Camboot Adjustment tomorrow

After 7 weeks with my foot at 40 degrees of plantar flexion, I will beginning to adjust the setting by 10 degrees towards 0 each week tomorrow.  In weight bearing regimes this would be similar to reducing the number of heel wedges.

However I am non-weight bearing for another 5 weeks.  I can remove the camboot to shower and to put my ankle through a range of movement - inversion, eversion and limited dorsiflecxon from the resting position.

i enjoy having my foot out of the 1.5kg boot when I typically apply a cold compress whilst it is elevated.  I also have some scar tissue beneath the skin anterior to the skin wound which caused some discomfort until Sue suggested massaging diclofenac gel into the area which has been effective, I believe.

i tried my Vacoped boot which is very supportive and will be great when I commence weight-bearing, but it feels tight on my leg and this is less comfortable than my camboot which is nearing its use-by-date but remains functional.

i wonder how functional my wasted leg with long lost ankle proprioception will be when I am allowed to weightbear.  Me thinks a lot of gait rehab and  prescribed exercise will be needed.  With this in mind, I bought the Evenup for my good foot because I anticipate that I will use the Vacoped to protect the Achilles from being strained by excessive plantar flexion. Because Ithink this lack of protection caused the re-rupture..

Cast off, Boot On

The cast was removed on 28th December and I returned to wearing the ROM boot after it was revealed that the wound was intact but for a small  superficial scab which was being abraded by the fibreglass cast.  I was to have remained in the cast for a further 2 weeks, so I wore the cast, night and day except when showering.  I changed the dressing on the small area on the scar whilst taking an antibiotic, cefuroxime twice a day.

I discovered that Paracetamol 1300mg in the morning and again at night, when i also take 50mg of Tapentadol enabled me to cope with the discomfort.  I could not take ibuprofen with the rivaroxaban due to the risk of bleeding.  I have the luxury of being able to apply a freezer pac form the fridge on my elevated ankle to reduce the discomfort.

I looked forward to seeing the specialist fresh from his holiday to see when i could begin my rehab, and start swimming, as well as sleeping without 1.4kg of boot attached to my lower leg.  Well I saw just 6 weeks after my surgery and he gave me the good news.

I was to stay in the boot non-weight bearing for a further 6 weeks.  After a week I could adjust the angle of plantar flexion to 30 degrees, then by 10 degree increments each week until i reached zero degrees. This would have me at zero degrees for two weeks when I next see him.  I am permitted to sleep with my leg out of the boot after 4 weeks.

My Flow hive now has its bees and is settled in my garden.  I scoot around the block with Tore, my Lagotto dog before my wife drives me to work.  Sue is now very competent at mowing our lawn.  My boat remains parked on the trailer in front of our home and my scuba gear is gathering dust.  I tried a session on my Wahoo Kikr with one leg, but strained its achilles and hamstrings.  Clearly I was a bit too enthusiastic as I had a virtual ride through Central Park, New York on Zwift.  My buddies still great me once or twice week at the coffee shop after their ride.  Sue takes me there and I get a ride home with my good friend, Michael.

Now that my next 6 weeks is planned for me, I have purchased my VACOPed boot to use as from next week when I go to 30 degrees of plantar flexion. I plan to adjust the plantar flexion by 5 degrees twice a week to maintain the schedule set by my surgeon who I will meet again on 19th February.

Sue and I will have another sanity break/holiday at the end of February.  This is in lieu of our planned holiday riding for a week on an Indian Roadmaster in New Zealand.  The achilles would be unable to support 400kg of motorbike so its is definitely not an option.  Sitting by the pool in Seminyak with an intact Achilles is looking good.

The Second Rupture

On a beautiful Sunday morning, just prior to going to Bali, I met my cycling buddies for coffee.

I was walking to meet my wife for the ride home when I stepped up from the road to the kerb and felt a sharp pain in my Achilles.  I suspected the worst and on feeling the tendon, I felt a gap.  I saw my Sports medicine doctor on Tuesday and she did an ultrasound to confirm my worst fear.  Sue and I were flying to bali the next day for 5 days.

A meeting was scheduled for my return with an orthopaedic surgeon who specialises in foot and ankle disorders.  I was to have an MRI before i saw him.  The “holiday” was difficult due to my injury but sitting by the pool was quite nice, particularly with a Bintang in hand.

I returned home and the MRI showed a 34mm gap amidst the residual scar tissue in my Achilles.  The surgeon gave me one option under the circumstances - an operation on 30th November.  As with others on this site, I was left with little choice so the op was done and i woke with my right lower leg in a plaster back slab, and a drain emerging from the dressing.  I spent 2 nights in hospital, learning to use crutches again and negotiating the shower chair in the small ensuite bathroom.  The drain was removed on day 3 and the surgeon visited me before going on holiday.  i was given an appointment to return to his rooms for the sutures to be removed two weeks later.

In the interim, I went home and began to appreciate the benefit of laxatives as i rested with toes above my nose for two weeks.  i got around on my knee scooter or crutches and was grateful for our hard floors, but struggled in the deep carpet of the bedroom.  The specialist had said i could return to work two weeks after the op so my staff booked patients for me accordingly.

I returned to the surgeon’s office where his assistant removed my sutures then, after my wife washed my leg, a fibreglass cast was applied with my ankle in 40 degrees of plantar flexion.  I returned to work the following Monday and soon learnt that half an hour with my leg under the desk was the most I could tolerate before climbing onto my examination couch for half an hour with my feet up.  My appointment schedule was modified by my staff and i continued to work for another two weeks, scooting around on my knee scooter as I greeted my patients.

We had a very quiet social life and Christmas was “different”.

However, on the Friday after Christmas, the discomfort in right ankle escalated to pain. Did I have an infected wound which was breaking down??  The fibreglass cast hid all.  I had elected to take oral medication  (rivaroxaban) rather than have injections to prevent a deep venous thrombosis in my immobilised calf so if there was an ulcer within the cast, it would be a bloody mess.  I contacted the surgeon looking after my surgeon’s patients , in his absence.  I was advised to go to the teaching hospital he was attending to have the cast removed.  So I cancelled my morning appointments and made arrangements to be transported to the hospital.

The First Tendon Rupture…

I am a Family Doctor aged 62.  I live in Perth, Western Australia and keep myself fit by cycling at least 3 times a week so that I can enjoy scuba diving and hunting for Rock Lobster.  I live with my wife who joins me for the occasional ride on my Indian Chief motorbike.

In September 2018, we traveled to Greece where we passed 3 delightful days in Athens before taking a bus to the western island of Lefkas to join a Sunsail flotilla for 2 weeks of sailing on a Jeunneau Sun Oddysey 349.  Sue and sailed doen to Spartachori on the island of Meganissi for the first night then onto Sivota on lefkada for the second night.  We were loving the company of the other yachts’ crews and the beautiful weather.  We then sailed onto Vassiliki where we stayed for two nights so I was able to get in a couple of scuba dives with the local dive shop,

Then we sailed to Kioni on the island of Ithaka and moored with a line ashore rafted side to side with the other yachts in our flotilla.  At the end of the days, Sue and I rowed ashore and took a walk around the little bay before our planned evening meal with our new friends.  We came across a set of steps going down to a platform which offered an opportunity for a photo of our moored yachts with a sunset as a back drop.  As I went down the steps with my multi-focal glasses on, I glanced down then stepped down to the platform to 4 steps below, and …. ruptured my right Achilles tendon.

We contacted our Travel Insurance company who advised me to get confirmation of the diagnosis form a doctor before they could begin to process our claim, so the following day we sailed to Vathy and attended the only hospiatl on Ithaka where a young doctor was educated by me in the diagnosis and an management of a ruptured Achilles tendon,  he kindly provided a letter for the insurer who promptly accepted our claim.  By now it was Saturday afternoon and we had to sail the yacht back to the Sunsail base at Lefkas which took the best part of Sunday.

We remained aboard Zoe on Sunday night in the marina, which meant i had to acquire some crutches on Sunday afternoon to get to the ablution block to shower and use the toilet.  This was a 200m journey including disembarking from the yacht via a narrow plank to the adjacent jetty.

On Monday we took a taxi for a 5 hour journey to Athens to meet our plane.  Emirates were unaware of my handicap which made check in a challenge.  We had arrived 3 hours before our flight which took us overnight to Dubai then onto Perth with a total travel time of 18 hours.

We arrived in Perth early on Tuesday and I had scheduled an appointment with Sports Medicine doctor that afternoon.  We discussed non-surgical vs surgical treatment and I elected to use an accelerated n0n-surgical regime.  I am not a patient patient…

I had a boot fitted with my foot non-weightbearing at 30degrees plantar flexed but took my foot out 5 times a day and wiggled it up and down about 25 times.  This is to stimulate healing.  two weeks later, my 21mm gap in the Achilles had closed and the tendon was healing.  I was then put into the boot with 3 heel raises to maintain the 30 degree equinus but weight bearing with crutches for another two weeks.

Over the following weeks, this was continued with the removal of a wedge every 2 weeks, bringing the foot to 0 degrees (neutral) by 8 weeks and then I was allowed to wean out of the boot into shoes, with crutches a desired.

All was good.  I has put  a wedge into my shoes to limit dorsiflexion to be safe and enjoyed standing in the shower, and my patients were pleased to see me walking into the waiting room to greet them rather than scooting down on my knee scooter.  My shower seat was about to be put in the loft for storage and the bed cradle was removed so I could enjoy the bed sheets and blankets on my damaged right leg when I slept.

Sue and I were looking forward to a 5 day holiday in Bali which had been booked earlier in the year.  We really felt like we had earned it after cutting our sailing holiday short then enduring 10weeks of treatment for my Achilles.  I was not cycling on the road but had been on the indoor trainer (Wahoo Kikr) and playing with Zwift to regain my fitness.  Sue had been taking me to the coffess shop to catch up with my cycling buddies once or twice a week because I wasn’t cleared to drive.  I had bought a Flow beehive to install in my garden, but the bees were not yet purchased…