Pop goes the achilles

I’ve basically weaned myself off of the boot at about the 8.5 week post-op mark, a little over a week before my next appointment with the doctor which is when he said I should be able to finish with it.  The boot started to piss me off because the velcro on the uprights was not sticking very well to the liner.  So if I put some weight down near my toe, the velcro would slip.  This effectively changed the limit of the range of motion.  I was also getting tired of putting it on and taking it off to do my stretches and range of motion.  If I had to do it again (please no!) I think I’d try to get a Vacocast.

Bump

The physio at the hospital has been good.  The ultrasound / massage / stretching has helped reduce the lump, although it’s still quite noticeable.  They said that when I get to the strengthening stage the fibers will doing some realigning which should also help with the lump size, although the doctor said there will likely always be something there.  My fears about the physio at the hospital being inferior were unfounded, I think.  I was surprised at how hard they stretched the tendon since my Dr. said no strengthening yet.  It was nice to know that it strong enough to take that.  The therapist did caution that the force of a stretch is nothing like what the tendon is subjected to during things like running or jumping.

My massages are nothing like this:

We went on a shopping trip this weekend (poor Zander wasn’t pleased with all the time stuck in the car seat).  I didn’t end up putting the boot on once and was able to walk all around the outlet center without any trouble.  (I think they should stop calling them “Outlet” centers, because most of the stores seem to be regular stores now selling regular merchandise, not clearance outlets).  I think I’m walking normally except that there’s no strength in my calf so I’m not really pushing off with my bad leg.  My heel stays flat on the ground until my weight passes to my good leg, then it lifts off as I move forward.  I’ve been very conscious of my walking, being very careful knowing that I’m vulnerable right now.

Unlike most people, I think, I haven’t experienced any pain or discomfort, especially since I ditched the boot (my heel would get sore in the boot - I think part of the reason for that was that I had the straps too tight).  I wonder if the pain level is related to the location of the rupture.  Mine was just above my heel, far from the muscle.  The daughter of the people across the street from me ruptured her achilles a couple weeks after me - she continues to have pain, and said that it hurt worse than childbirth.  Her rupture was just below her calf.

One more week to before I see the Dr.  Hopefully he clears me to start strengthening then.  I bought 20 buckets of balls at the local driving range in an on-line auction and I can’t wait to start using them.

I had my 5 week post-op appointment on Monday, and every time I come away from the hospital I just have to shake my head and laugh.

At my last appointment (3 weeks post-op) which my surgeon was not present for, I was put in my ROM boot at a fixed 22.5 degrees and told not to dorsi-flex and not to put any weight on my leg, even in the boot.  As I said in my last post, I didn’t completely follow this advice!  After the post though I did heed the comments that I received (exactly what I needed to hear) and slowed the pace of my activities.

Reading

I was nervous before this appointment.  Worried that maybe I should have listened to Archie.  Worried that I did some damage.  Worried that I would be told to stay as is (NWB, no physio) for more weeks.

I was taken to the examination room and I took off the boot and waited for the Doc.  When he came in he asked how the boot was working out for me.  I said fine, and I asked if he knew that they had the same thing in the box over by the wall, for $100 less.  He said he thought they were different.  I told him Archie said they were the same so he went and checked.  The adjustment mechanism was slightly different, maybe the previous generation (and covered with a generation of dust), but functionally the same.  He asked, to himself, why Archie didn’t tell him about these boots when he asked about the CAM Walker, and I told him how I thought they got confused with terminology.  ”Huh, well now I know”.  I didn’t bother complaining about the poorly informed ladies at the store.  I had hoped that Archie had taken it upon himself to tell the Doc that they had a stock of boots right there, but obviously that didn’t happen.

With that out of the way he took a look at my achilles.  With me on my stomach he looked at it, pressed on it with his fingers, and said “Good.  Looks good.”  That took about 8 seconds.  ”Do you want to start some physio, work on your range of motion?”  You bet your ass I do.  I asked if the bump on the back of my leg was scar tissue, and he said yes, and that it will probably always be there.  I forgot to ask if the scar tissue was on the tendon or the tissue around it, but it’s definitely higher up my leg than where the rupture was. 

People are probably tired about me complaining about these guys.  Plus I can’t remember the sequence of events well enough to do it justice even though it was only yesterday, so I’ll try to be more brief with the rest.

The Doc basically said that what I was doing as far and taking the boot off and dorsiflexing, having the boot range set from 0 (neutral) to full plantarflexion, and starting to put weight on it in the boot were all good things.  He called Archie in to tell him how he should have adjusted the boot.  He asked how long I had been walking on it and I told him.  He said I could ditch the crutches completely.  So I crutched in NWB (based on their last advice) and walked out FWB.  We knew that the Doc wasn’t going to be at the 3 week appointment - I wish he would have left better instructions.

I put the boot on and took some steps for him.  He said he wanted the boot locked at about 10 degrees dorsiflexion instead of 0 to prevent stretching the tendon.  He said I could still flex past that with the boot off, but he wanted the boot locked there for when I walk.  I set the boot to 7.5 degrees, but I don’t really understand why he wanted it like that and my foot doesn’t feel any different at 7.5 or 0 so I set it back to 0 when I got home because it’s so much easier to walk with it that way.

He said the physio is just for ROM. He doesn’t want to do any strengthening until 3 months post-op.  He said that’s when the tendon is at it’s strongest.  I asked about even doing thera-bands but he said no - nothing until 3 months.  That seems soooo cautious.  I can’t see myself doing nothing until then.  My next appointment with him is in 5 more weeks (10 weeks post-op), at which point he said I should be going to 2 shoes.  My physio is covered by our Universal health care if it’s done at the hospital, so he referred me there.  They called today and the first appointment they have open is next Tuesday.  The first one is just an assessment, then they schedule further appointments at that time.  I’m hoping that they’re well-equipped and that they’ll try to help with the scar tissue as well.  If not, I might try going to a private office.

My range of motion is pretty good as far as articulating from side to side and around.  Everything came back pretty quickly after the cast came off.  Dorsi and Plantar definitely need improvement though.  Walking around in the boot is great.  My heel got a little sore by the end of the day but the tendon area didn’t swell or get uncomfortable - I haven’t really felt any discomfort there since the surgery.  Once in a while I get a sharp little pain under my big toe or close to the ball of my foot - anyone else feel this?  It feels like a pin-prick or sliver.  I keep checking my sock and the boot liner to see if there’s something in there.  Of course there’s dog hair, which can be prickly, but I don’t know if that’s it or if it’s something internal.

I love the stairs now - it feels good to use the rest of my leg.  I’m not confident enough to try carrying Zander up or down them yet though - I need more practice.  I should be able to do it and keep one hand on the railing so it shouldn’t be too risky.  And as much as I appreciated the freedom that the iWalkFree gave me, I hope to never have to use it again.  It seems to be making my knee sore more quickly each day.

Zan-man

All in all a happy day.  You couldn’t beat the smile off my face with a stick - but don’t try.