Up and limping!
Well, not really even limping. Getting by is more like it, but my blog is up and running!
I’m not the kind of person who would normally have a blog, but the benefit I have received in the last few weeks from reading entries on Achillesblog more than makes up for any hesitancy to share my ramblings. It’s good to know I’m not alone, and that ATR it’s a rather well-trodden path, albeit the footsteps may seem odd for someone unaware that we are all limping.
My rupture happened like so many I have read, an innocent pick up soccer game in the gym with my daughter and some of her class mates on a Sunday afternoon. Less than two minutes in, an attempted quick turn and POP, down I went. I had no sensation of pain, or of anyone kicking me, just the sensation that this wasn’t good. I was quite certain it was my Achilles and a fellow parent and doctor did a quick Thompson test and showed me what I feared.
I was loaded into a car and driven around the block to the ER, and 3 hours later I was none the wiser. The PA felt the Thompson test was inconclusive, gave me a splint, a prescription for Oxycodone in spite of me saying there was no pain, and told me to call the orthopedist in the morning. The next day after some rather humorous time on the phone with the scheduling person who had reviewed the ER notes which incorrectly said it was my left leg that was injured, asked me if this was true. I told her no, it was the right foot. She asked which foot my splint was on. "Right foot." Without skipping a beat she said, "well no wonder you are having a hard time walking. The left tendon is ruptured and the splint is on the wrong foot!"
Later that day I saw a sports medicine doctor who said it was a tear, but unsure if it was complete. He told me the option of surgery or non-surgery, without pushing hard for either, although after hearing me say I wanted to return to being active, he suggested surgery, gave me an Air Walker boot and referred me to a surgeon.
In the shower the next morning, my already overactive mind was fixating on the image of the hero, suspended off the edge of a cliff by a badly frayed rope, barely holding him and about to snap. The image of my straining tendon and the expectation of a final, even louder pop made me woozy and it was only by luck that I made it out of the shower onto my bed to lie down again to avoid fainting. Deep breaths. Don’t think about climbing and stay off that leg.
Later that day the surgeon didn’t take long to ascertain it was a complete rupture and again, say there were two choices. Like his colleague, no hard sale, but the bias was clearly there - surgery for young and active, non-surgery for old fogies and smokers. We scheduled surgery for the Friday, first thing in the morning. Once I decided, I felt a little bit like I was buying a car - signatures, initials, handshakes.
That evening, I felt pretty good about having surgery. The idea that the tendon ends would be reattached was comforting, and as is likely often the case all my Google searches seemed to confirm my choice. I had a lot of work to do before surgery, however so I put my head down, leg up and got back to work.
I was first on the docket for surgery on the Friday, so stumbled out of bed around 4:45 am and took a cab to the hospital. My wife needed to get our daughter to school, so she would come and pick me up. At the hospital, I was entered into the system, had my insurance checked, prepaid, etc. etc. and sent to the pre-op area where I was given a gown and some oversized wetwipes to clean my body, and I was off. A horde of anesthesiologists, nurses and the surgeon filed by, more hands were shaken. I asked the surgeon if he had practiced his Krackow technique to which he flinched a bit and said he had just talked to his students about that - perhaps I should do the surgery? I was finally wheeled into the OR and given a general. Lights out.
When the lights came back on, my throat was raw from the breathing tube, but otherwise I felt good. I had a splint wrapped with an ace bandage on my leg and a kind nurse watching over me. The surgeon came by to say everything went well - it was a complete rupture and four sutures were put in keeping it together again. He had cast the foot at a neutral 90 degree angle and everything looks good. I could take a shower in two days, just don’t soak the wound, and keep the dressing clean. My wife arrived and the nurse offered to give me some fresh 4×4 dressings which we declined - we have a stash at home.
Two days post surgery I was itching for a shower, and started to unwrap the bandage. As it unwrapped, it became obvious the bandage was embedded in the plaster, and either they had done a bad job or the splint was not meant to come off. I re-applied the bandage and decided to call the clinic in the morning - the shower could wait.
After leaving my message with the clinic in the morning I received a phone call in the afternoon asking if I had taken the bandage off yet. No, I said to which she replied good - you should leave it on. It’s sterile now, and it should stay that way. You can wrap the cast if you want to shower.
So here I am, just over two weeks post op with a smelly but completely pain free foot, waiting to remove the cast. I have hopped around on a funky-looking crutch called the OnlyOne crutch which allows me to use both arms, walk up and down stairs and have a fairly normal existence.
Every day I have delved deeper and deeper into studies and experiences from folks on this blog, and am coming to both a new understanding as well as a whole new host of worries. These worries come in a variety of flavors - regarding my tendon, my cast, my surgeon, my rehab - and my interim conclusion, which seems to jive with many on achillesblog, is that there really is no standard approach to this, and it is absolutely incumbent on the patient to put together all the pieces.
While I have none of the knowledge or technical skill of a surgeon to make the incision, stay away from nerves, protect the sheath, clean up the tendon endings, minimize trauma, I do have deep knowledge of my own body, what feels right to me and how I want to be involved in the recovery. In the next 6-9 months and beyond, it will be incumbent on me to manage whose direction and insight to listen to and when to insist that my insight should take precedence. It will never be obvious, but I hope I will be able to know when to listen and defer and when to speak up. All the information and insight on this site is a huge help for me in making sure I manage my treatment in the best way, and I am grateful to all the time people spend sharing what they have learned so we all can be better prepared and have better outcomes in the end.
The cast comes off on Tuesday - I will come armed with questions regarding the surgery, the rehab protocol, which boot I should use, etc. and with everyone’s help, I will be on my way through limping to running and playing with my daughter again.
Happy recovery - more to come…
Subsequent posts won’t be as long…;-)
Good summary ekiaer. Looks like we are on similar timelines. Wishing you the best and will be watching your progress. I feel very comfortable with my orthopedic surgeon, but agree with you that it is up to us to do our research and come to the right paths for us. Best wishes. DJ
Erik, it’s great to have you along. I love your attitude (and writing style, too)! Also, the fact that you’re post-op (and not somebody who went non-op after reading my blogs) lets me “lighten up” while following your progress, rather than feeling personally responsible!
Keep healing, keep posting.
Whoa, nice first post. Welcome to the club. These days of NWB are no fun but the time from PWB to FWB goes by quickly and things get much easier. For traveling, consider getting a pair of compression socks because they really help keep the swelling down. Try to get the vacocast boot if you can…it makes life easier and more comfortable compared to all the other boots. Good luck!
yeah sorry you had to join the club nobody wants to join
you will get there and will forget you were ever NWB.
I must say that I am surprised your foot was cast at neutral after surgery. That would be one question I would ask the doc. I can’t recall anyone here having that done. Most are set equinous (ballet, planterflex) or in other words pointed down to take the pressure off the tendon. It would be good to ask why your doc has done this. While it is clear there is no real standard way to treat this injury (as you have realized), there must be some accepted truths. I always have an open mind. Having trained initially as a scientist I have come to realize that truth is what we believe with the facts and knowledge we have available. These can change and then our truths will change. The earth was once flat. The only problem is when we refuse to change our ideas. Doctors can be a bit like that so it is good you are taking the initiative to be an advocate for your healing. Ask lots of questions but always keep an open mind. It is hard not to worry about things in this early phase but generally your worries are baseless when the explanation arrives. Hope you heal well.
I was surprised as well, but I’m not entirely sure it was actually neutral. He said it was, but unsure what the margins are, so it could easily have been around 10 degrees. That said, once I was out, I had one wedge in my boot for perhaps two days before I put a footbed from a shoe in there, likely the equivalent of half a wedge. For the last week and a half, I’ve not even used the foot bed. Seeing as he trimmed the tendon ends before suturing, hard to understand how it can heal long, though. I will definitely ask him at the next checkup.
Thanks for the comment!, Stuart!
Glad you’re doing well. However, felt kind of down when you said non-surgery route is for old foggies and smokers. I’m non-surgery and am, for sure an ‘old foggie” (non-smoking one) but am a very active one. Hope I get a few more years of active living.
Good luck on the journey.
I wish I had the difintive answer on healing long. You were trimmed and maybe the angle was to avoid you healing the other way. Most of us here are not medical people and give comment based on a very general experience. Some things we know work better than other things but in a few years time with better knowledge and research, all of what we know now could be thrown out the window. I was told that surgery was better for younger, more active people but understand now this is not the case which tells me your doctor is relying on very old information. I am confident you will do well with this injury and be able to manage much of your own time schedule. The schedule Norm has mentioned is a good starting point. I was always a small amount ahead of it for the first 6 months and then it seems to even out over the next 6 months. Understanding your own body is good and I suggest you read up (if you haven’t already) about the stages of tendon healing. That will help you know when and when not to push. The AT is not the largest tendon in the body for no good reason. Logically you would assume it has more stress placed on it than the other tendons.
Loumar - It’s not my opinion that non-surgery option is for old fogies and smokers, but rather what the medical establishment told me. I actually think the evidence now shows that for the majority, it doesn’t make a big difference in terms of outcome which path you take, in terms of time and physical ability. That said, the surgical option may be more forgiving during rehab. With the non-surgical option, it is quite critical that you follow the UWO protocol, or an early motion protocol. When/if I tear my other Achilles, I will opt for the non surgical option.
Stuart,
I think my surgeon did what he believes is the right course of action because he’s a surgeon…and surgeons cut. That said, I believe he has done a good job. He expected me to be able to drive a car after 5-6 weeks and I can. He expects I will be able to be walking about in two shoes in another week, and I will be, in fact I have for the last two days. I think he’s a good surgeon, and so far I don’t have anything to say I’m healing long, but it’s early days.
That said - is the surgical option the best option? Not so sure, but it’s hard to be definitive. There will always be exceptions to the rule, and in medicine, those exceptions carry a lot of weight, for better or worse.
My recovery is so far going very well - I walked around town today in two shoes, five weeks after surgery. But the recovery at this point is rather general - no pain, ability to put some weight on the foot, etc. Later on is when I’ll see the details and be able to tell the finer quality of the repair. I’ll worry then!
Erik, most shoe-type footbeds have close to the same thickness under the whole foot, I’d say closer to zero heel wedges than even 1/2. But maybe yours is more tapered.
I don’t think there are many OSs out there who knowingly offer treatment that they don’t think is best. But we’re all humans, and we often respond to incentives and such even when we’re sure we’re not doing so. “If your only tool is a hammer, all your problems look like nails.” And if you and your partners also come out ahead if you do what your teachers taught you to do, and what you’ve been practicing for a while, and what clearly works OK, then so much the better. That’s not evil, that’s just normal.
Hi all, I have not posted in a while, this is Robina, I am coming up to 7 weeks post op tomorrow. I went two shoes last thursday, week 6, after 2 weeks fwb in the boot…let me tell you that was scary..did not tell me anything about what to do, stretch, type of shoes nothing! Just scheduled me for rehab starting tomorrow, so thank goodness for this Blog,,which taught me proper stretching and proper walking techniques. First day in two shoes, my foot felt FROZEN! i was so scared to walk on it without the boot and found myself using terrible posture and club foot walking to compensate, so THANK YOU @normofthenorth for comments you made to someone else for doing just that..i did put on my boot to get into the garden and pull radishes and onions..it has now been 5 days in two shes..still very stiff in the morning so i take it slow and bought a compression sock yesterday and it feels good, especially at night, when i swell a little and my tendon tends to get REALLY tight in the evening after being on it all day. I do alternate between different tennis shoes throughout the day, depending on comfort, and use the boot when i get into the garden, due to the uneven ground. i also just ordered the achilles foot strap from amazon to keep my foot more secure when moving around…flexibility is returning slowly and I can not wait for my pt evaluation tomorrow and a routine, also I cant wait till the pool opens so i can do water exercises. What I want to know is how long does it typically take to walk”normal” at a good clip in 2 shoes?!