goldman’s AchillesBlog

For me it has been a slow slog to get back to feeling anything like normal. Nine months to the day of my injury. But not to dwell on the negatives rather looking forward to hopefully skiing in Colorado this coming February and take my 11-year old boy along for a long overdue vacation.

So just wondering who out there who was injured this year thinks they are going to make it to the slopes?

And where are you headed?

And are you going to get Doctor’s sign-off or just head out?

My plan of the moment: Crested Butte.

I had two visits to PT people last week. I am week 11 as I write this post, and was looking forward to my first PT appointments since start of treatment for which I had to tease out of my OS’s office. I met with two gals last week at facilities convenient to either my workplace or home for initial evaluations. My plan was to try out two PT people on the same day, and then pick one of them to continue with for a few visits.

At the second PT office, I asked the woman who was evaluating me how I was walking. I was in two shoes and had brought my cane to the appointment. I have been using the cane a lot lately as my limp is still pretty severe, I still sense little to no push-off on my bad foot, and I like the idea of the cane as a warning system to types who whisk by me on non-injured feet. She had me walk down the hall and back.

After I returned from the end of the hall in an annoyed tone she states:

“You walk like a robot.” I looked at her and said: “No sh*t. That’s why I am here and you will fix it.” <– disclosure- I didn’t really cuss and say that, but I thought it. The funny thing is that even with that comment she was a little better than the first PT lady, so I am going to have at least one more appointment with her until/if I can find someone better.

While the evaluations turned out to be underwhelming I did learn things from each person. The first person taught me the valuable lesson of using the cane correctly and in the hand opposite to injury, and matching the cane stride with injured foot. She explained that the cane helps guide and balance my weight keeping my upper body (somewhat) centered as I step through with uninjured leg.

The first PT gal measured my ankle (on May 28). Here are the numbers:

The “robot” lady gave me some stretching fabric and taught me toe scrunching exercises for my injured side, which I have been trying to do and finding surprisingly difficult. But then I find them difficult for my uninjured side too so perhaps I should not be surprised. She also insisted that I ice and elevate at least three times a day. Sometimes I only do it once, but I always try to get in at least some daily RICE.

On other fronts lately I have severely slacked off my personal rehab and exercise routine, much to my own dismay. Work got real busy with some crazy unrealistic deadlines, forcing me to abandon my efforts to move all things achilles forward. I had a good talk with my boss today on the technical reasons of why the work is behind, and did mention that my injury/leg continues to be an issue and bog me down to some extent in life, but somehow forgot to mention that I need time to work on rehab and PT. He did promise me a new superfast computer so that I could code at speeds unheard of since the advent of computing. That cheered me up some, but it’s not like the programming tasks are going to magically code themselves. Oh well, somehow it will work out. Maybe I can use my robot instincts to get one thing done automatically while working on the other.

Nine weeks post-op.
Driving.
Walking.

The past two weeks have been somewhat interesting as I endeavor to transition out of the boot. At week seven I was to begin going two-shoes. Somewhat petrified I tentatively took a few steps. Being busy at work with software deadlines and not wanting to get too distracted and re-injure myself, or worse, fall down one of my two precarious flights of stairs at home and break something new e.g. the good leg, I stuck mostly to the boot. At week eight I called my OS’s office to complain that they were refusing me PT for no damn good reason, and to ask where I should be shoe-wise.

Nurse Betty (name changed to protect the innocent) instructed me that I should aim to be boot-free in two weeks, which puts that one-week from today. I took that advice to heart and have slowly been increasing my daily hours to the point that I am about 70% out of the boot, and even went for a walk into Colonial Liquors after work tonight. My goal was to enter boot free, buy a fifth of gin & a cigar, chug the gin, and walk back to the car without falling over to enjoy a nice rich victory stogie. I cheated and parked in the handicap spot, otherwise smooth sailing.

Nurse Betty also told me that I could get a prescription for PT. Finally. WTF? Why I was made to wait until (a) I called, (b) 8 weeks post-op is a mystery to me. But I jumped right on that; However due to time delays of one sort or another, early morning International Space Station orbit sightings or some such nonsense, I did not get my first, yes my first at nine weeks frigg’n post-op PT appointment set up until next week. Thank the Lord almighty for this web site because it has guided me thru the dark times.

Today at work I shocked a few people by emulating Homo erectus. I had to stand absolutely still, but it felt greeaaat to stretch the calf and groin muscles and gain about two inches in height from my usual injured stoop. I had a sh*t eating grin at one point and one of my co-workers, who is absolutely completely distracted with her own situation of being back at work four months after giving birth, looked at me and said: “Hey, no boot!?”. But really she was thinking: “You are such a pu**y. I pushed a human being out of my body. Try that and walk normal.”

On the exercise front I have been slacking off on all the week 4-8 exercises due to 2-shoes. My daily routine up until last week had been:
- core: plank
- core: Dragon Flag Advanced Core Exercise Credited to Bruce Lee
- 20 to 100 situps
- exercise bike - some boot, some non boot
- toe swirls and ankle flexions - many times a day, not just the three that the MGH protocol recommends
- hip abductions and hamstring curls
- a few pushups
- 12′ pole vaults
- chicken fights on wife’s back and defeating the next door neighbor couple two-out-of-three match

I was joking about the Bruce Lee and pole vault stunts.

Now I need to re-tool a bit and since I won’t be getting any PT feedback for a whole week, will rely on blogs on this site for some guidance. For example if not too swamped by work, I may try to make it over to the local high school pool a la Smick.

Over the weekend I developed my own form of calf raises against the wall sitting down and facing it. I just did a search on achillesblog.com and seems that others came up with or were instructed on same.

I have been boot free in bed for a week or more. Yesterday I woke up after getting a rare 5 hours straight sleep. For a second or two I could not remember which side I had injured. Another milestone!

Driving continues to challenge me. I thought by now that it would be 2nd nature. I have dramatically increased my average speed, but I still use the emergency hand brake a lot. I still dread going over bumps that agravate my sore heel, and stick to the back roads most of the way back and forth.

Regardless of complaining and the aggravation of the lack of PT prescription, I consider all of the above positives. On the negative side I am in pain a lot - most of my lower body: the heel, calf, groin, left foot which seems to sympathize with the right, back aches, and headaches. At least the tendons on both legs seem pretty good, so I should be thankful for that.

Meanwhile my leg is waking up. Last week I had this uncontrollable urge to stretch every part of it. That sensation waxes and wanes each day and I feel I need to be careful not to overdue the stretching. Usually I feel much better after succumbing to the urge. But still scares me a bit at how much my body so wants to be back to its previous normal two-leg walker self.

It’s now seven weeks, six days since my ATR operative procedure. I’ve been meaning to upload this for a while, finally got around to a) finding it, b) scanning it in, c) sanitizing the data. The scans following this post are the operative notes that my surgeon wrote shortly after the early morning procedure on March 18, 2014. I’ve removed IDs and names other than mine. I thought that this might be useful for other people to see the technical notes from an ATR repair that I think was mostly run-of-the-mill. Also, while I have read through it, I don’t know all the technical jargon yet, so I haven’t quite deciphered the entire procedure into layman’s terms. For example I have yet to determine if the #2 polyethylene FiberWire sutures are disolvable, or if they are going to be with me and my tendon forever.

The one deviation (I think) that my surgeon took from an even more run-of-the-mill ATR repair was to make use of the plantaris tendon (see page 2 of 3) to “improve” the healing of the Achilles tendon. I was told the day after surgery that it is a vestigial tendon, and that was why my doc used it to weave into the structure of the Achilles. On the web I found this blurb: “The plantaris is considered an unimportant muscle and mainly acts with the gastrocnemius”. I find this interesting because at the moment my right calf muscle, right around the gastrocnemius, seems to hang off my leg in a slightly odd way. I have no idea at this point if that is due to general atrophy of the region from lack of use and exercise and being in splint, cast, and NWB boot for a while, or if it has something to do with the plantaris. Perhaps others on achillesblog.com can enlighten me? One thing it might explain is why my heel is the most sore part of the area around my Achilles, and continues to bother me.

In the office the day before the procedure my surgeon described several possible things he might do to reinforce the repair once he got in and looked around. He mentioned animal tendon, such as pig; He talked about folding down some fascia, or something like that, but he didn’t mention the plantaris until two days later. I guess one should expect a pro to improvise as they see fit. Yet it feels a bit different when my Doctor does something unexpected inside my leg while I am asleep, compared to for example when my mechanic fixes an electrical short by cutting a cable under the hood and replacing it with something he likes.

When I’m driving in my car
And the man comes on the radio
He’s tellin’ me more and more
About some useless information
Supposed to drive my imagination

7+ weeks post op — So I was sort of forced to drive my truck into work today. I had planned on just driving to the train station (4 mins away) for practice, and taking the train/taxi into the work office. But I forgot to get the handicap placard from my wife’s car, and there was no regular parking available, so I just said to myself: “Oh fraggit, may as well drive the 30 min drive all the way in”. Figured I would be beholden only to my schedule and not the Train/Uber combo I’ve been using for the past couple weeks. I had my winter shoe on my right foot. The shoe is quite large and roomy but my foot was so swollen that I could barely slip on the shoe. I had to wriggle _very_ carefully so as not to wrench my foot up too fast or with too much force. Between that and driving like a grandpa at about 25mph all the way on back roads it ’twas a bit anticlimactic. I was paranoid about injuring the tendon pressing on my pickup truck’s stiff gas pedal, and its old-only-manual brakes, so I kept my foot pointed in a funny downward slant and pretended like I was walking with the Aircast boot. I used the left emergency foot brake a lot to pre-slow down at controlled intersections. I’m sure I annoyed the hell out of every driver behind me today