Week 15 update

It’s amazing how fast the time goes.  I first stepped into the boot at week 4 and now I’m ready to start jogging in a few days. Memorial Day (May 25) was the first day I tried to do toe raises in a pool. I had to be in shoulder deep water just to be able to do a few partial one, now I can do sets of 20 with full extension in knee deep water and sets of 10 (using 1 finger for balance and a little help) out of the pool. The swelling, which was a little annoying if I stayed on my feet for more than a workday, is only minimal now even if I’m on my feet for 16+ hrs. I pretty much have the OK to do everything but run and jump. I can walk at a 15min/mile pace, do all my leg workouts, golf and even bumped the volleyball around on the beach with no problem. The doctor said I can start jogging at 16 weeks and if all goes well they’ll release me at 5 months instead of the normal 6 months. I still go to PT but have cut down from 3x/week initially to 2x/week after a month to 1x/week now.  With my insurance, I still had to pay 20% of the cost and my own workouts were 3x-4x harder than what I was doing at PT. Once the massage and ultrasound treatments stopped, I found that my time (and money) were better spent using the PT as a resource for exercises. I told her it was my job to push my recovery along as fast I could and it was her job to reign me in when I got to far ahead of myself. That relationship has worked well but I’ve also been pretty good about following their aggressive protocols.  Hopefully the next 4 months will go as smoothly as the first 4 did, but I think it’ll be a lot more work to get back to 100% ….

Injury to week 4

I originally hurt myself on March 23, 2009. I had been playing squash for about 40 min when I heard a soft ‘pop’ in my left ankle while I was moving to the ball. I first thought that the glue holding down the court floor had given way and I was standing on a bump in the flooring .. no such luck. I laid on the floor and put a bag of ice on my calf as a few of the gym trainers came by and checked on me. There was no pain at all - I’ve been fortunate enough to never have any pain post-injury or post-surgery. Everyone was saying that since there was no knot in the back of my calf and no pain that I’d probably just sprained my calf and I just needed to rest for a few days … WHATEVER. I ended up driving my manual 5-speed home that night without too much of a problem.

The next day I called every orthopedist in the Blue Cross list and I couldn’t see anybody that day (wed) or really that week (since it was spring break). On a referral of a referral, I finally got an  appointment that afternoon at a sports medicine clinic nearby. When I saw the orthopedist, all he did was grab my ankle for a minute while I was seated facing him. He said that I probably had a slight tear higher up on my ankle and that it probably would heal on it’s own. He suggested I come back the following week and do some PT there. That was it ! No Thompson test, no MRI ! Of course, since I hadn’t found achillesblog yet, I was reasurred and off I went.   I limped around until the next Tues and then went to PT.  The therapist did the Thompson test and was a little concerned, but we did some stretching and ultrasound for the first session. I went back fri for another session, this time the therapist got the doctor and then he suggested that I get an MRI that day. Unfortunately, it was too late and they scheduled me for an MRI the following monday. At that point, they gave me a set of crutches and suggested that I use them for the weekend. Tues I went back to get the results of the MRI (2 weeks after the injury !) and they told me that I had ruptured my achilles and there was a least a 48mm gap in the tendon. “You must have torn it, then ruptured it in the last few days”, the doctor said.

I had been talking (by phone) to a friend who is a GP this whole time and he had told me that since I couldn’t get up on my tiptoes that I had torn my achilles or worse, but who would wants to believe a GP ?!? When I told him he had been right with his over the phone diagnosis, he suggested, STRONGLY, that I find another orthopedist. Luckily, another friend works with a lot of the orthopedists in town and when I called him, he recommended the ankle specialist that works with the pro basketball and football teams in town. I got an appointment with him that fri and they scheduled the surgery for the following Tues (April 14) … 3 weeks after the injury.  At that time they gave me a CAM boot with 2 wedges in the heel to use until surgery. They were going to put me in a cast, but I was still driving my manual car.  I’m a very active person (sand volleyball, running, squash, etc) so the non surgical route was never an option for me. 

The surgery went well (April 14). The doctor talked about a platelet rich plasma (PRP) therapy that he would do during the surgery. Here’s a NY Times article about it … http://www.nytimes.com/2009/02/17/sports/17blood.html.  I only took the hydrocodone they gave me a couple times that night. I ended up scratching during the night and then I read how that was a side effect. Haven’t taken anything since then .. lucky, I guess.  I live in a 3 story townhouse, so I had set up chairs everywhere (bathrooms, kitchen etc) to allow me to put my left knee on them and stand.  After a couple days (fri), I went back to work. I have a desk job so it wasn’t too bad although my ankle would swell after a while. I finally just started putting my leg up on the desk to relieve the swelling.  When not at work, I stayed on the couch for the first week, keeping my leg elevated on about 4 pillows.

My first post op visit was 9 days after surgery, the bandages came off, but the stiches weren’t ready to come out. They ended up putting my in a cast that went up to my mid calf. After a short discussion, I got them to let me come back at 2 weeks (5 days later). Of this whole experience, the 5 days in the cast was, by far, the WORST part off it. It was never comfortable .. it was itchy .. it swelled .. it was itchy .. it swelled .. it hit my other foot .. I’d have confessed to anything !!

My second visit (14 days after surgery) went great. The cast and the stiches came off and I got put into the CAM boot. My foot was pretty close to neutral, but they left the heels pads in the boot. They then told me I could put 30-50lbs of weight on my foot. I was so pumped about it that I didn’t hear/remember the part about increasing the weight every week. My next appointment was in 2 weeks. Of course I didn’t have a bathroom scale so I had to get one using my (automatic) rental car. As I walked up the stairs to my townhouse  with my hands full of crutches and bags, I caught everything on the top step and fell forward. Of course, I put out by bad foot (boot on) to stop myself with the heel (at a 45 degree angle). When I kept sliding I really pushed  hard on my foot and then felt searing pain as my whole leg cramped up. I crawed up to the couch and stayed there all night while my calf and achilles throbbed for most of the afternoon. By this time, I had discovered achillesblog and had read how a few people reinjured themselves by doing similar things .. uh, oh !

I called the nurse the next day and confessed. She suggested I come in for an ultrasound just to be sure. The ultrasound showed everything was fine, although when they showed me the comparision between my good and injured ankle, I was surprised much thicker the injured one was  (due to swelling, duh !).

On my third visit (28 days after surgery) I realilized that I should have been increasing the weight I was putting on my foot the last 2 weeks. I should have been up to 50-100lbs by then. The doctor told me I should get to full weight bearing by the end of the week and to get rid of the crutches. He also said I could start PT, they have PT facilities in their offices so I decided to use them.