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.”

One Response to “Weeks 2-3 First follow up; Sutures out, into boot; A scare”

  1. I believe that the gizmos used to remove plaster casts were the forerunners of those (by Dremel and others) that are now available to handy DIY types as reciprocal multi-tools, to cut and scrape and sand, etc. They can demolish anything that stays very still, but skin is usually mobile enough to vibrate with the tool, escaping all injury. (But they’re probably no good at cutting rubber or foam or anything else that’s mobile.)

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