5 Months Post-OP
Since I last updated my original April 2017 post I was finally scheduled for reconstruction surgery in March 2018. If you don’t want to read the saga of how I got to this point, the short version is I fully ruptured my left AT in September 2012 at 42 years of age playing baseball. My first OS only recommends a non-surgical protocol, which I followed. After 3 years of left achilles/foot and right hip pain the same OS told me I would just have to be inactive for the rest of my life. I was finally recommended to the top foot/ankle clinic in BC (Canada) and they discovered my achilles had healed much too long (about 1″).
The 6 months prior to surgery I led a very sedentary life aside from coaching hockey. This meant less pain in the leg and opposite hip, but being inactive was not how I wanted to live. When my former OS told me a few years ago I was just going to have to be less active, I suppose he was right…but it’s ridiculous to be told to be sedentary at age 45!
Prior to surgery my OS told me there’s a 70% chance my AT will improve, 20% chance it will stay the same, and 10% chance it could get worse than it is now. A year ago I would have jumped to do the surgery if there was a 20% chance at improvement, but being less active certainly reduced the aggravation of the bad tendon. I know the right answer was to get it done with the goal of being able to lead a more active and healthy lifestyle again, especially for my family, but the lazy, popcorn-eating, beer & Bacardi-drinking, TV watching side of me didn’t mind continuing this way. 
I read and watched everything I could find on the internet about achilles reconstruction surgery. It’s surprising how little information there is online about the procedure I was going to have called ‘Z-Shortening’. Effectively it’s a way to shorten the achilles without completely severing it straight across. They were also going to clean up any degenerative (bad) tissue from the original injury 5.5 years ago.
March 15th was the big day. I was given a nerve block in my leg prior to surgery to block the pain after the surgery, which is a wonderful idea…but more on this shortly. I was wheeled into the OR and 2+ hours later I woke up with a big dressing and cast on my leg and dreaming about accounting theory!?!?! The nurse must have thought I was a real exciting guy telling her all about it still half out of my mind.
The first few weeks were fairly standard stuff I would think. Sutures removed after 3 weeks and weight-bearing as tolerated. OH! I highly recommend getting a knee scooter for around the house and in an office environment. They are such an improvement on crutches! I was coaching baseball all Spring and even got an all-terrain version that kept me mobile outdoors. The healing process, weight-bearing and strengthening have been fine and I seem much further ahead of the non-operative timeline I experienced.
Once I had the dressings and stitches removed I finally realized numerous places on my foot were completely numb. 3 outside toes, all along the outside of my foot, in the arch of my foot, and all up the heel to the top of the incision. The incision area being numb is totally understandable, but the toes and foot were a concern. My OS figured the nerve block might be the cause given the nerve damage seems to be beyond the sural nerve area. I was told to give it some time and after 4 months I should see improvement. At the 4 month post-op appointment the OS changed his tune somewhat and said to give it 6 to 8 months and he thought there might be some sural nerve damage from the surgery. What’s getting me concerned is instead of getting better after 5 months it actually seems to be getting worse. More numbness in new areas of the foot and even less sensitivity on the side and underside of foot. If anyone has any experience with nerve damage post surgery I’d love to hear about it!
As for the achilles and recovery, it’s a slow process but I can see marked improvement in functionality compared to before the surgery. I have learned how much my body was compensating for the lengthened AT before the surgery and how much this affected my gait. I had to learn how to properly walk again (heel-toe, heel-toe, heel-toe) and as a result all hip pain is gone! I have an enormous amount of physio to do as I’ve essentially got a calf and toes that have not been used properly for almost 6 years. I’ve got an excellent physiotherapist and hoping 6-12 months of PT will get the calf back. I’m not happy with the nerve damage, but considering the functionality I’ve gained so far I would do the surgery again. Hopefully I get some feeling back in my foot eventually and hopefully I can get the muscles back enough to do a 1 leg heel raise or climb a ladder or even go for a run.
If I could give anyone advice who have recently had an ATR:
- If your OS recommends conservative treatment, get a second opinion. In my opinion, conservative treatment should be for people who have too high a risk for surgery or have no plans to play even recreational sports again. If you don’t plan on being overly active, try the conservative approach.
- If you choose the conservative method, cautiously weight-bare as early as possible. I think I was immobile far too long the first time around.
- Get a knee scooter! Crutches suck.
- Find a good physiotherapist and do the work!! Try to find a physiotherapist that allows unsupervised time so you can work out longer. You need to work hard to get that muscle strength back. Start strengthening all your leg muscles as soon as possible without stretching the AT.
- Get proper gait training! Take short steps to start and remember ‘heel-toe, heel-toe’. Don’t let your body compensate for weak muscles or pain. Use crutches longer or get a cane if you have to, but don’t let other parts of your body compensate for your healing leg. The body is amazing at compensating, but that leg needs to learn how to use the muscles and tendon again. If you have pain elsewhere you’re either trying to do things too soon or there is something wrong.
- Have your OS ensure the tendon is the proper length. I’ve read in medical studies how conservative treatment seems to result in tendon lengthening and trust me, you don’t want this!
- Be patient. This injury is life-altering for at least a year. I remember the first time that it was 18-24 months before the tendon stopped improving. Work hard, but you have to realize it’s going to be a long time to get better.
Good luck to all. I’d love to hear from anyone who’s had a Z-Shortening procedure to see how they are doing and would really like to hear about anyone’s experiences with nerve damage from the surgery or the nerve-block.
Thanks for reading!
Darren
Filed under: Uncategorized and
Good to hear you seem to be having success this time around, Darren. My story is complicated, so I won’t bore you with too many details. I didn’t have an ATR, but a Haglund’s deformity removal and Achilles reconstruction, after a posterior arthroscopy to remove an OS trigonum (floating piece of bone) and FHL tendon repair. My Haglund’s surgery was March 2017. In October 2017 while working to try to break up scar tissue I developed nerve issues - numbness and tingling in the sole of my foot through my heel, down to my big toe, and along the outside of my foot to my baby toe. Felt like my foot was asleep ALL the time. They told me it was a sensory nerve issue, not a functional nerve issue. So feels funny, but doesn’t effect function. It lasted 5 or 6 months, then eased completely, other than occasional tingling. I had had no more nerve issues until the last few weeks where I’ve had a little bit of on and off tingling again, and notice my foot falling asleep kind of spontaneously for no good reason. But again - it’s just sensory - ie. not a big deal (for the people not wearing the foot!!). As I said, my story is complicated and I have some issues with various other tendons, crazy stubborn scar tissue and lingering chronic inflammation that is likely compressing the nerves in the tarsal tunnel.
I chuckled when I read how your OS changed your timeline once the “promised” date had passed. My OS originally told me 4-6 months recovery. No big deal, right? Wrong. Once the 4-6 month mark had passed, it became up to a year, then, some people take 2 years for full recovery. At one of my last appointments (I’ve recently gone through a series of cortisone injections, so lots of appointments) he told me I have what they call Achilles enthesopathy, which can be REALLY hard to get rid of. But, he assured me, people who have it don’t die with it - it does go away eventually. So now my timeline is “somewhere in the next 40 years or so”!! Ha!
I have only just recently begun to walk with a normal gait on a regular basis, so after 3 years of walking wrong and using muscles/tendons improperly, I’m starting to get it! My hips are thankful too! Things in the foot/ankle get tired REALLY fast. We’re still trying to make sure my pain and inflammation is under control before I even start doing heel raises. And I’m at the 17 month mark. Long road for sure. The only reason I keep at it, and keep going to physio appointments is because I want to be more active again one day too. Don’t give up!
I’m 1.5 years out and still have some numbness on my heel. There is less numbness there then initially so some numbness does go away. My doc said there may be some numbness that is permanent. So the remaining numbness in my heel may be permanent. I do keep massaging it in order to give it some stimulation since I do know that nerves can regrown.