lotus10’s AchillesBlog


5 weeks post-op and PT

Posted in Uncategorized by lotus10 on the August 4, 2010

I was supposed to go see my surgeon for my second visit at 6 weeks post-op, but due to my work schedule, went in today. I worked this past weekend, and by the end my foot was quite worrisome: swollen to the point I couldn’t separate my toes, dusky and warm around the incision. Tried not to panic, although the warmth really worried me - took Advil, iced, elevated and it took 2 full days to look and feel like before the weekend. Also it felt unusually stiff and sore, it wasn’t so easy on one crutch anymore, I began to wonder if I re-ruptured it sometime while working. From what I read around here, some people don’t even know they tore it, right?

But the surgeon examined it and said it is indeed still attached. He also said it’s time to start physical therapy (2-3 times a week, 1 hour each) and that I could come out of the boot. “Um I don’t think so,” I told him, and also about my initial 5-heel-wedges. I had just got down to 2. He said, really, I should be coming off crutches, the boot, fairly soon. I was flabbergasted that I was behind his schedule - and insisted that I still need the boot, the wedges, and a cane instead of a crutch. I think he was a bit puzzled and said “well we can get you a cane but… really, you’ll come off all these soon…” and told me to come back in another 6 weeks.

I said humph to myself and went to the hospital’s pharmacy and bought a cane for $19.99. While I’m probably 80-90% bearing weight on the bad leg, there was just no way I was going to walk without some support.

And I went to physical therapy today. (I found out my copay is $40 a session and argued with my insurance company, “do you want me to be contractured and sustain another injury? huh?” but to no avail. I don’t think I’ll pay more than $600 for this whole ordeal including surgery, but PT is going to cost me more than that! Way to go US healthcare.)

The therapist evaluated me for an hour and apparently I am behind where I should be. I was like, I’m behind your schedule too? She wrote out several exercises for me, and although I should be grateful that I am far more mobile than 3 weeks ago, I have a feeling I am not going to enjoy this phase of recovery. It’s more the fear of re-rupturing, I know it happens but - right now, I just can’t think of going through this again.

Anyway, the surgeon and therapist both thought swimming would be good. I’m a bit afraid about slipping on the way to the pool. 4-6 months til tennis, even the machines, where I know the ball’s coming.

9 Responses to '5 weeks post-op and PT'

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  1. firstdayofsummer said,

    on August 4th, 2010 at 7:12 pm

    Hi Lotus,
    I am 6 weeks past ATR now (went the non-surgical way) and when my OS told me a week ago I have to go FWB I almost had a panic attack right there in his office. So once I got home and stopped hyperventilating I decided to give it a try and can I just tell you…..I have not stopped moving since! What a liberating feeling. Trust me, if he tells you you’re good to go (and you’re still wearing your boot), you’re good to go.
    I also had extreme swelling up until 5 days ago and then started taking foot baths and massaging my tendon daily….it worked like a charm! For the first time in 6 weeks my feet are actually starting to look the same again (oh and I also started doing the dorsiflexing which again gave me the hives when the OS was just talking about it a week ago).
    Try and do what they tell you to - at your own speed and while listening to your body and it’ll be ok.

  2. lotus said,

    on August 4th, 2010 at 9:24 pm

    Thank you firstdayofsummer. Are you still in your boot? Without crutches, don’t you limp - like I do? How do you do stairs? Are you back to some sort of exercise? I know these will all come to me in time - but just hearing that I was “not where I should be” irritated, and kind of saddened me. In case anyone is curious, for homework I am supposed to be doing isometric inversions and eversions, plantar flexion with resistance, and sitting heel raises (3 sets of 10, a day).

  3. GerryR said,

    on August 4th, 2010 at 10:51 pm

    Were you standing a lot while you were working? That alone will cause significant swelling for quite a long time after surgery. Elevation and ice will take care of it, as you found, but the best thing is to just not do things which will cause significant swelling. Don’t allow the boot or a cane to become a “crutch” that you convince yourself you will need for many weeks or months. At home, where it’s safe, take off the boot and walk around barefoot. You can minimize dorsiflexion by always keeping your injured foot in front and only really putting weight on your heel. You want and need to lose all that apparatus as quickly as possible. My original surgeon told me 2 weeks post-op stitches out, PWB and begin PT, FWB at 4 weeks post-op and 2 shoes as soon thereafter as I could manage it. Complications messed that up but that was the plan, not terribly unlike other recovery protocols discussed here. There is absolutely nothing to be gained by keeping your ankle immobile for 6 weeks, in fact there is a lot to lose in terms of muscle mass and strength. My current PT told me that studies show that within 24 hours of the ankle being immobilized the calf muscle begins to atrophy. Take it from me, because I was basically immobilized from August 3, 2009 until almost mid-November, you do not want your ankle immobilized any longer than is absolutely required. Yes, you will limp and do so for several weeks but you’ll get over it. When you go down stairs put the injured foot down first with your heel taking the weight. Sure, you can re-rupture but it is quite uncommon so don’t let your fear of that hold you back from getting beyond the “crutches.”

    And don’t blame the entire US healthcare system for something that is policy specific. Other insurance policies will have different co-pays or even no co-pays for physical therapy. I have had Medicare and a supplement since last September and have not paid more than $100 for anything since then, including two surgeries and extensive physical therapy. So from my point of view, the US healthcare system is just fine. My wife’s insurance has a $10 co-pay for physical therapy, so everyone’s policy is different.

  4. normofthenorth said,

    on August 5th, 2010 at 1:26 am

    Lotus, it’s an interesting tight-rope, figuring out how fast to go. In general, the studies show that going pretty fast works very well, and it also makes it easier to live a life and return to normal. On the other hand, taking chances is scary and risky, and re-rupturing is Very Bad indeed.

    You’re behind their schedule, and the good news is that you’ll catch up, and we’re all betting it won’t be anywhere as bad as you seem to be fearing. Most of us really appreciated and enjoyed the landmarks you’re about to reach, and pass, along the road back to “fit” and “normal”.

    On the other hand, you can’t just make believe you’re on schedule, or “snap” to their schedule, either, but you can do the exercises and stuff, take time to elevate, not abuse your leg, and gradually catch up.

    I borrowed a cane myself (at four weeks post-non-op), and I’m glad I didn’t even pay $20 bucks for one, because maybe 4 or 5 days after I started using it, I started forgetting where I’d left it! After that, it’s only useful occasionally, to help protect your space when walking in crowded places!

    If you can, please install the widget at http://achillesblog.com/dennis/2008/03/08/achilles-timeline-widget/ . That will quickly remind all your readers of your key facts (where, how, which leg, how long ago, etc.) so we can keep your story straight from all the others without having to re-read your earlier blogs.

  5. firstdayofsummer said,

    on August 5th, 2010 at 10:52 am

    Lotus, I am still in a boot without crutches when I go out, have to get things done quickly in the house and going up/down stairs. Other then that I have started to walk around the house without it (here’s hoping my OS is not reading the blog).
    I am not pushing it and definately do not want to re-rupture but instead I listen to my body and carefully tried to walk on my ruptured foot (with a crutch) without the boot. Had it not felt right I would have stopped right there and then but it worked and felt good.
    During this whole ordeal I learned ‘mindfulness’, that is paying attention to my surroundings (making sure nobody leaves anything lying around the house that I could trip over) and watching my every step. May I just say this is VERY unlike me.
    I can go up the stairs with alternating legs (that is one step per foot) and Norm’s explanation somewhere has helped me mastering stairs. Still working on going down the stairs properly….right now it’s both feet on each of the stairs.
    As to exercising, I am doing the PT exercises, bike 20-30 minutes a day, try to do hip and knee exercises, and do a few easy yoga poses.
    Good luck with the healing!

  6. andreea said,

    on August 6th, 2010 at 8:15 am

    Hang in there Lotus,
    I also miss tennis A LOT and running and all that other stuff. I think surgeons have dealt with this kind of stuff a lot and they know what they are doing. They would not suggest anything they are not sure of, so go with them. Once I started walking in my boot (also at 5 weeks by the way), it took me a whole week to get about without crutches. It was very hard and the tendon was tight and I worried a lot about distinguishing bad pain from good pain. I never thought I’d get there but it’s amazing what a difference even 4-5 days can do. Hang in thee and it will be fine. All the best from me!

  7. Larrylove said,

    on August 6th, 2010 at 8:54 am

    Hi Lotus,
    I had my surgery on July 1st. Since this is my second time through this, I was a little more comfortable going through the routine. I remember the first time at therapy, the first time around, I thought I would never walk properly again. I was in sooo much pain and it was soooo sensative I would not even let the therapist touch me! I know how your feeling when they are practically telling you that you should be doing sprints in the back yard by now…..it took me a full 6 mos before I was walking strong again and back to “normal”.
    This time around I am definately more secure and confident. I am still in the boot and removed all the levels. I am partial weight bearing…..although close to 100%, I am still using the crutches, more for security and further assistance. I am a very sloppy, unsteady walker without them at this point. I have been in therapy for the past 3 weeks. PT at this point consists of basic exercises and alot of ice and electro stim.
    I know its frustrating, just keep your head up. Its a slow and steady game at this point. That is the biggest pain in the azz about this injury…….

  8. Maida Broudo said,

    on August 6th, 2010 at 3:34 pm

    Hi There,

    I Had my surgery on June 28th, which was a repair of the tendon, which had only Frayed but not ruptured.

    I just got the boot on Tuesday and am walking with one crutch under my good arm which is great to have a free hand. Each day really does get better for sure.

    MY MD said no to the bike, but I can’t help it, I need some cardio and I keep the boot on and hardly put any wait on the healing leg. Leg lifts, ab work, arm excercizes help me feel better!

    Aloe and ocean salt water and massage on the scar have med it all but disappear.

    The biggest challenge is that it the other side of my body is taking a hit…imbalances etc….so I need to work on that.

    Good Luck!

  9. ggrace57 said,

    on August 7th, 2010 at 7:37 am

    Maida,

    I was allowed on bike with boot at two weeks. It does help to get some cardio. You should be fine as you describe with little weight as it turns. You will be out of boot before you know it!

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