Wanted to wait for my second PT session before posting. Good news is that things appear to be on the right track, despite a little bit of a scare yesterday.
My progression to this point (non-op)
Days 0-13, NWB @ 20º Vacocast
Days 13-26, NWB -> PWB — slow and cautious transition.
Days 26-31 PWB-> FWB. I was careful to slowly build the amount of time I spent FWB — couple steps the first day, 15 minutes the second, hour the third, etc. No significant pain at any stage. Maybe a tinge here and there but those don’t really register anymore.
Day 30: introduced stationary bike with boot (5 mins first day, 10 the second). No resistance on bike, and no pain.
Day 30 (night, before bed): Set Vacocast to 20-15º hinged. Felt a stretch in the achilles, but would describe it as pleasant more than anything. Went to sleep and felt no stretching sensation in the morning when I woke up.
No real ROM exercises to this point (I had started some feeble ones around week 2, but then decided that I didn’t feel ready for it and wanted to wait for PT instruction.) Started daily hip/glute/upper body/core work.
Day 31: Big scare. Was seated at a table and adjusting my leg in the process of either standing up or sitting down (the fear instantly wiped that detail from my brain) when I felt a very soft click/snap in my heel, below the rupture site (and below the achilles insertion point.) I was moving carefully and the force was about 1/50th compared to the impact that caused the injury, but I suddenly found myself with several new degrees of ROM in my heel that hadn’t been there seconds ago. In a way the leg felt great, as if something I didn’t realize had been holding it back suddenly unlocked, but at the same time my brain began screaming “RE-RUPTURE” and I began to feel blood rushing into the heel and I experienced a terrible pit in my stomach. I felt no pain in the actual achilles but my brain didn’t care and I was convinced that the leg was developing the disconnected feeling that accompanied the original rupture.
Took FWB steps to grab my crutches from across the room and felt no pain, but a little “loose” in the boot. Made it to my bed and felt the achilles - it seemed intact but there was no convincing my brain. I propped the leg up, reset the Vacocast up to 30º and mentally prepared to start the first 4 weeks over again while I browsed achillesblog for rerupture information. Fortunately I came across two users (eva and ryanb) who had experienced a similar sensation to mine and it was just scar tissue. I remembered that I had felt tingling in the same region (bottom/outside of heel) during the recovery phase, and also during ultrasound treatment for tendonitis years ago. Finally started to relax a bit but still had some rushing blood / pain sensations and every new feeling made my stomach turn. Managed to calm down and went to bed cautiously optimistic.
Day 32: Went in for my second PT appointment, told her what happened and she said it sounded like some scar tissue detaching to her too. No swelling, no pain anywhere when squeezing, and signs of life after a Thompson test was performed. Phew. Achilles looks and feels noticeably stronger than it did at Day 16. Some defect is still visible but it’s filling in. Note: I think most of this progress has happened in the last week because I remember being massively discouraged when I looked around Day 25 — the achilles had little body or shape to it at that point and I started to wonder if I was properly attaching.
We started to talk about the protocol going forward and my PT was under the impression I had NWB instructions from the OS. He actually hadn’t really said anything except “go forth” when I said I’d like to try a functional rehab, and mentioned that I’d be transitioning to shoes around week 8. I revealed that I had been walking around for about a week in accordance with the UWO / Exeter hybrid protocol I’ve been following. She was a little hesitant but then had me walk around the facility for a bit so she could watch. I didn’t have my evenup (arrives tomorrow, been using a hiking boot in the interim but there’s still 1/2″ inch difference) and at 30º my gait was pretty awkward. She gave me some pointers and then I have another appointment Monday where I’ll bring the evenup/protocols/I’m in the process of incrementally taking the boot back to my pre-panic 20º and we’ll figure it out from there. In the interim added one small resistance exercise to my daily PT (only in one direction as the other one produced a little bit of pain).
Will spend this weekend transitioning back from 30-20 (set it to 25 when I got home, will go to 20 tomorrow night provided no complications) and PWB -> FWB. Annoyed at myself for cranking back to 30º for effectively nothing and hoping the angle yo-yoing doesn’t have any negative impact, but what can you do!
Hope everyone else is doing well,
2 responses so far ↓
normofthenorth // May 31st 2014 at 2:33 am
I wouldn’t expect your brief angle backtrack to cause harm. RyanB was definitely surgical, and I’m guessing Eva was too (though I don’t recall). These “stuck” scar tissue problems are more common post-op than non-op — because multi layers have all been sliced so they have a chance to heal TO each other, and not just NEXT TO each other. . . But they do sometimes happen non-op, too (apparently!).
dcoughlan // May 31st 2014 at 6:57 pm
Yeah, I’m actually wondering if it was the result of something pre-existing that was triggered by / interacted with the rupture. I dealt with a host of achilles issues from roughly 2003 - 2011, so there are all sorts of things that could be going on in there, but that portion of the heel now feels better than it has in years! No complaints here.
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