to give me right knee (bad) and left ankle (good side) a break.

What about other devices? I know little of other alternatives. One-crutch, I walk free look interesting, but I haven’t found any informative reviews of these, and don’t want to shell out the cash to find out that it won’t work for me. I wanted to try before buying, the local medical equipment stores only carried the knee walker. So, that’s what I have.

Great stuff about the knee walker

I just went trick or treating with the kids! 20 blocks. Not easy, but possible. (early - our neighborhood business do a Halloween walk the weekend before)

Carrying things! I have a free hand (+ basket) for kids, dishes, coffee, and the like. When I’m daring, I have two hands free.

Walking with the kids! My favorite thing to do. I still can’t keep up with the four year old, but it’s a fairer race now. I’ve decided to just cheat and go to places where walking is easy (the zoo, the Locks.)

Warnings about the knee walker

It works great indoors and on very smooth surfaces, but is not an off-road vehicle. Hills and even slight inclines are frightening. You are on one leg or on tiny wheels with very little breaking power. Tt tends to slide off to one side. Any flaw in a sidewalk can send you over the top. A 1″ pebble outside my house got me last week.

It is not a scooter nor a skateboard. Don’t lean all your weight on the knee walker and push it along, even if you see me doing it. This is tempting - but I’ve spilled off the walker several times this way (pebble, table leg, sidewalk crack). If you actually “walk” with it, you have much more control. By this, I mean you take your weight of the walker while you move the walker forward. You keep as little weight on the walker as possible. If the walker flips or spins downhill you are still standing.

The super safe method of using it is like this (I do this on any questionable terrain)

1. start with nothing moving
2. move the good leg forward while walker is still not moving
3. shift weight off the walker onto good leg and “walk” forward: push the walker forward with your knee just barely resting on it.

This feels just like walking.. (However, I’m a slow learner, despite 3 tumbles in a week, I still scoot and coast. I’m practicing those judo rolls … )

Limitations / Complications

Very tricky to get up and down stairs: In the basement, I leave a rolling office style chair or my crutches near the stairs.

Did I mention hills? Ascending a hill gives you much time to contemplate high school physics, friction, force, intertia, but hopefully not corialis effects. I occassionally navigate two steep blocks in my neighborhood or to work. This is extremely unpleasant. For getting to work, I’ve found A map of seattle accessible routes - it has all the buildings in downtown with public elevators. I go well out of my way to find wheelchair routes.

Weird pains the first week. These aren’t as bad as with crutches (or hopping), but I’m had weird pains in butt and hips the first week. Keeping it stable requires use of muscles I don’t use much. No problems after I learned how to use it, except a sore right knee. I’m thinking of getting kneepads to create a flat surface from knee to splint.

Miscellaneous other mobility tips

Best when combined with a claw … I keep a 3′ claw / grabber thingy hanging off the front of my knee walker. This allows me to clear toys and clothes out of the way (the 2 year old is very tidy, the 4 year old is not). The claw saves me lots of hops, squats and other awkward one -legged maneuvers. We had to get 2 more (cheap ones) for the kids, though.

How do you get kids (2yrs / 4yrs ) to listen to you from a distance, so that you don’t have to hop 30 yards accross a playground to keep big brother from dragging little brother through the dirt under the slide? Getting a 2 year olds attention is especially hard when you can’t just run over and pick him up. This worked for a week: “Hey, Kepler, I think I hear a Zebra in your jammy drawer! Come look at the Zebra in your jammy drawer!”. Now, I try silliness: I scoot on my butt like a crab in the direction I want him to go. What will I do when these tricks wear off?

Hopping. With the knee walker, my left leg is much less tired, and I have plenty of energy for a short fast hop when needed. I have two very roudy spirited kids, and I sometimes need to get to them fast. ( If I had a legal department, they’d want me tell you that I strongly recommend against one legged hopping while in recovery. Therefore, I strongly recommend against hopping as a mobility solution. Hire a nanny to chase the kids with all the money you save from having your surgery in at a medical tourism resort Cuba / India / Mexico. If you can’t afford a nanny, keep your kids on a tether and indoors at all times, well away from anything that might tempt them to run around and squeal with delight. There, you are warned against hopping. )

Scoot on butt: I unpacked all the groceries today on my butt. I chase the kids to bed on my butt. They think it’s even funnier than hopping.

Insurance? It was pretty easy to convince my doctor to write a scrip for the knee walker. Now we’ll see if I can get my insurance to pay for some of it. I’m renting it, but it’s not horribly cheap.

Thoughts only peripherially related to this post

You really can get anything on Highway-99. (except books). For the last 6 years, we’ve been laughing at a silly quaint shop with a wheelchair hanging over the front door a ways up the road on Aurora Ave ( Highway 99 has many names ). It’s an effective gimmick … when I needed mobility assistance I knew where they were. They have knee walkers for loan and I got some instant gratification.

Anyway we’ve often attempted to come up with something we can’t find on Highway 99. I’m pretty sure I can get everything I need Highway 99 ror achilles tendon rupture recovery,: Groceries (and delivery services), a hospital, crutches (or walkers), and enough pawn shops that I’m certain I could get anything else. I could even get a cat to keep me company. There was an all night diner to eat at after a late night in the E-R the first night. The only think I can’t get on 99 is a good fiction book to read while resting my swollen calf.

Stuff I’d like to know from others

How do you manage busses? I manage them awkwardly.

Experiences with other ways to solve mobility problems?

Is there a normal bookstore on Highway 99 (in King County)? There are several a few blocks off 99. is a Christian bookstore, but they wouldn’t carry Ursala LeGuin or Kage Baker.

It goes like this. I was not really a couch potato: I walk, bike and hike frequently and far. I do have a desk job, so I decided to get back in shape.  Around July I start working out several times a week. In September I start playing soccer and finally I quit smoking around game 1. By game five, I was having so much fun. Lungs were clearing up, legs were strong, and I could run again!

Second half, I’m getting cramping and ankles are hurting. Maybe I should sub out?

Too much fun, play harder! Thinking about subbing, but we are dominating the game. I need to cover a spot off to my right, turn directions to sprint … Pop, I’m on the ground, and that is the end of my short return to soccer.

After wild speculation about why I couldn’t put weight on my leg, some buddies took me to the ER. I am the cliche of the weekend warrior. A 30 something, once athletic guy longing for his glory days. Perhaps I shall be a less ambitious soccer player for the 2009 season.

(We won the game, by the way!)

Here are a few tidbits that I didn’t know about Achilles tendon ruptures (this injury appears to vary from case to case):

• There is a pop, but it is not necessarily loud. I heard mine go, but no-one else did.
• Some say it’s painful. I have occasional onslaughts of severe pain that go away rapidly with elevation and ice. In a week, I’ve resorted to over the counter ibuprofen once, and I’m not particularly stoic.
• Not all medical professionals can diagnosis it well - and amateurs certainly can not. Ignore your buddies on the field / court. We went through a first responder (off duty guy who happened to be near soccer field) and even triage nurse before diagnosis:  My ability to wiggle my toes and only moderate  pain led some astray. The doctor walked in, gave the classic Simmons test, and diagnosed. However, neither of the doctors had any doubt that the tendon is gone.
• My medical insurance pays 90% of surgery …. which I thought look good. 90% of a lot is still a lot.

Information I’m trying to hunt down.

Experiences with non -surgical recovery. The doctor recommends surgery, but it will be difficult to manage a week of uselessness + my 10% “co-insurance”.

Dealing with all the secondary pain: crutch sores and tweaked backs from picking up stuff while leaning over stuff.

How do you chase a two year old on 1 foot? There’s no chance of catching my four year old.

Logistics: How soon do people go back to work after surgery?