A quick hello to old-timers and new recruits alike from the “other side” of recovery!

One year ago I was 3 weeks post-op and just moving to FWB in my boot.

Today it’s 13 months  exactly since my ATR rupture and I have just returned from a holiday in Africa climbing Mt Kenya (Pt Lenana trekking peak only) and Kilimanjaro. Although my injured leg is still not as strong as my good leg, and the achilles does get sore after a challenging day, it doesn’t limit me in any way. The only thing (apart from fear)that stopped us attempting the technical peaks on Mt Kenya was lack of extra days to acclimatise to the altitude - my achilles is now fine for rock climbing.

The achilles certainly wasn’t a problem on either mountain, although sadly viral gastroenteritis did stop us from summiting on Kilimanjaro. Apart from that, we had a great time on both mountains, and I would highly recommend the trip to anyone who enjoys hiking.

One year and one day from my rupture I found myself here:

kilimanjaro

Some more photos from the trips are here (links will likely expire in a few weeks) if anyone is interested:

Mt Kenya

Kilimanjaro

Unless I happen to rupture again (fingers crosssed this DOESN’T happen!!!), this is probably my last post on here. Thanks again to Dennis for setting up this fantastic resource, and to all the posters whose wealth of wisdom and experience made those early dark days more bearable.

To all of you still suffering there, best wishes for your recovery, and always remember the future is bright, and closer than you think!

Dylan

As foreshadowed in my last post my motivation for regular targeted PT/exercise has waned. In the last month I have probably only been to the pool twice, and many days I forget to do any specific exercises.

That said, I haven’t been lazy either, just not doing achilles specific rehab. On the road bike I’m riding at least once a week for rides of 80-100km, riding my mountain bike on 3-4 hour hilly singletrack rides, and oin the days I don’t ride to work, I’m walking instead.

I have recently decided to start doing some proper rehab again as I aimed to be back to normal by 1 Dec so I have no time to lose.

Milestones?

I can finally do heel-raises! First managed to get my heel off the ground only about 2 weeks ago by amillimetre or so. Today I surprised myself by getting up about 2 inches when showing the cleaner at work how limited I still was.

I’m also almost able to ride normally on the road bike - obviously still not sprinting quickly, but I can climb pretty comfortaby standing on the pedals.

That’s all for now, not enough water to drink today and only a red wine with dinner and I’m getting migraine-like visual disturbance…better get some aspirin going before the headache sets in!!

Today is three months post-op for me, and I’m getting back to normal. Anyone got any suggestions on how to keep the healing entertaining past the 3 month point? The possibilities of real life are starting to intrude on rehab…

In the last few days I’m finally starting to walk with a normal gait, raising my affected heel mid-stride before my good leg touches down. I still have a limp most of the time but am working towards being able to walk normally without having to think about it at every step.

I can’t quite manage a ‘proper’ heel raise from a standing start (legs straight), I get about high enough to slip a sheet of paper underneath but no further. I can stand on my toes when I put my foot down that way, for example I can now walk up stairs without touching my heel on the tread of the step -  hopefully within the next week I should finally manage to do proper heel raises. 

I have been taking the pool based-rehab to the next level, instead of trying to walk normally in the pool I’m now walking laps on tiptoes (did about 16 laps or 400m  this way on Monday night). I still have virtually no strength with my foot in the fully plantar-flexed position so that is the next thing I will start working on, probably by taking my scuba fins to the pool from now on. I have also recommenced the exercises I was give a few years ago for rehab from a knee injury (same leg as my injured achilles). These involve balancing on the affected foot on an unstable surface (bosu ball, or just a stack of towels) while pushing against a resistance band in various ways with the good leg. This should help increase all-round ankle strength, but unfortunately are also required by my knee going bad again (predictably due to the amount of muscle loss over the last 3 months).

I still get some swelling (”pitting oedema”) around the malleoli after standing for long periods, and some inflammatory swelling and pain around the tendon after workouts. I’m controlling the post-exercise swelling using the compression stocking, and controlling the pain with James Squire’s India Pale Ale prn <g>.

I’m riding my road bike more comfortably now, and can get up gradients of 5-6% in the 39×25 gear without a problem, but still don’t have much endurance. Planning to ride 70km (44 miles) on Saturday including about 4km at 5% gradient and 100km on Sunday (63 miles), but will give my stated goal of climbing Mt Wellington (1270m/4100 ft  climb  over 22km, with about 3km continuously over 9% gradient) a miss for another week. The new Dura Ace wheelset I have on order should help (1380g of carbon-aluminium laminate goodness courtesy of a nice fat tax refund) - yes, I’m prepared to cheat!

I’m going to wait a month or so while I work on my knee strength before I try running. I’m not a regular jogger anyway, and when I do run it’s mostly trail running which is still verboten until 6 months post-op, so it’s not a huge loss to me. I did briefly break into a jog  on my walk home last Friday (I was in a hurry!) which surprisingly felt fine, but I don’t want to push it too far.

 I’ll probably update my blog less from now on, but will keep an eye on the site to post my witty insights (or BS) every now and then. My next milestones won’t come until my activities are fully unrestricted - come December I’ll get back into multi-day off-track hiking, trail running etc and step my mountain biking up a notch or three. Early February will hopefully see me skiing powder in Japan, then maybe around April next year I’ll play a very nervous, tentative game of squash with that new racket which led to my downfall back in June!

Good luck everyone.

Dylan

Somewhat of an off-topic post (no AT pictures in this album), but here are some photos from my trip to Darwin last week. It’s so good to be on the mend and be able to get out and about.

http://www.facebook.com/album.php?aid=145635&id=734858267&l=b18c24fb25

Link will expire, let me know if you need a fresh one.

Dylan

Have had an action packed couple of weeks.

Went up to Darwin last weekend (still in the same country but about 4000km away!) where my wife was presenting at a conference. Had the chance to drive around and do some photography, and generally thaw out after a cold wet winter.

Amongst other things, I got to do my first beach walk, my first walk up a steep rocky trail, and my first walk along a slippery rocky creek bed. Was I cr***ing myself in fear of re-rupture? Yes I was!! “That is NOT what I meant by saying you could go back to 2-shoes” said the surgeon’s voice echoing in my head. Probably not the best of ideas, even though I was being super-duper careful and using a trekking pole for a bit of extra support…but the rock pool under florence falls was nice and refreshing to lounge around in.

Yesterday I finally got to ride my road bike for the first time since my injury - I have been holding off because it doesn’t have an easy gear, I can’t really stand on the pedals, and it would have felt like sacrilege slapping on a flat pedal so I could ride with the boot on (the boot just wouldn’t match, everything else on the bike is carbon!). But it was such a great sunny day that even though I still can’t do a heel raise, I decided I could push enough force through the pedal to get me up the hill home from the bike path, and off I went. Only a short ride of about 10 miles, and it was hard work not dropping my right heel, but felt like good rehab.

And today I finally got to go on a proper singletrack mountain bike ride, a big steep climb (and resulting downhill run) rocks, roots, mud and all. I played it safe for this and wore my cam-boot for the first time in 4 weeks, got some funny looks from other riders and some extra cred, despite opting out of the more technical section of the route. Only one minor “off” - that boot is so damn bulky I kept clipping rocks with it, resulting in one low speed incident where I came close to tumbling down the hill. It felt strange showering after the ride and feeling the sting of scratches on my legs from sticks and branches (really narrow track) - in normal times a week wouldn’t go by without this feeling, but of course it has been months since I have been able to get out there!

Do I need to say that my injured leg is tired today?;-)

Tomorrow it’s back to work, and the fact that my bus ticket has run out sounds like a good reason to start commuting by bike again!

Have fun everybody and stay safe (do as I say not as I do;-)

Dylan

How time flies.

2 months ago to the minute I was 12 hours out of theatre, struggling to get comfortable in our spare bed downstairs, having taken about 3 hours to eat my dinner due to nausea from the pain meds. Despite being spaced out, sleeping in the boot was very uncomfortable and I woke seemingly every time I tried to move with the sutures in the skin stinging.The worst part was staring down the barrel of months of confinement and incapacity to do most of the things I love…

But after all that negative expectation, it wasn’t so bad! Life has gone on; it has meant a bit of work on rehab instead of play time, and my wife has been a great support despite being incredibly busy with work. I’ve turned into that pathetic creature known as the blogger, and I’m nowhere near as fit as I would like to be, but I’m still (relatively) sane!

This weekend it’s time for a short break away from the cold way up in sunny Darwin, the opportunity for lots of photography and hiking, lounging in the pool, catching up with some old friends, and finding some croc-free waterholes to cool off in.

Looking down that tunnel 2 months ago this must have been the light at the end I was looking for, I just wasn’t expectingto get there so soon.

OK, Ok, I’m not out of the woods yet - I’m still not sure my abscess is cleared, and I’m still some way off from walking normally let alone running, climbing  or playing squash again but that will all come in time, time which no longer seems like an enemy.

Now my skin infection seems to be clearing so it’s time to start working towards another target.

I don’t think I’m quite going to make the heel raise with 50% body weight by Monday that the PT set me (after all I didn’t do any for a week because of the infection), but I’m slowly getting better.

Sitting on the bike trainer last night, I suddenly found I was able to pedal normally for the first time since my injury. On previous occasions I always found it hard to stop myself doersiflexing on the downstroke,  to the point wher I would overcompensate and roll over the front of the pedal axle. Last night it just clicked, I got on and pedalled and it just worked. Of course I still can’t really stand on the pedal and sprint, but it was the first time I didn’t have to consciously think about my foot position on every pedal stroke.

That got me thinking I’m not so far off riding my road bike after all! I’ll stay on the mountain bike (because of the lwoer gears available) for the next week or two, but watch out, here I come!

So what’s the target you ask?

Mount Wellington, 1270m

Mount Wellington, 1270m

 

By 3 months post-injury I’m riding up here again!

The second part of the taarget is that I also won’t be waiting at the bus stop (whence I took the picture this morning ) anymore, I’m going to start my short bike commute again soon.

A week ago I saw a GP for my cellulitis around the incision and was prescribed cephalexin. I wasn’t too impressed by the consult for a couple of reasons; firstly while it’s a broad-spectrum antibiotic, it’s not particularly effective against staph, which is the most likely beastie to be causing the infection. Secondly, the course he recommended I take was like a recipe for drug resistance, starting off with 3 x day for 3-4 days then dropping to 2 per day, plus he gave me a repeat script which would have lasted nearly 3 weeks. Now I’m not a doctor or pharmacist, but my wife is a doc (doesn’t have non-hospital prescribing rights) and I do have an honours degree in pharmacology, so I took my script but  we nixed the dose regime, going 4 x daily until both scripts finished.

When after 5 days it was still getting worse rather than better I made an appointment with the surgeon, which I am just back from a couple of hours ago.

The surgeon has confirmed the infection, and believes it is likely coming from a small stitch abscess. He has put me on a more aggressive course of flucloxacillin (500mg 4 x day for 12 days) and given me a follow-up appointment for 3 weeks time with instructions to call earlier if it doesn’t start resolving before I finish the script. Fingers crossed.

On the positive side, he also told me to resume all rehab activities, including walking, PT and swimming, so long as the wound remains closed. This is GREAT news as the GP had told me to rest and elevate, so my increases in strength and ROM had come to a grinding halt.

If only the weather improves I’ll get out on my bike after work this week after all!  It has been snowing down to 700m on Mt Wellington today (only a few km from here and within view out my office window) - in town apparent temperature has been below 2 degrees C with sleet and hail! More likely I’ll be on the indoor trainer and at the pool.

Some pictures showing my progress (or regress!) over the last week. There is less general swelling around the ankle, but more redness along and around the scar related to the infection. Yes, it’s nothing compared to some of the nightmares some of our fellows have suffered, but I’m very keen to keep it that way! 

A slight setback over the last couple of days, I have developed a bit of cellulitis (skin infection) around the scar.

It started of at what was the last part of the scar to lose its scab, about an inch up from the base of the scar. This area had been behind the rest in healing, was the last to lose it’s scab, and had remained a bit sensitive to touch - it looks like it just never completely healed over. 

I noticed at physiotherapy on Monday that it was more sore than usual, and over the course of Tuesday an area of redness grew from this point, spreading to about 3 cm long and 2 cm wide. The whole area felt itchy and sensitive to touch. I wasn’t able to get an appointment with the surgeon until Thursday afternoon, so on Wednesday (yesterday) I took myself off to the GP to get a course of antibiotics.

 As of today midday (after 3 doses) I think it is starting to improve, the redness doesn’t go quite as far up the scar. I’m still carrying on with land-based exercises, but am having a break from the pool until it has fully cleared up, and also (obviously) not massaging directly over the scar line. At it’s worst the redness extended about 50% further than in the pictures below.

I’m very glad I got it seen to quickly, before the wound started to break down, as it should only slow up my rehab by a few days.

Please keep an eye on your wound, if it starts getting worse instead of better, get it seen to PRONTO!
Dylan

Had my first physiotherapy session yesterday afternoon.

  • The worst thing was I didn’t really learn many new exercises to do.
  • The best thing was I didn’t really learn many new exercises to do, because I already found them on this site…thanks guys!

What did I get for my A$112?

  • Some ultrasound stimulation…no offence, but this rings my “quack alert” bells. Got a nice rub in the process at least:-)
  • Some stats on my ROM as a baseline:
    Dorsiflexion: less than -5 degrees (vs >-15 degrees for unaffected leg)
    Plantar flexion: about equal, a couple of degrees less than unaffected leg
    Eversion: a couple of degrees better than unaffected leg (probably due to lots of practice walking on outer edge of foot following smashed up big toe knuckle some years back)
    Inversion: a couple of degrees worse than unaffected leg.

Most of the ROM limitation in dorsiflexion is coming from the achilles (duh!) but there is still some tightness in the joint due to swelling.

  • Got some tips on massaging the tendon and mobilising tissue over the scar.
  • The main thing I got exercise wise was the instruction to go on to more intensive stretching and strengthening work. Basically I’m to do everything from the 12-24 week section of the rehab plan below over the next two weeks. Then I get a review with the aim of moving on to single leg heel raises if I can do it. A bit ambitious but I’ll give it a shot.

http://achillesblog.com/files/2008/03/achilles_tendon_rupture_mass_gen.pdf

  •  The other instruction was to start riding my bike without the boot, but on flat pedals so I could moderate the force on the achilles a little more. I assume this doesn’t mean the same sort of riding as peterh recently posted a picture of on his blog (for which I will certainly keep the boot!).

After the physio session I walked the 2.6km (1.6 miles) home - I did use a trekking pole for the second half which is more significantly uphill.

Today my leg is a bit tired (particularly the muscle in front of the shin) but overall the achilles is not too sore. If the rain lets up, I think I’ll walk home again.

 I’m updating my NYC Marathon widget now, as I don’t intend to be limited in any way by the time the southern hemisphere summer rolls around…

I can smell freedom!!!


  • ATR Timeline

    • Name: dsut4392
      Location: Hobart
      Injured during: Squash
      Which Leg: R
      Status: 2-Shoes

      438 wks  6 days Post-ATR
      437 wks  3 days
         Since start of treatment
  • Recent Posts

    • dsut4392 has completed the grueling 26.2 ATR miles to full recovery!
      Goal: 152 days from the surgery date.
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