Worst fears realised

Managed to get a private appointment with the consultant who performed my surgery. Unfortunately this confirmed my fears, basically my tendon is too long and I have too much dorsiflexion. MRI scan in a couple of days will likely confirm this. Spot of pain is likely to be the peroneal tendons trying to compensate for the weakness of the Achilles. MRI should show whether there is actually a re-rupture or tear. Although really bad news I’m glad I got the appointment as when I saw the registrar he told me to come back in 3 months and continue the physio. The consultant was off to “educate him” as I left today.

How could this happen? Well I probably have myself to blame by coming out of the boot too early and hence over stretching the tendon too early. How/when who knows! By the time I had the first private physio session I noted my foot was already back to neutral and at that time I was still wearing the boot with the wedges, but I had taken it off for sleeping and had been walking around without it on. Would this have been enough to over-stretch the tendon, probably, although at no time did I feel this was the case and I never had any pain. I came out of the boot because I felt I could and it felt good, but the consultant today suggested that it hadn’t been communicated to me correctly that the boot simply wasn’t optional. So, I guess a word of warning for those pushing it out there, without the boot it is possible to over stretch the tendon!

Where now for me? well only one real and practical option that is to have the tendon re-repaired if I want to get back to any sort of active pursuits. Left alone the tendon will remain too long and I won’t have any power in it, I’d probably be left with a slight limp too. MRI scan on Friday should confirm the route, the question for me will then be when do I want to start this miserable process all over again. The thought of a cast and NWB and then weeks in a boot is really depressing. I can’t do any more damage as I am, so I may well end up putting the enevitable off for some considerable time, like after the summer, but that puts skiing in Feb at real risk. 


It’s a mystery!

The spot of pain!

The spot of pain!

So, went back to see the Doctor (last visit was 6 weeks ago to have the boot fitted). This time I arrive in two shoes with the comments from the physio questioning whether the repar is complete. I spend all of 3 minutes with Doctor (a registrar), he looks at my injury says the repair is complete writes on the notes that the physio should continue as planned and that he’ll see me again in 3 months. That was Monday, NHS physio visit on Wednesday seems happy with all that and we continue.

Today I have my regular appointment with the “private” physio. He remains concerned about how weak I appear to be and how there seems little improvement. I explained that maybe because I’ve been walking in 2-shoes for so long I haven’t been as “dedicated” to the exercises as I should have been. However, he brings up the squeeze/Thompson test. On my injured leg you’d be forgiven for thinking I was still ruptured, kneeling on the chair and giving the calf a squeeze produces little movement of the heel. The achilles is definitely repaired (or in continuity to use the Doc’s words). When I do exercises now I get a sharp pain in one spot just on the top of the ankle bone on the right side of my right leg. This “pain” only occurs when I put the injury under load and only lasts whilst I do the exercise and it responds well to a little bit of massage.

So, two questions:

1. Anyone else been repaired and at 9 weeks post-op getting little movment in the heel with the squeeze/Thompson test
2. Anyone else get the “spot” pain I describe above

The only thing I can think of is that years ago I injured my calf muscle (again playing squash) on the same leg, felt like the whack in the leg you get with the achilles but right up in the calf. This was treated with just physio and I considered it all back to normal. I’m wondering if there was something lurking there and with the rupture it has surfaced.

I’m considering booking a private consultants appointment to discuss this, but suspect they’ll just confirm the repair is in place and that I’m weak from the injury and to continue with the physio.

Having a bad day - it had to come :-(

Visit to NHS physio this week has cast a nasty seed of doubt in my mind. She is concerned that I actually have too much dorsiflexion (she’d expect it to be tighter) and given the leg appears very weak she has questioned whether the repair is complete. Private physio this morning also felt the leg was very weak. I haven’t been religious with my exercices, but to be honest I have so little power in the bad leg there’s a limit to what I can actually do (largely I’m focussing on heel raises - which I can do when sitting, but when standing I struggle to get even a little way off the floor and the bad leg can not hold any weight in planta-flexion on its own). I feel connected and the exercises appear to work the right bits, the hope is that the repair is “long” and that I’m still very weak. If the repair isn’t complete this will be a major setback. I see the consultant on Monday so it will be interesting to hear his view - propbably slap my wrists for not still being in the boot!

The physio felt she was probably being over cautious but her comments are enough to get me worried.

How strong did you feel at just over 8 weeks? I appreciate that some wouldn’t have been out of the cast/boot at this stage!

Fingers crossed!

Wide Mouth Frog - you don’t see many of those around

As most of the pics I’ve seen show the vertical scar, thought I’d share my rather neat and small version:

My scar

My scar

Give me strength!

So, the “official” physio visit went well, she was very good, confirmed I have good elasticity in the tendon. Didn’t mind that I was driving already and confirmed that swimming, static bike, rowing machine etc. were OK for cardio work. However, this visit and the visit to the “other” physio the next day has confirmed that it’s a long old road. Like most, to this point I’ve been really trying to speed the recovery, got out of the cast and boot as fast as I could, got into two shoes, started driving etc. etc.  Actually I’m feeling exactly the same as the sentiments posted by Mark: http://achillesblog.com/mstahlka/2009/05/11/2-months-or-8-weeks-or-56-days-or-1344-hours-or-80640-minutes/

The focus for me is now to try and build back some strength, at the moment there is no way I can raise the heel on my bad leg, my limp is getting better but is still so obviously there. My exercises are basically to try and do this (without cheating by leaning forward!). The NHS physio has given me an exercise of sitting down, keeping the toes flat on the bad leg and then lifting it as far as the planta-flexion will allow (i.e. so I’m effectively on top toe but sitting down with the good leg there for support). Then with both hands push down on the knee of the bad leg and try and resist that. Doing this you can really feel how weak the bad leg truely is and I too have one of Mark’s “wiggley jiggly piece of flubber” for a calf muscle.

Now the initial shock of the injury and the crutches and boot are gone it does start to dawn than this truely is a marathon and not a sprint. My next target? Get rid of the limp (by focussing on walking properly - i.e. pushing off from the toes of the bad leg). After that I’d love to start some gentle jogging, but I can’t see that happening anytime soon.

First “official” Physio at 7 weeks

Quick update. I’ve had 3 “private” PT sessions now, nothing too much to report here, a little massage, good elasticity in the tendon, some advice on the type of the exerises, now trying to progress to gentle heal raises ensuring it’s a raise and not a cheating lean forward. I’m back driving with no problem at all. Limp isn’t quite as pronounced, but as others report it takes a while to get the calf strength back to drive this away (see doug53’s excellent post). Really focussing now on trying to roll from heal to toe on the bad leg when walking, there’s a twinge there but nothing too bad. Exercises with a resistance band pushing (plantaflex) to try and build some strength and move towards those heal raises.

First “official” physio appointment is on Thursday, this will be exactly 7 weeks post-op. Following the “official” rehab protocol I’d still be in the boot with 2 or 3 wedges and PWB with the next follow-up Doctors appointment still two weeks away. Thursday will be very interesting and I’m not going to dance in there shouting “look what I can do”, but it will be interesting to see what reaction I get and what advice I’m offered.

Back in the water

Today I have:

  1. Done 35 minutes on a static bike, nothing too strenuous, enough to raise the heart rate a little (up to about 130 bpm). Tried to keep the rpm at about 70 which felt about right. Did feel slightly odd on each rev due to the tightness of the tendon.
  2. Swum 800m (2 sets of 400m) the first normal front crawl, the 2nd with a pull buoy

Felt good to be back doing some form of exercise, just need to be careful not to over-do it.

Wii-Fit games are “interesting”, tried the ski-salom and the marble game and the tightrope. I know others have found them a useful addition to the exercises. Tried to do some “Rowing Sqauts” but just don’t have the strength to push down into the “blue zone”, which if nothing else serves to remind me this is a marathon and not a sprint. I have no power in my right leg and at this point there is no way I’m able to go anywhere on tip toe on the injured leg.

Still one “limping” step at a time!

What a difference a day makes!

Today I went to see a physio to try and get some informed opinion on what realistically I can start to do. Boy am I glad I went!
My op to repair the full rupture was done like this:

so, unlike most scars I have seen I have a 2inch incision across the back of my leg (rather than down the leg). The physio heard my tale and then took a look. He hadn’t seen an op like mine before and questioned whether I had actually had a full rupture (I confirmed I had). He prodded and pushed and was pleased there was no hardness or swelling around the wound and actually quite a lot of elasticity. He then had me try and bring my toes up towards me when lying on my back, followed by pushing my toes away against his resistance.

After this he confirmed that my foot was already back to neutral and beyond.

Can I swim? Of course I can!
Can I do some stretching exercises? Of course I can! He made the point that what we need to avoid is a sudden strain on the tendon. If you listen to you body then there is no way that you stretching using your own muscles (to whatever is comfortable) is going to re-rupture the tendon. So I can dorsiflex and hold to whatever pressure I can cope with. I can face the wall with my injured leg out behind and flat and gentley stretch the tendon by bending the knee on my good leg placed out in front.
Can I try a static bike? Why not!
Can I take the wedges out of the boot? Of course! I’m already at neutral and beyond.
Do I need to wear the boot? If I’m outside a “safe” environment then probably, just in case of a slip, but at home, at work two shoes are fine.

Well worth the money for this visit, go back in a week for some further work/advice.
All great stuff!
My first NHS physio appointment isn’t until early May and I’d been told not to remove the boot at all and I’d still be on 5 wedges! Go figure!

Give it the boot?

So, 4 weeks to the day (almost the hour!) since ATR. Largely due to the inspiration I’ve found on here I’m walking around in the boot without using crutches. Not easy to walk well or quickly, no pain and mentally it feels like a step in the right direction. Monday took out the first wedge in the boot (although I was told to leave all five in for 2 weeks). Thanks largely to doug53’s story I can’t help thinking my body is much more capable than people would lead you to believe. To the point yesterday where I went to two shoes and hobbled around the house. Again no pain, no problems and it felt great. However, one of the battles is persuading everyone else this is a good thing to be doing. I get a lot of opinions from family and friends asking “should you be doing that?”, quickly followed up with advice like “you don’t want to risk re-rupture, that would be a disaster!”. Tomorrow I’m going to visit a Chiropractor/Physio really to see if I can get some solid advice on what I *really* can be doing rather than the standard of line that you can’t do anything. My official PT appointment isn’t for another 3 weeks and post-op follow-up from the boot another 2 weeks after that. Does walking without crutches mean I can move my status to FWB? I know this isn’t a race and you can’t rush these things but a huge part of me thinks (and feels) things can and should be moving much faster than the medical profession would have you believe.

Also achieved another milestone today by taking a stand-up shower!

Next tasks:
- get in the pool (ASAP!)
- start work on a static bike
- drive (tried driving an automatic with my shoes on but didn’t feel too confident with the pedal pressure)

More weight to bear

Another quick update at the end of the week with an aircast boot.

Positive steps in more ways than one. With PWB it is much easier to get around. Managed to walk a mile or so with no problem (albeit slowly). Actually finding I can put more weight on the leg, even to the point of doing Doug’s “ministry of funny walks”, i.e. no crutches, heel of bad leg forward, good leg shuffle and so on. Slept last night with boot off, others appears to have tried this with no ill effects so I thought I’d give it go.

Happy Easter.