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Week 21 - Back in regular shoes and gaining flexibility! April 27, 2009

Posted by neteng in Uncategorized.
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It has been a while since I have posted.  The last time I posted I was suffering quite a bit from overdoing it the prior weekend.  It has come and gone over the past several weeks.  Just when I think I feel good enough press further I get a reminder that I have a long road still ahead.  I am still experiencing a lot of stiffness and lack of dorsiflexion.  It has been slowly improving and I can work on stretching and get quite a bit past neutral in a calf stretch.  However,  if I don’t stretch for a couple of hours it still gets quite tight and I feel like I am starting all over again. 

I was able to buy new shoes and put my “heel lift” shoes away.  It does feel good to be without impediments.  Once stretched out I can walk fast enough to keep up with most people and have only a slight limp.  The limp is probably caused most by the result of my weak calf. 

I plan on beginning to go back to the gym and do some walking around the track and light treadmill work.  I also hope to do some some low resistance exercise bike work.  I feel like I am progressing slowly but surely.  I still feel like I am a long way from even attempting to try to jog.  Hopefully now that I can wear regular shoes and get back into a gym regiment my recovery will speed up a bit.

Week 13 - Doctor says come back in 3 months (if needed) March 4, 2009

Posted by neteng in Uncategorized.

I have been working really hard at improving my ROM by doing calf/achilles streches.  This was working pretty well and I was finally able to get past neutral by a significant amount this past weekend.  It really reduced my limp a great deal.  I was walking without my “heel lift” shoe on around the house this past weekend and things felt good.  I must have overdone things as on Monday I began to have pain in my tendon for the first time since going to 2 shoes a month ago.  It got so bad that I could hardly bear any weight and contemplated dusting off my crutches.  I have been icing, massaging and resting my achilles as much as possible this week.  It has gradually been improving but no where near to how good things were going this past weekend.  I was on my feet a lot today and could barely weight bear by 6pm this evening. 

I had my 13 week appointment yesterday which was my first since going into shoes 4 weeks ago.  My doctor said “Come back in 3 months.  But if you feel fine cancel the appointment.”  So I guess I am on my own to just walk this thing off as no PT has been prescribed.  The only guidance I have gotten from him is to keep wearing the “heel lift” shoe and don’t do any sudden motions or tiptoe type motions.  He prescribed Voltaren yesterday for the inflamation and pain I was having.  He said everything looked fine and I probably just overdid it this weekend.

I am frustrated that I have had this setback and my doctor has pretty much signed off on me.  Hopefully, things will just take care of themselves and 3 months from now I will be much further along than I am now.

Week 12 progress update and Pics February 24, 2009

Posted by neteng in Uncategorized.

I have been in 2 shoes for 3 weeks now.  I am having gradual progress in my ability to walk somewhat normally.  If I put both feet flat on the ground I can get just slightly (very slightly) beyond neutral.  This has allowed me to walk much more naturally than a couple weeks back despite being a bit inhibited by having a heel lift on my shoe.  I keep doing calf stretches and the ROM exercises that Dennis posted to the PT section of the site.   I am thankful for that as it really is the only guidance I am getting on PT.  When trying to get beyond neutral the tendon feels like a taught rope and the muscles on the sides of my ankle and lower calf feel like they had practically calcified.  I do have ankle swelling that inhibits my ability to get much beyond neutral as well.  The lower front of my shin and the top of my foot gets swollen and this also acts as a barrier to getting my leg to be able to push forward. 

My doctor doesn’t want me using any resistance so I don’t know how far to push it when I am doing a calf stretch or trying to get beyond neutral.    I go back next week for my 1 month visit since shoes.  Hopefully my doctor will have some guidance on some sort of PT regimine I should follow on my own as he doesn’t recommend professional PT for my recovery.

Scar at 12 Weeks

Scar at 12 Weeks


Left Shoe with Heel Lift

Left Shoe with Heel Lift

Week 9 - 2 Shoes!! Learning to walk again! February 4, 2009

Posted by neteng in Uncategorized.
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I had my 9 week post-op visit yesterday and brought my shoe that the shoe shop had added a 3/4″ lift to.  They actually thinly sliced the bottom of the heel of the shoe off, added the rubber lift, then glued the bottom of the heel back on.  It looks pretty good on the two shoes they installed these on.  I was envisioning some sort of wedge but they almost look like they were manufactured with the lift built in.  At my last visit my doctor and assistant spoke of reducing the lift each month to ween me off of them by the end of three months.  Today they said I would keep this 3/4″ lift on the whole time.

I had been getting around with the walking cast pretty comfortably without crutches for the past two weeks.  The cast certainly provided stability and peace of mind.  It is quite different with just shoes.  There is quite a psychological side to this injury that makes it a bit daunting transitioning to shoes.  I am walking very calculated and slow but am crutch-free.  It feels a lot better than I thought it would.  I brought my crutches to the appointment just in case I didn’t feel comfortable right away in the shoe but didn’t have to use them.

It felt great to get my foot into some water and scrub the flaking skin off.  The scar looks pretty good and I hope the next week of scrubbing will result in a much better looking foot.

My AchilloTrain came.  I had heard nothing but positive comments for this device from other posts.  As soon as I ordered it though I received 2 posts on my blog about how others were told not to use this by their doctors or PTs.  I am a bit torn now.  I am contemplating sending it back as the particular company I ordered it from will allow a return.  Many of the online stores did not offer returns on this item.  I ordered it while my leg was still in a cast and used my good leg as a measurement.  My good leg measured at about 9.25in so I figured that if anything my bad leg would have been the same or a tad less.  Well, due to the larger size of the tendon and perhaps some swelling ,my bad leg measured nearly 10in in circumference.  The Achillotrain is sized for 9-9 7/8in.  Due to the negative comments I have recently received, coupled with the question about sizing, I am strongly considering not using it.  Maybe the heel lift on my shoe will be good enough.

Since my doctor isn’t a real fan of PT I am looking through other’s blogs for some suggestions on some PT I can do myself at home.  The only recommendations my doctor gave me was to walk with the adjusted shoe on at all times and do some movement of the foot without resistance.

Week 7 - 4th Cast - Foot finally in neutral - 2 more weeks to shoes!! January 21, 2009

Posted by neteng in Uncategorized.

For the past week I have been in a “walking” cast that wasn’t especially easy to walk in as my foot was still not to neutral (see week 6 post for pics).  After a few days however I was able to walk without crutches albeit a loose interpretation of walking.  It was more of a step-shuffle, step-shuffle gait.

Yesterday 1/20/2009 I went back to my doctor and was successful in getting my foot to neutral (relief!!).  It was quite difficult and painful to do but managable (and worth it).  Now my “walking cast” is much easier to walk in.  I am only using the crutches for getting around outdoors as change in elevations along with snow and ice cause stability problems.  In two weeks 2/3/2009 I am scheduled to have this cast removed and go into 2 shoes with a heel-lift on my left one.  I have had two shoes (one work show and one athletic shoe) fitted with 3/4″ heel lifts.  I will have the lifts reduced by 1/4″ each month for the next 3 months.  I am a bit concerned about stability when I go into the shoes so I may order an AchilloTrain to give me better lateral support.  The last thing I would want to do is roll an ankle and re-rupture.

I am also concerned that walking without crutches will take a bit as right now the cast is providing a lot more support than just a shoe will.  I’m not sure if I should change my status to FWB as I am currently walking with this cast but may be back on crutches for a bit when I initially transition to shoes.

Week 6 - In a walking cast (Sort of) January 12, 2009

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I had my six week appointment today 1/12/09.  I had been in my 2nd cast for the past 4 weeks with my foot in equinus position (pointing down at about 45 degrees).  My surgeon mentioned at my 2 week visit that he would be putting me into a walking cast at my 6 weeks post-op appointment. 

I had my cast removed and the physican assistant walked away with the following instructions ”work on getting your foot in neutral position.”  He didn’t give me any suggestions how I might best do this as I have had my foot in the same position basically since surgery.   As I sat on the exam room bed I tried to lift my foot up to neutral position.  No surprise, this didn’t result in much. 

My ortho returned and told the assistant to make me a fiberglass walking cast.  He also told me that in three weeks he would like to put me in shoes with “heel lifts.”  He gave me the name of a local shoe repair shop that would attach lifts to my shoes.  Our insurance won’t cover this I found out, but my wife thought it would be a good idea to get two shoes setup with lifts.  One work (dress shoe) and one atheletic shoe.  Hopefully it won’t cost too much.  I am not sure if the athletic shoe should be a running shoe or a basketball shoe with more support.  Does anyone have any suggestions?  He said that I would be in the “heel lift” shoes for 3 months and then left.

The assistant returned and pulled up a piece of apperatus alonside the bed with a metal bar on it for me to put my foot on.  He had me put my foot on it and try to get into neutral position.  My achilles was extremely tight and quite painful when trying to get into to neutral.  After about 10 minutes on the bar he just wrapped my leg in a fiberglass cast like before.  This time he attempted to put a base on the heel by using extra fiberglass gauze.  It is quite a heel on this cast.  He then had me put a boot-like cover with a rubber sole around the cast.  

Since I could not get my foot to neutral it really isn’t practical to walk in this.  It is quite a bit higher than my other foot even with a shoe on.  It is also not level on the bottom despite his effort to put a large heal on it.  I am able to put some pressure on it while using my crutches and also stand comfortably balanced without crutches.  I hope during the next week that puting some weight on it (60lbs or so) while I walk will loosen up my ankle and tendon so that I can get into neutral position.  Even being partial weight bearing feels like good progress.  Does anyone have any insight or advice on any thing I can do to achieve this next week?

Injury Progress 1st 5 weeks. January 5, 2009

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Surgery 12/2/2008

I had my surgery around 12:00pm on 12/2/2008.  I had a spinal block so I was numb from the waist down.  I was mildly sedated during the surgery and woke up as the surgeon was sewing up the incision.  I asked him how the ends of the tendons looked and he said that they were pretty frayed.  He put in 20 stitches to seal up the incision and let me choose my cast color.

That evening when the spinal block wore off I got up to use the restroom.  This caused the blood to rush into my leg and started to cause some discomfort.  This was normal with the splint the week prior to my surgery.  When I would get up after a period of rest the blood rushing into my ankle and foot would cause temporary discomfort.  It would settle down after a few minutes and I would only take an occasional ibuprophen.  NOT THIS TIME!  My calf began cramping and spasming.  The part of my calf that I could see near the top of my cast looked as if something was trying to crawl out of my leg with all of the spasms.  My pain that had been at 0 pretty much since the injury was now at about 8 out of 10.  They attempted to address this with a small amount of Morphine from the IV and some Percocet.  This did not work.  After a few hours of what felt like an intensly painful leg cramp I suggested that they give me a muscle relaxer to address the spasming instead of just trying to mask the pain.  They began giving me Flexoril every 4 hours.  They also gave me a PCA of morphine that I could press every 8 min.  Finally, the next morning at 6am the spasming and pain finally subsided (10 hours after it began).  Needless to say I didn’t get much sleep.

They kept me another night in the Hospital since I had just endured an entire night of pain that I would say was as intense as the pain at the moment of rupture but this time lasted 10 hours.  I went home on Thursday 12/5/2008 with a leg cast on and my foot pointing downward.

Back to Work

The Following week I returned to work.  As a network engineer for a computer consulting company I am able to a large portion of my job sitting down and sometimes even remotely from my house.  Living in WI during the winter causes a lot of problems as snow/ice and crutches don’t mix.  I purchased some metal spikes for my crutches that I can put down when needed.  We set a record in December with 37+ inches of snow so I had a few days working from home.  I know I owe my wife and neighbors for all of the snow shoveling/blowing they have done in my absence.

Surgeon’s Protocol (Confusing)

When I first met with my surgeon before my surgery he stated that for the first 4 weeks post-op I would be in a full leg cast.  Following this I would be in a partial leg cast for 4 more weeks.  Following this I would have heel lifts attached to my left shoe for a few weeks and slowly weened off of the lifts.

After the surgery he decided to put me in a partial leg cast instead of a full leg cast.  Thank God.  It is great to be able to bend at the knee to get around vs. a full leg cast.  I live in a two story house so it would have been very difficult to manage the stairs with a full leg cast. 

When he dismissed me from the hospital he changed his mind again and said that I would come back in 2 weeks to have my cast/stitches removed and then be in the next cast for 9 weeks.  That’s now 11 weeks in a cast.  When asked about changing the angle of my foot during this time he said he wouldn’t because it needed to heal.  So I left disappointed expecting 11 weeks in a cast with my toe pointing downward.  That seems more conservative than some people who opt not to have surgery.

Two Weeks Post-Op - Stiches out and 2nd Cast on

Two weeks post-op I had the stiches removed.  No infections and the surgery site looked good in his opinion.  My foot angle was very slightly raised  towards neutral for the 2nd cast.  If pointing down is 45 degrees I would say I am at 35 degrees.  My surgeon seemed to change his mind again and said that I should come back in 4 weeks and he would look at putting me into a walking cast.  I was relieved as it wasn’t 9 weeks with my foot pointing down like he mentioned in the hospital. 

Weeks 3-5 - The Holidays

I am surprised at how since the painful and grueling first night following surgery I have not really had any pain.  It swells up a bit and feels tight in the cast if I have my leg down for long periods of time but subsides if I raise it up for a little bit. 

It is a bummer during the holidays to be laid up like this.  My wife’s parents and my aunt have been very helpful on days my wife works and I need some help with my two boys.  I only asked for their help my first weekend alone with the kids.  Since my wife works every third weekend by the next weekend I was able to get by without any help.  It is a lot of work taking care of them when I can’t move very fast and am still NWB.

The holidays are stressful enough as it is without an injured spouse.  The extra work my wife has been doing is certainly wearing a bit.  She will be extremely happy when I can ditch the crutches.  Hopefully on 1/12/2009 on my 6 week post-op visit I will be able to get my foot to neutral and fitted with a walking cast.  I would prefer a boot at this point as it seems that a walking cast is not going to allow me to do any ROM exercises or PT.  I would also like to be able to have a boot so it can be removed at night or to shower.  Who knows what my surgeon will choose to do next.  I will keep you posted.

Too much too soon!! January 5, 2009

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I am a 34 year old male with a desk job that thought it was a good idea to get back in shape.  I played organized sports and pickup games regularly until my first son was born 7 years ago.  Since then I now have a 4 year old son as well and haven’t had a lot of free time.  In October 2008 I started going to the gym weekly.   Then in November a co-worker invited me to play in an informal basketball league at a local high school gym on Monday nights.  The second Monday night (11/24/2008) of basketball I tore my left AT about 30 minutes into the game.  I wasn’t doing anything explosive like jumping or sprinting.  I was simply planting on my left foot to change the direction I was dribbling.  I didn’t hear a pop but felt a sharp burining pain above my heal. 

I had thought that somebody from another court had dove after a ball and kicked me in the heal.  I hobbled off the court and asked who (or what) hit me.  When they told me that nobody was near me I immediatly suspected it was my achilles.

I drove home and my wife (an RN) drove me to her hospital’s ER and they confirmed it was a complete rupture.  I left with a splint and had an appointment scheduled for that Friday morning with the Ortho Surgeon.  My surgery was scheduled for the next Tuesday morning 12/2/2008.