Back to FWB. Great feeling :)

So, my last surgery was nothing close to ATR surgery. I am now back FWB after less than two weeks. I still struggle with lots of swelling and pressure, however, so I can’t really have the foot down too much.

Second worry: The ankle doesn’t really feel any better. At least not yet. I still have clicking and scraping inside the ankle joint, and I have quite some pain and tenderness along the malleolous. Both of them, actually. As well as over the top of my foot - I think it is something called the cruciate ligament (althuogh that is also in the knee, right???)

First PT tomorrow, looking forward to hear his assessment.

Second surgery in less than a year…

Finally, I got osme motivation to write a follow up on my surgery April 9th. The surgery - ankle artroskopy - actually went very well, and, according to my phone log with ym waiting parents, it took less than 15 minutes from me entering the operation hall to I was back from anesthesia. Quick and succesful, and the loose fragment was removed from my ankle joint.

During the de-briefing, OS claimed that the surgery was about as succesfu as anticipated, and that I should introduce PWB as tolerated. I was not put ina  cast, but a simple bandage. I was given anti-inflammatory drugs as well as painkillers, however, I could expect sudden swelling of the ankle and foot even after 4-6 weeks post-op. Important with rest, ice, compression, elevation.


1. Cartilage in the joint WAS at least as good as indicated in the MRI, so that’s thumbs up for me! I am allowed to pick up running from week 8 post-op, however, I should be prepared to limit running to 5k/week. No jumping, sudden side-to-side movements or sudden start-stop movements. I.e. no ball games.

2. Despite the fragment being rather large, and placed at the posterior-medial end of my talus bone, the surgery went well with a standard anteromedial artroskopy. No need for any osteotomy, which is really great! 2-6 weeks PWB versus 10-18 weeks NWB. (the fact that he managed to remove the fragment through a anterior-medial artroskpy is also proving these guys wrong, by the way -

3. Surgery went surprisingly well. I was off painkillers after 12 hours, and introduced PWB after 18 hours. Experiment with FWB after 7 days.


1. Ostechondritis Dissecans (OCD), unlike an ATR, doesn’t heal anywhere near 100%. Ever. How well I can possibly recover is uncertain, and there isn’t all that much I can do about it, except that keeping fit and active may improve prospects.

My new injury - what is ostechondritis dissecans?

So, I am now waiting for the final date of my new surgery. Hopefully before Easter. But what is ostechondritis dissecans, and what are the prospects?

The latter first: Not good, actually. While there are a wide range of available treatment options, none of them has delivered consistently good results over time in adults. From the few forums on this injury I have found, it seems like some 50% suffer life-long disability in the affected joint. About 0% has taken up running after surgery. The scientific litterature on the subject isn’t large, and it is generally optimistic. However also written by those who tries to specialize in treatment delivery, hence they have a strong incentive to be optimistic. Hence, I will not be subject to any of those fancy techniques, rather, the fragment, which is bout 17×7 mm in size, will simply be removed from the joint.

With two toddlers at home, I am not ready to get a new ankle joint at the age of 33. Now, my ortho doesn’t think I need that, he is quite convinced that I will be pain free for the rest of my life, just not being able to do any running or jumping based activity. Like playing football or basketball with my kids. Unless, he said, my articular cartilage proves to be intact, sound, and healthy. Something my MRI claim it is, but also something he has never seen under such circumstances. He has done something like 50 or 60 arthroscopic fragment removals, so I bet he knows what he is talking about.

Now, here is what the injury looks like (I am not managing to upload the picture… Help?):

And here is what Action Sports Physio (the best internet source I found) writes about it:

Evaluation and Treatment

Proper diagnosis will minimize the risk of long-term disability and provide the patient with more treatment options. Diagnosis begins with a proper physical examination followed by X-Rays. Your doctor may also request a bone scan or MRI to aid in the diagnosis and to pinpoint the extent of damage of the area affected.

If the patient is young and the bone is still growing a conservative treatment approach of complete rest will be suggested. All activities will have to be stopped and may require a period of non-weight bearing of several weeks. The treatment period could be as long as 12 – 18 months and will require follow-up X-Rays, bone scan or MRI to evaluate the progress and healing process.

If no progress is made or the healing is slow, surgery may eventually be required. In cases where fragments of cartilage are loose in the joint, surgery is necessary to either reattach the fragments or remove them to limit the irritation they can cause. The extent of the damage will decide the type of surgery, arthroscopic or open.

Rehabilitation and Recovery

Post-surgery rehabilitation will involve a period of non-weight bearing and require an extensive period of physical therapy to regain range of motion, strength, flexibility and coordination. The goal of rehabilitation will ensure proper and progressive weight bearing and to control pain. Ideally the goal is for patients to resume their previous lifestyle. Continued supervision and check ups with your doctor and therapist will be required to evaluate the effectiveness of the treatment an the evolution of the cartilage for degenerative arthritis.

Osteochondritis Dissecans is an uncommon but potentially a significant debilitating injury to young athletes caused by direct trauma or repetitive stress. Early diagnosis is imperative for proper healing and recovery. Surgery may be required with an extensive rehabilitation program to aid in the recovery and eventual return to physical activity.

Underlinings are my own.

10 months anniversary today - planning new surgery

Met with the podiatrist/surgeon today, in order to assess what could be done with ankle. He rapidly concluded that the primary problem was the loose fragment that was knocked off my talus bone. However, he said both the position and the size of the fragmented indicated that it could be surgically removed without the need for drilling or rebuilding cartilage.

This is good news in the sense that it means a smaller operation and much shorter rehab. He indicated one week compression (no cast!) and NWB  and then gradual return to WB with only light ankle support of a rehband, achimed, or similar generic soft ankle support brace.

But it also left me wondering: If you don’t fill the crater that is left in my talus bone, and there is damage to the cartilage in the ankle, doesn’t that means my ankle will never really heal? Unfortunately, that is the case. He said that transplanting cartilage to a chip fracture that is smaller then 2 square cm has proven to yield little benefit in the long run, and that in the short run you are in for 3 months to FWB. With drilling of the crater without transplanting cartilage, I would still be 8-10 weeks to FWB, and the benefits in the long run would be minor.

With this minimally invasive surgery, I would be off the crutches in 3-4 weeks. Which sounds much better.

But, apparently, I will need to find a new hobby. Taking up running doesn’t seem to be an option. Mainly because he doubted the MRI in the sense that the cartilage on my shinbone, which appears to be in excellent condition on the MRI, must be expected to be damaged. He wouldn’t know for sure until he opened my ankle up for the surgery, but he said in almost all cases he had operated, he found tha cartilage to be much more damaged than the MRI’s indicated. And with damaged cartilage, he gave me 10 years to destroyed ankle if I took up runing again, while cycling or XC skiing would be something I could do forever without any problems. With healthy cartilage, however, I should be able to run for at least 50 years before experiencing problems. He gave me a 10% chance. Not great.

My second problem, my peroneus brevis tendon, he claimed was an old injury. He could not understand how that could be related to the ATR, except that an already damaged and weak peroneus brevis tendon would be vulnerable to some overstretching during impact, and then to tendonitis during ATR rehab. We chose to let it be for now, and focus on the fragment in my ankle joint. In any case, I will not engage in any explosive sports with sharp side-to-side movements, like football, so I would not be in a position to challenge the weak tendon too much.

I will take the message back to my PT, and discuss further. Hopefully, I’m in at surgery before Easter.

But I will have to adjust to the idea of finding a new hobby. Not cool.

10 months since impact - bad news.

To make a long story short: From about 6 weeks post-op until today, I have been progressing pretty much steadily, however, I have been bothered with ankle pains and swelling. My PT assumed further ankle injury, and, indeed, that what it was. Because my ankle and claf would anyways be too weak to handle surgery, we figured out we would do what we could with conservative treatment until I had recovered better form the ATR. And, since conservative treatment for most ankle injuries are similar, it wans’t much to gain from taking an MRI. Furthermore, as my PT suspected that several things were wrong, it was better to wait, and reduce the options for error when interpreting and MRI. That is all history, as I have now taken and MRI, and got it interpreted. Verdict was out a few days ago, and it’s nothing to celebrate:

1. Ostecondrits dissecans of the talus. Ostechondral lesion at the medial corner of my talus bone, plenty of oedema, and a bone fragmet freely dislocated inside the joint. If sounds like some ancient language not spoken for the past couple of millennia, a good description in english is found here:

I have been receiveng appropriate conservative treatment for this condition for the past 10 months, apparently without good result. Bad news #1: One more surgery, followed by 4-6 weeks of immobilisation. Great.

2. Minor subchondrial fractures to the tibia - related to #1. Conservative treatment has been effective in the sense that the cartilage is now healed, although the bone behind the cartilage is still damaged. Hopefully, this won’t cause me much more problems, but will potentially make me susceptible to contain arthritis.

3. Peroneus brevis tendinoses and longitudinal split. Bugger. It is hard to find good information on this condition, however, from what I can undertsand, this may very well be an old injury, that I may have had on and off for as long as 15 years, but that haven’t been acute until my ATR put extreme strain on everything in my ankle/foot. I was probably lucky that it did not rupture at the same time as my ATR, and I hope that it does not require surgery, but, most likely, I am also in for surgery on this one: Bad news #2: I may need surgery on my Peroneal brevis tendon, which typically requires 3-6 weeks of immobilisation.

Bad news #3: While surgery on the peroneal brevis typically will heal in a cast or boot with the toes pointin downwards - same as after an ATR - surgery for ostechondritis is typically done from the front, requiring immobilisation with the toes pointing upwards. The opposite. Bugger. Two operations, and something like 3-4 months immobilisation. What could be worse? I surely hope my peroneal brevis does not require surgery…

I haven’t been much of a blogger on this site so far, however, with one more summer coming up, that may change. I will need all the inspiration I can get. But, if someone can fix my ankle, I can run. and if I can ever run again, I think the comrades is top of my list. Or the Lewa Safaricom . Stay tuned.

July 1st, 2013

From the PT on Friday (June 28th) :

As of firday 28th, the ROM walker was set at 100 degrees, which felt quite strange , and the result, I was back on NWB instead of ‘ rolling ‘ PWB. I was however back ‘rolling’ and PWB already the next day. Other words from my PT: Exercise more, elevate your foot more, do a lot less of everything else. Start manual therapy on the forefoot and big toe joint at ASAP. Good progression of ROM in the ankle, especially considering the starting point. Left thigh is in good condition, despite some atrophy . Soleus is in good condition, while the gastroc is in very poor shape . The wound has healed very nicely, and I am cleared to do exercises in the pool from day 42 after surgery.

Sunday 30th: Went fishing with my brother in law :) Yes, we walked/rolled through the beautiful Norwegian nature. I used a plastic bag to wrap around my ROM walker, and went happily on crutches. It was quite amazing, actually. We didn’t get any fish, we lost a few lures, but it was the best fishing trip in my life! And I managed to get myself a few kilometers off the road, although with frequent stops, resting with an elevated leg. Bring a mat so you can lay down, and a backpack to put under the leg in roder to elevate it!

I also figured out that cutting and splitting wood by hand is a hell of a workout - if you can just find that comfortable working position first…

All in all: Recovery is going well :)

June 21st 2013

Dear All

[Original post found here, in Norwegian. Edited and translated through google.translate.]

When it comes to exercise, I have good experience with rowing machine . I attach the uninjured leg as normal, and then I put the injured leg on the foot board and make it as comfortable as possible. And active as possible. It works best with the walker, but the main problem with the cast was that I still had a lot of pain, and would prefer to see the foot more elevated the chest.  You may find yourself comfortable if you do not have so much pain in your injured leg.

I also tried the arm cycle. Y ou can adjust your postition so you are lying down more than sitting, b ut then again it is incredibly boring. I rather watch paint dry.

I also ran interval in stairs with crutches . It works fine, as you lift straight up, which doesn’t create so much strain on your shoulders . And it’s exhausting too -  a really good exercise! I believe you can go uphill as well, but then you have the challenge with the shoulders again. Hard to find a hill that is steep enough to prevent the center of gravity to swing too far forward, which create the strain in your shoulders that gives you tendinitis.

I have also started with gentle exercise without the walker. Without any resistance, but I’m drawing circles with my big toe, wiggle my toes, and so on. Use pain as a guide. In addition, I try to stretch the tendon by pulling my toes upwards as hard as I can. T his is hard, as my muscles on the front of my leg are almost completely dead. It will be more of a stretch as these muscles grow stronger, I hope strength will increase at about the same pace as the felxibility in my AT.

I also has a really weird, puzzling, experience during strength training today: Why do I need to add extra weights for each set, when I run each set to exhaustion ( leg extension, ie machine for quadriceps )? It is almost as if the strength is actually there, but my body has forgotten how to mobilize it. For each set, it is as if it remembers a little more, so despite the burning of lactate in my muscles, I perform better the more sets I take. Puzzling - any ideas for the reason of this?

My first visit to the pool will be on July 4th . Can’t wait! And I can now ‘walk’ pretty far PWB. Did some 500m the other day, and it now feels much better. No more feeling of stretching the tendon, no more blisters on the inside of my skin :)

With maximum luck, I’ll get rid of the walker on July 19th. It is the earliest possible date. Probably I need to have it in two , maybe four , weeks after that, but it depends on how short my tendon is - and I am told not to stretch it much, except for walking a lot with the walker. Great… Anyway, I hope to have it off until Monday 5th August. When the plan is to push a pram to kindergarten , about 2 km, keep an eye on the kid for an hour , and then roll back home. I hope it goes without too much aspirin . Time will tell , but I stay active so I can now to prevent problems then.
Happy Healing

19th June 2013

Day 27 after rupture , day 22 after surgery : All quiet on the left foot.

[translated through google.translate (not optimal) and slightly edited, original here: - Norwegian only]

Well, now there is finally something new going on, and thus I have something to report.

It happened pretty much nothing the past weeks, however for the record:

1 There was no infection, but the bandage that held the cast (I had a short leg cast - kind of a ‘half -cast’ that was kept into place by a bandage - is this what you call a splint cast?) was too tight, and they had packed too much stuff around the incision . Thus it felt like infection. Everything was better when the bandage put on less tight. And in a herringbone pattern.

2 Do not think your are the world champion on forearm crutches. You get tendinitis in both shoulders , and then you will be completely immobilized . I have avoided this problem so far, but barely . The problem is due to taking too long steps with crutches, which give you excessive stretching of tendons in the shoulder when the body bends forward and the center of gravity is ahead of the crutches. Be careful, and exercise your upper body properly before going on long walks with crutches! (this issue is not a problem as soon as you are PWB and ‘ roll ‘ from the heel and over the toes. This goes slowly, is somewhat more painful for the leg, but you do not get as big strain on the shoulders , and you are therefore much more mobile. Could probably walk a mile or two , if I ever had the time it would take…).

3 It is important to wiggle your toes all the time. The body ‘ forgets ‘ how to do this after a few weeks without movement , and it is frustrating to learn that again.

Last Friday ( Friday, 14 June , 18 days after surgery ) was the last day with a cast and I finally got the ROM walker. And the first round of physical therapy. My tendon is way too short. Of course, some shortening is usual at this stage, but mine is waaaay short. It was with quite some difficulty - and pain - that my foot went into the walker when it was set to 110 degrees angle in my ankle. The PT considered 120 degrees, but concluded that 110 was fine. My tendon would not re-rupture at 110 degrees anyway. I will now gradually start weightbearing, by ‘rolling’ from my heel over to my forefoot. PT t old me to walk/roll about 5 min every hour, and add enough weight on the foot for the heel to make ​​contact with the bottom of the walker. This is painful - feels like it’e tearing in my tendon and calf, and I get the feeling of having blisters on the inside of my skin. but if it help recovery: To h**l with pain! Have had significant progress on the issue so far - I can already take the walker on and off without any problem with the angle.

The PT emphasized that as long as I had the walker on, I could do pretty much anythong, but whenever I took the walker off, it should be absolute rest , and it should be kept higher than my chest. Generally, the foot should only be below your heart during exercise , otherwise it shall be above the heart. It is a challenge to find a good posture like this, especially in the office - but hey, it’s easier in an office than, say, for a carpenter. So I’ll manage that :) Had I been artisan I would have gotten a 100 % sick leave. I am now 50 % off sick until 19 July (I have so much vacation days , time off days and paternity leave left that I take out holidays during my leave period anyways. Going home like that drives me nuts, and I love my job too much to stay at home. Especially in this condition.

PT also told me try rowing machine. As with the cast (I cheated by starting rowing machine early…) the wlaker can not be attached to the footboard , but I can push with it, so it’s some exercise for thigh, as well as early weightbearing. And : Be prepared, the rowing machine will give your buttocks on the good leg a heavy exercise. Muscle soreness can be expected. But rowing machine is nevertheless very much more enjoyable than arm cycle - which was so boring I stopped doing it…

First week of training, from day 12 to day 18 after surgery , I tried arm cycle to keep me in some shape. It is so incredibly boring that it was with difficulty that I managed to complete 10 minutes on it. Interval training was slightly better , but I never bothered to complete a set of 10×1 minute. It’s a good workout for your upper body, but 3×1 minute is enough, or you will die from boredom… Rowing machine is way better.

I have also been allowed to start with light strength training of the thigh on the injured leg. Leg Curl and Leg Extension . Muscle atrophy has been extreme in three weeks, and 25 repetitions at 15 kg is more than enough for both exercises. For comparison: With the healthy leg I easily do leg extensions with 60 kg and 12 repetitions. ( Which indicates that it’s stronger than it was before injury. That being said, my upper body strength exercises are up some 50% since injury, due to walking on crutches, wheelchair, armcycle, and so on).

My mood is now much better , and I see a little light in the tunnel. Looking forward to spinning and pool training. Hopefully I can start spinning next Friday (day 32 after surgery ) , and I’ll be in the pool on July 4 , ie, 38 days after surgery.

I’m looking forward to uphill running, but it will be in the spring, I think.
Happy Healing

31st May 2013

Achilles Rupture - day 9

[Taken directly from my facebook page]

31 May 2013 at 21:12

OK, so it’s friday evening. Ideally, I should have been in Oslo on the Round Table Norway AGM, however, more practically, I should have been in my office finishing our four-year-report to NORAD . Nevertheless, I am on currently my couch, holding my foot high. Not cool.

But, there are some good things to report. Horray!

1. My parents passed by this afternoon, and my mother re-wrapped my cast [my mother is a PT specialised in working with disabled people and people with Downs syndrome]. It is no longer too tight, and the whole thing is a lot less painful! I can now feel the stitches - which are painful to some degree - but the rest of the foot is much better, and the immense pain over the front of my ankle is gone. Keeping the foot downwards is better, but my toes still go purple after some minutes.

2. My parents also brought a pair of dumbbells, so I can start to do some simple exercises for my upper body. Light exercise feels fantastic after a week of almost complete immobilization. I can also do various sit-ups, and push-ups on my knees. Nothing heavy, but at least it lets me sweat a bit. Great!

3. While personal hygiene has been a bit challenging so far, we have decided to try to figure out how to best use the shower cabinet tonight, and a friend of mine have promised to let me borrow their tub tomorrow. Wonderful, I truly look forward to that. (Not to mention to June 14th, when I will get a ROM walker that I can actually take off while showering.)

Monday I will investigate the possibilities for getting hold of a wheelchair for outdoor use. Mainly for keeping myself somewhat mobile if the sun decides to come out, but also for the opportunity for exercising. Not exactly running, but hopefully, the wheelchair may help me keep somey fitness before I can start with spinning again.

Happy Healing

May 29th 2013 - second post

Achilles rupture - day 7.

29 May 2013 at 17:46

D-Day: May 22nd.

[This is copy-pasted unedited from my facebook page]

May, 29th. Day 7:

Had operation on Monday, and all thumbs are up so far :) I had traditional open surgery.

Nevertheless, I have increasing pain in the operation wound, and will be back to the ER tonight for a check up. Just in case of infection. It’s probably nothing, but I rather be sure not to have any complications.

I will wear the cast until June 14th, which means 18 days with the cast. After which I will be given a walker boot [i.e. a generic ROM walker], and extensive physiotherapy. I look forward to that! I am scheduled to wear the walker for some 5 to 6 weeks, depending on progress. So the walker will be off between the 19th and the 26th of July, pretty much on time for my first walk with Viktor, which I have scheduled for August 1st.

Furthermore: As I was discussing with the surgeon, he stated that hey had actually stopped with so called conservative treatment, because that required much more intensive follow up afterwards - which is expensive - and because that required much longer sick leave - which is also expensive. Good to know, I guess :)

Unless something significant happens, I’l be back with further updates in a couple of days.


In order to motivate my recovery, I have the following goals:

August 1st: Take a walk, with Viktor, in the stroller. To the store and back.

Early November: Walk/run 5k at the Lilongwe Half-Marathon. In 35 minutes.

Winter: Possibly some skiing competitions, if my leg allow.

April 2014: Run 10k at Rotterdam Marathon. In 60 minutes.

June 2014: Complete the team-run, 21k, at Lewa Safaricom Marathon. I repeat: Complete, no time estimate.