dcoughlan’s AchillesBlog

The healing continues. Recovery has been pretty much the same, spending most of my time reclined with my leg at various stages of elevation. I try to get a little physical activity in each day in the form of 10 to 15 minutes of upper body work with a resistance band and some light core on a balance ball.

A few small updates: ice/contrast baths, Vacocast, PWB/Rom, physiotherapy, tendon regeneration research, and general feelings and sensations.

Ice/Contrast Baths: Started doing these a few days ago and I’ve found my leg never feels better  than it does for a few minutes after I take it out of the bath, which is a great mental boost if nothing else, so I’ve kept it up. What I’m doing: filling a large bucket with water (tall paint /5 gallon buckets tend to work well for this) and a substantial amount of ice, so that the water line is roughly around the mid calf. I then sit on a stool with both hands locked under the hamstring on the injured leg for support/to make sure the leg stays suspended, and I submerge the leg, careful not to touch the bottom or sides of the bucket. Then I count to around 500. When finished, I lift the leg out and run shower-hot water up and down the leg for about 1 minute, just to get general sensation back. Then it’s off to elevate and enjoy the feeling of “wholeness” my leg seems to get after these baths.

Warning: some people find their first few ice baths quite painful for the first 2 minutes or so before their body numbs, so don’t be worried if you try it and it hurts at first.

Vacocast: My Vacocast arrived last week and I delayed putting it on until yesterday as I was adhering to a solid “2 weeks in the same position” (in my case, 22.5º fixed on my clinic-issued ROM walker) as seems to be the trend for most of the modern protocols. Initially I felt all sorts of weird bulges / pressure points with the Vacocast liner, so I took the boot off and put the Vacocast on my good leg to work out the lumps. Left it on the good leg for a few hours in an effort to break it in, and then put it on the injured leg again. Found the liner much more comfortable.

Overall: Would absolutely purchase again as the pros significantly outweigh the cons.

Pros: Enhanced rigidity and security brings me a lot of mental comfort as I feel more comfortable moving the leg around. The Achilles Rocker wedge feels much more natural / conducive to walking than the one in my old boot (and it’s removable!). Washable liner.

Cons: Heavier (not by much, but enough to notice.) Hotter (I had exposed toes in my last boot, which probably dropped the temp a fair bit). Slightly more pressure in the toe box, but still enough where I can wriggle my toes, which I do fairly often. Takes more time to get in and out of the boot (and some initial instruction manual reading or online tutorial watching if you don’t have a doctor to fit you.) Higher profile means you’re really going to want to take some kind of measures to approximate heel heights on your good/bad legs.

PWB/ROM: Tried taking a few PWB steps last night but my calf was not really having it (pain in the upper-middle region), so I settled for a few seconds of balancing it on the floor, heel down, and putting some slight weight into it. Felt my calf shake a little bit under the strain (2 weeks and all the muscle is truly gone!) Figured that was enough for day 1 and headed back to elevate. Made another attempt this morning and was able to approximate a walk up and down the hall with very little pain, and some tightness in the calf that I generally associate with healing, so I was okay with it. Tough to say how much weight I was really putting on the leg but it wasn’t much. Most of all, felt great to be doing something with the leg. Going to continue to take it real slow for now.

On the ROM front, I actually have more than I expected. I’ve been doing some reallllly light exercises before my ice baths. I’m pleasantly surprised with how much mobility I already feel, and am contenting myself with that, not pushing it, and waiting to see what the PT recommends on that front.

Physical Therapy: Shopped around for PTs last week and decided to go with my local clinic. My first PT appointment is Wednesday (tomorrow) and we’ll see what I’m in for. I know the clinic uses an aggressive/functional rehab protocol on their surgical repair patients, so my hope is to go in there and convince them to treat me identically to a surgical patient. I think they’ll go along with it — getting the okay from my OS, who is quite respected, should help. (I won’t mention the part about his extreme skepticism.) If they somehow refuse, I spoke to a second PT last week who was more than willing to entertain the idea of trying something new (despite being totally floored when she heard I was going non-op.) Don’t want to publicly share names until all is said and done, but for any Bay Area / Peninsula folks reading this a few months from now who want information, feel free to get in touch and I’m happy to talk about my experiences in detail.

Tendon Regeneration: I’ve been looking into the actual science behind tendon research in an effort to better understand the various approaches of the different therapies. e.g. why some start the weight bearing (or “loading”) process earlier than others. From my research I think the general scientific understanding is (and this has mostly been achieved through experimenting on animals, less on humans) that loading the tendon does something to enhance the ordering/alignment of reconnecting fibers in a way that is superior to what happens if they’re simply left alone, without loading (e.g. immobilization.)

When and why this happens is still an open question. Some science points to the fiber-ordering starting around week 4 post injury/op (weeks 0-4 being generally spent with initial healing and collagen generation), which may explain why Wallace’s patients had success with the NWB -> FWB transition after 4 weeks (the loading started at roughly the time of ordering). At the same time, there is no evidence suggesting that weight bearing before the fiber ordering commences is unsafe in any way. I found one recent Scandinavian study where they tried immediate weight bearing on non-surgical patients, with no negative effects. For those interested, this article provides a great, balanced overview of op vs. non-op thinking and protocols: http://www.danmedj.dk/portal/pls/portal/!PORTAL.wwpob_page.show?_docname=10547073.PDF

With the above in mind, I would love to see a combination of of Wallace’s technique of physically manipulating the ends combined with immediate weight bearing in an attempt to get a “best of both worlds” protocol. (Assuming neither has a negative influence on the other, which hasn’t been studied.)  Also, to whatever extent homeopathic / Eastern medicine treatments can influence initial collagen formation and subsequent ordering, those would be beneficial to implement as well.

General sensations: I get the odd pain and tingle every now and then. Some of this is to be expected as I had achilles problems prior / a bump (which is now reducing, similar to what Roark mentioned in his comments, which is interesting). They don’t last for more than a few seconds at a time, but still makes me a bit nervous when they happen. Looking forward to getting an image at 6 weeks to confirm that things are healing as they should be so I can really put my mind to rest about pre-injury implications.

Happy Healing!