Drop-foot or AFO Brace?

Has anyone ever used a drop-foot or AFO brace during the month they have transitioned into regular shoes?  I’m trying to find something to protect my foot after I am out of the boot.  I just want to do anything I can to avoid a re-rupture.  My friend was given an AFO Brace years ago but my doctor isn’t too receptive to it.  I see that it’s something I could order on my own so I thought I’d ask.  Thank you all!

Week 9- Standing Heel Raises

Well, I now officially know why people cry in physical therapy.  Up until now, it’s been pretty fun, aside from the occasional massage/torture on scar tissue.  Today, my physical therapist asked me to do things I don’t even remember how to do- like stand up from a chair without using my arms and leaning forward on one foot without using a bar for balance- without my boot on.  I told her that I thought I was going to cry but she really didn’t back off.   I am SO worried about re-rupture as this is the exact time it happened last time in my rehab process.  Granted, it’s an entirely different protocol but I am still so shaky.   She assured me I could do this and that my foot was protected since there was a towel under my heel.  So, reluctantly I followed her instructions and I could actually do everything!

She sent me home with a new set of home exercises, all to be done with a shoe and lift in the heel or a towel under my heel at all times.  She wants me to do “forward leans”, where I stand with my injured foot in the front and the uninjured foot in the back.  I lean forward on the injured foot until my toe grabs and hold for 10 seconds.  I repeat that until 3 sets of 10 are done.  Then, I do standing heel raises where I get to hold onto a chair.  I really didn’t think I could do these at this point but I could thankfully.  Next I do single leg balances, keeping my knee “soft”.  I hold for 30 seconds and repeat 3 times.  Last, I sit to stand where I literally just stand up without using my hands to push or any momentum.  I slowly lower myself back onto the chair and then repeat 10-20 times, depending on how I feel.

She told me I could start doing half squats during my work outs, as long as I’m wearing my boot.  She wants me to make sure I’m leaning back into the squat and not letting my knees move forward over my toes, as that would put too much strain on my achilles.

So the differences between where I am now and where I was last time, just a few days before I re-ruptured my achilles?  I remember always feeling like my achilles was SO tight last time.  I was already in shoes and running errands all over town.  I thought it was just normal for my achilles and bottom of my heel to hurt any time I walked or tried to stand.  This time, my achilles really isn’t hurting at all.  I stopped a couple of times to point out little twinges in the sides of my heels but she said that is normal.  It’s apparently just from all of the muscles and tendons realizing they need to work.  I told her I was concerned that I’m not as flexible as I was at this point last time but her reply was “good!”  She said that means the calf and tendon are actually getting stronger and she wants it to be a little less flexible at this point.

I am really having a hard time with switching to the flatter, skinnier sole on the Vacocast.  I try to put it on and it just seems like my heel is dipping below the 5 degrees it’s supposed to.  I guess that’s just because the achilles sole is so huge?  I’d love to hear everyone’s thoughts on this as my physical therapist and doctor aren’t too familiar with the Vacocast.

Week 8 Post Re-Rupture

Just when I feel like I am making such great progress, I realize how far I still have to go.  I started driving on Sunday.  While I have great control over my right foot, I still am paranoid about the chance of re-rupture.  I have to use my left foot to really brake hard or to rest at a stop light.  It’s super inconvenient because I have to use my boot until I get to the car, change into my sturdy shoe with a heel lift, and then change back into the boot once I get where I’m going.  But, I’m thankful for at least being able to run out to show a house or pick up the kids, if needed.  I still have my hired driver but she goes back to school in a week so I won’t have that luxury soon.

I did transition to sleeping without the boot.  That’s a nice treat although again, it’s a pain to have to put it back on if I have to get up in the middle of the night.  My ankle doesn’t feel any tighter in the morning when I put the boot back on so that’s good.

Physical Therapy was painful today.  She had me add weights to my seated toe raises and really added a lot of weight to the side lifts (on my side and weights strapped to the top of my foot.  I have to lift my foot and slowly lower it.) The most painful part was the scar tissue massage and the calf massage.  Ouch!  I’m so glad she is getting in there but man, it hurts.  She reminded me that if it hurts, it means it’s still connected.  She also has me on the stationary bike for 10 minutes with little resistance.

We talked about transitioning from the big achilles sole on the Vacocast to the flat sole.  She said she likes to do changes every 2 weeks if there aren’t any problems.  Since I just went down to 5 degrees a week ago, I’m going to wait until next Monday to try the flat sole.  Both my ortho and physical therapist really don’t want me going to 0 degrees quite yet.  I’m fine with waiting as it seems I’m making progress with strength.

I tried Pilates at a local studio on Monday.  That was interesting.  I’m still not sold on the effectiveness of it but I think it will be a good balance to the weight training twice a week.  I was super concerned about hitting my foot or her bumping into it but she tried to clear everything so I wouldn’t worry so much.   She really worked my good ankle to make sure all of the little stabilizing muscles are strengthened in case I trip or need extra support on the good foot.

Physical Therapy, Round 2

At week 7, I started up physical therapy again.  My previous physical therapist had taken a new job and wasn’t going to be there so I opted to go to a physical therapist who focuses only on foot and ankle issues.   My friend and tennis instructor (who was on the court when I initially ruptured my achilles) had also ruptured her achilles a few years before and highly recommended this physical therapist.

It was going to be different this time because I had gone the non-operative route after the rerupture.   This physical therapist doesn’t believe in stretching the achilles at all, but instead to focus on strengthening and loosening up the calf, which is attached to the achilles.  She said that my calfs were REALLY tight and that I could blame my genes for that.  She immediately had me doing strength exercises and had me doing leg presses (from the heel only) on the Pilates Reformer.  I was sent home with instructions to roll my calf twice a day on the Theraband roller, really focusing on the “knots” I could feel.  She said I should only need to come 2 times a week, as long as I do my exercises at home.

At home, I am doing 2 sets of 10 each: seated calf raises, arch raises, and windshield wipers.  I also roll my foot and calves out on the Theraband Roller.  I do this in the morning and at night.  She also suggested going in the jacuzzi and doing normal range of motion movements but nothing that would stretch the achilles.

My personal trainer from my former physical therapy office also had me focusing on stretching.  He showed me seated leg stretches that would loosen up my calf and hamstring.  I found them MUCH easier to do in the jacuzzi, but I am supposed to do them several times a day.

I’m a couple of weeks into physical therapy and feel so much better.  I don’t have any of the tightness  and pain that I had the first time around.  That could be because it’s been 4 months since the initial surgery and I went non-op the second time but all in all, I’m very happy with how things are going so far.

My doctor saw me at week 7 and said I should probably leave the Vacocast set at 5 degrees dorsal flexion and that I could gradually start opening up the plantar flexion so that I get some range of motion.  My physical therapist said to leave the achilles sole on for a little bit longer but I’m hoping I can make the switch when I see her tomorrow.

5 weeks down… PRP, PT, FWB?

The trip and the holidays made those 5 weeks NWB fly by.   I saw my ortho at the 5 week point and he was much more positive this time.  This time, my foot responded to the Thompson test and so there was a little cheer by everyone when it moved!  He was much happier with “the contour” of the achilles and said the thickening of the achilles that he expected was almost non-existent.  He wondered if that was a result of the initial PRP (Platelet Rich Plasma)?

We also talked about an additional round of PRP.  He said that it is unproven if it works but the feedback seems to be good.  He explained that I’d be casted again while my body goes through an inflammatory response to the PRP.  Given that they’d be injecting it into my achilles and there would be an out of pocket cost of $750, I opted to skip that process.  No thanks!

He did say he’d like me to start physical therapy after week 6.  I wasn’t able to get in to the physical therapy office until week 7 so that was delayed a bit.

Thrilled with the flexibility of the Vacocast, he gave me instructions on how to move to full weight bearing and then to 5 degrees dorsal flexion.  This time, rather than gradually going weight bearing over the period of 3 weeks while I was also adjusting the angle down to neutral, he wanted me to only focus on being full weight bearing within 5 days and then moving the angle of my boot to 5 degrees by the time I saw him again in 2 weeks.  This was HUGE to me and I would really recommend talking to your doctor about that.  It was so much easier and less painful to do it this way.  Within 4 days, I was full weight bearing but still at 20 degrees DF fixed and in the achilles sole.  Over the next 10-12 days, I gradually reduced my boot in 5 degree increments so that I was at 5 degrees DF fixed by the time of my next appointment, 2 weeks later.  Not that I ever want to do this again, but I wish I had this path laid out for me on the first go around.

All in all, he was pleased with how things were coming along and said he wanted to see me in 2 weeks and to start that PT.

Cruising on One Leg

This was going to be interesting… navigating through airports, new hotels, new places, different countries… all on one foot and a knee scooter.  I had so many questions and the “unknown” was unnerving.  I had already been dumped on my scooter because of bumps in the road so I was pretty nervous and feeling pretty vulnerable.

I alerted both airlines that I might have some trouble sitting in a regular seat.  We were flying Virgin America Airlines there and Southwest back home.  Virgin immediately emailed me back asking what I needed and how they could help.  Southwest, who we are A-list frequent flyers with, didn’t respond.   I was so happy when I went to print our boarding passes and saw that Virgin had upgraded us to seats with more leg room, free food, and lots of other goodies.  My kids were still in the regular seats but my husband and I had something to look forward to.  I’m a huge fan of Virgin America now!

My husband found a great parking service at LAX where they would drive us in our car to the airport, drop us off, and then return to the car to the parking structure until we returned.  This eliminated the need to move everything out of the car, into a bus, and then out of the bus.  Considering I was on a knee scooter, I was thrilled.   The cost was about the same as our normal parking service ($20 per day.)  This made life SO much easier the morning of the flight.

The airport security allowed us to move to the front of the line.  Being on a knee scooter may have gotten us to the front of the TSA line but the time it took for them to search me was really long.  It was actually pretty invasive but I understand the need for a thorough search.

The next 2 weeks was interesting and I definitely got more comfortable by the end of the cruise.  Each port was an unknown but it really did all work out.  I had rented a motorized sit-down scooter for the cruise but really didn’t use it that much at all.  I found that I didn’t like being down so low and that the knee discomfort being on the scooter was better than being “unseen” by the crazy cruise passengers.  The buffets were the worst!  People acted like I was invisible and would just plow over me to get to the food.  By the second day, we just made arrangements to always eat in the main dining room where the food was brought to us.  The window of time was shorter but it was just such a better experience.  Also, the scooter wasn’t very nimble so getting into tight spaces like a crowded main dining room was almost impossible.  I found the knee scooter to be much better for most situations on the cruise.  I really just had to be aware.  I had to make sure I didn’t go over a bump too quickly and I really had to hold on tight if I was going over uneven surfaces in the ports.

The cruise ship was good about providing a wheel chair (free) that I could have used around the ship so don’t spend the extra money for that.  They also provided a shower chair so that was nice.  Although we didn’t have a handicap room, it was pretty easy to get around and through tight spaces.

The cruise ship itself was really pretty handicap accessible.  I never had to wait in line for a bathroom and all of the doors had a big button I could press to open and shut the doors (except for in the stateroom.)

I had to do a lot of research about the ports early on.  I ended up hiring a private guide in Jamaica, who was awesome.  He dropped my mom and I off at an easy to get around shopping center while he took the rest of the family to cliff jumping and hiking spots.  I highly recommend Chris Jamaica Tours whether you are in a handicap status or not.

The private island of Coco Cay was also pretty easy to get around.  The tender boat was too difficult to scooter on to so I just took my crutches.  They had beach wheelchairs waiting at the dock so I transferred quickly to that.  My family parked me in a great beachside lounge chair so I could watch them.  There was shopping and lots of things to watch while the kids ran around everywhere having fun. We were on the first tender boat to the island and also on the last back to the ship.

Cozumel was also super fun.  The kids and my husband left early for a snorkeling trip while my parents and I took our time getting ready.  Since it takes me twice as long to do anything, I was ready about the time the kids finished their snorkeling trip.  We met them at the dock as they were finishing up and were able to catch a cab right from the dock.  It was super organized and they were very accommodating about my limitations.  We found a van that seated all 8 of us and we headed off to Paradise Beach.  It was perfect- easy to navigate, good food, lots to do for the kids, etc.  The cab driver waited for us to return and so it was a very easy, affordable way to spend the day at the beach in Cozumel.

I am so glad I didn’t let this injury prevent us from going.  Would I have liked to be out doing all of those fun things? Sure!  But we all had such a great time and I got to spend more time with my parents than I normally would have if I was out running all over the islands!

Questioning the fit of the Vacocast

I wear a size 9 women’s shoe so I was really in between sizes.  When I ordered my Vacocast, I went back and forth trying to decide on a small or a medium.  I chose small based not the advice of the Vacocast team.  They said I was right in between and it would be best to go down rather than up if I was in this position.  I chose small.

When the doctor allowed me to go into the Vacocast, I was surprised at how tight the cover was.  The top portion of the boot couldn’t fit down into the bottom as the video showed it should.  I was leaving for vacation the next day and didn’t really have a lot of time to replace it.

Again, I emailed the Vacocast team and she called immediately.  She asked a few questions and said that I really should just stick with a small.  I told her that my toes are practically hanging out but she said the next size up would be SO big (up to a women’s size 13) so it would be best to keep the boot I had.  She also told me how to make sure the bottom of the boot was lengthened as much as possible so I made that adjustment.

For weeks 4-5, I was to be NWB at 20 degrees fixed.  This was going to be an interesting cruise!

3 weeks post-rerupture- More casting or Vacocast?

My follow up with my doctor was 3 weeks after being casted.  We were supposed to leave for our Florida and Caribbean vacation 2 days later so I was eager to see what the doctor had to say.

They removed the cast and he flipped me over to do the Thompson test.  The Thompson test is where the doctor squeezes your calf and if there is movement in the foot, then it is assumed the tendon has reattached and is doing its job.  Up until this point, every doctors visit and every pt visit had always been so positive- as though I was progressing so beautifully.  So, when there was silence after the first few times he squeezed my calf, I knew things weren’t going as well as I imagined.  Sure enough, he called for the ultrasound machine.  He was able to show us that the tendon still hadn’t completely re-attached, although he said the scar tissue from the previous surgery did distort things.

I could tell he wanted to re-cast me.  Seeing that we were flying to Florida in two days, I begged him to let me in the Vacocast instead. I was worried about swelling from flying and being trapped in a rigid cast.   I had to do a lot to teach him about the Vacocast as he had never heard of it before.  I explained that the rest of the world uses the Vacocast in place of a plaster cast.  I demonstrated how sturdy the beads became once I vacuumed out the air.  The kicker was that I promised to treat it as a cast and even shower in it.  He agreed and we all marveled at the features of the Vacocast as I put it on.  He told his cast room director to look into getting these boots so I had to model the boot as he took pictures to do his research.

He instructed that he wanted me non-weight bearing completely until he saw me again, in 2 weeks.

New Gear

This time around, I decided I’m investing in good equipment.  I ordered my Vacocast, found a new knee scooter that doesn’t tip so easily, bought cushions for the crutches, and found awesome waterproof cast protectors at Walgreens.  Although I couldn’t put my Vacocast on yet, the new equipment made life SO much easier.  Sadly, insurance didn’t cover any of it but I’m worth it, right?

Noooo….. Re-Rupture

Just shy of 10 weeks post-op, I was out running errands.  Dumb errands- buying Christmas scented candles at the mall, grocery shopping (I have plenty of family members who would have done it for me), decorations for Christmas cookies  for a get together we were having that night.  All day, I kept thinking how my achilles feels SO tight.  At this point, I was in regular shoes with no lifts.  My doctor never mentioned buying any lifts and had released me with “no restrictions.”  So, out and about I went.  I felt tightness with every step I took but I continued on as I thought that was just the way it was supposed to be (maybe it is?)

I was coming out of the grocery store with my arms full of bags, crossing the street, looking for my keys when I stepped up on the curb to get out of the driveway quickly.  Sadly, I didn’t place my entire foot on the step and boom!  I felt it immediately and knew that I had torn it again.  My car was only a few steps away so I hobbled over and immediately called my husband.  I was shaking and having a hard time telling him what I had done.  I managed to drive home as I still had control over the foot.  I called my doctor and spoke to the physician on call.  He told me to go back in the boot and call the office first thing in the morning.

The next day, my doctor called first thing in the morning.  He was off that day but told me he was coming in to meet me.  My physical therapist also wanted to see me.  Since she was already in the office, I went to her first.  She did some initial tests and really couldn’t tell.  I could push and pull pretty hard with my foot so she was hoping that maybe I just felt scar tissue breaking away.  I could hope!

My doctor wasn’t so optimistic.  He said my foot didn’t respond to the Thompson Test but was perplexed since the strength and control were still there. He made an appt for the MRI that afternoon and said we should hear back within a couple of days.

The MRI is a pretty annoying experience.  I don’t mind laying there.  Or the loud noises.  But both times I had really unsympathetic technicians.  They gave me a changing room across the hallway from the MRI room.  Then, as I hobbled into the room, they told me I had to leave the crutches across the room and to lay down way over there.  They need to know that most people who are there with injuries probably need their crutches to get across the room.  She offered no assistance so I was left to hopping across the room.  I have a fear of rupturing the other achilles so I was a little annoyed at that point.  Then, they have to put your foot in 0 degrees in a rigid brace to do the MRI.  I could feel the tension and wondered if I was doing more damage to it.

Surprisingly, the MRI results came back that day and my doctor called me that evening.  He confirmed a 90% re-rupture of the achilles and said I have to start at Day 0.  I was devastated.  This time, he suggested not operating because there wasn’t a gap and a revision surgery could be messy.  He recommended immobilizing for 3-4 weeks and then going from there.

The next day, I was back in the cast room.  It was December 5th so I opted for a bright red cast with candy cane stripes.  It was about the only thing I could think to do to make this all better.   I recognized that the first time around, I didn’t have the best attitude.  I had a “poor me” attitude and really didn’t want to do much other than help my current buyers and sellers and tend to my kids.  I hadn’t used that time to read the books I was too busy to read, complete my business plan for 2016, research new ideas, finish my website… all the things I always say I need a break from real estate to do.  Well, I had a bit of a break and I got none of that done.  I wouldn’t have that luxury this time around so I vowed to have a better attitude.  My candy cane cast was a statement that this time was going to be better.

The doctor said he wanted to see me back in the cast room in 3 weeks, which was 2 days before we were supposed to leave on a 10 day trip to the Caribbean.  This had been planned for a really long time as we were all celebrating my parents’ 50th wedding anniversary.  We spent a couple of weeks trying to decide if we should cancel or not and finally we decided just to go for it.

This time was a bit easier to be NWB.  I was more used to the crutches and I was stronger from working out with the personal trainer at the PT office.  It was also a quieter time.  My daughter’s volleyball and son’s football seasons were over so they were home more.  School was about to be out for Christmas break.  And we were about to leave on a cruise.   I made myself read those books, work on my business plan, and research new ideas.  I also went to Costco and stocked up on groceries so I could make more meals at home.  It was a much better experience this time!