Hood’s AchillesBlog

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.

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.

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.

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.)

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.

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.

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.

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.