duke’s AchillesBlog

Tomorrow will mark 11 weeks from the day of my ATR surgery.  I have made continued, slow progress over the last few weeks.  Walking in shoes is becoming more comfortable and the length of my stride has started to increase (although still not back to normal) and my pace has improved as well.   By taking shorter steps and walking slowly I can minimize any limping.

I have been working in therapy twice per week.  My range of motion has been coming along and my PT hasn’t been having me push this much as of yet.  The focus in these sessions has been on strengthening and it as at these times when I am keenly aware of all the work ahead.  Double leg exercise is difficult and he has had me trying to do a little bit of single leg work.  Last week he did introduce some controlled jumping.  The focus it takes to carefully hop just a few inches off the ground is remarkable to me.

Over the past few weeks I have been increasing my work at the gym between PT sessions.  I have been riding the stationary bike and also added the elliptical trainer.  I have used the leg press machine to get a sense of what strength I have on the right.  It is no wonder I have so much atrophy, 30 pounds makes me sweat when I do single leg toe raises.  My tendon feels a bit sore while working, but no ’sharp’ pain and it has still been weeks (months maybe) since I have taken anything for pain.  Edema continues to be an issue but over the past week or so I haven’t been having to work quite as hard at the end of the day.

I will also admit that I spent about a half or so on the driveway last week shooting baskets (no jump shots).  It just made me feel better somehow.  Best wishes for continued recovery to everyone on this site.  Reading the stories of others continues to give me comfort.  Until next time…

I haven’t updated for a bit, have been busy at work and at home.

I lowered my heel wedges down to one (from two in my boot) but was on my feet a lot last week at work.  With lowering the wedges I started to get significantly more heel pain (pressure point).  I had been given permission to transition to a shoe with a lift when I felt ready.  Over the weekend, I wasn’t sure I was ready but I couldn’t take the boot any more (this really had more to do with all the walking I had to do last week rather than anything else).

Regardless, last Saturday afternoon I ditched the boot.  I am not having any tendon pain (and my heel feels better).  I have to walk very s-l-o-w-l-y to not limp right now.  This is counter to my usual way of getting from point A to point B, but not having the boot has made it worthwhile.  I also am loving not having to unstrap my boot to drive, and strap it on if I need to stop somewhere.  Getting into 2 shoes has been nice, but man there is a lot of work still to do.  That being said, it has been wonderful for my mental health.

I have been progresssing with walking, balance, etc in therapy.  I have found, however, that swelling is still a big problem.  I elevate and massage around the tendon area at the end of the day, but the whole ankle looks ugly by evening.  Where I am having pain is above my incision on the inside edge of the tendon (if that makes sense), I have some soreness in the tendon/rupture site but this has been fairly manageable.  At the end of a day it is the burning hot spot that bothers me.

I have been elevating my leg, massaging out the swelling, and then applying a little heat before massaging the hot spot directly.  This is an exercise in self torture but seems to help.  This is the same spot my therapist has been working after ultrasound at the last several sessions.  Does anyone have any tips or tricks?

Happy Thanksgiving…

7 weeks since my surgery.  I am in a phase where my progress continues but the pace has slowed.  I have been a bit frustrated but know that this is par for the course.

After my 6 week post-op visit I was down to two wedges with permission to drop to one when I felt ready.  I tried it and felt like I was doing okay until last Wednesday.  After being on my feet for most of the day, I had my first day of wondering whether working was the right thing for me to be doing.  I started getting more soreness in my achilles, a little too reminiscent of my achilles tendonosis pain and had a lot more swelling.  I elevated and massaged my ankle that night and then started alternating between one and two wedges through the rest of the week.

Went on a trip out of town (to Pittsburgh) and decided to relax, put two wedges in my boot for the weekend, and use one crutch.  I was on my feet for most of the day Saturday and really did okay.  Just didn’t feel like pushing it while going places/doing kids with my kids was going to further my cause.  Back to work today with one wedge all day and did all right–maybe slow and steady really will win the race.

Massaging my tendon has seemed to be helping me, less tightness, more relaxed ROM and helps get the swelling out at the end of a long day.  I have been obsessing a bit about ‘healing long’ (even though there aren’t clear answers to why it happens for some) because my ROM has been improving.  At the end of the day though, I am trying to follow my doc’s protocol, g-e-n-t-l-y stretch as symptoms allow, and follow my PT’s strengthening plan.

Until next time…

I had my 2nd post-op visit this week.  I saw my surgeon and had a chance to get some of my questions answered.

-details of the surgery– sounds like it was straightforward, he opened up, stitched the tendon together.  I had several years of tendonosis but he said thee tendon itself had some thickening but was surprisingly healthy looking at the time of the operation.

-numbness of my heel– not in the distribution of my sural nerve.  He is optimistic it will get better over time (and it is definitely better over the past few weeks)

-a big question was about stretching.  I have done no ‘active’ stretching outside of PT (even though it is on my rehab protocol) but my ROM is almost to neutral.  He reassured me that I can stretch ‘as tolerated’ with pain as my guide at this point.  Having read so much here about healing long, I remain nervous and quite honestly will like continue only with using my anterior tibialis to improve my ROM.

-the biggest question –> driving.  He gave me the okay as soon as I could tolerate FWB

He was satisfied with my progress, healing of my incision, the feel of the tendon, swelling (which is minimal)) etc.  He gave me permission to work on getting the wedges out of my boot and gave me a heel lift to put in my shoe for when the time comes.  He was optimistic that I would be into a shoe within 2 weeks.

I saw my therapist the next day, rode the stationary bike without a boot for the first time (official FWB), walked without crutches and had a wedge taken out of my boot (bledsoe achilles boot–had 3 to start so I still have 2 wedges in).  My plan is to take the 2nd wedge out over the weekend (as per my PT’s plans) when I don’t have to deal with being at work and on my feet.

In retrospect, I was starting to get depressed about this whole process earlier this week.  While driving home I had seen some people out jogging and I wondered when that would be me.  Sick and tired of crutches, boots, trying to figure out who was driving me back and forth each day, etc.  Getting the okay to put my crutches aside (I can use two hands again!), the okay to take my boot off to drive my car, encouragement from my surgeon makes me feel like I am on the right track.  I feel like I need to continue to take a ’slow and steady’ approach.

Reading posts on this blog makes me feel like I am too far ahead of other folks.  I have had no sharp pains and am getting good reports.  This is the rehab protocol my surgeon follows and the data shows it is no worse than slower approaches.  The reality is, I would be chafing at the slow pace if I was still in a cast (and complaining about that too) so I just need to roll with it.

One brief side note in this lengthy post.  While picking up at the pet store the clerk shared that she had torn both of her tendons while running track.  She also told me she has ‘never been the same’ (which  I am going to put out of my mind and continue to keep my head down).

Best of luck to everyone reading.  I can’t believe it is 6 weeks from my injury and hope to keep reading about progress from the folks on this site.

I had a follow-up session with my PT yesterday.  Scar massage, passive stretching and then standing stretching and strengthening (minus the boot).  The massage was uncomfortable but no ’sharp’ pains and my tendon feels better today.  I felt like I had quite a workout by the end of the hour.

The physician assistant told me I could sleep without my boot at this point following the surgery.  I talked it over with my therapist yesterday.  He encouraged me to sleep without it when I felt ready.  He wants me to spend as much time out of the boot as I can and reminded me to not try and walk without the boot at any point right now.

I took the plunge to sleep without the boot last night.  One advantage of dealing with achilles tendonosis for years is that I am used to sleeping with my foot off the bottom of the bed.  I got in the habit of sleeping with my toe towards the ground with my ankle bent over the years.  This helped keep my tendon from getting ‘tight’ overnight from pointing my toe.  Tendonosis is now yesterday’s news but I have to say I slept well and was happy to be free of the boot for a bit.

I see my surgeon next Wednesday.  I am ready to get behind the wheel and my fingers are crossed that I will get the okay to drive.  Having to inconvenience other people to get me back and forth to work is getting old.

Until next time…

This is my second week back to work and I have been using my rolling knee walker to get from place to place.  I’ve been getting used to it but I have found that I am tired by the end of each day.  I’ve been happy to be out of the house–and I’m sure my wife has been glad that I’ve been occupied as well.

I had my second PT appointment yesterday.  Partial weight bearing was the order of the day.  He warmed up my calf, did some scar massage and then I did some range of motion exercises with him.  Up to the parallel bars and I put my booted foot on the ground with weight for the first time in nearly 4 weeks.  Very nerve wracking, but I had absolutely no discomfort in my tendon repair.  Next up was walking with the assistance of my crutches.  I’m not entirely convinced I was putting much weight down on that side, but its a start.

I am still sleeping with my boot because I am just too nervous to go without it yet.  Hope to be getting more brave over the next few weeks.  Until then, I am just going to be happy that my foot is (sort of) on the ground again and keep working on my therapy exercises…

I had my first therapy visit.  I really like my PT.  He spent about an hour with me.  He gave me a pep talk about recovery from this injury.  He was pleased with the look of my incision and the status of my tendon.  He told me he has had good experience rehabbing fellow patients of my surgeon.

Funny enough he described my PT protocol as ‘very, very, very conservative.’  He explained that since I was in a boot early his job was to keep me from jeopardizing my repair over the next 4 weeks or so.  The initial goals are to work on range of motion in my ankle without stressing the tendon.  In contrast, he says patients he sees who have 6 weeks in a cast have stiffer ankles when he sees them but he can work more aggressively from the start.

One of his patients recently re-ruptured his tendon 4 or 5 weeks post-op after putting his full weight on his foot (without his boot) , a slip in the kitchen that undid a month of work.  My biggest fear is re-rupture in the next few weeks.  Frankly, this scared me and reminded me how vulnerable my repair is right now.

He gave me some inversion/eversion exercises and level 1 theraband exercises to do (no raising my toe with any resistance).  He massaged my atrophied calf (which is full of knots), I got some stim and compression/cryotherapy.  I am eligible for 20% weight bearing.  He told me this is really for balance and doesn’t have much to do with my recovery.  I am planning to skip it until I can put more weight on my foot (50% next week).

I am going to work on my own over the next week and see him in follow-up when he can introduce some new things for me.  I am nervous but feeling more optimistic about my recovery…

After much anticipation it was time for the post-operative visit.  My splint came off and despite being prepared for atrophy after 2 weeks immobilized it still was tough to see.  I can’t imagine what things would look like after 6 or 8 weeks of casting like some of the others on this site.

My sutures came out, the incision was closing, there was no sign of infection, although one small area was lagging behind.  After a discussion with the physician assistant (got my paperwork for a temporary handicapped tag, prescription for physical therapy and the rehab protocol).  I met with the gentleman from orthotics and I was fitted with my boot.  Fixed angle brace with heel lifts.  My floppy chicken leg was situated in the boot.  I was given permission to wash my leg and once at home it got a good scrubbing.

Despite good news from the visit and knowing that my PT appointment is on Monday, after putting my legs side by side it came home to me just how much work is ahead to get back to normal again.

My rolling knee walker arrived at the medical supply store.  They had to special order one for me.  The standard size they carried only adjusted to fit someone who was 5’10” (at 6’3” and change that wasn’t going to fit).  Fortunately, my wife had asked about the height when we dropped off the prescription.  I went to the store and I have to admit it was a little like getting a new bike.  My hands were getting sore from the crutches and I was looking forward to setting them aside a bit  There in the store, in the midst of bedside commodes, shower chairs, and power recliners was my new mode of transportation.

Fresh out of the packaging (complete with plastic still on the wheels) was my cherry red rolling knee walker.  Handbrakes and basket included.  I hopped on and the fit was good.  It was loaded into the car and I was off to roll around the house.  We have hardwood floors, my wife wasn’t interested in my idea of pulling all the rugs up to help reduce the drag.  I settled for cruising around and putting things in my new basket.

As silly as it was, having more freedom of  movement and being able to give my hands a break from the crutches boosted my spirits.  My insurance company is covering part of the rental fee and I am a big fan of the rolling knee walker.  As long as you are on level ground it beats crutches by a mile.

After a weekend with my foot up, my wife drove me to same day surgery at 6:15am.  I signed in and took a seat.  By 7am I was in the pre-operative holding area, I met with the anesthesiologist and signed my anesthesia consent.

There was a moment of comedy while I was on my stomach for the peripheral nerve block.  I was prepped and the anesthesiologist was ready.  The nurse asked if I was starting to feel more relaxed (from the sedatives), I felt no different and this led to a discussion between the two nurses that amounted to “did you give the meds” “no I thought you gave the meds” “I didn’t give anything yet”.  Bottom line was a little bit of light sedation and then a lot of pressure as the block was given.

The CRNA (nurse anesthetist) introduced himself to me, we had some small talk about his kids.  After another dose of sedative to relax me…I woke up in the recovery area with oxygen via face mask.  I vaguely remember the surgeon assuring me that everything went great with the surgery.  I snoozed a bit, my wife came back to see me.  I found out that the surgeon was able to simply stitch my tendon together–no release from the calf, no tendon transfer.  The surgeon’s physician assistant came by to give me my discharge instructions.  Post-operative visit would be thee following Friday and she recommended I try to stay home until then, keep my leg up and get my recovery started properly.

I was sent home with a wrap to ice my leg through the splint (it is a small cooler that circulates ice water through a wrap I put on my splint).  My instructions were to keep my leg elevated and continuous cooling for the next 72 hours.  The nerve block was great but I had to pay close attention to my foot whenever I got up to make sure I didn’t bump into things.    Heeding the anesthesiolgist’s advice, I took a dose of pain medication before going to sleep (even though my nerve block was in full effect).   By 2:30 am the block was wearing off and I was reaching for more medicine…