Week 12

I have been in 2 shoes full time since July 3. I had the day off work so I decided to see how long I could go over the weekend and didn’t ever go back. The Vacocast has been banished to the basement, hopefully permanently.

At this point I am building strength and working on my gait. I feel like I am walking smooth and fast until I get next to someone downtown and they fly by me. Also, my wife tells me it isn’t as smooth as I think. I guess compared to how bad it has been for the last 3 months this feels great but there is still a ways to go.

At my last appointment with the Dr. he told me it was okay to bike outside! I went for a few rides around the neighborhood and then rode to work twice this week! I had been riding to work year round for about 2 years at the time of the injury so it’s great to be back to my normal routine and avoid downtown parking costs.

My PT said she wants me to try a single heel raise at my next appointment which has me a little scared. I’m pretty sure I can’t do it so it seems kind of pointless and like there is only a potential for injury. I’ve been debating just telling her I don’t feel up to it vs giving it a try.

Good luck to everyone!

Week 10 and 2 Shoes

I tried walking with 2 shoes for the first time with my PT on June 22 (8.5 weeks). She gave me a 12mm heel wedge for both shoes and just went for it. It was slow going and I had pain on the top of my foot so I couldn’t keep at it too long. The AT was tight and obviously weak but afterward it felt fine. After that I was instructed to gradually build up in 2 shoes at home.

That also started weight bearing exercises. I was instructed to start 2 legged heel raises with a counter for support, heel to toe rocking while sitting, towel pickup exercises, straight and bent leg stretching, and balance exercises.

Over a week the foot pain outside the boot subsided and now I am able to spend most of my time out of the boot. I am out almost constantly in 2 shoes at home and today I went to work for the first time with no boot. I have an office job so it isn’t that impressive but I am wearing jeans for the first time in almost 3 months! I am wearing an ankle brace I was given for support.

I have been going slow on stretching exercises but my PT wants me to push more on those so I will be focusing more there. Over the next week my walking ability should get better as I spend more time out of the boot.

My motto has been steady progress instead of trying to make big jumps. So far it has been working but the next few weeks are going to still have a lot of risk with a weak tendon so I will have to continue to be careful.


Weeks 7 and 8

Lots of progress the last two weeks:

- I moved Vacocast to 5 degrees on June 7, then decided to move it to 0 degrees one day early on June 8. I was working from home that day and the following day I had to be up an about quite a bit and in the office. I decided a day at home would be a better transition. I didn’t have any problems and have been at 0 since then.

- The move to 0 meant ditching the wedge sole. I had tried the flat sole at 5 degrees but it wasn’t very comfortable. The toes still being pointed down put weight more on my forefoot and I was more comfortable with the wedge sole. Once I went to the flat sole I could get out of the hiking boot + evenup which was great because we were having 90 degree weather (hot for Portland!). I was able to wear ventilated athletic shoes and finally have even leg lengths. My gait also improved from where I was at with the wedge sole and 10 degrees.

- On June 9 I had a check in appointment with my OS. I saw my third different resident since the operation. He seemed to not really know what was going on and answered most of my questions of “let’s get you to the physical therapist and see what they say.”

- On June 10 I was supposed to have my first PT appointment. They called the night before at 4:30 and said the therapist was going to unexpectedly be unavailable and my appointment was cancelled. Initially they couldn’t get me in for 2 weeks but I called back in 2 days later and they were able to get me in one week earlier.

- I am FWB in the boot and my range/speed of walking are improving. It isn’t the smoothest walk but having both hands available is great! It improves a bit each day but I can’t really get up to full speed with good form.

- With more abilities comes more responsibilities around the house. I have been doing most of the cleaning, this weekend I cut and edged the grass for my first time in 2 months, went grocery shopping by myself for more than just one or two items, and many other “normal” tasks around the house.

- I was able to see the physical therapist for the first time on the 16th. She did an initial evaluation and gave me theraband exercises for homework. Next time I am to bring a shoe for my injured foot and if everything looks good I will try walking out of the boot.

So far no setbacks, which is great. We had to cancel a trip to Europe in June after this happened and my wife really wants to get a vacation in before she goes back to teaching in the fall. We bought tickets for the middle of August so that gives me a goal to shoot for. We typically do lots of walking on our vacations so I am a bit nervous but I will be at week 16 when we leave so if I don’t have any setbacks it should be okay.

Week 6 Update - FWB

Well it’s another Thursday so that means it’s been another week of recovery.  I’m getting to the point where I have to count the number of weeks to be sure I have it correct (let’s see, surgery was April 23, so five weeks gets me to the end of May, then one more week is 6…)  At 5 week and 3 days I took my first steps FWB.  I had previously tried one or two steps but it wasn’t successful.  I have been getting various aches and pains in my foot when I try FWB so it’s been a little slow.  It seems my foot just needed to toughen up.  Once the foot pain went away then I had knee pain when I got to full weight.  Using one crutch to just take a few pounds off made all the difference in the world but after a few days that pain subsided as well.  The first day was just shuffling across the room but things are picking up from there.  I wouldn’t want to go long distances at this point but for around the house I don’t need anything and my steps seem to get smoother each day.

On 6/9 I have an appointment with my OS and will be moving the boot to 0 degrees.  The next day I have my first PT appointment scheduled.  Looking at reports from first PT appointments I’m just expecting to have them evaluate my ROM, maybe some sort of massage or ultrasound treatment, show me some strengthening exercises and send me on my way.  Not much else I can do at this point.

Reading other’s blogs it seems like the next 10 weeks are going to be the fastest progress of the recovery.  A few days ago I couldn’t bear my own weight and in 10 weeks I should be able to go on long walks in 2 shoes.  After that progress seems to taper off to incremental steps between 4 and 8 months.  It also means I’m coming into a dangerous time as I try to do more every day and maybe even forget about the injury for an instant or push it a little too hard.  It’s a good time to remember we recover by doing just a little more than we did yesterday and not trying to jump ahead 3 steps.  Literally, I will have to learn to walk before I can learn to run.

My OS seems to have me on a fairly fast track as far as WB and reducing the angle of dorsiflexion but he’s also been fairly conservative about doing other exercise.  He wanted me to stay off the exercise bike, wasn’t thrilled about lifting weights for upper body only because of moving around between sets, and didn’t want me in the pool until he could check that my incision was completely healed.  I’m expecting much more clearance for activities beginning next week and then I can resume some exercise!  Let’s just say my beach body won’t be ready this summer.  I have started doing some open chain exercises for my injured leg I picked up during PT for other injuries (i.e. straight leg raises, quad sets, clam shells, etc) to get for activity again.  I haven’t been religious about doing them but I get a session in several days a week.  Maybe it will get me a little jump start on PT.

So far no significant set backs and I guess things are going about as well as I can expect.  Hopefully that trend continues, good luck to all those reading this :)

5 Week Update

I had my first follow up appointment at 2.5 weeks post-op.  The plan was to remove the stitches but the resident thought it would be better to leave them in for one more week.  She said there wasn’t anything that looked bad, it just wasn’t all sealed up.  The bottom half of the incision looked very wavy to me, almost like they purposely made it that way so the incision could handle swelling without separating.  I had almost no swelling at this point and I think that extra may have made it more difficult to heal. At the top where there wasn’t as much puckering everything looked great.  If the sutures were staying in I had the option of going back in a splint or getting the boot.  If I got the boot I had to leave it all the time because of the sutures but I would be able to PWB.  I decided to go with the boot so I could start PWB and get out of there quicker.

At home I tried PWB but it felt like the gauze over the sutures was rubbing on the boot and then putting pressure on the sutures.  I didn’t want to cause any problems at the incision so after the first day I just stayed NWB for the next week to let things heal.  Holding back one week now will mean nothing in 2 months if I can avoid wound problems.  In the end I probably would have been better off with a splint for this week because it was lighter, easier to cover in the shower, and I had some hot spots that first week while I learned how to adjust the Vacocast.

At 3.5 weeks the stitches were removed and steri strips placed over the lower half of the incision.  The top half looked great and didn’t need anything.  I was given 3 tubigrip compression socks to wear under the boot and the plan for the next several weeks;  1 more week at 20 degrees pf, then 2 at 10 degrees, then 2 at neutral.  I was also told to start PT at 6 weeks.

The first few days I started PWB and had some pins and needle pain on the bottom of my foot.  I also got some ooze from the wound site.  Because of this I fell back into my routine of NWB and using the knee scooter for a few days.  Finally at 4 weeks 3 days I decided I needed to put the knee scooter away and start weight bearing.  I had tightness in the Achilles and various pains in the foot but I’ve been progressing slowly and things seem to be going away.  Now I have some remaining pain on the outside of my heel.  I can go short distances with one crutch and I just moved to 10 degrees PF.  I think once I get used to 10 degrees I will be able to be FWB.

The steri-strips are still holding on at 10 days but they will probably fall off soon.  I can see some scabbing under the strips but nothing to be concerned with at this point.  I occasionally get a drop of ooze but from what I see that seems normal at this point and there is no blood.

Next step - FWB and new freedom!

My Story

Hello all,

Now that I have a few people behind me on the "NYC marathon" tracker I thought I would start my own blog.  I’m a 37 y/o from Portland, OR.  I have a desk job but I have always been active outside work.  I’m 6′2" and fluctuate between 195 and 205 lbs. with a muscular athletic build.  My activities vary throughout the year but I regularly attend Crossfit classes, bike commute to work year round 5 miles each way, walk my dog about 45 minutes every day, go for a long bike ride when I can, run, race sailboats, and was just starting up softball for the year.  Over the summer I had a 200 mile bike ride planned and I had started training for that, two running relay races, several sailboat races, and a 10k.  Oh, and I had started playing tennis 1-2 days a week.

Tennis was new to me around Christmas but my wife and her friends had started playing and I was taking some lessons and attending drills.  I was enjoying learning and getting some exercise running around the court.  On April 13 I was one hour into a two hour drill session and was moving toward the net for a short ball.  I pushed off hard with my left foot and instantly felt like I was hit in the leg with someone’s racket and then had the sensation my foot fell straight through the ground.  I looked behind me to see why someone had hit me and nobody was within 20 feet.

I pretty much instantly knew what I did.  I can count 6 people I know who have ruptured their achilles including my dad, father-in-law, a good friend, an old boss, friends of the family, etc and they all describe the injury as thinking somebody had hit them, getting shot, etc.  The pain was right in that spot and I could feel the gap in the tendon right away.  All I could think was was "there goes my summer."

I looked up the urgent care facility for my insurance provider on my phone and they were closing in about 45 minutes.  By the time I calmed down and confirmed this wasn’t going away, then called my wife, there wasn’t enough time for her to get me and make it there before closing.  I wanted to avoid the higher cost of the emergency room if I could and wasn’t thrilled about waiting until the next day.  I put some ice on my leg for about 15 minutes and let the nauseous feeling I had subside then slipped out.  I was worried they were going to try and keep me there for somebody to pick me up.  It was pretty tough making it to the car because I didn’t have any crutches and nobody was helping me.  I hopped on one leg most of the way and then started getting nauseous again.  I hobbled using both legs the rest of the way and was surprised it didn’t cause too much pain.

At the urgent care center I parked in the basement garage and hobbled over to the elevator.  Luckily there was a wheel chair which I commandeered to get me the rest of the way.  I had been there a few years before and since then the urgent care area was moved to the opposite side of the medical campus so instead of being just at the top of the elevator I had to make my way across the campus.  At that point it was about 5 minutes before closing so they were able to see me right away.  They confirmed the rupture and put me in a splint.

After the injury I saw two different doctors for treatment options.  I’m double covered for insurance right now because my job will only give me $10/month if I’m not on their insurance plan but my wife of 1.5 years is a teacher and she was able to add me for a minimal amount.  Teachers in her district have really good coverage so it was a great deal.  Her insurance is a HMO plan (Kaiser) and my work has preferred provider coverage.  The HMO was steering me towards conservative treatment and the PPO was recommending surgery.  In the end I decided to have surgery but went to the HMO because the cost was significantly less.  All of my after visits and PT will be much cheaper on the HMO as well.  If I want more PT than the HMO will prescribe I can always use my insurance and go to any PT I want.

I had surgery 10 days after the injury and everything went well.  I have had 4 previous orthopedic surgeries so I knew what to expect.  I have been able to work from home at my discretion so through all of this I only missed 2 days of work; the day of the surgery and the day after.  I had surgery on a Thursday morning and was off pain pills by the following Monday, except right before bed I took a pill for a few days to help with sleep.  I kept my leg elevated above my heart at all times other than when I had to get up to do something and never had much swelling.  If I was up for more than a few minutes I could feel the blood rushing to my leg and my toes would start to turn purple.  I just took it easy for the first two weeks and rarely left the house.