I am remiss for not posting more since my last tongue in cheek self-appraisal. But I’ve been busy.
Let me start by saying that everything I’ve been doing is paying off. The exercises, the ROM, the massage, the visits to PT, advice from a friend who is an athletic trainer, all of it has worked together to get me to this point.
I saw my surgeon and his PA yesterday morning at the clinic. I walked in with two shoes. When he came in he said ‘I’m not seeing your boot.’ I told him it was in the car but I wanted to show him I’m ready for two shoes. I confessed that my PT had just seen me three days earlier and had me doing some walking and stability exercises in just shoes and that his opinion was I was not ready yet. But over the weekend I had done more flexibility work, pool exercises for stability, and walking indoors (track) with poles. I was focusing on a normal gait and heel-toe motion while walking with poles. (They are a huge help!)
He went ahead and felt the tendon, observed ROM carefully, looked for swelling, and asked me how various things felt. His assessment is that it’s looking wonderful for 4 weeks out and he cautioned me that if I was to spend more time in two shoes to just be sure I don’t take any chances. I explained how I was approaching stairs and assured him that any walking out of doors with uneven surfaces I’m going to try and use the poles as much as possible for the next several weeks. He said that he believed in treating this aggressively and referred me to the clinic protocol so I’d notice I’m several weeks ahead. Then he said keep up the good work and make an appt to see me in 4 more weeks.
Whew. What a relief. Felt empowered to take more resposibility for my own recovery. With any luck by the next appt I’ll be doing a whole lot more and that my tendon will even appear a little more normal.
I feel that I’ve done a pretty good job of documenting here what my personal experience has been. In the next couple of weeks I will post more pictures and summarize things with a focus on what worked well for me.
This site has been a huge help in managing the injury, pre and post op. Thanks again Dennis for allowing this community to form.
Just for fun (poking at myself), my list of ‘how you know when you are overconfident in your newly repaired tendon’
So, I’m up in the middle of the night and take the very short stroll to the bathroom. Turn to leave and walk smack into the cat as I approach the doorway. And of course the foot that is forward that I prepare to brace myself against is the bad one. Good reflexes lead me away from pain in my tendon to go straight down to my knees. What a save. And all I was doing was shuffling the foot forward. Not like I had really picked it up or anything. (It’s totally dark or I may have tried to stay standing) Shook me up but no harm done. After I was done gasping I put the cat out of my bedroom for the rest of the night.
Now why would I even be thinking of walking in two shoes this early? The answer is that everything feels strong and stable. Oh sure the tendon is still stiff and I cannot get much more than 10 degrees of dorsiflexion, but walking on flat surfaces with shoes is getting easier. (hope my PT does not read this :-0 ) Stairs, inclines and little bumps are still precarious. I’m practicing with my running shoes indoors trying to get to a facsimile of heel-toe movement on the bad foot. I think I’ll be able to do a pretty convincing job at my next PT appt.
3 weeks post-op now and consistently making gains. Met with my physical therapist on 17th for second appt. Discussed more of what I’m doing at home and relative levels of pain with ROM and after strenuous exercise, ie. 45 mins on the elliptical. I showed him the jury-rigged heel wedge/insole I glued into the bottom of my boot. He was happy with that and said I probably created something more functional than the standard wedge he might have added. When I told him the modification had not helped alleviate pain with weight bearing and exercise he was not suprised. We talked about an alternative to the elliptical and I began using the UBE (upper body ergometer) yesterday. I find it is quite a workout and struggled to put in 40 mins. Will try more today and see how tired I am. (note: I did 30 mins of elliptical with no pain. Then topped off with 40 mins of UBE circuits 20/10/10 punctuated by dips/lat pulldowns/pullups. UBE is demanding. I like it!)
Then he worked on my tendon and pointed out to me what area I should focus on and the exact location of the repair. We finished up by talking about my next appt. I may be doing some walking in the pool. He also plans to talk to the surgeon about letting me start going two-shoes after seeing me next week. When I left I had permission to do more walking without crutches, so that evening I walked (with boot, no crutches) about a mile pausing once for a sitdown break. Pain in the heel by the end of the walk was quite pronounced.
The next day (yesterday) I saw my neighbor for massage. She worked the tendon and calf area more than any previous appt. And she discovered a knotty little sore spot of the tendon very close to the calcaneus. It grew more painful during massage and I asked her to avoid it for awhile. For two days now I have not done any direct massage myself but will resume today and see how things feel. This morning I was more tender/tight/sore than usual. I’m beginning to think the mornings will always be a good indicator of overall recovery of the tendon.
In preparation for walking two shoes I plan to pick up a pair of Exerstrider poles (walkingpoles.com). It’s a local cottage industry here in Madison and they come highly recommended from a friend. I plan to use them for stability while the ankle is still weak, but also will continue to use them for walking for their many benefits.
Wow, 4 days since I posted anything. I feel like an old pro at this now. Crutches, no crutches, boot, no boot, shoes sometimes, ROM, and on and on.
So, I’m back at work and mostly surviving the hours without foot elevation. I went crutching off to our cafeteria for the first time today and realized that my darn cargo pants were extremely functional. Stuffing food and drink into pockets so I could crutch ‘with attitude’ back to my desk.
I feel that my swelling is under control now. Still icing after exercise, especially when I do a long session on the elliptical. Looking at trying warm foot baths to alternate with cold. I continue to do my own limited massage of the area twice daily. (new picture posted today)
Return to PT tomorrow morning for my second appt. May get hooked up with a practitioner of Active Release Therapy soon. You can find info about that at activerelease.com
On a good day, when I have been sitting at work for 4 hours, exercised for 2+ hours including 45 mins of elliptical trainer, walked around a bit in shoes, massaged, iced, etc. I can actually say that my AT area feels strong and not that painful. It is in the morning that I realize how much further I need to progress.
Keeping up with things but tomorrow returning to work. Wondering how much swelling will be a problem and if I will be comfortable for a full eight hours at my desk.
I have found that pain in the heel directly correlates to time on the elliptical. The boot is hard to do a lot of activity in. So I made a minor modification to my boot today. I have the Bledso and it’s at neutral. I pulled out a ’superfeet’ insole and about .5 inch heel wedge and contact cemented it to my Bledsoe insole. I’ve not been given any wedges or instructions to use them from PT, but this did help with alleviating pain with activity in the boot. Elliptical more comfortable and I am going to try a longer ‘crutch walk’ later today. (will try and post a picture later today)
Also got a little adventurous and tried mounting a bike on my indoor trainer. It’s not the clamp type, just rollers you have to balance on. First I have to switch mounting technique because I’m used to planting my bad foot first before putting my right leg over the bike. That was awkward. I practiced using my clipped-in pedal on my bad foot to be sure I had the strength to unclip. Felt fine to do that. Then I mounted and put both feet into the clips and started to pedal. Did I mention this is a single speed? Just too hard right now to counter the initial resistance to pedaling with my bad foot. But I had to try.
I’m a little more adventurous in my modified running shoes. Walking around house, up and down stairs, etc. (uh, limping/shuffling, not really walking)
Smish responded to my last note commenting about the usefulness of massage. I’m doing it now at least 3 times a day after ROM exercise. Only been at it for a couple of days but swear I feel a difference in the swelling around the tendon already.
I admit my first PT appt yesterday subdued my spirits just a little. Today I decided to cut back on exercise and give myself a little recovery time. Left out elliptical and weights but focused more on ROM. Spent more time in running shoes and even did a couple of very short crutch walks outdoors in them. Tried to stay out of boot except for this evening when I went out with a friend. I did walk without the crutches into the restaurant and sat there for 4 hrs without feeling any pain or problems with swelling.
Another uplifting moment today came when I decided to try stretching and core exercises without wearing the boot. I wore my specially prepared running shoes of course. While I had to be a bit more careful about foot placement, it went very well overall. I usually do these exercises barefoot but I don’t have the confidence to do that yet. It felt great though not doing various leg lift type things without having the weight of the boot on just one leg.
Finally, after reading almost all of the book “Tendon and Ligament Healing”, I’m convinced that the majority of us ATR sufferers would really benefit by massage and other techniques Bill Weintraub (the author) writes about. I started doing a little massage directly to the surgery site myself today. I plan to make it part of my daily routine.
Here is the play by play as I saw it:
My physical therapist is stern, serious. But I know him well from several years ago and I believe I earned his respect then due to my fast recovery from hip surgery. Still, today he is looking at me in a different way. Kind of suspiciously, as I get up, walk over to grab my crutches, and then follow him in to his table. (I did talk to him before surgery and he told me flat out, ‘don’t expect this recovery to be as fast as your hip.’)
First thing he says is ‘So, Dr. X told you it was okay to be weight bearing on the affected foot.’ I grin and say, ‘well, not really.’ And he says, ‘How long have you been putting weight on that foot?’ and I reply, ‘Oh, the day he took the stitches out last week.’ Then he notices I’ve taken the Bledsoe boot and already changed the angle (designed to protect the tendon repair) from the post-op setting of 20 degrees to 0, or neutral. Now he looks worried. I’m still grinning.
He begins to do some hands on stuff and comments right away how good things look. In fact he has never seen anyone just 2 weeks postop that looks this good (see my foot pics from this morning). He has me push in different directions, checks my range of motion. He asks me what I’m doing and I tell him almost everything, including my little walk with my son yesterday afternoon. Then he says he wants to call Dr. X and talk to him about my care plan. Actually, he runs upstairs to the clinic and talks to him in person. (Now I’m worried, thinking he will come back and tell me they will put me in a cast just to slow me down. :-O )
When he returns he is still very serious. He pulls out the recovery document they gave me after surgery and says, ‘did you read this.’ I say ‘yes, but only day after surgery and then I promptly forgot it.’ He says, ‘you know, according to criteria here, you are already doing things we don’t expect you to be doing until the 8 week mark.’ Then we have a nice discussion about me knowing my body well and being conscientous enough to not cause additional damage. Bottom line, I am okay to keep doing what I’m doing, but don’t try to move any faster. I can keep the boot at the neutral position but I am not to be weight bearing without it. And he tells me that while Dr. X is very confident in the repair (sutured spot), he also observed that the overall look of the tendon is not that healthy. So, please be careful.
Finally, he leads me over to the treadmill-like leg pressure, footstrike measuring machine. I get on it, remove crutches and he instructs me to adjust my weight bearing until it feels like I would if I were standing casually in the kitchen. I do and then flips on the display. Oops! I have a little more than 50% of my weight on the bad foot. So, I modify until the display shows only 30% on my bad foot and he tells me this is the feeling I should strive for. No more.
We make appts for once a week over next 6 weeks. Talk a little bit about returning to work. I ask about massage and the shoes I’ve prepared as my best bet for when I get to ‘two shoes’ phase. He approves on both counts. All is well. He tells me I stole his thunder because I’m already doing everything he would advise me to and then some. But at least now he is smiling.
Had a good day yesterday. Continue to tolerate exercise and ROM very well. I received the book, “Tendon and Ligament Healing” by Bill Weintraub yesterday and plan to read most of it today. The chapter that Dennis has provided a link to (and I found so interesting that I put the link on my page here) is the basis for his case studies and practical manual therapies. I will post more on this later.
As for options, well, the more I read of the conservative method that restricts your options by casting, the more grateful I am that my orthopedic team (from the ER to the OR) has had me in the Bledsoe boot. I am experimenting today with dropping the angle to 0 degrees. And last night I rigged up some running shoes with heel wedges to take a few tentative steps with. Will post more on this tonight too.
… Back again
Going to 0 (or 90 depending on how you look at it) was partially successful today. I found it more fatiguing and somewhat painful. The pain is all focused under the heel, right at the back (I also noticed at this angle that the boot has a new pressure spot right at the top of my incision). My guess is that the extra strain on the tendon in this new position is causing it. Today I spent about half my day in the boot. Was out at an office working for a couple of hours, walked a bit in short spurts, stood around, and even did my longest outdoor walk (on crutches PWB) because it was over 50(f) and sunny. After my walk I did a shorter session on the elliptical (20 mins) and did my usual stretch/core/weights sessions. After all that I iced the heel for a good 45′. Put the boot back on and drove for about 45 mins doing a couple of errands. No notable pain. Now I’m resting with foot elevated. Things feel pretty good tonight considering. I’ll be doing some ROM and another practice session with wedgie running shoes.
I’ve not worn the boot to bed now for a few nights and I’m going to make a point from now on of ONLY wearing it when I plan to be weight bearing. With all this activity and gravity dependence, I think I’ve triggered a tiny bit more swelling. So last night I began to use a compression stocking (TED) when I am going to sleep. It feels supportive and I believe the venous circulation is better overnight. My answer to no longer raising my leg on a pillow while sleeping. Will have to put up a picture of the foot tomorow when I first wake up to show how little swelling there is.
Decided last night as I was doing ROM exercises that the time was right for adjusting the boot. I have a Bledsoe which is fairly easy to adjust. I dialed it back 10 degrees. Feels about right. I’m looking forward to a few minutes on the elliptical this morning to test it out. So far so good. I was getting too much knee pain and it just seemed to me that the ankle was ready to flex more.
Well, it worked out fine. Spent the whole day using the boot at the new angle. Did 3×15 minute sessions on the elliptical. A little easier with the new angle. I am more aware each day how much I depend on the boot for support and protection. As I exercise, stretch, etc. I think to myself, ‘what would it be like to be in this position without the boot?’ Some things would be intolerable, others would be risky if I misstepped while moving from one thing to another.
On the other hand, the boot itself causes some pain as I try to gain mobility and do more things. It seems to have its hotspots, pressure points. I think I will try leaving it off more, only use it when I’m going to be active and know I will put weight on the foot.
Had my second brief massage today after exercise. I’m lucky that I have a neighbor who is a massage therapist and willing to work with me every several days, time permitting. Because it is still very early she does not directly massage the affected ankle, just the foot below and calf/thigh above. (commented on the flabbines of the calf on the ATR side) I ask her to really work on the contralateral tendon in the hope of stirring up some reflected healing to the affected side. I’m waiting to see PT to get a greenlight on massage directly to the recovering AT.