6 months in the books (post-surgery)

Posted on February 29th, 2016 by davemulder

Starting out on my recovery, I had the intention of documenting on a regular basis. However, it has now been four months since my last update.

Here’s a quick recap of my timeline:

  • Early August 2015: rupture, initial consultation.
  • +0 weeks: surgery and gravity equinus cast.
  • +3 weeks: full weight-bearing on a cast shoe.
  • +4 weeks: cast removal and adjustable orthopedic boot.
  • +6 weeks: reached plantigrade in orthopedic boot.
  • +9 weeks: clearance for shoes.
  • +11 weeks: started physical therapy (strength + stretching).
  • +16 weeks: end of physical therapy sessions.

The biggest reason for my lack up updates is that after going into shoes, my progression moved to small increments. Early on, I had landmark moments coming every week, and it was worth writing about. Once I hit shoes, a sense of normality returned and my recovery slowed way down. Not complaining, though.

Now at six months post-surgery, I walk as smoothly as I did pre-rupture. However, I’m still not doing much in the running department. Despite weeks of exercises to rebuild my atrophied calf muscle, there’s not yet enough power in my recovering leg to return to jogging or basketball. That’s disappointing, but I am getting stronger and I get the feeling that I’m not far off.

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9 weeks down, and a few questions about shoes

Posted on October 11th, 2015 by davemulder

In my last update, at the 4-week mark, I was getting ready to be extracted from a gravity equinus cast. I wrote that my doctor wanted to put me in another cast, at plantigrade, for six more weeks. However, on advice from the folks here, I talked to my doctor and he gave me permission to use a removable orthopedic boot. I chose the VACOcast Pro Achilles, and that’s worked out well for me.

My next consultation isn’t until this coming week, at which point I expect my doctor to progress me to shoes.

However … I’ve already been experimenting with shoes on my own. At the 8-week mark, I felt able enough, and tried on a pair of sturdy trail shoes. I’ve been walking in these shoes around the house, and then using the boot for everything else.

At first, it felt like I was using someone else’s foot. A few days later, it still doesn’t feel like normal walking. Not that I was expecting to hop into shoes and cruise around, but I’m also not pushing too hard. Just like the transition from PWB to FWB, I don’t know if I’m physically ready but mentally holding myself back, or if a full-ahead charge will put my recovering Achilles tendon in jeopardy.

Anyway — here are my questions.

1. What advice did your doctor give you on how to manage the return to shoes?

2. Are there any particular activities/actions around the home you found to be difficult in shoes?

3. Would it be risky to go barefoot around the house?

4 Comments »

4 weeks post-op (and a treatment pattern question)

Posted on September 9th, 2015 by davemulder

4-week update

In my last update (at the 2.5 week mark), I wrote about frustration regarding my limitations. My doctor, at 3 days post-surgery, had given me permission to go full-weight bearing while in a gravity-equinus cast. I wasn’t ready at the time, to do that, and even at the 3 week mark I wasn’t doing much more than light weight-bearing while using two crutches.

Thanks to the advice of fellow AchillesBloggers, during the fourth week (the last seven days), I trusted the cast to protect my healing Achilles tendon and have been able to graduate to walking without crutches. My walking is slow and with an obvious limp, but I’m working to smooth that limp out.

Walking in a cast shoe

A question about my recovery/treatment pattern

At my first post-operative consultation, my OS didn’t give much explanation on how my recovery would be managed. I was to be in a gravity-equinus cast for four weeks, ramp up to weight bearing, the cast would come off, and then something else would happen. All along, I’ve been assuming I would move into a below-knee walking boot (like a VACOcast), because everyone else seems to move into one of those. I’ve been looking forward to this because the cast is generally not comfortable.

However, I spoke with my OS over the phone this morning, and he informed me that his plan is to go from the gravity-equinus cast directly to a plantigrade cast, for an unspecified amount of time (I wasn’t able to have a long conversation with him). I get the feeling that it will be another four weeks in this plantigrade cast, followed by who-knows-what.

I’m not keen to go into another cast, for that long, for the following reasons:

  • Going directly from gravity equinus to plantigrade doesn’t give me a chance to get used to the change by doing stepwise angle adjustments, which you would get with wedge removal in a boot.
  • A cast prevents me from being able to start physical therapy, or do any ROM exercises, until it is removed. The median start date for PT is around week 6, and if I feel ready at week 6, I’d prefer to start then.
  • A cast prevents me from being able to wash my leg, or sleep without this added weight on my leg. I’ve read from many AchillesBloggers that it’s common to start removing the walking boot for showering and sleeping around week 6.

Anyway, I said there’d be a question here, so here it is: am I crazy to want to do something different than another cast?

Quick update post-consultation

Thanks for the feedback, oscillot, Kent, and Sneaker!

I ended up bringing an orthopedic boot with me (the VACOcast Pro) to the four-week post-operative consultation. When the doctor came in, I requested that he clarify my treatment plan, and he said that the next step was a plantigrade cast for a further six weeks.

So I asked about using the orthopedic boot, as an alternative, and he was receptive. It was a modest surprise to him, but he warmed up quickly. He did offer a few words of caution — basically, make sure I’m wearing the boot when walking.

The cast came off, we inspected the incision site (healing nicely) and it turns out my calf atrophy hasn’t been too significant (knocking on wood). Or, at the very least, my calf is not twig-like. Then my leg went into the orthopedic boot, immobilized at 30 degrees below neutral, and I went home. Next consultation in two weeks.

My plan for the following few days is to get used to the new boot, and move toward neutral position.

6 Comments »

First 2.5 weeks

Posted on August 29th, 2015 by davemulder

This injury story is typical. Ruptured my right Achilles tendon on August 6th while playing basketball. While running down court, felt a kick on the back of my leg and found myself falling to the ground. If there was a popping sound, I didn’t hear it, but I knew immediately what had happened and crawled to the bench in shock. Got to urgent care within an hour to confirm my self-diagnosis, saw an orthopedic surgeon the next day and elected for operative treatment. Surgery was on August 11th and I went home with my leg in a gravity-equinus fiberglass cast.

My OS asked me to come in three days later (August 14th) for a followup appointment. He’s an older doctor, and his treatment is a mixture of what has worked for him, and what he’s read in literature. He’s keeping me in this cast for four weeks, but he also told me to get a cast shoe (which fits over the bottom of the cast) and gave me permission to go full weight-bearing. He gave me a goal of walking into the next consultation without crutches.

Now at 18 days post-surgery (and three weeks post-injury), the only significant frustration to achieving this goal is understanding my limitations. Even though the OS said I may bear full weight, it just doesn’t feel right as my leg sinks in the cast, presses into the cast shoe, and blood rushes toward my foot. There’s no pain, just discomfort from swelling (which does cause some loss of sensation). So I’m using crutches and left without any idea of where to go from here. Should I trust that the cast will protect me, set my crutches down, and really try to walk on my healing leg? Or should I gradually work up to it? Where are the real dangers of a re-rupture at this stage?

5 Comments »

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  • gutzer | March 3rd, 2016 | 6:55 pm

    good to hear from you Dave, we were about the same timeline as far as surgery. sounds like youre doing good, it’s great you are walking so good, jogging isn’t far behind! keep up the good work.

  • davemulder | March 1st, 2016 | 2:50 pm

    @Stuart — Yes! Thanks for the message. I’ve been working on single-leg calf raises, they are not as pretty as my good leg but getting stronger every day. I will continue with the eccentric exercises and walking!

  • Stuart | March 1st, 2016 | 1:58 pm

    Good to hear back from you Dave. Are you able to do a single leg raise yet? You are about half way and you will be surprised how much you improve in the next 6 months. Hope it goes well for you. Continue with the eccentric strengthening exercises and walk lots of stairs and hills.

  • davemulder | October 19th, 2015 | 2:04 pm

    Thanks for the advice, Stuart, djflight, and Sneaker!

    Ended up being progressed to shoes, and it’s going well so far. Heel lifts have been a great buy — I ended up getting an Achillotrain for my healing Achilles tendon, and I can walk without a limp while wearing that.

  • Sneaker | October 14th, 2015 | 3:27 pm

    1. I was told to go without the boot - only at home and wear the boot while outside until week 10.

    2. I actually started walking around the house without the boot around week 6 and the most difficult aspect was balancing myself and any type of eccentric bending of the ankle.

    3. I walked barefooted since week 6 and did not slip even once. I did almost slip two times - but it was in the boot!

    I have to advise you that walking around barefooted (I have marble floor) is not as comfortable as wearing a well cushioned sneakers (I have Nike Flightknit).
    Even walking on carpet is easier.

    But I felt that it helps me recover and progress faster - so I liked walking barefooted.

  • djflight | October 13th, 2015 | 5:21 pm

    I didn’t get into shoes until quite a bit after you, but I found a heel lift to be a godsend. I used it for about 2 days at full height, then kept it at the lowest level for a couple of weeks.

  • Stuart | October 11th, 2015 | 2:38 pm

    Dave - you have done well to change your doctor’s mind. What you are doing around the house is also good and the shoes you are using i.e. sturdy trail shoes are very good for support. I assume there is little flex or twist in the sole. They should bend at the ball of the foot and have very little or no twist. Going barefoot around the house may be OK for short distances but you will limp more due to the lack of dorsi flexion and limping is something to avoid. Managing a return to shoes is varied and you could get lots of different responses. Easing into the way you are is good. I used one crutch outside for a few days just to keep people away. I also had some wedges in my shoes to take pressure off the tendon. This helped me walk better and I removed them over a couple of weeks. I also took the boot with me in the car but never needed it. Avoid uneven or slippery surfaces and crowded places until you are confident.

  • Atrbuff | October 3rd, 2015 | 2:44 pm

    Hey Liverpool, you are kidding, right? The driving I mean of course. An insurance nightmare!

  • liverpool4me | October 2nd, 2015 | 10:02 am

    My plan is two weeks splint (done), two weeks hard cast (1 week served, but I can at least drive limited trips to the ice rink with left foot), then two weeks in a boot and I can start PT at that time too. When they took the split off and removed some sutures, I saw the incision - definitely something for Halloween. Anyway, four weeks of NWB should not be too bad - the cast is irritating though. Before surgery, it looked like the best plan is to limit your time in a cast.

  • gutzer | September 17th, 2015 | 1:16 pm

    At least it looks like you are walking great in your cast. I have been in a hard cast now for almost 6 weeks NWB!! It is ridiculous, can’t see the incision or anything. I’m starting to wonder about my doctors protocol.

  • Sneaker | September 11th, 2015 | 6:18 am

    Its a different approach with each Doc, even in the same countries from what I have seen.

    My Doc does not believe in full immobilization for more than 10 days.
    He had me walking in a tall boot since day 11 post-op, removing wedges each week and start light PT as well.

    I see the results from it already, as my AT is very strong and my surrounding muscles and calf have lost very little gains compared to what I see all around.

    After week 6, he cleared me for 2 shoes at home, but even with this progressive approach - prescribed the boot to be worn at all times outside home for another month…

    So, its a different approach and timetable for every Doc - I wouldn’t draw too much conclusions if yours differs from the majority out there.

  • Kent Mayhew | September 9th, 2015 | 1:00 pm

    yes seems different. I was two weeks in a splint then one week in a hard cast and then moved into boot. Just started therapy at about 8 weeks. Best of luck to you.

  • oscillot | September 9th, 2015 | 12:18 pm

    Your doc has some unique ideas, suggesting you should bear weight at day 3 and stay in casts longer than most. It might not matter in the long run so long as you are immobilized at appropriate angles, but you’d be a lot more comfortable in a boot. I liked having the freedom to adjust my angles +/- 5 degs based on how I was feeling that day, and I do think the nightly washings helped me mentally prepare for 2 shoes.

  • oscillot | August 31st, 2015 | 12:41 pm

    Looking forward to following your recovery, Dave. My surgeon prescribed the opposite (slow) approach, so I’m curious to hear how yours goes. The worst part of going slow was the atrophy and not having use of my hands while crutching / scooting. I wouldn’t be surprised if your recovery goes faster without any negative effects.

  • davemulder | August 30th, 2015 | 10:06 pm

    @Stuart — Thanks for the guidance. What you suggested has more or less been my plan but it’s been frustrating not really knowing if I could/should be doing more.

    @oscillot — Yes, full rupture. My OS gave permission based on what he’s read in studies and how he’s handled other patients.

  • oscillot | August 30th, 2015 | 4:27 pm

    Was it a full rupture? FWB at day 3, much less day 18, is by far the earliest I’ve heard of.

  • Stuart | August 30th, 2015 | 4:25 pm

    The cast should protect your tendon but there may be some movement now as your leg has reduced in size since it was applied. Weight bearing in casts is a bit harder than in a boot but not impossible. I image you are a bit uneven and that will throw things out. You need to start by placing weight on the your leg while using the crutches for balance and also to take some weight off. Gradually increase the weight as tolerated by pain and swelling. You will also need to rest and elevate more often. The progression to FWB without crutches can take a week or two.

  • richardk | August 30th, 2015 | 6:16 am

    Really didn’t help that there is no agreement on his to treat this. You’d think that for such a common injury the medical profession would have worked out the good, bad and ugly of treatment. Seemingly not.

    I can’t offer you any advice. For starters I elected no surgery, so or situations diverge from the start. I was told no weight for the 6 weeks I was in cast.