Painted Toes

chronicling my experiences from an achilles tendon rupture

Archive for August, 2008


7th PT and WiiFit

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 :D 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!

FULL WEIGHT BEARING!!!!!

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 :D 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 :D

Till then!

5th PT visit and BIG news and a pic of the incision

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! :D 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 :D

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 :D

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).

Operation Report

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.