Donor collagen

Today marks 6 weeks since I had the ATF and calcaneal ligaments reconstructed. I also had donor collagen added to the opposite side of my talus where the lax ligaments had allowed the bones to rub and wear the talus away.

I hadn’t updated my blog in awhile. Surgery went very well, no allergic reactions this time. My doc said the ATF was over 50% avulsed with really only scar tissue holding it on.

I went home in my Vacocast I had left over from my Achilles fun and was told to flex and extend my foot, but have no side-to-side motion. I was told to wear the boot only to protect it when going out. I ditched crutches for the iwalk-free and put many miles on that thing, I wish I’d recorded how many, it was a lot.

Doc took an x-ray of the donor cartilage area the day after surgery. He took another at 2 weeks. You could see a dramatic difference. It’s amazing to see cartilage growing back. He took another x-ray at 4 weeks and told me to start walking on it 2 weeks early.

I’m very grateful for the donor cartilage. I understand it’s juvenile cartilage and some family had to make a very tough decision, for that I will forever owe them a debt. My doc said a year ago this would not have possible as they didn’t have the procedure. From what I understand of the procedure they simply apply biometric glue in to the void of the bone, then sprinkle cartilage powder on to the glue. Over the course of 6 weeks it grows back to fill the void as if it was never there.

My doc also told me I heal better and faster than anyone he has ever seen come through his podiatry practice. He told me I have no frame of reference to appreciate it, but that I should be thankful for that as well. That may be the case, but I know he also stays up on the latest research and is constantly looking at better ways to do it. I know for my surgery they took blood, centrifuged it, and applied blood cells to the incision areas to help it heal faster, I’m sure everyone doesn’t get that.

Going back under the knife October 5th

Sadly my ankle is going back under the knife on October 5th. The Achilles is doing great, it will be to fix the ATF and calcaneal ligaments. Their laxness was a major contributing factor in the Achilles rupture in August 2011. My doctor also mentioned there is a new procedure to use biometric glue and cartilage cells grown in a petri dish to fill in the huge defect in my talus bone where my fibula broke a piece of bone and cartilage out. I’m up for anything at this point.

6 weeks off the foot AGAIN…. There is no way I’m doing crutches again, I’ve ordered one of these.


Coincidentally, I measured my two calves at the 11 month mark. My good calf was 13″ on the nose, bad was 12″ on the nose. Now at the 13 month mark my good calf is 13.25″ and the bad is 12.75″. It’s catching back up just in time to shrink again… sigh….

Achilles anniversary

Monarch Crest

I celebrated my Achilles anniversary last week by riding Monarch Crest, which goes along the Continental Divide. Full pictures here:

It’s been 9 months…

It’s been almost 9 months since tearing my Achilles. At the time I really wondered if I’d dare do anything active again. It really is a mental game and you get over it. The complete strength takes a LONG TIME to get back and I still don’t totally have it, but I feel great…

“Two shoes” still feels weird…

I’ll admit, it feels weird to walk around in two shoes.  I’m not necessarily talking about the fat tendon of my left leg just squeezing in to my shoes, I think I’m more feeling that I’ve been without the second shoe for so long that it doesn’t feel normal.  First, I had to find my other shoe.  Than I had to clean my right shoe as it’s had 6 weeks of use without its bud.  Then I had to pair up all my socks again, I’d been wearing just a compression sock on my left leg for 11 weeks.

I started walking around in both shoes last Friday, I guess for my profile I left it at that day even though I’d been walking barefoot for about two weeks before that.  Semantics I know, but I want accuracy.  :)

Tomorrow will make 12 weeks since my ATR surgery and I have a few milestones.  I did my first allowed physical strength physical therapy session on Tuesday.  I was able to push the upgraded clutch of my car (Subaru Legacy GT) twice today, that’s cool, and I’ll soon be driving that again.   The initial push was easy, but to get it all the way to floor with extension of the toes took a lot of concentration.  I was also able to do a whopping two sets of two single-leg heel raises on the left today.  I hadn’t tried these at all just out of paranoia, but I first tried it on a flat surface and was amazed that I could lift my left heel a good deal above the ground, a whole two times, and the second one wasn’t very pretty.  So then I went to a step and did two there, I noticed that my heel-raise strength when dropping my foot below parallel is nearly non-existent, which makes sense as that range of motion has been just recently attained.  EDIT:   My doc told me throughout this to be my own best clinical advisor. Even though the 1 leg heel raises can be done, and the clutch can be pushed in, it doesn’t necessarily feel like something I “should” be doing… I’m in no rush and am happy to keep doing the double heel raises and driving an automatic for a few more weeks.

As far as range of motion goes, my physical therapist says “angle-wise” that I have enough flexibility in my foot for  running, which would be hilarious to see, and doesn’t explain why I still limp while walking.   The limp is most prevalent if my foot and leg are cold, or if my calf is simply tired, which it gets easily.  When warm and loosened up the limp is nearly gone, which is amazing to me as well, but I’ve been accentuating pushing off on my toes on the injured leg since walking barefoot.  Up and down stairs feels good, and more normal than walking.

The past pain along my posterior tibialis I had from a loose ATF ligament has not returned as of yet, that’s very nice.  It would be nice if it never returned, but that would be an ideal scenario.  I still haven’t figured out what to do about surgery for that.  If it returns it will have to be fixed.  I don’t necessarily want to do one recovery and then start another.  I also don’t want to necessarily completely trash my calf, the ATR gave it a hard hit already.  Overall it’s nice to have both shoes on again.  Admittedly my VacoCast boot almost made it too easy to have that security blanket.  I could work normal and FAST with that boot, it was mentally difficult to put both shoes on and take two steps back, so to speak.

Need input, what would you do?

I’m at week 10 in a few days and feeling pretty good… walking barefoot is fine, push off strength is next to nothing.. But now I’m faced with a decision, my ankle wasn’t right before this happened, read about it here. My doctor said that it almost certainly put more strain on the Achilles and helped it rupture.

Since I really am asking others what they would do, I’ll summarize what’s going on.  The talus bone of the ankle which had the Achilles rupture has an osteochondral defect of 9mm x 17mm, meaning the bone there is mush, a leftover remnant of a skiing accident 3 years ago where my bindings didn’t come loose and instead, my foot pulled out of my tightened boot.  As a secondary result of that, my anterior talofibular and calcaneofibular ligaments are stretched.  This has caused ankle instability to the point that sometimes when stopping quickly it feels like my leg just slides out over my ankle.  It also causes nearly constant, but not overwhelming, interior ankle tendon pain which showed up as fraying on the MRI.

My plan was to have the ATF and calcaneofibular ligaments fixed with a modified Brostrom procedure this fall after gobs of physical therapy failed to fix the instability, that was until my Achilles ruptured in August.

It would make sense economically to try and have that procedure this year as we’ve easily met our insurance out-of-pocket with a new baby and my Achilles rupture, but I can’t bear the fact of thinking about another surgery and more time off my feet again this soon.  Plus, it would just be nice to let some of my leg strength come back again.

Add on top of that, my allergic reaction to, I think, Lidocaine which you can read about here.  It makes me paranoid for another surgery.  At the very least it would mean another trip back to the allergist and a fair amount of allergy tests.

So what would you do if you were at week 10 of your Achilles recovery, you know have ankle instability that’s fairly bad and won’t fix itself and could have even caused the problem, and you economically look at your insurance out-of-pocket being fulfilled for this year already?  Would you have the stability surgery and set your Achilles recovery back or would you hold off for a year or two and just deal with it?

The Biggest Loser - no Achilles tears?

I admit that I enjoy watching The Biggest Loser. Since tearing my Achilles though I just watch that show and wonder how they never have Achilles tears. It seems like the perfect opportunity for one to present itself, going from almost no activity to a lot of activity and many times being over 30, not to mention being really overweight… Makes me wonder if the biggest reason for tears is simply not warming up, I know I didn’t…

Attempting walking barefoot

My instructions for week 6-10 were rather vague. The instructions on boot use and adjustment were clear, but out of boot time was not as clear. Since the day of surgery I was told to move my foot as much as possible to get blood flowing and keep range of motion, this was reiterated for week 6-10. Range of motion is amazing, strangely it seems better than pre-surgery due to my other ankle problem.

What I’m not clear on is, should I be trying to walk bootless? I’ve been walking barefoot and it feels “ok”, I can even push off with my toes to a fair extent. However, the tendon is rather tight, as are the supporting muscles around the foot and ankle. Having done physical therapy to try and forego the ATF tightening surgery, which foregoing that my have caused the Achilles problem, the supporting muscles of my ankle were strong. With those muscles atrophied I can really feel how unstable the ankle joint is.

I can only assume that walking barefoot, based on the stories of others like ryanb who already have themselves in shoes, is probably just fine. The caveat being that I’m careful and smart about it. Throughout this whole process I haven’t felt rushed or anxious about being active again, which seems weird to me. Part of it could be that fresh out of surgery I wasn’t in a cast, boot, splint or anything. Sure, crutches were not fun, but the rest of the time I was just sitting there moving my foot around like nothing happened. The comfort level of not having something around my leg all the time made all the difference.

Reading other stories I may question the 6 weeks of non-weight bearing I had, but I was moving the tendon pretty much the day out of surgery, often flexing my calf to music to build strength and keep it engaged. At week 2 when my stitches came out my doctor told me, thanks for being careful with your foot, but really you should be setting it on the ground while seated, I didn’t know… It started feeling really good about midway between week 3 and 4, but I stuck with crutches for walking, and continued doing seated calf raises while trying to get my foot at 90 and my knee at 90. Overall I’m not sure I would follow a different protocol, it has felt about perfect for how my healing feels.

Week 8 check-in

8 week check-in, things seem to be going good, standing and walking with no boot on feels ok, but it’s also tight and I haven’t been pushing it much as I’m supposed to still be using the boot.

Appearing to follow the protocol of one of the studies I found, my doctor mentioned to take my boot down from 10deg this week every few days as felt comfortable. As the VacoCast can do smaller increments I think I went down to 5deg yesterday, half of a notch between 1 and 0, with zero being at 90deg. I get all confused with the angle numbers, I just know that my goal is to get to the 0 on the boot by the end of the week. I honestly don’t know if I’ll make it. I was zipping around with the boot set at 1, nearly walking normal, changing it even at the slight angle is very uncomfortable and I’m back to gimping again. It started to feel good for a small window today, then went back to being uncomfortable…

The one other thing I keep noticing is the feeling like “pop rocks” in my Achilles. I’ve felt it since day one, it’s not tingling, it’s not numbness, just feels like those pop rocks you eat, but in my leg. I had assumed it was simply the healing process, but now I don’t really know. It’s not uncomfortable, just doesn’t feel normal…

Week 7: Walking without crutches!

I’m walking without crutches!!!  Today I set my crutches down and just started walking, it’s awesome!  It’s 7 weeks to the almost minute of when I got out of surgery.  So far my ideas of “what I’m going to do now” have been met with an uncomfortable pause and a question along the lines of, “do you really think that’s a good idea?”.