Craig’s achilles blog - one day at a time

I plan on following up with my PT / ortho, but in the meantime I’m looking for some advice with regards to the angled setting on my boot.

I had my third PT appointment today, and there was a marked improvement in my dorsiflexion vs my last appointment last week (7 degrees vs 15 degress pre massage, 3 degrees vs 8 degrees post massage).  The real encouraging part is that it appears to be joint stiffness that is preventing me from reaching the goal of 0 degrees, and I’ve been able to get a lot of strength back quickly (blue colored thermaband and #3 setting on the Orthotron if these mean anything).  So really, it seems I just need to work on a long of stretching drills for my ankle joint.

My boot has settings in 7.5 degree increments.  Since I’ve started FWB, I’ve stayed at 7.5 degrees.  My PT today suggested that I try to go to 0 since I’m getting close in my sessions, and I won’t progress with it set at 7.5 degrees.  I tried 0 degrees tonight, and while I’m still able to walk on it, my foot really starts to hurt after a few minutes.  So I decided to drop it back to 7.5 degrees.  When I was putting it back to 7.5 degrees, it occured to me that I could set the front setting at 0 and the back setting at 7.5 degrees to allow the boot to flex between the two.  (Does that make any sense at all?)

My question is, does anybody have any thoughts on whether or not it is a good idea (safe?) to allow for flexing in the boot?

Braveheart has been on HBO recently.  I wouldn’t necessarilly say it is one of my top 10 movies of all-time, but I do really like it, so I’ve watched bits and pieces of it for the past few weeks.  Mel Gibson’s last word as WIlliam Wallace is when he yells out, “Freedom!”

Well, I felt like yelling that out a few minutes ago myself.  I was ready to head back to my office from the restroom, and I thought, “You know what, you can do this without crutches.”  So, I held them up and walked the whole way, ~200 feet, back to my office with no support.  Wow, what a great feeling, walking without crutches.  And the best part about it was that it took me a good 2-3 minutes, so I had plenty of time to enjoy my new Freedom.

I had my first PT appointment yesterday, pretty uneventful.  Most of the time was spent taking measurements and reviewing what my experience has been so far.  It’s pretty clear that my ROM is going to be the biggest challenge for the near-term.  I’m only able to get to -15 degrees dorsiflexion.  I was hoping to be to neutral by now, but it just isn’t happening.  The odd thing is that it seems that it’s the front of my shin which is preventing me from bending further.  I get a reasonalbly sharp pain in my shin when I’m doing exercises to bend my foot up.  My therapist said we’re going to push harder starting at my next appointment on Wednesday.  When people have asked me about the therapy, I’ve replied that I’m more than happy to go through an hour of being pushed hard if it helps get me to the finish line.

I was hoping to be able to ditch the crutches this week, but I’m thinking that won’t happen at this point due to my lack of ROM.  A bummer for sure, but I know my ROM will increase quickly as I continue to do my exercises.

My new goal is to get to 0 degrees dorsiflexion by the end of the week, so I can move towards FWB and walking without crutches.  Not sure how realistic this is, but I figure I need something to shoot for.  And I know it will be here before I know it, whether it is this week or next or the week after that.

On a completely different note, I realized this morning that I’m now looking at time frames in a matter of weeks as opposed to days.  I can’t believe that I’ll be 7 weeks post op tomorrow.  They say time flies when you’re having fun.  Well, I wouldn’t say I’ve necessarilly been having fun, but I’m amazed that it’s been over 50 days since my injury and nearly 50 since my surgery.

I’m now in my 3rd full day in the walking boot, and I’m slowly adjusting to this new freedom.  I’ve become less timid when doing things like putting on a sock, washing the seemingly endless amount of dead skin off my foot, and just touching around my ankle and foot.

I still have some numbness on the top of my foot.  I believe this is due to pressure from the cast I had.  There is a fair amount of bruising on the top of my foot and running up through my ankle.  It seems to be getting better, though.  I’ve been taking advantage of any opportunity to have my foot out of the boot.  Lots of icing in the bruised area and just letting it breathe, though I don’t think anybody will claim it has the bouquet of a fine wine.

I made it through 6 hours of poker last night.  It was a tournament put on as a fund-raiser for my kids’ school.  (I finished 4th out of ~25 when my AQ didn’t hold up against KJ, rats!)  No real pain, though I was starting to get uncomfortable towards the end of the night.  It was late when I got home, so I didn’t ice until this morning.  Definitely some more swelling visible today.

Lastly, I am scheduled for my first PT appointment tomorrow.  I have been doing some PWB for the past day and a half.  I plan on adjusting my boot the final 7.5 degrees today to get to 90 degrees, and will continue the PWB.  My goal is FWB by next weekend so I can watch the final little league playoff games sans crutches.  Keeping my fingers crossed!

Went to the doctor today for my fifth post-op visit.  All-in-all it was a relatively quick visit, but certainly a good one.

I had my third, and final cast removed.  The doctor told me that the stick thingy attached to the end of my knee was my calf and foot.  I’m not sure I believe him yet, but it seemed to follow me in the car ride home, so perhaps he is right.  Anyway, after a thorough alchohol swabbing and an amazing amount of dead skin was removed, my doctor came in and looked at my ankle and said it was healing well.  Next, he gave me the run-down for the next 4 weeks: boot today PWB leading to FWB as soon as I’m comfortable, start PT next week @ two times / week for the next 4 weeks, come see him in 4 weeks and if all is “normal” I’ll be in two shoes the next time he sees me.  Wow!  I was shocked.  I hadn’t expected to move to 2 shoes for another 6 weeks, but he said that the PT would lead the way and as soon as I got my dorsiflexion back to neutral then I could transition to two shoes with a 1/4″ lift in my heel.  Well, as happy as this made me, I don’t think it was anywhere near as happy as my wife was.  I may actually be driving again by the end of June.  We then joked about a few things (I really like my doctor, what a great find he was!)

After my doctor left, it was time to get into the boot.  The bad news was that I couldn’t get to 90 degrees in the boot, so I had to go into an adjustable one.  I’m at 22.5 degrees shy of 90 degrees.  I need to get to 90 degrees before I can start PWB (in 7.5 degree increments).  I’ve set a personal goal of hitting 90 degrees by Saturday.  I’m signed up for a poker tournament Saturday night, and would really like to be PWB by that point.  I can graduate to FWB as it feels comfortable which my doctor said will be between 4-10 days on average.

All-in-all, I feel like this milestone is a point where my body can move beyond just healing and start rehabilitating along with the healing.

I look forward to relaxing tonight and letting my leg air out some and a cast-free shower in the morning!

5 long weeks in either a splint or a cast down, 160 hours to go!  That’s slightly less than 1 week to go.  I’m now thinking about silly little things like, this is the last Thursday night dinner with a cast on.  What a knuckle-head.

 I’m happy to report that I’m back to work full-time now.  I think it is a mixed blessing for my co-workers though as I’ve been easier to communicate with while in the office, but I’m sure they are tired of picking me up/driving me home and dragging my luggage rack rigged to be a leg elevation device into various meetings.  They may be rooting for me to ditch the crutches more than I am.

 I’m also starting to count the days down to our family trip to the big island in Hawaii this summer.  I’ll be at ~17 weeks when we go.  I’ve been trying to figure out a place to stay that has the necessities relatively close to our room (and by necessities I mean a pool, a restaurant , and a bar) and also trying to figure out if I’ll be able to do any activities such as swimming with dolphins, walking/hiking by the volcano, etc.  Does anybody have experience with any of these at Hawaii either pre or post ATR, and have any opinions on how difficult the swimming and/or hiking will be?  I’m guessing surfing is probably out, but I would love to experience the dolphins and volcano with the kids.

Fourth post-op visit today.  When I met with my doctor prior to surgery, he ran through the recovery process that he would use, 6 weeks post op in a cast (all NWB), then start PT and 6 weeks in a boot while transitioning from PWB to FWB, then transition to shoes with a support in the heel.    This meant the plan was to replace my cast today with another cast for the next 10 days.

The last few days here have been very hot (think we maxed out at 99 on Saturday).  This is definitely not cast wearing weather, so I decided to see if I could get my doctor to allow me to go to the boot today.  Besides the discomfort of the cast, I also was worried about swelling in my foot each of the two previous times I’ve been put in a new cast.  Well, unfortunately, it wasn’t happening.  My doctor said that he wanted to keep me in a cast for the protection.  Specifically, he didn’t think a boot provides sufficient protection if I were to fall.  Bummer.

Back to the visit…  wow, it is amazing how much size I’ve lost in my calf.  My doctor was even teasing me about how bad my leg looks.  After the cast was removed, I cleaned the dead skin off my leg.  There were a couple of areas that felt odd when I touched them.  Kind of tingly, kind of “new”, like hey what is this area here.  While I’m looking forward to PWB and PT, I know it is going to be a lot of work.  I even was thinking about how I feel much more secure and safe while I’m in my cast than when my leg is exposed.

My wife took me back to my office after my appointment.  I worked for about 2 hours but realized I needed to go home.  Yeah, the cast was bugging me a little, but I was also a bit hung-over from yesterday.  Uggg, hot weather, cast, and a hang-over don’t go well together.  Note to self, don’t make that mistake again.  I came home and napped.  I still have a hard time getting very comfortable when I sleep, but it’s getting better, and I know that I’m one day closer to ditching the cast for good.

While it’s amazing how much time has passed since my injury and subsequent surgery, I’ve reached the point where I’m longing for the next milestone in the recovery process.  The weather has been warming up the last few days.  It reached 95 today, and I’ve really noticed a difference inside my cast.  I’m definitely sweating in there, which isn’t particularly comfortable, and I can imagine the smell isn’t pleasant.  (Oddly, neither of my kids are willing to stick their nose by my toes and take a whiff…)  I can’t wait to be rid of this cast and on to the next stage of recovery.

The swelling in my foot seems to have gone down quite a bit in the last week.  I now have nearly full movement in my toes.  I think the tendon on the top of my foot which goes to my big toe must be really tight as it is soar when I try to point my big toe upward.  Also, the ball of my foot feels like it has become quite soft.  I imagine it looks as-if it has been in the swimming pool for too long.

 I get a new cast on Monday.  The new cast will be on for 10 days, after which I’m scheduled to transition to a walking boot.  I’m considering lobbying my doctor to let me go NWB in a walking boot on Monday instead of another cast.  I’ve been able to work full days for the past week, and I’m afraid that the new cast will set me backwards for a few days as it will be a tighter fit and may cause more swelling and loss of circulation when my foot isn’t elevated.  In other words, I’d like to avoid going into my office and laying on my back with my foot stuck up in the air, though I’m sure everybody would get a chuckle out of that.  Not to mention that I’m looking forward to my first shower without a bagged foot.  It’s amazing how nice the little things in life can be.

Yes, there are some benefits of going through the ATR process!

Prior to my ATR, I was very active with our local Little League baseball program.  I serve on the board of directors, helping set up and run various activities within the league.  Additionally, I was coaching my 7 year old son’s team.  Unfortunately, I’ve had to give most of it up over the past month as I haven’t been mobile enough to do the things I was doing previously.

Tonight was the night of our annual little league night at Santa Clara University baseball game.  Every year, many kids from the league come out to watch present college, and possible future pro players.  They all wear their jerseys, and get to stand on the field for the national anthem before the game, and, for those able to last the entire game, run the bases on the field afterwards.  Additionally, two kids get to act as bat boys for the SCU team, and one kids gets to throw the ceremonial first pitch.  My 7 year old was picked to throw the first pitch tonight (I’m sure my injury had a lot to do with his selection).  What a great experience!  He got to go down on the field and play catch with the catcher before the game, and talk to a bunch of the baseball players too.  Then, the PA announcer gave him a great introduction.  He ran out to the mound and threw a perfect strike!  All of the other little league kids in attendance were yelling his name and cheering him on.  Afterwards, the entire SCU team lined up to give him 5, and let him take the ball home as a souvenir.  I’ve never seen my shy 7 year old’s face glow so much.

It’s moments like these that make me cherish being a parent.  Certainly an experience that I, and hopefully he, will never forget.  All made possible, at least somewhat, by my ATR.

I’ve been able to spend 3/4 days in the office for the last two days.  I even went out to lunch today and ate at the restaraunt.  What a pleasant break from daytime television.  (I’m hoping the imprint that I’ve left in the couch from the last 3 weeks will eventually go away.)  I’ve been using a luggage rack with a pillow on it as cushion, so I can keep my leg elevated.  I still get some tingling in my toes when I don’t keep my leg elevated, though it seems to be getting a little better every day.

I’m going to try and get out to a college baseball game tomorrow.  Our little league gathers for some pre and post game festivities (kids get to stand on the field for the national anthem and run the bases after the game), and the coolest thing is that my 7 year old was selected to throw the opening pitch.  Dad is definitely jealous!

Shame on me.  I realized today that I haven’t done anything for Mother’s Day yet, and other than an internet gift, I don’t have any good ideas on how/what I can do.  Since I can’t drive, I guess I need to start planning for these things a little sooner…

 I’m counting down the days to my next milestones: new cast in 11 days, out of a cast and in a boot in 3 weeks, but at the same time I’m trying to stay grounded with a one day at a time approach.  This is certainly a long healing process, but, as many others have said before me, life could be a lot worse.

Good luck to all in your recovery.