Two-shoes! (Ow!)

October 11, 2012

Well I’ve been in 2-shoes since Monday. Surgeon asked me if I wanted to get out of the boot and into shoes. Does anyone say no to that? Anyways, he took one of the layers of my heel wedge and told me to wear it for about a month then wean out. He said there’s no evidence to support that, it just makes him feel better.

So this wedge is a huge pain in the butt. It is not soft at all, and my heel is absolutely killing me. I layered a gel heel insert on top of the wedge, but it didn’t really help at all. It’s not helping that I’ve been on my feet for up to 16 hours a day this week. Today I wore Dansko’s without the wedge and felt a little more comfortable, but my heel definitely still hurts. Should be a long 4 weeks.

On to the good stuff! I have very little limp. I limped out of the office because I was nervous walking normal. I headed straight to PT, where she made me walk like a normal person. I was pleasantly surprised to find that I had very little tightness in the tendon. I also had only a slight limp. She made me do some heel-toe walking and told me to focus on pushing off my toes when I walk, so I wouldn’t shift all my weight to the left side. I’ve found that this is pretty easy to do, except in the morning or when I’ve been sitting a while - the tendon really tightens up.

PT this week has been biking, walking, and mostly working on my balance. I am very bad standing on only the bad leg. Doesn’t help that I’ve never had good balance. Anyways, who here has experienced this terrible heel pain? Have you found anything to fight it?

Pic of my legs - hello swelling (bad leg is on the right)
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7 weeks post-op

September 29, 2012

Well, 7 weeks since surgery #2. It has been a completely different experience this time around. Getting the walking boot after 4 weeks instead of not at all has been great. (And my current surgeon usually does it at 2 weeks, for first-time rupture-ers.) PT starting at 4 weeks has been awesome, not only for the calf-strengthening, but just so I can bounce little thoughts/concerns off the therapist 2-3 times a week. My surgeon is totally fine with me emailing him questions as well, and often responds the same day. I couldn’t ask for a better experience to be honest.

Therapy has now added green and blue therabands for resistance to plantar-flexion and inversion/eversion. I still am not dorsi-flexing at all. I’m also doing bridges, where basically I lie on my back with my legs bent and the balls of both feet on the floor. I then raise my body up on the weight of the balls of my feet, trying to put as much weight on the right (op) side as possible. Basically supine pelvic thrusts. It’s pretty sexy. 3 sets of 15. Then seated calf-raises with weight belts around my right thigh, 3 sets of 20. Otherwise still getting ultrasounds every time, manual massage (no more Graston thank God), biofeedback, and ice at the end. My therapist is killing me but I love her for it. I will post a picture of my legs this week - I think I have really gained some mass on the right side.

At this point in my recovery after my initial surgery, I was in two-shoes, and supposed to start rehab. I can’t imagine going to two-shoes right now, and I can’t imagine not having 3 weeks of rehab under my belt already. I am only in the boot for 9 more days, and when it comes off I’ll be happy, don’t get me wrong, but very nervous. I am starting to feel a little stretch on the tendon just with the full heel-lift in the boot. Hopefully that’s just my calf getting stronger with the rehab, and not something more ominous. A lot fewer weird twinges and pulls than last week, which I think is mainly a tighter boot and being more careful.

At this point, I can honestly say I’m glad that I reruptured right away. Of course, not re-rupturing would have been the ideal, but I think that eventually I would have blown it again. I base this thinking on the pain I was having in the weeks leading up to the re-rupture (and maybe micro-breakdown of the tendon?), the low “explosiveness” of the activity that caused the re-rupture, and the fact that my new surgeon said he didn’t find any of the long-stay sutures in the tendon that my original surgeon said he used. This is of course speculative as hell, and I say this with a decent amount of disdain for the earlier guy, but I’m going to continue to convince myself that that’s the truth.

That’s it for now. Sorry these are so long. I just want to say a little then vomit a ton of stuff that most people don’t care about - it’s good to get it out. I want to say thanks for the first and not last time to Dennis, for maintaining this site. Also, to everyone out there in the AB community: the emails I get when people respond to these posts with words of hope and encouragement do so much to brighten my day and push me along the path to recovery. You guys are awesome.

Well the title basically says it all. I moved out of my cast into a CAM walker 12 days ago. I haven’t used any walking assistance since. My surgeon told me I could weight-bear as tolerated, and so far, I’m tolerating. Started PT 8 days ago. Ultrasound for 8 minutes, then 10 minutes of manual massage, then 10 minutes of biofeedback calf strengthening, then picking up marbles, then ice. Same routine the 2nd visit with the addition of Theraband exercises - plantar flexion to more plantar flexion. The goal now is calf strengthening without stressing the tendon to make sure I don’t stretch the repair.

Another addition on my 3rd visit was Graston technique.
http://en.wikipedia.org/wiki/Graston_Technique
http://www.grastontechnique.com/AboutUs.html
Holy crap, that was intense. My PT scrapes this metal tool along the tendon, and dear Lord, it hurts. There’s very little science behind it, although in theory it sounds good. Breaking up scar tissue/adhesions sounds excellent - I’m worried about the resulting inflammatory response and the build-up thereafter of further scar tissue/adhesions. I talked to my surgeon and he said some anti-inflammatories afterwards wouldn’t hurt, so that’s what I’m doing.

It has been interesting to see the results thus far of the biofeedback. They attach two electrodes to your calf and measure the force of your contraction. I don’t know the units, but my good calf could generate 190 units of force (?), while my bad calf was in the 30s. That was the first visit. The second visit, I got up to the 90s, and I was at 130 at the third. Who knows how reliable these machines are between sessions, but my good calf continues to register in the 190s. In between PT sessions I am doing the same exercises non-stop, so it is likely that this is helping me get some calf conditioning back.

One question for you guys - during the CAM walker phase/PT, did any of you experience little twinges on the medial and lateral sides of the tendon when you turn a certain way? I know that the tendon is intact, and I am in my boot with a heel lift constantly, trying my hardest to not stretch out the repair. I am utterly terrified that I am micro-damaging the tendon and weakening it, setting myself up for another rupture. After I got into 2-shoes the first time, the first few days of walking (no prior PT, was in a cast for 7 weeks) were rife with these twinges. Just would like to know what you guys experienced.

Freedom!

September 9, 2012

Alright, so not really freedom, but close! I went and got my cast off 2 days ago. I can’t believe how great it is, and how much I take being able to use both of my legs for granted. It’s amazing. Here are the photos from that day.
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The scar looks really good actually, especially for a redo. It looks better than the first one did. My first scar also had a lot of “scar balls,” or little bumps of scar tissue along the scar line, and this one has none of those. What that means, I don’t know, but this one is more aesthetically pleasing and also feels smoother to the touch. It was glorious to have my foot in the open air. I got the alcohol rub down, and there were mountains of caked dead skin coming off. Nice, huh? It was really gross. Anyways, my surgeon set me up with a CAM walker, and said I can weight-bear as tolerated. I have a 2-3 inch heel lift in to keep tension off the tendon, and it’s not the most comfortable thing to stand on, but at least I can walk! It’s so great to be able to use both hands and not have to worry about strapping on my IWalkFree or unfold the knee-scooter. Here’s a pic of the legs side-by-side - the atrophy doesn’t look worse, and I think the right leg almost looks better, compared to last time.
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I rewarded myself with gross Subway for lunch and went back to work. As soon as I got home, I showered, without a plastic bag on my leg. My surgeon said it was okay to weight-bear without the CAM walker on, provided I stayed in equinus, with only the ball of my foot and my toes touching the ground. No way am I doing that. I am not going through this again. I tried it for about half a second before my right leg basically tried to give out on me. It is very weak. More dead skin came off in the shower, but it was great to just sit there and wash the leg. It needed it. Here’s how I spent my Friday night. (I’m have no friends in Houston.)
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Yes, that is Walter White in the background. Breaking Bad, just one of the great shows I watched too much of during this recovery.

Right now I am at work, and getting around great. It is still nice to take off the CAM walker and elevate my leg, and walking around or standing for more than 15-30 minutes makes my heel start to hurt because of the uncomfortable heel lift, but I couldn’t be happier at this point in the recovery. I am going to start PT next week and hopefully by the time I am in normal shoes, I will have some strength back in my right leg.

Oh, some people were asking about the IWalkFree. Basically, it’s a device that straps onto your leg and works as a crutch while allowing you to use your arms.
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Great device in theory, but to be honest, I never really was that comfortable in it. I would use it for 15-30 minutes at work, when I absolutely needed to stand, but I depended way more on the scooter. I was hoping it would be a replacement to the scooter, but I could never get it comfortable on my shin, and if I wore it for more than 30 minutes, I would start to get pins and needles in my foot. After an hour or so of wearing it, I was assured of pins and needles in my foot for 6-8 hours. Just not worth possible nerve damage to me. Was it worth $120 to rent it for a month. Hard to say. I’m definitely happy I didn’t buy one for $300-400.

Okay, that’s it for now. Probably won’t post for a bit, maybe once after I start PT. After that post, the next one will be in shoes (!!).

Well, I apologize to all my faithful readers (haha) for keeping you in suspense. The recovery from my re-rupture is going well. I was in a splint for 10 days before switching to a cast. My surgeon kept me in equinus, as I expected. He usually moves people straight to a CAM walker and starts PT at that point, but since I was a re-rupture, he wanted to have a couple more weeks of rest. At my appointment, he told me that I could weight-bear all I want, but that it would awkward and difficult, being in equinus and all. I was happy about that, because it meant I could hobble around and not use my knee scooter or IWalkFree to go from room to room. Here are some pics of my leg after 10 days of non-use (atrophy on top of atrophy, at this point) and the wound. Squeamish folks need not apply here, even though these are quite tame compared to my last post.

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The wound actually looked better than my old one did, which I was happy about. Anyways, got casted up and did a week at work using my IWalkFree and basically hopping around. I have a stand a lot at work and was relatively miserable. The IWalkFree is nice, but I haven’t been able to really get comfortable in it. I still use the scooter mostly, and use the peg leg for times when I need both hands, but I can only wear it for 30 minutes or so before I start getting a decent amount of shin pain, which later turns into neuropathy. If I wear it for more than an hour, I have pins and needles in my feet for up to 8-10 hours after. No good.

The scooter has been an absolute God-send though. If not for that device, I would be quite the depressed dude right now. Last week I spent in Ireland, which was not ideal, but I still was able to get around almost like a normal person. It also performed well at yet another wedding. Here’s a picture of me at the Guinness factory with my wheeled companion.

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It also traveled well, and all the cutting to fronts of lines and sympathy is worth the weird looks you get from basically everyone. Especially in Europe - people looked at me like I had extra limbs.

My next appointment is in two days, when the cast finally comes off (I shouldn’t complain, I’ve had it 3 weeks less than my last one) and I move to a CAM walker. Also supposed to start PT this week. Should have the CAM for 4 weeks, which is fine. As long as I can ambulate to some degree. Also, in no rush to rush things.

For those of you who have been unfortunate to also re-rupture, were you hyper-vigilant about the state of your other, non-injured, Achilles? I have some random pulls and pains around my ankle, which I am so worried is something more than it probably is. It likely is just weird strains from having to use my other foot so much, but holy crap, I’m worried about tearing the other one. Another update after the cast comes off. Consider yourself lucky that I can’t upload smells.

WARNING: I AM INCLUDING SOME GRAPHIC PICS OF MY REPAIR IN THIS POST. FYI.

So it’s 1 day after re-repair of my Achilles. I spent the 11 days in between my injury and re-repair in a CAM walker. At first I couldn’t put any weight on it at all, but the day before my case I was walking around painlessly with just the boot. I could completely dorsi- and plantarflex without pain. I couldn’t walk around without the boot but it really made me doubt whether I needed the surgery at all. I planned to ask the surgeon prior to doing all the necessary stuff in the preop area, but they moved so fast at the hospital that I didn’t even talk to him before the anesthesiologist had given me some sedation, and at that point, I didn’t really care what they did.

I chose to do spinal anesthesia again with peripheral nerve blocks. I requested a short acting spinal agent so I would be able to hop up the stairs to my apartment after I got home. The anesthesiologist was surprisingly rigid in her plan and said she would give me a longer-acting medication in case it wore off while I was on my stomach. Being an anesthesiologist, I was less than pleased. For those of you about to have this surgery, it should only take an hour or so and agents such as mepivacaine and demerol will be more than enough. If they use bupivacaine (which is what I got), you won’t be able to stand on your good leg for 6 hours or so. They also convinced me to have the sciatic catheter again, even though last time I felt the saphenous block was more effective. I’m glad they did, because even now, my foot is numb and I have no pain. I don’t know why the catheter wasn’t this effective last time.

The block and the spinal went well and the surgery only took 40 minutes, which I spent listening to music. Here’s a pic of my tendon prior to repair.

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My surgeon said (and you can see) that it was completely ruptured, so I’m glad I went through with it. Now a picture of what it looked like at the end of the repair.

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After they closed, they put me in a splint, which I’ll wear for two weeks. After the surgery, I spent about 30 minutes in post-op before they tried to discharge me. My dad basically had to put his foot down and make them let me stay, as I couldn’t move either leg at this point. We hung out for about 90 more minutes, at which point I could move my left thigh but not my lower leg. I was wheeled out to my car and 3 people helped me into the car. We went to get my prescriptions and some dinner. Whole thing took about an hour, and by the time we got home I could bear a little weight on my left leg. I rode my scooter to the stairs and used the railings to get up, which wasn’t too bad actually.

Today I’m hanging out on the couch and watching TV. The sciatic catheter is still working well and I haven’t had to take any pain pills yet. I ordered another apparatus from goodbyecrutches.com so hopefully this week I’ll be a little more mobile at work and actually be able to do my job. This is what I got. Once I’m a little more proficient at it, I’ll get a picture up of it.

New surgeon, new outlook

August 6, 2012

Well it’s been 7 days since my rerupture. They haven’t been the most fun, as I noted in my last post. Hopping around on one leg is terrible, but the knee scooter is really helping me out, yet again. If you’re currently on crutches and reading this, stop reading, and go here . You can also order these things on eBay for $200. They pay for themselves almost immediately.

Anyways, I made it down to Houston rather uneventfully. I had a packed bookbag, my crutches tied together and strapped to my back, and my knee scooter. It was quite the getup. I gate checked the scooter and shoved the crutches in the overhead. Everyone was very nice and accommodating. It could have gone much worse. I was able to drive myself back to my apartment, which was good, since I drive a manual. I have been wearing the CAM walker pretty much non-stop just to give me some stability. I try to sleep in it to avoid any weird calf contractions and the pain they bring, but I always end up taking it off in the middle of the night because it is so hot. My calf has completely atrophied back to where it was 3 weeks ago after a week of non-use.

7-days-post-rerupture

I saw my new surgeon today. Granted I am bitter about my past experience, but I got a really good feel from this guy. The staff was nice and the office ran like a machine. He came right in and saw me and actually asked me questions, did a real exam, and quoted literature when explaining his thought process. From his exam, he thinks that perhaps there is a little bit of tendon still in continuity, but for the most part it is reruptured. He said that if I went non-operative for this one, it might be really hard for the two ends of the tendon to reapproximate. He strongly advised surgery (he’s a surgeon, that’s what they do), and said he could do it this week. So I’ll be having operation #2 in 2 or 4 days.I’m planning on spinal anesthesia again, with single-shot sciatic and saphenous blocks for post-op pain control. I don’t think the sciatic catheter helped much at all last time - just left me feeling numb in an area that didn’t really hurt. At least I hope it didn’t do that much. I guess I wouldn’t really know if it was or wasn’t working since I was completely numb.

My dad is being AWESOME and coming down from Maine to drive me home from surgery and look after me for a  bit. I am living on the 2nd floor of a new apartment complex and it will not be easy for the first few days. Another update to come in 2 or 4 days.

4 days after rerupture

August 3, 2012

Well, I hobbled around for 3 days before my surgeon could see me. I kept the ankle wrapped in clean gauze and an ACE bandage to keep it somewhat immobilized. It’s weird - at first, the injury was only mildly painful, and I still had good dorsi- and plantarflexion. But as time crept on the pain increased. I got some significant bruising on my lateral ankle and dorsiflexing at all was very painful. I was back on my crutches/scooter, and reminded how terrible non-weight-bearing is. It really is awful.

A couple bad experiences while not immobilized: 1) when I start to fall asleep, my legs kick (I’m one of those weirdos). Every time they did this my calf muscles contracted and pulled on my retorn tendon. Not a fun way to fall asleep. 2) Trying to take stairs too quickly on crutches and falling down 5-6 steps. My wife, who weighs a little more than half of me, was at the landing below, and tried to catch me. It did not end well for her. She said that she would have felt terrible if she had just moved out of the way though. Just ended with some cuts and scrapes after that one.

Anyways, went to my orthopod yesterday. They confirmed the rerupture with the Thompson’s test. He said the defect isn’t as large as the first time, whatever that means, but he recommends surgical repair. He was less than sympathetic. I asked him if maybe I had been weakening the repair with all the walking I had been doing, since I had started having increased pain around my ankle. He said that no, that was a normal part of the rehab process, and I probably just overstressed it with my jump into the water. Ugh. Anyways, I got out of there with a new leg apparatus, which surprisingly is one that he never gave me during my initial recovery.

CAM walker

The weird thing is, it keeps me closer to neutral, which is more painful then just a splint with equinus.

If there’s any advice I can give to those in recovery, it’s not to rush the rehab process. It’s actually the same advice that the guy who sold me my knee scooter gave me, and I clearly summarily ignored. Don’t think that you’re going to be to 100% in 2 months. It just doesn’t happen. Take your time. It’s not worth throwing 8-10 weeks away.

I’m heading down to Houston in 2 days and am seeing a new orthopod down there. I assume he’ll also recommend surgery, which I assume I will have. It’s frustrating to basically waste 10-14 days in the walker before going to the OR, but I guess we have to do what we have to do. Another update to follow that appointment.

The nadir

August 1, 2012

POD 61. Also happened to the day of my boards, which is the test that certifies me to actually do my job. It was a big day. I felt fine in the morning. Was gimping around the test center ok. Finished up the test and went down to Starbucks to wait for my friends. One of them came down and I suggested that we go to the grocery store to pick up some stuff, as we were heading out on Lake Michigan once everyone was finished. Why did I suggest this? I don’t know. I had vowed to myself to walk as little as possible this week, as I was a little worried about how bad my ankle had been feeling during my move to Houston. Instead I decided to walk 3/4 of a mile to the grocery store and then back carrying groceries. My ankle was not feeling great. We met up with the other test-takers and got in a cab to head to the dock. I got on the boat, took off my shoes, and put my feet up. I had a beer. I felt good. The biggest test of my life was over, I felt ok about it, and I was hanging out on a beautiful boat on Lake Michigan with sunny, 85 degree weather. Things were good.

I decided to get in the water. I had read that swimming was good resistance training for the tendon, without putting too much stress on it. I got a little raft ready, stood on the edge of the boat, and hopped in. I knew right away that I had retorn it. I felt the separation before I hit the water. I reached down and could feel the discontinuity in the tendon. I can’t tell you how crushed I was. Almost 9 weeks - gone. I got out of the water and looked at it. My incision had opened up a little too, which was very weird, and I was bleeding a good bit. I wrapped it in gauze and an ACE bandage and got on the phone to my ortho friends. I am scheduled to see my surgeon tomorrow.

I don’t know what I’m going to do at this point. I start my new job in 5 days, but I assume I’m going to be non-weight-bearing for at least 6 weeks. Do I have surgery again or go non-operative this time? The advantage to surgery is reduced chance of rerupture. Right. Yesterday, I sat in bed and read all the rerupture blogs. They really helped. Thanks guys. Today I decided that I was done feeling sorry for myself and have tried to be productive. That has included making this entire blog. I guess I’ll have more to report tomorrow. Until then, I’m keeping it wrapped up, elevated when possible, and I’m back on the scooter.

The first two weeks in the wedges were very confusing for me. Was I supposed to be in any pain at all? Should I walk around a lot, some, just a little? Should I use my scooter or crutches sometimes, and just build up to more activity? Unfortunately, I couldn’t start PT as I was in between residency and fellowship, and didn’t have insurance. Apparently I had Cobra, but it was going to be a real pain to get it set up, so I decided to just start PT when I was down in Houston and had started my new job (August 6th). In the meantime, I did ROM and alphabet exercises 2-3 times a day. There were days when I felt great. My tendon always felt worse at the end of the day, rather than at the beginning, as it seems other people’s do. I was walking with a noticeable limp, which is normal, I guess, but I hated it. When I tried to walk normally, I could feel little twinges on the lateral part of my tendon.There were other days that were pretty miserable all around, and I was having pain pretty much throughout.

I moved into my new place in Houston on July 28th. I had to walk across some soft sod while moving furniture and my heel kind of sunk in the mud and really stretched the tendon out. I should have stopped then, but I finished up moving and hopped on a plane back to Chicago that day. After the move and walking through the airport, my leg was really hurting. I still had good range of motion and could do everything, so I assumed everything was fine. I got back to Chicago fine and got ready to take my boards on July 30th, 2 months after my injury.