As I have expressed before, my second biggest fear during my recovery is lengthening of the achilles to the point where I lose athletic ability.  My greatest fear is of course re-rupture.  Though I know what to be careful of regarding re-rupture, I feel much less confident about tendon lengthening, specifically what role stretching plays in it.

I have seen two pt’s now, and talked to 6 others, as well as my surgeon, and have not gotten a consistent answer on whether calf stretching should be done, and if so, when during the recovery.  I’m referring to the stretches you see here: http://www.massgeneral.org/ortho/services/sports/rehab/Achilles%20repair%20rehabilitation%20protocol.pdf on page 10 and 11 (calf stretch and dorsifexion stretch) as well as the seated towel stretch.  Of course searching for information on the internet has also left me scratching my head.  I have seen protocols that start it as early as 6 weeks post-op, and both of the pt’s I’ve now seen had me starting it at week 8.  A lot of other protocols don’t start until week 12, and many don’t seem to include them at all.  My surgeon, who is the only guy I fully trust at this point, indicated last week that he doesn’t really see any need to do those stretches, acknowledged that for the next couple of months (putting me at wk 16) tendon elongation is still something of a risk, and that I’m right where I should be right now with ROM.  My new pt today seemed to really want my ROM to increase, and gave me those stretches (albeit lightly) to do daily to help with this.  Every other pt I spoke to with the exception of 1 (including my pt today) didn’t really seem to know what I was talking about when I asked about elongation, or at best indicated that it only is something to be concerned about very early on (first couple weeks).  Needless to say I’m planning on seeing that pt who could speak intelligently about it this week for her assessment.

Is this something anyone else has gone over with either their pt or surgeon?

Of course I’ve poured over many posts and articles on this site and others, but I can’t seem to find any really useful consistent information on it.  Of course adding more confusion is the fact that general rehab protocols for the first 6-12 weeks are all across the board in terms of time of immobilization, weight bearing, rom, and time to two shoes.  For reference, I went to a boot, pwb, and basic active rom at 2 weeks, fwb in the boot at 5 weeks, two shoes at 6 weeks, and am now at 8.5 weeks and have been in pt for 2 weeks and basically boot free for the last 1.5 weeks.  My dorsiflexion rom is about neutral when I flex it actively, and when I walk I’m taking pretty small steps but can still feel a little stretch with every step.  To be honest, it seems as though just walking causes more of a stretch than gently performing either of the standing wall stretches.

Also for reference, here is an article that basically sums up my concerns:  http://www.aaronswansonpt.com/keys-to-achilles-tendon-repair-rehab/

I’d be okay if those who I spoke with could at least acknowledge that this is in fact a thing, and have an explanation for their approach in regards to stretching.

I’m a few days over 8 weeks post-op now, and had my last scheduled doctor’s visit on Thursday.  From this point on it’s just as needed.  I knew my surgeon had taken a job elsewhere, so I had fully expected to not see him and to have to deal with some inexperienced VA student or resident, but was really surprised and happy to hear he was still around when I checked in.  The resident who saw me first was actually really helpful and was able to answer my questions quite well, which I had only found with one other resident prior to (who I also caught on my way out and had a good chat with).  My surgeon then checked out my leg and said I was doing great.  We had a nice long talk, and I feel once again very confident in my recovery, and empowered to essentially ‘take it from here’ with the help of a good PT.

The coolest thing that we talked about was the graft that he wrapped around my achilles after sewing me up.  It’s an ‘extracellular graft’ made by Acell, and is made from porcupine urinary bladder.  It’s pretty cutting edge regenerative medicine stuff, and apparently is being used more and more with these kinds of repairs. He said he’s been doing it for about two years, and has been really happy with the results.   I’m really hoping to develop some kind of weird porcupine-type super power from this.  Apparently the same technology has been used to grow people’s fingers back - really amazing stuff!  Here are a couple links to check out:

http://acell.com/matristem-devices/current-indications/wound-care/

http://discovermagazine.com/2011/jul-aug/13-how-pig-guts-became-hope-regenerating-human-limbs

In terms of PT, I was able to get a transfer to a closer VA facility to me, about 20 mins away.  We’ll see how the therapist is on Monday.  My therapist in Denver wasn’t too bad, but you could just tell he wasn’t an athlete focused PT and was used to working with a more elderly population - not ideal for my goals.  If I don’t click with the new PT, I’ve found a good PT just down the street, so that is option B.

Otherwise, I feel I’m getting stronger and walking more normal every day.  I’m still using a cane when out and about, but am able to take normal steps without it at home (though very small steps still - basically one foot in front of the other - anything bigger becomes a little limpy).  It’s been nice to be able to shower mostly standing and without help, sleep without the boot, and put shoes and socks on without having to be super gentle.  I have to remain vigilant that I’m still quite weak relatively speaking and to be careful to not forget that when going up and down stairs, etc.  For the most part though, I’m feeling strong and getting stronger, and can move around without fear (though still slowly).   I’ve only been swimming once, and haven’t done any other exercise other than walking, my theraband moves, and seated calf raises, but am planning on getting back into a routine this week, with daily swimming, exercise bike, and upper body weights.  I’m sure it will feel amazing to start breaking a sweat again!

I had my first physical therapy appointment today at the VA, a couple days short of 7 weeks post op, 1.5 wks FWB, and 3 days in two shoes. I would say I’m underwhelmed with my physical therapist and am considering seeking out a different one. It’s a $50 co-pay anyway, and a good 40 mins from my house, so just for practical reasons alone it probably makes sense to switch. I called a couple clinics in my town and they charge $100 for the first consultation, and then $55 - $70 for each subsequent appointment if paying out of pocket. Just from a financial standpoint, I’d probably save money with gas and driving time, and I don’t really have much to gain specifically from working with the VA. Having said this, I’m wondering if people can weigh in on some of my specific concerns to help me in locating another PT, if that is what I decide to do.

Concerns

• He didn’t appear to have any notes from the surgeon, and one of the first things he asked was ‘if there was any protocol my doctor wanted me to follow’.  If nothing else, this is an indication that there is no benefit to getting therapy here for the sake of ‘consistency of care’.  I would have much preferred that he said:  "this is my usual protocol for this rehab".
• He was insistent that I use a cane, I believe from before the point that he even saw me walk.  In fairness, he may have seen me take a few steps first, and noticed enough of a limp that he was concerned that I would develop a limp without a cane, so this might actually be a good idea.  I do notice that I’m able to walk a little more normal with the cane, but whether with a cane or not, I’m still only barely pushing off.  I could see using a cane when I start moving outside and on uneven surfaces on two shoes, but it seems a bit overkill, and maybe preventing full stability/strengthening when taking small steps in my living room.  Does anyone who has used a cane (Donna?) have any input on the pros and/or cons of it?
• He did check my active ROM that I could perform on my own and several different axes and measured it and also compared to my good foot.  What he didn’t do is any passive ROM whatsoever, which kind of surprised me.  He also deliberately did not test for strength, saying he was going to hold off on that for now.  Is this typical for a first PT appointment at 7 weeks post-op and/or after 1.5 weeks FWB and several days in (limited) two shoes?
• I told him up front that my goals were: 1. To not injury myself (re-tear or otherwise) during recovery, or later on down the road.  2.  With goal number 1 in mind, to work as hard as is safe to get as close to 100% as possible in as short amount of time as possible.  That I have the time and the motivation and that I’d like to treat my recovery the same as Kobe Bryant would, with the exception of having access to expensive equipment, etc.  He didn’t seem to brush this off, but he wasn’t really encouraging of that per say, and later made a comment that I’d probably not get back to 100%, and then later indicated that I ‘wasn’t looking to push things to get back to a sport really quickly’.  He may have said that in a reference that I wasn’t going to be reckless, but it’s hard to say.  In any case, I’d prefer to have someone say "we’ll work really hard with you to get you back as strong as possible.  I can’t guarantee anything, but if you work hard you should be successful".  He just seemed over cautious in his approach, attitude, and expectations.  I don’t want someone to put me at risk or make false promises, but I wonder if working at the VA there is more a focus on getting old dudes who broke their hip walking again vs. treating athletes who are really motivated.
• The exercises he had me do and told me to do at home seemed really minimal, and frankly not enough to really make some good progress.  He has me doing the following once a day all with a yellow resistance band:
  • 2 sets of 10-25 reps plantar felxion
  • 2 sets of 10-20 reps inversion
  • 2 sets of 10-20 reps eversion
  • 3 times per day light gastroc stretch for 30 seconds (pull ball of foot back towards me with towel to stretch calf)
  • 3 times per day ankle circles for 1-2 mins
• Is the above typical for my stage, or should I be able to do more?  I just feel like I could do so much more without any pain or risk of injury.  I did them all and they barely felt like anything.  Am I off in my assessment and he’s being wisely careful at this stage or should I be able to do more to quicken my progress?  Maybe I just need to tighten the band resistance.
• When I asked him about what I need to be aware of to prevent tendon lengthening, it was pretty apparent he didn’t know what the heck I was talking about.  He indicated that the tendon was in a shortened state right now due to surgery (in order to heal better) but that any risk of ‘lengthening’ was just in the first couple of weeks?  Is this true, or is tendon lengthening a concern at this stage?  I’ve read that this is the worst thing that can happen in terms of negative affect on athletic ability.  His response to my question kind of indicated he wasn’t aware of such a thing.
• I asked him what I can do outside of PT for other exercise, and he said swimming and sitting weights is fine, but that exercise bike isn’t good right now (even with boot).  I feel pretty comfortable and protected in the boot, and can’t imagine that minimal or no resistance exercise bike with the boot leading with the heal would put me at risk.  Any thoughts?
• When I asked what are the biggest precautions I need to take to not re-tear right now he said "don’t jump, or drop off things".  That’s so obvious that it wasn’t a useful answer.  More to the point, if those are the only things I really have to be careful about, why can’t I do more to build strength - more exercises, exercise bike, etc.?

So those are my concerns.  I’d be interested in hearing people’s thoughts.  In any case, I’ll likely get another PT simply because there is no benefit to driving all the way down to the VA to see this PT anyway, but I’d be interested in what other people’s experience with PT has been as a guide for selecting another PT.  Also, I’d really love advice on how to select a PT.  They all seem to have an initial $100 consultation, which is kind of annoying as if I don’t connect with the PT the first session I’ve kind of blown that money and time.  Other than researching on the internet, can anyone recommend a good method to select a good PT for this rehab?

I’m just past 6 weeks now and had some big milestones recently.  On Wednesday I went to the court where I tore my achilles to watch my mens league team (The Grumpy Old Men) play their first playoff game.  I drove to the gym rocking Pete Rock and CL Smooth on full blast as if it was 1994 and I was on the way to my high school game.  I got some adrenaline going which was tough to deal with once I heard the echos of basketballs as I walked up the hall to the court.  I had only played one game (3 quarters actually) before the injury, so I had just met the guys on the team (I was a free agent pickup), but had really bonded with them and it was important for me to be there now that I was off crutches.  Still, I was nervous that no one would even recognize me 6 weeks later, so it really put a smile on my face when the guys I played with instantly lit up when they saw me and came over to say hi and see how I was doing.  There were only 3 of the guys I had played with there (out of 4 - yes they had to finish my game shorthanded) so the balance of the other guys on the team seemed a bit confused as to who the heck I was, but that didn’t matter to me.  I got my two free throws in for the foul from the ghost player who kicked me in the back of the leg, then made my way to the sideline with a ball to work on my handle before the game started.  It felt good to simply have a ball in my hands, but the feeling that I could go out in play in my boot was a good reminder to be careful to keep my distance from the gym once I’m boot-free until my tendon is ready.

Once the game was to begin, I stowed the ball and took a seat in the stands to enjoy the action.  Within moments, I was recruited by the refs to be the scorekeeper for the game as their guy failed to show up.  I guess it’s nice to be useful.  Watching the game ended up being a bit stressful as I had to also keep the score, check people in, and keep track of fouls, but it did make me feel part of the game, even though it wasn’t really the way I would have preferred.  The game was very tight, and went into double overtime, which apparently in small town Colorado basketball rules is sudden death.  Yes, the refs actually made the second overtime period first score wins.  Depressingly, the other team won the tap, got a man ahead of the defense, and won the game with a layup 3 seconds into the second overtime.  Despite the tough loss, I connected with my teammates after the game, and we made plans to put a dream team together for next year and run the town.  Overall it was a really therapeutic experience for me which left me feeling extra motivation to work hard so I can get back on the court and play the game I love again. The next time I don’t play for 2-3 years I better have grand-kids.

Another major event for me this past week was moving into two shoes on Thursday!  It was admittedly rather scary, but I had been full weight bearing comfortably in the boot for about a week, so I knew my leg could handle it.  Still, I got weirdly lightheaded as I first stood up and had to sit back down and take a few deep breaths.  Luckily, my wife was there to support me in case I fell (and support me emotionally, which was strangely more important).  Anyway, I overcame my fear and was able to take some real small steps around the kitchen for a half hour or so.  There wasn’t really a lot of tension in the achilles as I walked, but then again I wasn’t really flexing my foot too much and barely if at all pushed off on the ball of my foot.  I did end up buying some new shoes for the occasion, and I’m glad I did as the next morning I tried some old shoes that were a bit easier to put on, and within minutes the bottom of my foot started cramping.  With the new shoes this isn’t an issue, though they are a little tricky (but not painful) to get on and off.  I spent a little more time yesterday walking gingerly around the hard floor kitchen and some on our carpeting living room (more difficult). 

It feels good to be at this stage, but I’m still figuring out just how much my leg is ready for.  I’ll just take it a little bit further each day, and play it conservative at least until my first PT appointment on Monday.  I definitely can feel that my calf muscle is being engaged, as it’s pretty sore in places where it hasn’t been up to this point.  In fact, my calf hasn’t felt this sore since high school when I was jumping off boxes with weird platforms strapped to my shoes in a futile attempt to transform myself into a 5′9" dunking machine.  I may have to work just as hard to get my calf back to its pre-injury size and strength.

Today was a big day for me, in that I was able to confidently walk around the house FWB in my boot.  I had tried it a bit the last couple of days, but had really just started on 1 crutch, so it was a little too early.  I think the turning point was when I realized I didn’t need to take big steps like I had been with one crutch at first.  I’m taking fairly small and gentle steps, but feel comfortable doing it pretty much full time now.  My ankle always feels a little weak when I’ve been resting and try to take that first step, but things warm up quick.

Yesterday I had my week 5 follow-up which was a little frustrating at first as the surgeon was tied up and wasn’t sure he’d be able to see me, so I had a med student giving me information second hand.  I wouldn’t have been too concerned, but the surgeon now is having me skip my next week follow up and go directly to physical therapy as things have progressed well for me.  This means going into two shoes on my own a week from now, as opposed to the original plan of doing it first at the doctor’s office.  I was nervous about this, and the med student couldn’t do much to build my confidence.  Luckily, the resident who had been caring for me previously but had rotated to dermatology happened to walk by and came in to say hello.  He was able to answer my questions and helped alleviate my concerns/fears.  The key with two shoes is to just be very gentle at first he said, and to gradually build up the amount of time each day I spend in them.  As I have my first PT appointment just four days after the two shoes day (next Thursday), I’m going to be ultra conservative with it, as the PT will be able to better assess my strength and answer my questions.

I’m curious what advice people have for that first time in two shoes.  Although the surgeon said I’d basically just be shuffling around at first, I’m concerned about the idea of putting weight on the foot while also flexing the foot.  Of course right now all walking is while the ankle is completely rigid.  What are the biggest precautions I need to take in order to avoid re-injury, or even just overdoing it?  Also, I’m wondering if people have gotten a new pair of good shoes for this stage, or just used what they have.  All of my shoes are kind of worn out, but I suppose they are comfortable.  It seems a new pair of shoes might be more stable? It probably doesn’t matter, and maybe I’m just looking for an excuse to get new shoes.

Lowlights

• Impatience - starting to see enough progress and feel good enough that it takes some willpower to not run outside in a mad dash at any given moment.
• Boot still a bit uncomfortable when sleeping - enough that good nights sleeping are somewhat rare.
• Boot starting to stink.
• Competent first year resident rotated to dermatology, leaving me with a nice, but very green med student to be the first one to see each week.
• Showering still a pain for the most part.
• Skittish putting more weight on my foot.

Highlights

• Moved to one crutch today!  Was really scary making the transition, and certainly does put more pressure on my foot, but no real pain to speak of.  Over the next week I’ll move to FWB!
• Great follow up appointment - surgeon manhandled my tendon and it felt fine.
• Continue to feel very confident in my surgeon as he answers all my questions along the way.
• Improved ROM a little bit each day.
• Wound is healing well - still some scabs, but looks good.
• More and more weight bearing each day - and no significant pain - just a little discomfort.
• Was able to go out to eat a couple times without too much discomfort (including tonkotsu ramen!), and sit at the dinner table normally.
• Due to working at home, am able to stay rested, elevated, and iced as much as needed, and get up and walk around as much as comfortable.
• Able to fend for myself at home for the 4 days my wife was gone (thanks in huge part to her setting me up so well) and felt a lot more independent.
• Ongoing support from family, friends, and achillesblog folks!

Lessons Learned

• Using a table or similar to balance yourself when moving from 2 to 1 crutches is really helpful, and the toughest thing is the balance.
• It’s worth picking up a nice big ice wrap with built in velcro - the white gel type stay colder.
• If you use raw ice or peas or something like that, don’t leave it on the skin too long without something in between (I had some frost bite where I had been icing behind my knee that the skin is still recovering from).
• Don’t forget to stretch out other parts of your body that get strained from being inactive (my neck in particular).
• Scooters can be useful especially in the kitchen by yourself, as can backpacks.
• Listen to your body as you move from resting and healing into weight bearing and strengthening and don’t be afraid to take steps forward, but just make sure they are all incremental.  If you step a little too far forward to feel comfortable, back off and rest.

I saw my surgeon yesterday and everything went well.  He actually kind of manhandled my tendon and there was no pain at all.  I’ve been pretty delicate still when handing my foot and leg, and especially the tendon itself, probably no more than 5% of what he did, so it was good to see that everything is actually fairly solid back there.  He indicated that most of the actual healing of the tendon itself is done, and at this point it’s mostly strengthening the tendon and everything around it.  The resident who saw me first had me push down on his hand with my foot and I could barely provide any force, but then when the surgeon came in I was able to push a lot harder.  He said this will improve a lot as I continue rehab and start PT.

I’ve been slowly putting more and more weight on it with the boot, but after yesterday I’m going to make more of an effort to be up and about putting weight on it during the day.  He basically said the more I can do within the limits of pain and discomfort in the boot, the better at this stage.  I’m at one wedge now, and in a week I’ll move to no wedges and should wean to full weight bearing in the boot.  He said I can start the process of moving to FWB now even if I’m able to.  Still not quite there, but getting more confident every step it seems.  After the week of no wedges and FWB I’ll move to two shoes.  At first it will just be a little bit, shuffling lightly around the house.  As I mentioned in an earlier post, my surgeon says the stability required for that is good for building strength around the tendon, and also aligning the tendon fibers the correct way.  I’ll likely be using the boot quite a bit for the first few weeks still, but it will be good to be in shoes, even if just shuffling around the house at first.  I’ll also start formal PT at that time.  I’ve been doing active ROM 3x per day for two weeks already, so will continue that.

I celebrated my 1 month progress with a big bowl of tonkotsu ramen at a new Japanese ramen shop that opened in Denver.  Tonkotsu is made from pork bone stock, so is chock full of tendon-healing collagen.  I’m lucky that tonkotsu ramen and Vietnamese pho are among my favorite meals, as they both are made from bone stock.  If you’ve never tried either of these, do yourself a favor and go treat your tendon and your taste buds!

Overall, I’m feeling quite good today, and realize that the worst is behind me at least in terms of daily lifestyle.  I know pt will be hard work, and it will be tough emotionally to be able to feel ‘normal’ but still not be able to run, or bike, or ski, or play bball, but especially after yesterday I feel that I’m no longer trapped in my own house having to constantly elevate my leg.  I can now get around - continue to put more weight on my boot as tolerated, and am looking forward to two shoes and PT in a couple of weeks.  Even though I realize I still have to be careful and take things slowly and incrementally, I feel like I’m in the ‘working to get stronger’ phase vs. the ‘resting to heal phase’ which feels really good emotionally.

My friend in Portland delivered some sad news this morning that Wesley Matthews of the Blazers went down with an achilles tear last night.  He’s only 28 and has been having a career year, so certainly a bummer for him and Portland fans.  I’ll be following his recovery closely, as I’m sure he’ll have surgery right away so we’ll be on a similar timeline.

Lowlights

• Though better than the cast, the boot is still uncomfortable while sleeping, and I still get random weird hot spots on my leg.
• Could barely move my foot up and down and spell out the abc’s, especially early on.
• A little afraid to put much weight on my foot all week.
• Once the stitches came out, the scar looked a little ugly (still very clean though).
• Having to deal with VA physical therapy office incompetence - had scheduled earlier than doc intended so had to reschedule with them.

Highlights

• Another good follow-up appointment: no oozing over the week, good ROM for this point.
• Got great explanation of tendon healing and protocol from the surgeon, and also talked hoops a little bit - feeling very confident in the surgeon and his recovery protocol.
• Improved ROM a little bit each day.
• Able to relieve pressure anytime by loosening or taking off boot.
• Got my stitches out.
• Able to put some weight on my foot, and see that there is no pain.
• Got a bit more confident taking off and putting on the boot, and doing my exercises each day - foot not feeling as ‘fragile’.
• Able to get up and down stairs easier, and spend a lot more time upstairs in the living room vs. in bed all day.
• Found out that competent resident who had been helping me the last two visits is rotating to another department.  Will likely have to start over with another resident and/or just ask to see the surgeon each time.
• Ongoing support from family, friends, and achillesblog folks!

Lessons Learned

• If you have a question about your protocol or anything else, don’t hesitate to ask your doctor.  Whether he/she knows what they are talking about will quickly be revealed (ie. the earlier resident couldn’t answer my questions intelligently, whereas the surgeon has been able to).
• Take advantage of the adjustability of the boot to relieve pressure, and let the foot breath once in a while.
• Moving forward in your recovery can be as much mental as physical (probably could have put a little more weight on my foot last week, but was squeamish).
• Changing your location where you are resting and elevating during the course of the day can be a huge mood booster.
• As your foot sweats in the boot, you’ll get some condensation, especially when showering with the leg/boot covered in plastic.  It’s a good idea to dry out the boot and foot once in a while, especially after showering.

Yesterday I had my three week post-op follow up.  Aside from the treacherous drive to and from the VA here in Denver due to a huge storm, the appointment went very well.  They took out my stitches and everyone remarked at how well both the incision and my range of motion was.  The doctor told me that there was no need to put anything over the scar, and advised that I wait 4 weeks or so until the ’skin matches the other skin in the area’ before applying any scar cream.  He recommended Mederma.  There had been no oozing the last week, but there was a small amount that evening when I took off my boot.  I decided to wrap it in a single layer of gauze while in the boot, as it makes it more comfortable.  In the morning I had only a very little amount of oozing, and I suspect it’s done with that now.  I’m curious what others have done with their scar/incision spot once the stitches are out.  I’m still a little nervous to put a sock on for some reason so am barefoot in the boot, which is actually pretty warm and comfy, aside from some discomfort last night when the incision was apparently still a little raw and rubbing against the boot.  With the gauze it’s comfy (more or less).  The boot is getting a little gross though, so I’ll need to clean it up a bit.

I also had a really nice chat with the surgeon about his protocol, how the tendon heals, and Chauncy Billups and Kobe Bryant.  He’s a really cool and smart guy, and I think I was really lucky to get him as my surgeon.  He also told the resident to have me come in each week until week six when I’ll move into two shoes, which makes me a bit more comfortable than the original plan of waiting until week 6 to come in again.  He also explained that getting in shoes as soon as possible/safe is good as the stabilization needed to ’shuffle’ around helps to strengthen the muscles around the tendon and also align the tendon fibers.  He gave the example of recovering NBA and NFL players that you’ll see on the sideline just barely shuffling around.  That made me happy, because ultimately, even though I am far from a professional athlete, I see no reason not to treat my recovery in exactly the same manner.  So the bottom line is I’ll be in shoes, but starting out just shuffling lightly around the house for an hour or so a day, boot rest of the time, and will gradually work my way to more shoes and less boot.  I’ll start PT during week 7.

The doctor was also encouraging me to start putting more and more weight on the boot as tolerated.  I did this inadverantly while walking into a restaurant that night.  It was snowy outside, and the floor inside was nice and smooth.  I put my left crutch down, and away it went, and down came my boot, rather hard.  It was scary, but luckily no pain, no pop, just an elevated heart rate and a great reminder to be really careful.  The bottom of my heal was actually a little sore from the impact - I’d say it was at least 50 lbs, and prior to that I probably hadn’t put more than 15, 20 tops.  I actually am feeling a little braver today and have been putting some more weight on it as now I know it’s not so fragile, but I do have to remember that it’s healing.  I think this is the time where I need to be really careful, as I’m moving around more and feeling more confident in my foot, but I’m certainly not even close to being out of the woods.

Lowlights

• Significant calf muscle atrophy at two week follow-up - surprising considering it wasn’t bad at all just a week earlier.
• Showering was a major ordeal and genuinely scary, even with a shower stool.
• Tough to get comfortable and fall asleep most every night due to general discomfort in leg.
• Neck sores from having my head at a weird angle while working in bed.
• Time spent researching for possible second opinions on protocol, and then apprehension leading into my second followup.
• My wound not being quite ready for the stitches to come out.

Highlights

• Second week follow-up appointment went really well, and I now feel confident in my medical team and recovery protocol.
• Rewarding myself with a big bowl of Vietnamese pho after my appointment.
• Making it to the boot phase much earlier than expected.
• Swelling going down enough such that I could reasonably get up and down the stairs at home, and hang out some in our upstairs living room, and also go to the bathroom without extraordinary discomfort in my leg.
• Able to move around in bed and change positions a bit more such that restlessness was less of a problem.
• Was able to transition from  percocet to just the occasional tylenol at night - pain and discomfort was for the most part minor.
• Awesome, healthy food every day thanks to my wife and weekly visit from her Dad.
• Had a really nice valentine’s day despite being unable to get out and do anything.
• Ongoing support from family, friends, and achillesblog members!
• Improved a little each day.

Lessons Learned

• When you get to the phase where you can take a shower, definitely have some kind of stable stool/chair, and if at all possible, have a partner help you and be there to make sure you don’t fall.
• Often think about how things were for you a week before, as even if progress feels slow you’ll realize that you are moving forward.
• Answer questions and give encouragement to those who are a few steps behind you in the process.  It helps you feel useful (hard when you are in bed all day) and reminds you that you are making progress as well.
• Be useful in ways that you are able to.  For example, I booked all of my wife’s flight and hotel arrangements for an upcoming weekend getaway with her friend, and have been handling any other things for her I can that can easily be done from a computer.
• Outdoor sun/lawn chairs make excellent alternatives for laying in bed all day.  You can adjust the back angle as needed, and pile a bunch of pillows under your leg.  Of course if you have a nice reclinable chair this would essentially serve the same purpose.
• If you have to drive an automatic with a non-weight bearing cast, you can stack blankets up underneath your left leg (this only works if your injury is left) such that the foot just kind of hangs.
• Pay attention when getting a cast made and make sure to emphasize plenty of padding to allow for swelling.