Posted on June 25th, 2016 by keyoung74
I am approaching my 7 months post surgery mark and I guess its fair to say that things are not going well. When I last checked in I was having pretty severe pains in the tendon during physio and had to really back off on the exercises as I had some pretty severe tendinopathy. Recently I tried to incrementally start up again with exercises that would be more in line with someone at the 4month mark (double heel lifts, ankle strengthening with theraband, balancing, etc). Unfortunately, my ankle swelled up almost immediately and the pain was so intense it almost dropped me. To add to this frustration an old injury on the same leg ( subluxating peroneal brevis tendon) returned …..after 20 years. I am not anywhere near returning to sports, running and even cycling competitively.
I have since seen a sports medicine doctor who is quite well respected and was the head physician for a few professional hockey and olympic level teams here in Canada. He was concerned so I went in for an ultrasound and the results were not good. As it turns out I have “holes” in my tendon distal to the sutures from my repair. These holes are filled with fluid and debris. There are also partial tears in this same area. Furthermore, the tendon is extremely degenerated for about 6-8 cm at the point just below the sutures. Oddly enough the peroneal tendon looks only marginally agitated.
Clearly I am beyond frustrated but I like this new doctor and we are throwing everything but the kitchen sink at getting this better. Despite my strength deficit he does not feel that I have healed long because when I plantar flex both feet move at the same time and I do not have more dorsiflexion in my injured leg. So here is what we are doing about it:
- Going to try PRP (Platelet Rich Plasma) injections in the tendons. They are going to guide the injection via ultra sound into the area of the hematoma’s. Its not a silver bullet but is supposed to promote healing in a relatively avascular area.
- Revisit my ortho surgeon to get his perpective on re-surgery? or continue with conservative treatment going forward.
- Visit a foot and ankle surgeon for consult on the peroneal tendons…apparently these do not heal well without surgery.
- He still wants to try to do heel lifts to load the tendon. If the pain becomes too great he wants to try them in a swimming pool at shoulder deep water and then gradually get shallower as my tolerance and strength increase.
This has been a pretty long rehab but I have this feeling it is less than halfway complete still. I guess there is still hope as the doctor sees no reason why I cannot return to normalacy ….just a setback. However, I find myself in this conundrum as my tendon needs activity to repair…..but research shows that pereoneol tendon issues often need immobility in the ankle to have any chance of being repaired non-surgically.
Not sure what happened here as I thought I did everything right in the rehab process.
Kevin
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Posted on May 16th, 2016 by keyoung74
I hit the 5 month post op date on May 5. Although I was not as far along as other on this blog I was making slow but steady progress. I have been diligent about the physio and have made great improvements on the ROM…its about 95% of good leg. However, the strength gains have been abysmal. I still cannot do the heel lift on my bad leg and I am starting to get frustrated as i cannot run still. Recently, I tried to increase the eccentric heel drops to 180/day and my leg swelled up (large bump on my achilles above the heel) and it was extremely painful. It was so bad I could not even ride a bike without pain. The physio told me to back it off a bit and then start up again in a week or I will get a chronic tendonitis.
I have taken the last week off and the pain has subsided so I tried to start up the eccentric heel drops again…..instant pain back. I have no problem working through pain but trying to distinguish between good and bad pain is causing me to second guess how hard I should be pushing through this.
Any words of wisdom out there?
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Posted on March 12th, 2016 by keyoung74
Its been about a month since my last post so I am just checking in to see how everyone is doing. From what I can see it sounds like everyone is doing really well. Manny you sound like you are not too far away from dancing?
I have been out of the cast for a few weeks now and am still incredibly stiff. I am no where near walking normal - Is this on par with everyone else at this point? It think it is due to weak plantar strength and very limited dorsiflexion. I have been really focusing on ROM with a focus on dorsiflexion. So far I have gotten some big gains but its like ground hog day everyone morning because it takes me approximately 15 minutes to get my leg to the ROM I achieved the day before. Is this familiar to others? or unique to me?
I had a scare yesterday as I my heal slipped off the stairs on the way to work (I was an idiot and looking at my phone at the time). I definitely felt a pretty good strain and ’stabbing pain’ but I would not call it a pop. Anyways….I am pretty sure everything is ok because I can push down with a theraband and do a seated calf raise…..this tells me there must be some connectivity. Right?
Beanie - I saw a post you had on your daily achilles exercises so I am going to try for a bit.
Take care all
Kevin
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Posted on February 2nd, 2016 by keyoung74
I have seen a few comments on here lately on how to walk in an air cast. One thing that I am unclear on is “what is a safe walk”? Currently, I strike on my heel and roll foot forward until flat footed but will not push off with the forefoot. What are others doing?
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Posted on January 26th, 2016 by keyoung74
I have been away for a couple days here but thanks to everyone’s comments/advice on my plantigrade challenges! Anyways, since my last post I have managed to coax my foot down in the flat position on the air cast. It was really tender and the tightness in the tendon really surprised and scared me as I didn’t want to pull too much. Nonetheless, after much massaging and slowly pushing the ROM in the ankle I managed to get it in yesterday. Today it feels great…and is so much easier to walk as the legs are that much closer in length.
I now have 5 more days of PWB on crutches and then move on to FWB. I have already been experimenting today on it….its odd to learn to walk again. I have no problems with the heel strike but am still compensating with my other leg when pushing through the stride….I am sure this will get better.
Anyone else notice their good leg (particularly in the achilles area) getting sore from over compensating?
Kevin
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Posted on January 24th, 2016 by keyoung74
Tried to take out the final wedge today…unfortunately I can’t get my heel down. The other 3 wedges came out fairly easy…a bit of stretch but the foot adjusted with out much pain. This time is different and I am not sure how hard I should push. After struggling for about 30 minutes I put the wedge back in for now. I figure I will attempt slowly over the next week.
Anyone else have this issue? how hard did you stretch the tendon?
Kevin
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Posted on January 21st, 2016 by keyoung74
Just got back from my 7 week assessment with the ortho. Everything looks good….good tension in the tendon which is a relief because of the divot I had following my fall in week 1. I take my final wedge out on Sunday and then hopefully will be on the final week of crutches!
Going forward I am supposed to start doing some light active ankle movements to get the tendon sliding in its sheath but no physio until 12 week. I am being encouraged to full weight bear and also have the go ahead to start doing the exercise bike once I have my final wedge out.
Moving on…
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Posted on January 18th, 2016 by keyoung74
I am down to the last wedge in my aircast now! Definitely easier to walk with each wedge coming out because my legs are getting closer in length. The last two times did not hurt when the wedge came out but this time was different…definetly a stretch. On one hand that is good..it means there is something connected to stretch! On the other I am crazy paranoid of re-rupturing (my heartfelt condolences to those on this site who have done that - I cannot imagine going through this again.).
Big day this Thursday as I meet the surgeon for a 6 week post-op assessment….will follow up after.
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Posted on January 9th, 2016 by keyoung74
Progress! I am down to 2 wedges on my walking cast now. Today I took out the third wedge and was happy to feel a stretch this time in my achilles as that tells me something is happening down there. I didn’t feel this when I went down to three wedges last week.
I have been desperately trying to keep in shape but it is hard as constantly moving around on crutches. So far my exercises consist of push ups, (I am trying this challenge: http://hundredpushups.com), sit ups and the extremely boring arm cycle rehab machine! Its not running or mountain biking but gets my circulation going so hopefully gets me prepared for when I can get moving again.
That’s it for now. Take care all!
Kevin
1 Comment »
Posted on January 7th, 2016 by keyoung74
Hello world!
I have been reading this blog now for about 2 weeks and as I read earlier…I now suffer from “achillesblog addiction”. This is certainly the most frustrating injury I have ever had. I am 41 and enjoy maintaining an active lifestyle…..until 5 weeks ago.
After reading through the multitude of posts here I am really surprised at the variability in treatments for this relatively common injury. My treatment was surgery followed by a plaster cast for two weeks and then a walking cast at week 2 with instructions to start partial weight bearing.
The most frustrating thing about this injury is the time between check ins with the surgeon. I am pretty nervous these days as the day after surgery I fell on the stairs and while stopping my fall felt a ripping/stretch sensation in my bad leg. I called the surgeon and was able to see him 7 days after surgery…..he thought the sutures were still holding but there was likely some ripping.
I returned to the surgeon 14 days post op and he was pleased with a strong response from the foot with a Thompson test. While this was good I was quite shocked when he said “you have a divot above the heal and I don’t know why”….not sure what to think about this! I cannot stop thinking about this and if something is not healing correct! On a positive note, I was ecstatic to be in a walking cast. I was given 4 heel wedges with instruction to take the first one out 2 weeks later and then every week from there on. I am currently on 3 wedges and due to take one out in two days. The odd thing here is I was expecting it to hurt as I took out a wedge but I really didn’t feel anything.
Another thing…amazing how much atrophy occurs in only 4 weeks!
That’s about it for a 5 week summary….plan to update more frequently now!
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