8 week post-op visit

Went for my 8 week post-op visit last Wednesday, I was cautiously optimistic that the OS would allow me to start PWB but it was not to be. He is adamant based on the surgery performed that there be no load on my mending Achilles to jeopardize the grafting taking place. I wasn’t really surprised, but still a little disappointed. My ROM is terrible, my exercises were put on hold until we could get the wound that wouldn’t heal under control. I did talk the OS into PT for ROM, he initially said I didn’t need PT until I was ready to start PWB but since I’m behind on ROM he agreed to PT. During my first PT visit this week I discovered that my big toe no longer curls down. During the ’scrunching the towel’ exercise, all my toes curled except big boy. The tendon that was taken to support my Achilles is the culprit. No worries for me, OS says it will only impact me if I am an ultra athlete and that is surely not the case.
So, not much new here, scootering along, just biding my time for the 12 week follow up visit. I will get another x-ray and maybe, just maybe, I’ll get the nod to start PWB.

Week 4 done - question - how long did you do therapy?

Week 4 completed, not much happening, I’m in the ‘hurry up and wait’ segment of my recovery. 4 more weeks until I go back to the Ortho. At 8 weeks post-op I hope we will be discussing PWB. My really ugly incisions are turning out to look quite good, except for my lower heel, it just does not want to close :( After the stiches were removed last week, the PA put steri-strips on, spaced apart, and told us to change them every day for 2 weeks, alternating the position, so each day we were removing a steri-strip, along with freshly formed scab and opening the wound again. As this seemed very counterproductive, I called the dr’s office and was told “oh you don’t have to keep using them if it’s doing that” HuH?? I am considering putting a couple on my lower heel and just leaving them for the 7-10 days it takes them to fall off by themselves.
So, I’m curious…to anyone reading this who has had physical therapy, I know most of you experienced a ruptured AT, I don’t fall in that category but I’m just wondering what the average physical therapy duration was for you, I understand everyone is different, I don’t need to be told that, how many weeks of therapy did you have? And how many days per week?

3 week post op visit

Yesterday, I had my 3 week follow up. The assistant removed both stiches and staples. Portions of the incisions are not fully closed and so we will be rotating steri-strips over the next 2 weeks. I was switched out of the post op boot and into the clunky aircast that I ‘will eventually begin walking in’. I discussed the pain I am experiencing that seems to be sural nerve related, upon examination, palpitating, etc. the doctor agreed and said the sural nerve could have been impacted, we’ll have to wait and see if it recovers. I was prescribed Neurontin, the directions have a 16 day regiment ramping up an additional capsule every 2 days for a total of 8 capsules at days 15 and 16. There were no directions as to what to do after day 16, everything I’ve read says ‘do not stop this medication suddenly’ and the doctor gave 3 refills, so I have a call in to the office for further guidance (sigh). X-Rays were taken yesterday, I’m told everything looks great. I was reminded “NWB” my OS said he understands it plays with one’s psyche but it’s absolutely critical to my Achilles that I remain NWB. No worries, I only want to do this once. I am to return in 5 weeks, hopefully to discuss beginning PWB. I spoke with a local physical therapist/rehab manager at the facility where I plan to rehab, they offer “Anodyne Therapy System” I was hoping it might be beneficial for me to improve circulation and wound healing, unfortunately the therapist said it would not help in my case. I also discussed my OS’ recovery protocol and asked his opinion, he stated if it was his foot, he would boot and protect it like a baby for 9-10 weeks before beginning any PWB. And so, while so many here advocate the faster protocols, I will follow the guidance of the OS and the PT and bide my time until my 8 week visit.
I received a copy of my operative report, the procedures performed were:
1. Right Achilles tendon debridement and repair.
2. Gastrocnemius recession.
3. Posterior calcaneal ostectomy.
4. Flexor halluces longus transfer
5. Popliteal block (also had a sciatica block - see previous post)
The OS told my boyfriend after the surgery that he had removed one of the largest bone spurs he had ever seen. This was referenced in the op report and to quote, “This patient has an enormous chunk of bone that had grown in and around the attachment part of the Achilles and particularly between the Achilles and the calcaneus itself. This bone measured 2 x 2 x 2 cm, putting tremendous pressure in and around the Achilles tendon itself.”
All in all, it’s going well, if it weren’t for the pain from the sural nerve, I would be pain free, hopefully the Neurontin will help, I understand the nerve recovers pretty slow. I’ve been back to work for almost 2 weeks, thankfully, I have a mostly sit down assignment and the knee scooter makes it practically a breeze to get around.
Now on to countdown the 35 days to the next appointment…..

10 days post-op

What a difference a week makes! Yesterday I ‘booty’ climbed the stairs to get a real shower, it was amazingly easy compared to trying it at day 3.  Went to the movies with my mom, used the scooter for the first time, the wheelchair and crutches have been best for getting around the condo. Went to BJs later with the boyfriend, again on the scooter, at the end of the day I was nicely tired.  I had some swelling by then but all in all, the swelling has really been minimal. My 1st post op appointment was on Wed, doc said everything looked good, got rid of the miles of gauze and put me in one ace wrap. I was told to take the boot/bandage off daily and let it air, back in 2 weeks for stitches/staple removal, I have both. Stitches in the lower incision and staples in the upper. Also at the next appt, a new boot, the one I will eventually begin walking in.  Tomorrow I will return to work, I have a mostly desk job, we’re going to the office today and prep my area, for elevating, etc. I’m going to try and attach a photo of my incisions.

Day 2 post op - Can’t wiggle my toes

Overnight wasn’t too bad, the pain meds make me dream silly stuff, I kept to 4 hours but backed off to one pill. Yesterday after getting home from the hospital I could wiggle my toes, except the big one.  Today…nothing, I can’t get one iota of movement out of them, my leg feels heavier and like it’s more swollen today, could this be why I can’t move my toes? My nerve blocks still have not worn completely off but that shouldn’t be it, any ideas?

Surgery today

The deed is done. Surgery at 10:30 this morning, pre-op procedures were fairly normal with a couple minor bumps, my veins are sneaky, so it took 2 sticks for success with the IV. The anesthetist came in to do the knee block, the IV delay put us behind so suddenly everything was hurried, the OR was waiting. He told me the OS ordered a popiteal but he was going to do a sciatica block, at that point I had already been given a ‘cocktail’ so I couldn’t seem to think straight enough to ask why. Off we went to the OR, I was awake while everyone introduced themselves and next thing, they were calling my name in recovery. Pretty intense pain, a 7 on their unhappy face pain chart. They said they had given me substantial pain meds during surgery and 3 more cocktails in recovery. The anesthetist was called in and guess what, he ended up giving me the knee block the OS ordered, substantial relief within minutes. The remainder of the recovery experience was up eventful, no nausea. I have a drain tube, wasn’t expecting that. Was sent home with 20 tubes to change out myself as they filled, we’re on -#7 already, I hope it slows down tomorrow or I will be calling to inquire.  Pain is minimal, I’ve taken 2 rounds of vicodin (x2) I hope to reduce this tomorrow as well. Leg is substantially elevated, everyone says this is key and I intend to abide by it aggressively. Gimping to the bathroom in the middle of the night worries me but other than that, it’s been a pretty decent day.

Scooter Mo - ideas for the scooter knee pad??

Fun stuff arrived yesterday, a wheelchair, shiny new crutches and a blazing fast scooter.  There was a major snafu with the insurance company dropping the ball on the scooter but it arrived in time so all is well.  I can easily see why everyone says the scooter is a lifesaver, soooo much better than the crutches.  I can also guess, just based on a few minutes zipping around the condo that the knee pad will get irritating on any long distance.  I’m looking for a little more cushy solution so I don’t have a knee problem when this is all over.  Any suggestions from the alumni would be most appreciated.  Oh, and I think it needs a horn :)  5 more days until surgery, anxiety increasing, sound sleep decreasing.

My first achilles blog post

Well here I am, soon to join the ranks of hundreds here who have had Achilles tendon surgery.  I am not among the majority who have had a rupture, my downfall has been slow coming, 2 years in the making.  OS says I have a bone spur that is slowly shredding my Achilles tendon.  "Like a rope unraveling".  Surgery is scheduled for June 17…12 more days.  It’s been both a blessing and a curse that I’ve had advance warning of the looming surgery.  Good in that I have time to prepare, get all my chores done, sneak in a vacation to the Outer Banks, time to prepare the boyfriend for the many  hats that he is going to wear.  But it’s been a curse in that IT’S.ALL.I.THINK.ABOUT. I’ve had time to read dozens of blogs here, it’s been hugely informative, for example, I wouldn’t be getting a knee block if I hadn’t read someone’s post to ask for it.

It appears, based on all the blogs here, that my OS is pretty conservative; 3-4 months NWB, 3-4 months PWB, "hope to have you walking normally in 12 months".   I hope to speed up his timeline a bit but I won’t really know what I am dealing with until after hearing the outcome and surgery details.  I’m expecting a 10-12" scar, initially I assumed it was be 4-6", not for vanity but such a large mass of infection real estate.

I’ve done my homework, I think I’m ready, I know I’m ready.