From Volley to Folly and Back

I just had my 12-week follow-up with my surgeon on Wednesday.  Very quick - I arrived sporting shorts, T, and my crocs.  I thought maybe the Dr would at least take a look at my foot - test my calf strength or comment on my ROM, but wasn’t quite as I expected.  She took a look at the chart to recall when my surgery was (end of May), counted the months on her hand (3) and then said ‘Everyday walking is ok, no running for 3 more months’.  Hmmm, I’m already back to walking my dogs 1.5 miles along our community trail, maybe that’s too much - ‘oops’.  I pushed back a little on the ‘no jogging’ prognosis, so she agreed to see me in six more weeks and maybe release me to do light, straight-ahead jogging after that.  Of course, she can’t really stop me either way, but I’m not looking to start back at square one and it does give me something to work towards.  Ideally, too, I’d like to get the blessing from the person who actually saw my formerly shredded tendon.  So onward I go.  I’ve been seeing dorsiflexion improvement about every two days - I can now stretch my knee to reach directly above the front of my toes in barefeet.  My calf strength is also improving - I do about 10 miles on the stationary bike with varying resistance several times per week.  I can heel lift about 100lbs 5-10 times.  This is what I’ll be focusing on in the next 6 weeks - whipping this calf into shape.  We’ll see how it goes…

Ok, well - I sort of went on a rant about my P.T. session on Wednesday, and then decided to pull down my post, as I felt my attitude wasn’t in the right place and it did nothing to serve other people on this site.  I’ll just say recovery (mine at least) is a swing of lows and highs.

For a recap, let’s just say I didn’t feel I was being led by an ATR ‘expert’ at my first weight bearing PT session.  I had another session this morning and still feel largely the same way, but I also realized she was right on Wednesday about needing to push my flexibility before I get too ahead of myself in other areas such as strengthening.   I was basically at neutral but couldn’t follow through in my step with my bad leg beneath me because of this limiting angle.  I could get around this somewhat with the heel wedges in my shoes, but I really wasn’t seeing much progress in bare feet.

So the last few days I really just focused on stretching and trying to increase my dorsiflexion enough to enable my walking gait to feel more normal.  I started stretching my achilles just to the ‘edge’ of discomfort as my PT suggested (using a towel to pull my toes toward me, sitting in a chair and sliding my feet towards the chair, etc. ).  I assume this is one of the most scary things many of us will do during recovery. After all, at first every time I would put pressure on the tight tendon, the back of my mind is hearing (and fearing) one thing: ‘pop’.  But you can’t be afraid forever, and it took me awhile to stop hiding behind the fears and realize the tendon is strong enough to be reasonably pushed (well, pulled - technically).

The stretching really paid off quite quickly.  I couldn’t have gained more than 5-8 degrees of ROM in two days but it was enough to make a huge difference in my walk.  I ditched the wedges in my shoes and spent quite a bit of time on the gym track focusing on my walking technique.  What a great feeling.  My limp decreased to the point where my walking motion is not ‘interrupted’ by the bad leg.  Right now, it is just limited in the size of step and the amount of push-off my weaker calf can give.  This is just fine for now - I’m not looking to burst out of any starting blocks anytime soon.

Perhaps progress in your walking gait doesn’t warrant a full blog post, but for me it was a big deal so I’m sure someone out there also found this to be a milestone.  I posted my ‘first steps in shoes’ video last week, so I’ll post another one later this weekend showing my shiny new walking gait.

Footnote: Thanks, Stuart, for your comments to my previous post before I yanked it back off the site  My doctor didn’t specifically mention heel wedges in shoes, but she did indicate that I shouldn’t expect drastic improvements in my dorsiflexion before our next visit in 5 weeks.  The heel wedge idea made sense to me, so I tried it and it felt good.  This is where much of the disconnect with my PT was -  I was just really taken aback when she acted like the heel wedge idea was the craziest thing she ever heard, as it seems like such a common technique used by other people rehabbing on this site.

Yesterday I was feeling pretty good about my recovery, having just learned to take steps in the boot during week 5 for the first time.  I decided to get some heel cushions/wedges (Scholl’s) and try on my running shoes.  Wow, feels so much better than the boot!  My ankle and leg are obviously still very weak - having little to no calf strength means I’ve got a good limp yet, and my ankle has weakened enough to where I definitely wouldn’t try the shoes on an unpredictable surface just yet as an ankle roll isn’t out of the question.  The best part about it though, is that after concentrating on and ’shooting for’ the proper walking form, my calf definitely feels used afterwards, which to me means huge progress.  Still have to be careful though - with two shoes on and weeks of inactivity my instinct is to take off running or just start jumping in place!

Here’s a short video of my first steps. (I’m mumbling basically the same thing I’m describing above)

I also took a test drive in my wife’s car (not mine, it’s a manual so I’ll start with two pedals).  Felt pretty good, however I’m not quite ready to hit the interstate towards downtime in morning traffic.  A few more days of practice and strength in my calf should do it though.  The problem now is that with my heel on the floor mat rolling from gas to brake, my calf still gets worn out pretty quickly, so I have to lift my leg from gas to brake.  Fine if you are driving in calm traffic, not good when you are constantly getting cut off in traffic.  I’ll get there very soon though.

I’m just pleasantly shocked at how quickly things are coming back after finally (carefully) applying some weight.

Here’s a smile for my fellow ATR’ers.

As I mentioned before, my wife and I have two very high-maintenance Huskies.

Meet Rafa and Rush:

Rafa

Rush

Cute, right?  Yeah, ONLY when they have had their daily walk.  After all, they are huskies, that’s what they are made to do.  We live in a nice suburban neighborhood and our house backs to a 1.5 mile walking trail that we use every day.  Which made my achilles rupture on May 21 that much more devastating - start of summer, and now my wife is on her own with the dogs.  That is, until I decided on about the 3rd day after surgery that I wouldn’t let this destroy my summer on the walking trail.   The problem is, it’s a hike all the way around and something like a knee walker just won’t do.  Time to get hardcore.  And thanks to craigslist, I found the answer.

Meet ‘The Mulberry Machine’

You laugh at the basket, but they put those there for a reason.  Use. ful.

If, in your recovery, you have ever used one of these things at Wal-Mart or the grocery store, don’t worry - mine goes much faster.  Those are for sissies, this is the real deal.

Simply put, this is the best $350 I have ever spent.  Period.  I’m off the couch, enjoying a little nature, giving my boys the attention they need, and as a bonus have given a chuckle to countless friends, neighbors, and passerbys (picture a petite woman walking two large dogs with a guy on a scooter and my guess is you will smile :)).  But, you ask, where does the nickname ‘Mulberry Machine’ come from?  Well, turns out this thing is useful beyond just carting my broken down body around the trail.  Our walking trail happens to be on a stream filled with mulberry trees, and if you’ve never had mulberry pie or mulberries ‘n’ icecream, you are missing out.  We hauled in over 2 gallons of freshly picked mulberries using the scooter, and it treaded in the grass and carried the load with ease.  Yes, I’m a 30-something year old on a mobility scooter, and regardless of your age, you know you want one too

I had my 2nd post-op visit with the surgeon this morning, at almost 6 weeks.  It’s funny how you look forward to a date on a calendar for so long and the meeting literally lasts for a few short minutes.  That’s pretty typical here I’m sure.  Luckily, it was short but also very sweet.  At my 2-week appointment I had been told ‘absolutely no weight bearing’, so I expected to be told to slowly start applying partial weight, but she took a look at the incision and said it looked good and my next step was to ‘ditch the crutches’  - using the boot as needed and progressing to shoes.  I really like this as it feels like I am now more in control of my own destiny (although I knew I was before and cheated a bit on the NWB, but very cautiously).  So, it’s on to more involved PT.  The thing I really want to focus on is to increase my dorsiflex range so my walking motion is better - still very much of a limp in the boot and I haven’t tested the waters much without it due to the limited motion at about neutral.  And of course waking the calf from the dead will be fun - I saw someone signs of re life this week as I did some swimming (felt wonderful) and also some light thera-band plantarflex exercises.  I will say if you have access to a pool there isn’t anything better at this point in the recovery for boosting your mood and giving your foot more confidence.  I’m ready to get moving again!

Here are a few photos of my first few weeks:

Day after injury #1 - OUCH!  The bruise was still slightly visible at 5 weeks!

Day after injury #2: Another beauty shot of the bruise.  Sexy!

Day after injury #3.  Well hello calf, I remember you - and miss you dearly.

Post-surgery cast.  R.I.C.E., R.I.C.E., R.I.C.E.

2 wk post-op visit #1: Post surgery cast - waiting to give it the boot in favor of ‘the boot’.

2 wk post-op visit #2:Oh lord, please watch the leg with those things.

2 wk post-op visit #3:Whew, freedom - I don’t think the smell was too bad but I wasn’t the one removing it either!

2 wk post-op visit #4: I remember this - scary feeling hangin’ in the air there.

2 wk post-op visit #5:  I little bit of an oversight from the surgery clean-up crew - yuck!

2 wk post-op visit #6:  The stitches’ last seconds.

Today at 6 weeks:  ’The angry red line’.

I guess I was off by a week on my last post, so technically I’m almost to Week 5, which I guess is a good thing.   Recovery is pretty steady right now, no big milestones.  I continue to do the range of motion exercises and try to push my ankle flexibility a bit more each day.  I did try removing the heel lifts in my boot to test if I’ve gained dorsiflexion range, and can now put my foot flat in the boot which means I’m at neutral.  At work, I’ve left the lifts in though, as the swelling decreases my flexibility and then it feels strained as the day goes on.  I think just a little bit more flexibility should take care of that issue though.  I did have some new pain in my lower calf / upper tendon overnight, but doesn’t seem too bad today - hopefully I had just had my foot in an awkward position for awhile.

It’s interesting how little the average person knows about this injury.  Most people are really surprised at the length of recovery time, as I’ve received quite a few comments from friends or coworkers being surprised that I’m ’still on crutches’ and assuming that I can sign up for the end of July 10K since that is ‘a long time from now’.  Usually when I point out the tendon and what actually happened to it though, they finally ‘get it’.  I sure am growing tired of telling the same story over and over though!

Ok, I got started late in filling out my blog but future posts will be up to date.  I’ll try to post some photos soon as well.  Today is the first day of week 5.  Not too much has happened since my first post-op appointment.  I have gone to two physical therapy sessions, which just consist of range of motion exercises - ankle side-to-sides, up/downs, ABC’s, circles, and swings with no weight.  I simple do each of those twice a day, 10-20 times each.  My therapist said from the first week to this week I gained 10 degrees of motion.  I need 10 degrees more to remove the lift in my boot and be ‘at neutral’, and 10 degrees after that to be able to have any kind of walking motion.  I feel like I could push harder on the up/downs, but I’ve been cautioned to not overdo it or pull too hard and I really don’t want to do any damage.  It’s difficult to know how hard to work at this point.

I’ve been back to work for several weeks now.  It has been difficult.  I have a desk job and have always gotten away for lunch - almost always to the gym.  With my wife driving and dropping me off, I’m stuck at my desk and my workplace doesn’t have any sort of lounge area where I can lay down over lunch and elevate my leg, so by the end of the day it is pretty sore and puffy.  When it gets this way even the boot is uncomfortable.  I brought in a large exercise air ball and the most comfortable position is with my knee and leg rested on that without the boot.

I did have one scary instance in week #3.  Crutches aren’t safe even for the seasoned crutches pro.   After showering I realized I didn’t have a towel and tried crutching too fast across the bathroom tile floor.  Hit a patch of water and hit the floor fast.  I landed on my back and my head hit the edge of one doorway and my good foot hit the wall, but I was smart enough not to try to correct with my bad leg.  It hurt and scared my wife to death who came running upstairs to check on me.  Other than a headache and a scraped foot, no damage done.  Let’s not do that again…

Countdown to July 6 and Post-Op Appointment #2!  I can’t wait to really test this thing out!

I was highly anticipating this appointment.  I wasn’t sure if I would get the ‘comfy’ boot back that they gave me before surgery or if I would get another cast.  I really wanted the boot back, as I could not lay my foot flat on the floor with the post-op cast.  It would also be nice to see the injury, get the itchy stitches out, and not have to bag up my foot to shower.

The appointment went as hoped.  A nurse came in and cut away the cast.  The stitches looked ugly but not horrible, the incision was held together nicely and I didn’t have a lot of swelling.  There was a small bruise on my calf and some bruising under my ankle that was there before surgery.  I also had a big spot of blood on my skin where they probably missed cleaning up after surgery - yuck.  I’m so glad I wasn’t a witness to the operation.

What a strange feeling - my foot felt so strange dangling there after being held in one place for so long.  I nudged it upward a little bit and immediately felt the ‘tightness’ everyone else describes.  Man is there going to be work to do before it eventually stretches out like before, BUT… at least I can tell it is attached again!

The resident doctor who assisted in the surgery came in and removed my stitches.  Painful but only short bursts of pain.  For me, the thought of the threads pulling through my skin was what was causing most of the pain, there’s something about skin injuries that is difficult to watch or think about for me.  I asked the doctor more about the surgery since he was present assisting.  He said it was among the more severe tears he had seen and that they had to do quite a bit of ‘cleaning up’ before reattaching it - whatever that means.

My surgeon then came in and inspected it and says it looks good.  I’m to go back to the compression stocking and boot I had before (good news).  Absolutely no weight until my next appointment in 4 weeks, as the tendons take 6 weeks to firmly bond together and in the meantime they are held together by only sutures.  I asked how long until I can walk without a limp - she said the calf will be the challenge because of atrophy but that I could be ‘active’ normally again in 4-6 months - hopefully that means more than just walking normally but I would even take just that.   I’m not about to argue about a weight bearing timeframe, I would rather have a slightly slower road to recovery than to go back to square one.  She did give me a prescription to start physical therapy in terms of range of motion and very passive stretching.

My wife and I had sort of joked that we hoped the ‘evil’ assistant lady who had fitted my stocking and boot roughly before surgery would not be showing me the ropes again.  Fail.  After speaking with the surgeon I immediately began trying to get the stocking on before she came in but didn’t make it.  She saw that I was working on it and insisted on ‘helping’, muttering that I hadn’t started it on the right way, and was actually grabbing my achilles tendon for something to hang on to while she pushed and pulled on the compression stocking.  Then when it was on she felt the tape that had replaced my stitches and said ‘Oh, you must have had surgery - those are where your stitches were, right?’  Are. You. Kidding. Me.? Grrrrr….  I’m sure I’ll laugh about it someday…

So, it looks like my crutches and I will be buddies for at least another month, but at least there is one milestone to cross off the list…

The first few days home weren’t so bad, which happened to be  Memorial Weekend.  I was still taking pain meds which made me too dopey to get worked up about too much, plus my wife was home so I had company and help whenever I needed it.  We rented quite a few movies and just relaxed together.  During the day I didn’t move much from the couch, with pillows elevating my leg.  When I did get up I could feel the blood immediately rush to my leg and it would start pounding - it’s a good thing to keep it elevated (R.I.C.E’d) as much as possible!

Showers suck - a little tip though: a long sock works great to seal up the trash bag and keep the cast dry.  Use a trash bag with a drawstring and tie it up like a shoe snuggly above the knee.  Then, use a long sock to cover the top of the trash bag and pull it really tight (just overlap once, no knot).  Unless you are in the shower for a long time, the water won’t have time to get past the sock - I did this for two weeks, not a drop of water on the cast.

The third night after surgery it occurred to me that I had eaten a lot of good food since surgery but hadn’t taken care of some other normal business, an obvious side effect from the pain pills.  The next morning I spent two hours discovering why - this was way worse than any pain I could be having at this point so I immediately stopped taking the pain killers.

The next week was where things began to get difficult.  My employer graciously allowed me to work from home so I didn’t have to burn through my PTO (I’m a web developer so it’s not difficult to code away on the couch using a laptop), so that kept me fairly occupied during the day.  At home, though, with my wife gone is where I started really getting down.  I’m a very active and independent person.  I work out every day over my lunch break and my wife and I walk our two Huskies religiously, 1.5 miles around our neighborhood walking trail every day, rain or shine, snow or heat.   We had been counting down the days to summer weather all winter long during our frigid and bundled-up walks with the dogs, and here I was, out of commission at the start of the summer for who knows how long.  My wife would have to take the dogs by herself everyday (not an easy thing given her size and theirs) and all I could do was sit here… and sit here…  this is where all the ‘why me’, ‘what if’s’, and ‘not fair’ thoughts are difficult to fight off.

After about the third day of my wife taking the dogs out, I decided it wasn’t acceptable to just sit inside and miss out.  I tracked down a killer deal on an electric scooter (yes, the kind the elderly use in grocery stores with the basket on the front).  My wife and I went and picked it up and I started scooting along beside her and the dogs on our walks.  Plenty of friends and neighbors have gotten a kick out of me riding down the trail on an electric scooter, but my pride can take a hike for awhile.  Being somewhat mobile outside was a godsend - that little scooter was one of the smartest purchasing decisions I have ever made.

My goal at this point is to just make it to the first post-op and get rid of this hard cast!