Painted Toes

Hello all-

Sorry for not posting much. I was at a wedding out of state late August then returned to work on September 1. Work often comes home with me during the evenings, so I don’t really have much time for much else, unfortunately.

The wedding was beautiful, and I walked 100 yards on grass as a matron of honor dressed in pink with a cast that had matching pink straps! Did not limp. Whew. Leg swelled badly at the end of the evening-I am sure alcohol did not help matters much The bride and groom just returned from their Grecian honeymoon. I can’t wait to hear all about it!

Anyway-PT 2 weeks ago was alright. It was boring actually. Didn’t do much except for toe lifts, walking laps and standing on my bad leg with my eyes closed. I still struggle with the latter exercise still.

PT last week was very interesting. They took off the cast, and I officially became 2 SHOES!!!!!!!!! So exciting. Walking was another matter. I had a pronounced limp and my ankle felt extremely weak. I was very nervous about walking around without the support of my cast.  The PT says to wean myself off of it, but wanted to see me without it by the following week. Thursday, I went to work with the cast on then had it off for the rest of the day. Friday, I decided to go full day without it, and what a mistake that was. My leg swelled badly-it was twice the size of my good leg! I kept my leg elevated on Saturday and the swelling went down pretty quick. Sunday I took it easy-no cast all day and walked around a bit. Monday, back to work without the cast, and my leg did not swell. Yesterday I had some swelling because I stood around for 4 hours straight teaching (I’m an assistant professor).

Today I went to see my doc. He continues to be pleased with my progress and says I should be running in 2 months!!?!? I can’t really see it happening but he is certainly optimistic! He also said that when I conclude with PT in November, I should be able to return to playing sports. Again, I can’t see that happening! I reported some heel pain, and he thought my plantar fascia was inflamed from lack of use. I asked about the hard scar and he said the hardness should not be an issue in 18 months. 18 MONTHS?!?! Wow. My other scars softened up much quicker, but these were minor!

I went to PT after the doc’s appt. and oh joy! New exercises! I did my first toe presses! First day on a real exercising machine since ATR. The PT put 20lbs of pressure and I placed both of my feet on the wall and pushed it until my knees were straightened out. Then I was to let the wall dorsiflex my ankles until it was uncomfortable then I used my toes to push the wall back. I did that 20 times quite easily. The PT said it was way too easy for me and asked that I remove my good leg and just to use my other leg. Man what a difference that was! My leg shook as I pushed the wall. It felt reallllly good though.

Then he had me walk sideways, backwards and then sideways again. That was FUN, but I didn’t like it when I had to walk sideways pass the waiting area and everyone was staring at me walking like that! Anyway-the PT then had me stand with my feet pressed together and close my eyes. Did that and had no problems-did not sway or flail my arms, but then again, I thought it was a strange exercise.

Then the PT brought out the ball. Whoo. I’ve read about the “ball” on this blog. I wasn’t sure what to think. PT asked me to use my good leg to step on the ball and then step down 5 times to get a feel of it. Then switch legs and do 15 reps. I can see how previous PTs have prepared me for standing on such instable ground and I did better than I thought.

I reported to the PT about the heel pain and he recommended that I roll a tennis ball under my foot each morning to loosen up the plantar fascia (imagine this-I did not KNOW that we had another tendon connecting the heel to the toes! I used to be a biology major-how embarassing is that!?!?). He also gave me other exercises to use with the Therabands-I am now back to the yellow one-to do inversion, eversion and dorsiflexion exercises at home.

So that is it for this time around! I am so enjoying the cool weather, but I think my AT doesn’t like it-it takes me longer to get it warmed up in the mornings-do you have the same experience?

Soon, I will post pics of my scar, leg comparables and a picture of me at the wedding!

Hello-

nothing amazing to report this time Is this the dreaded plateau that so many of you talked about? We’ll see.

We did pretty much the same exercises as I mentioned in my last post. Additionally, I asked to stand on my bad foot with my eyes closed and with one finger on the parallel bars. Did that without any problems. Removed my finger. Could not do it for 10 seconds-maybe 2-3 seconds tops. So that is something I need to work on.

The splint will come off in 3 weeks Then, I can be 2-shoes! I start teaching at university on Sept 1, so, that means I’ll be in my splint for a week-then after that-nothing. I am a little anxious about not having my “protection.” Perhaps by then through PT I will gain confidence. We’ll see.

I asked the PT about using WiiFit for the Wii-as WiiFit has yoga and some balancing exercises. The PT said they actually use it for OT-I suggested maybe that they start thinking about how to incorporate WiiFit for PT. He thought it was a great idea. He said to be careful using it-only do things that are similar to exercises prescribed for home and always always always with my splint, and nothing more than that. Also, I need to be careful not to fall off the raised mat! Again, I am not a PT or a doctor-just reporting on my conversation wtih the PT-please consult with your drs or PTs before attempting to use WiiFit!

Enjoy your week!

Hello all-

Yes, you guessed correctly. I am now officially full weight bearing! I went to PT on the 15th and was instructed that I was no longer to use crutches. I am officially walking now. But, don’t tell anyone-I was already walking after the last PT last week-I really didn’t need the crutches.

The PT introduced me to new exercises. First was the toe raises-I sat on the edge of a bed and planted both feet neutrally on the floor. Then I pushed on my toes to raise my heels off of the floor. Wow. I truly took things for granted-it was very difficult, but I was able to get off 10 repetitions. My calf muscles were sore after this activity. PT recommended that I do this at home 4-5 times a day.

Secondly, the PT introduced me to inversion, plantarflexion, dorsiflexion (eek), and eversion exercises. Basically what I needed to do was to use my hand to manipulate my foot into an inversion position, then do that ten times. I did the same for eversion of my ankle. Plantarflexing my foot was easy as we all know that the casts/boots force our foot into that position for TOO long Then the worst one of all: dorsiflexing my foot. I was very nervous because it was the first time since the injury that the tendon was stretched-other than passively through the heel lifts. The PT pushed my foot up until I told him it was becoming uncomfortable. He said this is where I should be pushing my foot 4/5 times a day for 10 reps. My tendon feels very very tight and short and this limits my ability to dorsiflex-but over time this should not be a problem.

Thirdly, this is my favorite exercise. I was to stand on my two feet and lift my good leg and to count 10 seconds. Man!!!!! I have NO balance on that foot. Good thing I was standing between the parallel bars. It took a couple of tries before I was able to stand on it for 10 seconds without falling over or flailing my arms wildly!!! It was still fun though! I think next week I will be asked to stand on my bad leg with my eyes closed.

After that I walked out of the clinic without crutches. Such a liberating feeling-8 weeks of dependence out of the window, yay!!!!!!!

My cast will remain on for another 4 weeks until I get my leg strengthened to withstand dorsiflexion.

So, it is for sure that I will walk down the aisle as the matron of honor without any crutches! Whew. At least I have pink straps on my cast to match my pink bridesmaid dress

Till then!

CHECK the operation report-it was posted prior to this post. For some reason that particular post didn’t show up on the list of recently updated posts. This is not the first time this happened to me (i.e. my dogs and recovery post did not show up either). Does it happen to you as well?

After visiting the surgeon, I went to PT. I did some plantarflexion exercises and my therapist did not even see me do them. He was like, you finished it? I was like yep and handed him the dark purple rubber thingy. He asked me to put 120lbs on my bad leg. I was nervous because my last PT it took me several tries to put 90 lbs on my leg. So we went to the medical scales and I pressed my foot on it. The needle did not move an INCH. Ugh. Tried again. No luck.

The PT suggested we try the digital scale. So I put weight on that, and only managed 40 measly lbs. So I tried again and again-the highest I got was to 93lbs. The PT asked me to walk with crutches and he would slide the scale under my foot at the appropriate time. I still managed at best 50lbs. I was still distributing my weight on my good foot and could not force my body to cooperate!!!!!!!!!!!!!

The PT and another PT put their heads together and suggested that I go to the parallel bars (unfortunately not to do gymnastics hah!) and that I remove one crutch. I froze and asked for walking instructions. Amazing you forget at only 8 weeks how to walk after walking for nearly 33 years! So I took my first step and it was definitely not a step of a walking professional!!!!!!! I practiced walking and then when I was ready, the scale was slid under me again. Still 50 lbs!!!!!!!!!!!!!!!!!!!!!! The PTs were amazed how my body refused to put the weight on my bad foot, even on only one crutch. They removed my remaining crutch and gave me a cane. Still same result. Then THEY TOOK AWAY THE CANE! They instructed me to place three fingers on each hand on the bars on either side of me and walk. I walked on my toes and the PTs chatised me and said to walk normally with a normal stride. Easier said than DONE! I stood there for like 5 minutes trying to gather some courage and took my first step. No pain. Whew. After many awkward steps, they slid the scale under me and it was still like 80 lbs but an improvement. They then instructed me to walk with 2 fingers on either side, then reduce to 1 then to ZERO fingers and to place my hands on my waists! So after like 20 trips up and down the parallel bars, I was ready to walk without assistance. Man did it feel GREAT to walk!!!!!!! It was clumsy but its still walking! The scale was slid under me again, and it was still not 120 lbs but the PTs determined that the fact that I was walking without assistance trumped over a belligerent scale.

After PT was over, I reached for both of my crutches to walk out of the place, but the PT grabbed me and said ahahah! nice try! ONE crutch from now on! I was shocked. The PT said I did so well that they are skipping one week of the protocol and that I was to use just 1 crutch (not planned) and will be FWB and walking without assistance on August 15 as planned. I just thought I’d be using both crutches until then. WRONG! Such a nice surprise for me

Here’s a pic of my splint-I need to wear this for 6-7 more weeks before I can be 2-shoes. Paige is so good-always stays near me. Fifi is a bit more independent-she’s probably in the other room looking out of the windows

This is a pic of the hosiery support that I spoke of earlier. I love it! You can find it here: http://www.jobst-usa.com/UltraSheerKnee.html. I wear this under the sock. The splint goes over my sock-this helps prevent the splint from rubbing my skin raw on my foot.

here’s a pic of the incision-after the surgeon removed the scabs. See where my finger is-this is the beginning of the incision-already fading away! And there is an area near the heel where the dot is still oozing (just because the surgeon took the scabs off).

I went to my surgeon for a routine 8th week checkup. He was extremely pleased with my progress and says my ROM was much better than patients he’ve seen who are approx. on the same timeline as I. I was very happy. I asked him why the scabs were still hanging onto the incision and I was getting frustrated that they weren’t falling off. So he took them off!!!!!!!!!!!!!! That was indeed a surprise for me. One little dot started bleeding so he put on a band aid. I was given the all clear to SUBMERGE my leg in water!!!!!!! Yay! I took a nice bath after getting home and it felt great having my leg under water. I also rubbed off the dead skin (like kkdub-snake skin indeed!) and overall the incision is looking good. I will post a pic later.

Here’s the report for those who may be interested:

Preoperative Diagnosis: Left Achilles’ tendon rupture.

Postoperative Diagnosis: Left Achilles’ tendon rupture.

Operative Procedure: Open repair of left Achilles’ tendon.

Anesthesia: General.

Indications: This is a 33-year old status post Achilles’ tendon rupture during soccer. She has weakness and clinical evidence of an acute rupture. She has listened to the risks and benefits of surgical and nonsurgical management and elects for surgical treatment. The plan is to treat this operatively on 06/18/08.

Findings: Complete rupture of the Achilles’ tendon treated with an open repair.

Description of Procedure: The patient was taken to the operating room and was placed in supine position on the operating room table. After adequate induction of general anesthesia, she was positioned in the prone position  and the left lower extremity was prepped and draped in the usual sterile fashion. Prior to prep and drape, the opposite exttremity was examined to understand the resing tension on the Achilles’ such that this could be reproduced. A skin incision beginning at the levl of the calcaneus was extended along the medial border of the Achilles’ insertion in the midline and extended in a proximal direction for a total length of 12 cm. This was carried sharply through skin to subcutaneous tissue. The subcutaneous tissue was then carefully divided down to the level of the deep fascia. The Achilles’ tendon sheath was then entered. The 15-blade scalpel and Metzenbaum scissors were then used to open the tendon sheath for its entire length. It was noted that the sural nerve did traverse the area of the operative wound and this was carefully mobilized and care was taken to ensure that this was retracted from the operative field. (This is why I have the numbness in my foot).

The Achilles’ tendon was identified as a complete rupture. The rupture occured at approximately 4 cm proximal to the insertion to the calcaneus. There were no intact fibers present. The tendon ends were carefully identified and refreshed. The distal stump was a single unit and the more proximal stump was divided into a V-shape. This allowed for placement of two #5 Ethibond stitches in a Bunnell type fashion in the proximal stump, on in each limb of the V. The distal stump was similarly prepared with a #5 Ethibond in a Bunnell type fashion.

The wound was then copiously irrigated with sterile saline. The repair was then carried out wiht a 6 limb #5 Ethibond repair. The 4 limbs from the proximal stump were advanced distally grasping the distal stump, two medial and two lateral on the stump with a separation of approximately 1 cm. This allowed for overlap of the distal stump into the base of the V. The two limbs in the distal stump were then advanced out through the more proximal tendon.

The tendon ends were then overlapped such that the more distal stump seated deeply into the V shaped tendon tear and resting length was checked at this point. This advancement recreated the appropriate tension in the repair and all suture limbs were then firmly tied. This completed the repair. The resting length was restored. The repair was secure, and the wound was ready for closure.

Copious irrigation was performed with sterile saline. The tendon sheath was then closed over the tendon with figure-of-eight #1 Vicryl stitches. Care again was taken to avoid injury to the sural nerve. The subcutaneous tissue was closed with 2-0 Vicryl and a series of 2-0 nylon vertical mattress stitches were used for skin closure. The skin was then cleaned free of Betadine prep and a sterile dressing consisting of Xeroform gauze, dry gauze, and sterile Webril was applied. The drapes then were broken down and a posterior splint with side struts (wow, I’m a car!) made of plaster was applied and allowed to fully harden. The position of the foot was in plantar flexion at the appropriate resting length compared to the opposite side.

The patient was then returned to the supine position on her preoperative stretcher and was allowed to awaken from general anesthesia. She was then extubated without difficulty. She was transferred to the postanesthesia care unit in good condition.

there you go.

Went to PT. To my surprise I was to start walking in my crutches putting in about 90lbs on my bad leg walking using my heels/toes. I have been walking on my toes during previous PTs. The PT was careful to remind me to walk using the same strides as my other leg. Another surprise was that I will be FWB in two more weeks!!!!!!!!!!!!!! That means I can walk down the aisle as a matron of honor rather than do that in crutches or a wheelchair!

I went to the medical supply store and bought myself trouser socks that is designed to help with swelling. It could be mistaken for calf-length pantyhose. I went to Target the other day and looked at compression socks but they are too tight for me. Thus, the trouser socks. I will let you know how it feels.

It felt great to change my status from NWB to PWB. Thanks Marianne for the tip!

Mindy joined me for my appointments. I had my splint/cast reaglined. Ankle is at 5 degrees from 85%. This was my last orthotics appointment. They took off the heel from my sneaker, yay! A heel lift was placed in my sneaker and I was ready to go.

At PT they gave me a blue rubber thingy. Did plantarflexion exercises. Weight on ATR foot increased from 37 lbs to 60 lbs. It took me a while to keep the pressure on the scale at 60 lbs. Then I walked around the gym (with crutches and 60lbs on my ATR foot). PT suggested that I pull at my foot using the blue thingy with the splint on (to prevent from overstretching as I have a front slab splint) and hold it for 5 seconds 4x a day. And that was it. I will return next week. It was very nice having Mindy for company.

I went fishing the next day with Dacia and it was so nice just to be out of the house and doing something that I love to do! We fished off of the pier as I am not ready to brave riding boats yet. I am still fearful of a re-rupture. Dacia just bought a beautiful boat and I was sad that we could not ride on it. I will next year.  I had a few bites but no fish. People came to watch us fish off of the pier. I wonder if they were interested in the fish, or watching me in a wheelchair fishing?! :D  Unfortunately, I was left with a bad sunburn. I forgot my SPF 50 lotion. Stupid. Came home feeling really nauseous and stayed in bed for the rest of the day. Thanks to Dacia for the fishing opportunity!

Not much to report this week-other than one large scab fell off recently, yay! I have two more big ones left. Still have not been able to submerge my leg in water yet..hopefully soon.

I see my surgeon on August 6 and I am looking forward to it, as I think he will declare me PWB by then…HOPEFULLY!!!!!!!!!!!!!!!!!!!!! If not that, I’ll still be happy as I’ll be nearly 9 weeks post surgery by then. Just the number of weeks that go by is recovery in itself.

Hey-here’s another pic of my french bulldog, Paige. She was using my leg as her pillow. I thought it was too cute and had to post it for you all. Paige and Fifi (in the background-sorry her face is cut off) have been instrumental for my recovery-they stay near me, offer sympathetic support, encourage me to take them to the loo, supervise me when I hobble around the house, and generally remind me that there’s more to life than being miserable My husband is watching the Open laying on the couch

I was bored and doing my plantarflexion exercises with my foot. I decided to have my husband take 2 pictures to share. I think my incision is improving rapidly and that there are just a few scabs left to fall off before I can officially submerge my leg in water. I can’t waiiiiiiiitttt.

The other pic-you can see the atrophy on my left leg. But I can say that I’m really happy that there are minimal swelling.

Enjoy!

Hello-

Went for orthotics. Reshaped cast. Removed one layer of heel from my sneaker. Pretty much an unremarkable appointment except the lady was a little rough on my leg. Ugh.

Went in for my PT. Received a red rubber thingy. Did plantarflexion exercises. Went to the scale and was told to put 37 lbs of weight on my foot. I had a hard time doing it-as I usually put in too much weight-they wanted me to hold onto 37 lbs steady but that was difficult! I did it though, and then hobbled a lap with crutches and 37 lbs on my bad foot. I had 2 pts watching me the whole time. Whee! I love entourages

The Pt then told me that i am to cease using the wheelchair at home! The chair is now in the van when I need it for long walking distances. The PT says I can walk on my bad foot with crutches inside my house,  and outside anywhere only if its a flat and smooth surface and not too far. Man, I was so excited!!!!!!!

I asked when I will be able to ditch the crutches-Pt said in about 4 weeks. Mmm. Better than 6 more weeks. I need to remind myself-one day (or week) at a time.

I complained to the PT that I was deprived of any massage therapies like many of you have!!!!! He laughed and said there was one that I could do at home. I thought, ME DO IT? Someone else doing it for me is even better!!!!!!!!!! Oh well-better than nothing! So he said to use my thumb and gently press it on the side of the scar and run it across it and back. I was to do that until I reached the end of the scar. There was one area where I pressed that caused a lot of “electricity” or what the PT calls “lightening” feeling. The nerves are sensitive in that area. The PT said that my doctor noticed that I have an abnormal nerve structure in my leg/foot and that I had more than necessary. Just wonderful. The dr. was not able to avoid all of them, and was forced to cut through some. The PT said it was very possible that I may have permanent nerve damage, but the doctor was not too concerned. He thinks the nerve will resolve itself in a couple of months. MONTHS? Gosh. Ok. Fine. At least that won’t impede with walking/running! Anyway-the PT says to put Vitamin E on the scar (NOT on scabs-they must fall off first), and massage as instructed. I am looking forward to doing that, as I want to relieve the itch!

Got home and stood on my two feet for the first time since June 17 (of course, just 37 lbs on the bad foot). It felt GREAT. Gosh, I never thought I’d miss such a simple act as standing up on your own two feet. After a while, I realized I was exhausted. Just putting on 37 lbs and standing up took a lot out of me.

Next week will be my last orthotics appointment, so that means I will no longer be in that pink/white splint/cast. I have mixed feelings as the splint offers me some protection and some confidence…we’ll see. I also wonder if they’ll put some heels inside my sneakers, but I doubt it as it’ll be my last appt.

Till then!!!!!!!!