Into the boot

Well - last Friday was the big day!

I finally got out of that (insert adjective here) cast and was transferred into the boot.

While the cast was quite light compared to the cast, the psychological aspect of not being able to get out of it was starting to wear on me. Because of scheduling issues, I was actually in the cast two days longer than the three weeks the doctor suggested. Those last two days really dragged on!

This was also the appointment that my sutures were removed - this time by the Medical Assistant instead of the Orthopedic Tech. I have to say the MA was quite a bit more gentle - despite the fact that there were considerably more stitches to remove, I was quite a bit more comfortable than the first time.

The surgeon didn’t spend much time with me at all - she looked at the sutures, said my wound was healing well, and basically told me that she’d like me on a four week schedule to come back (for a total of 8 weeks post-surgery - so pretty much the same pace as it would have been without the extra two weeks in a cast). She suggested that I start at 20 degrees of wedges as I did last time.

I did express my concern that my calf/tendon felt very tight last time and I was concerned about being able to make it to that angle, especially given the fairly plantar-flexed position I had been in for the last four weeks. She told me that it would be ok to start at 30 degrees, but to work on getting to 20 degrees at home.

When the orthopedic tech came, I pretty much took charge. I explained my prior experience to him, and he was willing to let me do all the work. He did provide an extra wedge for me (since we had left our extras at home).

When I first tried to get into the boot at 20 degrees I felt a very familiar feeling - quite extreme tightness in my lower calf and tendon down to my heel. This time I fortunately knew better than to try to push things. I decided to start at 30 degrees, which was a comfortable angle for me.

When I got home, I experimented with taking the extra wedge out again. I found that if I inserted a folded sock under my heel (about half the width of the wedge I would feel a stretch but still not be to the point of pain - so that was my compromise for the rest of the day.

Contrary to doctor’s orders (actually choosing to follow my doctor’s original answer rather than her most recent advice) I chose to sleep in a half-splint that I had from my pre-surgery appointment. I found that to be quite secure-feeling - i.e., I don’t think I’m likely to put any strain on the tendon, and size-wise it’s much more pleasant than the boot in bed.

This was also the day of my first complete shower since the second surgery - it felt great to get some of the dead skin off my leg (I didn’t get it all in the first try, though).

The following day, I went into the boot without any additional “shims”. I couldn’t quite get my heel down in the morning, but during the day, it got closer and closer. By evening it was making light contact with the wedge.

By Sunday morning I was fully in the boot at the 20 degree angle. I’ve started going through walking motions while I’m crutching around the house - not really applying weight but just letting the boot lightly rest on the ground as I move around. I’m hoping that this movement will increase the blood flow in my leg a little bit to keep the swelling in my ankle and foot down (This is the interesting thing, by the way - I’d say the swelling is about as bad as it has been - even worse than it was after the first surgey and the rerupture - I’m guessing it may be because I’m not elevating as much anymore).

One thing that’s really obvious now that I can see my leg is how much it has atrophied.

Here are my upper legs at the appointment on Friday:

And my lower legs - can you tell which one is the “bad” one?

And for the surgical junkies a picture of my healing incision prior to removal of the sutures:

The plan is to remove the next wedge on Wednesday.

Update - waiting…

The good news is that my allergy symptoms started settling down shortly after my previous post.

By mid-week, my ear looked like an ear again, and the rashes on the rest of my body had just about disappeared.

At this point I’m effectively just waiting for my follow up on March 29th. That’s when I will get placed in a boot and I assume I’ll find out more about the pace of my rehab. (I’ll also have my sutures removed in that appointment - it’ll be interesting to see whether having them in so much longer will make the process more painful).

I’m definitely not a big fan of the cast: It creates pressure points on my ankle bones when I’m sleeping which tenses me up - I wake up with a sore and stiff leg several times each night.

I think I jinxed myself a bit with my comment in the last post about the area under the cast not itching - I’ve had a few pretty frustrating episodes, but fortunately nothing as bad as the allergy symptoms.

11 days to go and counting!

Second opinion; Into a cast; Itchy all over

This’ll be  recap of developments from the last week.

On Tuesday, I had an appointment with a podiatrist from the medical group I’ve been using from my primary care. I was trying to get an appointment before my surgery, but this was the earliest they had. I figured it would still be worthwhile to get a second perspective on the reinjury and the recovery process.

I actually quite liked his approach: Pretty much all of the doctors I’ve had appointments have left me feeling like they’re willing to answer my questions, but are in rush to get to the next patient. He seemed less like that than the other doctors I’ve had recent experience with.

In any case, he didn’t really come up with anything significantly different from what I’d already read elsewhere, but he did mention a couple of things of note:

- In his experience, it’s not unusual for a rerupture to happen higher on the Achilles

- The location of my rerupture is actually where they would normally do an Achilles lengthening procedure - so it’s not a bad place to work on.

- For recovery he mentioned that there is some evidence that being in a cast (vs. going directly into a boot) improves outcome

- He mentioned that he lets his patient ride a stationary bike with a cast (heel on the pedal)

In general, he gave me some things to think about, but I didn’t hear anything to make me think that my current path is incorrect.

The good thing about this appointment is that he wanted to take a look at my leg, so he cut me out of my torture device of a splint; It felt great to be able to hold my ankle in a somewhat normal position again!

Unfortunately the pictures of my splint didn’t turn out that well, but here’s a picture my wife took when I was out of the splint - Even though I was more relaxed, you can see my foot is still stuck at an angle from being contorted for close to a week.

Here’s a shot of the new incision from the same appointment:

In any case, that was pretty much it for the second opinion. I left feeling reassured, but not necessarily much more enlightened.

Wednesday was the day of my appointment to get my splint looked at and adjusted.

I called half an hour before my appointment to see if the doctor was running late, and much to my chagrin found out that I had no appointment! Apparently somehow the appointment had never been recorded despite the fact that the PA confirmed the time with me.

I was nearly panicking - the idea of more days in that splint was sending cold chills down my spine!

In any case, cooler heads (my wife) prevailed, and we decided to go down to the outpatient center anyway.

As it turns out they were very accommodating. They said that they’d find a way to fit me in, and as it turns out, it was my shortest wait to date!

The doctor saw me and said that this time they’d like to put me in a cast (agreeing with the other opinion), and would like me to stay in it until four weeks after the surgery. Coincidentally, that means my next followup was to be scheduled at the same time that was supposed to be my 8 week follow up from my first surgery, so I didn’t even need to make a new appointment.

In any case, I get to be in this thing for the next 3 weeks:

(My follow-up is on March 29th).

The cast is still at a very plantar-flexed angle, but it’s putting no strain on my foot/ankle anymore, so I’m much happier.

Unfortunately, it seems like the fates are conspiring to make sure that I don’t get too comfortable, because the most recent new development (it actually started shortly after the last surgery) is rashes that have broken out all over my body. Basically the spots I’ve found are: Both ears, both forearms, my lower belly, both knees. My right ear was particularly bad - it swelled up to look like grotesque caricature (no pics, sorry).

I had already read up a bit about this, and it seemed to me like I had some kind of systemic allergic reaction. I contacted the doctor’s office and they agreed with me. I told them I was taking anti-histamines and applying corticosteroid ointment when necessary. I agreed to let them know on Monday if things hadn’t gotten any better.

As it turns out, it does seem to be getting better (slowly), but based on the rate of improvement, I’m going to be fighting the urge to scratch for a while yet. The one thing I’m thankful for is that the leg under the cast hasn’t been that itchy (yet?).

I’m really looking forward to getting a comfortable night’s sleep; Hopefully things will continue on their current trajectory.

Two bad nights - Over the post-surgery hump?

I’ve had two pretty bad nights in a row.

My splint is in a pretty extreme plantar-flexed position (I think the surgeon wanted to make really sure there wasn’t any strain on the tendon these first two weeks), and as you can see my foot is also pointed off to the left.

Since they put my splint on after surgery, they couldn’t ask me if I’m comfortable or not - and I’m anything but!

I already was feeling the stretch in my ankle and the top of my foot while I was on the full dosage of pain meds, and Friday night things came to a head… I started feeling a sharp pain on the right hand side of the top of my foot - imagine if someone grabbed the front of your right foot and started pushing it down and to the left - basically the portion of the foot which gets stretched when that happens was starting to feel really painful.

I ended up having to stack up my pain meds to be able to get to sleep - but for a while I was just barely staving off an anxiety attack, because the pain was nearly unbearable and I knew that there was nothing I could do about it short of removing the splint.

Fortunately, the oxycodone has a tendency to make me sleep, and when the last pill I took kicked in, I managed to drop off into a not-quite-restful sleep.

When I woke up four or five hours later, the pain had dropped off to a manageable level - I felt a little bit of numbness in my toes and the area on the foot that was sore - but other than that, I felt no more than a dull ache.

During the following day, I discovered that by changing my position I could sometimes relieve the pain a bit (although nothing seems to completely eliminate it). Every now and then, the pain still flares up. I’m planning to contact my doctor’s office on Monday (tomorrow) to see if they can do something about it.

In the “good news” department - the pain from my surgery was diminishing significantly. I would still occasionally have some pain around the incision area, but it was to the point that I decided to  try to see how long I could last without pain meds.

This may have turned out to be a mistake. By the evening I started developing a migraine-like headache. I ended up taking an oxycodone around 9:15 pm and going to bed. I dozed off and woke up again around 11pm with what must have been close to the worst headache I ever had. I also felt quite nauseous (I get migraines from time to time, and it was similar to that, except worse). I ended up taking another oxycodone, and after struggling for half an hour to keep it down, managed to drop off to sleep.

Everything I’ve read about oxycodone indicates that it takes longer exposure and high doses to develop a dependency, but I’m wondering if my relatively sudden abstinence after taking the biggest dose the previous night (due to the pain in the foot) may have triggered a migraine-like episode.

In any case, I’ve decided to try to wean myself a little more slowly over the day today - I took a 5mg pill in the morning at 8:30, and plan to take two more half doses at four hour intervals and see how I feel.

If I’m ok, I’ll try stopping entirely again.

So far, I’m considerably less comfortable than I was after the previous surgery - I hope I’m getting all of the discomfort out of the way early in the process!

Second Surgery - This seems familiar…

I’m one day post-op from my second surgery now. I have this definite feeling of “deja vu.”

Leading up to the surgery, I had asked my surgeon a few questions about the new rupture:
1. I was wondering there are any theories as to what might have caused the new tear. Do I have a personal predisposition for these injuries? Was it some issue when being placed in the boot? Was there some complication of the original surgery? I know there can’t be a definitive answer to this question, but I was hoping to hear if there are any possible explanations.
2. What are the plans for the new surgery? Are there specific techniques/approaches that are being considered? The new tear appears to be higher than the previous one, and also appears to be incomplete. Does that influence the surgery?
3. I’m not leaning away from surgery, but for completeness’ sake are there other treatment options than surgery? If so, what makes them inferior to surgery?
4. How does the fact that I just had a repair influence this surgery? Any additional risks of complications? Any risks for the outcome for the tendon?

I asked these questions via the hospital’s secure email system, and to her credit, my Doctor called me back the following day with some answers. Unfortunately, as probably is to be expected, the answers didn’t clear things up as much as I’d hoped.
For question #1, she basically didn’t have many theories - she said that she’d be able to see more when she did the surgery - the MRI gave some idea as to what was going on, but there was a lot of scarring from the first surgery (normal), so it was hard to see exactly what was going on.
For #2, she said she’d basically use the same technique as for the first - rejoining the tendon. I asked her if there was a specific technique that she used, and she said she used a Krackow stitch (which I later Googled - it appears to be used in a large percentage of Achilles repairs). She mentioned that they used the strongest sutures available (I think they’re actually steel), so she was particularly surprised that there would be issues.
3. She said that given the gap in the tendon she’d definitely recommend surgery. Doing a non-surgical path would be an option, but she felt the surgery had a better outcome.
4. She mentioned that there aren’t too many additional risks - maybe a slightly higher risk of DVT because I had been less mobile leading up to the surgery.

So basically, I was left without a much clearer idea of why this second rupture happened.

I went through surgery yesterday; I was scheduled for a 9:30 slot, so I had to show up at 7:30.

The process was pretty much identical to before - I had the nerve block put in in the pre-op area, and then was wheeled in for surgery.

I had more of a reaction to the anesthesia or the pain meds this time, however, and woke up more groggy and a little queasy.

When I got home, I had to take a nap. I started feeling better by late afternoon.

Unlike last time, the nerve block from surgery started wearing off around 7 pm, so I had to start on pain meds. Fortunately I have plenty left from my previous surgery.

I didn’t talk to the surgeon much about the surgery itself, but she did call me to let me know that the tear seemed to be in the same area as the previous repair. She had given my wife a little more detail while I was still waking up; Apparently she had said that she stitched up the new tear and also reinforced the old repair or something like that. I expect I’ll get a more detailed description later.

I’m also going to get a copy of my medical records - the P.A. told me that the doctor’s notes from surgery would be in there, too (and I want to know what they did differently with the anesthesia, so I can file the information away for future reference).

In any case - it’s a big relief to be back on the road to recovery.

I’m in quite a bit of discomfort still (and have some additional discomfort from the somewhat extreme position of my splint - it feels like it’s twisting my ankle into an unnatural position), but I know that by the weekend, the worst of the initial pain should be over.

Here are some pics from before the operation - you can see how nicely my wound was healing, only to be cut open again (and this time the incision will be a little longer):

You can also see the way my calf is wasting away :(

They gave me a nerve block pump again, which was pretty much a waste of time, I think. I didn’t feel much help from it, and the thing makes sleeping pretty complicated and uncomfortable.

I figured I’d show a little of how it works… Here’s what they tape to your leg:

Here’s the whole thing with the balloon filled with anesthetic and the regulator. The catheter which drips the anesthetic around the sciatic nerve is right above my knee…

Removing the tape was the hardest (and most painful) part - here I am starting to pull the catheter out…

The catheter actually slides out really easily - here it is completely removed:

That’s pretty much the update for now - Now it’s about pain management and the long road to recovery. Hopefully this second start will be a little smoother…

Picture of my cast

Here’s what my cast looked like right after it was opened up…

You can see all the absorbent material they stuffed it with (unnecessary in my case), and the slack angle of my foot (it’s still pretty much the same angle as I had while the cast was intact)

Since I’m going to be going through the process again, I’ll try to take more pictures…

Week 3 - A follow-up appointment - Bad news

On the weekend, my experience at the boot fitting was still bothering me - it just didn’t seem like everything was right.

I decided to research how much pain people experience when their angle was adjusted, and whether anyone felt any “tearing” sensation.

I did find one reference to adherence of the tendon to the skin via scar tissue - but that was a report from much later in the process.

Also, there didn’t seem to be many reports of significant pain when getting put into the boot.

I started getting worried enough, that I decided to call the on-call doctor (Unfortunately it was President’s day weekend by now, and there was no way to contact my regular doctor).

After hearing my description, the on-call resident predictably asked “So what’s changed since Wednesday?” and I had to say nothing, other than I started getting worried.

He basically told me there wasn’t much he could do for me, and that the best path was to contact my doctor’s office next week to see if they could see me. He did confirm that what I described didn’t seem normal, and that he would be concerned.

As an aside: One of the things that’s been the hardest for me to take about this experience is the long periods of uncertainty - I like knowing what’s going on, and can usually cope well if I have an idea what to expect. The uncertainty is just stressful to me, and it seems there’s been many periods where I had an idea that something was wrong, but no way to get confirmation (like after my initial misdiagnosis, for example).

In any case, I settled in to wait - my doctor’s office scheduled an appointment for me a week after my previous appointment, on Wednesday.

Of course, as the things go, the doctor was running an hour and a half late that day.

After a long wait I was led into an exam room.

The first person to see me was a resident (he didn’t introduce himself that way, but I figured he was likely to be one, and later confirmed this via some cyber-stalking).

I described the whole experience to him, and he listened carefully.

He then asked me to lie on my stomach on the exam table and to bend both legs at the knees.

He squeezed both my calves and then palpated (probed) my bad leg extensively around the tendon.

He left without comment and said the Doctor would be in to see me in a minute.

Shortly after this, he and my main Doctor returned and she repeated the process.

They briefly discussed whether they could do an ultrasound on the spot (It was 4:45 pm, by now), but ended up deciding to schedule an MRI. They told me I’d probably have to wait until the next day, because it was too late to get in on the same day. The doctor said she’d call me when she had a chance to view the results.

I asked how much pain people normally experience getting put in the boot - and she said emphatically, “None.”

I ended up getting scheduled for a mid-day MRI the next day. This was my first MRI, and it was quite an interesting experience. I highly recommend bringing your own earplugs - I brought mine but stupidly didn’t put them in before the procedure. They did provide a sound-reducing headset, but I would have liked some additional sound deadening. The hardest part of the process was trying to stay still during the scans. The longest scan was around 8 minutes, but most were between 4-6 minutes for a total of around 45-50 minutes of scanning.

I asked for a copy of the MRI on the way out, and they were able to give me a CD within 5 minutes.

I took the CD home, and as a pleasant surprise, saw that the images came with some viewing software that I could run.

Here’s what I saw (this is a slice toward the back of my leg, viewed from the front of the leg - the red circle is on the right side of my Achilles area):

After another 24 hours of impatient waiting, my Doctor called me.

The irony of her first words didn’t strike me until after the call: “Are you sitting down?”

She told me that it was a rerupture - she said she couldn’t understand how/why this would happen. They had used the strongest sutures you could use, and nothing like this had happened before. She had a few reruptures, but they were caused by accidents (one individual tripped over a toy once out of the boot, and caught himself with his bad leg).

I told her I’d seen the MRI and it looked to me that the tear was actually slightly above the repair. She mentioned that there’s often a lot of scar tissue post-surgery and that it can be hard to figure out exactly what’s where.

In any case, she said they’d prioritize me for surgery next Thursday (this was yesterday afternoon as I’m writing this, so the surgery will be on 2/28) and that her surgical assistant would call to arrange the details. After that we said our quick good-byes and hung up the phone.

Two minutes later, she called back. She said she had taken another look at the MRI and that I was right - the tear does appear to be above the site of the original surgery and she *really* couldn’t explain what had happened. She said they’d be able to tell more when they opened me up, but this was very unusual. I asked if she would still recommend surgery, and she said yes, with the size of the gap that she saw.

In any case, I’m finally caught up with my blog - the rest will be posted near real-time.

It’s a bit of a bummer - I’ve now lost four weeks and bought myself a possibly more complicated recovery. I don’t regret choosing surgery as my path, and would almost certainly do so again, but there’s no doubt that this incident would probably not have happened had I opted for non-surgical treatment.

It’s also a start reminder that regardless what the statistics are, ultimately as an individual your chances for a complication are either 100% or 0% - so be it.

Weeks 2-3 First follow up; Sutures out, into boot; A scare

13 days after my surgery, I had my first follow-up appointment.

I was ushered into the exam room, where an Orthopedic Technician wheeled in what looked like a large vacuum cleaner with a special saw-blade attachment. This contraption was to be used to remove my cast.

The technician showed that while the saw looked scary, it actually operates by vibration, not by “tearing” into the cast like a traditional sawblade - He pressed it against his wrist and showed that it didn’t cut him.

Removal of the cast was pretty straightforward - the technician cut the front of the cast from shin to instep and then split it apart using a special tool. The only slightly uncomfortable part was when the saw made contact with my ankle bone briefly - The strong vibrations were pretty startling and made me flinch (no pain, though).

It felt great to let my skin “breathe” again.

Here’s what my leg looked like fresh out of the cast:

Once out of the cast, the technician left and a few minutes the doctor showed up to check me over. She didn’t take much time at all to ascertain that everything looked ok, and she basically told me that the technician would be back to remove the sutures and get me into my boot, and the next time she would see me would be in six weeks (eight weeks post-surgery). Oh - she did also explain that I’d start out with two wedges in the boot and would be having one wedge removed every two weeks.

The technician came back in and started by removing my sutures. I asked if I should lie on my stomach for this, and he said that would be great. I tried to stretch my out flat on the exam bench, but when it was straight, I felt a lot of tightness in my calf and Achilles, so I asked if I could hold it up a little. He said that would be fine.

Removing the stitches was a little uncomfortable, but not too awful - I’d liken the pain to the time my wife convinced me to get my eyebrows tweezed - mostly inconsequential, every now and then a sharp “tweak” that would be enough to make me wince. Soon enough, the technician asked me if I wanted to take a break, and I said “No - let’s just get over with”. He replied, “Actually that’s ok - I was just kidding - we’re done.” Whew!

The next step was to get me in the boot.

He handed me the boot, and I set it down next to the exam table and started gingerly putting my leg in place.

I immediately felt a lot of tightness and moderate pain - again in my calf and tendon area.

He started adjusting the front strap and putting it in place to strap me in. I told him that my Achilles felt really tight, and if that was normal - He said yes.

At this point, he mentioned that my foot was almost touching, and started tightening the first of two straps over my instep - I tried to relax and let my heel touch, with the pain getting stronger.

Suddenly, I felt a “pop-pop-pop-pop-pop” feeling in my Achilles area - sort of like tearing apart two pieces of cloth that were coarsely stitched together, with the pops happening as each stitch broke. At the same time I felt a really intense pain, and felt like my lower calf spasmed a bit.

I gasped that I needed to stop (I’m pretty suggestible, and tend to get faint when I think of these kinds of injuries) and lay down on the exam table, drenched in sweat.

I spent a few minutes breathing deeply and letting the pain subside. I told the technician I felt a tearing sensation, but he just kind of shrugged it off.

He said that he would put another wedge back in the boot, but I should remove it within a day or two at most, because it would slow down my healing process if I didn’t have it.

The pain by now was fairly manageable, so I tried to get back in the boot - and this time, with the extra wedge, there was no real feeling of tightness, just a little residual pain from the previous attempt.

The technician asked me what the doctor had said about the wedges, and I told him about the wedge every two weeks. He said I had a choice of coming back to have him remove the wedge, or I could just remove the wedge myself. The process seemed pretty simply, so I told him I’d just do it myself.

With a reminder to take the extra wedge out as soon as possible, the technician showed me out of the exam room.

When I got home, I noticed that I had some pressure points from the boot around my ankle, and it just generally felt uncomfortable.

When I took a closer look, I saw that there was a heel strap that was attached with velcro, but attached way too low to catch my heel - it basically was strapped behind the wedges. The ankle bolsters on the strap were also too low, which let the metal supports dig into my ankle.

The lowest strap on the leg of the boot was also place so low that it was applying pressure to a tender area around my Achilles, so I decided to see if there was a way to get everything adjusted a little better. Fortunately, with Google and the Internet I was able to find some instructions for the boot.

As it turns out the boot was slightly out of alignment in a way that sharpened the angle of my foot. Also, with the lack of the heel strap, it would let me foot sit farther back in the boot, which if my knee position didn’t change would make the effective angle even sharper. I hypothesized that this may have been why things felt so tight.

I repositioned the straps, and the leg of the boot to be more in line with the instructions, and also raised the heel strap so it would catch my heel. I decided to remove the extra wedge, and lo and behold, I had no problem at all getting my foot flat into the boot.

I figured that the orthopedic technician who initially fitted me in the boot pre-surgery probably just did a quick job of setting things up, since I was only going to be in the boot for a day at that point. The orthopedic technician  who put me back in the boot basically didn’t adjust much other than removing two of the four wedges that were in the boot. As a result, I probably ended up with a poorly adjusted boot.

In any case, the pain disappeared during the day and I figured it was just a “scare.”

Weeks 1 and 2 - Living with the cast

I’ll start numbering my posts with the weeks post-surgery.

The next couple of weeks post-surgery I was in a fixed cast, with strict instructions not to touch the cast down under any circumstances - not even to lightly balance myself.

Further instructions were to keep the leg elevated “23 hours a day” for the first 5 days, and then “as much as possible” until the first checkup. My first checkup was scheduled for 2 weeks post-surgery.

As far as hygiene was concerned they recommended sponge-baths, or showers, but only if the cast was completely sealed with a plastic bag, and held outside the shower.

I ended up buying a shower bench similar to this one: to help in the shower. We have a detachable shower head, so I managed to figure out a way for me to sit in the tub, with one foot hanging out while still managing to shower the rest of my body pretty well.

Other adjustments were keeping a chair next to the toilet so I could elevate my leg while “taking care of business.”, and using a rolling office chair to move around the kitchen while preparing my coffee, etc., while propping up my foot on a bar stool at every opportunity.

I’m fortunate to have a job that lets me work from home (I’m a computer programmer), so I set myself up with a laptop in a recliner and spent most of my days happily reclined :)

For the first week or so, I would get fairly severe discomfort/pain in my ankle/foot if I stayed upright for more than 20 seconds or so. I’d brush my teeth while lying on the floor with my foot raised, and just generally avoid being on my “feet” (well, one foot and two crutches) as much as possible. I’d describe the sensation as an initial swelling feeling as the blood filled the area, followed by a feeling of pressure and pain. I believe the foot and leg was actually swelling, because I’d also start feeling various pressure points inside the cast (note that the cast was not solid - it had a slit down the back, presumably to allow for some swelling and to keep pressure off the incision - It also was open over my instep and the top of my shin - the only solid part was a sort of “stirrup” around my upper foot)

After the first week, the discomfort lessened a little - I could keep the foot down while in a seated position indefinitely - and when standing, it would get uncomfortable, but I could easily last a couple of minutes before wanting to elevate again.

The second week I was getting pretty tired of the cast - it was starting to get a little grungy, and I was starting to feel itchy - I was looking forward to my two-week appointment when I hoped to be transitioned to my boot.

As a catch-up, here are some pictures…

This is my Achilles on Day 3 in the podiatrist’s office:

Here’s a view that shows the comparison of the good leg with the bed.

Notice the shape of the calf and also the position of the foot (I was trying to be relaxed on both sides):

Day 6-8 Pain management

I had a great night’s sleep after the surgery.

The only pain I felt was from the area of the catheter for the nerve block and pump. I still had the pump shut off, since my leg was giving me no pain whatsoever, but the pain from the catheter eventually became so severe that I decided to turn it back on. After only a minute or two, everything was fine and I went back to sleep.

The next morning, my foot was still quite numb, and I was pretty comfortable.

The surgeon’s team called to check in at around 10am and asked what my pain level was. I was happy to answer “zero.”

Shortly after that, I started being able to move my toes again, and started regaining some general feeling in my foot.

Soon, I realized the irony of the timing of the call - the pain started getting progressively worse. When it hit a 3 or a 4, I decided to take my first Oxycontin.

A couple of hours later, I took an Oxycodone (pain level 4-5). The next 24 hours I basically was in varying amounts of pain ranging from not too bad, to “pretty darn uncomfortable.”

I never took the full dosage of Oxycodone (I was allowed to take two at once every 4 hours, in addition to an Oxycontin every 8 hours - dosage 5mg for the Oxycodone, 10 mg for the Oxycontin), but at one point I did take two within a two hour period.

The pain was pretty much as described elsewhere - a combination of an ache with the feeling of the area being “on fire”.

Fortunately, the drugs made me drowsy enough that my sleep wasn’t impacted.

By mid-day Saturday, I was feeling much better - I weaned myself off the Oxycontin and only took 2 Oxycodones during the entire day.

I think I took one more Oxycodone on Sunday, and that was it for me.

I have to admit, I was feeling pretty cocky after the first day, and ended up being surprised by the amount of pain I felt.

I’m not sure how much the pump actually help. After the nerve block wore off, I can’t say that I felt much numbness I’d attribute to the pump, although the jury’s out on how much pain I would have been in without the pump.

BTW: I was really worried about removing the catheter - after all it’s this tube that’s inserted 10cm (4 inches) into your leg. As it turned out, my worry was unfounded: The thing glided out with no pain at all. It was much more painful removing the tape they used to seal the area around the catheter (along with any hair that happened to get in the way).