Upped my time on the elliptical today to 30 mins. Definitely good for my morale to think that I can at least start to build aerobic capacity again. And overall I think it must help with swelling too. I added a link today to my blog for ‘venous circulation.’ Very good medical presentation of how much we count on muscles as pumps, how important the valves are, and why the lower leg is special.
Added two pictures to my ‘following the foot’ page. You can see dramatic lessening of swelling in my affected foot in just several days.
And I cannot resist adding a picture here of my cat playing with my recycled karate belt. I hang it off the ceiling fan going at low speed. Great toy for her and almost no energy from me. It’s a laugh.

Spending a lot more time up and about in the last day or so. With boot on and not using crutches except for long trips across parking lots. Also spent an hour sitting today in normal position as I met a friend for coffee out. That was a little uncomfortable and underscores that I will have to have a good arrangement at work when I go back in another week.
But during this next week I’m determined to stick with a schedule of stretching, ankle ROM, core exercise, and weights for upper body strength. I continued to experiment with the elliptical trainer today. As with any prolonged standing in the boot, the first thing that bothered me was the bottom of my heel. It seems to be the big pressure point in the boot. Still, I completed 15 mins at the lowest possible incline. High incline seemed to aggravate things by asking for a lot more range of motion of the affected ankle.
So, totalling things up for the day it’s like this: 2-3 hours of standing in the boot for various things. 1 hour of sitting in boot without having my foot up. Maybe an hour of driving with the boot. And the rest of the day in a chair or in bed with foot elevated. I did ice things after exercise today.
The good news, tonight I did a little more ROM and I pulled off the ace bandage. I swear the swelling is less than it was yesterday. I’m encouraged.

Ah, now this is fun. Finally took a picture of the ankle and posted it here. I’m not too bothered by the looks of it. Still covered in steri-strip so hard to tell. Look at it on my photos/following the foot page.
I pulled some of the PT exercise diagrams off this site last night. Some are out of sight yet, but others are helpful. Doing my own little AROM set of things several times a day. Leaving the boot off at night is helpful for overall comfort. The twitches causing pain wake me once in awhile, but it’s a small price to pay for not carrying that boot under blankets. I’m also taking it off several times a day and elevating/relaxing. Couple of times a day I ice the heel area.
Managed a full shower today. That was interesting. I had no plastic bench or any suitable furniture for setting up in my bathtub/shower unit. Looked around and improvised with a smaller exercise ball that I no longer use for core workouts. Turned out to be stable enough to sit upon for half the time and the other half I just stood on my knees. Way to squeamish about the unsupported surgical side to even dream about a balancing-on-one-leg shower.
Trying to keep to a regimen of exercise while I’m still off of work. Stretching, core, weights, ROM. Discovered today that with the boot on I may be able to workout aerobically by using my elliptical machine. Going to experiment with a big winter boot on the unaffected side to be at least a little balanced across the two legs. Otherwise, I think that pushing the elliptical with the boot on one side is just asking for problems. I’ll post again tomorrow after I try it for a serious length of time.

Saw my surgeon today. Dressings off and wound looked nicely healed. Steri strip stays in place. Swelling not too bad. Full showering/bathing now allowed. Have to try and post picture later. Supposed to be NWB but I have already cheated on that for last couple of days. WB in boot is not bad at all right now. May have first visit with PT in one week. Meantime starting my own ROM exercises and continuing with routine exercises for the rest of me.
I have read quite a bit of blogging up here about conservative vs. agressive tx and rehab. I am lucky I think in that my surgeon is a big name among our University athletic teams. He sees a lot of young people. Today his staff that attended me after stitches were suprised at how old I was. So, it’s no surprise to me that he is giving me a wink as he says ‘NWB till you see PT.’ He could look at the sole of my boot and tell that’s not happening.

Meantime, I want to tell you all that if you are determined, and have some core strength, and don’t mind adapting your positions, you can do a lot of exercise WITH THE BOOT ON. I just finished a dumbell workout after my normal stretching and core routines. Yes, the boot is an encumbrance, but hey, that heavily weighted side is getting more of a workout and I don’t mind. I do think that standing with knee bent and most of your weight on the unaffected leg is probably not good for the health of either leg. But at least the boot lets you stand some and I have done a few exercises now from standing position, or using both legs in support of some other posture.

Okay, I’m five days post-op and feeling like an old pro. I’ve read many of my fellow bloggers here and followed links to lots of articles, other blogs, etc. Last night I had my first difficult to sleep night since the day of surgery. I could not find a comfortable position to be in. I read, watched a great documentary on Hulu, and then decided to take the boot off. Went to sleep pretty promptly and awoke only once in some pain from a possible twitching of my leg. Slept like that for about 4 hours then got up to start the day immediately putting the boot back on.
I did have a pretty big day yesterday. Was my third day of doing stretching and core routines, plus a little more time standing, a slight amount of weight bearing on the boot, some AROM on my own, and a little massage, mostly of contralateral leg. I have my first post-op visit tomorrow and will probably not admit how much I’m trying to do.
Today I’m going to write down a daily routine to help keep me sane. I do work remotely but I want to limit that more and focus on my recovery. Set times for certain things, and a dedicated time for recovery is what I’m planning.
Today I will do an experimental drive to the library. Very short, wearing backpack, and on crutches of course. Need to know how this will work since I have to drive myself to two appts tomorrow and drop/pick my son up for a meeting this evening.

Ah, the boot, the boot. I grow tired of the boot. I’ve taken it off a little at a time, trying to ice, or just be more comfortable. But the truth is I know how important it is right now to keep any accidental flexion at bay. The pain tells me that, and my surgeon told me that.
Last night though I tried a little experiment. I took the boot off a few minutes before calling it a night. Used same comforatable arrangement of pillows, and started drifting off. Does anyone else have their legs twitch a little during sleep? I do, and gosh darn it triggers an acute plantar flexion each time. Ouch! So, end of experiment, boot back on after several ‘almost asleep’ twitches that jarred me awake.
What was interesting though is that in the middle of the night I had this dream/nightmare where I was walking down some stairs and my affected foot (no boot, not even sure I was conscious of any past injury) slipped and pounded down to the next stair. At that moment, my ankle in the boot flexed so hard that it woke me up in pain anway. Wow, so much for knowing that your body is completely relaxed during sleep.

Okay, no longer dealing with the immediate challenges of being post-op. Pain is pretty well subsided, manageable with small doses of Ibuprofen. Other bodily functions all on the mend. About the only ADL that is hard is getting food since my bedroom is upstairs from main living area and kitchen. Might be a good thing if I want to keep from ballooning out. LOL
Did a little stretching this morning and then spent a few more minutes gravity dependent. Paying for it now with a slightly increased level of pain. Planning to get into some kind of routine here soon.
I’m dutifully reading the article off the rehab links about tendons and ligaments. Now all the cautions from my surgical team make sense. Wow, the healing process is a big deal. This should be required reading for all of us ATR sufferers.

Hard to believe I’ve been home two days. Seems like a short time ago waking up in recovery and then trundling off to my room before release from outpatient surgery.
Tonight I have reason to contemplate my pain. I am bootless and attempting cooling with an ice pack. Hardly penetrates the bandaging but I’m convincing myself it’s therapeutic. I arose only briefly and felt blood building up in the ankle and the pressure elicited pain. After two minutes I’m back to sitting in bed with leg elevated. The pain is more acute secondary to the discontinuing of Percocet. But I read over some notes on Zen of pain (see link) and I focus on it for several minutes. I think to myself that this pain is about the trauma of surgery, yes, but it is also good to visualize the tendon pulled back into place and connected. So, this represents healing pain, which gives it a different character than the pain of the injury itself. It may feel the same, but I imagine that as I focus on it there is an active process of fibers knitting around sutures. And I feel compassion toward the afflicted area that is trying so hard to heal after the trauma of injury, and then knife.
It is a hard enough job and so I tell my body that my mind supports it. That I believe in what it is doing to reconstruct the damaged area. And that I can deal with a little pain if that is the cost of the work it is doing. I want to allow that healing process full, unburdened access to every resource it needs. My mind takes on some of the responsibility of healing. We are partners in an amazing journey of renewal.

Couple of daft things to chronicle here. Been 6 hrs since my last Percocet and think I may be able to go off it now. Been buttressing with Ibuprofen in hopes that the changeover will go smoothly. Spent much more time with affected foot gravity dependent today. Sponge bathing, washing hair, shaving, trip downstairs to kitchen, etc. I did a brief stretching routine in the morning and just finished an abbreviated core routine using exercise ball. A little tough with the boot on but mostly feasible. Feel like I should have one on my other leg sometimes just to balance out.

My favorite snack during this recovery period has been frozen and fresh fruit. The frozen fruit was perfect for the rough throat after intubation. Favorite recovery music going right now is Bach. Makes me believe that when this is all over I will be lighter on my feet than ever.

Pain management is easier now. When I posted yesterday morning I thought the block had worn off, but by mid-day I realized it was fully gone and the pain increased. I continued to manage with a combination of Percocet and Ibuprofen, with the aim being to limit the Percocet asap. If you keep track of your pain levels, time with foot in dependent position, pain medications taken and relative relief, you can begin to find your pattern. I found yesterday that even brief times (10-20 mins) with my affected foot in gravity dependent position would cause quite an uptick in pain.

I want to comment on the conservative vs surgical debate I see playing out here on the blogs. I had a classic injury: the big pop, the falling to my butt, looking behind me to see who had just hammered my achilles tendon. And it presented clinically with a positive Thompson test, and a big gap between the end of the tendon which was balled up about 1 to 1.5 inches below the bottom of calf muscle (I felt this myself). I don’t know if any strands of tendon were still connected but it seemed dramatically, completely ruptured to me.

I reviewed a lot of literature via the Internet in my first couple days after injury. I was hoping that I could find a lot of good evidence that conservative mode might work for me. It was not that I was afraid of the surgery and its complications, I was primarily focused on how quickly I could return to activity (not work, but life!). When I went into the orthopedic consult the day before surgery I already knew that they had fast-tracked me for surgery based on my visit to the ER the night of the injury. I had plenty of questions and the intake RN and PA both allowed me plenty of time to discuss things. By the time the surgeon came to see me I was pretty well convinced but still we talked about both measures. In the end it came down to this. My rupture was severe, maybe complete. I would be able to return to activity faster and have a stronger repair if I was treated surgically.

While there are many factors at work in each individual case, there is also a lot of conflicting evidence presented both as medical research and anecdotal information. Diagnosis of the injury is easily made by physical exam and most practitioners don’t place much stock in diagnostic imaging such as MRI or ultrasound. So, you have to have faith in your practitioner when they evaluate the extent of injury. Presenting an accurate and detailed history of the injury is important. Knowing what your goals for post-injury rehab and recovery are important too. Your lifestyle, your age, and even your mental/emotional makeup will contribute to your decision.