6 months in the books (post-surgery)

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.

9 weeks down, and a few questions about shoes

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 weeks post-op (and a treatment pattern question)

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.

First 2.5 weeks

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?