My achilles is a killin’

In doing some research I ran across a before and after picture of an ATR treated conservatively. I can’t even remember how I stumbled across this, who only knows what I was searching on. (I can only imagine what my google log looks like). Annnnyhoooo…the MRI is not mine, obviously, because I was treated surgically, but apparently the MRI is of an 80 something year old woman who ruptured b/c of antibiotics. The after MRI was after 8 weeks of casting. I hope you all find it as fascinating as I do. You can clearly see all the scar tissue, and most of all you can see it healed.

I have a question for anyone that understands how to read these things, (doug53 - you’re a doctor, right?), is the rupture in the before a full or partial?  Looks like it’s hanging on by a thread, but I could very well be mis-reading it. And if it’s hanging by a thread would that be considered partial?  Anyone have any insight?

Here’s the link, btw:  http://content.nejm.org/cgi/content/full/357/20/2067/F1

I hope some if not most of you will take a moment to answer this. What have you been told in terms of when the tendon is healed after surgery? I was told that it is 90% healed at the six week mark, but not 100% until one year.

I’m not talking about calf strength, normalcy, playing sports, etc. I’m talking about the tendon itself actually being healed and somewhat out of the “danger” zone. I’m curious to know what you’ve been told.

Thanks, I hope to get some responses.

Happy Healing-
Shay

Again, don’t worry about reading this drivel.  I’m logging this so I can reflect and remember when I started feeling certain things, etc.  So, anyway, I hit the 8 week mark today.  Yahoo!  It’s funny how we all talk in weeks, isn’t it?  Kinda how people refer to their babies in months?  I don’t know what sounds better..8 weeks or 2 months.  Anyhooo, here’s the scoop on my “goings on” the last few weeks.

Week 5 to Week 6:

Began Physical therapy.  I had been instructed by my surgeon during the weeks prior to do a little bit of range of motion exercise, so I think that helped once I actually started PT.  During the first week it pretty much consisted of heat, icing, ultrasound, stretching and deep massage of the Achilles region.  Surprisingly the massage wasn’t as bad as I had anticipated based on all the stories I read.  In fact, I would leave there feeling loose and stretched if that makes any sense.  Anyway, that was it for that week.  As far as how I was feeling.  I guess ok.  Still tentative about bearing any weight, so I wasn’t.  I have the boot on, but was still using the chair.

Week 6 to week  7

Physical therapy was much of the same - heat, ice, etc.  Although now we added in some balance disc stuff.  Does that make sense?  Basically I’d put my foot on this balance disc and move the disc around, put it up and down, etc.  I did all these while seated, mind you.  And, then of course much of the same in terms of range of motion, ice, heat, and lots of massage.  My PT says the scar tissue isn’t so bad.  My surgeon actually did my incision a bit off to the side, so any scar tissue isn’t on the tendon region itself.  What I did notice during this week is what looked like puckering around the bottom of the scar.  Well, not puckering really, but almost like loose skin.  Turns out it’s actually a good thing, b/c I ‘think’ it’s a result of where scar tissue used to be, but has since been worked out b/c of the massage.  But it left a bit of a skin bubble.  Not explaining it well, but it’s fine nonetheless.  My scar feels pretty smooth…I still have the knotted type feeling/bunch of scar tissue at the top of the scar.  My PT has been working through it and it seems to be lessening. Also, I’m curious how the tendon feels on people when you run your finger down it.  Mine feels bumpy in spots, which I assume is scar tissue.  At some points it feels like a nice smooth tendon, then it goes in, then it bumps up, etc.  It’s in tact, however, but it just feels different than my other one.  I know that’s a “duh” statement, but it just gives me pause sometimes.  Anyway, I started to PWB this week with crutches, in the boot.  It was surreal to stand up.  I know most of you have used crutches the whole time, but I’ve used mine sparingly, and have mostly relied on a chair. So, to stand up and crutch made me feel like the jolly green giant…verry odd.  PWB wasn’t so bad, and I’m excited to be making progress.

Week 7 to week 8:

PT has been a lot of the same, but now we’re adding the resistance bands into the mix.  It was such a weird feeling to plantarflex against a band, I couldn’t believe how weak my calf was; however, that said I was also equally amazed at how quickly the calf seemed to strengthen.  My PT gave me bands to bring home with me and I have been very diligent to do my exercises daily.  Within days I could start to see my calf muscle again, and actually see it move while doing the bands…way cool!  I also started my version of FWB, which is basically using one crutch almost for balance, and still in the boot.  But holllllllly crap does my heel hurt.  This is the first week that I’m starting to get achey, etc.  I notice that my heel hurts like a “mutha” , so I actually put an orthotic like insert into my boot (since my boot has no wedges) and it seems to be helping.  Sounds like heel pain is a pretty common occurence once you start weight bearing.  It’s Plantar Fascitis (sp?), which occurs after long periods of being immobile…ta da…that’s me.  So, it sounds like the more weight I start putting on the better it will get.  My PT also thinks once I get in two shoes it will start to feel better as well.  Also, my ankles feel weak.  Again, I’m sure from all the weeks of inactivity, but sometimes when I’m walking they just feel unstable.  That’s the only way I can describe it.  Not painful, just unstable.  Again, I’m told it’s normal.  I also notice that my leg is tired at the end of the day, and a tiny bit swollen.  Not a lot, but it’s defintely there.  At first I thought, “oh cool, my calf muscle is coming back”, but um, no, just swelling….lol.  I also feel what I would call “tenderness” in the achilles region.  Not necessarily on the tendon, but in the area that surrounds it.  It just feels tender, like I want to rub it, and actually rubbing it actually does the trick.  And, last but not least…I, too, have the weird pain at the top of my ankle that others have talked about.  Mine is at the top left, and does like a half moon to the bottom left as well.  Hard to explain,…almost like it hugs the left side wrapped around where the foot meets the ankle…in that crease.  However, I was given an explanation that makes perfect sense.  Apparently it’s pretty common that when we are casted in the plantar flexed state for so long that many people actually come out with a tiny bit of an ankle sprain from the ligaments being pulled and positioned in that unnatural position for so long.  Makes sense to me.  Sucks, but makes sense.  And, in my case since my incision is more off to the side I was not only in a pointed down position, but my foot was also casted so it was pointing inward as well…both positions take stretch off the achilles; hence the reason I feel my soreness on front and bottom and on my left side only b/c my foot was pointed to the right.

The feel of my scar seems to change daily, and I’m quickly learning how important massaging that scar tissue is.  So, that’s where I am right now.  The goal is to be two shoes next week.  My guess is I’ll still use a crutch while in the two shoes, but that’s ok.  I’m fine with taking this slow. 

Other random thoughts
Are any of you hyper-aware of people plantar and dorsi flexing?  HA, I’ll watch tv and think, yah, rub it in with that tip toe move, you @#$%^.  LOL   Or, how about this one…I find myself  telling people, “be careful with that, it’s hard on the achilles, ya know”  What am I, 80 years old or something?  Geesh.  Shut me up already.

Oh, and with all these scar photos I can’t help but think it would be funny if we all met someday and had to identify each other by our scars.  LOL.  I picture a bunch of us mingling, walking around on our tip toes, comparing battle stories and scars to prove it.  Ahhh yes, too much time on my hands, I suppose.  In normal environmnets we’d be posting pictures of ourselves, but nope, vanity has no place here.  We’re all about…oh yah, well check out this scar.  And,  wanna see how far I can dorsiflex compared to my other foot.  And, plantar?  forget about it, yo, I’m practically a ballerina…lol.  What have our lives become? :-)  I love, love, love that I can relate to all of it, and we can all relate to each other.  Thank God.

Ok, I’ve gone on enough.  Soldier on my Achilles Family

I don’t expect anyone to read through this whole thing.  I’m jotting these things down so I can go back and remember things that were worrying me and/or happening.  Also hoping it will help some random surfer to realize they aren’t alone and/or my experience mirrors what they are going through.  I know I would have loved to have read a timeline of events so I could have known what to possibly expect.

Day after surgery  to week one:  In a splint, no pain.  no swelling.  Kept leg elevated and iced as much as possible.  You would be shocked at the penetration that ice can have through a splint.  I would not have believed it, but I would surround my leg with ice bags and after a while it would really work, I strongly suggest it.  I never got the blood rushing to toes feeling when I stood up. No red or purple toes.

Only symptoms I felt were a sensation of blood trickling down my leg inside the splint, and some small muscle spasm type feelings.

Week one to week 2 - same as prior week.

First post-op visit - at the 2 week mark.  Well technically was at the 13 day mark.  The Doctor took off the operative splint and my leg was shaking like crazy.  The doctor didn’t use staples or stitches, so there wasn’t any of that to remove.  Just some surgical tape holding the incision together.  He examined the incision - looked good.  Did the Thompson Test - yep, it’s attached.  Again, he said looks good.  My husband was in the room, however, and while he said my foot definitely moved he could tell the weak and stiff muscle was preventing it from really jolting.  I was put into a removable splint, still NWB, and told to take it off twice a day to do a very basic range of motion exercise.  I was to sit with my foot hanging over the edge of the bed, gently lift my toes towards my shin (using my shin muscles, not the calf) and then let gravity pull the foot back down…so, almost letting it be dead weight and then just fall.  Does that make sense?  Oh, and by the way, that blood tricking feeling I was getting, where I was almost certain it was the incision?  It wasn’t.  Who knows what it was, but once the splint was taken off there was no sign of any blood trickle.

Week 2 to Week 3:  Terrified to begin exercises, but did.  I could barely move my foot and it was scary.  I gradually got used to it throughout the week and it became more flexible, but for the first time since surgery it started to swell.  Not a lot, just a tiny bit.  Also, this week I started to feel a soreness right in the tendon.  The only way I can describe it is a soreness.  Not a pain, but more like an ache that needed to be rubbed.  I also, this week, started to get the red toes that people spoke of.  Again, it wasn’t painful at all, and I never got the “rush of blood feeling” but I definitely would have purplish toes about 30 seconds after getting up to do anything.  They would subside within seconds of elevating, so I figured the recent soreness and red toes had to do with my recent exercises.  Albeit tiny movement, it was still movement nonetheless.  Still NWB

Week 3 to  Week 4 - More of the same as the week prior.  Although now I noticed a hardness at the bottom of my calf area, almost above the incision site.  It was a pretty hard area.  I didn’t know what to think - I thought clot, scar tissue, etc.  I also realized that it could have been there all along and I just never noticed it before.  Anyway, something I was going to bring up at the next visit.  Still NWB.  (oh and by the way, I still got that trickling feeling that I was getting post-op, and since I could now SEE the incision I for surely knew it wasn’t blood…guess it’s just some weird nerve sensation.  Nothing big, nothing to worry about.)

Second post-op visit:  4 weeks post op, well actually, 25 days after surgery but who’s counting?

Got the splint removed and was put into the boot with two wedges.  I was scheduled to begin physical therapy on the following Monday (week later).  Initially the Doctor told me to go ahead and just start walking in the boot.  Then he said, actually, stay off it another week and then let the PT assess me on Monday.  Fair enough.  I’ve said it before that I’m not one that is too worried about getting back to something too soon.  I want this to heal and heal properly,so I’m cool with not pushing too much too soon.  He told me that the incision looked great, I could now shower without the boot, but have the boot on at all other times - even bed.  He also told me there was  no clot, the soreness was from the recent movement, and the tight/hard feeling was something to do with where the calf muscle meets the tendon, and that the tendon is used to getting worked and when it doesn’t it tightens up, or something like that.  I don’t know I was half  listening to the “why” and more elated that it was normal.  Oh, and he also did the Thompson Test again and this time (since I had been working my leg a little bit for the weeks prior) - my husband said the foot jumped at the same sort of velocity as my good leg.  Woo hoo!  I left there with instructions to see him back in six weeks.

Week 4 to Week 5:  I continued to stay off it and do my range of motion excercises.  Although, I considered myself PWB, because I was putting TINY amounts of weight on the boot whenI would get up to go to the bathroom, etc.  PWB wasn’t possible before with the angle my splint was on.  I have to say that I had a whole new confidence in the boot.  Not only did I feel good because it seemed  one step closer to the finish line, but it just feels more sturdy than the cast.  My toes don’t stick out, and that makes me feel confident.  Ialso noticed during this week that the red toe thing did not happen at all.  And that achilles soreness area- gone.  I think it had something to do with being in the splint in that weird position, and possibly having the ace bandage too tight.  I don’t know - all I know is this week all that was gone.  Oh, and I am at 90 degrees with my foot/ankle.  When I’m doing my excercises I can firmly plant my foot at a 90 degree angle on the floor…minimal weight of course!

Beginning week five - Physical Therapy

Today is Monday, and Wed. will be officially 5 weeks.  I went to my first physical therapy appointment today and there was really nothing “physical” about it.  He basically talked me through some stuff, massaged my leg for about 30 minutes and then iced me down.  I like him though, and I feel good about his background so that’s good.  I’ll be going there 2-3x per week,  and he says I should easily be in two shoes in a month’s time.  He, however, wants me revert to NWB for at least another week.  So, I guess my tiny little PWB has to shift back to a strict NWB.  Again, I know some people are in two shoes at four weeks and FWB.  I’m fine with my slower more conservative pace if they think that’s what’s best.  His school of thought is that at 6 weeks post-op the tendon is pretty much near 100% healed, so why stress it out any sooner.

Other points of interest:

I started out in pity city doing the “why me” crap.  then I transitioned into the reality of my situation and fear started to creep in.  Then, I think the depression started to creep in around week 3.  I went through the tired of being inside, tired of not being able to do things for myself, tired of leaning on people, blah blah.  I guess it’s normal to go through that, but it sucked.  Finally by week 4ish, I tried VERY hard to leave a lot of those feelings behind.  Sure, I visit pity city now and then, and sure fear creeps in at each new step, but I realize that God has a plan. I firmly believe that.  And, I also believe that things aren’t in my control so it’s better to just surrender and keep living.  I also realize that in the scheme of things I’m lucky that this is my only problem.  People recover from this, there is light at the end of the tunnel.  It may be a lonnnnnnnng ass tunnel, but at least there is light, which is more than a lot of people can say for situations they are in. 

Have I gained weight?  Probably.  I haven’t weighed in, but I decided to try and do something about that and began doing some chair excercises last week.  My doctor also told me I could do one legged stationary bike, which I have yet to do, but will.    It’s all about trying to live in the moment.

Good luck to anyone going through this.  It’s not an easy road, but at least the road leads to recovery.

Sorry - one more point of interest to mention.  I’ve opted to use a wheelchair as much as possible.  I’ve been told that women don’t have quite the upper body strength as men, which would explain why crutches were such a pain.  Yes, technically I could do it, and I was using them prior to surgery, BUT, I was worried about having an accident with them, so I rented a wheelchair for the last month and it has helped me a lot.  Our house is all wood floors, so it makes it easier to wheel around, plus I can carry things, and it gave me such a greater sense of freedom than the crutches did.  Also, I’m a business consultant, so I’m able to work from home which means I don’t have to struggle with a wheelchair in an office environment.  If I had to go into an office, then perhaps I would have re-thought the whole thing.  I know I’m not the norm with that decision, but whatever works for the individual.  I will, however, now that I’m in the boot start to crutch more than wheel. 

Lastly - a huge shout out to my husband.  The most amazing and supportive man on earth.  Honestly, without him I do NOT know how I would be getting through this.  His moral and physical support are unwavering.  I hope everyone has a good support system through this journey.

…and that’s just what I’ll do (soon)!

hee hee.  

Just wanted to share the news that I’m officially in “da boot”! PWB and I start PT next week. Woo hoo.

God is good. There is a plan…

Oh, and I can shower without the 20 minute hefty bag/duct tape ritual!

A shout out to all my fellow hobblers… :-)  It seems everyday I have random questions swirling in my head, so I thought I’d see if anyone can answer my question of the day:

After surgery my doctor told me that when he got in there that some of the tendon was actually still attached, but very stretched out.  Okay, so why did the MRI say complete rupture and does that mean it was technically a partial rupture?  Annd, if so, could I have avoided this whole sugery business?  Grrrr.  I asked him, so, did you cut the stretched piece, and he said no.  Now, I don’t know if he was listening to me, nor do I know if that was a dumb question to begin with, but logically I can’t picture how you’d pull the torn part together, without cutting the long one that was still attached.  does that make sense?

I read all of your blogs and I’m so impressed with your confidence.  I am having a very hard time with this whole thing, emotionally.  Today was by first post-op visit.  My Ortho is the absolute best, I really like him and trust him.  My scar looks amazing, no stitches to remove.  All is on track, I’m still in a splint, but I’m supposed to take it off once a day and just slightly flex my foot.  Other than that I have the splint on non-stop.  The splint is basically a solid cast everywhere except the front of my leg (shin area), and it is tightly wrapped with an ace-like bandage.  I find myself sitting here, staring at my wrapped leg and scared to take it off.  Afraid to flex my foot.  I’m SO afraid to do damage.  Am I the only one?  I read about how everyone else can’t wait to move to the next step, and don’t get me wrong, I want to recover, but each step scares the crap out of me.  I can’t even imagine how I’ll be when PT starts.  I am just so afraid of doing damage.  I’m supposed to move to a boot in two weeks with PWB.  I also start PT in two weeks.  Please tell me PT starts slow. 

I would love to hear from anyone who is either feeling the same right now, and/or felt this way at one time and is now nearly healed and can look back and realize the worry was for nothing.  Can anyone relate?  I’m sorry to be such a baby.

Also, I can’t believe how much muscle atrophied in two weeks time.  My leg was so weak when he first unwrapped it that it was shaking.  Has anyone experienced that?  I think it was so used to being in the cast that it got scared.  (um yes, I did just give my leg it’s own brain…lol…the truth it I was scared, so maybe that’s why it was shaking?)  I don’t know.  I just have SO many questions and I think people are getting sick of me talking about this.  I’m just so scared.

Thanks for listening.  I know we’re all in this same crappy boat.

Ok, so I think I’m getting this blog thing down.  I’ve run into some technical difficulties, but I think I’m now up and running.  Figuratively that is, b/c we all know that’s the only kind of up and running this gal can do these days.  I realize I didn’t post my “details” from time of injury until now, instead  my first blog post was just me moaning.  Don’t get me wrong, this one will be more of the same in terms of moaning, lol, but I’ve found it so helpful to read others journey from the point of injury forward, so I thought I’d fill in the gaps.  WARNING - this will be a LONG post.

I’m a 37 year old female and decided to really try and kick in an intense workout routine.  I’ve been consistent since January of this year, and then in March decided to add a personal trainer to the mix.  Anyway, he’s awesome, and was definitely pushing me hard.  I was doing cardio on my own, but doing strength training, core, weights, etc., with him.  So…I decided to up my cardio workouts to some intense sprints, followed by normal treadmill time and then more sprints.  That seemed to be giving me the best workout and burn.  I did that everyday for only about 20 - 30 minutes, followed by a similar amount of time on the elliptical.  Then, two days a week I would have this trainer kick my butt with the other stuff. 

Well, May 13 was “the day”.  I did my cardio in the morning, and then my trainer around 4:00.  We had probably the best workout ever, which I guage by how soaked I am.  Gross, I know, but anyway.  So, it was LITERALLY the last excercise we were going to do that day.  We had properly warmed up.  I had already cardioed that day, we had been at our stuff for nearly an hour and BAM!  He had me doing these step-ups on a raised aerobic step.  Basically I would have one leg (in this case my right) firmly planted on the step, while with the other leg I would bring it down to the floor, touch the floor with my toes, and launch off the floor with my toes into a knee raise.  Does that make sense?  We were doing three sets of 20 each leg.  Well, on my last set, I was literally on number 19, I came down on my left leg and heard the dreaded snap.  At first I thought I had hit the step or something, but nope.  Just my aging body messing with me. 

To be honest the pain wasn’t bad.  I was shocked and the first word out of my mouth to the trainer was, “do you think I’ll have to have surgery’?” Anyway, he told me he thought it was my achilles and he helped me up the stairs to my family room.  He wanted to take me straight away to the ER, but being a girl, and um being VERY sweaty at the time I just wanted him out of the house so I could a: cry and b: shower!  Stupid, right?  So, I hobbled myself up another flight of stairs, freshened up, changed clothes, etc.  In the meantime I called my husband home from work.  So, I got to the ER, waited FOREVER, with what I swear was a couple with swine flu.  I didn’t know whether to ask for an ice pack for my leg or a hazmat suit for my life.  I opted for ice so as not to cause a scene.  :-)  So, my husband and I finally got called and all the docs are busy so I’m seen by a PA who casts me up, tells me it’s not torn, but that I will most likely have to be in a cast for 6 weeks.  He also tells me to follow up with an Orthopedic Surgeon “just to be sure”.  Niiiiiice, that’s encouraging.  Glad I just waited forever for a “not sure” diagnosis and a “pretty sure” exposure to swine flu.

Well, the next day I see an ortho that immediately does the Thompson test (something that wasn’t done in the ER), and he tells me yep it’s ruptured and schedules me for surgery the following week.  That was pretty much all he told me, and after that he vanished.  His assistant appeared with orders to go get an MRI, they swapped my ER cast out for a boot, told me to stay off it, and then gave me a packet of surgery instructions.  My head was spinning!!  My worst fear was surgery, hence the reason that was my first question to my trainer.  I SO didn’t want to do it, and then after the arrogance of this guy, I certainly didn’t want his ass to be the one doing it.  His description of the surgery was so barbaric I was waiting for him to tell me he was going to have me biting on a leather strap vs. having anesthesia.  Seriously, all I heard was, 8 inch incision, grab more tendon from your calf, wrap it around “real good” blah blah, I love myself, blah blah.  Needless to say (or in my case since I over-explain everything, needful to say), I went and got another opinion from a much more experienced, much more respected, much kinder and much cuter surgeon.  And while I didn’t go in there with any false pretenses of his second opinion being one of “you crazy girl, you’re fine, in fact why don’t you jog home”, I did go there hoping he’d be the one, and he was.  And his version of surgery was much less third world.  No wrapping of tendon, no python long incision…just a simple repair.  Glorified stitches as one of my friends called it.  It was not nearing Memorial day weekend, so surgery times were pushed b/c of the holiday and I was slated for the Wed. after. 

I was so glad he was going to be my surgeon, but still had TONS of apprehension about the surgery itself.  I still weighed the consertative route all the way till the day prior to surgery.  In my heart I knew I’d do the surgery, but my brain was pissed about it. 

Day of surgery went so much better than I expected.  I went in there in tears, and came out cracking jokes.  The anesthesiologist came in when I got there and said, just so you know we do this surgery under a nerve block.  Not a general, not a spinal, but just a simple nerve block to the affected leg and some nice sedation drugs.  Oh my gosh, I was elated.  Slept comfortably through the surgery, woke up right when they were done and was talking coherently with my doctor as I was being wheeled out of the OR.  Went to the recovery room, had some juice and was on my way home 20 minutes later.  No pain, b/c my leg was still numb and would be for the next 18 hours - fantastic!  About four hours before the block was supposed to wear off I took some pain pills so I could be ahead of it.  Once the block did wear off I had some pain, but not major.  Maybe a 5/10?  That lasted maybe 30 minutes and that was it.  I took some pain pills, but was completely off of them by about 30 hours past the surgery. 

I’m now a little over a week past surgery and so far nothing too major to report.  I’ve banged my splint a few times against walls, my dog’s head, etc., and that has freaked me out.  I get little twitches in my calf, and I get some dripping feeling near what I think is the incision point.  The thing that is bothering me more is that my good leg is starting to feel strained.  Did others experience that?  I suppose it makes sense given it is bearing all my weight now, but it’s starting to freak me out.  I elevate and ice it as much as my other one.  I am so acutely aware of every sensation in my body, and I’ve never appreciated life so much.  I go to my surgeon next Tuesday morning for my first post-op visit.  Wish me luck.  And of course I wish all of you the best as well.

So, I’m new here.  A 37 year old female who ruptured her achilles two weeks ago.  Had surgery Wednesday, and have luckily not had much pain.  I didn’t have much pain with the actual rupture either and kept trying to fool myself into thinking that it really didn’t happen.  This whole thing is sureal, no?  I can NOT believe this happened.  And right before summer.  The mental pain is as hard as the physical pain.  I never do the why me thing, but I admit, I did it this time.  Why why why?? 

Anyway,  my fears before were about the surgery.  I’m a total hospital phobe.  Now the what ifs are flying around my head about the road ahead.  I mostly have fear.  I can’t imagine ever walking fearlessly again.  Do you guys feel that way?  I am going to be so afraid of this happening.  I hate it.  Sorry, I’m rambling.  I tend to do that.

One other quick question.  Did any of you get little muscle like twitches/spasms in your leg after surgery?  And any sort of sensation like you could feel liquid or blood dripping inside the cast or out of the incision? 

I’m sure I’ll be blogging a lot - hope to hear others stories.

Cheers!