Nightmare scenario 10-wks post op

Posted on August 15th, 2015 by outlaw

Update below

So everything was going great with the recovery thru 10 weeks post op. I was doing 2-legged calf raises in PT, balancing on the injured foot for over a minute, and had almost normal ROM. I was mostly out of the  vacocast around the house and made an excursion out of the house in 2 shoes last Monday.

This past Thursday I went camping with the family, and feeling confident, I was out of my boot setting up camp and around the site. Then I tripped over the gyline on the tent in the dark. Stupid, I know. I went down hard and felt a lot of pain in the ankle and calf. I jumped up quickly and did my best to walk it off. It’s hard to remember; but it didn’t feel like it did when I ruptured. Still felt horrible. You can all imagine the anguish I am experiencing.

My Achilles is still functioning. I can flex my calf and plantar flexing is good. I can do seated calf raises and the calf is engaged. Dorseflexion is decreased significantly. Swelling is minimal (no more than it has been the past couple of weeks), and there is no bruising. I think I can feel a gap, but I don’t know if that has been there this whole time. When I was in to see the OS 2 weeks ago I asked him where the rupture occurred and he could feel where it was by palpating it. Hopefully I am feeling the same thing he did. There is a lot more pain and soreness in the tendon. What’s also new is the pain and soreness in the calf.

I’ve got an appointment with the OS on Monday. Thoughts swing from optimism to despair…..

Update -

I had a visit with my OS 4 days after my accident. He felt some weakness in the tendon and ordered an MRI, which I had later that week. Went in to get MRI results (now about 11 days after reinjury), and it showed a rerupture. He seemed to think that it wasn’t at the original site, but I’m not so sure about that. However, he said that functionally it looked “pretty good”. Function and MRI weren’t jiving. Basically, he wasn’t sure what was going on with it. The options were to do an exploratory surgery to see how it looked and to fix it if there was a clear rupture, or to wait few weeks to see if I can strengthen it. He said that it wouldn’t make a difference if we did surgery that day or waited a month, so why not give it a chance. I asked about going back in the boot, but he said, “we’ve done that already. Let’s continue with therapy where you left off and see if it gets stronger. If it doesn’t, then we may have to go in there and do something.” It wasn’t very reassuring that he didn’t have a more definitive answer for me, but I’m glad that he wants to give time and PT a chance.

So I’ve been back in PT for 2 weeks, and it’s feeling better. I’m a little bit beyond where I was before the notorious camping “trip”, mostly in ROM and balancing. I’m at 13 weeks post-op on the calendar, but with the set back, i’d put myself at about 10-11 weeks in reality. Therapist had me try one legged eccentric lowering today, which i wasn’t even close to achieving. Sticking with 2-legged standing, and one-legged sitting raises with weights. Concentrating on losing the limp when I walk.

When were other people able to do single-leg eccentric lowering? Should I expect to be able to do that at 15-16 weeks following the UWO protocol? Everyone’s recover is different, but I want to know what the range of this expectation is.

Continued thanks for everyone’s input

6 Comments »

Vacocast questions

Posted on June 22nd, 2015 by outlaw

Hi All,

I’m 2 weeks, 3 days post-op for ATR. I had my stitches out and was put in the boot at 11 days post-op. I brought my Vacosast to the post-op visit, and although the OS wasn’t familiar with it he was fine with me using it instead of the Aircast boot. I left there with it set at 5 degrees with the wedge sole because he seemed like he was having trouble correlating the angle to the 2cm heal lift. That setting felt a little tight, so I moved it to 10 then eventually  15 degrees. He has me on the OWU protocol, and I noticed that the study states that the 2cm heel lift is approximately 20 degrees of plantarflexion.

Has anyone used the Vacocast with the OWU protocol? If so, what settings were used? I’m a little concerned with the Vacocast because it leaves an indentation on the upper part of my incision. Anyone else with a similar experience?

For comparison, I tried out the Aircast boot that I was using before my surgery and it felt like a torture device vs the Vacocast. However, the air bladder might be more forgiving on the incision. Overall it was very uncomfortable.

I’m sticking with the Vacocast, but wanted to know if anyone had similar experiences/concerns.

Thoughts?

4 Comments »

New to the club - 1 week post surgery

Posted on June 12th, 2015 by outlaw

I would start by complaining about how much being in this situation truly stinks, but it’s a moot point because, if you are reading this, then you most likely know what I’m talking about. Let’s just say that this is not how I wanted to spend my summer. Big thanks to Dennis and the contributors to AchillesBlog. It has been a huge help.

The Injury

My story is fairly typical, as I’ve discovered. I was doing some kickboxing drills with a partner in class, when I stepped back with my left foot to load up and felt I had been kicked in that heel, immediately falling to the mat. Of course, no one had kicked me. It was the force of my AT snapping that I felt. I was taken to Urgent Care and then referred to an orthopedic surgeon that afternoon. He put me in a boot and briefly discussed my options - surgery vs. conservative non-operative approach.

Decisions, decisions

I struggled a bit with which approach to take. The OS said that he would opt for the surgery if it were his ATR, but he didn’t push me either way. I could tell that didn’t feel that comfortable with conservative treatment. I read all of the published studies on the topic, and read the information on this blog. Despite the data showing similar outcomes between surgical vs conservative, the surgery appeared to be more of a sure-thing in terms of re-rupture risk and AT strength. My mind was made up?

My follow-up/pre-surgery visit was a week later with a PA and another OS. I had been referred to a different OS (who was the foot/ankle specialist in the practice) from the one I saw on the day of my injury because he didn’t have any OR time in the near future. The PA discussed the process a bit more and said that surgery was definitely the way to go. My surgery was scheduled for the next week. I didn’t get to meet the new OS until the next week (2 days before my surgery) because he was running behind. I really didn’t want to go under the knife without first meeting the guy who was going to do it. During that visit, I was looking for reassurance that surgery was the best option in my case. To my dismay, he seemed non-committal  with either approach. He also scared the hell out of me by informing me about the risks of surgery. Those being infection at the incision, skin-tethering, and deep infection. That last one was particularly frightening due to the fact that it could result in complete loss of the AT. Not to worry though, he could replace it with the tendon that connects to the big toe to get some AT function. Again, this is 2 days before my surgery. He was doing the right thing by informing me of the risks, but I came out of that visit with a lot less confidence in my decision.

Don’t get me wrong, I think that patient preference has a place in medical decision making, but the physician, who is the expert, should ultimately drive it. I just wanted him to tell me what to do, but it seemed like a coin-toss would work just as well.

So I called a buddy of mine who is an OS looking for some advice/reassurance. He’s a good friend that I unfortunately hadn’t spoken to in a couple of years. True to form, he made some great points. Yes, there are risks to surgery, but they are very small. Not to brag, but I had none of the risk factors for infection or poor wound healing. Secondly, be skeptical about the studies. The subjects in those studies were under a rigorously controlled protocol. Would I be able to get that same level of therapy? Did they know how to do that? Also if the OS thought that the conservative approach was just as good, then why does he even do the surgery? Why are they equal options? His advice was to just get the surgery. After that, I’d be on auto-pilot and I wouldn’t spend the next several months second guessing myself. My mind was finally at ease and was once again gung-ho for the surgery.

The Surgery and the Aftermath

Let’s do this. It’s been 15 days since the injury and I was looking forward to getting the recovery started. My OS spent a few minutes with me during pre-op and explained the whole process. His demeanor made it was clear that he enjoyed surgery much more than in-office patient interactions. I got the nerve block and heavy sedation. Woke up feeling great and not feeling my leg from the knee down. I recommend the nerve block. It helped with the trip back home and allowed me to get settled without being on heavy painkillers.

Things got interesting when the block wore off at 3 in the morning though. I was on oxycontin, but needed to pop a couple of vicodin for the breakthrough pain. I was on those drugs for the next 2-3 days. Everything was mellowed out by then.

I’ve basically been on my back with my leg elevated for the last week. I can get upright for a few minutes here and there, but the blood rushing downwards is really uncomfortable. After a few minutes, my toes turn blue. Needless to say, with the exception of being able to binge watch shows, read, play Xbox, nap, and work a little, I’m useless.

I knew this going in, but I’m an incredibly lucky man that I married the woman I did. She has done everything; taking care of our 2 little boys, making sure I have all that I need, all while working a full-time job without complaint. In return, I’ve tried to be a good patient. I would elevate her stress level if I tried to pretend that I didn’t have a debilitating injury and was hopping around the house doing things I shouldn’t. So I remain in bed and accept her good will. Being useless has been the toughest part of this adventure so far.

Next, steps

I have my first follow up visit in 4 days (11 days post surgery). With any luck, my incision will look good, I’ll get the stitches out, and put in the boot. I’ve already ordered the Vacocast thanks to the recommendations on this blog. Looking forward to trying that bad boy out. If all looks good, then PT starts the following week. My OS  isaware of the benefits of early weight bearing, so I think I’ll be on a fairly aggressive PT schedule, again, if all looks good. Fingers crossed.

Wow, has anyone made it this far? Regardless, writing my story has been therapeutic for me. This is my first blogging experience, and I haven’t written anything that wasn’t work-related in quite a long time. Might as well make the most of this situation, right?

3 Comments »

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  • donna | September 4th, 2015 | 4:34 pm

    You asked: “When were other people able to do single-leg eccentric lowering?”

    Heel raises and drops, commonly known as “calf raises” are exercises that progress from sitting - double leg- heel -raises and progress over time to single leg, unassisted, calf raises.

    There is great research about the 12 week eccentric heel drop program and I highly recommend it.

    I could do double leg, going up on both legs but come down (eccentrically) on the injured leg at 16 or 17 weeks or so.

    At around 20 weeks or so I could do assisted single leg calf raises and then a month or so later without assistance.

    It is different for everyone, I’d say the average from reading blogs is 5 months and some NEVER do one. You can put “single leg calf raises” in the search box, top right of main page and read up on it yourself.

    There are many variables, but I’d say primarily calf strength and tendon length.

    Hope this helps.

    I personally don’t think it’s a good goal and causes some people to do it too early. I didn’t care about it, just one day I found I could do them no problem…again I think it was about 6 months or so.

  • honeybadger | August 18th, 2015 | 7:57 pm

    Hope you received good news. Speedy recovery!

  • BobFV | August 18th, 2015 | 5:32 pm

    Outlaw I am so sorry to hear this. Hope you are okay - did you try a Thompson Test at home? My wife is an expert at administering it now.

    Best of luck!

  • cpo | August 16th, 2015 | 11:21 pm

    Hoping you get good news on Monday! Fingers crossed for you, and sorry that you have had the long wait.

  • outlaw | August 15th, 2015 | 7:04 pm

    Thanks cpo. Sorry to hear about your setbacks too, but I’m glad they weren’t major. This is just killing me because everything was going so well up until that split second. I can handle having to rewind the rehab a few weeks, but starting over is unimaginable. I’m growing more confident that I didn’t do serious damage, but the new pain is a sign that something isn’t exactly right. Trying to stay positive, and your comments really helped.

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

  • cpo | August 15th, 2015 | 6:16 pm

    Outlaw, sorry to hear of your fall. A good clinician can tell a lot from an exam and I’m hoping you get good news. I had two similar scares and one was a sprained ankle and one was a slight tear…but not at the graft site. It has healed on its own and only slowed down my timeline by a few weeks.

    If your OS feels anything funky, he or she will likely ask for an MRI, which is what my OS did (and what identified the slight second tear). My second injury happened about six weeks ago and it’s now a total afterthought. Someone wrote that scares are a part of the recovery for many of us…hoping that’s all you have.

    I am at 22 weeks now and the amount of activity I’m doing has ramped significantly in the last few weeks. Good luck and I hope you get good news!

  • ianandhenry | June 26th, 2015 | 8:23 am

    The Vacocast should not leave a mark on your incision. Try to shake the internal vacuum liner to even out the beads inside. You may have a point in the liner where the beads have created a bump and is pressing on the incision. Shaking the vacuum liner every day has helped me. My doc was completely unaware of the Pro Achilles, and when he looked into it, he thought it had many advantages over the other available boots. The main problem is that none of the health insurance plans in my area, Pittsburgh, will cover the Vacocast boot, so I had to buy it myself. You would think that with quicker recovery time, fewer PT visits required, fewer side effects on the knees and hips, and fewer re-ruptures with the Vacocast, that the insurance companies would be demanding that it be used. BTW, if you haven’t got an Even-Up yet, do so asap as it helps greatly with the uninjured knee and hip.

  • outlaw | June 23rd, 2015 | 1:50 pm

    Thank you both for the helpful comments. I’m just going with what feels right for now, but will put a call in to my OS to make sure I’m not doing anything that will delay or disrupt my recovery. He seemed reluctant to have too much plantar flexion at my post-op visit. I was able to do a push-up, pull-up, sit-up workout with the Vacocast at 15 degrees. I don’t think I would have been able to do it with the Aircast.

  • vball | June 23rd, 2015 | 9:31 am

    Hi

    I started in the vacocast at 2 weeks post op and had the setting at 3 (30%) for about 1.5 weeks and then moved it to 2.5. gradually moved it by .5 until i got to 6 weeks and then moved it to 0 at my 6 week post op visit.

    hope that helps

  • ericm | June 22nd, 2015 | 10:11 pm

    Hi there,

    There are people on here who know much more about the study than me, but that protocol was for non-operative treatment of ATR. The timeline works for operative as well but the specific angle for operative somewhat depends on how much your surgeon had to shorten the tendon for reattachment. From your description he didn’t seem concerned so I’m guessing he didn’t have problems but that may change things.

    For one reference point, my OS uses the Vacocast so he is familiar with it and gave me the settings. I had a relatively clean rupture and he said he didn’t have to shorten things much. My initial setting was 20 degrees. I have seen others on this site start at 25-30. Oscillot, for one, started at 30 degrees and had surgery.

    If it feels tight I would go with more plantarflexion and ease it down later as the tendon heals. Somewhere between 20 and 30 seems to be the norm. If I didn’t have any guidance from my OS, and had to figure it out on my own, I would start at 25 just because it’s in the middle.

    Good luck

  • eyceman | June 12th, 2015 | 5:28 pm

    You guys will be up and at it before you know it. You both had surgery and I didn’t, but I’m at 17 weeks and moving along very well. Walking without limp and can even run a bit. I was in shoes and walking at 9 weeks. Just find the beauty in the journey and let it teach you lessons that will springboard you forward. Good luck and lots of prayers!

  • JuanV | June 12th, 2015 | 5:18 pm

    Thanks for sharing your story outlaw. My story is very similar only I was playing basketball when I was injured. I just had my surgery last Friday June 5th. For the first 4 or 5 days, I kept my foot elevated as much as possible. I felt the same way after putting my foot down. All that blood rushing down was a bit weird. I’m scheduled for my first post-op appointment on June 18th and I’m hoping to get the cast off then and move over to the boot. I hear the recovery time can be anywhere from 4 to 6 months. I’m highly motivated to keep at 4 months. I know it’s going to be a long recovery but all we can do is be patient and listen to the Dr.
    Good luck and thanks for sharing your story!

  • cpo | June 12th, 2015 | 12:06 pm

    Sounds like you are on the right track and have gotten good care. I am just past week 12 post-op and in two shoes…seems a long ways away for you, I’m sure, but it went pretty fast in retrospect. I tried to focus on what I could do as much as possible, without doing anything to risk re-rupture.

    I had the same sensation you report whenever I didn’t elevate, but that went away for the most part after a few weeks. That said, elevation was my friend and I’d encourage you to elevate as much as you can.

    I’d also recommend renting a knee scooter, way better than crutches, and I was able to do a lot around the house (and outdoors, too) on the scooter. Your OS will know where you can rent, and you can always find them used on Craigslist or whatever. You are not too far from being much more mobile, I would guess.

    I never thought I would be excited about wearing two shoes. And I did get powerful perspective from cabbing to the grocery store and riding around in the electric cart. It’s still early in my recovery, but that will be an enduring memory for sure.

    Anyway, hang in there, and know that it does get better. Good luck with yo

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