Archive for March, 2014

Mar 30 2014

Vacocast Tips

Published by smick under Uncategorized

I’m at 5.5 weeks and am using one crutch only for longer excursions where I might want to rest my foot if it starts aching. Still have an achy heel when I walk for more than a couple minutes and a burning/stretching feeling in my tendon with steps that stretch it more, but otherwise all good so far!

Here are some tips from using my Vacocast for the last three weeks that I’d thought I’d share:

- If you swim in it and didn’t buy an extra liner, I just remove the liner and swim in the air bladder. Makes drying afterwards a breeze!

- When I got to PWB, I still locked the boot at night to force my ankle at whatever angle I’m supposed to be at. This stretched my achilles overnight (I could feel it burn!). The next morning I set it to hinge to aid with walking.

- I took off the soles at night because they were dirty, but also it makes the boot a lot lighter when I have it elevated on pillow.

- I didn’t pay a lot of attention to setting up the liner the first week and had some strange lumps of the beads inside, a huge lump at the ball of my foot for instance. This actually made walking/weight bearing more difficult. Make sure you follow their instructions and smooth out the beads to make it even, particularly the sole of the liner. Then suck the air out and strap it up. The downward pointing angle also tended to make the beads gather by my toes.

- Being able to wash the liner is a big advantage over my old boot which got smelly within days. I just did a quick hand wash in the sink and then a tumble dry on low temp for thirty minutes while I iced my foot nearby and it smelled great!

8 responses so far

Mar 28 2014

2nd Post Op - 5 weeks

Published by smick under Uncategorized

Just had my 2nd post op yesterday. Overall things are going well and I’ve been essentially FWB in my boot for the last week. I still use a crutch to get around for longer excursions, but walk with just my boot in the house and office. I moved to 0 degrees in the boot last night, which is definitely a little uncomfortable today (some stretching/burning feeling).

My Doc was a little conservative and said he wanted me to do two to three more weeks at 0 degrees in the boot before weaning to shoes. His original protocol was to start weaning in a week. He claimed it would have little impact in my recovery as the strengthening work won’t start in full until week 12. Oh well. I know I’m entering the prime danger zone for a re-rupture so I’m fine with playing it a little safe!

One question I have for all the folks on here is that my tendon has been a little sore this past week as I’ve gone from PWB to FWB with my boot on. Part of it is from lowering the angle from 10 to 5 to now 0 at the same time. But I feel a little burning/stretch feeling everytime I take a step at the end of the step. It goes away immediately. I’m using a hinged Vacocast by the way.

Is this typical or should I be concerned? I’m also worried it might be tendonitis, which I’ve had in this achilles before.

3 responses so far

Mar 17 2014

PWB: 25 Days Post-Op

Published by smick under Uncategorized

Ok, so technically according to my protocol I am supposed to be non-weight bearing except for toe touches for balance. But, 4 weeks is on Wednesday and I couldn’t help but notice that starting week 5 I get to go to Weight Bearing as Tolerated, gradually going to full weight bearing by the end of week 6 and then weaning off the boot.

With the cloud of my blood clot still hanging over me I wanted something positive to be happy about.  After reading stories of other people on here that went to even full weight bearing in their boot earlier in their recovery, yesterday I decided to try PWB slightly ahead of schedule. I used one crouch on my good side and spent an hour experimenting with building from 30 to 70% weight bearing with my boot on. No pain, no weird feelings, and it felt so good to finally use my right leg again!

Anyway, after yesterday I’ve switched full bore to using one crouch and growing to walking with 70%+ of full weight on the injured foot. I’m being very careful, but so far no pain and just healthy tiredness!

So psyched to be *walking* again finally! Woo hoo!

5 responses so far

Mar 14 2014

3 weeks Post-Op: New Vacocast arrives!

Published by smick under Uncategorized

The only bright spot in a week spent fretting about my calf dvt and whether it was growing is that my vacocast finally arrived!

I had gotten so used to my old boot with its heel wedges, I almost felt like I didn’t need the vacocast when it showed up at my door! After getting it set up, I am very happy I bought one. It’s incredibly comfortable and lightweight, plus the adjustability, including hinging, in amazing!

Since I’m still non-weight bearing, i’ve been trying to find ways to get my calf muscle moving to keep the blood clot from growing. With the hinged boot, I can plantarflex my foot and pump my calf as I lie around with the foot propped up. So much better than having to remove my old boot to do some ROM exercises. I can’t wait until I move to PWB and can walk with the boot!

One response so far

Mar 10 2014

19 Days Post-Surgery: Pain in the Calf…

Published by smick under Uncategorized

A couple days ago I started to notice my calf being a little sore. I’m still non-weight bearing and haven’t been able to do much other than some range of motion on my foot when I take my boot off. As a result, I first thought my calf muscle was maybe just sore from getting used lightly again for the first time.

The discomfort felt like a cramping pain on my lower calf where my achilles joined the two calf muscles. Tender to touch, but aching most when I moved my leg around or went from sitting to standing.

Searching this site, DVT popped up as a potential cause and I called my Doctor this morning who suggested I go in and immediately get an ultrasound to rule out a clot.

So, after spending most of my Monday in an ER, I finally got the ultrasound and was crushed to learn I do have clot in my soleal vein (the main vein of the soleus muscles).

It’s a deep vein and a real concern if the clot moves further up my leg, but I guess the location is not as dangerous as some of the other veins higher in the calf. The treatment for it seems fairly conservative with just two aspirin a day and then another ultrasound in a week to see if the clot is moving or shrinking. No warfarin or heparin for now, which I am at least happy about.

I am not, however, happy about having to worry about DVT. Just another distraction to deal with versus focusing on getting my Achilles fixed.


Anyway, I hope my description of the pain and location is useful for any other ATR patients that feel anything similar. My advice, which is echoed on here and from my Doctor, is go get a scan if you feel any unusual pain in your calf, knee or thigh.

7 responses so far

Mar 04 2014

13 Days Post-Surgery

Published by smick under Uncategorized

I met with my Doctor today exactly 13 days after surgery. The splint came off, then the sutures, and finally I was fitted for a boot!

So weird to finally see my ankle again. It felt very weak and unprotected out of the splint. Swelling wasn’t bad and the sutures seemed pretty tight and well done. I’ve attached a picture of my foot before they pulled the stitches out. The incision was around 3 inches long, which I guess is reasonably small. It certainly looked big still to me!

I’ve ordered a Vacocast based on all the reviews, but had to leave the office in the normal boot as I haven’t received my Vacocast yet. My doctor had heard/seen of Vacocasts before and endorsed me trying it. I think he was curious about how I would like it and was considering whether to recommend them to other Achilles patient.

Most exciting, I finally got my recovery protocol! It was nice to have something to look forward to after 2 weeks of sitting on the couch with my foot up.

Here is a quick summary:

Weeks 0-2: NWB in Splint, No foot/ankle ROM
Weeks 2-4: PWB in Boot, Decreasing from 30 to 10 degrees PF at week 4. No more than the weight of my leg on the ankle during this period. Gentle ROM with limited DF, no active PF, scar mobilization, other joint mobilization.
Weeks 5-6: Moving to FWB in Boot, Boot in Neutral by week 6, More active ROM to tolerance and gait training
Week 7-8: Wean from boot to FWB in shoes, More ROM and progressing to DF and calf stretches, beginning strengthening with therabands
Week 9-12: FWB, ROM to tolerance, More weight strengthening, Elliptical/incline treadmill walking
Week 13-16: FWB, More strengthening, Alter G treadmill running
Week 17-20: FWB, More strengthening, Treadmill running
Week 20+: Dry land running, build to full intensity, Continued Strengthening

What do you guys think of this recovery protocol? Aggressive enough? I feel like my ankle is going to be very weak by the time I start to move to shoes and most of the strengthening work seems to happen then. Sound normal?


5 responses so far

Mar 02 2014

I’m in the club!

Published by smick under Uncategorized

I just signed up for a blog and am around 16 days post injury. A quick hello and catch up post!

So, like many my injury caught me by complete surprise. I’ve never torn or broken anything before and despite the fact that I am 40, thought I was in decent shape. On Feb 15 (President’s Day weekend) I was snowboarding and took a tumble, flipping over twice. It wasn’t that violent but I caught my board at the end and felt an instant blast of pain in my right calf. I couldn’t stand or put any pressure on that foot and I immediately knew something bad had happened!

After a not so fun ride down in a ski patrol sled (which my kids loved) I was limping around using ski poles in place of crutches until I finally went to the ER two days later and confirmed what I had suspected, my Achilles was completely ruptured!

Fortunately, I was able to get in with an Ortho at Stanford the next day who could operate on me the following day. For me, surgery was a no brainer as I wanted to make as fast and as full a recovery as possible in order to keep doing sports like snowboarding, skiing and surfing. So, less than 24 hours after seeing the doctor I was prepped for surgery and ready to go under the scalpel! He was able to do a minimally invasive surgery (3 inch incision) and gave me photos from the surgery which I can use to gross out people.

I had a nerve block put in for the surgery and they gave me a portable pump to take home that kept the nerve block active via a catheter inserted behind my knee. The good news is that the nerve block lasted almost three days, although it faded in strength towards the end. As a result, I had none of the intense pain that others seem to get post-surgery and I skated through the first few days with minimal use of painkillers.

The last week has been more an exercise in keeping myself from going crazy at being stuck in my house with my foot mostly up. I did get a knee scooter, which has been a game changer in getting me around. Pain has been tolerable, more just soreness and chafing around the incision site against the back of my cast.

My follow-up is in two days (around 13 days post-surgery) and I am supposed to get into a boot at that point although I’ll still be NWB. PT is supposed to start next week as well! Yay, something to do finally!

Anyway, I’ll share my protocol for rehab when I get it. But I think it’s supposed to be around 6 weeks in the boot with increasing weightbearing and PT throughout until I get to wearing a shoe again.

Thanks for all the info and shared experiences on here! It’s been invaluable for me in figuring out how to handle this injury and try to stay positive about the outcome!

3 responses so far