Sorry, it’s been a couple of weeks since my last update - been busy at work and been spending less time on my backside, which is a good sign of recovery. Much has happened of late…
Week 8 - Everyday I’m shuffling
At the 7 week and 5 days post-op point (1 week and 5 days out of cast and into 2 shoes), I started moving about indoors without crutches, a pretty big milestone! But I was far from having a normal walking gait. I was shuffling along, moving my injured (right) foot forward then bringing my good foot just slightly in front of my injured foot. But this has opened up a whole new world - I was able to make a hot drink and carry it over to the coffee table, and I was able to move items about in the apartment without carrying them in my satchel!
Week 9 - Monster week for change
Getting to neutral: A day or two into the 9th week I was able to get my foot to neutral, which was also another big milestone. It enabled me to stand with an even weight distribution over both feet and not have my right foot slightly in front. It is also another step towards a normal walking gait. By the end of the week, I was able to get about 8 deg beyond neutral.
Post-cast OS visit: Saw the doctor at the 8 week and 2 day mark and he thought I was progressing ok, but probably a bit behind average since I was barely at neutral, and still on 2 crutches. He encouraged me to be much more aggressive in my stretching, which is surprising since most protocols I’ve come across have said gentle stretching at this point. I asked if there was any risk of re-rupturing with this aggressive stretching and he said that it is minimum at this point. I told him I would feel a "tearing" sort of pain and he said that it’s normal - any stretching of the tendon actually results in slight tearing in order for it to lengthen. He said that he could prescribe painkillers if it’s the pain that’s holding me back from stretching more. The key point he gave about stretching was that it needs to be sustained for about 20 sec or so for it to be effective. I asked him about scarring and the size of the mass in my heel, and he said that it’ll take a couple of years for it to return back to normal.
Change of PT: I was happy with my previous PT but I would’ve only been able to go a max of 6 times due to an insurance benefit limit. I realised that my insurance would provide more PT sessions if I changed to another PT practice, so I made the change. I was very unimpressed with my new PT - not only was his personality obnoxious, he was quite hands off, with the session consisting of 5 min ultrasound, 20-30 min of TENS, and 15-20 min of waiting around for him. I’d say only a total of 5-10 min of time covering Q&A and hands on treatment (the previous PT involved a solid 45 min of hands-on 1-on-1 and no ultrasound nor TENS). The one positive from this first visit was that showed me how to get in behind the Achilles and massage away some of the swelling and scarring. I figured I would be patient and give him a chance.
Weaning off crutches: Did anyone else feel that this was an anticlimax? I mean, not only was there no fan fare and people high-fiving me with every step I make (jokes), it wasn’t exactly a clear transition point where you go BOOM, I’m now walking without crutches! It really is weaning. During week 9, at home I would be crutches-free other than when I would get up in the middle of the night, when I would use 2. In the office I would use 1, dropping down to none by the end of the week. Outdoors 2, dropping down to 1 by the end of the week.
Going solo on public transit: HK is quite a crowded city, there are lots of pedestrian obstacles to get to the train/tram/bus, and sudden stops wouldn’t be so great for the Achilles if I couldn’t access a seat. I’ve been riding public transport for a couple of weeks with my wife present, but mid-way through this week I finally built up the confidence to do it alone. Woohoo!
Week 10 - Look no hands!
At 9 weeks and 4 days post-op (3 weeks and 4 days out of cast), I finally felt comfortable enough to ditch the crutches outdoors - woohoo!
PT still disappointing: One of the sessions this week, I went for a whole hour without seeing the PT (other than him sticking his head in for 10 sec to see how I was). This hour was again filled with ultrasound and TENS (administered by an assistant who is more or less a receptionist!) and waiting for the PT to show up. The ultrasound head actually hurt my scar a bit, and it’s left a bit of a rash, which I’m not thrilled about either. The one thing I was happy about was that he got me on a stationary bike (medium resistance for 15 min and 40rpm) and got me doing leg extensions to work on my quads. I really had to push him to get advice on next steps and exercises I can work on between PT visits. He would let out a sigh and say, "Rome wasn’t built in a day", which I found super frustrating. I’m not looking to go do a marathon, but simply take the next step and work on rehab in between visits.
Back to the gym: Now that I’m more mobile without crutches and had some exercises could work on, I realised I could get back to the gym. I’d ride a stationary bike for 15 min and get a sweat on, do leg extensions, and work on areas other than my legs also.
Week 11 - Walking better, and walking away from my PT
My flexibility has been coming along - I can now bend my ankle so that the front of my knee is just in front of my toes. My walking has been coming along too, with the limp almost non-existent at times. I can now descend stairs with either foot without holding the hand rail. Although when stepping down with the good foot first, it’s not as slow and controlled and for larger stairs I end up landing the good foot out a bit to the side. I’m finding that my heel would be quite stiff at the start of the day, and both stiff and very sore by the end of the day.
Today I said bye bye to my 2nd PT clinic. Over the past few days, I put a lot of thought into whether this clinic is working for me. I felt that I’ve been wasting my time with this guy and couldn’t take it anymore. I consulted 5 PT friends who work across Australia, NZ, Canada, and the UK to get their perspectives about the treatment I was receiving, particularly around the reliance on Ultrasound and TENS. Here’s the low-down:
Ultrasound: 3 said that ultrasound can be helpful in healing and reducing swelling but only in the first couple of visits post-injury. 2 said that there is no evidence-based research that proves ultrasound is beneficial in rehabilitation, with one of these 2 saying you’ll be hard pressed to find an ultrasound machine these days in a reputable clinic in the country he works in.
TENS: All 5 believe that TENS is helpful for pain relief, with 1 emphasizing that it doesn’t always work well. However, I’m finding the pain manageable, and I don’t think this pain is completely avoidable anyway.
All 5 said that they would expect to see more hands-on rehabilitation, with a focus on strengthening and proprioception.
I will be going back to the previous clinic, but to a branch further away that happens to be covered by my insurance so I will be able to get more visits in too. I feel relieved to have parted ways with the useless PT and am looking forward to the next session.
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