I need some advice please.
In Sept 2011 I had my right Achilles lengthened,a fasciotomy on one of the muscle compartments on the right leg, plus scar tissue removed from a previous operation. Since then I have had problems with sitting for any period of time (sitting in an upright position, like you would at a table), what I find happens is that the ankle swells and I get a build up of pins and needles within the leg, plus the leg gets tighter. I am aware that swelling will be causing this, what I was wanting to know is how others are doing further down the track. Is swelling still an issue? What have actions have you taken to reduce the swelling? My PT is not surprised that I still have this going on, but he surprised at to the extent it is happening. We have changed what I am doing for PT to see if that helps it, but I would be really keen to receive info on how others have done 1yr down and what people have done to help reduce the swelling.
October 25th, 2012 at 1:09 pm
My swelling lasted so long (2nd ATR, non-op), that I started a blog page about it — something like “At __ weeks, this swelling is getting OLD!” But that was nothing like 13-14 months in, like you. I’m puzzled.
Obviously gravity has a huge effect on the volume and pressure of fluids — blood and lymph and whatever — in our lowest extremities. But valves in our veins (valves that misbehave if we have “varicosity”) work hard to limit the effect on blood, and the other fluids are usually a nuisance only when there’s a reason for inflammation, like a recent “trauma” (injury, including surgery).
If you were suffering from varicose veins, your other leg should have a problem too, and it apparently doesn’t. Unless your PT (or somebody else) is “abusing” you, it’s not obvious why your ATR leg is still prone to inflammation.
Long-shot question: Are you showing any other signs of “retaining fluids”? Some people do (especially post-op), for reasons I’m unaware of, and common drugs (diuretics) seem to help. Just a stab in the dark from a non-professional voracious learner. . .
Also, have you tried compression socks (or just one)? No matter the cause of the swelling, I’d expect compression to limit it. They are available in a wide variety of heights and “strengths”, either in drug stores (pharmacies) or surgical-supply stores.
October 25th, 2012 at 3:21 pm
Fasciotomy? did you have a compartment syndrome? My son spent a week in the hospital last year with compartment syndrome in his lower right leg: scary stuff.
Something I’ve heard/read is that your calf muscle acts as a “pump” - helping, through actuation, to push blood up and out of the lower leg. How is your strength on that side (single heel raises)? Is the muscle - from the ATR and other injuries - still seriously compromised? I wonder (just a stab in the dark) if rebuilding the calf muscle and improving it’s function might be part of the answer for you. Does getting up and walking around alleviate your symptoms?
October 25th, 2012 at 5:30 pm
@ Norm - Glad to see others get tired of the swelling. It is definitly getting better, but it is still causing a problem to the extent where I have to go careful with what socks I put on, as some of the bands on ankle socks cut into the back of the Achilles, which increases the pins and needles. In answer to your question, no, there is no other signs of swelling, varicaose veins and the PT may give me some verbal abuse now and then
but no phyiscal abuse. I think I will try going back into the compression stockings for a bit to see if that helps.
@ Ryan - Yes, I had compartment syndrome in my right lower leg (in 3 of the 4 muscles compartments) - because it took so long to diagnose it (18 months) there was real concern I had done permanent nerve damage, however I have been for 2 nerve conduction tests now (about a year apart) and there is no sign of nerve damage. However, the last test showed signs of muscle damage in the calf, and I think it might be an idea for me to follow this up, as after a year I still can’t do a single leg raise. About 5 months after the compartment op, the muscle fascia on the front of the leg gave way, which resulted in a herniation of that muscle compartment, the result of that was the surgeon who I had at the time suggested we leave it to see if it repaired itself, which it didn’t, and he was less than helpful when I returned 6 months later to discuss other options, so I spoke with my doctor who referred me to a new surgeon. The new surgeon proposed she re-do the fasciotomy on that compartment, and I had this done at the same time I had my Achilles lengthened. I had been using the exercycle for 30 minutes each day and swimming twice a week, but that was reduced about 2 months ago as the left leg was getting more micro-tears in it due to muscle tightness. There was never an accident or incident that I can put this all down to, the surgeon I have now (different to the one who did the compartment syndrome operation) has put forward the notion that some people calf muscles are just too large, which can cause leg and foot problems. Apparently it shows up in children more, but at 39yrs old I am way past that era. In Sept this year she performed a gastroc release (release of the calf muscle) on the left side to help prevent what happened to the right leg from occuring to the left, so I understand why I getting the swelling and pins and needles in that leg as it has only been a month since the op. Yes, walking around does alleviate the symptoms, but on Saturday night we went to a show and walking at the interval and afterwards didn’t do anything and the pins and needles didn’t go away until the Monday. I think from the information both you and Norm have put here I will go and see the surgeon to talk it through with her, as I want to get to the bottom of why the right leg is still doing what it is doing. Thanks for the input, much appreciated, Karen.
October 25th, 2012 at 5:53 pm
Sounds like you developed a chronic compartment syndrome- I didn’t realize that a fasciotomy was a treatment option for that. My son’s was acute- pulled the muscle in a longboard crash, caused internal inflammation (a day later), building pressure in the fascia so high that it cut off blood supply, leading to tissue death, necrosis, and all the fun stuff associated with it. A few more untreated hours, and there was a very good chance he would have lost his leg-
Pins and needles is the classic symptom of a nerve issue. I’ve been told nerves grow back at about the same rate as hair- and my son is very slowly getting the feeling back in the area where the dead tissue was removed. I wouldn’t be surprised at all, if through the various surgeries, you’ve endured some nerve damage. Have you tried TENS/ems? Some folks have had pretty good luck with it for nerve related pain. If nothing else, it might de-sensitize the area to unwanted nerve activity. I’ve always found it odd that nerve damage often leads to hyper-sensitivity… ~8 years ago, I ran my finger through a table saw and effectively severed it at the last knuckle. It got sewn back on (a bit shorter) - but rather than being numb, that fingertip has always been super sensitive to the touch. Tough to discern a light touch from pain though.
A good long talk with the surgeon (and maybe a neurologist) does sound in order. Good luck!
October 25th, 2012 at 8:22 pm
Thanks for the advice. What is TENS/ems? Haven’t heard of these terms before. How is your son doing with his leg now? Just out of interest, did they ever messure the pressure inside his compartments, and if so, do you know what the readings were? I would be interested to get a comparison. My mother in law has had the same experience with long term sensitivity, she had surgery nearly 20 years ago and still finds the area sensitive. Will let you know how I get on. Thanks again for the info, Karen.
October 25th, 2012 at 9:24 pm
TENS = Transcutaneous Electrical Nerve Stimulation
EMS = Electrical Muscle Stimulation
You can buy units that do both for around $100.
Muscle in one of his compartments is still quite compromised, it’s the muscle that rolls his foot side to side. But, he cycles, skis, snowboards, runs, plays soccer, etc., so given what happened, he’s doing extraordinarially well. His scar makes mine look like nothin’
They did do a pressure reading. I wasn’t there. My wife does not remember the number, or the units… but does remember that it was pretty much off the chart. They scheduled an immediate, emergency, fasciotomy- and had it open for over a week.
October 25th, 2012 at 9:25 pm
My son just got home, and remembers. He says “normal” is 12, his pressure measured 57. I don’t know the units on those numbers though.
October 25th, 2012 at 10:18 pm
I just and went and checked the read out we got when I did the compartment syndrome test, mine was 54. The muscle compartment I had the most pressure in was the one on the inside of the leg, the one that I had the herniation happen in was a little lower. It is the muscle that controls lifting the foot up and down, works in conjunction with the Achilles. I am seeing my PT on Monday and have booked some extra time to discuss options with him. He has a lot of experience with these injuries as he has worked with many international and national sports teams. Think I need to put a new action plan in place. Will talk to him about the TENS and EMS. Thank you so much for the info, it helps to get a different perspective.
November 8th, 2012 at 5:27 pm
Saw the surgeon on Wednesday this week, she is sending me off for ultra-sounds. She isn’t 100% sure why I am still getting the pins and needles and related pain and wants to investigate before any decisions are made. There is the possibility I will have to do a set of nerve conduction tests as well to shed some light on what is going on. Looking forward to those like a hole in the head, don’t mind the nerve conduction part, but the muscle compression tests which get run in conjunction hurt alot. Anyway, on a positive note at least the surgeon is wanting to investigate and therefore there is a way foreward.