“Look at that!”

April 28, 2017

After telling myself I’d take the PWB process slow and steady, I ended up testing out some unassisted steps in my boot last night and it went better than I thought. I gave myself 5 minutes to shuffle side to side along behind our couch, holding on initially, and mainly focusing on shifting weight from one foot to the other.

That got me over some of the fear of putting weight on my healing side, I guess. I tried a few shuffle steps from there and ended up in the kitchen, then down the hallway to the bedroom, and then I quit while I was ahead.

This afternoon and evening I practiced some more and managed to prepare dinner without any crutches or iWalk…what a treat after so many days stumping around in the iWalk. The best part, though, was my son following me around saying “Look at that! Look at that!” and “You’re walking! That’s good!” Kind of an emotional moment, to be honest. It’s 2 months to the day since my injury and this is the first time I’ve walked anywhere near normally since then. It’s been hard to deal with not being able to be active with my son, so his delight at me moving around - even in a still-limited capacity - meant a lot.

It’s kind of fitting, really. I’m not sure how much of this he remembers, but about a year ago the roles were reversed and I was helping him with PT exercises. He was a little delayed in starting walking, so we did leg strength and coordination exercises every day at home for about 7 months. We used the same timer and checklists that I’ve been using for myself. And ultimately, we were after the same result - learning (or re-learning) to walk.

Still a long way to go, but it’s nice to have a bright spot, that’s for sure.

7 weeks post-op - fastest checkup yet.

April 27, 2017

It’s hard to believe I had surgery seven weeks ago. And the injury itself happened two months ago!

My doctor erased my PWB timeline concerns by declaring I could go PWB as tolerated, and then on up to FWB when I feel ready, so that’s nice. I’d already tested out standing and bearing some weight in the boot; now I’ll make it official and see how I do. I was only in the office for 10 minutes or so. It’s such a change from my first visits when I’d get light-headed at the thought of going in there and getting evaluated, talking about surgery, getting stitches out, etc.

For boot aficionados or shoppers, the Breg boot (Genesis Walker), though a welcome change from the cast four weeks ago, doesn’t feel particularly well-suited to this injury or at least the PWB/FWB phase. I’m eyeing those VACOcasts with envy now. But hey, the Breg and I have come this far so I’ll give it a go. I added an orange SuperFeet insole that provides a better feel when I practice shifting weight around. Without it my foot moves around in there (the liner also slides against the outer shell), and that kind of movement doesn’t give me confidence as I try to re-learn this whole walking thing.

I thought the doc would be impressed with my range of motion but he rightly pointed out that moving my toes doesn’t count. :) It feels like I’m moving my foot a lot more than I actually am. With three weeks of PT between now and my next checkup, I should be able to show him some more progress.

My goal is to have everything looking good enough to get an all-clear for driving at week 10. Even though I know some folks have started earlier, I didn’t even ask about it today. I don’t think I’d want to try at the moment - the stiffness and weakness make me think I’m simply not ready. I’ll be happy working on my PWB-FWB work and going from there.

Onward we go! Here’s to PT twice a week, exercises at home, and with any luck a lonely iWalk gathering dust in the corner soon.

6 weeks post-op, first PT visit.

April 21, 2017

Today was PT appointment #1 and I liked the DPT who worked with me (and the practice overall). She measured ranges of motion on my good and bad ankle, showed me some basic ROM exercises similar to what I’ve been doing, and added in a contrast bath recommendation to help with swelling. 3 minutes hot water / 1 minute cold water repeated 5 times, twice a day. She did some really gentle stretching of my foot/ankle and then hooked me up to a TENS machine for the last 10 minutes. I can’t say I felt any different after the TENS thing. It was an interesting experience nonetheless.

(edited to add exercises)

Here are the specific exercises if anyone’s curious:

  • Ankle Pumps - bend foot up and down at ankle - 2 minutes, 3 x daily
  • Ankle Circles - move foot in circular direction - 2 minutes each direction, 3 x daily
  • Calf Stretch with Towel - hook towel under foot and pull until you feel a stretch in calf - 30 seconds x 5 repetitions, 3 x daily (taking it easy on this one as I’m still wrapping my head around pulling on my foot, even gently)
  • Straight Leg Raise - lying on back, raise leg with a straight knee, hold 3 seconds. 2 sets of 10, twice daily
  • Hip Abduction - Sidelying - lying on side, raise top leg with knee straight and toes forward, hold 5 seconds. 2 sets of ten, twice daily

I forgot to note the ROM measurements but the therapist said my good calf is really stiff, and that a similar level of inflexibility could have played a role in the rupture on my bad leg. I’d thought about that as I looked back on my pre-injury fitness and it makes sense. I hadn’t spent as much time stretching as I used to back when I was running regularly. She’s going to make sure to emphasize stretching and strength work on my good side as well; I’d mentioned that one of my main goals is protecting my left leg and improving flexibility overall.

There’s some kind of disconnect between what my orthopedic surgeon wrote on the PT prescription regarding PWB, what he told me in the office last week, and how the PT folks are interpreting all of that. I’m going to proceed as planned, which is gradually getting used to PWB with the crutch for help. The therapist thought the instructions indicated starting PWB 2 weeks from now, at the 8 week post-surgery mark, and that doesn’t sound right to me. She’s going to call the doctor to verify. I also have another doctor’s appointment next week so I’ll run that all by him again. I don’t think that had a huge effect on the early PT schedule because all I’m doing out of the boot is ROM stuff anyway.

It’s funny - I’m kind of numb to getting mixed instructions from the doc and now the PT. I get the sense both are caught firmly between the old ways and the new with regard to this injury and the options for recovery. I’m glad I found this site and have been able to combine all of the information from multiple sources to come up with a general plan that feels comfortable.

All in all, I’m glad to get started on this next phase but there’s also a bit of a letdown feeling. There’s not much new to do at the moment - maybe a slight increase in the exercises - and scheduling 2-3 visits a week is quite a task until I can drive myself. I have to get my wife or my parents to drive me and watch my son, and that’s a tall order during the work week. I could only schedule 2 visits for next week…that might be the most I can do on a regular basis. Seems like most of the real work is done at home, anyway, so maybe that’s not the worst thing in the world. Now that I think about it, 3 visits a week doesn’t feel that necessary.

But hey, progress is progress! I’m happy that ROM is steadily getting better and there’s no pain to speak of. I think I’m just in one of those valleys you hit during the recovery. There’s still sooooo far to go.

5 week post-op checkup, PT ahoy.

April 13, 2017

I had a 5-week checkup today with no surprises (it’s actually day 34 but who’s counting?). That’s a relief given my fall last week and the fact that every little twinge made me think I’d messed something up. I’ve felt good but it was nice to see the doctor give my leg a once-over and say that everything looks like it should.

I’m cleared for neutral in the boot, I can slowly start PWB, and I’ll have my first PT appointment late next week. Also continuing the gentle ROM exercises with the boot off. Neutral isn’t too much of a stretch now (ha) but I’m going to leave my little heel wedge in for one more day so I can get used to the idea. The fall spooked me so I’m feeling extra careful these days.

Has anyone “interviewed” PT places before the initial session? I didn’t get much guidance from the doctor - he said all 3 that are in-network are good - but I want to be confident in the PT plan. I suppose I can always change providers if I don’t like how the first visit goes.

Aside from having the checkup to look forward to, this was a fairly boring week. I have random pangs and twinges in my calf and ankle. Nothing that causes alarm, really. The incision looks good - most of the scabby stuff is gone. The skin around the incision is sensitive, especially by the end of the day. Sometimes it feels angry and irritated, other times it’s almost numb. I’m assuming the nerves are still figuring out what the heck is going on down there.

Overall, I guess boring is good at this stage. At least next week it’ll be boring with a dash of PT!

The dreaded slip and fall. Or near-fall.

April 5, 2017

Man, just as I was feeling good about keeping myself protected in the first 4 weeks…I go and fall on my injured foot (in the boot, thank goodness) last night.

It was the simplest, thing, too - just crutching in to the bathroom and my right crutch slipped out from under me on the tile floor. Before I could even think about what happened my right leg was out and catching the brunt of the near-fall. It hurt, but it was more of a burning sensation up and down the back of my heel and calf. I did my best to quickly prop myself up with the other crutch and stumble around a bit. I think I pressed the bad leg down twice reflexively. My leg flexed in the boot a bit - there’s a little give in the upper part of the liner - but I can’t imagine it moved very far.

It’s hard to separate the physical feeling from the initial fear. And there was a lot of fear. The pain and burning stopped as soon as I got weight off of my leg. In the end it felt more like a stretch than anything worse - no tearing or popping sensation. There’s no swelling and the incision looks fine. Basically, everything looks the same this morning as it did before the stumble. I have the same basic ROM but haven’t pushed that. I just strapped the boot on tight and will now keep my fingers crossed.

My guess is that my calf flexed/tensed for the first time in 5 weeks and most of what I felt was tightness related to that. I did have a few little twinges in the upper calf, like a light calf strain, but those went away within an hour or so.

Well, I made it 26 days before a fall. Here’s hoping that’s the last one! I’m not quite sure whether I’ll check in with my doctor this week. I have an appointment next week…without any other signs/symptoms I’m inclined to wait for the scheduled visit unless I start noticing swelling, bruising, etc.

25 days post-op. Waiting waiting waiting.

April 4, 2017

This week will be a grind. My next appointment is on 4/13 so there’s nothing like that to look forward to. Now I’m back to my regular weekly schedule and tasks as a stay-at-home dad, only everything takes twice as long due to iWalking or crutching around.

Random thoughts:

  • My boot is comfortable, and I enjoy the freedom of being able to take it off for showers or resting on the couch. I still have the discomfort of the casts in the back of my head so really anything is better than that 3 weeks of frustration. My only complaint is that the boot liner is loose and can irritate my incision. The assistant who fitted the boot mentioned that Breg used to include two socks and they don’t anymore. I checked out options online and decided to buy 6 pairs of tube socks (hello, ‘80s version of me) for the same price as one “official” Breg or Aircast sock. The tube socks work great - I put them on, fold them halfway down my calf, and the incision has some nice padding. And with 12 I don’t have to worry about washing them all the time.
  • My incision gets irritated now and then but appears to be healing up well. There’s still a lot of scabby stuff hanging on, which is kind of gross. I clean the area each time I take my boot off and change out my sock - I sweat like a pig and it’s already warm here so I’m paranoid about keeping everything clean in there.
  • I started using a cold therapy wrap on my ankle and foot a couple times a day and that’s reduced the swelling a bit. I think it also helped with ROM. My doctor didn’t give me any specific advice when he mentioned doing gentle ROM exercises (he also didn’t mention any icing) so I made up my own routine based on some protocols here. Basically, I do 15 side to side movements, 15 super-gentle up and down movements, 15 toe curls, and the spell-the-alphabet thing. Ice wrap before and after that, and I stop any movement if I feel any discomfort. Each day has been a tiny bit better, especially after I added the cold wrap component. I don’t notice any extra swelling or discomfort after these exercises so I figure I’m okay at this point.
  • My secret hope is that being diligent with the early, gentle ROM stuff will somehow get me driving faster. Only time will tell!
  • Seeing my foot move, even slightly, has been a nice morale boost. I finally stopped wanting to barf every time I saw my swollen foot and incision, and I’m starting to think I might want to play tennis again. (Immediately after the injury and surgery I never wanted to exercise or move quickly again.)
  • Others have recently mentioned the fatigue at the 4-5 week mark and I have to agree. I’m not even fully 4 weeks past surgery and I feel like I’ve been extra tired at the end of the past 2-3 days. I guess it’s another one of the stages…I’ve been doing more work in the yard and around the house, but not enough to make me feel so wiped out (or so I thought).
  • Still taking vitamin C and adding a protein shake as a mid-morning snack. Not sure if that helps, but why not? I’m trying to eat well and maybe even lose some weight over the next couple of months.

That’s about it. I’m in one of those doldrum periods - a ways to go until the next appointment and milestone. I’m hoping to get PWB clearance next week. Fingers crossed for some kind of progress indicator like that.

Second post-op visit (20 days since surgery)

March 30, 2017

I’ve officially hit the boot stage of this process. I went in for a checkup and to get the rest of my stitches removed, and my doctor decided I displayed a cautious enough nature to graduate from his horrible, 3-ton plaster casts to a Breg Genesis Walker boot that I can take off occasionally for gentle ROM exercises and showers. (more on boot selection in a moment)

Everything appears to be progressing nicely. I can actually move my foot up and down a bit, so that’s a big change from the immediate post-injury phase when it was just flopping around. The incision site is less swollen and less squeezed and wrinkled up. The only issue was the assistant struggling to cut the remaining stitches out. On the first visit the PA got 6 out in about a minute at most. Today it felt like 10 minutes of picking and pulling and snipping. I guess the doc sewed them up pretty tight.

I’ll go back in 2 weeks, at which point I’ll be at the 5-week post-op point and will most likely move to PWB. After that, PT starts somewhere in the 6-8 week range. That seems to match up with the average times I see around here, or might be on the conservative side a tad, and that suits me just fine.

I’m so happy to be out of the cast. The 9 days since my last visit weren’t bad in terms of pain…it was more mentally challenging due to general cast discomfort. The last one was super heavy and didn’t quite conform to the shape of my ankle and foot like the previous one. By the end of each day it was so uncomfortable that I was seriously considering cutting the damn thing off and showing up at my appointment with nothing. The boot feels like it’s made of feathers in comparison. Now I can loosen the boot straps, adjust the air pressure, or even take the entire boot off if I want. It’s a big, if only temporary, morale boost.

I held off on the Vacoped purchase to see what the doctor came up with. My insurance company gave me mixed information about reimbursement for a purchase I made on my own, while having no issues with approving something a doctor ordered and put on a claim. I have to say I don’t mind the Breg too much. I know it’s early, but it has an air bladder system that’s not bad and the three wedges make it fairly easy on my ankle and tendon. The cost will be fully covered so I’ll give it a go and reevaluate the Vacoped option if necessary.

Now to fill the 2 weeks until my next appointment. I have a list of 3 recommended PT providers so I’m going to try to call or visit them to see how they’d approach rehab. More immediately, I’m going to beg someone to take me out to get a haircut as I’m 4 weeks overdue and going crazy. That was on my schedule the day of the injury but I wound up in the ER instead. The mop must be tamed! My son also has a friend’s birthday party to attend on Saturday so I’m hoping I can impress a bunch of kids with my futuristic bionic leg. :)

First post-op visit (11 days since surgery)

March 21, 2017

I was excited to get to this day. Last week went fast, but the weekend dragged along as I waited for my office visit. Nothing dramatic to report, thankfully. The doctor and his PA took off my cast and checked everything out.

The surgical site looked good but the doc played it safe by having half the stitches taken out (every other stitch). I’ll get the rest taken out next week. I’d have preferred getting them all out but what can you do? Better safe than sorry, I guess. There was some discomfort as they tugged out the stitches. Nothing too terrible.

There was more bruising than when I saw my leg before surgery (I had very little bruising at all from the injury). My ankle was swollen but not terribly so. The entire area felt stiff and I was scared to move. Petrified, really, like my calf, ankle, and foot were made of very thin glass. Still, it felt good to see that everything is okay and that I can already move more than before the surgery. I’ve had some random burning/tingling sensations around my heel and I was worried that was a sign of infection. As it turns out, it was most likely just discomfort from the cast moving around a bit.

I’m back in a lighter cast and we’ll see how things look next week. I was slightly disappointed about the lack of a concrete plan. The doctor said he’d like to put me in a boot when I can tolerate my foot being in a neutral position, which sounds a little different than what I’ve read here. He pushed gently on my foot and it was uncomfortable but not painful. Still, I’m not quite ready to think about moving anything anywhere just yet.

I’m going to bring up the VacoCast at my next visit. It sure looks good to me, and maybe that can prompt more of a discussion about how things will go after the initial recovery from surgery. I’m learning quickly that I’ll really have to push for info and be ready to help steer this recovery if I want to feel 100% comfortable with the plan.

Here’s a link to a pic of my stitches before half were removed. I also have a photo from surgery if anyone wants to see it (I didn’t add it in automatically in case it’s too gross). Surprisingly, seeing the stitches was more of a shock than seeing the actual ruptured tendon. Something about how the skin gets squeezed together weirded me out!

Six days post-op - random thoughts.

March 16, 2017

Happy to report a small bit of progress - the pain from surgery seems to have tapered off and I’ve reduced the pain meds to almost nothing. I still get some odd sensations in my calf and ankle but nothing like the first three days. I’m glad to be off the stronger stuff (oxycodone/hydrocodone) because I feel sick when I’m on those.

I’m able to get through a half-day with my son without any assistance. My parents come over for a morning or afternoon spell to give me some time to rest. I’d like to work up to a full day at some point. Now that the pain is subsiding that feels possible.

The iWalk has been great…but I’m already sooooo tired of using crutches or the iWalk to get around. I stay in bed until the last possible moment each morning because the thought of getting the day started is so frustrating. I guess I’ll get used to that at some point. Another iWalk note: this thing is so creaky and squeaky after a week of use! That would be my only complaint to date.

My first follow-up appointment is set for 3/21. Not too far to go. It’ll be fun to see what the incision and stitches look like, and to feel like I’m slowly checking off some milestones.

My neighbor is a nurse at a nearby military hospital. She said they have 26 people in boots or casts like mine at the moment. ‘Tis the season for lower leg injuries, I guess. She’d never seen the iWalk before so maybe it can help a few of those folks out, too.

Three days post-op.

March 13, 2017

It’s been three days since surgery and I’m slowly working my way through a bunch of old TV shows on Hulu. Also playing Basketball Stars and Hill Climb Racing on my phone.

My leg feels decent overall but it starts throbbing if I’m on my crutches for more than a few minutes. It’s worse in the evenings, when no matter how I’m situated my ankle and Achilles area hurt more than any other time of day. Something about that 8 to 10 p.m. timeframe makes it the worst. Fortunately I’ve been sleeping through the night without much trouble.

I might strap the iWalk back on today to at least get it re-adjusted to account for this giant cast. This thing feels about 3x heavier than the pre-operation splints. It appears to be made of the same OrthoGlass strips…they just used a bunch more. Makes sense considering the nature of the surgery and need for immobilization. I wasn’t quite prepared for that extra weight, though. I mean, I read other people’s accounts of the heavy casts but it wasn’t until I felt like my leg was encased in cement that I actually understood.

There sure are some strange feelings around the incision (or where I imagine it to be). I’m not sure what I expected, really. Sometimes there’s a burning sensation, sometimes it aches, and sometimes it feels like there’s something moving around in there - stuff twitching, pulsing up and down the surgical site, etc.

We ordered a week of dinners from a “gourmet on wheels” service in the area so that took away one worry for the next few days. I’m the primary grocery shopper and cook so it’s nice to know we’re good on dinners up until the weekend. We used the same service right after my son was born and it worked out pretty well. My wife is off today but working the rest of the week so the fun is about to begin! Thankful to have my parents nearby for some help with day-to-day stuff.

I’m not sure I have any practical advice for someone entering the same early post-op phase. I guess my one tip would be this: once you find a comfortable position, don’t move, ever! I’ve been trying to eat well and I’ve added one mid-morning protein shake and a 500 mg vitamin C dose to my routine. The doctor has me on one aspirin a day, as well, to reduce the chance of a clot. I’m slowly reducing the oxycodone and hope to be done with that stuff soon (don’t like how it makes me feel).