Here we go again?

It’s interesting and coincidental that I’m being asked about my recovery at this time because although the ankle that was operated on is feeling better (finally) I’m now having pain in the other ankle. I’m obviously prone to tendinitis in my Achilles because my left ankle began bothering me right after the surgery on the right.

To bring everyone up to date, my last PT was in November. I determined there was not point continuing since what I was doing with the therapist I could do myself at home and save the $$$. I still have pain the area when I’ve been on my feet for long periods or if I need to drive for extended times. I don’t expect to be fully pain free until I lose some weight.

My left ankle became tender about the same time as the operation and has become increasingly painful. But the discomfort is localized more in my heel and almost at the bottom. On 5/22 after walking around that morning it became so painful I couldn’t even put pressure on it and contemplated going to the emergency room since it was a Saturday. But instead I applied iced and rested. Slowly my ankle felt well enough that I could walk, but just barely.

I couldn’t get in to see the Orthopedic who performed my operation until the end of the next week so I went to the Podiatrist first. He took x-rays which showed a great deal of calcium build-up in the area. Gave me a boot to wear and said to rest and come back in 4 weeks.

A few days later I saw the Orthopedic. He also took x-rays (I didn’t tell him I’d visited the Podiatrist), gave me a cortisone shot – which supposedly should not be given for tendon tendinitis – and told me to add elevation to my insoles and see a Physical Therapist. I didn’t wear the boot to the appointment and he didn’t suggest I wear one.

Two differing treatment opinions.

I’ve been wearing the boot now for 3 weeks and although the area doesn’t feel as tender there is still pain, especially if I’ve been on me feet for extended periods. I’m self-employed and had committed myself to some projects before the injury worsened and couldn’t cancel so I did what I could wearing the boot. Consequently I didn’t rest as much as the Podiatrist would have preferred.

Yesterday I removed the boot and added some extra cushioning to my shoe and began wearing them. So far I don’t feel as much pain but I think it may because I’m resting more. I return to the Podiatrist next week and will inform him of my visit to the Orthopedic and ask why the differing treatments. Until then I’ve declined any work to rest and “clunk” around the house.

Things get real messy

Wow, did things ever get bad. The tenderness I mentioned in my last installment developed into a severe Staph infection. A band-aid I put on the area that night was soaked with fluid the next morning. The ankle area was so swollen and felt like a balloon filled with water. When pressure was applied so much puss and other fluid came out we had to use a towel to absorb it all.

I usually retain water in my legs and feet when I’ve been sitting for long periods of time so it wasn’t all puss that came flowing out. But it was a mess. I had to wrap my ankle in gauze and change the dressing every two hours. Not a pretty sight.

The surgeon was very quiet while he examined the area, and that’s unusual as he’s usually quite chatty. He took a swab sample and set me up with an Infectious Disease Specialist later that week. Also prescribed some heavy duty antibiotics. By the time I saw the specialist the antibiotics had succeeded in diminishing the swelling and fluid considerably. He kept me on the meds and told me to come back in a month.

Today the area appears healed, although I still cover it with a bandage that’s changed daily. I see the surgeon this Monday for a follow-up. I sure he sent me to the specialist as a precaution that the infection hadn’t been caused during surgery. He had mentioned it could be a suture abscess but I’m fairly certain it was caused by my shoe.

Therapy was put on hold during this ordeal, which actually worked to my advantage since the initial swelling from the operation has decreased. The range of motion in my ankle is better now and I’m getting closer to my goal of being able to do stairs without one step at a time.

Infected scar tissue

Well, time to add another installment. Physical Therapy has been going on for about 6 weeks and the progress is good and bad. Good is the movement in the ankle area. When I first began my ankle was stiff and inflexible. Now it can rotate around. Walking is much easier but stairs are still one at a time, especially going down.

But the bad overwhelms the good. One of the exercises is to step on and off a foam cushion, one foot at a time. During one of the sessions I must has twisted my back – it’s a bit difficult to keep your balance –and since then I’ve had extreme pain on the left side of my body from the hip down to the foot. So a back evaluation has been scheduled for this Tuesday. But that won’t happen because something more serious has developed.

I drive a great deal in my work and this past Saturday I went out working. A little less than 100 miles, which is not a large amount for me. But when I got home the incision area on my foot was tender and sore from the shoe rubbing against the scar. Now it’s worse, clearly raw and infected. So back to the surgeon I go tomorrow (hopefully)for treatment. And since it’s my right foot, which receives a great deal of use while pressing on the accelerator pedal, I have to devise some method where the shoe doesn’t constantly rub against the scar.

Began therapy for the next 6 weeks.

I’ve been lax in detailing my further adventures.

The cast came off on 8/7 with the incision still tender and soft. Probably due to the moisture that collected in the cast. My whole foot smelled like old cheese. So I was on antibiotics for a week before therapy began.

Therapy is scheduled for 12 sessions and I’ve completed 3. My ankle area is very stiff and the therapist focuses on loosening up the area by having me perform range of motion exercises along with stretching. I can see and feel the progress as my foot has become easier to move and especially rotate. However I still must maneuver up and down stairs one step at a time and icing my foot is a daily routine in the evening.

One painful aspect is driving. There is considerable discomfort along the outer ridge of my heel, right where it makes contact with the floorboard in front of the gas pedal. The therapist can trigger the pain by pressing on the area but doesn’t know what’s causing the problem. I’m going to try various soft pads on the inside of my shoes (bought 2 new pairs) to determine if that can eliminate the pain. If not I’ll head to a doctor, but I don’t know if I should go to the surgeon or a Podiatrist.

The cast is off. Am I done?

The cast finally came off for good this past Monday. The biggest surprise is that may be the end. I wasn’t given any boot or physical therapy. Just told to use some heel lifts and not immerse my foot in water since the incision is having trouble healing completely. Go back again this Monday.

I don’t have any pain in the tendon area. But when I’m walking I am extremely sore and stiff in both legs. Something I cannot explain. But I can only walk very slowly with small steps and it feels like my legs are going to cramp any second now. This will be the main focus at the next appointment.

I found out some interesting information concerning the connection between Achilles ruptures and the use of antibiotics. Seems there are several antibiotics that have been linked with an increased likelihood of an Achilles rupture. One of those medications is Levaquin.

This past March I had a respiratory infection and took two different antibiotics. And one was Levaquin. I don’t know if there’s a connection, but I’m going to investigate since there appears to be a class action law suit pending.

One month down - at least one more to go.

Well, it’s been a month now and time to reflect. Hopefully people who are about to undergo an Achilles operation will read this blog and find it helpful. Before you have the operation there are a few things you may wish to consider purchasing.

I’ve found a walker is easier to use around the house than crutches, although crutches – which should be given to you before leaving the hospital – will be necessary for maneuvering any stairs/steps. I’m fortunate to already own a wheelchair which I occasionally also use downstairs.

I highly suggest purchasing a stool you can sit on in the shower/bathtub. Balancing while bathing is difficult. Forget the trash bag and tape for covering the cast and buy the plastic cast cover/bandage. Less than $20 and worth it. If you don’t have some grab bars consider purchasing some. Either permanent or suction.

I ordered everything from Amazon before the operation. Came to less than $100. Since I had a $100 deductable for medical equipment I didn’t bother with insurance, which I’ve been told may pay for the items. If you elect to use insurance, the purchases will have to be through a medical equipment supply store and you’ll find the prices considerably higher.

I’m self-employed and my profession requires driving upwards of 100 miles a day. Since the cast is on my right foot and I cannot drive, I elected to stay home and recuperate. Fortunately I have a good internet connection and subscribe to Netflix. With the exception of their cheapest plan you can access hundreds of movies online at the website and watch them on your computer - in addition to mailing back and forth. Without that and Turner Classic Movies I probably would have gone stir crazy by now.

Buy some cheap shoes larger and wider than your regular size. I was surprised to find I could fit my casted foot inside a larger New Balance. Of course I’m not waking on it, but on the occasions you do need to plant your foot it’s considerably more comfortable than just a sock.

They will tell you not to get the cast wet. Even if you don’t, unless it’s changed every two weeks, your foot will begin to smell. To reduce the smell throw some baking soda in the shoe and allow to air out for a few hours. Before you put the shoe on again, stuff some scented dryer sheets inside. The smell will be much more bearable.

I head back this Monday (22nd) for the next follow-up and will add to the blog if anything new occurs

Third week.

I still marvel at the fact there’s never been any pain associated with the operation. But everyone keeps telling me to wait until therapy. The cast applied last week is so much more comfortable but its angled sharper than the one applied at the hospital. So it’s taken me almost a week to accustom myself to the new angle without the top pressing on the front or back of my leg.

I’m getting antsy and want to do some jobs around the house. My wife has been wonderful during this time. She’s retired and even though she’s home all day we haven’t stressed each other out. Yet. For the first time in 20 years she’s been taking the trash to the curb on a regular basis. And bitching the whole time. Thinks she should receive some medal or daily acknowledgement for taking out the trash.

I still can’t get a real good night’s sleep. I keep tossing and turning in the bed. And when I use the chair downstairs it takes awhile to fall asleep. Walking up and down the stairs isn’t a problem, one step at a time. But I’m worrying that my inactivity is decreasing my stamina and little tasks like the stairs and other things will become difficult after the cast is removed. I think I’m spending too much time just sitting.

Taking a shower is still an ordeal. I’ll go into more explicit details at a later date. Let’s just say the Army could move a battalion in the time it takes to bath.

Old cast off - new cast on.

Today (29th) was the first visit with the Orthopedic since the operation two weeks ago. I got to see my ankle when they changed the cast. Ten stitches and two staples held the skin together. It looked nasty but didn’t hurt and there was no swelling. Thankfully I never got an infection, probably because he had me on antibiotics for the past two weeks. Talk about making you fart – jeez.

The doctor did mention again my tendon was a mess when he got inside. He stated there was virtually no tendon attached to the bone and what remained further up was difficult to pull down to fasten to the bone. Because of this I’ll be in a solid cast for at least another 6 weeks. Today’s replacement cast was identical to the one applied at the hospital, angled downward with my toes pointing to the ground. This position enables the tendons better connectivity during healing. If there aren’t any complications the next cast in 3 weeks will be angled a little more even. But I’ll still be walking/hobbling mostly on my toes.

Getting around hasn’t been as difficult as I envisioned. Taking a shower is a different story. Plastic trash bag tucked in at the top and then duct-taped. I ordered one of those elastic sacks that cover casts and will see how that works. Getting in and out of the tub/shower is exhausting. We have a whirlpool tub, which means the rim is wider than a normal tub. Lifting my leg over the rim is a little difficult but I’m getting the hang of it. And since it now appears I’m stuck at home for another 6 weeks, I’m sure I’ll get plenty of practice. Then the therapy will kick in, which I’ve been told can be worse than the surgery. Can’t wait.

Done

Well, the dirty deed was done this past Tuesday. I actually received a call from the doctor’s office the night before asking if my operation could be moved up a few hours. Which actually turned out much better, allowing me longer to recuperate and leave the hospital that night.

Of course the surgeon was behind schedule that morning and the procedure began 90 minutes late. So I got to spend some extra time lounging around the pre-op room. Around noon I was wheeled into the operating room, told I would be feeling a bit drowsy and the next thing I knew I was waking up two hours later with a cast up to my knee. The most amazing aspect was the lack of pain or discomfort. Nothing. I don’t know if this is normal or because I was already taking Vicodin and wearing a Fentyl Patch for other pain issues. Because I have Sleep Apnea, the hospital wanted to observe me for a few hours before allowing me to go home. I was taken to another room to “nap”, then around 6:00 PM Tuesday I was on my way back home.

I never saw the doctor after he greeted me that morning. He did speak to my wife and told her the damage was much more intensive, with several small bone chips in the area he had to remove. The doctor cleaned up the tendons and grafted them together. There were enough tendon pieces available that the doctor didn’t have to place any pins in the bone, just tendon to tendon. The Orthopedic also informed my wife the recuperation time may be longer, now 8-12 weeks in a cast

I was given Percocet and an anti-biotic to take. But even the next day I didn’t need the Percocet. The doctor said it was a “non-weight bearing cast” but only because my foot was positioned so I walked on my toes. This was very uncomfortable until I found an older and larger shoe in the house and stuffed it over my foot. I was surprised at how easily I could now move around. With a shoe on both feet I was able to get in and out of the wheelchair and use the walker without any difficulty. I just needed a good sense of balance. What did hurt was the upper top portion of the cast where it pressed against my shin. I take a diuretic on a regular basis and between being swollen with fluid and the swelling from the operation; my leg was a tight fit in the cast. No matter how I positioned my leg, the upper shin pressed against the cast. No other pain elsewhere.

A call to the doctor resulted in being told to elevate my leg even more and wait for the swelling to decrease. That really never happened so I just took some extra diuretics and that took care of most of the swelling. I have an appointment this Monday but don’t know if I need to keep it now.

So it’s been 4 days now. I use the wheelchair and walker downstairs. I can go up and down the stairs using one crutch for balance and yesterday attempted a shower. It wasn’t easy so I ordered one of those bags that wrap around the leg to keep it dry.

So now comes the boredom.

The doctor and date have been selected.

I had an appointment yesterday (8th) with the Orthopedic who injected me. We are set for next Tuesday (16th). One of the concerns about this entire endeavor was the inability of my wife to drive me to appointments and other necessary visits. Fortunately this doctor has an office nearby and he elected to perform the procedure in a hospital around the corner from me instead of his own operating room in another office location further away. Some of the reasons for the use of the hospital involve the irregular heartbeat I have and the availability of some cadaver tendon in case it’s needed. The doctor said my tendon probably didn’t completely sever from the bone but did tear low to the bone.

The ortho explained the differences between casting now – which he said would remain on for up to 12 weeks – and the surgery, with a cast for 6-8 weeks. You can guess which choice I selected. So next Tuesday I’ll head over to the hospital at 1:00 PM and hopefully be home later that day. But until then there’s a lot of stuff to do.

Today I go back to my doctor for another EKG and blood tests. I still have a few days of work I must finish before next week and then there’s the massive amount of work around the house to get it more accessible. Purchased a new sofa last Saturday, so that needs to be delivered and the old one moved. (Going to try to tip the deliverymen to move the old one upstairs). Also need to order from Amazon a bunch of stuff to make life easier while in the cast. And since my wife doesn’t drive I need to stock up on food – Costco and BJ’s watch out, here we come.