DavidUK’s AchillesBlog

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!