Archive for October, 2014

1 Week post-op

Following the operation, I’ve now spent the first week pretty strictly laying down with the foot elevated. I haven’t had any pain, and stopped taking the painkillers a day after the operation, the only meds I’m on now are the clexane injections to prevent blood clots (since my first time on these looking for instructions from youtube-videos, I’ve now become adept at injecting myself). The only uncomfortable feeling has been when I’ve had the foot down for a few minutes, when I could feel the blood flowing to the foot and the surgery wound. I haven’t experienced any swelling, on the contrary the plaster cast is actually feeling really loose around my leg, which had me a bit worried about damaging something by moving my foot too much, but no worries there.

My planned recovery protocol outlined by the doctor is to get the cast and stitches removed next week (two weeks from the operation), at which point I should move to a boot and immediately start full weight bearing to the extent I can. Following that I’m supposed to get out of the boot at 6 weeks, between 6-12 weeks walking should be without a push off the ball of the foot, weeks 12-24 normal walking but no running, and after 24 weeks have no restrictions anymore. Obviously this is a very rough outline that will be worked on with the physio depending on real progress (I have my first appointment with the physio when the cast gets removed).

Other than that, this first week has made me realize how relatively lucky I am with some things with this injury. I have a great family that has been taking care of me, allowing me to not do much at all and focus on keeping the foot up and taking it easy. Also, I’m fortunate enough to have a job that I can to a large extent do from the bed with a laptop and my mobile, which has also been quite helpful in passing the time and making me feel useful rather than just becoming a couch potato. My employer has been great in offering any help I need, and understanding the situation, they’ve more been telling me to take it easy than anything else. Compared to some of the other stories I’ve read on the site, all-in-all I’ve so far had it pretty easy in the sense of being able to focus on the recovery and not worrying about anything else.

Well, that was my first three posts to start the blog, I will try to make sure I write something at least weekly as the recovery progresses, happy healing to everyone!

The Operation

The day after flying back home, I went to the appointment with the doctor in the morning. He took away the splint I had on, did a bit of testing, and found the rupture very quickly in the “typical spot”, about 5cm up from the heel. The foot wasn’t really swollen at all, and so I was off to surgery prep within about ten minutes of meeting the doctor (we had discussed the treatment options etc on the phone previously).

I had a brief discussion with the anesthesiologist, and opted for a spinal block instead of general anesthesia, which was also her recommendation. My decision was mainly based on curiosity of wanting to be awake during the surgery, as well as lack of grogginess and need for strong pain medication immediately post-op.

Eventually I was taken to the operating room, got a cannula in my hand, and the spinal block was done. This was completely painless, and pretty soon my legs started to go numb, a pretty strange feeling as such. At this point they washed the foot, turned me over, set the automatic tourniquet on my leg, and were ready to start the operation (sadly they didn’t have a monitor available for me to follow what they were doing).

Once they opened the foot, they found out that I had also ruptured my plantaris tendon, which I understood to be somewhat rare. This turned out to actually be a good thing, as they used the plantaris tendon in tying up the achilles, and spread it over the stitching to “create a slicker and smoother surface” over the rupture. In my op report this is called the Lynn technique. Apparently they wouldn’t fix the plantaris otherwise, but would’ve just basically thrown it away. At this point I also got the nurses to take a few pictures of the finished product before closing, one of these pictures below (the white part is my plantaris tendoen spread to cover the ATR fix). It is actually pretty difficult to associate the picture as being my own foot…

In the end they set the foot in a plaster cast, with the foot almost at 90 degrees. They doctor was quite happy that it got so close to 90 already immediately following the surgery, as in his view that will make the transformation to the boot ultimately easier. He prefers to use a plaster cast compared to a synthetic cast as it is more absorbent and he has seen better results of the wound healing with the traditional cast. Also, he noted that it might as well be the boot immediately following the operation, but having a cast at least removes the temptation of taking it off for the first weeks.

All in all the surgery was very smooth, I felt no pain or discomfort at any stage, and refused all the offers of sedatives / relaxants throughout the surgery. It was all over fairly quickly, the report states that the automatic tourniquet was active for 41 minutes.

After the surgery, it took a few hours for the spinal block to start wearing off, starting with my toes moving up. The last thing to recover feeling was my butt J Before the effect wore off, they gave me some mid-level painkillers, so at no point did I feel any pain at all. I was out of the clinic about 9 hours after walking in the door, of which about three hours was spent waiting for the operation.

I’ll get back to my planned recovery protocol and the plan going forward in my next post shortly…

The Injury

Ok, so I thought I’d give this blog thing a try, as much for my own amusement and for logging down my thoughts / progress as anything else. I’m now 1-week post-op, so will divide this first post in to three separate shorter ones (injury, op, first week).

I guess my injury was about as typical as it gets, being a 37-year old fairly fit and active male, playing basketball in a recreational game with some colleagues. The event itself was completely harmless, was running backwards and set my right foot back to change direction to go forwards, no contact with anyone etc. Heard a pop (not quite sure if it was real or just in my head), felt like I had stepped in a hole, and got an immediate numb feeling in my ankle. I have a history of competitive sports with a number of ankle twists and turns, so despite there being hardly any pain I could immediately feel that something was clearly wrong.

With the help of my colleagues I got transported to the local hospital (I was travelling at the time). There it took the doctor about a minute to diagnose the ATR (Thompson test), and so I got the bad news, which wasn’t really a much of a surprise anymore at that point. As I was flying back home in a few days, they put the foot in a splint, and sent me packing armed with a few painkillers and clexane injections.

I spent the next day reading material online (this site was obviously very helpful), talking to some surgeon friends, and trying to figure out what to do. Based on a recommendation from a friend I got in touch with an orthopedic surgeon specializing in tendon ruptures and foot injuries at a private clinic specializing in sports injuries. Discussed the different options with him, and landed on surgical repair based on his recommendation (along with some other consultations with friends). We agreed that I would come to the clinic the day I was back from the trip, and if the foot wasn’t too swollen, it would get operated on immediately.

Managed to fly back uneventfully, thanks to my great colleagues who were more than happy to help out…