DavidUK’s AchillesBlog

Time flies huh? Realised I am coming up to the anniversary of my re-rupture. Things improve, i am running (on the treadmill) regularly, happily doing 10K + and comfortably for an hour or more. It took longer than i expected to get to this point, but it is what it is.

I can say that my ankle always hurts - and keeps finding different ways to hurt! So never far from my consciousness. I tried laying off the running for a while but that made little difference (except to my weight!). First thing in the morning i take time to warm up, and the knot of stitching under the skin is very prominent first thing when there is no swelling. After a couple of hours on my feet the knot is subsumed into the swelling which always occurs. I guess this is the ‘new normal’.

I think, having re-ruptured, i am maybe more wary than i should be in terms of what i put my ankle through. In the gym, i am happy to jump up / down steps, doing some backward and forward shuttle runs and some bounding. However, outside the gym environment i am (probably over-) careful about how i use my ankle. I have certainly consigned my squash kit to the dustbin of history!

Sitting here typing, i can feel my achilles pulling, and having sat down for an hour i know when i get up it will be stiff again. I am more convinced than ever of the benefit of early mobilisation - my relatively slow mobilisation protocol involving several weeks in plaster after each ‘event’ is, i am sure, causing more discomfort than the achilles inhury itself. Two long stints in plaster have taken their toll!

Anyway, good luck to all on here! I finally got round to taking my ROM boots to the household rubbsih tip at the weekend (in the UK they are single use - always seemed a waste!). Heading for the gym later! It’s not all bad…

Something of a catch-up, having just realised it’s 6 months post surgery following myre-rupture and 9 months post the original rupture.

So, recent achievements include my first 5k run (slow!) and my first solid hour of running. Both of these on the treadmill. Pre-injury most of my running was also on the treadmill, and right now i am happy to continue this rather than have to watch out for the perils of running on streets / in woodland where a trip may cause issues. I’d like to think i will be back to where i was (10k in c.40-45mins) within 2-3 weeks. My fitness is good, it’s a case of building confidence in my ankle.

I am still having physio - with lots of exercises to strengthen the calf. After so long in plaster after each rutpture the flexibility in my ankle is still challenged, and (like most here?) i still have the need to get my ankle warmed up / flexing in the morning. I also still have a noticeable red mark where the internal stitch knot is - but no infection and maybe less tenderness now.

Long time no post…so here goes…

August was a month of holidays - a week in the English countryside and 10 days on Huntington Beach in sunny SoCal. Lots and lots of walking, very different terrains (rocky / hilly tracks and beach!) so some good range of exercise for my ankle. Still very stiff in the mornings and after car journeys etc, and a lot of swelling during / after an 11 hour flight. I feel i am making progress - although i have not yet had a chance to see my doc with regard to the stitches which are still clearly there. Still not sure to what extent the swelling is ‘normal’ and to what extent caused by the stitches (one of which is still trying it’s hardest to push it’s way through my skin!)

Yesterday was my first day back in the gym. An hour on the exercise bike and 30 mins fast walking. I have now started interspersing long periods of walking with short jogs - walking at 6-6.5 km/h and then breaking into a jog at the same pace for 30 secs to a minute. I am getting no adverse effects, although my physio is intending to hold me to mid-October (six months post-op) before running. I think i will be well head of that schedule - i can feel my calf getting tired but no ‘pain’ as such. I take tiredness to be a good thing, the calf is working and so it can be (slowly!) strengthened.

I am also doing single leg heel raises - whoopee! Obviously not geting very high off the ground, but a good 2-3 inches. To be honest i am not stressing over this particular test / exercise - if i can work on the running / cycling i reason that the calf strength will come in it’s own good time.

So - good luck to all, maybe i’ll update when i actualy see my doc about the stitches.

daviduk

Progressing well, i think. Gym every day, alternating between 60 mins on stationery cycle / 30 mins walking on incline and a mix of stationery cycle / treadmill / upper body weights. The advice from my phyiotherapist today is to add in cross-trainer and leg weights (always keeping damaged leg ‘flat footed’). Still very stiff pre-exercise, and that stiffness is less to do with the achilles and more to do with the rest of the ankle having been immobilised for two sets of rupture treatment.

One problem though. I have an internal stitch which is trying to push through the skin. In itself not a big problem (although extremely tender at the point at which it is trying to push through), except that i suspect there is quite a long piece of stitch under the skin and possibly still anchored at one end. Having had this apparently trying to push through the skin for several weeks, talk is turning to surgical removal. I am not eager to have another (although minor) surgery on the ankle.

Has anyone had similar challenges? Any advice?

daviduk

6 months post my initial ATR and i am finally back to 2 shoes again! The issue now, of course, is that every pair of shoes i own looks extremely odd - well-used right shoe, pristine left shoe!

This time round the physio is going well. I have been out of the ROM boot at home for a good couple of weeks, only using the ROM boot for trips out (i should say journeys, ‘trips’ is a dirty word for an ATR patient!). I have also been using the stationery cycle in the gym quite hard - alternating 60 min and 30 minute sessions day by day. Even my wife has noticed some visible re-development of my left calf muscle.

Last week, on the advice of the physiotherapist, i introduced treadmill walking into my workouts. Very gentle at first - 10 mins at 2.5km/h to 3.0km/h. My physiotherapist has now suggested upping this - yesterday was 20 mins at up to 4.0km/h and introducing the incline a little. This latter advice, going to incline, is suggested to be beneficial given i still have an awful lot of stiffness in my ankle due to the long periods of immobilisation. In truth, my achilles is fine it’s the rest of my ankle that’s struggling! The incline is intended to encourage more flexibility in the ankle, along with a whole set of exercises i have for home use.

I find the treadmill a useful exercise insofar as it encourages focus on the quality of walking and not just quantity. To a certain extent i am re-learning how to walk - getting away from gimpy flat footed walking to more normal heel - toe motion.

The next major milestone will be running again. Current outlook is by end-October. Right now i am feeling that must be achievable, but i am really having to rein in my enthusiasm and continue taking care to avoid mishaps.

Onwards and upwards!

daviduk

Today is a good day - i am wearing a matching pair of shoes (well trainers) for the first time since January! Under physio’s instructions, i am weaning myself off the ROM boot gradually - wearing shoes in the house and the boot for outside. Hopefully i will be fully bootless in about two weeks, c. 12 weeks post op (this is the protocal we are working to). That will be mid July, and the next step will be running by end-October.

It’s great to be getting more independent. I have been using the stationery cycle at the gym, and have been pleasantly surprised at the strength i have left in my leg, although i am not putting any real work through my calf. I have also learnt over the past couple of days that i need a shoe with some heel in it’s construction - bare feet and flat sandals don’t work well.

I’m still getting a substantial amount of swelling, mainly around the repair area - more so now i am using the leg. Also, there is still a lot of stiffness in my ankle, but i guess that just takes time and exercise - at least i can see light at the end of the tunnel! (What’s that funny ‘train’ noise??!)

I renewed my acquaintance with my physiotherapist this morning - i am seeing the same person who treated me after my initial rupture. Now, 9 weeks post-op following surgery to repair my re-rupture, we are going through it all again!

I had some interesting observations following our session today. Firstly, this time round there is much less swelling in my foot / ankle, and my foot is a much healthier, much more normal colour. First time round (conservatively / non-surgically repaired) i had quite a bit of swelling and my foot was very red. This time i also have much less pain / tenderness in the area of the achilles, particularly noticeable when my physiotherapist was manipulating the tendon. She did observe that the scar was very neat / straight, and there seems to be very little scar tissue or other ‘lumpiness’ in the area. I had expected, given the more ‘traumatic’ treatment of surgery, that there would be greater tenderness than with the conservative treatment - not the case for me.

I now have a set of exercises to work on to restore my range of motion and to build strength in my skinny ‘chicken leg’. A total of 13 weeks in NWB plaster since end-January 2010, and the rest of the time in NWB / PWB ROM boots has left me with very little in the way of calf / thigh / buttock muscle – I have a very lopsided profile at the moment!

The vacation season is almost upon us. I have a week in the English countryside at the end of July, and it would be great to be out of the boot and off sticks by then. In mid-August, we are heading back to visit friends in the OC, and I definitely want to feel the sand of Laguna Beach between ALL my toes!

I’m feeling very positive today – the challenge, as ever, is to push just hard enough but not too hard. It took me a while to convince my physiotherapist that I was joking when I pointed out that the squash season starts again in a few weeks…

8 weeks post-op, I met with my consultant yesterday. He is happy to sign me over into the capable hands of the physiotherapists. I am currently in the ROM boot, set to neutral, and able to weight bear on my damaged leg - obviously only in the boot and only in the neutral position. I am still using two crutches, as much for balance as anything else - i am conscisouly putting more weight through my recovering leg.

The initial rupture was in January and the re-rupture in April. Having spent over three months in non-weight bearing plaster and the rest in partial weight bearing ROM boot, my left leg is pretty wasted. Also have quite a bit of discomfort in my left hip. I think this is partly a legacy of a life of sport, but it’s not being helped at the moment by the cumbersome lurching in the boot. Ah well, once my ATRR is fixed i can start planning my hip replacement!

Now about 10 days out of cast following surgery to repair my re-rupture, i am once again enjoying the relative freedom of the ROM boot. When the medics cut off my cast and fitted my boot, they could not get to neutral so left me with 10 degrees of plantar flexion. However, within 4-5 days i was able to adjust the boot myself to neutral, and on advice from my surgeon he is happy for me to weight bear in neutral. Not sure whether there is a standard boot used in the UK, both times i have had the ROM walker from Townsend:

http://www.townsenddesign.com/Townsend_Design/Walking_Boots.html

I am back with my surgeon on Monday. Ostensibly, this was so that they could adjust me to neutral - slightly superfluous now but will be useful to get a physio referral.

I find i am being very careful second time round. I am wearing the boot to bed, which i didn’t do first time, and i am still using two crutches, although in truth i am taking more and more weight on my leg and less and less on the crutches.

After the initial repair i had conservative / non-surgical treatment, and after the re-rupture i had surgery. I know it’s a really live debate as to which is ‘best’ (i know some believe debate is in the past on this point!) I can say that my foot is a lot less red now, implying much better blood flow, and my achilles feels a lot thicker / more robust to the touch. However, i am well aware this could be wishful thinking / scar tissue / mind over matter! I am looking forward to rehab, but i am doing so with the absolute certainty that this time i must not push too hard!

Met with my surgeon today - yes, the man himself! I was attending his clinic, six weeks post op and in a NWB cast. I attended anticipating that I would have my cast removed, and replaced by another NWB cast for 2 weeks, with my foot coming up towards neutral, with a view to a third NWB cast for a further 2 weeks after that. Then into a boot. At least, that’s what I expected based on my initial post-surgery meeting with the surgeon’s team - as before (see previous posts), however, with multiple medics in the clinic the protocol changes according to who you meet. This time, I was lucky enough to get the top dog - with the following conversations taking place…

My surgeon reviewed the notes - “ah, yes, we’ll replace your cast with another. If we can get to neutral we will see you in four weeks, otherwise we will see you in two weeks for a further cast in neutral”. Ok, thinks I, this is what I expected. So, in all innocence, I ask “And then into a boot?” And that’s where it gets interesting…

“A boot?” Say’s the surgeon “Hmm, you could have a boot today, in fact you could have had a boot 2 weeks ago [4 weeks post-op]. We will put you in a boot today instead of the cast - if we can get you to neutral, we will see you in 4 weeks, if not, we’ll see you in two weeks to get you to neutral”

“That’s great” I say, wondering why he would have suggested NWB casting for another 4 weeks. “PWB?” I ask?

“FWB as and when we get you to neutral” and off I go to have my cast removed and boot fitted!

In the event I ended up with 10 degrees of plantar flexion (I think thats the right term, toes slightly down still) in a ROM boot, with instructions to continue to be NWB until I return in two weeks to be set to neutral.

So, in a sense, I am happy - better a boot than a cast, and I feel confident to add a little PWB into the mix over the next couple of weeks. I am, of course, once again struck by the differences in protocol between medics within a team, and also the somewhat ‘on the fly’ nature of the decision making. Also struck that, once again, the medic did not examine my achilles - he reviewed with me when the cast was on, and despatched me to the plaster room to have the cast removed and the boot fitted. This means that my wound / AT region have not been reviewed by the surgeon or any of his team since the day of the operation. I wonder if this is common practice.