Archive for November, 2014

4 weeks post-op - Physio #2

So, had my second physio appointment today with no real surprises, seem to be making good progress. Scar has continued to heal nicely, she thought it looked very good for four weeks, which sounds nice. She did the Thompson test and a couple of other things to check the tendon, and all is as it should be there. No swelling present at all in the ankle, measurements around the ankle were an exact match to the healthy foot. Calf atrophy on the other hand is pretty noticeable, circumference difference is little over 1cm, which sounds surprisingly little compared to the visible difference to the healthy leg. ROM was also good, no difference to healthy leg in plantar flexion, and only a slight difference in dorsiflexion (would say about 10 degrees or so). According to her I’m well on track to get rid of the boot in accordance with the planned timetable in two weeks, 6 weeks post-op.

Got some new rehab exercises, now incorporating a resistance band for some of the movements. Exercises still mostly consist of plantar/dorsiflexion, different “sideways” rolls, toe curls etc. She stressed the importance of the other movements beyond just the straight flexions for stabilization when moving into two shoes away from the boot, and for maintaining the arch of the foot normally at that point as well. Feels good to be adding some resistance to the movements, not exactly strength training for the calf, but at least moving more towards at least stopping further atrophy. Considering how my calf now looks after four weeks, can’t imagine folks that are in a cast for eight weeks without any movement and how that would impact the muscle.

Otherwise been rolling along comfortably, walking in the boot comes pretty naturally at this point, and I have a steady walk rather than a limp as such. Have been covering also some slightly longer distances now, the only issue for me is that the heel gets a little sore after some time, but that stops immediately when I take a break from walking. At home I spend most of the time without the boot, I’ve been given an ok to carefully walk around the short distances at home without the boot, just making sure that I keep the weight on the heel when doing that. Generally I feel like the initial month following the surgery has actually gone by fairly quickly, and progress has been constant and noticeable. That also makes me think that I need to now adjust my mentality somewhat, I need to settle in for the long haul of recovery and accept that progress will be relatively slower and the increments smaller (which isn’t saying I’m accepting a slow recovery). Otherwise I can see myself getting frustrated very soon :)

Here is also the mandatory scar update, so at 4 weeks + 1 day:
4w1d

Photos

As I’ve now finally figured out at least one way of adding photos, I will add all of them here in a new post, and then on an ongoing basis add them to the posts.

Surgery photo, the “white” thing is my plantaris tendon, which has been spread over the achilles’ after its been fixed, to provide a smoother surface.
Surgery

Two photos from the when the cast came off after two weeks. The first immediately after the cast came off with the stitches still there. The other after they’d taken the stitches out and added a piece of tape as cover.
With Stitches
Stitches Out

And finally the photo from a few days ago, about 2.5 weeks after surgery, when I first took off the tape that had been there after the stitch removal.
2.5 weeks post-op

EDIT: Here is one additional photo, this is what the scar looks like right now, at 3 weeks and 4 days post.op
3-4 post-op

3 weeks post-op - Back in the office

Ok, a few days late, but Thursday was three weeks from the operation. Fairly uneventful week actually, but healing seems to continue to progress well. Went back to the office on Monday (had been working for home for two weeks), and really no issues with the foot, main challenge is finding a working position where I can at times keep the leg elevated while not completely destroying my back or shoulders. But as the foot hasn’t been swelling up really at all in any case, it seems to work ok.

Have gotten pretty good at walking around in the boot, stride feels surprisingly natural (i.e. not limping / gimpy) once I got the hang of it. Took me a day or so to learn how to roll the boot from heel to toe, the key for me was thinking about pushing with the shin against the boot (just mentally, not necessarily a strong movement as such). I think the difficulty comes from everyone naturally wanting to put weight on the toe of their foot when walking, which you obviously can’t do in the boot. So maybe that is helpful for some people who are struggling with the technique of walking with the boot: don’t lock your knee, and think about forcing the boot to roll from heel to toe by pushing your shin forward.

The only issue I’ve had with walking with the boot is that when I’ve gone longer distances, it seems to put more stress on your heel compared to normal walking. So yesterday when I was travelling and had to walk fairly long distanced through airports, the heel got a bit sore during the walking, but it went away immediately when I took a little break. No swelling etc as a result of the walking either so far.

Have also spent quite a bit of time with the boot off, both when sitting at my desk in the office, as well as home. Feels good to have the boot off once in a while, and allows me to do some of the physio-prescribed exercises over the course of the day as well. So all in all everything is progressing as well as it can be I guess, looking forward to my next physio next week to hear what she has to say and what I can add to my rehab exercises.

Here is also a picture of the leg, this is from 2.5 weeks after the surgery, the firs time I took off the tape they put on when they took away the stitches. Actually looks better now.

2.5 weeks from surgery

EDIT: Noted I’ve just also made it into Brooklyn in the marathon tracker, at least I’m off that bridge :)
EDIT2: Finally figured out the photos

2 Weeks post-op – Hello boot and FWB

Had my first appointment after the surgery today. Got the cast and stitches off, the scar was actually cleaner than I had anticipated, and there was effectively no swelling at all. To be honest, I’m not actually bothered about the scar in terms of looks at all, as long as it heals ok I’m happy. Should be noted that I have been able to have the leg up very strictly during the first two weeks, so that has possibly helped quite a bit. Stitches also came out easy, was told to possibly expect some fluid leakage in the next few days, but otherwise they were happy with how the scar looked (I do have photos as well, but still haven’t been able to figure out how to add them to the post).

Also had my first physio appointment at the same time, she tested the movement and had me do some short exercises to see what was happening. Everything was working well, and I had no problem having the foot at the 90 degree angle for the boot. She also took some measurements to follow progress over time, right now the injured calf was 1cm less around compared to the healthy leg (at the thickest point), but impossible to tell how much I have lost in the last two weeks as there is no starting reference. You can tell there’s a difference looking at the calves, but so far the difference isn’t massive. Got some exercises to do three times a day for the next two weeks (until the next physio), basically ankle flexion-extensions, rolling foot side to side, toe curls and a few other similar things. We discussed that we’d include resistance to the movements the next time.

Finally, I got fitted for the aircast walking boot, set directly at 90 degrees (no heel lift). No significant tightness at that angle, and the boot feels pretty comfortable (at least so far). I’m supposed to go full weight bearing right away as much as I can, and only use crutches if I start getting pain from walking without them or I want to use them for additional support for specific situations etc. I have now for a couple of hours been walking around the house without crutches and haven’t had any problems or any pain. All-in-all, so far everything seems to be moving along as well as it can be, and the additional freedom from moving around without crutches is a big lift mentally.