Down but not out!

This past week marks the end of my visits with my orthopedic surgeon and my physical therapist!  My doctor measured my range of motion, tested the strength of my repaired AT, and the scar tissue from the surgery.  I have a regained 100% range of motion, I have above average strength in my foot movements in all directions, and the scar is completely repaired.  I expect to continue the PT at home with daily sessions until I have 100% strength in my repaired AT.  I expect this will take another 6 or 7 months. 

I am walking normally.  If I sit too long in one position, my ankle stiffens and I walk with a slight limp for a few minutes.  Its important to keep stretching which I do every morning due to the advent of winter weather in New England (USA).  I will start a Nintendo Wii Fit exercise regimen next week.  I was surprised at how quickly my ruptured AT healed (particularly at my age-64+) and my strength returned.  The physical therapist measured my calf on the injured leg and it was 2 cm smaller than the uninjured left calf.

After three weeks of PT, my ATR is feeling significantly better.  My PT is very similar to what others have described on this blog: 10 to 15 minutes on an exercise machine, followed by range of motion, isometric plantar flexion, isometric dorsflexion, isometric eversion/inversion exercises.  This is followed by 15 minutes in an Aircast ice boot to reduce swelling and a AT incision massage.  I like the ice boot and massage the best! During the exercise bike and ice boot, I listen to some country music and relax!  I have been walking around full weight bearing (FWB) for short periods in my sneakers around the house and on short errands.  No pain whatsoever.  I haven’t received a bill for the PT, since my insurance covers it after my co-pay which is $11.74 per session.  Enclosed is a photo taken today in my running shoes (No, I am not jogging….yet!)  My ankle tends to get a little swollen both in and out of my Aircast boot.  The evening ice wrap seems to take care of it.

This is my ATR incision scar 44 days after my surgery.  It feels good.  The scar tissue is softening up.  I have been taking showers without the plastic coverings.  This photo shows my heel is slightly swollen from walking around too much in my Aircast pneumatic boot.  I worked for five hours today at the bank and we were busy with the influx of medical and graduate students arriving from all over the US and the world to attend Brown University and the Rhode Island Institute of Design.  I used a hospital issue ice pack to ameliorate the swelling.  I am doing range of motion (plantar/dorsiflexion) physical therapy three of four times a day at home.  The planar flexion is improving, the opposite flexion (moving the foot toward the front of my leg) is tight and less flexible.  The incision scar which my surgeon used plastic surgery to close looks better everyday.  (Note: no staple or suture marks)  There is a slight indentation about 2.5 cm above the incision (in the photo0 from the end of the incision.  I can live with this!

On 8.13.08, I had my first physical therapy session at 41 days post-op.  The physical therapist conducted the obligatory medical history, measured the dimensions and angles of my repaired AT/foot/calf/and ankle and conducted strength tests on both of my legs. She also advised me to keep wearing the Aircast boot until she could check with my orthopedic surgeon.  She demonstrated a three part AT surgery incision massage, and demonstrated and had me do three AT stretching exercises (basically moving your affected foot as far forward without pain (planar flexion) and backwards toward my shin (also w/o pain) and holding both for three seconds with 10 reps.  The other two exercises were moving my foot in a circle clockwise & counterclockwise and pointing my foot to the right and left.  I was instructed to do three sets of these exercises a day and ice my AT and heel for 15 minutes a day.  She then put a professional ice bag on my heel and AT for 20 minutes.  It was a remarkable relief!  My ankle and heel were a little swollen and my heel had moderate pain.  These symptoms disappeared after this treatment.  She advised me that I could take a shower without the boot or a covering because my incision was completed healed.  I had to pay a $10 insurance co-pay.  This was a good initial session.

I returned to work on August 8th, 36 days post op.  I wore my Aircast boot and used one crutch to support my injured AT.  The only problem I had was some heel pain which I believe was caused my some tendonitis. I treated the pain with NSAIDs (Advil liquigels).  I was able to work 8 hrs on Friday and 4.5 hrs on Saturday.  My incision has healed very well.  (see enclosed photo)   I am starting physical therapy in three days on August 13th.  There are online videos which show how to massage your injured AT.  I found these to be very useful and I think they helped.

Four days I started to walk around my condo barefooted with full weight bearing.  I was very concerned that I would either damage my injured AT or interfere with the scarring process, so I walked very flat-footed and really limped instead of walking with a normal motion.  My foot, ankle and AT feels OK.  However I do not want to rush and have a relapse on my recovery to date.  All the best to my fellow AT patients!  I must say, I feel really optimistic about my recovery!  Jim from Providence, Rhode Island , USA.

I’m 31 days post op and I returned to my job at the Bank only to find that due my medical leave, I was “disabled” on our ultra secure banking computer system.  After hanging around in my office for three hours, my heel started to hurt so I returned home and elevated.  I did enjoy the homemade zuchini blueberry cake for my “welcome back” party.  It may take another week or so to get me on the system.  In the meantime, I am on disability leave.  My ATR incision scar has improved (see attached photo).

Also, for those interested in the economics of this AT injury, I received an anesthesia bill of $1080 of which my share was $115.20.

I injured my AT on 6.29.2008.  I visited my primary care physician on 6.30.2008 and was referred to a sports orthopedic surgeon.  Cost: $69.00 Paid by my insurance with a $15.00 copay for my account.  (Blue Cross Blue Shield)

6.30.08: Orthopedic consultation:   $284.00/Xray: $84.70/Copay: $25.00

7.03.08: Surgery: $2270.00; Copay: $25.00

7.03.08: Hospital Expenses: Pharmacy: $377.00; M&S supplies: $1,377.54; Operating Room: 2,085.00; Recovery room: $698.00  Total: $4,537.54

7.03.08: Percocet: $10.00 copay & Zolpidem Tartrate 10 MG: $10.00 copay.

Summary: Medical Expenses:$7,231.24 to 7.28.2008; of which I paid $945.00 which included my $300 annual deductible.  I believe this is atypical of a corporate insurance plan.

My visit to my orthopedic surgeon was very positive.  I am walking in my Aircast boot (FWB) without any AT pain.  My heel has slight pain but tolerable.  I highly recommend plastic surgery following the AT surgery.  The wound is healing with a small scar. I have been scheduled for physical therapy on August 13th, about six weeks after the AT surgery.  I expect to remove my Aircast boot at that time. I have also arranged to return to work in one week (on a part time basis ie: 20 hrs a week which is my regular work schedule.)  I am looking forward to getting back to work!  Enclosed are two photos of my AT repair.   

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