4th wedge is out.
I am now stepping in my CAM boot with my whole weight bearing on my tendon.

I thought it would be a huge change - but its not.
Feels as if the wedge is still there and I am actually able to normalize my walk (as much as you can in the CAM boot).
I bet I would be limping the same if I would put the boot on my good leg.

-

Tried walking without the boot and standing - feels good, easy and puts no stress on the tendon.
Of course, bending the knee/tendon in any angle beyond my current ROM does not feel comfortable, so I don’t even try.
I still put the boot on at home, while sleeping and surely when going out.
It feels so safe and sound with the boot.

-

Bad news - my good leg knee is simply killing me - it was never any good, but apparently 5 weeks of solely using it - have done their damage.
It aches, clicks, pulls and cries pain almost every time I sit down or get up.
I am intentionally trying to use my ATR knee to do these motions now that I am FWB (which does not help a lot).

I ice the knee, and I started wearing my old Bauerfeind brace, which helped me nurse it a few years ago.

Oh man, I just hope that this knee won’t give up on me before I go back to 2 shoes and balance it out!

The Good:

• Walking with the boot much faster
• No pain in the heel/tendon/calf area
• Doing a lot of ROM exercises & deep scar massages - no pain
• Down to the last tiny crust bit in the scar area
• ROM = -50°; +10°

The Bad:

• My right (good) knee is getting worse every day
• I am now much more worried about my good leg, than my bad leg

3rd Wedge is out, 1 left.
Again - no pain, no nothing, tendon had more ROM than last wedge allows - making the transition to it smooth.

-

Started going back to work - end of last week (2 days) - went all days this week.
Not moving around too much at work, except to/from parking, lunch downstairs (riding the elevator) and 3-4 trips to make coffee/tea/soda (50m each).
Walking is super easy and my confidence is rising by the day.

-

As a result of my overconfidence - got a big scare today, trying to pick up my walking pace (stupid idea - DO NOT ATTEMPT).
Twisted my ankle in the boot just a little bit (as much as it allowed) - tendon started yapping and crying - right away.
No harm was done, just an unexpected pull on it, way above my current ROM.
Went right home to ice it, since tendon was painful to touch and got swollen.

-

The next day, my ROM actually improved, without any pain when touched!
I have also added passive ROM, massages to the tendon, calf muscles and scar.
Also working with a rubber-band to stretch/push with it, doing passive toe raises in the shower, pressing with my hands over the knee for resistance.

As usual - I always stop when I feel that “glue” tightness in the tendon.

-

A fun exercise I have invented while showering (I am still sitting on a stool in the shower):

I start pulling my leg backwards, flat on the shower floor, until I feel the tightness.
I then hold it for 6-10 seconds and release.
My shower floor has these little lines running across, so I can count my progress and quantify it!

Each day, I can pull back farther and farther.

The Good:

• Walking with the boot a lot
• Can finally sleep 6-7 hours straight
• Doing a lot of ROM exercises
• Heel pain is almost gone
• ROM = -40°; +5°

The Bad:

• Smacked my boot into my good ankle while sleeping - very painful
• Tried to walk too fast and pulled my tendon too much
• My right knee has been aching a LOT, too much stress on it as it is pulling my weight for a whole month now - all alone

2nd wedge is out.
Eased into the boot with 2 wedges without any effort, pain or inconvenience.

All pain in the tendon is gone, with the exception of the tissue surrounding the heel.
It does not pain as long as the CAM boot/sock fabric does not come in contact with it.
When it does - I feel a very unpleasant sensation, described best as if I am covered in blisters on the sides of my heel.
Sleeping is hard, because I only have two positions with the boot - resting it on the left or right side - putting that irritated skin/tissue in contact either way.

-

I am much more mobile now, went out two times to the store to grab food and other supplies.
Went to the post office to send my insurance the op bills (3000$ total).
Still extremely careful where I put my leg down and walking at a turtle pace.

-

Started ROM exercises on my own (got a PT friend who tipped me a lot).
Honestly - there aren’t that many ROM exercises you can do for an AT rehab at this stage…
Able to stretch my tendon about 5 degrees in each direction (up/down), anywhere beyond is not painful, but feels tight - as if I have the ankle glued hard.
I stop as soon as I get the “glue” sensation.

-

One great tip - use baby powder!!! The more the merrier, as it smooths every friction and movement you make!
Dump loads of it into the boot, the sock, over the tendon, calf - anything goes!

The Good:

• Can walk much more in the CAM boot
• Crutches are now stashed in the warehouse
• Flexibility is getting better by the day
• ROM = -40°

The Bad:

• Still cannot sleep more than 2 3 4 hours straight
• Woke up to a very bad cramp in the calf, it pulled the tendon and it was painful
• Sleeping with this heel pain in the boot is excruciating

1st wedge is out.
Felt some very minor pull of the tendon when easing into the boot, which went away after 10 seconds.

Sunday (11 days post-op) - was the first time I tried to make a step with the CAM boot on.

It felt great, though very strange. The boot gives you almost 0° ROM mobility to move your ankle up and down, so you can only step on your heel, then roll the boot off to make the step.
I tried to balance on one foot a bit, but the muscle tissue and the tendon immediately told me to lay off them.

-

From that point on, I took the whole week very easy - walking very very little, mostly scooting around the house on my computer chair.
I am staying home - not going out, keeping myself as immobile as I can.
When the boot is off in the shower - the whole ankle is swollen as an elephants leg and the incision scar has little crusts where the stitches were taken out.

-

I feel muscles twitch and pull up the leg very pleasantly, as if they are slowly getting re-attached to the tendon, fiber by fiber.
I change the bandage (10×10cm) over the incision scar every time I take a bath (x2 a day) - never saw any blood or anything else on the old one, when I change them.

The Good:

• Can walk a little bit in the CAM boot
• Don’t need the crutches for support anymore
• Showering is epic

The Bad:

• Still cannot sleep more than 2 3 hours straight
• Some needle piercing sensation in the tendon - comes and goes in 5 minutes or so, happens every few hours
• Absolutely no flexibility of the ankle
• ROM = -50°

Exactly 6 days after the surgery, I was hopping on my crutches in 38c degrees and 80% humidity from my car to the Doc’s office.
I don’t like to bother my family with stuff, so I came on my own.
Did not sweat this much in my life, crutching these 800 meters…

-

Doc went all fancy on me, touching me with the automated cast saw which does not cut skin, but vibrates its blade through when it touches a solid cast.
Cast off, stitches out - incision looks amazingly good!
Then the good Doc decides to grab & feel the exact stitched location of the tendon - and I get a VERY unpleasant sting of pain.
Worse I ever had since the injury. Doc does not flinch and seems to be pleased with the result.

“We’re done torturing you” he says - “it looks all good, come back in a month”.

Fits me into my CAM boot (4 wedges) and says I am good for PWB, being allowed to step on my leg while in the boot (note, we are 6 days post-op)
I try it right away - understanding that it is still a good idea to use the crutches for support & balance.

The Good:

• Allowed to step/walk in CAM boot
• Allowed to shower without CAM boot
• Boot feels a million times more comfy than cast
• Stitches out - no bleeding, wound closed

The Bad:

• Still cannot sleep more than 2 hours straight
• Sometimes get mild pain attacks in the ankle area
• Cannot stand/sit with my leg down - it swells up like motherf*
• Cannot sleep without boot
• Still have to use crutches for balance

Here comes the pain! 12 hours pass - and all the blood vessels, stitched tendons, muscles and general tissue start aching.
Actually - less dramatic than I thought it would be - but still keeping me up and unable to fall asleep.

I swallow one painkiller tablet. Wait 3 hours. Nothing. Swallow another. Wait 3 more. Still Nothing.
Pain annoys the hell out of me, feeling as if my ankle is being tortured by the Spanish inquisition.

At 5am, I realize that a big guy like me (186cm; 93kg) - might need double the painkillers to get high.
So… I swallow two tablets.
The bliss!!! I fall asleep like a baby, waking 7 hours later with very little pain.

I honestly did not elevate my leg a lot - it didn’t feel swollen or uncomfortable, so I only rolled a huge winter blanket under the cast while sleeping to elevate it.

-

The following days were much easier to cope with. Still couldn’t sleep for more than 2 hours straight - but the pain subdued more and more each day.
Not knowing what the tendon looks like inside the hard cast was my biggest concern, I am too curious.

Took it easy, did not misstep, nor put ANY weight on my cast. Scooting around on my computer chair, standing with my knee on a chair and so on.
I am a huge shower sucker (I consider it to be one of the greatest indulgences in life) - so showering was done with a trash bag, taped above my knee with a simple duct tape and tied by a shoe lace for extra security.
Not a drop of water ever got through!

Preface - many believe that Israel has the most advanced medical practices in the world, with a huge list of world-renown surgeons who hone their craft to perfection.

I didn’t really know why, until I went to my procedure.

It was so different and advanced compared to what I see being done in countries like US and in Western Europe (which are believed to have top health care systems) - that I was in awe.

I have seen a lot of surgery reports in Achillesblog.com - most people got butchered with the incision, got outdated stitching procedure and ended up with a 20 year old rehab program.

No disrespect to any of my ATR sisters and brothers - but I do want everyone to know how progressive treatment & reahab of ATRs look like in 2015.

-

20 minutes - that’s what it takes to get into a private operating room and get prepped for the surgery.

God (or whoever) bless private health care and my ability to actually pay for it…

-

In came my hand-picked Ortho-doc, asking if I want to watch my own surgery.

Sure I do! So he handed me the iPad and I got first seat in the audience to watch him dig into my ankle.

Local anesthetic is tingly (I would even say a bit painful) when the shot is made - but maaaan it makes you feel good once all the nerves go numb.

-

Small horizontal cut, maybe 3cm wide (cannot get for the life of me why I see all these horrible vertical cuts which are 20cm long everywhere?!).

My doc used this tech clamp to pull the two ends of my mop-looking tendons together, needled 5 organic threads with loops through each.

Then took out the clamp, tied all loops together and stitched it up:

Overall procedure time - 34 minutes. Pain - almost negligible. Blood - barely a few drops. Feeling - great, to be honest.

-

Got fitted with a solid cast (weights a ton) - cannot of course step on it or put any weight on it.

Post-op inspection, cast and stitches removal set in 1 week (notice the timeline, unlike most old-dated treatment approcahes - where you keep being in-cased in a full cast each post-op visit, up until 6 weeks on average)

You know an ATR when it happens.

I don’t get all the folk I read on the web, who said they have mistaken it for a partial tear or just pain for a few days (or weeks!).

No way - it snaps - you can feel the gap, and without even knowing what is the Thompson test, you can tell.

Its a fun feeling, when you try to use your torn AT: toes just drop into a void, as if your leg is gently falling inside a huge sinkhole.

-

Walked back to my car (luckily I don’t own a manual and ATR is left sided) - drove myself home.

Took an awesome shower, headed to the ER, just to make sure Dr. Google and I got it right.

Dr. Night-shift & MRI both confirmed, put a light splint cast (back opened) and asked if I want to get into the waiting list for a surgery, or simply leave.

I picked the latter, since a waiting list for ATR repair might take 3 weeks (well, free health care system does have its drawbacks and ATR is NOT a life threatening injury).

The way health care works in Israel is extremely similar to the US, and I bet everywhere else - if you got some money/insurance for private med-care: you will get fixed much much faster and get better treatment while at it.

-

Most believe that surgical ATR repair gives you less chance of re-rupture and faster recovery timetable.

Just what I want, so found the best 5 ortho-docs here, selected the one I liked most and scheduled a private surgery within 38 hours of the ATR.

-

Bought myself crutches (about 150$) and a CAM walker boot (about 350$) - not fancy brands (just good quality UK made ones):

Wed: 10K at a 4:52 min/k pace, at age 36 - pretty darn good for an old fart like me!

Both tendons ache and cry the morning after - but who cares, right?

↓

Thu: A couple of hours on the court on my own, working on that crossover and vertical leap, can’t even dunk once. :((

Left tendon is feeling slow to respond and weak when I push off - man, I wish I was 15 years younger and slam this rock down…

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Fri: 6K at a 4:33 min/k - my hip bursitis is back, but I fight it through, as I have been doing the last two months it appeared.

I never run on Fridays, I always rest it off - but I feel I need to push myself more.

↓

Sat: Another b-ball pick-up game. Left AT bothers me at the start, but the physical pain goes away as my team keeps losing.

↓

Sun: 4K at 5:16 min/k - I am slacking, these bursitis pains are killing me - dammit.

↓

Mon: My lower body is screaming HELP!!! - both ATRs hurt like a motherf*, hip bursitis, right knee - whatnot, alright - let’s have a light shooting practice, listening to my beats.

3 on 3 finishes on the other court, a youngster approaches - says something (can’t hear the dude).

Beats off - he wants 1 on 1? Pssh. I’ll show him who got game.

6-4 my lead, he tries a long one, I leap forward to mess his shot.

Snap.