sacrebleu62’s AchillesBlog

I had my last appointment with the surgeon today. He told me the achilles looked “awesome” (as he said previously - his work, after all!). The therapist had told him that I had full range of motion but just 2/5 of calf strength. That seemed right to me, and the surgeon agreed. It has been so cold and icy here in Maine that I haven’t done much walking, although I have been doing the exercises prescribed at PT. The surgeon told me, as he had before I decided on surgery, that I probably would not ever achieve full power, and because the rupture had not been immediately repaired (thus bringing atrophy to the calf even before surgery) recovery would take 8 months. However, even now I am walking fine, and comfortable on stairs and hills - and, at age 70, my basketball days are far in the rear mirror. So it felt fine when the surgeon said he did not need to see me again. Thank you for everything, Dr. Asherman.

Fourteen weeks after surgery that involved augmentation with my FHL tendon I am enjoying full mobility, though of course my leg is not back to full strength. I cannot do full heel raises with my “bad” foot yet, but my PT has been working me hard and my balance and gait are pretty good. It feels great to be able to get out and shovel snow (a lot of snow, here in Maine) and zip up and down stairs.

I have been using Mederma on my long scar and it seems to be eradicating it slowly. However, after a day’s activities I have considerable edema, which I have been treating with ice and elevation. No pain at all. This is a long haul, but as so many have said, it is worthwhile, for sure.

I had a happy appointment with the surgeon this morning. He was very pleased by the recovery of my achilles, and said I did not need the boot anymore (after 10 weeks), although he advised me to wear it when the footing was insecure (wet pavement, uneven ground) for the next three weeks.  For the last week I have been enjoying full mobility in the boot, no cane or crutches, and it seems that the progression continues. Indeed, it is a long haul, but I am very grateful to bloggers and commentators for making the route clear.

During my ninth week of recovery I was able to walk in the boot with just a little help from one forearm crutch. Good thing, as my family traveled from Maine to The Virgin Islands and spent a week on a catamaran. There was a huge variation in my treatment in the airports. When the reservations were made, we ordered wheelchairs, but they were not forthcoming at Boston-Logan or St. Thomas. Miami was great. St. Thomas TSA made me stand on crutches for 20 minutes before a long screening. During the week at sea I wore the boot on the boat all the time except at night, but was able to paddle around in the water without it. The warm Caribbean felt great, but I learned how weak I had become during ATR period. By the end of the week I could walk in the boot with no support. Liberation. On Friday I see the surgeon and perhaps the boot will come off.

Weeks ago, the surgeon said I would be walking in the boot with a cane or crutch for balance after week 8, as my kids took us down to the Caribbean for a week’s charter to celebrate my 70th birthday. A week ago, it seemed unlikely. But he also said I would be walking in the boot with one crutch after  7 weeks and it was so, The cheap ($22) Drive forearm crutches make it easier. So I am feeling good about the trip and look forward to aquatics in the blue blue water.

Just ending week 7, I was able to use a friends “endless wave” pool to walk without the boot. Four feet of water reduces body weight to 50%, and it really felt great to walk in crocs (with soft brace and ace) without the boot. I walked in small laps for 12 minutes. The longer I walked, the better it felt. At the end there was almost no swelling. As my PT said, this is the best therapy. Although single malt scotch is pretty good, too.

I entered Week 7 four days ago. The protocol said I could begin PT, which I did. But the PT found my specific instructions and the protocol at odds a bit (as did I). So he called the surgeon’s office. A physician’s assistant told him that I was a “risk taker” and therefore he should retard the protocol by two weeks. Whoa. I am a rather cautious 69-year old, risk taking in the (happy!) past. So I called back and asked the surgeon, himself, to speak to the PT. This morning I dropped by the PT’s office. He had a big grin, and said, “You called him, didn’t you?” Then he told me that the surgeon had OKed PWB, pool walking, and exercises with the bare foot, not beyond neutral. So I am on the way. Whew.

So far, all of my entries have been in the past tense, because I started my blog so late: sorry! Anyway, the two weeks of the cast passed, as I tore around on my scooter, using the crutches only for outdoors (we are rural here in Maine). Two weeks after the cast went on, the surgeon pronounced the long scar “awesome” and I was soon in a Bledsoe boot,with two wedges, permitted to put “10 or 15 pounds” on the boot. It didn’t take long to realize that walking with the boot and crutches was great. I touched the boot for balance, swung out on the crutches, and kept up a good safe pace. A nice benefit: when the technician cut away my cast, he put three velcro strips on the bottom half so that I can wear it for protection at night during the first two weeks in the boot.

I am rubbing Mederma into the scar several times a day, working my foot up and down (not past neutral) and getting my exercise. It is pleasant to air out the foot. I have also been giving it epsom salt baths, which provide some magnesium, in case lack of that was a factor in the paresthesia. Things are looking up. Since it was my left foot that was operated on, I can drive my automatic car all over the place. That, and walks in the New England autumn, make life a lot easier to bear than it was a month ago. PT starts in a week, and then I can also take out one of the wedges.

Paresthesia is the sense of pins-and-needles or burning on the skin. The splint and cast provide pressure on nerves, and of course there is no recourse while you are shut up in plaster or fiberglass. It was not a problem except at night, when I had trouble falling asleep, and it would occasionally wake me. Now that I am in a boot and can expose my foot, I have tried using Capzacin cream, as well as other topical ointments, but they don’t seem to do much. Then I read about a cure that involves tapping on the area where the tingling occurs. So I used a little cheap Conair vibrator, at low speed, to do the tapping, and after three days the paresthesia is way down, no longer a real problem. Maybe it is just because I am now using the foot more; or the boot has more latitude; or the vibrator helps. Anyway, life is good again.

In any case, I understand that paresthesia wears off eventually…unless there is nerve damage. [Note: indeed, once I got out of the cast and into the boot, the tingling disappeared, though occasionally traces, not troublesome and easily massaged away, appeared. By week 9, nothing.]

I was prescribed dilaudid (hydromorphone) for pain, but the pills made me woozy and I stopped them after two days. For some reason, Tylenol doesn’t do much for me, but in any case, there was no pain, just a throb down there. Although I left the surgery with crutches, the best thing that happened to me was that my son-in-law borrowed a Drive knee scooter for me. That made all the difference, and the single best piece of advice I could give is to rent a knee scooter. Not only mobility but also confidence are much better than with crutches.

After four days I went in to have the splint changed. The new one caused excessive paresthesia, so two days later a was re-splinted. That helped, but still the pins-n-needles and burning sensation on the skin kept me awake. The doctor said it was pressure from swelling into the splint that caused it. More on this problem later.

After two weeks Dr. Asherman felt the healing was coming along well and I was put into a bright blue fiberglass cast for the next two weeks. Of course, during this time I was not to put any weight at all on the foot, and I didn’t, except for one fall with the crutches that hurt, but seemed not to leave any lasting problem.