All this for a foul ball?

So during my doctor’s visit last Friday he tells me, “It’s time to transition out of that thing.”  That thing is The Boot.  The boot for many–myself included–almost takes on mystical importance in the early days after the ATR. It represents freedom from the cast and a recovery milestone.

Indeed, I did progress during my three and a half weeks in the boot. I went from two crutches to one to none. It was hot and heavy, but I was fortunate I didn’t have any of the incision issues others have battled with. I’m among those who found it a hassle to strap the monstrosity back on to go short distances in the house. I’ve done a lot of hobbling around barefoot.  And yes, there have been a couple of missteps where I’ve seen stars (just last night I stepped in a minefield of kids toys–yow).

Couple of things I discovered…my boot had a big button to pump it up with air and a valve to release the pressure.  I immediately had flashbacks of Dee Brown at the 1991 Slam Dunk contest pumping up his Reeboks. So I filled ‘er up. The support felt good.  Then it got tight. REALLY tight. Turns out when I walked my shin would push up against the underside of the button and continue to inflate it with every step. Deflated, that experiment quickly ended.  Also, the whole mechanism for that button was a pain — literally. I had a nice bruise on my shin until I finally got used to it.

Now it’s into two shoes. My doc told me to have a shoemaker fashion a one inch heel wedge. Picked it up today. Strange. Makes me limp worse I think.  Anyway, PT starts next week and I’m certainly looking forward to it.

P.S. Below is a copy of my operative report.

PREOPERATIVE DIAGNOSIS: RUPTURED RIGHT ACHILLES TENDON.

POSTOPERATIVE DIAGNOSIS: RUPTURED RIGHT ACHILLES TENDON.

OPERATIVE PROCEDURES: REPAIR OF RUPTURED RIGHT ACHILLES TENDON.

ANESTHESIA: SPINAL.

OPERATIVE INDICATIONS AND FINDINGS: At surgery, the patient was noted to have
a complete rupture of the right Achilles tendon. There was this partial rupture of the tendon
sheath of the Achilles tendon. The plantaris tendon was intact.

DESCRIPTION OF OPERATION: With the patient under spinal anesthesia and in the supine position, the right lower extremity was prepped with Betadine and draped in the usual sterile fashion from the toes to the upper calf. An incision was made along the medial border of the Achilles tendon and dissection was carried down through the skin and subcutaneous tissue. Bleeding points were cauterized by electrocautery. The tendon sheath of the Achilles tendon was opened with a Metzenbaum scissor exposing the tendon tear. The plantaris tendon was retracted anteriorly. Minimal debridement of the tendon was carried out. Then a #1 Prolene suture was tied through the tendon in a “Bunnell” fashion and the two ends of the Achilles tendon were then brought into contact. With the splint on, the ankle was kept in the equinus position. Then, a series of horizontal mattress sutures were placed in a circumferential fashion around the tendon tear using #2-0 Vicryl sutures. After this, there appeared to be a secure repair of the tendon in good position. The subcutaneous tissue was then closed with #2-0 Vicryl sutures and the skin with metallic staples. A sterile dressing was applied. The patient was placed in a well-padded short leg cast in equinus. The patient tolerated the procedure well and returned to recovery room in good condition.

As the song goes, “I’m walking, yes indeed I’m…partial weight bearing?” Forgive the lengthy post, but hey, I’ve got time on my hands.

At day 15 post-op my cast came off and the 15 staples were plucked out (not painful, photos below).  The scar looks okay, though I’ve noticed a little bulge near the top.  I guess I’m glad my surgeon went in “off center” after reading of people’s complaints that the incision on the back of their heel gets irritated by the boot.

I was then outfitted with the must-have fashion item sweeping the runways: a black DJ Ortho boot.  I waited a few days before posting so I could report on the transition.

First, let me outline my doctor’s timetable.  His plan is for me to use the boot for 4 weeks and then start PT.  I don’t have any heel lifts, but my doc did tell me to get one made for when I go into two shoes.

As for instructions…Dr. Very Laidback said I did not have to wear the boot while sleeping.  That’s a relief because, as others have stated, the sucker is hot.  Especially during these dog days of summer. It’s also heavy.   I bought some of those Under Armour moisture wicking socks which have yielded mixed results. I suppose covering the sock in a tight boot defeats the design that lets it breathe.

Next issue was mobility.  He said I could go from two crutches to one, to a cane if I needed it, then nothing.  “So, um, doctor, what does putting some weight on it mean? Like how much, and when should I start?” “Just do whatever you can,” was his sage advice.

So how has it been?  So far, so good.  By day two I was rolling the foot heel to toe, making crutching much easier because I’m no longer supporting my whole body.  By day three I was down to one crutch for most of the day.  I’ve even tried ditching them both, though I’m not really there yet.  And kkdub, I slept the very first night without the boot with no problem at all.

I’m in the same boat as those who describe the injury as not being all that painful. Yes, the incision is a little tender, and the tendon feels tight and stiff, but moving the foot does not cause excruciating pain that would make me stop. I have noticed swelling, for which ice and elevation provides immediate relief.

–and I’m seeing fireworks on this 4th of July.  At least some stars when I put my leg down.  As the doctor–and so many here have stressed–I’m elevating as much as possible.  I’m not trying to be a hero, I am taking the vicodin that was prescribed.  But man, does it make me itchy! I’m starting to wonder if it’s actually an allergic reaction.

My surgery was, in keeping with the nature of an ATR, frustrating.  I was wheeled into the OR at 2:45 for my noon surgery.  Hey delays happen, no biggie.  But I was thrown a curve right at the last minute by the anesthesiologist.  After speaking with the orthopedic surgeon last week, I assumed I would be put under general anesthesia. But the anesthesiologist says, “Surgeons just want patients who are asleep, we can do this three ways.”  He goes on to explain the risks and benefits of general, spinal and the nerve block some here have described.  His professional opinion was that the spinal epidural would be the most effective, and he would still give me something to knock me out during the procedure. I went along with it, but felt like I was being put on the spot with a pop quiz I hadn’t studied for.

Everything went fine until I was in recovery and was told I wouldn’t be able to leave until I regained feeling in my legs.  FOUR HOURS LATER I was good to go.  I didn’t get home until 10pm. It’s not like I had a train to catch, but still.

I haven’t been able to read every blog on this site, so I have a couple of questions I hope people will chime in on. From the photos I’ve seen, most incisions are directly in line with the tendon on the back of the heel. I haven’t seen mine since I’m still in the cast, but my doctor told me he was going in on the side of my foot. His reasoning is that an incision on the back can be irritating when you go back into two shoes. Anyone else have this?  Also, as I drifted off to sleep I heard him say he closes with staples instead of sutures.  It seems more people have stitches. Does it matter much?

Anyway, I’m glad the surgery is over being that I had to wait 10 days after the injury.  I know I can’t rush things–my wife calls me the impatient patient–but I’m happy to be on the road to recovery.