Peter’s ATR blog

I went to see my surgeon for my 7 week follow up.  I’ve been walking in the boot since week 2.5.  I’ve been doing my stretches using the front of my leg very regularly (5 times a day), and have seen good progress on my ROM.  I’m now slightly past neutral.  If I put my toes against the wall, I can bring my knee to 5cm away from the wall.  As a comparison, with my good foot my toes are 15cm away from the wall, so the difference is 20cm.

My surgeon is concerned that I may be progressing too fast with the ROM.  He didn’t seem too overly worried about the long term, as long as I stopped doing any more stretches for 3 weeks.  So basically, it isn’t too long yet, but at the rate I’m going it could get too long.  So take it easy, and basically wait for 3 weeks and do nothing.  Weight bearing is OK, but keep the boot on with the wedges in.

I’m OK with this, as I’m pretty much back to normal lifestyle and am comfortable with the boot.  3 more weeks until my tendon is “set” and I can start doing rehab and go 2-shoes!

Peter

An update on my progress in the boot.  I was a groomsman in a wedding over the weekend and had to walk down the aisle and stand front and center.  My boot is black and I could put my dress pants over it, and with my Walmart raised shoe to compensate for the height difference of my legs, most people didn’t even realize anything was abnormal.  I guess I’m not limping at all.

I also got out yesterday and went for a REAL mountail bike “downhill” ride.  I was going pretty much full speed, only I avoided the bigger jumps on the trail to be “responsible” given my injury.  Pedalling up the steep access roads (and having to walk the steepest parts), I can say that it was my fitness, not my injury, that was holding me back.

So overall, I’m really happy to be getting back into what I love a lot earlier than I first feared.  I was really glad I didn’t have to be in my friend’s wedding on crutches!  Although I have a long way to go in terms of healing of the achilles injury itself, and going back to something like soccer, I am glad to be basically more active and capable than some of my non-athletic friends, thanks to the boot.

To think if I’d followed my doctors instructions to the letter I’d still be 1/4 weight bearing on crutches still!  I have a doctor’s appointment with the surgeon this week to see if I’m ready to go to FWB in my boot.   Um… yes..?  Should I limp in on crutches?  Probably won’t.

I’ve also found a way to try to use my “rigid” boot with similar functionality to the vacoped boot some people have.  I just put it on really loose around my leg, so it acts like a shoe for the first while, but at a certain level of dorsiflexion it hits my shin and prevents the tendon from being stretched.  I’m limping again when I do this, because my calf is actually being used, but I think it’s good for weining off the boot.

Since getting to FWB in the boot at 2 1/2 weeks, life is cruising along.  I’m gaining flexibility (down to 1 wedge) and some strength (70lbf plantar flexion with my toes).  Incision is healed nicely and swelling is quite low.  More than anything, I’m gaining some confidence that the tendon can’t be re-injured while I have the boot on.  It doesn’t swell up or hurt after exercise.  I biked to work last week: 44km total trip.  It felt good, other than a bit of chafing on the boot.

So today I went out on a full suspension bike, and cruised around the neighborhood.  I did some small jumps and drops (less than a foot high), hopped speed bumps and went down a few flights of stairs.  It all felt good.  I’m thinking I might go and try a real trail in the next week or so.  I also want to get back into rock climbing.  I think if I adapt the toe of the boot with some stiff sticky rubber I could start getting back into that too (at a lower difficulty level of course).

Having full support in the boot I’m wondering if I’m going to develop a dependency on the boot.  So I have a question about other less restrictive type braces for later in the recovery process.  Once I am comfortable walking without the boot, I’m going to want to continue to do mountain biking and hopefully some rock climbing.  At first I may just put the boot back on, but sooner or later I’ll want to use the proper shoes for the job.  But I really don’t want to risk re-injury, as a slip or fall of the bike could be bad if I’m not booted up.  Are there braces out there which allow you to wear normal shoes and perform sports activities, but limit the dorsiflexion of the ankle to prevent over stretching the achilles?  I’d love to hear about some.  I was thinking of making my own if nothing else.  Something like an “L” plate that straps to your shin and loops under your heel to keep it from riding up.  Or attaching a telescoping rod (like a gas strut used for the hatch of your car) from my knee to my toes?  If my toes go too far up the rod bottoms out and starts taking the load?  How can you tell I’m a mechanical engineer . . .

That’s all for today.

It’s amazing how fast things change.  From the depths of despair when you first get injured, to the pride of being able to go down stairs on crutches.  I feel like the “exciting” part of the injury is over - the pain, the surgery, the crutches, the sympathy, the daily challenges to do the simplest tasks.

I’m 3 weeks post op and I feel like life suddenly went back to normal.  I can walk around as much as I want with no pain thanks to the boot.  All of a sudden I have to do chores again:  making dinner, picking up after myself, take out the garbage, doing the dishes.  In just a few days since getting the boot I’m no longer a cripple - I’m just a guy who can’t do sports, walks funny, and wears a silly robo-boot.

I’ve been going on bike rides to try to stay active.  Each day I’ve gone out for an hour or so of hard pedalling.  I think biking is a really good thing for me since I can really go all out and get some exercise.  The geometry of pedalling with the boot on is quite favorable.  You sort of point your toe in a similar angle with the good foot anyway, and it feels mostly balanced.  It does get really wet inside though afterwards from the sweat buildup.

My calf is regaining some definition, but is still quite small and soft compared to the good one.  I can now raise my leg while sitting and with my other leg crossed over top.  Although it feels strong, I measured that I could push only 30 lbs with my toes (plantar flexion) before I felt a tug of pain on my tendon.  With my good foot it is likely more than 200lb strength.  So I’ve got a long way to go.  As a point of interest, I also measured the reverse strength of my foot (dorsiflexion) to be about 30 lb.  This is of interest since the doctor said I can stretch the tendon using the muscles on the front of my leg.  So I should be able to put 30 lb worth of tension on the tendon using my calf safely too.  Since this is the same point where I feel pain, it sounds like my pain receptors and my surgeon both agree on how much force my tendon can take right now.

That’s all for now.  The next milestone is 2-shoes.  Maybe by 8 weeks?  Hopefully sooner around the house.

Today came my much anticipated visit back to the hospital.  For the last week or so I have felt that my healing was going very well.  There was no pain or swelling.  Of course I couldn’t see inside my half-cast, but everything felt good and strong.  I could push against the bottom of the half cast with what felt like at least 1/2 the strength of the good leg, but it was hard to tell.  There was no pain.

The first thing I noticed when they cut off the cast was how much dead skin there was!  It was really gross and quickly made a big pile of pink flakes on the sheet (they had used some sort of pink dye on my skin during the surgery).  After that the atrophy set in.  It wasn’t as bad as I feared, but still it was noticeably smaller than my other leg.  Although entire calf hadn’t shrunk too much (2cm circumference), the much of muscle itself had turned to fat.

The next thing I noticed was how weak it felt.  While it was in the splint, supported by the tensor bandage, it felt strong.  But now out in the open, it was shaky as I did little circles with my toes.

The incicion site looked good.  It is less than 3 inches long, which was a pleasant surprise as some of the pictures I’ve seen have had much larger cuts.

I was then fitted with the boot.  I was told to use crutches still and only put a very small amount of weight on the boot.   The doctor then told me basically not to do any excercise with the calf at all.  I was only allowed to take the boot off occasionally to do stretching using the muscles in the front of my leg to stretch it.  I’m not to push down using my calf at all.  I asked him if I could just to very gentle calf exercises with to try to retain some amount of muscle tone, but he said no.  But he did say that movement was good.

It didn’t make too much sense to me.  If I can stress the tendon my stretching it, why can’t I stress it by using my calf?  Also, why can’t I fully bear weight on the bad leg when it’s fully supported in the boot?  Needless to say, I think I’ll be taking some “liberties” with respect to my rehab program.  I’m already full weight bearing using the boot.  It just feels totally fine to do so, other than needing to learn to walk with one leg 4 inches longer than the other.  I’ve also been doing “leg raises” while sitting — just lifting the weight of my leg with my calf.

I probed him a bit about newer research concerning more aggressive rehab, and he sort of smirked and admitted that he was quite “conservative”.  I took that to mean that I could take liberties?  After all, it’s my summer which will be ruined if I don’t get back to sports ASAP, and his reputation if I re rupture, so I guess that makes sense.  He also seemed very confident in his repair and boasted that he’s never had a patient re-rup.

Although I was getting quite agile on my forearm crutches, I am really enjoying being able to walk.  I even went for a bike ride today.  A “real” bike ride, not just circling around the driveway.  I even went off-road a bit down a winding dirt path.  It felt good - almost normal.  With the support of the boot, it felt completely safe.  I could use both legs equally, and was happy to discover that my upper legs hadn’t lost too much strength (I’ve been making a point to work them out as much as possible).

Now comes bedtime.  The doctor said to keep the boot on.  Again, WHY?  It is rediculously big and clunky and hot to wear to bed.  Again..  errr… no.

Here’s a picture of the back of by legs the evening after the cast was removed.

The incision site:

Hi,

I’m still on crutches, and will be for another 2 weeks.  I was orignally given regular “armpit” crutches from the hospital.  With these crutches, I felt really disabled.  My armpits got chaffed really quickly.  I didn’t want to go anywhere.  Going up and down stairs was just plain scary.  This was important for me since I live in a 3 storey townhouse with the bathroom on a different level from the living room and kitchen.

I rented “forearm” crutches.  What a difference!  There’s a real reason why permanently disabled people use these.  You are way more agile, able to have a whole new range of motion with your arms.  You no longer just pivot around your shoulders.  Before, if there was a obstacle on the ground (like my wife’s crap littered around the house) it was really hard to go over it.  With the forearm crutches it’s no problem.  Don’t even notice it.  Stairs are easy!  I can go 4 stairs at a time going down, 3 at a time going up.  With the armpit crutches it felt dangerous, and I had to go 1 stair at a time.  Now I can go faster than if you were walking at a normal pace.

I’d deftinitely recommend anyone on crutches to go to a pharmacy and rent/buy these type of crutches.  I don’t even know why they sell the regular ones at all.  Worth the effort to trade for sure.

Sitting at home can be very depressing.  So I decided to take a break from elevating my leg and get out on my bike!  I toured the neighbourhood for about 20 minutes using my bike fitted with a BionX electric assist upgrade kit.  That allowed me to pedal at my own pace with my good leg, get a bit of aerobic excersice, and not worry about getting stuck at the bottom of a hill!  I’m still NWB on my left leg, but was able to rest the cast on the pedal with enough force to spin the crank around so my good leg could give another push.

I got the thrill and adreneline rush of real mountain biking just riding around the block!  I had to be very careful not to fall or stop leaning towards my left side since I wouldn’t be able to put out my foot to stop my fall.  It would have been my shoulder against the sidewalk.  Of course I’m used to that from when I was first leaning to use the clip-in pedals.  Felt like I was doing a log ride 6 ft off the ground in terms of concentration required.  Okay, maybe not quite, but it was more fun that usual just riding on a sidewalk.

Anyway, trying not to get too bored and enjoying the outdoors, if only for 20 minutes between lying on the couch with my leg in the air.

Thursday evening soccer.  I was running, accerlerating hard, when “bang”!  It felt and sounded like someone slide tackled me from behind, taking out my leg.  As I fell down I was angry because the ball was 2 meters in front of me.  When I looked back to see who it was I realized there was no one there.  That’s when I realized what happened.  As I tried to stand up my fears were confirmed.  Zero strength in my calf.  It felt like I was walking down a really steep hill which propells you forward.  Complete rupture of my achilles tendon.

Interestingly enough, there was almost zero pain or swelling, considering the gravity of the injury.  Only a very dull ache in my calf.  The only thing which alerted me to the injury was the fact that the muscle wasn’t attached.  You could also visually see the defect in the tendon.

After 2 solid days of frustration in hospital waiting rooms, I was on the recovery bed after surgery.  2 weeks in a plaster cast is what they say, then I get a moon boot.  I’m only 26, and very athletic, so I’m eager to do as much as I can to speed the recovery.

My leg felt instantly better after the surgery.  My calf actually is not just a wad of jelly stuck to my leg anymore!  It actually can push my foot against the inside of my cast.  I’m wondering if this is a good idea, or it needs more rest.  It’s only been 2 days since surgery.  I know with ankle sprains (of which I’ve had lots) you want to stress it as soon as possible to trigger the recovery process and break up the scar tissue.

Sometimes I feel depressed that my summer plans are ruined.  Other times I’m eager to start the recovery process.  I big thanks to my wife for all the support I’ve gotten so far.

How long unil I can jump off 10 foot drops?  I want to get back on my mountain bike as soon as possble.  The doctor said the sutures he put in are stonger than the tendon.  If that’s the case, what’s the reason for the long recovery times?  Why can’t I be out there using my leg sooner?  Anyway, time will tell how long it ends up being before I am back out there.