Filed Under (Uncategorized) by starry on 19-06-2011

8w post op and my protocol is to wean off the boot, which allowed me to do two things which I had missed so much!!!

1. Showering standing up instead of sitting in a chair in the bath tub holding one of those shower hoses. Oh my god words cannot explain how good it felt to feel warm running water on my back. Similar to the feeling when I’ve gone camping for a week and had my first shower at home after, but much much better!

2. Sleeping without the boot on. The feeling of your foot moving around between the soft sheets, and no boot to get caught on the quilt when you need to move - heaven. AT does feel a bit stiff in the mornings as it stays roughly in plantarflexion while I sleep, so I have to be careful to dorsiflex it a bit in the air before I step out of bed, but who cares it feels so good.

This got me thinking about all the other milestones earlier in the AT recovery, all the little achievements that made me so excited that I would jump up and down cheering if it weren’t for the AT!

The first time the cast comes off and you can finally scrub the dead skin off (gross) and get rid of the smell, and finally itch your leg without trying to poke your finger down the top of the cast.

Walking in the boot with only one crutch and able to carry something in my other hand. Usually to feed myself or enjoy a cup of tea. Being able to make that cup of tea without assistance was nice too.

FWB in the boot and not having to use crutches, what a feeling of freedom for the arms and hands, made it so much easier to do all the day to day things like cooking and even buying groceries. It was hard trying to shop with crutches, there were only a limited number of items I could carry while holding the crutches too. Although I did think about carrying a backpack and putting things in, but didn’t end up trying it as I thought they might think I was shoplifting.

Standing on two feet without the boot, then being able to walk without it, even though the walk is a limp and ridiculously slow that it makes you want to put the boot back on for convinience. Also realising that your heel isn’t used to uneven surfaces that walking on a rug feels like you are walking on glass shards, but again who cares, you’re walking on two feet!

I am still waiting to drive my manual car, left ATR and my clutch is heavy so I’m waiting for more calf strength to return before i try it, but I think that will be another "moment" in the ATR recovery! Anyone who’s back driving manual got any advice on when postop the clutch felt comfortable, and any tips?

Oh and I’m finally back to work full time working up to 10 hour shifts half on my feet half sitting, and the AT is holding up well with the boot. Still aches a bit at the end of the day but recovers once I elevate and ice. Another milestone, but not necessarily one I am celebrating!

Filed Under (Uncategorized) by starry on 05-06-2011

Had my 6w post op check with my surgeon a few days ago, nothing exciting to report, he had a feel of the tendon and said it was doing well, not too hypertrophic like some ATs can become. It is still bumpy in some points and likely to remain that way permanently, but this is normal. Incision healed well, but does take 6-12 months to fade.

The brusing around the inside bottom part of the ankle has finally disappeared, think it took about 5w after surgery. Swelling is minimal even at the end of a day being up on my feet or sitting with legs not elevated.

My ROM is also finally coming along nicely! Still not the same as my normal ankle yet, can only just dorsiflex a little (maybe 5-10 degrees? hasn’t been measured) but plantarflexion is pretty much normal, same as my other ankle. I think compared to some others my dorsiflexion has been very slow to come back, even with starting gentle ROM at 2 weeks post op. I only got to neutral around 5 1/2 weeks. Because I only got to neutral recently, even though my protocol says to remove my 2 heel lifts at 6 weeks, I decided to phase them out a bit slower, a bit similar to what Norm did. I removed one about 5w 5d and didn’t feel a stretch on my AT. The last heel lift was removed 5 days after that, felt a little bit more of a stretch this time. Followed another suggestion by Norm which was to remove the lifts at night before bed, to allow the AT/calf to adjust to this overnight before weight bearing - a really good idea as this morning my ankle felt comfortable in the neutral position in the boot and weight bearing has been fine.

Second PT session a few days ago, he massaged my calf and tendon, working a bit on the scar tissue. Also increased my strength/ROM exercises to 3x daily with the green theraband. Each time 4 sets of 15 reps dorsiflexion/plantarflexion, 3 sets of 10 inversion and eversion in the plantarflexed position, and then again in the neutral position. Next week when i see him I will begin proprioception training without the boot and learn to walk again without the boot (although the boot will still be worn at least in scary situations until 10-12w)

I am now FWB comfortably and can go for walks around shopping centres etc in the boot without crutches and my leg holds up well. About 2 weeks ago at 4w post op it would still ache a bit after walking a bit, but this has settled. A few days ago I managed to do grocery shopping by myself  holding a basket for the first time since the rupture!! And tomorrow I am finally going back to work for the first time in 7 weeks.  My job requires me to be on my feet quite a bit, I am starting with just 3 hours tomorrow and seeing how i go. Life is finally starting to return to normal!

Filed Under (Uncategorized) by starry on 28-05-2011

Looking back to when the achilles first ruptured I feel i’ve come a long way,even just at 5w post op -  so all you people that just had your ATRs hang in there it gets better, even at 5 weeks! (I am aware that there is still a lot of work ahead of me, but one step at a time)

I transitioned into full weight bearing in my boot about a week ago, at first the day after walking on it a bit or FWB I would get some mild aching in my AT. After about a week it all settled down, my physio wasn’t concerned and thought it was just due to my calf getting used to weight bearing again. I remember the first time I was able to carry my tea in one hand and my toast in the other and walk to the other room to eat I felt so happy… like everyone says, we celebrate all the little victories!

A few days ago at eactly 5w post op I had my first physio visit. I brought along the UWO protocol that my surgeon recommended, and he was happy to follow it. I showed him the ROM exercises that I had been doing already and he introduced a green theraband to provide some resistance when doing plantarflexion, inversion and eversion - no resistance on dorsiflexion yet. He massaged the lower leg and showed me how to massage the scar area to help with adhesions and desensitise the area. I’m meant to do it 2-3 times a day, both parallel to the scar and perpendicular to it. Since most of the strengthening exercises start at 6 weeks post op, most of the hard work will start next week. I spent 10 minutes on the exercise bike just with one leg, and realised that my fitness had really deteriorated!!

I don’t know if it was the massage or the theraband work I started but the next day my leg felt really good - in fact, the aching that I had around my AT stopped the day after the physio visit, and I’ve been walking on the leg much better since. Coincidence? Maybe, but I doubt it.

One last thing I asked the physio about wheether to do dorsiflexion/plantarflexion ROM with the knee flexed, or extended (i.e. leg bent or straight). When I firsted started doing ROM at 2 weeks post op I was doing them when the knee flexed, so in a sitting down position with my leg dangling in the air. Then I saw some exercises on this site which shows the leg with knee extended/leg straight, and I was worried I had done it wrong. Apparently though my physio likes to do ROM with knee both flexed and extended as when the knee is flexed it is mainly the soleus muscle which is working vs leg straight working the gastrocnemius. I thought this was interesting, and was reassuring to know I hadn’t been doing the ROM wrong. At one stage I had a moment of panic thinking I’d overstretched in dorsiflexion, but turns out I haven’t even reached neutral yet - seems my eyes aren’t very good at judging dorsiflexion when the knee is bent?!

Anyway, have 6w post op visit this coming thursday and hoping to be cleared to start work again, will update again after this.

Filed Under (Uncategorized) by starry on 17-05-2011

I hate to be paranoid but I’m worried I may have tried to push things a little too fast… yesterday at close to 4w post op my leg/ankle felt really good. So I started walking a bit on the front veranda with one crutch and the boot (which i’d been doing for a few days already) then slowly doing fwb with the boot. It felt really good with no discomfort or pain, and I only walked a few lengths of my veranda. This morning a particular spot on the AT just under the repair is a bit tender, and if i put quite a bit of weight on my bad leg in the boot, supported by a crutch, it aches a little.

I have had it mostly rested and iced a few times today hoping that it will settle down by tomorrow, but has anyone else experienced a bit of soreness in the AT itself after starting fwb?

Any comments would be helpful, I’m obsessing/worrying about this way too much!!

Filed Under (Uncategorized) by starry on 11-05-2011

So the past few mornings i’ve woken up and had occasional mild shooting pain in the back of my heel.  Not on the weight bearing surface of the foot, but almost on the back of the bone or round the side, about 2cm above the bottom of the foot. I go back to sleep and it sometimes comes back for a short while then disappears. It goes away after I get up. I have been elevating my foot in the boot with 2cm heel lift on a pillow at night.

Did anyone else experience this, and any theories as to why it is happening?

I also experiemented with FWB at 3w post op in the boot - can move short distances placing weight more on the heel of the bad foot and taking very short strides. Was very slow to move but was so happy to be able to walk (shuffle) with no crutches! Think I will continue to use 2 crutches to get around faster, and transition to one crutch on the good side before ditching them altogether.

Filed Under (Uncategorized) by starry on 08-05-2011

So last wednesday I had my post op check 2 weeks after my surgery - the stitches were taken out from either end of the incision (apparently they were attached to absorbable sutures underneath the skin!) and my wound looked good. I was now allowed to shower and get my leg wet for the first time in 2 weeks which I was excited about.

The surgeon then passed me onto the physio, where I was fitted into a boot. The physio sees lots of ATRs as they work with a foot and ankle surgeon in the same building. While i was waiting for my appointment i saw two other guys with casts on waiting for the same thing as me! However, because of this, the physio usually follows the ATR protocol by the other surgeon : Partial weight bearing (up to 30 kg) in Achilles boot with 30° wedge for next 3 weeks. Weight bearing as tolerated in Achilles boot with 20° wedge for next 3 weeks. Weight bearing in shoes with 2 cm heel rise for next 6 weeks. This was different to and a little less aggressive than the UWO protocol my surgeon had given me.

They also recommended that I don’t start any ROM exercises till 5w post op, as they are worried about the tendon healing long. Obviously if the tendon is stiff you can stretch it out, but if it is too long there is nothing much you can do to fix this except another surgery to shorten it. Although I do worry about healing long, I’m thinking if i follow the UWO protocol and not dorsiflex the ankle past neutral I don’t see how I can overstretch it as there is still that 15 or so degrees of dorsiflexion that I woudln’t have used.

I decided I was going to follow the UWO protocol myself for now then start formal physio in another 2 weeks. Started partial weight bearing which has been great as it makes it easier to balance, makes it easier for my arms to cope and makes me feel that I am moving closer to full recovery! I went home and measured my heel lifts carefully, and removed one of the lifts to make it 2cm. It actually felt more comfortable with 3 at this stage, probably as my tendon was still a bit stiff, so I left 3 heel lifts in that day and started ROM exercises to loosen my tendon a bit. By the next night, I removed a heel lift before bed and it has felt comfortable and easier to walk since.

The UWO protocol I have does not state how many reps and how often I am meant to do my exercises - so from looking at other protocols I have decided to do around 10-20 reps 3x daily of dorsiflexion and plantarflexion (not past neutral), decreasing the ROM if there is pain. I do the same for inversion and eversion. Leg lifts lying on my back and side, about 20 reps at least once daily, and then situps and pushups to try and keep a tiny bit of general fitness up! Does anyone have ideas on how many reps and how often I should be doing ROM exercises at 2-4 weeks post op?

The swelling in the leg is causing much less discomfort these days, no throbbing feeling when getting up. Along with PWB, this has been great as I have now been able to get out of the house and go out to visit friends and eat out - I guess the thing with the ATR is it has made me take a step back and appreciate all the simple things in life! The ankle still swells and becomes uncomfortable when I sit down and don’t elevate the leg for a few hours, but quickly goes away once elevated. I am assuming it will continue to improve as the days and weeks go by. Can’t wait for another week and a bit when I can start increasing my weight bearing to be FWB in the boot (at 4w post op!)

Filed Under (Uncategorized) by starry on 29-04-2011

So my ATR story reads much like everyone else’s, happened while playing basketball on a sunday night, 17th of april, about 15 minutes into the game. I remember catching a pass, and probably twisted a bit and went to accelerate (details a little hazy it happened so suddenly), then thought that someone had kicked me in the back of the left heel! I fell over and clutched at my ankle and like everyone else, looked around me to see who had kicked me - I knew i was in trouble when I realised there was noone around, and everyone was looking at me with worried expressions. After the pain decreased a bit I hobbled off the court hopping on my good leg.

After dorsiflexing my leg and feeling a gap where my achilles was meant to be and comparing it to my good leg, I realised straight away what I had done. My partner gave me a ride to the hospital, where they took some xrays of my ankles, then waited a few hours to be seen by the dr. They performed the thompson test and confirmed it was an achilles rupture, placed me in a backslab and told me to return at 7am the next morning to be seen by an ortho specialist. The specialist discussed my options - surgery vs non surgery, they did inform me that there was little difference between outcomes of the two but maybe a small decrease in reruptures with surgery. Given that I am younger than the usual people that have ATRs and quite active, they recommended surgery and I was happy to proceed. After all, if i was going to be out for weeks then I may as well try and decrease the chance of rerupture! Another backslab was placed back on my leg and I was sent home with surgery scheduled for the wednesday (3 days post rupture).

Surgery all went well, complete rupture which was sutured together.  I arrived in the morning fasted and had to wait a few hours before it was my turn. I had to put one of those backless gowns on, they inserted an IV and gave me a dose of sedation before wheeling me into the theatre. The last thing I remember is moving onto the operating table, then being awake in the recovery room. They gave me fetanyl (an opioid) IV as pain relief for immediately after the operation, then digesic tablets every few hours - I have a few doses of this but felt like they were making me have shortness of breath and feel nauseus so I stopped, with my last dose in the early morning the day after my op. I was sent home the next morning with ibuprofen, panadol (panadiene forte if necessary) and blood thinning injections of heparin (clexane) to prevent DVT. Surprisingly I have felt nearly no pain throughout the whole incident apart from the intial sharp pain when the rupture happened. I didn’t even use any of the ibuprofen or panadol. Apart from the initial rupture, I think the most pain has been from those daily blood thinning injections I’ve had to give myself under the skin in the abdomen - they sting like a bitch! But each one means I’m a day closer to my post op visit and a boot with partial weight bearing!

The first few days were the hardest, for a few reasons:

1. Kept wondering why it happened, whether it was preventable, and why me? From all my reading, ATRs generally happen to people in their 30-50s, especially men. I am a 24 year old female who has been active my whole life and never had any signs of tendonitis, so this all came about very suddenly. The night of the rupture I had not warmed up or stretched much, which would not have helped, but this was no different from my usual routine (but lesson learnt the hard way!). Secondly, I had only started playing competitive basketball again 2 weeks ago - this was my second game in about 1.5 years, so might have placed too much impact on my achilles too suddenly. Although I did play basketball casually with friends prior to this, and played oztag (touch footy/rugby type thing). So I guess I had two risk factors for an ATR, but I thought my body would still be able to handle it since I am young. Eventually after a few days I learnt to accept that sometimes things happen and there was nothing I could do about it but stay positive and stay determined to heal completly from this injury.

2. The thought of rerupture or rupture of my good leg scared the sh*t out of me. I was so scared of having to go through this all again, especially further down the track when I was able to start walking again. Because this is an injury which occurs quite suddenly and without warning, I felt a bit helpless that I could not do much to prevent it from happening but strengthen my leg muscles, warm up well and stretch before games. After some time I accepted that this was a possibility, but that there was not much I could do to avoid it completely, and there was no point worrying about it happening.

3. I was about to go on a 3.5 week holiday to USA and toronto, my first big holiday since I started working 1.5 years ago. This trip was cancelled due to risks of DVT on long haul flights, the need for post op visits and rehab, and the inconvinience of moving around in a foreign country on crutches (hard enough in my home city!). This crushed me as I had been looking forward to this holiday for months, and initially I was more upset about this than the injury itself. Again after a few days I accepted it and am looking forward to making a full recovery so I can go next year instead!

So now I am 9 days post op, I have been elevating my leg above my heart religiously as I do not want any complications with wound healing. This means I have been mostly lying down with my leg propped up on 2 pillows (1 to sleep on, was too uncomfortable sleeping with 2). The first week everytime I got up I would feel the blood rush to my leg and mild throbbing around the achilles area. The past 2 days though this has decreased a lot, and I assume it will continue to improve until my post op check at 14 days.

My surgeon has already sent me my rehab protocol, which I was pleased about as it happened to be the UWO protocol. So fingers crossed I will have a boot on in less than a week and be able to start partial weight bearing - very excited! This means that I can at least get out of the house a bit and drive also (left ATR), and have some sort of social life! Until then I will overdose on tv series, movies and books.

A quick question for you all - anyone that has followed the UWO protocol, how much time in the first couple of days after being fitted into the boot were you able to walk? Did anyone have issues with their tendons being too tight to be placed comfortably into the booth with a 2cm heel raise? Looking forward to getting a better idea of the next step from here, reading everyone’s blogs has been so reassuring!