kathyw’s AchillesBlog

Well, I drove a bit with my husband last Sunday, he decided I could safely drive and so last Monday & Thursday I drove to and from Physical Therapy.  Tuesday & Thursday I drove to the pool and back (and had  great swims).  I had signed up to take a continuing ed class on Friday & drove to and from that.  Saturday & Sunday my husband & I did some shopping and other errands, I drove us around for those, too–probably close to 130 miles last week… It’s great to be driving again, to have that much more freedom, and I have had no trouble at all with it.

Saturday & Sunday I wore 2-shoes all day, not open-back ones, and that went fine…I walked all around 2 grocery stores (pushing the shopping cart for a little stability), and I have had no pain and only a small increase in swelling (I have a bit of swelling in my foot all the time).  I am slow in walking, but my gait is fairly even, with a slight tendency to rotate the “bad” foot laterally as I step forward.

My PT has said she feels I am safe in 2-shoes, but on Thursday and again this morning counseled me to wear the boot to my MD appointment  today…she says my orthopedist is quite conservative and would want to be the one who tells me when it’s OK to go to shoes…  This morning she measured my active assisted dorsiflexion at 30 degrees and active flexion at 19 degrees.  Active plantarflexion was 30 degrees.

I took my PT’s advice regarding the boot, did not mention that I have been driving for the past week, and my visit to the orthodoc went very well indeed.  He says I can (officially) drive, wear 2-shoes and continue PT to work on my gait & strength.  Best of all, I can plan to go back to work on February 27th!  (That last is particularly good, as it will keep me from having to pay almost $2k for insurance coverage for the month of Feb.  I ran out of sick leave about a month ago, so have no money coming in right now.)

I am feeling very positive about my progress, and feeling positive about the future.  I plan to swim every day this week, and have been working on getting my exercise bike moved here (to my mother’s house, where I am living these days) so I can use that daily also.

I have had 1 more session of PT, last Wednesday, and have been faithfully continuing my home exercise program.  At my PT session, the therapist noted that when walking (on 1 or 2 crutches) without the boot, that my right foot still walks as if it were in the boot, that I am not putting it through normal flexion with each step.  She had me focus on walking very slowly while mindfully attending to all the motions of each foot.  We discovered that my metatarsal head were a little bound up, and she worked them loose, which made everything a bit less stiff, and my walking more normal.

Now I am walking with the boot and no crutches while out & about and at home sometimes with boot/no crutches (when I want to cover ground and/or carry things) or with crutches & bare feet, when I can walk more slowly and attend to proper foot motion.

Yesterday my husband and I spent the day together, mostly doing errands and shopping, and I walked more than I have since my initial ATR in October.  Later in the day, I was a bit tired and sore in the hips/low back, but I was very pleased at how well it all went.  He was impressed too–he had not seen me walking so much without the crutches.

When I last saw my orthodoc, he said we would discuss my driving again at my January 30th appointment.  My PT has said for the last 3 visits that she feels I could safely drive now.  I am planning to drive to my appointment with her on Monday, and to the pool to swim on Tuesday and perhaps other days as well.  This afternoon I will do a “test drive” in a parking lot with my husband…I figure that since in October I drove for 2 weeks with no functional Achilles tendon in my right leg, driving with a repaired one will actually be safer/better…

I feel I have made a lot of progress since beginning physical therapy, and am eager to get back to driving.  I am also hoping that perhaps I can get back to work sometime in February…

I had my first PT appointment last Wednesday and my second one today.

On my first visit, the therapist was pleased with my range of motion, incision healing and limited scar tissue.  She did some tissue work on my plantar fascia and along the incision, had me work a bit on stretching and then scrutinized my gait, with and without the boot.  She measured my plantarflexion (42 degrees ) and dorsiflexion (3 degrees ).  She said I could walk in the pool in chest deep water, focusing on keeping my foot pointed forward.  (I tend to have my toes pointed out a few degrees.)  I came home with a set of exercises to do daily, most of them stretches.

Today I worked more with the therapy assistant, after a brief discussion with the therapist.  The assistant did more tissue work, focused on the incision area.  It was pretty painless, though he said that it might be sore later in the day or tomorrow.  He had me work (seated) on eversion and inversion, which is tricky for me because of the laxity in my knee joint.  I also did some strength work on my right leg.  My plantarflexion had increased by 5 degrees and my dorsiflexion by 2 degrees .

I have not had a chance to swim again, but once I am able to drive again, plan to swim every weekday.  I do feel I am improving every day, and am eager to be making more progress…  I am also hoping to be able to wear 2 shoes at least part of the time in the next week.  I continue to walk with 1 crutch most of the time, 2 crutches some of the time, and no crutches occasionally.

Today was my day to try swimming, and it all worked very well.  My friend Terry picked me up at 6:15, I checked with the lifeguard staff to make sure the “no street shoes on pool deck” rule would be waived, and it was…  I followed Ryan’s rule for getting in (good foot in the water before the boot comes off), then went over the side, into the water…

It was great.  I haven’t been swimming for over a year, but I saw 2 old swim buddies and almost made half a mile before it was time for Terry (and thus me) to get out.  I used the kickboard for about half my laps, had a little cramping in the middle 3 toes of my ATR foot (they used to cramp when it was in the second cast, too).  I followed my PT’s suggestion that I not attempt walking in the pool (I have my first visit with her tomorrow, and she may relax that).

I scuttled up the steps of the pool on my backside, pushing with the “good” foot, then sat on a kickboard to dry my leg & reboot.  Showered at home, ‘cos I didn’t feel comfortable in the pool’s shower area without my boot…
I was secretly hoping that Terry would say “Let’s do it again tomorrow!”, but she didn’t….I am hoping we will go again this week, and if not, then next week.

Today was a very nice day…My husband took me to the Winter Farmer’s Market, and shopping in a few other places too, for groceries & other odds and ends. We also had a nice lunch out…and have some fresh local apples & veg for the next several days!

I moved in with my mother in March, due to her failing health, and don’t spend as much time with David as I would like, so it is very nice to have a day together.  I did some walking (1 crutch, ⅜ inch lift in boot) while we were out, and some of the time I spent in the wheelchair.  After our shopping, lunch & errands were done, we went to our house–I have not been there since I ruptured my Achilles’ on October 18th, so it felt good to be “home” for a while.

Any entrance to the house requires going up at least 4 stair steps, and I didn’t want to risk that while NWB.  I had no trouble at all with the steps–up with the good foot, down with the bad–and David was at hand to steady me, but that wasn’t needed.  I was able to gather up swim gear for next Tuesday and a few other things I have been wanting.

One of those things was a golf ball to roll under the arch of my foot to loosen things up–I have done it a few times (gently) today, and will check with my PT when I see her Wednesday about doing a bit more of that.

I am happy to have had such a pleasant day–yesterday was a bit more of a downer–I was home all day with my mother; her caregiver was ill, so I had to look after both of us, and deal patiently with her dementia-induced repeated questions.

Last Thursday I was given 2 lifts to put in the boot I had first been issued after the ATR, to wear until surgery. There was already a 1/4 inch lift in it, and the other 2 lifts added 7/8 inch to that.  I took out the ¼ inch and the ⅛ inch lifts immediately, and cruised for the past week on the ¾ inch lift…today I replaced it with the other 2 lifts, going down ⅜ inch.

For the first time, I’m feeling a stretch in my Achilles’ when I step on my right foot…I’ve gone back to 2 crutches for today & will back down to 1 and sometimes 0 crutches tomorrow…  I can’t say I enjoy the stretching sensation, but it is forward progress.

I talked with my Physical Therapist yesterday–I’ll be starting therapy on Wednesday next week.  I mentioned to her that I hope to start swimming next week also.  She said, “You can swim and use the kickboard as much as you want, but I’d rather you not do any walking in the pool til I’ve seen you & seen how your tendon is doing.”

Here’s an amusing story:
2 weeks post-op (November 15th) I had to talk on a conference call with my boss & 2 co-workers.  They asked how I was doing, and I explained that I was spending my days sitting on the couch with my foot elevated, and that the orthopedist had said I should not expect to begin weight-bearing until February.  My boss said that she knew what I was going through, that she had had the exact same experience when she broke a toe rough-housing with her kids–it had to be taped and she had to keep her foot up for a whole week!

Actually, my co-workers have been wonderful–the first week after my surgery, 1 - 3 people came over every day, most bringing food for us, and visiting and offering to help out in many ways.  A few still bring over meals, but several call or come by every week…It has been both heartening and humbling…I have realized that I have not done enough in the past to help others, and know that I can’t repay all the kindness.

Last night my husband took me to the shoe store & I was fitted with a thicker-soled left shoe–(MBT)–with my orthotic & 1 heel lift from the boot, it makes my hips level…the back-ache from yesterday is pretty much gone, but I will be taking it a little easy this afternoon.

One of the questions I had for my doctor last week was about returning to work.

I used up 9 weeks of family medical leave between March & October of 2011 with my mother’s pneumonia/stroke/bleeding disorder hospitalizations and after care.  I had 3 weeks of FMLA left when I ruptured my Achilles’, then went on disability hours after my surgery.  I will run out of disability hours this week or next, so will stop getting paid.  I will also, beginning next month, have to pay both my and my employer’s premiums to continue my husband’s & my medical/dental & vision coverage.

The form that the doctor originally faxed to my employer said I would be out til the 8th of April.  When I saw him last week, he said that if I can wear my boot to work, I could go back “a lot earlier” than that.  (I work in a hospital, on the locked psych wards, so there is some physical danger in my work.)

Unfortunately, at my hospital, “light duty” work is reserved for workers’ comp cases only–when I go back to work, I have to be able to do my full job, 8 hours a day.  I spoke with my boss today, and she may be willing to make a few concessions for me–allowing me to do most of my work on the safest ward, and arranging my schedule so I am not having to walk too many distances.

I am so hoping I can get back to work sometime in March rather than April–I need the money, and not having to pay $2K for April’s premiums would be good!

Last Thursday (December 29th) was the day I was to go to 3rd cast or to boot–and it was boot!  With 3 lifts inside–the only information I was given about the boot was “You’ll find a bit of a stretch when you walk in this–you should take out 1 lift a week.”  and “Don’t get too crazy walking on that–I’ve had patients come back with stress fractures in their foot…”  Since I already had the boot at home from my first visit, I just took the lifts.

Now when I first got the boot, a week after the rupture, I LOVED it–my foot had been so unstable for the past week that I had stumbled & lost balance a few times, but the boot felt so safe and secure…I was looking forward to having the boot on again.

Got home, put the lifts in, booted up, stood up and started swearing a blue streak at the pain under the arch of my foot!  The doctor had not mentioned that I should still use crutches, but I knew there was no way I could walk on that foot yet without them.  It felt like I had a 1×1 right under the arch of my foot…

I decided to take out the 2 thinner lifts immediately, and found it possible to walk, as long as I just put weight on the heel.  I didn’t think that was what I was supposed to be doing, but have since found that that is about the only way to begin…

Each day it has gotten a little easier.  Yesterday I discovered that I can take a few steps with no crutches, and can do some food prep work in the kitchen with just one crutch.

This morning I woke up with a mid/low back ache–my left shoe sole is thick, but not thick enough to make my hips level…Putting one of the spare lifts in that shoe wasn’t quite enough to even things up…I will need to do something else…

I would say it all started in 2001.  I fell playing volleyball, and dislocated my right leg at the knee.  My foot was pointing 90 degrees to the right.  I tore 4 ligaments, 2 tendons & the IT band.  There was also damage to 1 meniscus, and an avulsion fracture, where tissue was torn from bone.

I had surgery 10 days later, after some of the swelling had subsided.  I had another surgery 10 months later, ‘cos there was still laxity in the joint.  (I could bend my knee backwards about 30 degrees–it was my party trick that Christmas, made nurses & physical therapists close their eyes, wince & turn away.)

After each surgery, of course, there were months of rehab…  I went through knee braces each time, and did end up walking without a limp.  I was pretty proud of that–I worked hard on my gait.

I ended up with decreased range of motion in my knee, and couldn’t go as far or as fast as before, except when swimming.  I was in my mid-40’s, though, and accepted that my life had changed.

My gait must not have been quite right, though, because in 2007 I started to develop pain in my right Achilles’ tendon.  I started PT again, my therapist did mobilizations, manipulations, ultrasound, ice, heat etc.  I did the exercises.  She made me a night splint to keep the foot at 90 degrees (my joints are naturally loose, and when I sleep, my toes point downward), and after 4 months of hard work, the pain subsided…

It came back, though, in 2009, and this time the therapy and night splint didn’t do much to relieve the pain.  I tried steroids, and they worked only briefly.  I got orthotics, and took Alleve & ibuprofen, and all in all the pain was controlled, but never went away.  Finally, at the end of the year, I started acupuncture.

Acupuncture helped, but it took 4 months to really see results that lasted more than a day or two.   After 5 months, the acupuncturist felt he had done all he could.  A few months later, the pain was back, and I was taking Alleve & ibuprofen daily again.  In July, I won a free acupuncture sesison with a different therapist, and again, in time, those treatments helped…

I was on my way to an acupuncture session on October 18th, when I tripped and fell on the sidewalk….I thought I had a very bad sprain.  My purse had flown about 10 feet away from me, my right shoe about half that far.  I had just gotten up and was holding onto a tree for balance when a man picked them up & handed them to me, asking if I was OK.  I assured him I was “fine, just a sprain”, and went into the clinic (up 2 flights of stairs) and told the acupuncturist I had fallen & hurt my ankle.  She did an emergency treatment to reduce pain & swelling, I lay there and cried, then drove myself home.

I spent the evening with ice on my ankle & my foot up.  In bed that night, I had a painful spasm then cramping in my calf, and thought, “I can’t deal with leg cramps AND a sprained ankle, it’s too much!”

I called in sick the next day (I work at a hospital, with people who are mentally ill), and went to see my doctor.  He palpated my Achilles’ tendon area and said he didn’t think it was torn, he couldn’t feel a break in it, but suggested I get an X-ray.  I did, it showed no bone breakage.  My doctor was going out of town for the next 5 days, but said that if the swelling persisted beyond Friday (2 days later) I should call the clinic and speak to the on-call doc.  I did, but he just said to continue to rest it & see my doctor the next week…

My doctor said I should see an orthopedist–I did, 2 days later.  He asked if I could stand on my toes, and I found that I could not…he said that was consistent with an Achilles’ tendon rupture, gave me a boot and scheduled an MRI for the next day.  I saw him again the Monday after, he confirmed that my tendon had ruptured and he suggested surgery on Wednesday, November 2nd.

When I saw him after surgery, he said that my tendon had retracted 3 inches into my calf muscle, and that was likely the cramping I had felt the night of my injury.  That was also why my primary care doctor did not feel any gap…  (And it was also why, after my fall, the tendon itself wasn’t causing pain any more…)